E-cigarettes: How “safe” are they?

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Applied Evidence

E-cigarettes: How “safe” are they?

J Fam Pract. 2016 June;65(6):380-385

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From The Journal of Family Practice | 2016;65(6):380-385.

References

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16. Rojewski AM, Coleman N, Toll BA. Position Statement: Emerging policy issues regarding electronic nicotine delivery systems: a need for regulation. Society of Behavioral Medicine. 2016. Available at: http://www.sbm.org/UserFiles/file/e-cig-statement_v2_lores.pdf. Accessed April 22, 2016.

17. McNeill A, Brose LS, Calder R, et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. 2015. Available at: https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update. Accessed April 22, 2016.

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SIDEBAR
Cigarettes vs e-cigarettes: How does the experience (and cost) compare?

If you were to ask a smoker to describe how cigarette smoking compares to using e-cigarettes, he or she would probably tell you that while the process of drawing on an e-cigarette is similar to that of a conventional cigarette, the experience in terms of reaching that state of relaxation or getting that “smoker’s high” is not.

In fact, a recent national survey of current and former smokers found that more than three-quarters of current smokers (77%) rated e-cigarettes less satisfying than conventional cigarettes and stopped using them.¹ “Being less harmful” was the most highly rated reason for continuing to use the devices among people who switched from conventional to e-cigarettes.

How do they work? E-cigarettes do not burn anything and users do not light them. E-cigarettes work in much the same way as a smoke or fog machine. They use battery power (usually a rechargeable lithium battery) to heat a solution—usually containing nicotine, flavorings, and other chemicals—to the point that it turns into vapor. Much of whatever substances are in the vapor enter the bloodstream through the buccal mucosa, rather than the lungs.

Devices typically have an on/off button or switch, an atomizer containing a heating coil, a battery, and an LED light, which is designed to simulate a burning cigarette. A sensor detects when a user takes a drag and activates the atomizer and light. Some of the devices can be charged with a USB cord.

Because e-cigarettes don’t burn anything, they don’t have any smoke. They also don’t have any tar, ash, carbon monoxide, or odor (except perhaps a faint, short-lived scent matching the flavor liquid chosen). But the issues of second-hand exposure and effects on air quality are still being investigated.

With over 500 brands available, devices generally fall into one of 3 categories:²

Cigalikes: About the same size and shape of a conventional cigarette, these cigarette look-alikes may come pre-filled with about a day’s worth of liquid and then may be discarded, or they may be non-disposable and have a replaceable cartridge.

eGo’s: Also known as "vape pens," these devices tend to be longer and wider than cigalikes, have a more powerful battery, and usually are refillable or have a replaceable cartridge.
Mods: Short for “modules,” these “vaporizers” tend to be the largest and most expensive type of e-cigarette. They may be refilled with e-liquid or accept replaceable cartridges and have even more powerful batteries.

What do they cost? A pack of cigarettes (containing 20 cigarettes) costs anywhere from $5 to $14, depending on where one lives.³ The price of e-cigarette devices starts at about $8 and can climb higher than $100. A 5-pack of flavor cartridges or a refill tank of e-liquid (which may last as long as about 150 cigarettes) costs about $10 to $15.⁴

To put this in perspective, a pack-a-day smoker in New York might spend about $5000 a year on cigarettes ($14 per pack x 365 days in a year), whereas someone who uses an e-cigarette device ($10) plus a refill tank per week ($14 x 52 weeks per year) will spend about $740 a year. (The actual cost will be higher because atomizers or devices as a whole must be replaced periodically, with some lasting only days and others lasting weeks or months, depending largely on how often one uses them. Although the cost of atomizers ranges widely, many can be found for $3-$5.)

Of course, the difference between cigarettes and e-cigarettes will be less dramatic in states where cigarettes are cheaper.

References

1. Pechacek TF, Nayak P, Gregory KR, et al. The potential that electronic delivery systems can be a disruptive technology: results from a national survey. Nicotine Tob Res. 2016. Available at: http://ntr.oxfordjournals.org/content/early/2016/05/03/ntr.ntw102.abstract. Accessed May 13, 2016.

2. Center for Environmental Health. A smoking gun: cancer-causing chemicals in e-cigarettes. Available at: http://www.ceh.org/wp-content/uploads/CEH-2015-report_A-Smoking-Gun_-Cancer-Causing-Chemicals-in-E-Cigarettes_alt.pdf. Accessed May 11, 2016.

3. Holmes H. The price of being an American. What a pack of cigarettes costs, in every state. August 28, 2015. Available at: http://www.theawl.com/2015/08/what-a-pack-of-cigarettes-costs-in-every-state. Accessed May 11, 2016.

4. Blu. How much do e-cigs cost? E-cig & vapor cigarette prices. Available at: http://www.blucigs.com/much-e-cigs-cost/. Accessed May 13, 2016.