An electronic cigarette is an electronic apparatus that simulates smoking tobacco. It consists of an atomizer, a battery-like power source, and a container like a cartridge or a tank. The user inhales vapor instead of smoke. Using an e-cigarette as such is often referred to as “vaping”. The atomizer is a heating element that atomizes a liquid solution called e-liquid. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes and are reusable in most versions.

E-cigarettes create an aerosol made of particulate matter, commonly known as vapor. Propylene glycol, glycerin, nicotine, flavors, and traces of toxicants, carcinogens, heavy metals, and metal nanoparticles are typically contained in the vapor. Its exact composition varies and depends on several factors, including user behavior.

Electronic cigarettes’ health effects remain uncertain but they are probably less harmful than smoking tobacco. E-cigarette vapor contains fewer toxic chemicals than cigarette smoke at lower concentrations, but it also contains harmful chemicals that are not found in tobacco smoke.

Nicotine is highly addictive and toxic. Young people are particularly susceptible to this, and most smokers start before the age of 18 (90 percent). Among first-time users, 32% of nicotine-trying individuals become addicted. People who vape are more likely to start smoking. Vaping has a role to play in reducing tobacco harm for smokers who are unable or unwilling to quit using conventional smoking cessation methods like NRT.

Types of E-cigarettes

Some devices were designed to resemble regular cigarettes. When e-cigarettes first began entering the market around 2007, while others looked more like cigars, pipes, pens, and even USB flash drives.

Some researchers have classified e-cigarettes as first, second, or third-generation devices in order to account for the diversity in product design.

An e-cigarette of the first generation is one that closely resembles a cigarette and is disposable.

An e-cigarette of the second generation is a larger device, typically pen-shaped, that can be recharged.

An e-cigarette of the third generation refers to devices that do not resemble a fuel cigarette and often have very large and sometimes customizable batteries. Some components may be replaceable, which is why they are sometimes referred to as “mods.” These devices are refillable.

More recently, e-cigarettes have entered the market with a sleek, high-tech design and easily rechargeable batteries.

JUUL, the most popular, emerged in 2015 and quickly established itself as a leading e-cigarette product by July 2019, comprising almost three quarters (73.4 percent) of the e-cigarette marketplace.

Copycat “products such as Suorin Drop, myblu and Vuse Alto, through the use of nicotine salt e-liquid formulations, follow JUUL’s blueprint of high-tech design and high nicotine delivery.” Because of the brand’s ubiquity, these devices are all often referred to as “JUUL,” but they are also referred to as “pod mods,” as the e-liquid is sold in self-contained disposable pods.

JUUL ‘s enormous popularity has encouraged copycat devices that are specifically JUUL-compatible, including Eonsmoke and Vapor4Life, delivering similarly high amounts of nicotine in sleek, discreet devices or devices that either use JUUL pods or have pods that can be used in JUUL devices.

How much nicotine?

Nicotine levels are highly variable in e-cigarettes, with some levels found in combustible cigarettes reaching or exceeding them.

Labeling is not always a reliable indicator of the nicotine content, since studies have found that mislabeling is a common issue in the category.

The way an e-cigarette is used or modified also affects nicotine delivery to an individual user.

Some e-cigarette products supply nicotine just as effectively as a cigarette. The use of nicotine salts also reduces the pH of e-liquids, which allows the delivery of higher nicotine concentrations with less irritation. For instance, JUUL’s maker claims that the product has a nicotine content like traditional cigarettes, delivering the nicotine up to 2.7 times faster than other e-cigarettes.

With a 5 percent nicotine salt pod, JUUL devices were originally introduced in the U.S. Following suit, JUUL competitors started offering up to 7 percent nicotine salt concentrations in what was called a “nicotine arms race.” However, in 2018, JUUL introduced a lower nicotine pod with 3 percent nicotine strength.

The nicotine content of products like JUUL also raises concerns about the potential for addiction, in addition to the rate of nicotine delivery. A study published in Tobacco Control in the 2018 Truth Initiative found that among current youth and young adult JUUL users, the majority, 63 percent, did not know that nicotine is always included in the product. Anecdotally, youth report signs of severe dependence, such as being unable to concentrate in class, using an e-cigarette upon waking, and using nighttime e-cigarettes after waking with a craving.

ARE E-CIGARETTES LESS HARMFUL THAN CIGARETTES?

It is usually accepted that less of the toxins found in cigarette smoke are produced by e-cigarettes. However, it is becoming increasingly apparent that this frame is not adequate to tell the whole story about the impacts on individual health. The latest evidence suggests that e-cigarettes may pose unique health harms of their own and that cigarette comparisons may not be the only relevant issue to determine their impact on individual health. Indeed, growing evidence of potential e-cigarette-related health risks has led some researchers to question whether e-cigarettes are safer than fuel cigarettes. See “Health Effects” for details

Also, the recent outbreak of vaping-related lung injuries supports caution regarding e-cigarettes. While a significant number of cases appear to be related to THC vaping in the recent outbreak of vaping-related lung disease and vitamin E acetate has recently been identified by the CDC as a substantial chemical of concern, the agency was cautious to say that it did not find a single cause and continues to recommend caution with respect to all vaping as the investigation contents This outbreak at least dramatically demonstrates the dangers of an unregulated market in inhaled substances with no pre-market consumer safety review.

