I don’t want to repeat it! E-cigarettes are really not the “white moonlight” of smokers…

Everyone knows that smoking is harmful to health, but they still cannot resist the temptation of smoking. In recent years, e-cigarettes have become popular around the world as a new type of smoking. "E-cigarettes are much less harmful than cigarettes, and e-cigarettes can help you quit smoking." Under the influence of these statements, countless old smokers have turned to e-cigarettes, and at the same time, they have attracted many people who want to smoke but dare not smoke and are hesitant. But is this really the case?

What are e-cigarettes?

Electronic cigarettes are a new type of tobacco, also known as e-cigarettes, electronic nicotine delivery systems (ENDS) or electronic nicotine delivery systems (ENNDS). They do not require combustion, and the smoke does not contain harmful substances such as tar and carbon monoxide. The smoke oil containing nicotine, flavors and other chemicals is atomized by electronic heating, and users inhale this vapor to achieve the feeling of smoking [1].

Are e-cigarettes safer than traditional cigarettes?

Whether e-cigarettes are safe or not, we need to first look at whether their ingredients are harmful. E-cigarette liquid is usually composed of ingredients such as propylene glycol, glycerin, food-grade flavorings, and nicotine. Propylene glycol and glycerin are the basic ingredients responsible for producing smoke; food-grade flavorings give e-cigarettes a variety of flavors; and nicotine is one of the main ingredients in e-cigarette liquid and is one of the substances that smokers are addicted to[2]. In addition, e-cigarette liquid may also contain some auxiliary ingredients and additives, such as water, ethanol, ethylene glycol, etc., as well as preservatives, antioxidants, etc., to improve taste and stability.

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However, although propylene glycol is a recognized safe food additive, the U.S. Food and Drug Administration (FDA) points out that "edible does not mean inhalable", and long-term inhalation of propylene glycol may have adverse effects on the respiratory tract, especially in the absence of long-term research. In addition, nicotine, as one of the main ingredients in e-cigarette liquid, is still addictive, and after the e-cigarette is vaporized, the actual nicotine content inhaled may be higher than the content marked by the manufacturer, or even higher than ordinary cigarettes. Its unevenly released nicotine flavor components may also cause users to experience uncomfortable symptoms such as bad breath and dizziness. In addition, due to the large number of e-cigarette manufacturers and uneven quality, heavy metal components and even tobacco-specific nitrosamines have been detected in some e-cigarettes.

Can e-cigarettes help you quit smoking?

The answer is no. In theory, you can successfully quit smoking by gradually reducing the nicotine content in e-cigarette liquid, but whether e-cigarettes can be an effective smoking cessation tool has been controversial. Many studies have not found that e-cigarettes can help quit smoking [3-5], and successful smoking cessation is not related to the use of e-cigarettes [6].

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On the contrary, studies have shown that smokers who have used e-cigarettes are less likely to successfully quit smoking [7]. Since e-cigarettes contain different harmful ingredients from cigarettes and have different usage habits, they may become a new source of nicotine dependence, causing smokers to fall into a deeper addiction and may also cause dual harm and dual dependence on cigarettes and e-cigarettes. A survey of 2,000 high school students in the United States showed that 12% of them were dual users of e-cigarettes and combustible tobacco [8]. In addition, the WHO has also clearly stated that e-cigarettes are not recommended as an auxiliary tool for quitting smoking.

What are the health effects of e-cigarettes?

0 1Nicotine Addiction

Nicotine in e-cigarettes is not harmless. In fact, it is one of the main ingredients that lead to addiction. Long-term use of e-cigarettes will make people more and more dependent on nicotine, and they may experience discomfort such as anxiety and irritability when they quit.

0 2Respiratory system damage

The smoke produced by e-cigarettes contains many harmful chemicals, such as propylene glycol and formaldehyde. These substances have direct damage to the lungs, including DNA damage[9], and adverse effects have been observed in all areas of the respiratory tract, including the oral cavity, nasal cavity, and lower respiratory tract[2], which may lead to airway inflammation, dyspnea, and diseases such as chronic obstructive pulmonary disease.

