Electronic cigarettes or e-cigarettes are a type of electronic nicotine delivery system, which are much in rage today as alternatives to cigarettes. The younger generation is increasingly switching to e-cigarettes because they feel that they are safe to use, less harmful that normal cigarette smoking and satisfy their cravings. Meanwhile, the recent regulation on e-cigarettes by the Food and Drug Administration (FDA) restricting its sale and promotion to the younger generation proves otherwise. Welcoming the move, the Indian Medical Association (IMA) is running a public awareness campaign educating the masses about the dangers of e-cigarettes and dispelling common myths e-cigarettes are safe and nicotine free.
E-cigarettes are battery-operated devices that heat a liquid to produce a vapour that the user inhales. Unlike conventional cigarettes, which burn tobacco and generate smoke, e-cigarettes have a cartridge containing a liquid (sometimes referred to as ‘e-liquid’), which contains nicotine and other constituents. The liquid is heated to produce a vapour the user inhales. Across all brands, the main components of the liquid vapourised are nicotine, propylene glycol or glycerol, and flavourings. The nicotine content of e-cigarettes and liquids vary and usually range from none (nicotine-free) up to 36 mg/ml. Unlike conventional cigarettes, e-cigarettes can be sold with flavourings. More than 7,000 flavours are available, including candy, fruit, soda, and alcohol flavours. Flavourings may increase the attractiveness of e-cigarettes to youths, especially those who are not already smokers.
Metals such as tin, lead, nickel, and chromium have been found in e-cigarette liquids and vapour. Other compounds detected include tobacco-specific nitrosamines, carbonyl compounds, metals, volatile organic compounds and phenolic compounds.
Commenting on the issue, Dr KK Aggarwal, Secretary General, IMA said, “Nicotine exposure from e-cigarette use, as with cigarette smoking, increases heart rate and produces measurable levels of blood cotinine, a nicotine metabolite. Experienced e-cigarette users tend to take longer puffs and use the device more intensively compared with novice users. As a consequence, they have higher blood nicotine levels that more closely resemble the levels achieved by smoking conventional cigarettes”.
“Most believe that inhaling e-cigarette vapour is likely to be less harmful than inhaling cigarette smoke but the consequences of chronic inhalation of e-cigarette vapour are unknown, and levels of toxic and carcinogenic compounds may vary by e-cigarette liquid components and device used. Little is known about the overall safety or the carcinogenic effects of propylene glycol or glycerol when heated and aerosolized. At high temperatures, propylene glycol decomposes and may form propylene oxide, a probable human carcinogen,” Dr Aggarwal said.
“Similar to cigarette smoke, e-cigarette vapour contains particles. It is not known whether the particles in e-cigarette vapour have any toxicity. IMA, therefore, does not advocate e-cigarettes as an effective way to reduce smoking cessation and believe that they are as harmful as normal cigarettes and must not be promoted,” Dr Aggarwal further added.
Given the concerns that e-cigarette use may be a gateway to nicotine dependence in adolescents, many public health authorities have recommended restricting e-cigarette marketing and advertising to youth, much in the same way that conventional cigarette smoking advertising is restricted. The nicotine in e-cigarette fluid poses a potential for accidental ingestion, especially by children. The typical five mL vial of e-cigarette liquid refill may contain a nicotine concentration of 20 mg/ml (100 mg/vial). The known lethal dose of nicotine is about 10 mg in children.
E-cigarettes have been banned in some countries such as Brazil, Singapore, Canada, and Uruguay. In Europe, the European Parliament approved a directive that regulates nicotine-containing e-cigarettes with concentrations up to 20mg/mL as tobacco products. E-cigarettes with higher nicotine concentrations are regulated as medical devices. As per World Health Organization (WHO), regulations are needed to stop promotion of e-cigarettes to nonsmokers and young people, minimise potential health risks to users and nonusers, stop unproven health claims about e-cigarettes, and protect existing tobacco control efforts.
In India, we have many types of tobacco products available such as bidi, cigarette, chilling, hukka, snuff, gutkha, paan among various others. E-cigarette is nothing but yet another type of Nicotine. Studies have proved that all types of tobacco are harmful. Since it is taken as aerosol, e-cigarettes should be placed in the category of hukha, which also produces vapours.