E-Cigarettes: Safe or Just Blowing Smoke?
By Lindsey Ryan, MSN, RN, CCRN-K, ACNS-BC
Cigarette smoking remains the leading cause of preventable sickness and mortality, responsible for more than 400,000 deaths in the United States each year. The worst health consequences associated with smoking (e.g., cancer and heart disease), are linked to inhalation of tar and other chemicals produced by tobacco combustion; the pleasurable, reinforcing and addictive properties of smoking are produced mostly by the nicotine contained in tobacco (NIDA, 2015).
Electronic cigarettes (e-cigarettes) are battery-operated devices designed to mimic the act of smoking by emitting a flavored vapor that looks and feels like tobacco smoke and delivers nicotine -- but with fewer of the toxic chemicals produced by traditional cigarettes (NIDA, 2015).
Many devices are constructed to resemble traditional tobacco cigarettes, cigars or pipes. Some are even made to resemble everyday items like pens or USB memory sticks, although newer devices, such as those with fillable tanks, may look different. More than 250 different e-cigarette brands are currently on the market.
Most e-cigarettes consist of three different components, including:
• A cartridge, which holds a liquid solution containing varying amounts of nicotine, flavorings and other chemicals
• A heating device (vaporizer)
• A power source (usually a battery)
In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The resulting vapor is then inhaled (called "vaping").
Are They Safe?
As with traditional cigarettes, the nicotine used in e-cigarettes is addictive and harmful. When users stop vaping they may experience withdrawal symptoms including feeling irritable, depressed, restless and anxious. Vaping can be hazardous for people with heart disease and can damage arteries over time (NIDA, 2015).
However, to date, evidence suggests that e-cigarettes may be a more sound choice than traditional cigarettes. The data indicates that electronic cigarettes are a less harmful alternative to smoking, and smokers who switch from tobacco to electronic cigarettes can expect to see significant health benefits (Farsalinos & Polosa, 2014). The biggest danger from tobacco is the smoke, and e-cigarettes don't burn. Trials have revealed the amounts of carcinogenic chemicals they produce represent a small portion when compared to a traditional cigarette.
E-Cigarette Use Among Youth
According to the Centers for Disease Control and Prevention (CDC, 2015), the prevalence of e-cigarette use among adolescents from 2013 to 2014 has tripled. Findings from the 2014 National Youth Tobacco Survey show that e-cigarette use (defined as vaping at least 1 day in the past 30 days) among high school students increased from 4.5% in 2013 to 13.4% in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1% in 2013 to 3.9% in 2014—an increase from approximately 120,000 to 450,000 students.
In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as a gateway product for youth who go on to use other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death. In a recent study, students who began using e-cigarettes by 9th grade were found to be more likely than others to start smoking traditional cigarettes and other smokable tobacco products within the following year (Rigotti, 2015).
An intense debate exists among the scientific community over the risks and benefits of e-cigarettes. Healthcare providers seek to reduce the disease and death caused by tobacco, but disagree about whether e-cigarettes are the right answer. In a recent article, Khan, Stanbrook & Allehebi (2015) found the use of e-cigarettes correlated with frequent short-term respiratory events which may pose a higher risk of serious adverse events than a nicotine patch.
Supporters believe that e-cigarettes could help people quit, just like nicotine gum, but additional studies are needed. Evidence shows that e-cigarettes achieve higher rates of smoking cessation at one month than a placebo, but limited data suggests that this effect may not be sustained over longer periods of time (Khan, Stanbrook & Allehebi, 2015).
Substantial gaps in literature highlight the most important role that science can play in the current e-cigarette debate: Identify the acute and longer-term effects of e-cigarette use, especially given the widespread variability in devices, liquids and user behavior (Breland, Spindle, Weaver & Eissenberg, 2014).
Breland, A. B., Spindle, T., Weaver, M., & Eissenberg, T. (2014). Science and electronic cigarettes: current data, future needs. Journal of Addiction Medicine, 8(4), 223-233.
Centers for Disease Control and Prevention. [CDC]. (2015). E-cigarette use triples among middle-school and high-school students in just one year. Retrieved from here.
Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review. Therapeutic Advances in Drug Safety, 5(2), 67-86.
Khan, M., Stanbrook, M. B., & Allehebi, R.O. (2015). Efficacy and safety of electronic cigarettes for smoking cessation: A systematic review. American Journal of Respiratory Critical Care Medicine, 191, A3715.
National Institute on Drug Abuse. [NIDA]. (2015). Drug Facts: Electronic Cigarettes (e-Cigarettes). Retrieved from here.
Rigotti, N.A. (2015). E-cigarette use and subsequent tobacco use by adolescents: New evidence about a potential risk of e-cigarettes. JAMA. 2015; 314(7):673-674.
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Lindsey Ryan, MSN, RN, CCRN-K, ACNS-BC is a course author for RN.com. She graduated from Point Loma Nazarene University in San Diego, California with both her BSN and MSN. Lindsey’s clinical experience ranges from Acute to Critical Care where she has functioned in the roles of frontline staff and CNS. Most recently Lindsey is responsible for leading efforts associated with new knowledge and innovation including interdisciplinary quality initiatives, evidence-based practice projects and clinical research. She identifies areas for development, leads evidence-based implementation efforts and performs evaluations to ensure positive patient outcomes.