E-cigs vs. T-cigs
Electronic cigarettes may be less harmful in the UK than cigarettes but may still be dangerous. Under which circumstances should a person use ecigs? Will they fill your body with plastic?
Electronic cigarettes can contain propylene glycol or vegetable glycerine with nicotine (and in at least two cases polyethylene glycol 400) to form a solution that when heated by an atomizer, produces a visible vapour that provides nicotine to the bloodstream via the lungs when inhaled.
Electronic cigarettes have not been studied enough by scientists in laboratories to form conclusive evidence that their use is either beneficial or harmful to humans. However, some are concerned that unknown side-effects could occur with continuous, consistent use of electronic cigarettes, including cancer.
Behaviour surrounding their use is worrisome because e-cigs are being used habitually by a percentage of non-smokers who otherwise would not use nicotine, they may seem attractive to children, they are not closely regulated, and their use makes it very easy to overdose on nicotine even for experienced smokers.
UK Electronic Cigarettes and E-Liquid
[Thorpe] Welcometo Beyond the Data.
Phoebe Thorpe, and herewith me today is Dr.
Brian King from CDC's Office onSmoking and Health.
Thank you for joining us Brian.
[King] Thanks somuch for having me.
It's a pleasure to be here.
[Thorpe] Our topictoday is E-cigarettes.
Can you tell us why they areconsidered a tobacco product? [King] Yes, so in the UnitedStates we regulate tobacco products through the US Foodand Drug Administration, and the way they describe atobacco product is any product that's made or derivedfrom tobacco.
And we know that the vastmajority of nicotine that's used in tobacco products,including e-cigarettes, is indeed derived from tobacco.
So since these productscontain nicotine, we consider them a tobaccoproduct in the United States.
[Thorpe] And E-cigarettesare little bit different than regular cigarettes.
Can you describe how they work? [King] Yeah, so E-cigarettes isshort for electronic cigarettes, but we know them by alot of different names.
And they can be calledthings like vapor products, hookah pens, vape pens, butthe bottom line is they're all really the same product.
And they work by containinga liquid that's heated which the user then inhales intotheir lungs, and it's important to note that this isn'ttechnically a vapor which is how peoplefrequently refer to.
It's actually an aerosol thatcontains small particles as well as various other ingredientsthat the user inhales, and so there's no combustion.
You're not burning anything, butthere is a heating of the liquid which turns into an aerosolwhich the user inhales.
And they can alsoexhale into the air as other bystandersare around them.
[Thorpe] And the aerosolis not just water vapor.
I mean, that's animportant part to understand because I get asked as aphysician about E-cigarettes, and the thing from the session that I found veryinteresting was the idea that were not reallycertain about the risks that flavorings addto E-cigarettes.
The one that was mentioned wasthe butter flavoring Diacetyl that has been associatedwith bronchiolitis obliterans or what's called popcorn lung,which is a deadly disease.
What more do we know aboutthe risks of E-cigarettes? [King] So our knowledgeabout what's contained in both the E-cigaretteliquid as well as the aerosol hascontinued to evolve over time that these products enteredthe United States marketplace in around 2007.
They didn't really start touptick in use until 2010, 2011.
But, since that time, we reallyincreased the amount of research into what these productscontain.
And what we can say isthat the aerosol admitted by these productsis not harmless.
We do know that the ingredients and the levels aresignificantly less dangerous than conventional cigarettes,but that doesn't mean that they're completelyrisk-free.
And so, some of theingredients we found in the E-cigaretteaerosol are things like ultrafine particulatethat can be inhaled very deep into the lungs, and alsoheavy metals that are found in the filaments of the deviceand are omitted in the aerosol, as well as, things likevolatile organic compounds.
But one of the most commoningredients is nicotine, and we know that nicotineis highly addictive.
But there's alsoevidence indicating that it can harm thedeveloping adolescent brain which really makes itimportant for youth to avoid these devices.
In addition to some of theseother harmful ingredients, we also know the flavorings.
And so, Diacetyl is justone, but there are a variety of different flavoringsthat are used that, although they may be safe toingest in things like food, we don't know what the risks are for inhaling thesedevices into the lungs.
You know, your gut can handlea lot more than your lungs, and that's reallyimportant when we look at the ingredientsin these products.
And finally, it's alsoimportant to remember that people are using a lotof things in E-cigarettes, and that includes otherpsychoactive substances like marijuana andTHC and others.
And so, when we are talkingabout youth in particular, the use of both the nicotinecontaining varieties as well as other varietiesfor other types of drugs are really apublic health concern.
But we have had somerecent good news about the youth meaningmiddle school and high school useof E-cigarettes.
Can you tell me about that? [King] Yes.
It's really a commendablepublic health accomplishment.
We started assessing E-cigaretteuse among youth in this country in 2011, and through 2015,we saw exponential increases in the use of this product.
And 2016 was the first time that we actually saw declineamong youth in this country, and that was really a resultof the coordinated efforts to not only educate thepublic about the harms of youth E-cigarette use but also implementingcommon sense strategies to not only prevent youth accessbut also to protect people from the aerosol andpublic environments and various other campaigns to educate peopleabout these products.
But, on balance, the badnews is that we still have over 2 million youth thatare using E-cigarettes, and they're now the mostcommonly used tobacco products used among US youth.
So we made great progress,but we really need to continue that momentum toreduce all forms of tobacco productuse among youth.
[Thorpe] So it's going down, butnot as lot much as we'd like.
So what's driving the use ofthe E-cigarettes in teens? [King] So there's avariety of factors that we believe are contributingto these increased rates of use among youth thatwe saw through 2015.
