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E-Cigarettes: A safe alternative to smoking?

December 18, 2014

Little is known about electronic cigarettes, the newest smoking device on the market. What is certain—the recent phenomenon is sparking a lot of controversy.

The battery-operated gadget, also called a personal vaporizer and electronic nicotine delivery system (ENDS), simulates tobacco smoking. While the device holds promise, there are aspects which greatly concern Hilary Tindle, M.D., MPH, associate professor of Medicine at Vanderbilt.

“A lot of people who smoke combustible cigarettes or burnt tobacco have switched to e-cigarettes to quit smoking,” she said. “One of the biggest problems is that they have not been proven as a smoking cessation entity or device. If e-cigs do help people quit burnt tobacco, fantastic. But what if e-cigs actually keep people smoking (both products)?”

Another concern: “These devices are not regulated. Which means that no one really knows what is in the solution people are inhaling,” Tindle said.

E-cigarettes work like this: the user inhales through a mouthpiece and the air flow triggers a sensor that switches on a small, battery-powered heater, which vaporizes liquid nicotine in a small cartridge. There are also non-nicotine options in which the user gets a puff of hot gas that feels like tobacco smoke, then exhales a vapor that quickly dissipates.

The heated liquid is propylene glycol, a substance generally recognized as safe. It is used in many food and cosmetic products and related to the smoke effects at theatric performances and concerts, Tindle noted.

“Puff for puff, e-cigs are not as dangerous as cigarette smoke, but that doesn’t mean that they are safe,” she said. “And what is also concerning is that they are being marketed to both children and adults. Children can walk into businesses and purchase e-cigs in many states.”

Additional public health issues center around concern that the e-cigarette could heighten a person’s reliance on nicotine.

“Will e-cigs entice former smokers back to using nicotine and put them at increased risk of smoking combustible cigarettes?” Tindle asks. “Will e-cigs entice kids to become nicotine addicts, perhaps later moving to combustible cigarettes? It’s a real public health worry.”

Tindle stressed that the most effective treatment for smoking cessation is a combination of medication and behavioral therapy. While studies have shown that 25 to 35 percent of smokers quit on the first try using this proven therapy regime, it often takes repeated attempts to kick the habit, she said.

“It can take up to five tries or more, which is normal and expected, for someone to quit,” said Tindle. “People need to understand that they are not a failure if they don’t quit on the first few tries. Just like with diabetes or high blood pressure, for instance, no one would expect it to be controlled on the very first try.”