An Attack of the Vapers… Er… Vapors?

Unless you have been a shut-in with a phobia of all forms of media, you will be aware of an up-ticking trend in nicotine use. It involves the use of the electronic cigarettes. There has been recently and increase in the debate concerning regulation and health concerns regarding the use of these alternatives to combustible tobacco use. Warning, dear readers, this may get “sciency”. I’m not going to apologize. In this particular issue, science is a significant player in the regulation debate. So, with the disclaimer out of the way, on with the show…

What Are Electronic Cigarettes?

The first electronic cigarette, vaporizer, or nicotine delivery system was patented in 1963 (Gilbert, 1965). The devices work by using an electric heating source to heat a solution to vapor state by which it can be inhaled (Czogala, et al., 2013). The liquid solution or “e-juice” is usually a mixture of propylene glycol (PG), vegetable glycerine (VG), and or polyethylene glycol (PEG). These chemicals are mixed with flavors and nicotine. These days, there are a wide variety of flavors. Additionally, not everyone is keen on PG and PEG to which many are allergic and/or it exacerbates asthmatic conditions. So, there are 100% VG versions that do not contain any PG or PEG. The solution of nicotine is also variable these days, generally from 24 mg down to 0 mg of nicotine. The user breathes in the vaporized solution, and exhales mostly water vapor. Unlike other smokeless nicotine delivery systems (gum or patch), the electronic cigarette more closely resembles the feeling of the physical and behavioral aspects of smoking.

With the expansion of non-smoking laws and limitations, the popularity of non-combustible tobacco options grew. There are a wide variety of electronic cigarettes that closely resemble traditional cigarettes. Some brands also have a glowing tip that mimics the fire of traditional cigarettes. There are disposable options. Other options have disposable cartridges that attach to rechargeable power sources. With the increasing popularity of the vaporizing trend, there are a wide variety of power sources (batteries) with varying power charge and time. More advanced options include ability to adjust power and delivery. With these new power options there are detachable tanks that run the gamut from disposable tanks to artisan crafted hand-blown reusable options.

As the number of electronic cigarette users increased, the language also expanded to incorporate new vocabulary associated with the trend. Because the mechanism is vaporizing the solution, the behavior has been labeled “vaping.” The devices have been called e-cigs, e-fags (U.K. primarily), e-hookahs, or hookah pens (Richtel, 2014; The Time Out London blog, 2014).

Why Are More People Vaping?

So, why the up-tick in the vaping trend? In four years, from 2008-2012, the number of e-cigarette sales increased by nearly 7000%. It seems that while the mere restriction on smoking in public places may have pushed traditional smokers to the non-combustible alternatives, this may not be the only reason for the increase in number of vapers. So what are the leading reasons for people to choose e-cigarettes?

  • Avoidance of smoke-free laws (Koch, 2012)
  • Convenience (Noguchi, 2014)
  • Smoking cessation (Pokhrel, et al., 2013)
  • Health concerns (Farsalinos & Polosa, 2014; Koch, 2012)
  • Financial (Koch, 2012)

The concern for environmental factors and second-hand smoke made more and more indoor environments become non-smoking. Smoking sections in restaurants, airplanes, hotels, and other facilities became a thing of the past. Smokers were relegated to outdoor designated areas. Complaints about non-smokers entering buildings through a cloud of second hand smoke, prompted building owners and businesses to post boundaries and zoning to bar smokers from proximity of the doors. However, more and more organizations, companies, etc. are moving towards the smoke-free environment entirely. The push has been for users to choose smoking cessation options, such as nicotine gum or the patch. However, the new prevalence of e-cig options have made vaping a more convenient option. Vapers can remain at their desks (in places where vaping indoors has not yet been banned) rather than being pushed into the weather for their break (Noguchi, 2014).

Some people saw the e-cigarette as an alternative to smoking cessation (Koch, 2012; Pokhrel, et al., 2013; Richtel, 2014). While there is a significant lack of evidence to support the efficacy of e-cigarettes as a smoking cessation intervention; people still believe that vaping is a viable alternative to nicotine gum, the patch, or other pharmaceutical options.

