If You Think E-Cigarettes Aren’t Bad For You, Think Again

In this technological era, I suppose it should not be all that surprising that even our bad habits have gotten a techy remake.  E-cigarettes, battery-operated devices that simulate smoking by vaporizing a liquid solution containing nicotine as well as added flavors have hit the market with storm.  Vaping—the term for the use of these electronic cigarettes—has become quite popular. Many brands feel and look like conventional cigarettes, and they provide a nicotine punch without the ashes and the nasty smell.

Reports estimate sales of $250 million to $500 million in 2011 and 2012, with four times that anticipated this year.  In fact, e-cigarettes are projected to soon outsell tobacco cigarettes.  Even more alarming is their popularity among teens.  The U.S. Centers for Disease Control and Prevention reported that more than one-quarter million teens who said they never smoked cigarettes have taken up vaping.

With e-cigarette manufacturers touting flavors like “vanilla cupcake” and “maple pancakes,” and claims like “love your lungs,” “everything you enjoy about smoking and nothing else,” “no toxic chemicals,” and my personal favorite, “Smoking is not cool anymore. Switch to electronic cigarettes,” it is not surprising that the public may be convinced that e-cigarettes are a safe and appealing alternative to tobacco cigarettes.

Before trading in one habit for another—or starting a new one—it is important to know that there are many questions about the safety of e-cigarettes, and there is increasing evidence that this unregulated smoking substitute is not as safe as its marketers want you to believe.

While most experts agree that the vapors emitted by e-cigarettes are less toxic than cigarette smoke, that doesn’t mean they are risk free. Vaping exposes users and those around them to nicotine and other potentially harmful chemicals. Emerging research is sounding a warning alarm to users, and particularly those who have underlying lung diseases, such as COPD or lung cancer.

“E-cigarettes have been marketed as devices that deliver nicotine safely and free of toxins, but little toxicity testing has been performed,” says Johns Hopkins pediatric resident Iris Leviner, M.D.  “Primary components of the nicotine solution and vapor content include propylene glycol, glycerin, and nicotine, and trace amounts of N-nitrosamines, diethylene glycol, polycyclic aromatic hydrocarbons, anabasine, myosmine, and nicotyrine. Some of these compounds are carcinogenic, a warning generally not mentioned by marketers.”

“E-cigarettes are not neutral in terms of the effects on the lungs,” says environmental health sciences researcher Shyam Biswal, Ph.D.  In a recent study conducted by Dr. Biswal and other Johns Hopkins scientists, mice that were exposed to e-cigarette vapor were found to be at greater risk of developing respiratory infections.  Mice that were exposed to both e-cigarette vapor and the bacteria that cause pneumonia and sinusitis or the flu virus were less able to fend off the “bugs” than bacteria/virus-exposed mice that were breathing in clean air instead of e-cigarette vapors.

“E-cigarette vapor alone produced mild effects on the lungs, including inflammation and genetic damage,” says Dr. Biswal’s collaborator Thomas Sussan, Ph.D. “When this exposure was followed by a bacterial or viral infection, the harmful effects of e-cigarette exposure became even more pronounced.”

With the dangers of secondhand tobacco smoke now well documented, experts like Joanna Cohen, Ph.D., of the Johns Hopkins FAMRI Center of Excellence, says e-cigarettes raise new concerns about the potential health risks caused by inhaling secondhand vapors. She says there is a lot that is still unknown about this largely unregulated product.

Want to Quit?

One thing that essentially all experts agree on is that quitting smoking is one of the most important things a person can do to improve his or her health.  Johns Hopkins has a number of programs to help:

• Johns Hopkins Bayview Smoking Clinic:  410-550-2799

• A Spiritual Approach to Quitting Smoking:  410-550-5990 (ask for Mary)
• www.ResearchStudies.DrugAbuse.gov or call 1-800-535-8254 to learn about Johns Hopkins studies sponsored by the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) and U.S. Department of Health and Human Services.
• See the Johns Hopkins FAMRI Center of Excellence for research and discoveries on smoking-related diseases.

More from Johns Hopkins on e-cigarettes:

• Johns Hopkins School of Public Health - "All Steamed Up"
• Johns Hopkins Children's Center - "Are Electronic Cigarettes Safe"

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Update July 18, 2016

The following update is in response to several comments on this blog post.

In general, the U.S. position—and most American experts agree—is that more research is needed to determine whether e-cigarettes are a safe and effective smoking cessation tool. Right now, there is no long-term data that permits us to fully know their risks or benefits as a smoking cessation method, says environmental health sciences expert Shyam Biswal, whose research revealed a higher risk of respiratory infections with e-cigarette use.

Let’s not forget that the full health affects of cigarettes were not fully understood until decades after they were marketed and millions of people became addicted. As a result, people around the world continue to pay the price in the form of heart disease, cancer, and many other diseases.

“Right now, many believe that e-cigarettes are less harmful than cigarettes, and that may turn out to be true, but it has not been proven yet,” says environmental health sciences expert Tom Sussan. Cancer prevention and control expert Elizabeth Platz reminds us that there are proven ways to quit smoking.

In the U.S., public health experts at Johns Hopkins and elsewhere are particularly concerned about the possibility of a negative impact on teens whose use of e-cigarettes is on the rise. Experts say what is most alarming is that some kids who never smoked are using e-cigarettes.

“We just don’t know if the use of e-cigarettes is a good or bad smoking cessation approach for the population overall, but evidence continues to accumulate, so hopefully, we’ll get a better handle on trends soon,” says Joanna Cohen, Director of the Johns Hopkins Bloomberg School of Public Health Institute for Global Tobacco Control.

Ideally, the greatest health benefit would come from not smoking cigarettes and not using using e-cigarettes. I think we can all agree that inhaling anything into our lungs that does not naturally belong there is unlikely to be a good thing. For current smokers, each person must make his or her own decision, working in conjunction with a health care provider and using the best available information to identify the safest and most effective way to quit smoking.

For more information on e-cigarettes:

E-Cigarette Information for the Centers for Disease Control

Cigarette smoking among U.S. high school students at an all-time low, but e-cigarette use a concern

More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping

Feds Announce Much Tougher E-Cigarette, Cigar Rule