E-cigarettes the unanswered questions Posted on May 30, 2013 by Claire Knight

Five years ago youd probably never heard of electronic cigarettes, or e cigarettes. Now it seems you cant open a newspaper or go into a newsagent, supermarket or pharmacist without seeing them advertised or on sale. For smokers concerned about the toxic cocktail of cancer-causing substances in tobacco smoke, e-cigarettes sometimes touted as a safer alternative to smoking might initially sound like a Holy Grail. Were determined to reduce the number of smoking-related cancers. If e-cigarettes can help reduce this toll, its crucial to public health that this avenue is properly explored to fully understand the benefits and risks of these devices. There are widely differing responses to the replication of the act of smoking offered by e-cigarettes use, known as vaping. Some people see a unique opportunity to promote a mass switch to vaping that would avoid the massive

health toll of smoking tobacco on the 1 in 5 adults smoking in the UK today. Others see e-cigarette as posing a great risk that would keep people too close to their cigarette habit, making a lapse back to smoking more likely. Currently e-cigarettes are not regulated in the way that approved nicotine replacement therapies (NRT) such as patches and gum are. This means they havent undergone all the rigorous tests needed to ensure their safety and effectiveness. We want to see light touch regulation brought in, to ensure the products contents and delivery is monitored and consistent, they are not sold to under 18s and that their marketing does not promote smoking itself. The increasing popularity of e-cigarettes makes it crucial to answer questions about their impact not just on the health of smokers who use them, but on non-smokers, ex-smokers, children and society as a whole. Thats why we commissioned researchers at the University of Stirling to identify the unanswered questions and concerns around e-cigarettes, and look at the broader issue of tobacco harm reduction measures to reduce illness and death caused by tobacco use.

Weve just published their report (pdf), and a summary has been published in the journal Tobacco Control). In this post, well look in more detail at the questions and issues it raises. What are e-cigarettes? E-cigarettes look like real cigarettes and usually consist of a battery, a cartridge containing nicotine (the addictive ingredient in tobacco), a solution of propylene glycol or glycerine mixed with water, and an atomiser (a device that turns the nicotine solution into a fine mist or vapour). When someone inhales on the e-cigarette the nicotine solution is heated and evaporates.Research shows the e-cigarette user inhales a hit of nicotine as they would when inhaling smoke from a cigarette (although other research has questioned how effective some e-cigarettes are at nicotine delivery). Cartridges are available in different concentrations of nicotine, and in various flavours such as apple, chocolate, coffee and mint. Most e-cigarettes have an LED at the tip which lights up when someone inhales, in a similar way to the lit tip of a cigarette.

Are they really safer than cigarettes? While its the highly addictive nicotine that keeps smokers hooked, its the toxic cocktail of chemicals in tobacco smoke that kills half of all long-term users. Traditional tobacco cigarettes contain around 4000 different chemicals, including toxins like arsenic and radioactive polonium-210. Tobacco smoke has long been recognised as a carcinogen responsible for more than one in four UK cancer deaths, and the biggest single cause of cancer in the world. The lack of tobacco in e-cigarettes means they are almost certainly much safer way of getting a nicotine hit than smoking cigarettes. But there are still some questions about the safety of the chemicals that are in e-cigarettes, and the current lack of regulation means theres no way of verifying whats actually in them, especially with so many different companies now entering the market. For example, we know little about the safety of the propylene glycol in many e-cigarettes. And nicotine itself can be toxic in very high doses. So there are questions about the safety of leakage from cartridges and refill bottles.

Research has found that some e-cigarettes contain chemicals other than nicotine and propylene glycol or glycerin. Tests on some e-cigarettes have found small amounts ofnitrosamines, formaldehyde (both cancer-causing chemicals), acetaldehyde and acrolein (toxins) in the vapour or liquid. These are all chemicals found in tobacco smoke, at far higher levels. Given reports of malfunctions, wed like to see these products regulated to help ensure that the mechanical components in the device are safe and reliable, and deliver consistent doses of controlled chemical contents. Who uses e-cigarettes and why? E-cigarette manufacturers arent yet allowed to market their products as quitting aids, as they havent been through the strict tests needed to see how effective they are. Some research suggests that smokers are already using them to help give up and we want to see much more research to be sure if e-cigarettes could be useful in helping smokers quit (or cut down) smoking. So we need to know more about how people use e-cigarettes, and why. For example:

How many people are using them to cut down their cigarette consumption, or to try to quit entirely?

