Introduction
E-cigarettes, also known as electronic cigarettes or vapes, have become increasingly popular in recent years as an alternative to traditional tobacco cigarettes. However, there is still much debate around whether e-cigarettes are truly a healthier option. While e-cigarettes do not contain tobacco and do not require burning like traditional cigarettes, they still contain nicotine and other potentially harmful chemicals.
This article will analyze the latest research to compare the health impacts of e-cigarettes versus traditional cigarettes. We will examine the ingredients and chemical exposure, effects on the lungs and cardiovascular system, cancer risks, and other short and long-term health outcomes. Although the evidence suggests e-cigarettes are less harmful than regular cigarettes, they are not completely harmless. The thesis is that e-cigarettes pose fewer health risks than combustible tobacco cigarettes, but still contain toxic chemicals and are not safe.
What are e-cigarettes?
E-cigarettes are battery-operated devices that heat a liquid to produce an aerosol that users inhale. The liquid usually contains nicotine, flavorings, and other additives. The liquid used in e-cigarettes is referred to as e-liquid or vape juice. E-cigarettes come in many shapes and sizes but the most common resemble cigarettes, pens, or USB sticks.
E-cigarettes were first invented in 1963 by Herbert A. Gilbert, but it was Chinese pharmacist Hon Lik who patented the modern e-cigarette design in 2003. Hon Lik's design was the first to use a high-frequency, piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution. This design produced a smoke-like vapor that could be inhaled to deliver nicotine without burning tobacco.
The main components of an e-cigarette device are: a mouthpiece, heating element, battery, and e-liquid cartridge. When the user inhales through the mouthpiece, a sensor activates the heating element which heats and vaporizes the e-liquid. The vapor is then inhaled by the user, delivering nicotine without burning tobacco.
What are the health risks of e-cigarettes?
E-cigarettes contain nicotine, which is highly addictive. Nicotine exposure during adolescence can harm brain development and impact learning, memory, and attention (1). The nicotine in e-cigarettes is readily absorbed through the lungs and can lead to dependence. Some research suggests that nicotine addiction may occur faster with vaping compared to smoking traditional cigarettes (2).
Nicotine is also toxic in high doses. Exposure to high levels of nicotine from e-cigarettes can cause nausea, vomiting, and seizures. There have been reports of children and adults accidentally ingesting or absorbing toxic doses of nicotine from e-cigarette liquid (1). Long-term nicotine exposure may also increase the risk of cardiovascular disease (3).
Sources:
(1) https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
(2) https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive
(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958544/
What are the health risks of traditional cigarettes?
Traditional cigarettes contain a wide range of toxic chemicals and carcinogens that can cause severe health issues when inhaled into the lungs. Some of the major health risks of cigarette smoking include:
Lung Cancer - Cigarette smoking is the number one risk factor for lung cancer, which is the leading cause of cancer death. The smoke from cigarettes contains multiple carcinogens that can damage lung tissue and lead to cancerous mutations. The risk of developing lung cancer is about 23 times higher for male smokers compared to nonsmokers, and 13 times higher for female smokers.[1]
Heart Disease - Smoking cigarettes increases the risk for cardiovascular diseases like heart attack, stroke, and heart disease death. Chemicals in cigarette smoke can damage and narrow blood vessels, increasing strain on the heart. Smokers are 2-4 times more likely to develop coronary heart disease.[2]
COPD - Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, which damage the airways and restrict oxygen flow. Cigarette smoking accounts for about 80-90% of COPD-related deaths. Smokers are 12-13 times more likely to die from COPD compared to nonsmokers.[3]
Other Diseases - Smoking increases risks for many other health problems like stroke, blindness, tuberculosis, gum disease, reduced fertility, type 2 diabetes, rheumatoid arthritis, and immune system weakness.
Direct comparison of health impacts
When directly comparing the health impacts of e-cigarettes versus traditional cigarettes, research shows that e-cigarettes are likely less harmful overall. According to a comprehensive review in Respiratory Research, while e-cigarettes are not harmless, they contain fewer toxicants and carcinogens compared to combustible cigarettes https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01737-5.
A key metric is mortality rates. A study in JAMA Network Open found that daily e-cigarette use was associated with significantly lower odds of lung disease mortality compared to smoking combustible cigarettes. The mortality rate for e-cigarette users was very low at 0.15 deaths per 1,000 people per year. For cigarette smokers it was much higher at 4.98 deaths per 1,000 people per year https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782796.
When looking at specific health conditions, evidence suggests e-cigarettes pose lower risks for lung cancer, chronic obstructive pulmonary disease (COPD), and heart disease compared to traditional cigarettes. However, risks are not zero and e-cigarettes can still negatively impact lung function and cardiovascular health.
