Myth: Alternative nicotine products are as dangerous as smoking: Difference between revisions

==Toxic==

2021: Screening of different cytotoxicity methods for the assessment of ENDS toxicity relative to tobacco cigarettes

All tests showed reduced cell viability following 1R6F smoke exposure and slight or no reduction with ENDS at 24 hours.

2020: Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016 (PDF  23 pages)

-Blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who used e-cigarettes and participants who did not.

-However, participants with a smoking history were more likely to have higher blood lead and urinary cadmium than participants who neither used e-cigarettes nor cigarettes.

2018: NASEM report on E-Cig Health Effects evaluates the available evidence of health effects  

related to the use of E-cigarettes: Public Health Consequences of E-Cigarettes (750 pages)   Report At A Glance  

Comparisons of using e-cigarettes vs smoking:

There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.

There is substantial evidence that except for nicotine, under typical conditions of use, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes.

There is substantial evidence that completely switching from regular use of combustible tobacco cigarettes to e-cigarettes results in reduced short-term adverse health outcomes in several organ systems.

There is moderate evidence that risk and severity of dependence are lower for e-cigarettes than combustible tobacco cigarettes.

There is moderate evidence from randomized controlled trials that e-cigarettes with nicotine are more effective than e-cigarettes without nicotine for smoking cessation.

While the overall evidence from observational trials is mixed, there is moderate evidence from observational studies that more frequent use of e-cigarettes is associated with an increased likelihood of cessation.

There is moderate evidence that second-hand exposure to nicotine and particulates is lower from e-cigarettes compared with combustible tobacco cigarettes.  

There is limited evidence for improvement in lung function and respiratory symptoms among adult smokers with asthma who switch to e-cigarettes completely or in part (dual use).

There is limited evidence for reduction of chronic obstructive pulmonary disease (COPD) exacerbations among adult smokers with COPD who switch to e-cigarettes completely or in part (dual use).

There is limited evidence suggesting that switching to e-cigarettes will improve periodontal disease in smokers.

2018: Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and  

Combustible Cigarettes   (PDF 16 Pages)

In this population-based cohort study of 5105 participants, current exclusive e-cigarette users had greater concentrations of biomarkers of nicotine, tobacco-specific nitrosamines, volatile organic compounds, and metals compared with never tobacco users. However, these concentrations were lower than those observed in current exclusive cigarette smokers and dual users of both products.  

2018: Chemical Composition of myblu™ Pod-System E-Cigarette Aerosols: A Quantitative Comparison with Conventional Cigarette Smoke (PDF 1 page)

-Testing of the myblu™ aerosols indicate low or no detectable levels of the toxicants tested. Over all the e-cigarettes yielded <1μg/puff of the toxicants tested compared to the reported cigarette yield of 381μg/puff. Of the 51 toxicants tested, eight were detected in the e-cigarette aerosols but at substantially lower levels than reported in cigarette smoke.

-Findings from several recent clinical studies indicate that smokers who have switched to e-cigarettes have significantly lower exposure to carcinogens and toxicants found in cigarette smoke, with reductions largely indistinguishable from complete smoking cessation or use of licensed nicotine replacement products.

2017: Trace Metals Derived from Electronic Cigarette (ECIG) Generated Aerosol: Potential  

Problem of ECIG Devices That Contain Nickel (PDF 17 pages)

-In general, the findings of this study suggest that the concentrations of most trace metals extracted from cigarette smoke exceed the concentrations of trace metals extracted from ECIG-generated aerosol.  

-Only Ni in the ECIG-generated aerosol was higher than control (smoke). The most probable source of Ni in this aerosol is the core assembly.

-From this study, it is unlikely that the ECIG-generated aerosol contains enough of the other trace metals to induce significant pathology.

2017: Benzene formation in electronic cigarettes (PDF 10 pages)

The risks from benzene will be lower from e-cigarettes than from conventional cigarettes.

2016: Royal College of Physicians - Nicotine without Smoke (PDF 206 pages)

-Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking.

-The hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.

-In the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking…

2016: A randomised, parallel group study to evaluate the safety profile of an electronic vapour product over 12 weeks (PDF 14 pages)

In this study, we have demonstrated that no clinically relevant, product-related safety findings were observed for smokers of Combustible Cigarettes (CCs) switching to an Electronic Vapor Product (EVP) for 12 weeks under real-life settings. EVP use was associated with significant decreases in exposure to nicotine and other chemicals such as benzene and acrolein, typically found in CC smoke. Changes were also observed in the level of WBC, haemoglobin, RBC and LDL cholesterol, which although minor, were consistent with those observed after smoking cessation.

2016: Tobacco Consumption and Toxicant Exposure of Cigarette Smokers Using Electronic  

Cigarettes (PDF  28 pages)

Smokers using ECs over 4 weeks maintained cotinine levels and experienced significant reductions in carbon monoxide, NNAL, and two out of eight measured VOC metabolites. Those who switched exclusively to ECs for at least half of the study period significantly reduced two additional VOCs.

2016: Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes (PDF 16 pages)

-Subjects switching to e-cigarettes had significantly lower levels (29 %–95 %) of urinary BoEs after 5 days. Nicotine equivalents declined by 25 %–40 %.  

-All groups experienced significant decreases in exhaled CO (27 %–89 %).

2016: Electronic cigarette aerosol induces significantly less cytotoxicity than tobacco smoke (PDF 16 pages)

Under the conditions tested, Vype ePen e-cigarette aerosol was significantly less cytotoxic than reference 3R4F cigarette smoke.  

2014: Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review (PDF 20 pages)

Conclusion: “Existing evidence indicates that E-cigarette (EC) use is by far a less harmful alternative to smoking. There is no tobacco and no combustion involved in EC use; therefore, regular vapers may avoid several harmful toxic chemicals that are typically present in the smoke of tobacco cigarettes. Indeed, some toxic chemicals are released in the EC vapor as well, but their levels are substantially lower compared with tobacco smoke, and in some cases (such as nitrosamines) are comparable with the amounts found in pharmaceutical nicotine products. Surveys, clinical, chemistry and toxicology data have often been mispresented or misinterpreted by health authorities and tobacco regulators, in such a way that the potential for harmful consequences of EC use has been largely exaggerated. It is obvious that some residual risk associated with EC use may be present, but this is probably trivial compared with the devastating consequences of smoking. Moreover, ECs are recommended to smokers or former smokers only, as a substitute for conventional cigarettes or to prevent smoking relapse; thus, any risk should be estimated relative to the risk of continuing or relapsing back to smoking and the low efficacy of currently approved medications for smoking cessation should be taken into consideration…..”

2014: Comparison of select analytes in aerosol from e-cigarettes with smoke from conventional cigarettes and with ambient air

No significant contribution of tested HPHC classes was found for the e-cigarettes.

2013: Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract

This study indicates that EC vapor is significantly less cytotoxic compared to tobacco CS.