Are people using e-cigarettes in combination with smoking, for example to get round smoke free laws?

If so, what impact does such dual use mean for their future attempts to quit? Are they more or less likely?

Are smokers who may have otherwise successfully conquered their nicotine addiction more likely to stay on e-cigarettes (and thus addicted to nicotine) long term, if they start using them?

More research to answer such questions is needed to understand the longterm impacts of using e-cigarettes. Effects on tobacco smoking? One of the effects of decades of legislation against tobacco is to make smoking less socially acceptable, as more people are aware of the health risks and it has become more difficult to smoke in public. But the UKs smoke free legislation doesnt cover e-cigarettes. So we also need to consider

whether using e-cigarettes in places where tobacco smoking is now banned might make smoking more acceptable again. Likewise, e-cigarettes arent covered by the UKs ban on tobacco advertising. So e-cigarettes are marketed all over the place, and even promoted by celebrities and at celebrityevents techniques barred to the tobacco industry since 2003. Its important to look at whether e-cigarettes could serve as a gateway to smoking traditional cigarettes by ex-smokers, nonsmokers and, most importantly, children. More than 200,000 under 16s start smoking in the UK every year, so protecting children from the dangers of smoking is a top priority for us. We need to find out more about whether e-cigarettes are attractive to children (particularly given the appealing flavourings and heavy advertising involving celebrities), and whether this will affect the number of children who subsequently take up smoking. Tobacco industry involvement Over the last few years, the tobacco industry has become heavily involved in selling e-cigarettes a move that is seen by some as an insurance policy

against future potential losses in cigarette sales. This raises many issues around conflicts of interest and the role, if any, of the tobacco industry in public health. The World Health Organizations Framework Convention on Tobacco Control (FCTC) is a global public health treaty set up to provide a united response to the tobacco epidemic. Part of the FCTC aims to prevent tobacco industry interference and there are concerns this will be weakened by the industrys entry into the e-cigarette market and that this may simply be another tactic to keep profits high. Next steps Todays report by Stirling University will help guide future research and ultimately answer questions about potential benefits and harms of ecigarettes. A comprehensive report by the French Office for Smoking Prevention (OFT) has also just been published (pdf), which recommends a strict approach to marketing among other proposals. In 2010, the Medicines and Healthcare Products Regulatory Agency (MHRA), which regulates all medicines and medical devices in the UK, asked for

feedback on how to regulate new nicotine-containing products (including ecigarettes). We told them (response 1015 in this pdf) that we think such regulation will help address questions around the safety and effectiveness of e-cigarettes. The MHRA response to this consultation is expected imminently, along with results of the research they undertook to inform their decision. Similarly, the National Institute for Health and Care Excellence (NICE) is due to publish new guidelines on tobacco harm reduction approaches to smoking, which may have implications for e-cigarettes. (Update: these guidelines are now published and do not include e-cigarettes.) Quitting smoking is still the single most important thing smokers can do to for their health. We hope that the NICE guidance and the upcoming MHRA announcement will help provide smokers with the information and advice that they need to achieve this. And Cancer Research UK looks forward to working with others to deliver the research needed to inform the development of effective policies to support them.

http://scienceblog.cancerresearchuk.org/2013/05/30/e-cigarettes-theunanswered-questions/

E-cigarette study hints at quit-aid potential By Andrew M. Seaman NEW YORK | Mon Jun 24, 2013 5:05pm EDT

(Reuters Health) - In a trial of e-cigarettes among Italian smokers with no desire to quit using tobaccoat the outset, up to 13 percent of participants were not smoking regular cigarettes at all a year later. Though the study was not billed as a smoking-cessation test, more than half of participants cut down on tobacco soon after they started using the ecigarettes. And the percentage who quit smoking entirely by the end rivals results achieved with medications, the authors note in the journal PLOS ONE. "I think the main message of the study is that we can use these products as an extraordinary tobacco control tool," Dr. Riccardo Polosa, the new study's senior author from the University of Catania, told Reuters Health.

