Safety of electronic cigarettes

The safety of electronic cigarettes is uncertain. There is little data about their safety, and considerable variation among e-cigarettes and in their liquid ingredients and thus the contents of the aerosol delivered to the user. Reviews on the safety of e-cigarettes have reached significantly different conclusions. A 2014 World Health Organization (WHO) report cautioned about potential risks of using e-cigarettes. Regulated US Food and Drug Administration (FDA) products such as nicotine inhalers may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products such as cigarettes and cigars. It is estimated their safety risk is similar to that of smokeless tobacco, which has about 1% of the mortality risk of traditional cigarettes. A systematic review suggests that e-cigarettes are less harmful than smoking and since they contain no tobacco and do not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke, such as ash, tar, and carbon monoxide. However, e-cigarette use with or without nicotine cannot be considered harmless. Repeated exposure over a long time to e-cigarette vapor poses substantial potential risk.Appeal to Young PeopleE-cigarettes pose potential risks to the population as a whole. E-cigarettes could cause public health harm if they: The safety of electronic cigarettes is uncertain. There is little data about their safety, and considerable variation among e-cigarettes and in their liquid ingredients and thus the contents of the aerosol delivered to the user. Reviews on the safety of e-cigarettes have reached significantly different conclusions. A 2014 World Health Organization (WHO) report cautioned about potential risks of using e-cigarettes. Regulated US Food and Drug Administration (FDA) products such as nicotine inhalers may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products such as cigarettes and cigars. It is estimated their safety risk is similar to that of smokeless tobacco, which has about 1% of the mortality risk of traditional cigarettes. A systematic review suggests that e-cigarettes are less harmful than smoking and since they contain no tobacco and do not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke, such as ash, tar, and carbon monoxide. However, e-cigarette use with or without nicotine cannot be considered harmless. Repeated exposure over a long time to e-cigarette vapor poses substantial potential risk. The long-term effects of e-cigarette use are unknown. The risk from serious adverse events, including death, is low. Less serious adverse effects include abdominal pain, headache, blurry vision, throat and mouth irritation, vomiting, nausea, and coughing. They may produce less adverse effects compared to tobacco products. E-cigarettes reduce lung function, but to a much lower extent than with traditional cigarettes, and they reduce cardiac muscle function and increase inflammation, but these changes were only substantial with traditional cigarettes. A 2014 WHO report said, 'ENDS use poses serious threats to adolescents and fetuses.' Aside from toxicity exposure in normal use, there are also risks from misuse or accidents such as nicotine poisoning (especially among small children), contact with liquid nicotine, fires caused by vaporizer malfunction, and explosions resulting from extended charging, unsuitable chargers, or design flaws. Battery explosions are caused by an increase in internal battery temperature and some have resulted in severe skin burns. There is a small risk of battery explosion in devices modified to increase battery power. The cytotoxicity of e-liquids varies, and contamination with various chemicals have been detected in the liquid. Metal parts of e-cigarettes in contact with the e-liquid can contaminate it with metal particles. Many chemicals including carbonyl compounds such as formaldehyde can inadvertently be produced when the nichrome wire (heating element) that touches the e-liquid is heated and chemically reacted with the liquid. Normal usage of e-cigarettes, and reduced voltage (3.0 V) devices generate very low levels of formaldehyde. The later-generation and 'tank-style' e-cigarettes with a higher voltage (5.0 V) may generate equal or higher levels of formaldehyde compared to smoking. A 2015 Public Health England (PHE) report found that high levels of formaldehyde only occurred in overheated 'dry-puffing'. Users detect the 'dry puff' (also known as a 'dry hit') and avoid it, and they concluded that 'There is no indication that EC users are exposed to dangerous levels of aldehydes.' However, e-cigarette users may learn to overcome the unpleasant taste due to elevated aldehyde formation, when the nicotine craving is high enough. E-cigarette users who use devices that contain nicotine are exposed to its potentially harmful effects. Nicotine is associated with cardiovascular disease, possible birth defects, and poisoning. In vitro studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated in vivo. There is inadequate research to show that nicotine is associated with cancer in humans. The risk is probably low from the inhalation of propylene glycol and glycerin. No information is available on the long-term effects of the inhalation of flavors. E-cigarettes