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Last updated : July 16, 2018
E-cigarettes are battery-operated devices that resemble tobacco cigarettes, cigars or pipes except that they do not contain tobacco. The device allows users to inhale nicotine and other chemicals in a vapour form rather than smoke. There are also a number of non-nicotine devices that contain a variety of ingredients and flavours like fruit, sweets, coffee or alcohol flavours.1
Some devices resemble conventional cigarettes, cigars or pipes where others look like everyday items such as pens, USB memory sticks, and larger cylindrical or rectangular devices.2
E-cigarette products can be bought online from overseas, which raises safety concerns about the lack of regulation governing their manufacture and distribution. Most countries have no regulations governing e-cigarette design and product approval. There have been frequent reports about nicotine poisonings as well as injuries and property damage arising from product malfunctions.2
E-cigarettes are sometimes mistaken for approved nicotine replacement therapy as some manufacturers market them as devices designed to help people overcome tobacco dependency. E-cigarettes may be used as a quitting aid in the future, but at the moment there is no conclusive evidence about its effectiveness. There is also very little known about the other chemicals found in e-cigarettes, and how it affects the smoker as well as bystanders.3
Electronic cigarettes, electronic nicotine delivery systems (ENDS), e-cigs, ecigarro, electro-smoke, green cig and smartsmoker.3
E-cigarettes contain nicotine solution, flavour and other chemicals in a disposable cartridge that can be replaced or refilled. E-cigarettes use heat to transform nicotine solution into vapour which is inhaled.4
People may use e-cigarettes for various reasons including:
As yet, there is very little available research that indicates if e-cigarettes can help people quit smoking as the results of studies on individual brands vary. Their effectiveness in helping people give up tobacco can only be assessed by the Therapeutic Goods Administration (TGA), which to date has not occurred.
While it has been suggested e-cigarettes may offer a safer alternative to smoking, other research points to a potential rise in smoking rates by re-normalising smoking, reducing a smoker’s motivation to quit or indirectly encouraging non-smokers to take up the habit.
There is also the risk that smokers may become dual users of both e-cigarettes and tobacco cigarettes. There is currently no evidence to support the use of e-cigarettes as an effective form of smoking cessations, for this reason the Therapeutic Goods Administration (TGA) is yet to approve e-cigarettes as a quit tool. 6 7
Research into health risks associated with smoking e-cigarettes is extremely limited. However, there are known risks associated with nicotine exposure on brain development meaning that pregnant women and adolescents should avoid smoking them. They should also not be smoked around children. There are also risks linked to nicotine poisoning via ingestion and skin contact.1
Concerns have been raised about the appeal of flavoured e-cigarettes among children and adolescence, in countries where data is available concerning trends are being noted in the uptake of e-cigarettes in adolescence and children. 7
While it is thought that e-cigarettes may pose less harm than conventional cigarettes because they do not contain tobacco6, significant differences in product designs and individual smoking patterns make it difficult to determine the potential level of nicotine toxicity in e-cigarettes2. Manufacturer quality is not guaranteed, and can be highly variable. Nicotine labelling on e-cigarettes and e-liquids has also been demonstrated to be inconsistent. Labels have also incorrectly denied the presence of nicotine and other potentially toxic chemicals 7
The limited research to date does not distinguish between the many brands and models containing different e-liquids, batteries, heating elements, nicotine concentrations and flavourings. Nor differentiate between the chemical compositions of e-liquid and aerosols that users inhale.6
There are safety concerns from prolonged exposure if smokers inhale vapour many times a day for many months.
E-cigarettes contain chemicals that may be acceptable for use in foods and cosmetics but it is unclear if the vapours are safe when inhaled into the lungs though research suggests that long-term inhalation of these agents directly into the lungs, is likely to pose a risk to health. 3 ,7. Some e-cigarettes contain propylene glycol and glycerol (purified vegetable glycerine) that are potentially toxic 6 and may cause mouth and throat irritation8. Some e-cigarette manufacturers now use distilled water and glycerine instead of propylene glycol vapour in an attempt to address such safety concerns. E-cigarettes may also contain toxins such as formaldehyde and heavy metals, such as chromium, aluminium, arsenic, copper, lead, nickel and tin, all of which cause adverse health effects, including cancer. In some cases, these metals have been detected at levels similar to, or greater than those found in tobacco7, 8
Over 200 cases have been reported in the US and UK of e-cigarettes overheating, catching fire or exploding, causing serious and in some cases life threatening injury, disability and disfigurement. 7
While the risks of passive smoke to bystanders are considered to be lower with e-cigarettes than conventional cigarettes. Studies have demonstrated that e-cigarettes expose both users and bystanders to particles that can cause adverse health effects, especially to those how have existing chronic disease. The WHO has warned that any level of exposure to these particles may be harmful and should be reduced. Exposure to heavy metals such as nickel and silver may be greater than in conventional cigarettes. 1, 6, 7