Smoking vs Vaping : Fact vs Fiction

The following is a far better reference tool than I could have compiled myself.  This article, originally posted on the onvaping.com website, gives a summary of all of the most recent information, articles, studies and reports on the safety, effectiveness and health concerns surrounding e-cigs. I've been searching for material to give you the facts as they stand and not the propaganda that the general media are touting and this is just perfect.  These documents ignore the bad press and pseudo 'facts' that have been thrown around up until now and deal with the proven science about how e-cigs can affect your body and those around you, containing the latest, up to date information.

In the scheme of things, e-cigarettes are only new to the World and while it's true we don't know and can't possibly predict the long term effects of using them, consider that in the not so distant past, cigarettes were promoted for their 'health' benefits too ... until it was discovered that cigarettes weren't in fact 'healthy' but instead have a nasty habit of making people die a lot.  I'm not saying that e-cigarettes will prove over time to be just like tobacco or worse . . . that's impossible.  What I am saying is that we don't have the full story yet . . . the device is only in it's infancy (which is demonstrated by the huge advances made in the technology since we were introduced to e-cigarettes in 2011) and as with all new products, only time will tell.

Having said that, I firmly believe that e-cigarettes will eventually be the death of smoking traditional tobacco.  Tobacco can't be killed off completely because e-liquids require tobacco oil or essence and it has to be derived from a natural source.  Still, I can't see smoking  tobacco having anything more than a finite lifespan.

In our own little World here in Australia, we can only hope that "the powers that be" will consider all the facts before legislating; that they will consult with the community and that their choices will support e-cigarettes and therefore the future health and well being of those same communities.  Let's face it, e-cigarettes cannot possibly do more harm than smoking traditional tobacco . . . it's only logical . . . and the benefits (improved health, improved lifestyle and improved cash flow) obviously far outweigh any current concerns.  Lets hope that our Government won't be influenced by 'Big Tobacco' and that they will recognise that the loses in tax revenue from decreased cigarette sales will be balanced by the savings made in the provision of health care, thereby removing the need to heavily tax e-cigs when doing so would take them out of the reach of the very people who will gain the most advantage by having access to electronic cigarettes.  Perhaps some forward thinking politician will put forward legislation to have e-cigs listed as a smoking cessation device, just like nicotine patches, gum or lozenges and perhaps even take it one step further and lobby to list electronic cigarettes and e-liquids on the Prescription Benefits Scheme (PBS) creating access for anyone who has the desire to stop smoking tobacco, regardless of income.  Let's face it, most of the 'quit smoking' products commercially available cost almost as much as the cigarettes themselves, some even more, and there's still no guarantee of success with any of them, including e-cigs . . . but from what we've experienced and seen, the odds are much better for success with an e-cig than with most other forms of replacement therapy.

Updated [finally] In December 2016 . . . Thanks Greg!

Got an email from Greg Jacobs at onvape.com.au about the article below.  Apparently, the link provided to the original article was broken [didn't know that] but Greg's sorted it for us by sending another working link to the updated and still the best list of research, articles and studies from all over the World.  A big thanks to Greg for keep us in the loop..

All the updated stuff is directly below, or you can flick over to view the article in full
I was looking for some references for e-cigarette studies. I found some promising links that led to expired web pages. I managed to find the original article and I think you will benefit greatly for such a wonderful resource. Unfortunately the list only had studies up until 2014 so I have added more peer-reviewed studies from 2015 and 2016. Next time someone tries to tell you that e-cigarettes are not safe or have not been studied send them to this page.