"This really is the first clinical trial that's ever been reported on electronic cigarettes. There has been survey evidence and anecdotal reports, but this is the first serious study," said Dr. Michael Siegel, who studies e-cigarettes but wasn't involved in the new research. E-cigarettes were first introduced in China in 2004. The battery-powered devices let users inhale nicotine-infused vapors, which don't contain the harmful tar and carbon monoxide in tobacco smoke. While past studies have looked at the use of e-cigarettes, the new study is the first to follow hundreds of smokers for an entire year. It did not, however, compare the devices to traditional nicotine replacement therapies, such as gum or patches. To see how many e-cigarette users would cut down or quit smoking cigarettes without any encouragement, the researchers recruited 300 people between June 2010 and February 2011. All were current smokers who stated they had no intention of quitting in the near future. Each participant was then randomized into one of three groups.

One group received e-cigarettes along with cartridges containing 7.2 milligram (mg) of nicotine. Another group also received the devices and 7.2 mg nicotine cartridges, but later in the study they were switched to 5.4 mg nicotine cartridges. And a third group got e-cigarettes and cartridges containing only tobacco flavor but no nicotine. Each participant received enough supplies to last three months and went to regular checkups throughout the year. At the end of the study, 13 percent of the group that first received the highestdose nicotine cartridges was no longer smoking. That compared to 9 percent of those who were in the reduced-nicotine group and 4 percent in the group without nicotine. Since there was no control group of smokers who got no e-cigarettes at all, it's hard to know how many would have quit smoking on their own by the end of a year, experts noted. Siegel, a professor at the Boston University School of Public Health, said he would expect about 2 percent of the participants to quit within a year if they weren't involved in a study.

However, Polosa's team also found that between 9 and 12 percent of people in each of the nicotine-cartridge groups had reduced the amount they smoked by at least half. "The study is very positive in that it shows if you smoke even a low- or medium-strength e-cigarette, you can get some increased quitting and decreased smoking," Dr. Murray Laugesen, a tobacco and nicotine researcher who was not involved with the new study, told Reuters Health. "It also has to be acknowledged that these are good results in people who had no intention of quitting," said Laugesen, a public health medicine specialist at Health New Zealand Ltd in Christchurch. He is also involved in an e-cigarette clinical trial and hopes to present the results in September. Siegel told Reuters Health that what's attractive about e-cigarettes is they can not only provide the nicotine that smokers crave without other harmful substances, they allow people to mimic their traditional smoking behavior. Researchers said that's one reason why e-cigarettes might turn out to be a better form of nicotine replacement therapy than patches and gums, but there's no data yet to prove it.

"I think that's why they found the people who actually got no -nicotine electronic cigarettes had some sort of quitting behavior But obviously the people who got the nicotine and the high dose of nicotine did the best. Clearly having the nicotine and device structure is ideal," Siegel said. But he cautioned that more research is needed - especially on the long-term safety of e-cigarettes and how the devices stack up against traditional smoking cessation methods. "My advice to people is to try the traditional therapy first. But I think electronic cigarettes are for people who have tried and failed nicotine replacement therapy, which is, sadly, most people," Siegel added. http://www.reuters.com/article/2013/06/24/us-e-cigaretteidUSBRE95N1C720130624

Price of Smoking Tobacco vs Cost of E-Cigarettes Cigarette and Healthcare Costs Steadily Increasing For Tobacco Smokers
Smoking Vapor 2013

