E-cigarettes rising in popularity, but risks still unknown

Experts say e-cigs could be safer alternative to tobacco, but long-term studies and federal regulations are imperative

French actress Karole Rocher smokes an electronic cigarette on May 19, 2013 at the 66th annual Cannes Film Festival in Cannes, France.
Loic Venance/AFP/Getty Images

Spend a few minutes roaming the streets of young, tech-savvy areas like Brooklyn and San Francisco and you're bound to spot somebody vaping — that is, puffing away on an electronic cigarette.

Chinese pharmacist Hon Lik invented the e-cigarette in 2003 as a tobacco-free alternative to the traditional cigarette after his father died from lung cancer. Fast-forward a decade, and the popularity of electronic smokes has exploded into a global industry worth more than $2 billion in the U.S. alone, according to consumer analysis firm Euromonitor International.

E-cigarettes aren't lit up in the conventional sense. Rather, a battery powered atomizer heats up a nicotine-laced solution into a vapor for the smoker to inhale — hence, the term "vaping" — a process that's touted by e-cigarette companies as healthier than regular cigarettes because it doesn't involve combustion.

Watch TechKnow's report on electronic cigarettes on Al Jazeera America Sunday night at 7:30 ET.

But while more and more people are using electronic cigarettes, often with the hopes of quitting conventional ones, "we don't have any data on the long-term consequences of using these products," says Maciej Goniewicz, an oncology professor at the Roswell Park Cancer Institute in Buffalo, N.Y.

He and his colleagues measured the chemicals present in the vapor of 12 brands of e-cigarettes and discovered that despite a lack of tobacco, they contained some of the same toxic compounds like acetaldehyde and formaldehyde, the latter of which is known to be carcinogenic.

Granted, the compounds were found at significantly lower levels than in regular cigarettes, according to their research, which was published in the journal Tobacco Control. The team also found propylene glycol, an additive that is a known irritant when inhaled. The U.S. Food and Drug Administration (FDA) considers it "generally recognized as safe" when used in food, but Goniewicz said more studies are necessary in order to determine whether long-term exposure to such compounds — as well as to the vapor itself — is harmful to the respiratory system.

'Not as safe' as claimed

A woman smokes a 'Blu' e-cigarette.
Paul J. Richards/AFP/Getty Images

Indeed, the World Health Organization cautions that the safety of e-cigarettes "has not been scientifically demonstrated" and says that claims by manufacturers that they are healthy alternatives to tobacco or effective tools to quit smoking tobacco “are unsubstantiated or may be based on inaccurate or misleading information.”

France announced its intent to ban e-cigarettes in public places after a study conducted by the country's National Consumer Institute that was similar in design to Goniewicz's found ingredients in e-cigarette vapor that were "potentially carcinogenic." The French scientists concluded that e-cigarettes were "not as safe" as their manufacturers claimed, and said they could be as harmful as regular cigarettes because some brands contained the same amount of formaldehyde.

Even so, the rising popularity of e-cigarettes in France has led to a 1 percent decrease in regular cigarette sales each month for the past year — meaning a 12 percent annual decrease — "without any explanation [other] than e-cigarettes," according to Dr. Bertrand Dautzenberg, a pulmonologist at the Pitié-Salpêtrière – Charles Foix Hospital in Paris and chair of France's Office of Smoking Prevention (OFTA), who led the French study.

"For smokers to switch from tobacco to e-cigarettes is a very clear health benefit," he wrote in an email to Al Jazeera.

Part of the reason that's the case, according to some public health experts, is that the e-cigarette mimics the behavioral aspects of smoking, which can help smokers wean themselves off tobacco more easily than with nicotine gum or patches can. A recent study published in the British medical journal The Lancet found that e-cigarettes were slightly more effective than nicotine patches in helping smokers to quit tobacco cigarettes.

"Many people who are successful in quitting cigarettes are eventually able to get off e-cigarettes, too," said Dr. Michael Siegel, a physician and professor at Boston University's School of Public Health who studies e-cigarettes.

That's because e-cigarettes deliver much lower levels of nicotine in a less efficient manner than cigarettes do, and that may temper a smoker's level of addiction, he said. "Any health risks they have are minimal, especially when compared to tobacco cigarettes," Siegel added.

No quality control

What all experts do agree upon is that heightened regulation of electronic cigarettes is imperative. The FDA in 2011 announced its intent to regulate them as tobacco products rather than drug delivery devices, putting them in the same category as traditional cigarettes.

But the agency still doesn't regulate quality control, meaning that there aren't requirements for consistency in terms of ingredients even within the same brand. The WHO has warned that "there is no way for consumers to find out what is actually delivered by the product they have purchased."

What's more, many brands are flavored in order to appeal to children, and experts worry they could be a "gateway" to becoming tobacco smokers. A study by the Centers for Disease Control (CDC) found that e-cigarette use among children doubled from 2011 to 2012; 10 percent of high school students had smoked e-cigarettes in 2012, and among those kids who had, 76 percent of them reported having smoked regular cigarettes, too.

While the Public Health Cigarette Smoking Act of 1970 required stricter warning labels on cigarette packaging and banned cigarette advertisements on television, those sorts of controls aren't in place for e-cigarettes. Manufacturers don't have to label their products with any warnings, and TV ads for e-cigarettes are unrestricted.

Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, says the FDA has been dragging its feet in terms of regulating cigarettes, and feels that indoor clean air legislation should include electronic cigarettes along with tobacco cigarettes.

"They are less polluting than cigarettes," Glantz said, "but they are still polluting."

As one of the nation's foremost experts on secondhand smoke, he is the principal investigator of a new $20 million, five-year study sponsored by the FDA in order to help the agency examine how it might better regulate tobacco and smoking.

But Glantz points out that regardless of what the FDA decides to do about e-cigarettes, it can't regulate where they're smoked, because smoking bans in public places are under the jurisdiction of local governments. The Department of Transportation has, however, banned the use of e-cigarettes on airplanes (PDF).

In the meantime, the FDA is in the process of drafting new proposed regulations on the advertising, ingredients and sales to minors of e-cigarettes, and in September, the attorneys general from 40 states co-signed a letter to FDA commissioner Margaret Hamburg (PDF) urging the agency to meet its previously stated deadline of Oct. 31. The release of the draft legislation was delayed due to the government shutdown and is expected to happen this month.

Even so, while Glantz wishes the FDA would push harder to regulate electronic cigarettes, he doesn't have much faith that it will do so. When the FDA asked him what kind of research it should be funding, he said he told the agency, "they should be funding stem cell research to grow backbones."

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