World Health Organization Wants to Ban E-cigs in Public Areas
While electronic cigarettes are used by millions of smokers across the globe to help them cut down their tobacco use, a World Health Organization report released at the end of August called for a ban on the use of e-cigarettes in indoor public spaces and the workplace(1). After reviewing the evidence on the exhaled aerosol from e-cigs, the WHO believes that the background level of nicotine and toxins from this vapor is great enough to pose a danger to public health, which has informed their recommendation of a ban in enclosed areas. Even though New Jersey, North Dakota and Utah already prohibit the use of e-cigarettes in the workplace, bars and restaurants, and individual cities across the US have similar laws in place(2), if the proposed universal ban goes ahead, this could see many smokers returning to traditional cigarettes and more than likely placing their own health at risk.
The Dangers of E-Cig Vapor
Although manufacturers of electronic cigarettes have long been adamant that their products merely release water vapor, the results of research suggest otherwise. For instance, researchers at UC San Francisco who completed a comprehensive review of the published literature on e-cigs concluded that while bystanders are not exposed to smoke, the vapor released from the devices contains measurable levels of nicotine, acetaldehyde, acetic acid and formaldehyde, all of which are toxic(3). Even though levels of these chemicals are typically lower than from exposure to tobacco-containing cigarettes, nicotine contributes to the development of heart disease and the other substances are carcinogenic. More recent studies do, however, show nicotine levels from secondhand exposure of e-cig vapor are similar to that absorbed from cigarette smoke, casting doubt on earlier safety claims.
Concerns have also been raised about exposure to heavy metals from the aerosol of e-cigarettes. Indeed, while a recent study by the University of Southern California highlighted that e-cig vapor is virtually free from organic cancer-causing toxins, they contain 4 times more nickel than traditional cigarettes, as well as chromium, which is not present in tobacco, with the cartridges most likely releasing these metals(4). Breathing in nickel and chromium is bad news, as both are lung irritants, which can lead to inflammation and cancerous changes in the lungs. Electronic cigarettes also release lead and zinc, albeit in lower amounts than from standard cigarettes, though any level of exposure to heavy metals is potentially dangerous to a developing fetus. Bearing this in mind pregnant women may want to think twice about using e-cigs for smoking cessation. However, metal levels in e-cigs could be significantly cut by stricter manufacturing standards.
Acceptability of E-Cigs
If given the choice of whether you stand next to someone smoking an electronic cigarette or a tobacco product, most people would choose the person vaping. While this decision might in part be based on the lower content of certain toxins present in e-cig vapor than smoke, the experience for bystanders is also an important consideration. Certainly you don’t have any choking smoke coming from e-cigs, so the vapor is much kinder on your airways. E-cigarette vapor also doesn’t have the unpleasant smell of cigarette smoke and with the flavored cartridges it almost has an attractive aroma, though the WHO is keen to ban the likes of fruit and candy flavors until research confirms these do not appeal more to children and teens. However, there are still e-cig opponents who argue that smoking is an unpleasant habit in all its forms and overall these electronic devices are no more socially acceptable than traditional cigarettes.
Reducing Smoking Health Risks with E-Cigs
While the WHO does not recommend the use of electronic cigarettes for smoking cessation, instead advising smokers to quit completely with the aid of approved stop smoking aids, there is evidence that e-cigs can help smokers to kick their habit. For example, a study published in The Lancet last year found that smokers using e-cigarettes as a cessation aid were as effective at quitting as smokers who used nicotine patches, irrespective of whether the electronic devices contained nicotine or not(5). Using nicotine free cartridges could therefore remove the problem of secondhand nicotine exposure, which this study suggests would still aid quit attempts, as e-cigs offer a similar experience to smoking that goes beyond the nicotine hit. The benefits of using e-cigs for smoking cessation have been questioned following fears over their safety(6), but in their favor they offer a less dangerous option than tobacco products.
The American Cancer Society discussed the issue of harm reduction using electronic cigarettes earlier this year and while they acknowledged that it is a controversial issue, as it may normalize smoking and promote it to younger users, they highlighted that 500,000 people still die from smoking-related diseases in the US each year(7). As a result the organization is keen that the potential of e-cigs as a harm reduction strategy is explored to slow the death rate from tobacco use. Since then researchers in the UK have estimated that 6000 early deaths could be prevented for each million smokers who make the changeover from tobacco to e-cigs(8). Their research, which was reported in the British Journal of General Practice, also pointed out that some of the concerns about the use of the electronic devices are unfounded. For instance, in England figures show that since the rise in popularity of e-cigarettes, smoking rates have continued to fall and more people are successfully quitting smoking, not to mention that there has not been any rise in smoking rates among those aged 16 to 25.
With 1.3 billion smokers globally and the potential to save close to 8 million people from premature death if they switch to vaping, can we really deny them the chance to a healthier future by banning e-cigarettes in public areas and workplaces?
- 1. “Backgrounder on WHO report on regulation of e-cigarettes and similar products,” World Health Organization, accessed September 14 2014
- 2. “US state and local laws regulating use of electronic cigarettes,” American Nonsmokers Rights Foundation, accessed September 14 2014
- 3. “E-cigarettes expose people to more than just harmless water vapor,” University of California San Francisco, accessed September 14 2014
- 4. “Secondhand e-cig smoke compared to regular cigarette smoke,” Science Daily, accessed September 14 2014
- 5. Christopher Bullen et al, “Electronic cigarettes for smoking cessation,” The Lancet, 382(2013):1629, accessed September 14 2014
- 6. “E-cigs may not help smoking cessation,” KwikMed, accessed September 14 2014
- 7. “E-cigarette’s – it’s complicated,” American Cancer Society, accessed September 14 2014
- 8. Robert West & Jamie Brown, “Electronic cigarettes: fact and fiction,” British Journal of General Practice, 64(2014):442, accessed September 14 2014