It is a device that produces inhalable vapor with or without nicotine, presenting several flavors (e.g. peppermint, coffee, fruit, etc.) and can serve as an alternative to the smoker, as well as delivering nicotine taste and physical sensation similar to that of inhaled tobacco smoke, although there is no tobacco, combustion and smoke. Also, electronic cigarette mimics the habit of smoking, which for many smokers is one of the obstacles to success in smoking cessation, however, it does much less harm than tobacco because of its composition with far fewer toxins.
The classic model of the electronic cigarette is visually very similar to the true product, that is, it has the same white and yellow color, the same shape and even the tip pretends to be on when drawn upon. However, this model has already fallen into disuse, giving rise to “box mods”, which have the same functioning of the electronic cigarette like a normal cigarette, but with temperature and adjustable voltage, and, in most cases, with replaceable battery. In addition to these, there are several models available in the market, and the so-called electronic cigarette goes beyond offering an alternative to the smoker of conventional cigarettes, since there are also devices in the form of cigars, cigarillos, pipe, among many other formats.
Currently, most of the electronic cigarettes available for sale are reusable and contain spare and / or rechargeable parts. However, it is also possible to find fully disposable electronic cigarettes, being used more like a test version.
Components and operations
The electronic cigarette consists basically of three parts: a battery with some electronic components, a vaporizer (also called atomizer) and a cartridge, which works in the same way as nicotine gum and stickers, gradually delivering this substance to the smoker.
In most models, the battery of electronic cigarettes is connected to a sensor that detects the suction performed by the user, which activates the atomizer and starts to vaporize the liquid contained in the cartridge (called e-liquid or e-juice), and then inhaled by the user. Also, this sensor activates a LED (small light device), usually of orange color, located in the tip of the cigarette. With this, the electronic cigarette simulates the real act of smoking very well.
E-liquid or e-juice is a liquid more viscous than water, has a high surface tension and has the property of being easily vaporized and is therefore used as vehicle to reach the lungs.
In most e-liquids the main component is propylene glycol, followed by glycerin, water, nicotine and flavoring, which give the flavor and aroma. E-liquids therefore do not present tar, carbon monoxide and any of the other substances commonly found in tobacco products.
The FDA (The Food and Drug Administration) has long recognized that this substance is safe for human use in food, cosmetics and medicines (including inhalants), being widely used by various branches of industry. Among other examples, this substance is used as a solvent for food coloring and flavoring, as a food preservative, as a non-toxic antifreeze, as a moisturizer in medicines and cosmetics, in toothpaste, mouthwashes as a fixative for perfumes and is also used in machines that simulate smoke. In e-liquid, propylene glycol is used to produce steam and carry flavor and aroma, and the inhalation poisoning of propylene glycol is not of concern. Still, propylene glycol does not cause sensitization and does not present any evidence of being a carcinogen, however some individuals may present allergy to this component
Also called glycerol, it is a hygroscopic, odorless, viscous and sweet-tasting substance, widely used by the industry as a humectant, solvent, softener and food and beverage additive and in the medical, hospital and pharmaceutical area in ointments, elixirs, syrups, anesthetics, etc. Glycerol has been recognized as safe for human consumption since 1959 and can be used in various food products for a wide range of purposes. Several studies have shown that a large amount of glycerol (synthetic or natural) can be administered without the appearance of any adverse effect to health.
Generally distilled water is used in e-liquids, although that in reduced quantities.
A basic alkaloid substance similar to caffeine contained in liquid, yellow coffee found in certain types of plants, especially in tobacco, but is also detected in small amounts in tomato, potato, eggplant, cauliflower, in some teas, among others. In e-liquids the amount of nicotine varies from 0% to 18% being diluted with the other components of the liquid. When consumed through tobacco, it manifests itself in two distinct ways: it has a stimulating effect and, after some deep swallowing, has calming effect, blocking stress. Its use causes psychic and physical dependence, causing uncomfortable sensations in abstinence. In excessive doses, it is extremely toxic: it causes nausea, headache, vomiting, convulsion, paralysis and even death. The lethal dose (LD50) is 0.4 mg / kg in adults.
They are substances (natural or synthetic) or mixtures that added to a food or medicine give them a characteristic flavor and aroma. They can be natural (essential oils extracted from plants and natural fruit flavors) or artificial (aromatic alcohols, aldehydes, balms, phenols, terpenes, etc.). They are widely used by the food and pharmaceutical industry.