Update: 2016
​
  • Electronic cigarette use in the EU: More than six million smokers in the European Union have quit smoking and more than 9 million have reduced smoking consumption with the use of electronic cigarettes, according to a study published today in Addiction. Scientists from the University of Patras-Greece, Onassis Cardiac Surgery Centre-Greece and the French National Research Institute for Health and Medical Research analyzed the data from the 2014 Eurobarometer on smoking and the use of the electronic cigarettes. According to the study findings, 48.5 million Europeans have ever tried electronic cigarettes, but 7.5 million are current users. Among current users, 35.1% have quit smoking while an additional 32.2% have reduced smoking consumption. Published August 2016.
  • Switching to E-Cigarettes lowers blood pressure: The study concludes “smokers who reduce or quit smoking by switching to e-cigarettes may lower their systolic BP in the long term, and this reduction is apparent in smokers with elevated BP. The current study adds to the evidence that quitting smoking with the use of e-cigarettes does not lead to higher BP values, and this is independently observed whether e-cigarettes are regularly used or not”. Published February 2016.
  • TSNA’s for E-cigarettes at minimal levels. This Study was in response to a South Korean study that claimed TSNA’s (tobacco specific nitrosamines) were higher in the aerosol than the liquid. This study disproved that claim with aerosol levels unable to measured on normal dosages and measuring the same as the liquid on the spiked samples. Published July 2016.
  • Nicotine absorption comparison of Vapers and Smokers. This study compared the nicotine absorption of long term vapers, new vapers and cigarette smokers. The conclusion was that, obviously, there is no risk of nicotine overdose from intended use of e-cigarettes in first-time users. Naive users obtain less nicotine from e-cigarettes compared to experienced vapers, verifying that there is learning curve in e-cigarette use. Smokers should be properly informed that they might not get enough nicotine during e-cigarette initiation and that they need to adjust their use patterns. Published August 2016.
  • Metals Emitted from E-Cigarettes. This study was in response to 2 studies which had negative claims regarding e-cigarette metal emissions. In the response study emissions were measured for first-generation Ecigs and at twice the average use. The results were metal emissions 2.6-37.4 times lower compared to acceptable intake from inhalational medications. Published May 2015.
  • E-cigarettes are safer then cigarettes by orders of magnitude. The study verified that tobacco-derived toxins are lower by orders of magnitude in e-liquids compared to tobacco products. Characteristically, nitrosamines were 146-1447 times lower in e-liquids compared to tobacco products (in 1 mL liquid compared to 1 gram of tobacco), while nitrate was 1360 times lower. Published August 2016.

The Original Article

Electronic cigarettes are becoming more and more popular, both with smokers who are wishing to quit and smokers who dislike analog cigarettes but wish to continue exhaling something that closely resembles smoke. While some are quick to jump headlong into new products and devices, there are others who wait for research on the the safety of these new devices before jumping on the bandwagon. Due to these concerns, many leading scientists and health experts around the world have researched the safety of e-juice, second-hand vapour, and the effectiveness of e-cigarettes as a smoking cessation device.

Whether you are a smoker looking for a way to quit, a smoker who detests the taste and smell of analogs, someone who is worried about breathing in e-cigarette vapor, or someone who is wanting flavor and taste without the calories or allergens, the studies compiled below should help to alleviate any of your fears regarding the use of e-cigarettes and e-juice.

Any updates to this article will be presented at the end of this article. Last updated on 9/2/14.

