Last updated March 13, 2018 at 3:28 pm
E-cigarettes may not be the saviour from smoking-related diseases, according to two new pieces of research.
The sale of e-cigarettes is booming around the world. However, health experts still aren’t quite sure yet if e-cigarette use results in more benefit than harm at the population level.
New research has shown that it could be all smoke and mirrors – vaping has the potential to reverse years of health efforts and increase the harm caused by tobacco. And in a separate study, researchers found certain e-cigarettes may release highly toxic chemicals.
In Australia, while e-cigarettes are legal, liquid containing nicotine is still off-limits (nicotine-free liquid is freely available). There have been recent cries for nicotine-containing liquid to be legalised, with the arguments that it would assist people to quit smoking, where they could wean themselves off cigarettes using vaping as a tool.
Indeed, cigarette giant Philip Morris, a highly ethical company, have pledged to put their might behind e-cigarettes to help people quit.
With claims of it being a quitting tool, and lower toxicity than cigarettes, the arguments seemed to stack up. However this new research, which adds to the scant findings in the area, throw those arguments into question.
e-cigarettes reversing public health measures
Australia is a world leader in tobacco control. With strict laws and measures such as plain packaging and graphic health warnings, there has been a steady decline in smoking rates. Although, some point to a flattening over the past 3 years to suggest that current measures have run their course.
Scotland and New Zealand have both backed e-cigarettes as harm reduction aids.
However the researchers from Dartmouth University in the United states have questioned whether that would deliver an overall benefit.
“Although the tobacco industry markets e-cigarettes as a tool to help adult smokers quit smoking, e-cigarette use actually only marginally increases the number of adult cigarette smokers who are able to successfully quit,” said lead investigator Dr Samir Soneji.
“On the other hand, e-cigarettes may facilitate cigarette smoking initiation and confer substantial harm to adolescents and young adults once they are introduced to nicotine.”
Using census data, national health and tobacco use surveys, and published literature, the team calculated the expected years of life gained or lost from the impact of e-cigarette use.
“E-cigarettes could lead to more than 1.5 million years of life lost because their use could substantially increase the number of adolescents and young adults who eventually become cigarette smokers,” said Soneji.
Getting back on track
The results suggest that increased promotion of e-cigarettes could encourage younger adults who have never smoked to begin vaping, and that then lead onto cigarette smoking – the opposite effect than what is hoped.
And this could increase the effect of cigarettes on health when looking at the entire population.
The paper found that based on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit.
While tobacco control efforts have successfully led to a substantial reduction in youth cigarette smoking since the 1990s, e-cigarettes have the potential to slow or even reverse that trend.
The researchers do suggest that e-cigarettes could be beneficial, with the right safeguards in place. Rather than rushing headlong into promoting e-cigarettes and allowing certain advertising, as is the case in the UK, health authorities should approach it strategically.
“E-cigarettes will likely cause more public health harm than public health benefit unless ways can be found to substantially decrease the number of adolescents and young adults who vape and increase the number of smokers who use e-cigarettes to successfully quit smoking,” said Soneji.
“We also need to close the regulatory gaps that make e-cigarettes appealing to adolescents and young adults by reducing the availability of kid-friendly flavors (e.g., fruit-flavored e-cigarettes) and issuing product standards that reduce the level of known toxins and carcinogens in e-juice.”
By taking well thought-out measures to prevent the uptake of vaping by people who don’t currently smoke, we could reduce that negative side, and help get smoking kicking the habit.
And that would be good for everyone.
Some e-cigarettes have their own health concerns
There is also the question about whether ‘heat not burn’ e-cigarettes really match up to their lower-harm claims.
The iQOS, made by Philip Morris, is one of the first ‘heat not burn’ smokeless tobacco products marketed as a safer alternative to conventional cigarettes.
It contains a specially designed heat stick which uses a tobacco plug to deliver nicotine. This is heated to lower temperatures than those at which conventional cigarettes burn. Rather than producing a smoke, this type of e-cigarette produces a tobacco-infused vapour for inhalation.
It was thought these could be safer, as tobacco smoke is what contains the cocktail of chemicals that is so harmful to health. The lower temperatures would, theoretically, prevent many of these chemicals being inhaled.
While it has been evaluated in several published studies by the manufacturer, there has been little independent research.
As each iQOS heat stick only lasts for 6 minutes, after which it automatically shuts off and requires recharging, the researchers say that they encourage users to change their puffing habits. To get the most out of each heat stick, real life users would have to shorten the interval between puffs, speeding up their puff rate, and potentially breathing in larger amounts of vapour.
The researchers also found that the tobacco plug ended up charring during use, and that the heat generated by the e-cigarette also caused a polymer filter to melt.
While melting plastic is not great at any time, it’s particularly concerning as this polymer releases fomaldehyde cyanohydrin at temperatures that all users will easily exceed. This chemical is highly toxic even at very low levels.
Using the manufacturer’s recommended cleaning instructions increased both the extent of charring and the melting of the polymer film.
“iQOS is not strictly a ‘heat not burn’ tobacco product,” write the researchers. “This study has shown that the iQOS system may not be as harm free as claimed, and also emphasises the urgent need for further safety testing as the popularity and user base of this product is growing rapidly.”
Results on the effects of e-cigarettes on the population have been published in PLoS ONE
The iQOS e-cigarette safety results were published in Tobacco Control