Affects on health
Smoking, that is, tobacco smoking is a serious health problem in the world, because:
- With more than 4,700 toxic substances, 60 of which are known or suspected to cause cancer, smoking negatively affects all parts of the human body;
- Approximately 47% of the entire male population and 12% of the world’s female population smoke. While in developing countries smokers constitute 48% of the male population and 7% of the female population, in developed countries women’s participation more than tripled: 42% of men and 24% of women have a smoking behavior;
- There are 1.1 billion tobacco smokers in the world, and if the current trend continues, that number is expected to rise to 1.6 billion by 2025;
- The top 10 tobacco smokers in the world are China, India, Indonesia, Russia, the United States, Japan, Brazil, Bangladesh, Germany and Turkey. These countries account for two-thirds of the world’s population of smokers;
- Around the world about 10 million cigarettes are purchased per minute, 15 billion cigarettes are sold every day and 5 trillion cigarettes are produced and used annually;
- Smoking is considered by the World Health Organization (WHO) the leading cause of preventable death worldwide;
- On the other hand, passive smoking is considered the third leading cause of preventable death in the world, following active smoking and excessive alcohol consumption. A study by the British Medical Journal (August 2004) reported that a cigarette releases 10 times more air pollution than a diesel engine;
- In 1993, the Environmental Protection Agency categorized passive smoking in Group A – the most serious form – along with many other carcinogens, such as arsenic, mustard gas and asbestos;
- Passive smoking poses a 30% greater risk of lung cancer and 24% greater risk of heart attack than non-exposed non-smokers;
- According to the World Health Organization (WHO), total deaths due to tobacco use amounted to 4.9 million annual deaths, which corresponds to more than 10 thousand deaths per day. If current trends in the expansion of their consumption are maintained, these numbers will increase to 10 million annual deaths by 2030, half of them in productive age individuals (between 35 and 69 years);
- In Brazil, according to data from the National Cancer Institute (INCA), smoking is directly responsible for 30% of cancer deaths in general, 90% of lung cancer deaths and 25% of deaths from coronary heart disease;
- Tobacco kills more Americans than AIDS, drugs, homicides, fires and car accidents together;
- Smoking causes a worldwide loss of $ 200 billion a year, with half of it occurring in developing countries. This figure, calculated by the World Bank, is the result of the sum of several factors, such as the treatment of tobacco-related diseases, deaths of citizens of productive age, a higher rate of early retirements, an increase in the rate of absenteeism and lower productive income
- Annually, smoking costs the United States alone more than $ 97 billion in lost productivity (“smoking breaks”) and more than $ 96 billion in health expenses;
- If a person smokes a packet of tobacco cigarettes a day for 50 years (average age to start smoking tobacco is 13), she will spend about $ 109,500 on tobacco cigarettes, compared with $ 122,220 on groceries during the same period;
- In the United States, every year cigarette fires account for more than $ 6 billion in social costs and direct damages, about 2,500 injuries and more than 1,000 deaths. One in four forest fires are caused by tobacco cigarettes;
- For a person to succeed in quitting smoking, on average, six to eight attempts are needed. Every year, 45% of people who smoke will stop smoking for only one day, less than 3% will be able to stop smoking again
- In the United States alone, smokers spent about $ 3 billion worldwide on smoking cessation products in 2008. In 2002 this amount was 1.4 billion. Still, existing smoking cessation products are known to be only about 5% effective, with 80% of sales of these products being made to regular nicotine users;
- 90% of smokers start smoking before age 19. Seducing young people is part of a strategy adopted by all tobacco companies to replenish the ranks of those who quit smoking or die by other consumers who will be the regulars of tomorrow;
- In Brazil, a study was carried out among students from 12 Brazilian capitals, in 2002 and 2003, and found a prevalence of experimentation ranging from 36 to 58% in males and 31 to 55% in females, between cities. According to the same study, the prevalence of current schoolchildren ranged from 11 to 27% in males and 9 to 24% in females;
- The risk of myocardial infarction, pulmonary embolism and thrombophlebitis in young women who use oral contraceptives and smoke is 10 times greater than those who do not smoke and use this method of birth control. Smokers who use oral contraceptives are at risk for diseases of the circulatory system, increasing by 39% the chances of developing coronary diseases and 22% of strokes;
- Female smokers who do not use hormonal contraceptive methods reduce the fertility rate from 75% to 57% due to the effect caused by cigarette toxins in the ovary;
- Smoking is estimated to be responsible for 40% of deaths in women younger than 65 years and for 10% of deaths from coronary disease in women over 65;
- Women who smoke two or more packs of cigarettes a day are 20 times more likely to die from lung cancer than women who do not smoke;
- Smoking during pregnancy poses serious risks. Spontaneous abortions, preterm births, low birth weight infants, fetal and newborn deaths, placental complications, and bleeding episodes occur more frequently when the child is a smoker. Such problems are mainly due to the effects of carbon monoxide and nicotine exerted on the fetus after absorption by the maternal organism. A single cigarette smoked by the pregnant woman can accelerate the fetal heart rate in a few minutes due to the effect of nicotine on her cardiovascular system.
