This piece was written by one of our contributors; public health and clinical nutrition graduate – Saskia Craine
Are you confused about e-cigarettes? You are not alone. Unsurprisingly, there are lots of misconceptions about e-cigarettes. This article aims to provide you with everything you need to know about the benefits and harms of e-cigarettes.
What is an e-cigarette?
An electronic cigarette, also known as an e-cigarette, is a battery powered device that mimics the sensation of smoking (3). Unlike cigarettes, which burn tobacco and produce carbon monoxide (two of the most damaging elements in tobacco smoke), e-cigarettes work by heating a liquid which generates a ‘vapour’ that is inhaled by the user (4,6). The liquid is made of propylene glycol and vegetable glycerine mixed together with distilled water; e-cigarettes can also contain nicotine and flavouring, though not all do (5). As a result, e-cigarettes are considered a safer option to smoking tobacco for people addicted to nicotine.
Who uses e-cigarettes?
Despite most smokers wanting to quit, few manage to succeed in the long term. Almost half of those who attempt to quit, rarely make it a week without returning to the habit, and less than 5% remain abstinent one year after quitting (7,8). Therefore, smokers are more likely to use e-cigarettes or other nicotine replacement products such as patches. Nicotine products combined with expert advice and behavioural support can make a genuine difference (9).
Are there benefits?
If you are a smoker, and want to quit for good, e-cigarettes may be helpful. Smoking an e-cigarette provides sensations similar to smoking a tobacco cigarette, such as taste and sensation. It also addresses the behavioural aspect that smokers miss when they stop smoking, such as holding a cigarette in their hands and inhaling (7). The vapour resembles smoke and is only produced after the user exhales.
As some e-liquids contain nicotine, it’s unsurprising that the e-cigarette is a popular tool for those attempting to quit smoking. Nicotine is a highly addictive substance; it directly causes the release of dopamine in regions of the brain (reward system) that control pleasure and motivation (10). However, nicotine can also have a sedative (calming) effect, depending on the level of the smoker’s nervous system arousal and the dose of nicotine taken (10).
Some research suggests e-cigarettes are the ideal smoking cessation product, because it helps relieve the unpleasant side effects of nicotine withdrawal, but it is also an effective substitute for smoking behaviour and the rituals and sensations that accompany smoking (7).
What are the risks?
As e-cigarettes are relatively new to the market, first released in China in 2003, the long-term effects are still unknown. Data is continuously being gathered, though it will take several more years before definitive conclusions can be drawn (11). However, whilst e-cigarettes are not risk free, the bulk of medical opinion still considers them 95% less harmful than cigarettes (12).
Increase in non-smokers smoking e-cigarettes
There is a common belief that smoking e-cigarettes does not have any negative side effects, especially among adolescents. A group who were previously considered at “low risk” are more likely to try e-cigarettes first, and later, because of nicotine dependence or other social factors try cigarettes (17, 18). E-cigarettes may be helping some people stop smoking but also be a gateway to start smoking cigarettes for others (19).
E-cigarettes do not produce the same smoke that comes of a lit cigarette but pollute the air in the form of exhaled mainstream aerosol from people using e-cigarettes. Nicotine ultrafine particles, and products of heating propylene glycol and glycerin are increased in the air where e-cigarettes are being used (20). There is evidence that bystanders may absorb nicotine when people around them use e-cigarettes, they are absorbed at comparable level to tobacco second-hand smoke (21).
Current UK Guidelines
Current National Institute for Health and Care Excellence (NICE) guidance recommends e-cigarettes as a smoking cessation tool (13). Nevertheless, people are still cautious about using them. Due to the following factors (9):
- a long-standing emphasis in national guidance on total abstinence from nicotine.