One of the most notable is theadvertising for these products.
We know that many of the themesand tactics that have been used to advertise conventionalcigarettes are frequently used for E-cigarettes.
And we also know thatthere's some media of for which conventional cigaretteadvertising is banned that is allowed forE-cigarettes.
Things like television.
And so, there's reallya prominent advertising of these products, and we know that it's reachingkids in particular.
About 18 million US youthreported being exposed to E-cigarette ads in 2014.
Another factor isflavorings, and we know, from the existing science, that flavorings can beparticularly appealing in terms of enticing youth and youngadults to use tobacco products.
And a variety of E-cigarettesare flavored, and we know, from the existing data, thatabout two thirds of youth who use these cigarettes reportusing flavored varieties, and flavors are the mostcommonly cited reason for why youth startedusing these products.
And so, in the end, wereally have a situation where you know the advertisingis bringing the horse to water.
The flavorings aregetting them to drink, and then the nicotine is keepingthem coming back for more.
And so, it's kind of aperfect storm in terms of the youth rates of this use.
But the good news is, we knowwhat works to prevent that.
And if we implement those commonsense public health strategies, we can continue to seethe declines that we saw within the past yearamong our nation's youth.
[Thorpe] And the realconcern is about nicotine and the teenage brain.
Can you just briefly tell mea little bit more about that? [King] Yeah.
So nicotine is found in thevast majority of E-cigarettes that are sold on the U.
marketand, you know, nicotine we use in things like nicotinereplacement therapy among adults.
And it can be, youknow, an effective drug to help people quitconventional cigarette smoking.
But it's important to note thatthose are in very measured doses and weans the individual off of conventional cigarettesover time.
But nicotine is notnecessarily risk-free.
Particularly forvulnerable populations.
We know that nicotineis highly addictive, but there's also a growingbody of scientific evidence that was outlined in a recentSurgeon General's Report noting that nicotine exposure can harmthe developing adolescent brain.
And we know that thebrain continues to develop into young adulthood upthrough 25 or 26, and so, there's really implicationsfor not only youth use of these products butalso young adult use of any nicotine containingproduct.
And another thing to remember with nicotine is it'salso been shown to result in adverse health outcomesamong pregnant women in particularly fetal toxicity.
So there's also implications about pregnant womenusing any form of nicotine containing product,and so, it's really important for them to talk with theirphysician before they use any type of nicotine containingproduct including E-cigarettes.
[Thorpe] So is there a placethat physicians could go to learn a little bitmore about these parts with the E-cigarettesand the nicotine? [King] So there's many resourcesthat have been developed over the past fewyears, particularly as the sciences begun to grow.
And we have, you know,more concrete evidence about what works effectivelyto help warn people about these products and alsoprovide them scientific-based information to makeinformed decisions.
And in 2016, the U.
SurgeonGeneral released a landmark report on E-cigarette useamong youth and young adults.
And as part of therelease of that report, there were severalmaterials including resources and provider cards to helphealth professionals really communicate to both childrenand adults about these products.
And so, in the context of youth, it really enforces theimportance of warning them about the dangersof these products.
Particularly with regardto the nicotine content.
And among adults, it's amore nuanced conversation about knowing that we dohave FDA approved medications to help people quit, and thoseshould really be the first line of defense to help you quit.
And if that doesn't work, youcan consider E-cigarettes, but in consultation withyour healthcare provider.
And right now, based onthe evidence we have, there is no conclusive evidencethat E-cigarettes are effective for long-term cessation, andso, it's really important to use those resources thatwe know are most effective to help you quitand in coordination with your healthcare provider.
[Thorpe] And then foryouth, where if parents or other adults wanted to knowmore about how they could talk to teens and young adults aboutthe risks of E-cigarettes, where would they find someinformation about that? [King] So as part of the releaseof the Surgeon General's Report, there's an excellent interactivewebsite that was coordinated with the release of that report, and it isE-cigarettes.
And it has a varietyof information on both the reportitself as well as a public service announcementas well as informational cards for both parents andclinicians to educate our youth and young adults in particularabout the dangers and risks of using these products.
[Thorpe] That sounds like anexcellent place for our viewers to go and see whatthey can find out.
Thank you very muchfor joining us.
[King] Thank you verymuch for having me.
[Thorpe] And thankyou for joining us.
See you next monthon Beyond the Data.
Safety of electronic cigarettes UK
The entering into force of the requirements of the European tobacco products directive in Estonia made e-cigarette seller Nicorex Baltic destroy 19,000 bottles of e-cigarette liquid worth €135 000, as the packaging size did not meet the new requirements.
The liquids were actually in order, had undergone laboratory testing and met the new requirements, but their packaging did not have the necessary warnings on them and the boxes did not contain instructions.
Nicorex said that the transition period allowed by the government was too short, as the shelf life of the liquids was two years, but the length of the transition period only one year.
At the same time, Nicorex welcomed the requirement that the liquids have to undergo laboratory testing and that both the equipment and liquids must be registered in a single European database.
Nicorex described the restrictions concerning the size of packaging as unreasonable, as they increased the ecological footprint.
The transition period under the new tobacco law arising from the European tobacco products directive will end on May 20, after which the stricter requirements will apply to e-cigarettes in full.
Liquids can't be sold in containers bigger than 10 ml, they can't contain more nicotine than 20 milligrams per milliliter, and the vaporizer can't be bigger than 2 ml.
The packaging needs to include a leaflet, instructions, a batch number, a date, and a warning that nicotine is an addictive substance.