Regarding the electronic cigarette, although the health effects of its use are not fully known in the scientific field, several studies have demonstrated that this device presents enormous advantages with respect to tobacco cigarettes, because, precisely because it does not have tobacco or combustion, presenting only nicotine, brings a series of:
- Does not compromise smell and taste;
- It does not cause darkening of the teeth, inflammation of the gums and bad breath;
- Does not cause aging of the skin (wrinkles);
- It does not leave a bad smell in the person who smokes and in the environment in which it is smoking;
- It does not compromise the breath;
- Does not cause clearing (“catarrh”);
- It does not cause chronic cough;
- Does not promote fire hazard;
- It does not pollute the environment with butts;
- It does not cause tobacco-related diseases such as pneumonia, cancer (lung, bladder, larynx, pharynx, esophagus, mouth, stomach), myocardial infarction, chronic bronchitis, pulmonary emphysema, stroke, thrombosis, digestive ulcer, sexual impotence, ;
- It does not expose other people to the risks of tobacco smoke (passive smokers);
Several studies have failed to prove that nicotine alone, as in drugs used in nicotine replacement therapy, causes significant harm to the cardiovascular system. In addition, some studies have suggested that nicotine appears to be beneficial in a number of ways, for example in stimulating recovery from brain damage in Parkinson’s disease and Alzheimer’s;
Propylene glycol, the main constituent of the e-liquid used in electronic cigarettes, has known bactericidal and antiviral properties and can protect people who use electronic cigarettes from colds and respiratory infections, while tobacco smoke doubles the risk of death in an epidemic of influenza and lastly, it is cheaper than tobacco cigarette.
Among the studies highlighted, the pioneer “Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol” conducted in New Zealand with the help of Canada in 2008 by Dr. Murray Laugesen has shown that the electronic cigarette, designed to be a safe alternative to smoking, “is very safe in relation to tobacco cigarettes and also very safe in absolute terms in all measures that we have applied in this study.” In addition, the same researcher has conducted further studies and discussions in which he confirmed the safety of electronic cigarette, proving scientifically once again that electronic cigarette has no toxic levels of harmful substances to human health.
However, in this same context, in May 2009, the Food and Drug Administration (FDA) conducted a study that tested the content of 18 varieties of electronic cigarette cartridges produced by two US suppliers NJoy and Smoking Everywhere (a now discredited website) and found results trace amounts of the substance diethyleneglycol in one of the cartridges manufactured by Smoking Everywhere, as well as traces of tobacco-specific nitrosamines (TSNA’s) known as cancer causing agents in all cartridges of one brand and two of the cartridges of the other brand. The study also found that actual nicotine levels did not always match the amount of nicotine the cartridges were said to contain. Further, the analysis found traces of nicotine in some cartridges that were said to be without nicotine and other concerns were raised about inconsistent levels of nicotine delivered when in use.
As a result, in July 2009, the FDA issued a press release discouraging the use of electronic cigarettes, repeating the above concerns, stating that e-cigarettes may be attractive to the young public and do not have adequate warnings about the risk to health. Most recently their new campaign is “The Real Cost.”
However, the aforementioned 2008 study by Dr. Murray Laugesen had already concluded that the traces of TSNA’s found in electronic cigarettes do not come close to reaching cancer levels and that the same amounts of TSNA’s are found in already approved nicotine replacement therapy by the FDA itself, such as nicotine chewing gum. In addition, the 2009 study by the same author showed that the toxic emission score, which is based on 59 toxic substances, was 0 (zero) for the electronic cigarette, in contrast to 126 for the Marlboro cigarette brand and more of 100 for other brands.