Even for those who do not desire abstinence from nicotine, there are aspects of vaping that have smokers switching in hopes of improving their health (Farasalinos & Polosa, 2014; Koch, 2012). Detractors have argued that there are still dangers and volatile chemicals associated with the vaping process that endanger the health of humans (Koch, 2012; Reasons Supporting Regulation of E-Cigarettes, n.d.). Additionally, nicotine is still a poison and can be dangerous to anyone inhaling, ingesting, or absorbing transdermally (Glatter, 2014). Nicotine toxicity is a concern for those handling the nicotine infused e-juices. Additionally, the risk to children who might mistakenly consider the intriguing smells and colors to be something edible supports the push for child-proof closures on e-juice containers. The detractors also are concerned with the second hand vapor expelled into the environment. However, much to the chagrin of those who want to claim harmful effects of vaping as being as dangerous as combustible tobacco, what little research is out there has shown that the negative effects of vaping on the primary user and the innocent bystander from second hand exposure are a fraction of what would be experienced with traditional smoking (McAuley, Hopke, Zhao, & Babaian, 2012; Noguchi, 2014). Studies have shown that there is still some nicotine expelled in the vapor resulting from e-cig use, but that it is ten times less than the amount found in traditional combustible cigarette smoke making it less harmful to those exposed second hand (Czogala, 2013). Additionally, there is none of the “side smoke” (fumes from the burning tip) that occurs with puffing a traditional cigarette. Goniewicz, et al. found in 2013 the levels of other toxicants to which vapers are exposed were 9-450 time lower than by traditional cigarette smoking. Most sources acknowledge that the research is just very limited at this time and more time and studies are needed to examine the long term effects.

There are many anecdotal accounts by former smokers who have reported that vaping has improved their own perceived health (Koch, 2012). Vapers indicate that the traditional “smokers’ cough” disappears after a short period. An unexpected development for some former smokers switching to vaping is a return of their olfactory sense. One former smoker/new vaper stated, “I went outside to sit and vape and smelled something. I couldn’t identify what it was, but it didn’t seem very pleasant. After looking around, it finally dawned on me… I was smelling the ash tray [that was still sitting on a table for smoking guests].” Because the oral behavior and nicotine are present, many report that they have not seen the weight gain that accompanies other types of nicotine replacement systems, and even though there is no current research supporting vaping as an effective smoking cessation method, the ability to step down the e-juice nicotine to zero might provide options for those who wish to break their nicotine addiction (especially for those to whom the “ritual” of smoking is as important as the actual chemical addiction).

One of the other major foci of the people against vaping has been the aspect of vaping as a gateway for young people and the behavioral aspects of the trend. Several outspoken antagonists of the vaping trend say that the “candy” flavors and colorful packaging target the young (Richtel, 2014). Additionally, the non-smoker rights movement have viewed the vaping trend as setting back smoke-free society by decades by “making smoking seem acceptable” again (Reasons Supporting Regulation of E-Cigarettes, n.d.). The argument is that the “mimic behavior” of vaping is just going to draw more people to the smoking behaviors, and nicotine addiction will keep them there. The lack of federal regulation leads detractors to fear the marketing of these items to teens and children.

Finally, the last reason on this list is the financial perspective. E-cigarettes present options that are far less expensive than smoking (Koch, 2012). With the cost of cigarettes and “sin tax” making the price of combustible tobacco rise astronomically, vaping provides a significantly less expensive alternative. Even with the cost of starting (purchase of power source, tanks, and e-juice), most vapers find that the choice to vape instead of smoke significantly decreases the amount of cash expenditure monthly. Let’s look at an example of an average user:

Assuming a moderate smoker as a pack of cigarettes per day use, this averages approximately a carton of cigarettes per week. Obviously, the cost of cigarettes varies significantly from state to state, but for this exercise, we will use the prices from Tennessee. Cartons of cigarettes vary in price. The range is somewhere between $36-70 depending on brand. Taking the cheapest option as the choice, a carton of cigarettes per week gives us about $156 per month or $1872 annually. This does not include accessory costs (lighters, lighter fluid, flints, etc.); or incidental costs of accidental burns in clothing or upholstery, smokers deposits (some rental agreements), and cleaning costs of ash and smoke in clothing and environment. For this case, we will calculate cost based on one of the mid-range electronic cigarettes known as the “hookah pen.” This particular model includes a battery with removable tank that charges using a USB connector. The basic start-up kit at the local vapor emporium includes one power source, charging adaptor, one disposable tank, and one 10 ml bottle of e-juice; all for $30. Disposable tanks cost $5 a piece and last between 10 and 30 days depending on intensity of use. However, there are alternatives. There are also rebuild tanks that cost $5 new and have replaceable coils for $2. Coils last about the same time as disposable tanks. The e-juice is the primary consumable in this process. From speaking with vendors and vapers, a 15 ml bottle of e-juice is the approximate equivalent of a carton of cigarettes. This amount varies person to person according to reports. Factors that impact usage are nicotine load in the e-juice, prior smoking rate before switching, and behavioral differences in drawing vapor/smoke. In general, the cost of e-juice runs $8-10 per 15 ml bottle. Right there, you have a comparison: One carton of cigarettes, $36; the equivalent amount of e-juice, $8. To take it a bit further, let’s follow our new vaper/former smoker for a year. At the end of a year, assuming the pattern above, the smoker would spend approximately $2000. For the equivalent vaper, the annual spend would be (including start-up, additional tank purchase, and coil replacement) $473. That is a difference of $1527.

Would it be an even greater savings to quit smoking or vaping all together? Of course it would. However, for those who do not want to stop the “ritual” or abstain from nicotine, vaping provides a fiscal alternative that is far less offensive to the bank account. Now, keep in mind, these things are not currently federally regulated or taxed. Some states are imposing their own taxes, and sales tax is definitely applicable (Koch, 2012). If regulations are implemented, it is possible that the cost of vaping may increase, especially if those already lobbying against vaping succeed in their efforts. The inexpensiveness is another point they make in the risk to teens and young people for whom the cost of cigarettes has exceeded their lack of adult income.

To Vape or Not To Vape… What Was the Question?

So, what is the conclusion? There is no doubt that more research is needed. The long term effects of vaping are, as yet, unknown. There may be health impacts that we have not seen. It is still not recommended to expose children or pregnant women to electronic cigarette vapors, actively or passively. Nicotine is still a poison, and unless you are using the zero nicotine e-juice, you are still inhaling this chemical. Additionally, the danger to anyone ingesting or transdermally absorbing the nicotine solution can be significant. E-juice should be kept away from children, and vapers should always wash their hands after filling tanks to prevent accidental overdose exposure. However, as noted in the studies mentioned here, the levels of carcinogens and harmful toxicants are significantly less for e-cigarette use than for combustible tobacco. The second hand risks and impact to the environment are also decreased. Financially, at least for now, vaping is less expensive than smoking. The trendiness of vaping, along with the flavor and color associated may draw younger people. However, as with all trends, the potential for long term use may be less as the newness wears off. Since it is possible to vape without any nicotine in the e-juice, those choosing to vape initially as opposed to switching from traditional cigarettes do not face addiction risk in the same way. Also, with the capability of stepping nicotine down, it is possible for former smokers to break their own addiction to nicotine while still participating in the behavioral “ritual” of smoking. The biggest deterrent for anyone considering vaping is that there really is just not enough research to indicate what the risks and benefits might be.

Bottom line is that for those who do not smoke, vaping is an unnecessary habit to form. For those who smoke, weigh the pros and cons and do your research (there are articles listed in the references as well as links for organizations that have more scientific research to offer). Think about your reasons for switching. If it is for health reasons, set yourself a timeframe and think about the step down process. Keep a calendar and stick to it. Remember that nicotine is a poison. Keep e-juice out of reach of children and pets. For those who are looking at the financials, watch the news and be aware that regulations may decrease the fiscal benefits of vaping. Also, watch out for the “shiny” aspects. There are a lot of toys, gizmos, accessories, and flavors of e-juices that go with vaping. You aren’t saving if you are buying all the latest “shiny” new things.