We also note Public Health England’s frequently cited claim that e-cigarettes are definitively 95 percent safer than traditional cigarettes. First, prior to recent research on the health effects of vaping, this analysis was originally conducted in 2013. Additionally, further analysis of the original research finds that the evidence for such statistics remains unclear and incomplete, among other concerns about conflicts of interest between the author and the funding. The Public Health England claim also fails to recognize the reality of the potential for negative net public health impact among a population of users who otherwise have never used tobacco products, or the lack of clinical and long-term evidence of the safety of these products in humans, regardless of current smoking status.

While a 2018 National Academies of Science, Engineering, and Medicine report found substantial evidence that e-cigarette exposure to toxic substances is significantly lower than that of fuel cigarettes, recent studies show that this is not the end of the health impact story. E-cigarettes now appear to present their own unique health risks, including the respiratory and cardiovascular systems. Given the relatively recent marketplace introduction of the products, further research is needed to assess the short- and long-term health impacts of e-cigarettes.

Evidence of the effectiveness of e-cigarettes as a cessation tool also remains inconclusive and a combination of counseling, nicotine replacement therapy, and/or cessation drugs such as varenicline, approved by the FDA, should be included in the safest, most evidence-based cessation strategy until an FDA review. In addition, while the basic technology behind e-cigarettes is consistent, within the product category, there is enormous variability and there is no typical e-cigarette. The products include various ingredients, various hardware and deliver highly variable amounts of nicotine, including heavy metals such as cadmium, lead, nickel, tin, and copper, as well as potentially toxic chemicals. This variation makes it difficult to issue general category public health recommendations and demonstrates the enormous and longstanding need for pre-market review of these products.

Consumers need to know consistently what they are getting and whether it’s safe — especially from a product designed by frequent inhalation to deliver chemicals. The increasing evidence of possible health hazards and lung injuries associated with the use of e-cigarettes has led researchers to question whether e-cigarettes are safer than fuel cigarettes.

Quitting Smoking

There are considerable research gaps in proving the effectiveness of e-cigarettes as aids to quit smoking. NASEM ‘s 2018 report has found limited evidence on the effectiveness of e-cigarettes to encourage quitting. In addition, e-cigarettes are not approved by the U.S. as stop aids. Task Force or FDA on Preventative Service.

While some evidence supports the use of e-cigarettes as quit devices, recent research suggests they are overstated in their effectiveness for quitting.

A study published in 2016 reported that e-cigarettes with nicotine helped people quit better than non-nicotine e-cigarettes within two randomized control studies. NASEM has also reported that more frequent use of e-cigarettes can increase the likelihood individual quitting smoking.

A UK study for 2019 Published in the New England Journal of Medicine, the National Health Service found that e-cigarettes can help adults quit. Compared to a group using nicotine replacement drugs, a group allocated to e-cigarettes as a combustible tobacco replacement is more likely to remain abstinent at one year (18 percent versus 9.9 percent). At the one-year follow-up, however, a number of e-cigarette consumers were already using e-cigarettes. Researchers noted the research was focused on a middle-aged adult population (median age 41) actively trying to stop smoking and obtain behavioral support for at least four weeks. Especially in the UK. The marketing of e-cigarettes is also heavily restricted.5 These findings have not been repeated in a similar study in the United States.

Another new research in 2019 investigating whether the existence of e-cigarettes on the U.S. market has prompted more active quit attempts found that e-cigarette users have 70 percent lower quitting chances than non-users.

Although some e-cigarettes can be an effective method for quitting smoking, the product variability as well as the content differences and the lack of regulation make it difficult to determine the effectiveness of any specific product as a quit aid. Some smokers have turned to e-cigarettes or used them to quit tobacco altogether; however, unlike FDA-approved cessation treatments, e-cigarettes lack evidence base to show their safety and effectiveness. Truth Initiative promotes legislation that encourages the creation of consistently less harmful alternatives to nicotine delivery that allow smokers to quit tobacco entirely or turn to a far less harmful, well-regulated product completely.

One study indicates that product appeal, including flavoring, is likely to inspire smokers to attempt to use e-cigarettes to fully quit or move. But, as the U.S. youth e-cigarette epidemic and the youth popularity of flavored e-cigarettes go hand in hand, the Truth Initiative strongly supports the elimination of flavored e-cigarettes from the market, pending an FDA review. The pressure should be heavy, considering what we now know about how dramatically flavors impact the use of an e-cigarette by young people. If a company can show three points to the FDA, we support a permanent ban on flavors: 1) that a specific flavor encourages existing tobacco consumers to quit smoking, 2) it will not lead non-tobacco consumers (such as young people) to start, and 3) it does not raise the risk of harm from using the product. In addition to the flavor limits, the Truth Initiative promotes stringent legislation to keep all tobacco products away from children, including e-cigarettes.

 

Source Information –  Wikipedia

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