Are they safe? Clearing the air on electronic cigarettes

If you haven't seen someone puffing on an electronic cigarette yet, you probably will soon. Sales of the devices are soaring. And the debate about the safety of e-cigarettes is heating up, too.

Manufacturers of the battery-powered devices say their products carry far fewer health risks than regular cigarettes and can help smokers quit.

But critics say e-cigarettes are dangerous to the user and to people exposed to secondhand vapor.

Meanwhile, scientists are struggling to do the kind of research that could help clear the air on key health questions.

“Because it can take many years for the detrimental effects of inhaled substances to develop, the long-term effects of e-cigarette use or secondhand vapor exposure are not known,” says Dr. Matthew Brenner, professor in the UC Irvine Division of Pulmonary Diseases and Critical Care Medicine. “The rise in use of these devices is associated with many unanswered scientific questions regarding risks that will require long-term studies.”

A nicotine-delivery device?

Not all e-cigarettes deliver nicotine. Some – particularly popular among teens – contain just flavorings. But all e-cigarettes mimic cigarette smoking and involve drawing in or inhaling chemicals.

The major question is whether e-cigarettes – even if they carry some risk – can help tobacco smokers quit. Or are the devices just perpetuating nicotine addiction in adults and providing a stepping-stone for children and teens to take up regular cigarette smoking?

Let's look at what's known so far:

• The devices deliver inhaled doses of nicotine, flavor and/or other chemicals through a vaporized solution contained in cartridges. Using an e-cigarette is referred to as “vaping,” since it releases vapor, not smoke.
• Electronic cigarettes provide the nicotine fix that smokers crave and preserve the "smoking" habit. However, e-cigarettes don't contain tar, which is linked to tobacco-related cancers.
• So far, studies are mixed on whether e-cigarettes are significantly less harmful than regular cigarettes. 
• No one really knows how much danger exists from inhaling secondhand vapors. 
• The Food and Drug Administration, which has announced plans to regulate e-cigarettes as a tobacco product under the Tobacco Control Act, contends that e-cigarettes contain many chemicals and particles that can harm human health. 

Proponents point out some positives: E-cigarettes can help smokers quit by transitioning them to a less-harmful product that soothes nicotine cravings. Electronic cigarettes don't smell. Butts don't end up on our beaches. Ashtrays could become a thing of the past.

What's inside an e-cigarette?

However, health experts aren't buying it.

“Data on the long-term effects is not available," Brenner acknowledges. "What we know is e-cigarettes, in some cases, contain more nicotine than cigarettes, and nicotine is highly addictive. The majority of people who are vaping also smoke regular cigarettes. So in many cases, vaping may be additive, not an alternative."

A recent federal study found vapors from e-cigarettes contain a toxic brew of carcinogens, including nitrosamines, chemicals found in cured meats, pesticides and tobacco products.

“When you use e-cigarettes, depending how you heat things up and how frequently you inhale, the breakdown of polyethylene glycol and other additives can lead to products that are known to be carcinogenic,” Brenner says. “Since e-cigarettes can contain more nicotine than regular cigarettes, there are also concerns raised of the potential for people being poisoned or dying from an overdose,” although there is little data to determine if this is more than just a theoretical concern at this time, he adds.

Popular among teens

Demand for e-cigarettes is on the upswing. A 2011 study found that e-cigarette use quadrupled from 2009 to 2010 among U.S. adults.

A recent study from the U.S. Centers for Disease Control and Prevention found that use of e-cigarettes among middle- and high-school students more than doubled from 2011 to 2012, with 1.78 million students saying they had tried e-cigarettes last year.

Moreover, manufacturers have been accused of marketing to minors with e-cigarettes that come in gummy bear and cotton candy flavors and at prices kids can afford (slightly lower than regular cigarettes).

For youths who are vaping with flavored e-cigarettes that do not contain nicotine, there is concern – but no data as of yet – that they may be more susceptible to smoking, for social and other behavioral reasons, Brenner says.

Even for smokers who claim they are using e-cigarettes temporarily to help them stop smoking, government health officials point out that there are proven, safer ways to quit. Start by going to smokefree.gov or calling 1-800-QUITNOW.