Is Vaping as Harmful as Smoking

Cigarettes?

Prepared By: Brwa Badraldin Fatih

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Introduction
Tobacco smoking is a major contributing factor in the development of most
diseases and it poses major challenges in the perioperative period. In 2015, the
World Health Organisation (WHO) published the “global report on trends in
prevalence of tobacco smoking”. It was reported that smoking is responsible for
about six million deaths across the world. The report estimated that about 19% of
the South African population smoked in 2010. Due to the adverse health effects
attributable to traditional tobacco smoking, vaping or electronic cigarette (e-
cigarette) use is becoming a popular nicotine alternative. The popularity of e-
cigarette use is further promoted by the perception that they are healthier than
tobacco cigarettes. It is also believed that they help smokers to quit (1).
Use of electronic cigarettes (e-cigarettes), referred to as vaping, is a relatively new
phenomenon that is quickly gaining the interest of many long-time tobacco
smokers. According to a report by UBS Securities LLC, sales from the e-cigarette
market doubled from $250 to $500 million between 2011 and 2012, and are
expected to quadruple by 2014. E-cigarettes are becoming a preferred alternative
for nicotine delivery among many smokers because of their realistic look, feel, and
taste compared to traditional cigarettes. Furthermore, many cigarette smokers have
turned to vaping because e-cigarette vendors have previously marketed their
product as a cheaper and safer smokeless alternative to traditional cigarettes, and a
possible smoking cessation tool. The Food and Drug Administration (FDA)
rejected these claims, and in September of 2010 they informed the President of the
Electronic Cigarette Association that warning letters had been issued to five
distributors of e-cigarettes for “violations of good manufacturing practices, making
unsubstantiated drug claims, and using the devices as delivery mechanisms for
active pharmaceutical ingredients.” Many web sites still claim that use of e-
cigarettes is safe because tobacco is not burned and hence there is no inhalation of
the many toxins found in cigarette smoke. For example, Electronic Cigarette
Consumer Reviews , an e-cigarette website, is filled with anecdotal consumer
claims relating how e-cigarettes helped them to quit smoking and improved their
overall health (2).

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Cigarette smoking
Cigarette smoking, hereafter referred to as “smoking,” is the largest single risk
factor for premature death in developed countries. Approximately one fifth of the
deaths in the United States are attributable to smoking, and 28% of the smoking-
attributable deaths involve lung cancer, 37% involve vascular disease, and 26%
involve other respiratory diseases . More than 400 000 deaths per year and 30% of
all cancers in the United States are attributable to smoking . Lung cancer is the
largest single cause of cancer-associated mortality and is the most common cause
of smoking-related mortality in the United States. The attributable risk from
smoking for oral, pharyngeal, and esophageal cancers is substantial, although less
than that for lung cancer. The attributable risk from both smoking and alcohol
consumption accounts for the majority of both oral and pharyngeal cancers and of
esophageal cancer. Morbidity and mortality attributable to smoking would decline
in the future if reductions in smoking prevalence were to be observed. However,
despite dramatic declines in adult male smoking prevalence in the United States
observed from the 1960s through the 1990s, the decline in current adult smoking
prevalence slowed by about 1990, and recent surveys of current smoking in youth,
defined as cigarette use on at least one of the last 30 days preceding the survey,
show a statistically significant increase (from 27.5% in 1991 to 36.4% in 1997) .
The prevalence of current smoking among adults in the United States, defined as
smoking daily or smoking on some days, is now about 23% in women and 27% in
men and is statistically significantly higher in those less than 65 years of age; in
those with 9-11 years of education; in those below the poverty threshold; in whites,
blacks, and American Indians/Alaskan Natives; and in military veterans. Projected
demographic and smoking prevalence trends suggest that the absolute number of
current smokers in the United States, about 47 million individuals in 1995, will
continue to increase, especially in those below the poverty threshold, in those with
less than 13 years of education, and in those greater than or equal to 65 years of
age (3).

Vaping Electronic cigarettes

Vaping Electronic cigarettes (e-cigarettes) are defined as “products that deliver a
nicotine-containing aerosol to users by heating a solution”. This solution is made
up of propylene glycol or glycerol, nicotine and flavouring agents. E-cigarettes or
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electronic nicotine delivery systems (ENDS) simulate the cigarette smoking
experience, and it has been portrayed as an alternative to reduce the amount of
tobacco cigarette consumption. Heating of the solution leads to generation of a
vapour, which is inhaled by the user, hence the term “vaping” (4).