Secondhand Exposure Risks
Secondhand exposure to vapors from e-cigarettes versus secondhand smoke from traditional cigarettes is an important consideration when comparing the health impacts. Much less research has been done on risks from secondhand vaping, but initial studies suggest some key differences.
Secondhand smoke contains over 7,000 chemicals, including hundreds that are toxic and at least 70 that can cause cancer. It has definitively been linked to numerous health problems in non-smokers exposed regularly, especially children. E-cigarette aerosol generally contains fewer chemicals than cigarette smoke, but it is not harmless. The aerosol includes nicotine, ultrafine particles, and low levels of toxins. [1]
One study found similar levels of nicotine in people exposed to secondhand vape versus secondhand cigarette smoke. More research is still needed, but this suggests secondhand vaping could also lead to nicotine dependence and adverse effects. However, toxins appear to be significantly lower. Secondhand vape exposure does not contain the tar and carbon monoxide found in cigarette smoke. [2]
While secondhand vaping is likely less harmful than secondhand smoking, it is not risk-free. People exposed regularly, especially vulnerable populations like children and pregnant women, may face health consequences that warrant caution about vaping indoors or around others.
Gateway to cigarette smoking?
There has been debate around whether e-cigarette use leads non-smokers to progress to smoking regular cigarettes. Some key points around this issue:
Evidence suggesting e-cigarettes could act as a gateway:
- A review by Australian National University researchers found that non-smokers who use e-cigarettes are more likely to go on to smoke regular cigarettes compared to non-smokers who don't vape.
- Studies have shown that the nicotine in e-cigarettes can prime the brain for addiction to other drugs like cocaine.
- Teen vaping has been linked to an increased risk of smoking traditional cigarettes later.
Evidence suggesting e-cigarettes do not act as a gateway:
- Most adults who use e-cigarettes are current or former cigarette smokers, not non-smokers.
- For teens, other factors like peer influence may drive smoking rather than e-cigarette use itself.
- The rise in vaping has coincided with declining rates of teen cigarette smoking in many countries.
Overall, more research is still needed to determine if e-cigarette use directly causes non-smokers to transition to regular smoking. But it does appear that vaping may make some non-smokers more open to trying cigarettes.
Impact on addiction and quitting
There is ongoing debate about whether e-cigarettes truly help smokers quit traditional cigarettes. Some studies have found that e-cigarettes can be an effective smoking cessation tool. For example, a 2024 randomized controlled trial published in the New England Journal of Medicine found that e-cigarettes containing nicotine were nearly twice as effective for smoking cessation after one year compared to nicotine replacement therapy. However, other analyses suggest e-cigarettes are not associated with higher rates of successfully quitting smoking.
One key factor seems to be whether smokers completely switch to using e-cigarettes or continue to smoke traditional cigarettes as well. Those who fully transition appear more likely to quit smoking, while dual use may undermine quitting. There are concerns that e-cigarettes could perpetuate nicotine addiction and make it harder to quit all tobacco products. More research is still needed to understand the long-term impacts of e-cigarettes on smoking cessation.
Regulations
There are various regulations around e-cigarettes at both the federal and state level in the United States. Here are some of the key regulations:
The federal minimum age to purchase e-cigarettes is 21 years old. This was enacted by federal law in December 2019, raising the age from 18 to 21 (https://www.cdc.gov/statesystem/factsheets/ecigarette/ECigarette.html).
At the federal level, the FDA regulates e-cigarettes as tobacco products. All e-cigarettes introduced to the market after August 2016 must go through a premarket review process with the FDA to assess their impact on public health (https://www.fda.gov/tobacco-products/products-ingredients-components/e-cigarettes-vapes-and-other-electronic-nicotine-delivery-systems-ends).
States also regulate the sale and use of e-cigarettes, with laws varying widely. Some key areas regulated at the state level include age restrictions, smoke-free air laws, taxes, product packaging and labeling requirements. Many states have also enacted laws specifically restricting e-cigarette advertising and marketing practices, especially those targeting youth (https://www.publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review).
Conclusion
In conclusion, while e-cigarettes may be less harmful than traditional cigarettes in some respects, they are not harmless. The long-term health impacts of vaping are still unknown. E-cigarettes do expose users to toxic chemicals that can damage lungs and cause cancer. They also sustain nicotine addiction. However, they may help some people quit smoking and reduce cigarette consumption for those who switch. More research is still needed, but it appears e-cigarettes are likely the lesser of two evils compared to regular cigarettes. This suggests some individual and public health benefits if adult smokers switch, but does not mean e-cigarettes should be promoted or that they are safe.