Examining all the various arguments for and against as well as observing the phenomenon first hand, my own leaning is that vaping is positive option for smokers. It can save money. Vapers smell better (both the individuals and their own olfactory sense). Until research proves otherwise, I believe that this new trend is a better option for those who are forced or would like to avoid combustible tobacco but aren’t ready to let go of the “ritual.” For those who do not need the “ritual” but want to quit, there are viable options in the form of gum, patches, and pharmaceuticals. And for those who are just fine with their tobacco in fiery form, enjoy while you can as the non-smoker rights advocates chase you from pillar to post.

I know that this has been a very long post, but I hope that it has presented useful information that will help any of those teetering on the brink of decision.

References

Czogala, J., Goniewicz, M., Fidelus, B., Zielinska-Danch, W., Travers, M., & Sobczak, A. (2013). Secondhand exposure to vapors from electronic cigarettes. Oxford Journals: Nicotine & Tobacco Research, doi: 10.1093/ntr/ntt203

Farsalinos, K., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Therapeutic Advances in Drug Safety, 5(2), 67-86.

Gilbert, H. (August, 1965). Smokeless non-tobacco cigarette US Patent 3200819 A. Gilbert Herbert A. Retrieved from https://www.google.com/patents/US3200819

Glatter, R. (2014). The real dangers of liquid nicotine. Forbes (online). Retrieved from http://www.forbes.com/sites/robertglatter/2014/03/24/the-real-danger-of-liquid-nicotine/

Goniewicz, M., Knysak, J., Gawron, M., Kosmider, L., Sobczak, A., Kurek, J., Prokopowicz, A., Jablonska-Czapla, M., Rosik-Dulewska, C., Havel, C., Jacob, P., & Benowitz, N. (ABSTRACT, 2013). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, doi: 10.1136/tobaccocontrol-2012-050859 Retrieved from http://tobaccocontrol.bmj.com/content/early/2013/03/05/tobaccocontrol-2012-050859.abstract

E-cigarettes and coffee at London’s Vape Bar. (March, 2014). The Time Out London blog: your daily guide to city life, news and culture. Retrieved from http://now-here-this.timeout.com/2014/03/26/e-cigarettes-and-coffee-at-londons-vape-bar/

Koch, W. (September, 2012). E-cigarettes: No smoke, but fiery debate over safety. USA Today. Retrieved from http://usatoday30.usatoday.com/news/health/story/2012-08-18/electronic-cigarettes-smokeless-vaping-risks/57121894/1

McAuley, T., Hopke, P., Zhao, J., & Babaian, S. (2012). Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhalation Toxicology, 24(1), 850-857.

Noguchi, Y. (March, 2014). Ok to vape in the office? Cities, feds and firms still deciding. NPR Shots. Retrieved from http://www.npr.org/blogs/health/2014/03/21/291139371/ok-to-vape-in-the-office-cities-feds-and-firms-still-deciding

Pokhrel, P., Fagan, P., Little, M., Kawamoto, C., & Herzog, T. (2013). Smokers who try e-cigarettes to quit smoking: Findings from a multiethnic study in Hawaii. American Journal of Public Health, 103(9), e57-e62.

Reasons Supporting Regulation of E-Cigarettes (n.d.) Retrieved from http://tobaccofree.ucsc.edu/pdf-only/regulating_ecigarettes.pdf

Richtel, M. (March, 2014). E-cigarettes, by other names, lure young and worry experts. The New York Times (online). Retrieved from http://www.nytimes.com/2014/03/05/business/e-cigarettes-under-aliases-elude-the-authorities.html?_r=0

More Resources

Scientific and Medical Information on Electronic Cigarettes, National Vapers Club – http://www.vapersclub.com/science.php

Smoke-Free Alternatives Trade Association (SFATA) http://www.sfata.org

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