0 3 Cardiovascular Health Risks

E-cigarette users may be at risk for cardiovascular health problems. Nicotine and other chemicals may cause heart disease, high blood pressure, myocardial infarction and other diseases, and increase the risk of heart attack and stroke [10, 11]. The "China Smoking Harm Health Report 2020" cited relevant research and found that the probability of myocardial infarction in smokers of traditional tobacco products is 2.7 times that of non-smokers, while the probability of e-cigarette smokers is as high as 18 times that of non-smokers.

0 4 Youth Health

The appeal of e-cigarettes poses a huge threat to teenagers. Because of their sweet taste and variety of flavors, they are more likely to attract young people to try them. However, the adolescent brain is still in the development stage, and substances such as nicotine may have long-term effects on it, including affecting learning and memory ability [12].

0 5The “entry effect” of e-cigarettes

Compared with traditional cigarettes, e-cigarettes are more acceptable in terms of cognition, and their various flavors and appearance designs are more attractive, which makes non-smokers become addicted to tobacco. Studies have observed that no matter how many different tobacco products adolescents have tried, when they begin to become nicotine dependent, they will switch to traditional cigarettes [13]. It is very important for adolescents and non-smokers to understand the existence of this effect so as not to inadvertently fall into the quagmire of nicotine addiction.

In summary, e-cigarettes are not harmless. We should seriously consider these potential health risks and seek professional advice before considering using them. Health is far more important than momentary pleasure. Let us be vigilant about the possible harms of e-cigarettes and cherish our health!

References:

[1] Spahn JE, Stavchansky SA, Cui Z. Critical research gaps in electronic cigarette devices and nicotine aerosols [J]. Int J Pharm, 2021, 593(120144.

[2] Gordon T, Karey E, Rebuli ME, et al. E-Cigarette Toxicology [J]. Annu Rev Pharmacol Toxicol, 2022, 62(301-22.

[3] Grana RA, Popova L, Ling P M. A longitudinal analysis of electronic cigarette use and smoking cessation [J]. JAMA Intern Med, 2014, 174(5): 812-3.

[4] Chapman S. Should electronic cigarettes be as freely available as tobacco cigarettes? No [J]. BMJ, 2013, 346(f3840.

[5] McQueen N, Partington EJ, Harrington KF, et al. Smoking Cessation and Electronic Cigarette Use among Head and Neck Cancer Patients [J]. Otolaryngol Head Neck Surg, 2016, 154(1): 73-9.

[6] Popova L, Ling P M. Alternative tobacco product use and smoking cessation: a national study [J]. Am J Public Health, 2013, 103(5): 923-30.

[7] Adkison SE, O'Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems: international tobacco control four-country survey [J]. Am J Prev Med, 2013, 44(3): 207-15.

[8] Wills TA, Knight R, Williams RJ, et al. Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents [J]. Pediatrics, 2015, 135(1): e43-51.

[9] Menicagli R, Marotta O, Serra R. Free Radical Production in the Smoking of E-Cigarettes and their Possible Effects in Human Health [J]. Int J Prev Med, 2020, 11(53.

[10] Alzahrani T, Pena I, Temesgen N, et al. Association Between Electronic Cigarette Use and Myocardial Infarction [J]. Am J Prev Med, 2018, 55(4): 455-61.

[11] Rose JJ, Krishnan-Sarin S, Exil VJ, et al. Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products: A Scientific Statement From the American Heart Association [J]. Circulation, 2023, 148(8): 703-28.

[12] Soneji S, Barrington-Trimis JL, Wills TA, et al. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis [J]. JAMA Pediatr, 2017, 171(8): 788-97.

[13] Pierce JP, Chen R, Leas EC, et al. Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking [J]. Pediatrics, 2021, 147(2):

Contributor: Chongqing Jiulongpo District Science Popularization Creation and Communication Society

Author: Deng Rurong, attending physician, Erlang Street Community Health Service Center, Jiulongpo District, Chongqing

Review expert: Chief Editor of Jiulongpo District Media Integration Center (Tian Junying)

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