In addition to Dr. Murray Laugesen, several individuals and organizations questioned the FDA study and filed for electronic cigarette: “A group of prominent physicians and tobacco researchers, including Dr. Michael Siegel of the Boston University School of Public Health, Dr. Joel Nitzkin of The American Association of Public Health Physicians (AAPHP) Tobacco Control Task Force and Dr. Brad Rodu, Endowed Chair of the Tobacco Harm Reduction Research University of Louisville, challenged the FDA to provide full quantitative study data on which the FDA based its warning against electronic cigarettes. They further claimed to be concerned that the FDA falsely incriminated electronic cigarettes through a partial presentation of scientific data, causing a significant negative impact on the public perception of electronic cigarettes, while the best available evidence has shown that the devices offer great potential to reduce serious health problems among traditional tobacco smokers.”
Vaping as an alternative to cigarettes
Adding to this, according to Professor Carl Philips of the Tobacco Harm Reduction Institute at the University of Alberta, Canada: “There is absolutely no doubt that electronic cigarette is a safer alternative to tobacco cigarette”, “we electronic cigarette is 99% less harmful than tobacco cigarette “and” the benefits of switching tobacco from cigarette to electronic cigarette are almost the same benefits of quitting smoking, which also applies to the drugs used for the therapy of nicotine, such as nicotine chewing gum. If a tobacco smoker can switch to electronic cigarettes, the benefits are about the same as quitting smoking: they reduce the risk of cancer, they reduce the risk of cardiovascular disease, they get rid of problems in the lungs and airways and so on. In this case the change is as good as quitting smoking, because from the point of view of health there is no reason to worry about the difference between quitting smoking and using electronic cigarettes.”
Also, about the findings of the study by the FDA, the professor states that “there is no meaning of these findings from any scientific or health point of view. From the political point of view, the fact that they did it was quite significant. Thus, in the first point, the existence of any detectable levels of any molecules that can be found in the tobacco plant in the electronic cigarette is by no means surprising. Whereas nicotine is extracted from the tobacco plant, detecting traces of contaminating molecules in the electronic cigarette means that basically any molecule found in the tobacco plant that is small enough to be a contaminant will also be found in the electronic cigarette and, in addition, it will also be found in Nicoderm, Nicorette and in any product containing nicotine extracted from the tobacco plant. So this is completely meaningless because the amount of nitrosamines found in electronic cigarettes has been so much lower than that found in tobacco cigarettes that this information does not even matter, since that amount does not cause any major cancer risk.”
The FDA on ecigs
Finally, the Electronic Cigarette Association ruled that the FDA test was too limited to reach valid and reliable conclusions. To prove this, he hired the company Exponent Inc. to review the FDA study. Thus, after analysis, Exponent Inc. has evidenced that the FDA studies, “in summary, suffers from several limitations, which together result in failure to properly support the adverse effects of electronic cigarette on health and its consequences, compared to medications for nicotine replacement therapy already approved by FDA itself in the past. ” Thus, Exponent Inc. concluded that the FDA study had no basis to support the claims of potential adverse health effects in the use of electronic cigarettes.
As if that were not enough, the FDA classified electronic cigarettes as being drug-releasing devices, being subject to regulation under the Food, Drug and Cosmetic Act (FDCA) to be imported and sold in the United States. Next, this classification by the FDA was challenged in court and overturned by Judge Richard J. Leon, citing that “devices should be regulated as tobacco products rather than drugs and drugs.”
In March 2010, the US Court of Appeals suspended the injunction pending an appeal, during which the FDA argued the right to regulate electronic cigarettes based on its previous ability to regulate nicotine replacement therapies such as gum nicotine or adhesives. In addition, the agency argued that tobacco legislation adopted in the previous year “explicitly excludes any device that is a drug or combined product from the definition of ‘tobacco product’ and provides that such objects must be regulated under pre-existing provisions of the FDCA (Federal Food, Drug, and Cosmetic Act).”
On December 7, 2010, the appeals court ruled against the FDA in a unanimous 3-0 vote, ruling that the FDA can only regulate electronic cigarettes as tobacco products, and therefore cannot block their imports. The judge ruled that such devices would be subject to drug legislation only if marketed for therapeutic use (manufacturers of electronic cigarettes successfully proved that their products were intended for smokers and not for people intending to give up smoking). Today, electronic cigarettes are legal in the United States, but may be subject to statewide legislation].
Therefore, more studies need to be done to establish whether there are health risks from electronic cigarette consumption, whether this risk is greater or less than the risk of tobacco cigarettes and, finally, whether electronic cigarettes could be used as a strategy for stop or reduce smoking.