- a distrust of e-cigarette manufacturers
- an uncertainty about the long-term health effects of e-cigarettes
Nicotine does have some health risks, and this applies to other smoking cessation tools as well (such as nicotine patches). However, nicotine is far less harmful than smoking tobacco. One particular study found nicotine replacement therapies improved the rate of cessation by 50-70%. NICE have also updated their guidance (13) and it gives advice
for those who:
- may not be able (or do not want) to stop smoking in one step
- may want to stop smoking, without necessarily giving up nicotine
- may not be ready to stop smoking, but want to reduce the amount they smoke
Nicotine is the reason people become addicted to smoking, but it is the other chemicals contained in cigarette smoke that cause harm (14).
There is broad consensus across leading UK health and public health organisations including Cancer Research UK, British Medical Association and Royal College of General Practitioners that e-cigarettes are much less harmful than cigarettes (9). In Hong-Kong e-cigarettes have been banned, however cigarettes which are more harmful, have not (16). Some may argue that governments have every right to spell out health risks, nevertheless consumers must still be allowed to make their own judgement on these risks.
What is the regulation of e-cigarettes?
The UK has strict regulations for e-cigarettes, some of the strictest in the world. Under the Tobacco and Related Products Regulation 2016, e-cigarette products are subject to minimum standards of quality and safety, as well as packaging and labelling requirements to provide consumers with the information they need to make informed choices (15).
E-cigarettes and tobacco cigarettes are not the same and should not be treated as such. It is important to be aware of the differences and have accurate information to inform your health decisions. Remember that whilst e-cigarettes aren’t completely risk free, they carry a fraction of the risk and are helping many smokers quit and remain smoke- free.
(1) Mail Online. (2019). E-cigarettes cause ‘signs of lung damage’. [online] Available at: https://www.dailymail.co.uk/health/article-6760231/E-cigarettes-cause-signs-lung-damage.html [Accessed 17 Apr. 2019].
(2) BBC News. (2018). E-cigarettes ‘should be on prescription’. [online] Available at: https://www.bbc.co.uk/news/health-42950607 [Accessed 17 Apr. 2019].
(3) Bhf.org.uk. (2018). Is vaping safe?. [online] Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/e-cigarettes [Accessed 17 Apr. 2019]
(4) WHO, Framework Convention on Tobacco Control (FCTC) (2014) Electronic nicotine delivery systems. Sixth session. Moscow, Russian Federation,13–18
(5) Philips et al (2017) Toxicity of the main electronic cigarette components, propylene glycol, glycerin, and nicotine, in Sprague-Dawley rats in a 90-day OECD inhalation study complemented by molecular endpoints. Food and Chemical Toxicology. Volume 109, Part 1, Pages 315 – 332 https://doi.org/10.1016/j.fct.2017.09.001
(6) www.parilament.uk 2. Reducing Harm: E-cigarettes’ comparative lower harm
(7) McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P (2014) Electronic cigarettes for smoking cessation and reduction (Review): Cochrane Library Database of Systematic Reviews Issue 12. Art. No.: CD010216.DOI: 10.1002/14651858.CD010216.pub2
(8) Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99(1):29–38
(9) Patient.info (2018) Are e-cigarettes a safe way to quit smoking? [online] Available at: https://patient.info/news-and-features/e-cigarette-safety-vaping-quit-smoking [Accessed 17. Apr. 2019]
(10) Psychology Today. (2019). Nicotine | Psychology Today UK. [online] Available at: https://www.psychologytoday.com/gb/conditions/nicotine [Accessed 17 Apr. 2019].
(11) Patient.info (2017) Quit smoking (smoking cessation) E-cigarettes. Available at: https://patient.info/healthy-living/quit-smoking-cessation/e-cigarettes#nav-1
(12) GOV.UK. (2018). PHE Health Harms campaign encourages smokers to quit.
Available at: https://www.gov.uk/government/news/phe-health-harms-
campaign-encourages-smokers-to-quit [Accessed 17 Apr. 2019].
NICE (2013) Smoking: harm reduction: Public health guideline [PH45] Available