Across the country, tobacco cigarettes are costing smokers more money every year, prompting many people to buy e-cigarettes. In addition to higher costs for dry cleaning, dental cleaning and loss of resale value on vehicles and homes tainted by tobacco smoke, many smokers experience illnesses that require expensive treatments. And with many states charging increasingly higher taxes on tobacco cigarettes, buying e-cigarettes is a better choice. E-cigarettes save money at half the price of tobacco cigarettes Today, a single pack of tobacco cigarettes averages $5. That means a packa-day smoker spends about $35 per week and upwards of $1,800 per year. A three pack-a-day smoker spends nearly $5,500 a year on cigarettes. In a lifetime, those costs can exceed $200,000, which most people would rather spend on healthier things.

People who buy e-cigarettes spend roughly half the amount tobacco smokers pay per year. Both rechargeable and disposable e-cigarettes cost much less than tobacco to purchase and smoke. Each disposable e-cigarette is the equivalent of about two packs of tobacco cigarettes. With rechargeable products, smokers can enjoy an even longer life out of a single e-cigarette. Smoking e-cigarettes not only saves money, it allows users to enjoy a cleaner smoke in more locations than tobacco cigarettes offer. Healthier workplace initiatives cost smokers more making e-cigarettes a better choice Tobacco cigarettes cost tobacco smokers more in workplace insurance as well. According to a New York Times article, policies that force employees who smoke, are obese or have such chronic issues as high cholesterol, to pay financial penalties have doubled since 2009. Today, employers can charge workers who donate meet health standards to pay up to 20 percent of their insurance costs. The new federal healthcare law will increase that amount in 2014 to 30 percent of cost of the employees policy, with the potential to rise to 50 percent.

Additionally, diseases caused by smoking tobacco cost $96 billion each year, much of which is paid by U.S. taxpayers through publicly funded health programs. Healthier e-cigarettes cost less, help tobacco smokers quit E-cigarettes contain only citric acid, nicotine, distilled water, natural and artificial flavors and glycerin, making them a much healthier choice for smokers. E-cigarettes can help tobacco smokers quit without the discomfort of tobacco withdrawal, helping save employees who must comply with health standards a significant amount of money. http://www.smokingvapor.com/price-of-smoking-tobacco-vs-cost-of-ecigarettes/

MORE KIDS USING E-CIGARETTES Updated: 7/13 7:36 am | Published: 7/11 8:46 pm SALT LAKE CITY, Utah (ABC 4 Utah)- A study by the Prevention Need Assessment surveyed kids back in 2011 and found an alarming trend. One in 20 Utah kids has tried electronic cigarettes. And experts say its against the law and could lead kids down a dangerous path.

Unlike regular cigarettes, electronic cigarettes dont have the regulations or the studies to give us more information. But health experts say Big Tobacco is using them to target kids.

Were just teaching you stay away from anything that could be addicting in anyway, said parent Catherine Mower.

Its the rule of thumb in the Mower household. But more kids are straying away from that thought process and trying electronic cigarettes. Big Tobacco says its not as bad as a normal cigarette, but Salt Lake County

Health Department Tobacco Prevention Program Manager Kathy Garrett disagrees.

Its still nicotine and its not FDA approved or regulated. So we really do not know what are in them, said Garrett.

Garrett says companies are blatantly targeting kids with wacky flavors any kid would like. Chocolate, Apple, and orange soda flavors top the list.

Not only is it illegal for kids or anyone under the age of 19 to use these electronic nicotine sticks, but Garrett says Utahs Indoor Clean Air Act means even an adult cant use them in public places like schools, clubs, or businesses. But because of their small size, its easy to conceal.

Im getting reports they're in their classrooms and their teachers don't even know that they're vaping, said Garrett.

Research shows more kids are using these e-cigarettes and that could lead to

trying other drugs. Current federal and state laws havent caught up with this latest health concern. So that means its up to parents to regulate their kids access and ability to smoke.

There will always be something that comes out something new some other way of advertising it, said Mower. http://www.abc4.com/content/news/slc/story/More-Kids-Using-ECigarettes/BOJX12ivm0ikA3kN9wjsNA.cspx

What Are The Side Effects Of Electronic Cigarettes?

