Abstract
With an increasing rise in electronic cigarette use and marketing telling us that they are the new, healthier alternative to smoking tobacco, Iszaid Bin Idris discusses the need for further research to be done into the health implications of electronic cigarettes.
Electronic cigarettes, commonly known as e-cigarettes, are electrical devices that generate an aerosol from a liquid in a manner used to simulate smoking behaviour without burning any tobacco. 1 Recently, a report published by the European Respiratory Society in 2019 indicated that there has been an alarming increase in the use of e-cigarettes, especially among young adults. 2 Current regulations for e-cigarettes vary among cities and even countries across the globe. 3 In concert, some health policies have become less prominent, which has led to a rise in the use of these devices as a means to signal a certain modern lifestyle. Although the health risks of e-cigarettes remain somewhat unclear, the social effect of their representation as a potential gateway to smoking is still influential.2,4 This suggests the need for more research to understand the nature and use of e-cigarettes.
In a recent UK survey, it was estimated that around 3.2 million adults currently use e-cigarettes, although these users are mostly ex-smokers. 5 However, since their introduction to the market in 2003, global use among adolescents who were not previously smokers has risen exponentially. 6 While the prevalence of e-cigarette users in Asia is lower than in the US and some European countries, their adoption is still on the rise. 7 One study showed that out of smokers who have tried e-cigarettes, up to 15% become everyday e-cigarette users. 8 On top of this, the daily use of e-cigarettes is at its highest rate among young adults to date, causing public health concern. 2 Thus, health-related issues related to the use of e-cigarettes warrant further attention.
In developed countries like the UK, most consumers prefer to use the e-cigarettes with refillable tanks. 9 The flavour and sometimes the design, colour, and brand often attract them to trying the device. Millions of dollars have been spent by companies around the world on marketing e-cigarettes by claiming that they are newer, healthier, safer, and cheaper than traditional tobacco cigarettes. Indeed, e-cigarettes have come to be perceived by consumers, especially college students, as representative of freedom and a modern social lifestyle.
There are many conflicting opinions among experts about the risks and benefits of e-cigarettes. At present, there is inadequate evidence to prove that any beneficial effects exist, while long-term adverse complications remain similarly underexplored. Known common short-term adverse effects include throat and mouth irritation, nausea, vomiting, coughing, abdominal pain, and headaches. 10 Aside from the direct toxicity inherent with normal use, there is risk of burns or other injuries due to misuse or accidents, such as explosions resulting from extended charging or a fire due to malfunction. 9 Nicotine poisoning may occur, especially in children. 10 In vitro studies of nicotine levels in e-cigarettes have suggested a cancer risk, although the carcinogenicity properties of e-cigarettes have not been definitively established in vivo. 2 Furthermore, even though the level of toxic chemicals in e-cigarette vapour is minimized, the vapour may still contain trace amounts of harmful chemicals not found in traditional tobacco smoke, requiring further investigation. 11 There are also still limited data available about the environmental and ecological impacts of the production and disposal of e-cigarettes. Since the cartridge of an e-cigarette contains a battery, adverse disposal-related effects on the environment are of concern.
Due to their novelty, our current level of understanding as it pertains to e-cigarettes is limited – perhaps the e-cigarette is safer than we think. However, the debate remains ongoing, and the answer is still inconclusive. Regardless, we must act fast and more effectively to establish an evidence-backed view and subsequent definitive health policies regarding the use of e-cigarettes, before it becomes too late.