Short and Long-term Health Effects of E-Cigarettes

The NASEM review found some novel adverse health effects from e-cigarettes as
well as some similarities to health outcomes from smoking, such as addiction and
vascular cell damage. Overall, the health effects of e-cigarettes are less severe than
smoking in the short-term. Evidence for long-term harm does not exist, though
mechanisms for long-term harm, such as the presence of chemicals that can
damage DNA, are present in e-cigarettes (5, 6). Specifically, NASEM found
conclusive evidence that:
 Electronic nicotine delivery devices can explode, causing burns and other
injuries.
 Exposure to e-liquids through skin, eyes and mouth can result in poisoning.
NASEM found substantial evidence that:
 Use of e-cigarettes can result in symptoms of dependence.
 Heart rate increases in the short-term after taking in nicotine from e-cigarettes.
 Exposure to aerosols from e-cigarettes can cause dysfunction in the thin layer of
cells that line blood vessels (endothelial cells). Such dysfunction is related to
development of cardiovascular disease and is seen in exposure to tobacco smoke.
However, there is not yet clear evidence about the effects of
long-term exposure as there is with tobacco smoke.
 Exposure to some components of e-cigarette aerosols can produce oxidative
stress, which is linked to many inflammatory diseases. Existing evidence shows
that oxidative stress from e-cigarettes is generally lower than that from
combustible tobacco and the consequences of long-term exposure are unknown.
 A complete switch from regular smoking to e-cigarettes reduces adverse health
outcomes in the short-term.

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Vaping Among Teens
Vaping devices are popular among teens and are now the most commonly used
form of nicotine among youth in the United States. Some research shows that
many teens do not even realize that vaping cartridges contain nicotine, and assume
the pods contain only flavoring. The easy availability of these devices, alluring
advertisements, various e-liquid flavors, and the belief that they're safer than
cigarettes have helped make them appealing to this age group. In addition, they are
easy to hide from teachers and parents because they do not leave behind the stench
of tobacco cigarettes, and are often disguised as flash drives. Further, a study of
high school students found that one in four teens reported using e-cigarettes for
dripping, a practice in which people produce and inhale vapors by placing e-liquid
drops directly onto heated atomizer coils. Teens reported the following reasons for
dripping: to create thicker vapor (63.5 percent), to improve flavors (38.7 percent),
and to produce a stronger throat hit—a pleasurable feeling that the vapor creates
when it causes the throat to contract (27.7 percent). More research is needed on the
risks of this practice. In addition to the unknown health effects, early evidence
suggests that vaping might serve as an introductory product for preteens and teens
who then go on to use other nicotine products, including cigarettes, which are
known to cause disease and premature death. A study showed that students who
had used e-cigarettes by the time they started 9th grade were more likely than
others to start smoking cigarettes and other smokable tobacco products within the
next year. Another study supports these findings, showing that high school students
who used e-cigarettes in the last month were about 7 times more likely to report
that they smoked cigarettes when asked approximately 6 months later, as compared
to students who said they didn't use e-cigarettes. Notably, the reverse was not true
—students who said they smoked cigarettes were no more likely to report use of e-
cigarettes Page 2 when asked approximately 6 months later. Like the previous
study, these results suggest that teens using e-cigarettes are at a greater risk for
smoking cigarettes in the future. Another study has shown an association between
e-cigarette smoking and progression to smoking actual cigarettes. This study
suggests that vaping nicotine might actually encourage cigarette smoking in
adolescents. Additionally, a study of adult smokers in Europe found those who
vaped nicotine were less like to have stopped smoking than those who did not.
Those who used e-cigarettes also smoked more cigarettes than those who didn’t. In
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another study of more than 800 people who said they vaped to help them quit
traditional cigarette smoking, only nine percent reported having quit when asked a
year later. However, more research is still needed to understand if experimenting
with e-cigarettes leads to regular use of smokable tobacco. Under U.S. Food and
Drug Administration (FDA) regulations designed to protect the health of young
Americans, minors can no longer buy e-cigarettes in stores or online (see
"Government Regulation of E-cigarettes"). The FDA now regulates the
manufacture, import, packaging, labeling, advertising, promotion, sale, and
distribution of e-cigarettes. This includes components and parts of e-cigarettes but
excludes accessories (7-9).

Reference
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1999;91(16):1365-75.
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