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e-cigarettes – what is the damage?

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There has been a lot of debate about whether electronic cigarettes are the best technological solution to the smoking pandemic or the biggest looming threat to public health.

E-cigarettes are battery-powered devices that deliver nicotine to the user through a vapour by heating a solution of propylene glycol or vegetable glycerin, flavouring, and other additives. Flavours range from butter rum to caramel macchiato to strawberry lemonade.

The US Centre for Disease Control and Prevention reported earlier this year that the use of e-cigarette devices among middle school and high school students tripled between 2013-2014, with around 13 per cent of students using the devices. This surpasses the number of teens who smoke conventional cigarettes in the US.

Currently, there are more than 500 e-cigarette brands and more than 7000 flavours, and they all work in different ways to deliver varying amounts of nicotine, toxins, and carcinogens. With most e-cigarette studies funded or otherwise supported, influenced by manufactures of e-cigarettes, the current evidence base on e-cigarettes is very poor.

Julia Belluz from Vox recently examined more than 60 articles, studies, and reviews, and interviewed nine researchers and health experts to try and determine whether e-cigarettes were actually safe.  You can read her detailed findings at.

She found that the health effects of e-cigarettes were unclear because of the lack of credible research. But she said that so far the short-term exposure to e-cigarettes doesn’t appear to carry any serious side effects, however the research is still early.

She found that e-cigarettes were mostly composed of nicotine and a nicotine solvent (propylene glycol or vegetable glycerin) and that the levels of toxicants and carcinogens in e-cigarette vapour were nine to 450 times less prevalent than in conventional cigarette smoke. Though propylene glycol and glycerin are generally considered safe substances, not a lot is known about the long-term effects of daily inhalation.

Most researchers were inclined to cautiously say that e-cigarettes were safer than regular cigarettes because the immediate harms of e-cigarettes appear to be minimal compared with regular cigarettes.

Co-Director of the US Center for the Study of Tobacco Products Thoman Eissenberg said that its probably fair to say that a long term e-cigarette user is not going to die from tobacco-caused diseases, but it’s not clear whether they will die from an e-cigarette caused disease and whether their rates of death will be less than, more than, or the same as the rates of death we see from tobacco-caused diseases.

Australian law doesn’t ban e-cigarettes but we have strong regulations regarding the potential therapeutic use. E-cigarettes must be registered via the Therapeutic Googs Administration and liquid nicotine has to have a prescription.

The AMA has written to the Federal Health Minister Sussan Ley to encourage the tightening of legislation around the use of e-cigarettes, concerned that they are targeted towards younger consumers.

The AMA is asking for:

·         the introduction of laws to prohibit the advertising of e-cigarettes as per the prohibition on advertising of tobacco products;

·         enforcement of laws that prohibit the advertising of e-cigarettes as a therapeutic good, specifically as an aid to cessation; and

·         the prohibition of marketing of e-cigarettes to people under the age of 18.

The AMA has considerable concern about the increasing control of e-cigarettes by the tobacco industry, as Big Tobacco continues to invest heavily in the development and promotion of e-cigarettes.


Kirsty Waterford

Image by Vaping360 on Flickr, used under Creative Commons licence