create vapor that consists of fine and ultrafine particles of particulate matter, with the majority of particles in the ultrafine range. The vapor have been found to contain propylene glycol, glycerin, nicotine, flavors, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other substances. Exactly what the vapor consists of varies in composition and concentration across and within manufacturers, and depends on the contents of the liquid, the physical and electrical design of the device, and user behavior, among other factors. E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke. The majority of toxic chemicals found in cigarette smoke are absent in e-cigarette vapor. E-cigarette vapor contains lower concentrations of potentially toxic chemicals than with cigarette smoke. Those which are present, are mostly below 1% of the corresponding levels permissible by workplace safety standards. But workplace safety standards do not recognize exposure to certain vulnerable groups such as people with medical ailments, children, and infants who may be exposed to second-hand vapor. Concern exists that some of the mainstream vapor exhaled by e-cigarette users may be inhaled by bystanders, particularly indoors. E-cigarette use by a parent might lead to inadvertent health risks to offspring. A 2014 review recommended that e-cigarettes should be regulated for consumer safety. There is limited information available on the environmental issues around production, use, and disposal of e-cigarettes that use cartridges. E-cigarettes that are not reusable may contribute to the problem of electrical waste. Reviews on the safety of electronic cigarettes, evaluating roughly the same studies, have reached significantly different conclusions. Broad-ranging statements regarding their safety cannot be reached because of the vast differences of devices and e-liquids available. A consensus has not been established for the effects as well as the benefits related to their use. Due to various methodological issues, severe conflicts of interest, and inconsistent research, no definite conclusions can be determined regarding the safety of e-cigarettes. However, e-cigarettes cannot be regarded as a harmless alternative to traditional cigarettes. Guidelines for the design, manufacture or assessment of their safety has not been established. Repeated exposure over a long time to e-cigarette vapor poses substantial potential risk. Although companies state that e-cigarettes are safe, there is no scientific evidence to support this view. Long-term data showing that vaping is a 'healthier alternative' than cigarette smoking does not exist. There is little data about their safety, and considerable variability among vaporizers and in their liquid ingredients and thus the contents of the aerosol delivered to the user. The health community, pharmaceutical industry, and other groups have raised concerns about the emerging phenomenon of e-cigarettes, including the unknown health risks from their long-term use. A 2017 review found 'There is a justifiable concern that any broad statement promoting e-cig safety may be unfounded considering the lack of inhalational toxicity data on the vast majority of the constituents in e-cigs. This is particularly true for individuals with existing lung disease such as asthma.' A 2014 review has stated, there are 'Many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health.' There is concern that e-cigarettes may result in many smokers rejecting historically effective quitting smoking methods. Concern exists that the majority of smokers attempting to quit by vaping may stop smoking but maintain nicotine intake because their long-term effects are not clear. A policy statement by the American Association for Cancer Research and the American Society of Clinical Oncology has reported that 'The benefits and harms must be evaluated with respect to the population as a whole, taking into account the effect on youth, adults, nonsmokers, and smokers.' The widespread availability and popularity of flavored e-cigarettes is a key concern regarding the potential public health implications of the products. It is assumed that vaping leads to serious health concerns due to the levels of various toxicants such as nicotine. A 2016 Surgeon General of the United States report stated e-cigarettes typically contain nicotine as well as other chemicals that are known to damage health. For example, users risk exposing their respiratory systems to potentially harmful chemicals in e-cigarettes. E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products. A July 2014 World Health Organization (WHO) report cautioned about the potential risks to children and adolescents, pregnant women, and women of reproductive age regarding e-cigarette use. E-cigarettes are an increasing public health concern due to the rapid rise among adolescents and the uncertainty of potential health consequences. A serious concern regarding vaping is that they could entice children to initiate smoking, either by the argument that nicotine leads to smoking or by making smoking appear more acceptable again. Concerns exist in respect to adolescence vaping due to studies indicating nicotine may potentially have harmful effects on