Electronic cigarettes are becoming increasingly common, with more people using them in bars and restaurants and more stores selling the devices.
But what exactly is an e-cigarette? It’s a device that uses a small battery and a heater, called an atomizer, to vaporize a nicotine solution for inhalation.
Heather Eagleton, Director of Government Relations for American Cancer Society Cancer Action Network, says, “Because there are 250 kinds of e-cigs and no federal regulation, it is hard to get a comprehensive definition of what an e-cigarette is.”
There is variation among e-cigarettes. “When the FDA has analyzed various samples of e-cigarettes, they’ve found that some of them have varying amounts of nicotine, even among the same brand. There is no standardization,” says Shannon Gavin, a clinical oncology pharmacist and tobacco-cessation specialist at the NorthShore University HealthSystem’s Kellogg Cancer Center.
The lack of consistency has not impacted the product’s popularity, however. Kris Dayrit, owner ofVapeCity Chicago with locations in Skokie and Lincoln Park, says business has been booming with the best-selling product being a basic e-cigarette.
E-cigarettes are also gaining the attention of elected officials. New York City banned electronic cigarettes last month. Chicago has also recently banned the use of all e-cigarettes in restaurants, bars and most indoor public places in the city.
A new Illinois law took effect at the start of the year banning the sale of e-cigarettes to minors.
“Until we know the answers to questions like what are the health effects of inhaling nicotine and the health risks to smokers and non-smokers, we need to keep these away from our kids,” says State Representative and co-sponsor of the legislation Laura Fine of Glenview. “I am a mom of teenagers, and when I talk to my friends who have kids, they are upset that e-cigarettes can be purchased without proof of age. They are concerned that their kids can become addicted to something that may be harmful to their health.”
A national youth tobacco survey by the Centers for Disease Control showed that the percentage of students using e-cigarettes more than doubled between 2011 and 2012, but adults are also very interested in them, often as a way to cut back on smoking.
“The majority of my patients ask about them,” Gavin says. “They look fancy; they claim that they are not as bad as cigarettes, but the claims that they help people stop smoking are not backed up by clinical studies.”
“It is important that people know that none of the more than 250 brands of e-cigs on the market have been approved by the FDA as a quit-smoking product,” says Erica Sward, Assistant Vice President for National Advocacy of the American Lung Association. “We want the FDA to use its existing authority to make these manufacturers stop making therapeutic claims. They don’t help smokers quit.”
Dayrit says, “People are using it as an alternative to smoking, but we don’t market it as a smoking cessation option.” He does note that many of his customers “initially match nicotine level to the cigarette they are using and then move downward” so that they are using less nicotine.
Gavin “definitely does not recommend” e-cigarettes, in part because “most contain propylene glycol, which is similar to what is used in antifreeze. There is no long-term safety data as to the effects of a person inhaling propylene glycol. We have no clue what we will start seeing in patients in several years.”
One alternative to an e-cigarette is a nicotine inhaler, which Gavin said she recommends to her patients. “It smokes like a cigarette but only contains nicotine. It does require a prescription from a physician. If someone is interested in how the e-cig looks, the nicotine inhaler is a safer alternative that does help people stop smoking.” She says the FDA has approved it for the treatment of tobacco dependence.
Eagleton agrees that while nicotine inhalers may be a more effective and better nicotine delivery system, “The same concerns exist, including that we do not know the long-term impact and that it furthers the socialization of cigarettes. Kids were not used to seeing people smoke in public places, and we’d like to see that trend continue.”