Electronic cigarettes, which are also known as smokeless cigarettes, have become increasingly popular with smokers who are concerned about their health or are trying to quit the habit. Although an electronic cigarette looks and tastes very much like a regular cigarette, the small battery powered device contains no tobacco, tar or carbon monoxide and does not give off any unhealthy or unpleasant second hand smoke. Although these e-cigarettes, as they are also commonly known, are considered to be safe, there are some possible side effects of electronic cigarettes. Because these cigarettes are a relatively new invention, having been widely available only since around 2006, the possible side effects and the effects on health in general are still being studied to some extent. In addition, not everyone who uses them will experience the same effects from smoking an electronic cigarette, or suffer them to the same degree. If you have been smoking for many years and switch to e-cigarettes, you may find the side effects more severe or more noticeable.

However, many of those who make the switch from real cigarettes to the electronic variety seem to suffer from no adverse or unpleasant side effects. Because e-cigarettes still contain nicotine, anyone using them is just as likely to experience some of the same nicotine related effects and symptoms as they would get from smoking an actual cigarette, and can also experience withdrawal symptoms when giving up e-cigarettes. These electronic cigarettes still contain nicotine, although it is in a liquid form. However, it is very easy to inadvertently suck some of the liquid nicotine into your mouth, which can potentially be dangerous, and can harm the bodys respiratory system. To avoid doing this, most e-cigarette manufacturers recommend taking short drags on their product; ideally of less than a few seconds, although as many smokers know, this is not always an easy thing to do. Because they still contain nicotine in some form, they can still be addictive and many experts argue that they can even be more addictive for some people than actual cigarettes. One trend has been towards the introduction of artificial cigarettes that are entirely nicotine free, yet which still closely mirror the experience of smoking.

The nicotine and chemicals present in these virtual cigarettes can also cause various other side effects; it is not always obvious that these are being caused by smoking, making it difficult to diagnose accurately. Too much nicotine can cause headaches, which can vary in their severity, and the propylene glycol present in the device can also lead to a dry or sore throat or nose. These e-cigs also require an adjustment from inhaling smoke to inhaling vapor, and this can also cause a sore or dry throat in some smokers. Some smokers also report an unpleasant aftertaste, when they make the switch from real cigarettes. Electronic cigarettes can also cause other side effects. The propylene glycol present in the devices can release lactic acid into the body, which can cause aching muscles. Switching from smoking real cigarettes to using the electronic ones can also lead to bleeding gums, the reason being that smokers often tend to have stronger gums. If you experience bleeding gums because of using one of these devices, the problem should disappear by itself after about a week or so. Other more minor side effects can include a feeling of tightness around the shoulders and neck, sinus congestion and dry eyes. Some smokers become jittery, and may notice that their hands are shaking.

One side effect of these artificial cigarettes is that they can perhaps encourage smoking among children and teens. Because they are widely advertised as being both safer and healthier than cigarettes, they are often perceived as not being cigarettes at all, or as being some type of fun product or gimmicky device. Some brands of e-cigarettes are even available in a variety of enticing flavors, such as mint, strawberry, chocolate and caramel, which can not only attract children to try them, but non smokers as well. Although the side effects of electronic cigarettes are not generally severe, there are still risks associated with this product. You should always buy a reputable or trusted brand of electronic cigarette; there have been problems in the past with less reputable brands containing far more nicotine than they should, or was indicated on the packaging. The FDA has not officially recognised the electronic variety of cigarette as being a much safer alternative to traditional cigarettes. It is certainly a safer and healthier alternative to real cigarettes, and many non smokers appreciate the fact that they are not breathing second hand smoke; you can also smoke them anywhere and they cost a lot less than real smokes. However, a much

better solution for anyone considering these e-cigs would be to give up smoking altogether.

http://www.ecigs-coupon-codes.com/what-are-the-side-effects-of-electroniccigarettes/