the brain. It is recommended the precautionary principle be used for e-cigarettes because of the long history of the tobacco crisis, in order to assess their benefits and long-term effects and to avoid another nicotine crisis. A 2015 review suggested that e-cigarettes could be regulated in a similar way as inhalation therapeutic medicine, meaning, they would regulated based on toxicology and safety clinical trials. A 2014 review recommended that e-cigarettes could be adequately regulated for consumer safety with existing regulations on the design of electronic products. Regulation of the production and promotion of e-cigarettes may help lower some of the adverse effects associated with tobacco use. The medical community is concerned that increased availability of e-cigarettes could increase worldwide nicotine dependence, especially among the young as they are enticed by the various flavor options e-cigarettes have to offer. Since vaping does not produce smoke from burning tobacco, the opponents of e-cigarettes fear that traditional smokers will substitute vaping for smoking in settings where smoking is not permitted without any real intention of quitting traditional cigarettes. Furthermore, vaping in public places, coupled with recent e-cigarette commercials on national television, could possibly undermine or weaken current antismoking regulations. Fear exists that wide-scale promotion and use of e-cigarettes, fuelled by an increase in the advertising of these products, may carry substantial public health risks. Public health professionals voiced concerns regarding vaping while using other tobacco products, particularly combustible products. The entrance of large US tobacco manufacturers, which are Altria Group, Reynolds American, and Lorillard, into the e-cigarette sector raises many potential public health issues. Instead of encouraging quitting, the tobacco industry could market e-cigarettes as a way to get around clean indoor air laws, which promotes dual use. It is argued to implement the precautionary principle because dual use could end up being an additional risk. The industry could also lead vapers to tobacco products, which would increase instead of decrease overall addiction. Concerns exist that the emergence of e-cigarettes may benefit Big Tobacco to sustain an industry for tobacco. A 2017 review states that the 'Increased concentration of the ENDS market in the hands of the transnational tobacco companies is concerning to the public health community, given the industry's legacy of obfuscating many fundamental truths about their products and misleading the public with false claims, including that low-tar and so-called 'light' cigarettes would reduce the harms associated with smoking. Although industry representatives are claiming interest in ENDS because of their harm-reduction potential, many observers believe that profit remains the dominant motivation.' E-cigarettes are expanding the tobacco epidemic by bringing lower-risk youth into the market, many of whom then transition to smoking cigarettes. E-cigarettes have the potential for benefit and harm, the nature and scale of each being uncertain in the absence of much evidence. The health effects related to e-cigarette use is mostly unknown. The health effects on intensive e-cigarette users are unknown. The effect on population health from e-cigarettes is unknown. Smokefree.gov, a website run by the Tobacco Control Research Branch of the National Cancer Institute to provide information to help quit smoking, stated that 'Since e-cigs aren't regulated yet, there's no way of knowing how much nicotine is in them or what other chemicals they contain. These two things make the safety of e-cigs unclear.' The chemical characteristics of the short-lived free radicals and long-lived free radicals produced from e-cigarettes is unclear. The English National Health Service has stated in 2014, 'While e-cigarettes may be safer than conventional cigarettes, we don't yet know the long-term effects of vaping on the body.' While quitting smoking may be firmly recommended for smokers who have asthma, it is not clear whether replacing e-cigarettes for cigarettes is a universally safer alternative. The American Diabetes Association states 'There is no evidence that e-cigarettes are a healthier alternative to smoking.' In August 2014, the Forum of International Respiratory Societies stated that e-cigarettes have not been demonstrated to be safe. Health Canada has stated that, 'their safety, quality, and efficacy remain unknown.' The National Institute on Drug Abuse stated that 'There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown.' There is insufficient data regarding the health benefits of vaping. Vaping requires more forceful sucking than smoking, and this action is still unclear on increased absorption of harmful substances and the user's health. Sucking more forcefully from e-cigarette use may be adverse to human health. The risks from long-term use of nicotine as well as other toxicants that are unique to e-cigarettes are uncertain. The long-term consequences from e-cigarette use on death and disease are unclear. There is limited available research regarding their effects to vulnerable groups such as minors.