E-Cig and E-Juice Safety: Are They Safe?
  • Scientific Errors in the Tobacco Products Directive: A letter sent by the very scientists whose research was cited by the EU Commission to draft legislation geared towards e-cigarettes and their usage. The letter details the many ways in which their research was wrongly used and misinterpreted.
  • Ecigs Do Not Stiffen Arteries (PDF): Researchers from Onassis Cardiac Surgery Center in Greece have found that while smoking just 2 tobacco cigarettes caused significant stiffening of the aorta, no difference was observed after the use of an e-cigarette by smokers AND vapers. Published December 2013.
  • Smoking Kills, and So Might E-Cigarette Regulation: Gilbert Ross MD, is a medical and executive director of the American Council on Science and Health. In this special report on The American, he states “simple common sense would dictate that inhaling the fewer, less harmful ingredients of e-cigarettes as compared to inhaling the thousands of chemicals in the smoke from burnt tobacco, many of which have been shown to be carcinogenic, is highly likely to be healthier.” Published November, 2013.
  • Research on Safety of Electronic Cigarettes (PDF): Dr. Konstantinos Farsalinos’ comprehensive presentation on existing data relating to the safety of e-cigarettes. Presented at The E-Cigarette Summit, Royal Society, London in November 2013.
  • Nicotine Safety in the Context of E-Cigarette Use (PDF): Contrary to popular belief, the fatal overdose level for nicotine may be far higher than the generally accepted 50 to 60 mg (adult) says Dr. Jacques Le Houezec. This research was presented at the The E-Cigarette Summit, Royal Society, London in November 2013.
  • E-Liquids Shown To Have Low Cytotoxicity (PDF): The results of testing of 20 e-liquids, has revealed the majority of the vapor samples were found to have no adverse effects on cardiac cells. Even on the several that did have some effect (two of which were tobacco derived), the worst was 3 times less toxic compared to cigarette smoke. Published October 2013 in the International Journal of Environmental Research And Public Health.
  • Nicotine Levels Selection and Patterns of Electronic Cigarette Use: Study from Dr. Konstantinos E. Farsalinos that concludes nicotine levels seem to play a crucial role in achieving and maintaining smoking cessation in a group of motivated subjects. The study involved 111 participants who completely substituted smoking with electronic cigarette use for at least 1 month. Published September 2013.
  • Vaping: coronary circulation and oxygen supply (PDF): Recent research indicates that electronic cigarette use does not affect the oxygenation of the heart. Lead by principle investigator Dr Konstantinos Farsalinos; results of the research were presented at the European Society of Cardiology annual congress in Amsterdam in August, 2013.
  • Eliquids: No Health Concerns: A study by Professor Igor Burstyn of Drexel University School of Public Health based on a review available data has confirmed chemicals generally found in e-cig e-liquids pose no health concerns. Published August 2013 (PDF).
  • MHRA Ecigarette Research: The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) carried out extensive research on e-cigarettes, arriving at the conclusion there was little concern that e-cigarettes can harm users by delivering toxic nicotine levels and little evidence of non-smokers taking up electronic cigarettes. Published in June 2013.
  • Evaluation of Electronic Cigarette Use And Liquid Consumption: This 2013 study challenges an EU proposal that would result in e-liquids containing more than 4 milligrams of nicotine per millilitre being banned unless approved as medicinal products.
  • Electronic Cigarettes Do Not Damage The Heart: Electronic cigarettes appear to have no acute adverse effects on cardiac function according to research by cardiologist Dr Konstantinos Farsalinos.  He says based on currently available data, e-cigs are safer and that substituting tobacco with electronic cigarettes could be beneficial to health.
  • Principles to Guide AAPHP Tobacco Policy: The American Association of Public Health Physicians recommends electronic cigarettes as a safer smoke-free tobacco/nicotine product.
  • Athens University Ecig Study Challenged: Dr. Michael Siegel questions a University of Athens study claiming e-cigarettes can cause lung damage.
  • Regulation: When Less Is More (PDF): Presentation slides from Clive Bates (of the Counter-factual) concerning the dangers of over-regulating e-cigarettes. Mr Bates urges positively about the vast potential about e-cigs, to put the (minor) risks in perspective and regulate as though the 1 billion who are predicted to die from tobacco related illnesses in the 21st century matter most. Presented at The E-Cigarette Summit, Royal Society, London in November 2013.
  • Vaping profiles and preferences: 1,347 vapers were surveyed in an effort to characterise e-cigarette use, users and effects. Results generally showed respondents found e-cigarettes to be satisfying to use; cause few side effects; considered healthier than smoking, resulted in improve cough/breathing and lowered levels of craving. The survey was hosted at the University of East London. Published March 2013.

Second-Hand Vapour Safety: Is Vapour Safe for Others?
  • Peering Through the Mist: Systematic Review of what the Chemistry of Contaminants in Electronic Cigarettes Tells Us about Health Risks: A comprehensive review, by a Drexel University professor, based on over 9,000 observations of e-cigarette liquid and vapour. He found “no apparent concern” for bystanders exposed to e-cigarette vapour – even under “worst case” assumptions about exposure.
  • Contaminants In E-cig E-liquids And Workplace Health Risks (PDF): A study that reviewed available data on chemistry of e-cig aerosols and e-liquids. This study found no evidence supporting the claims of e-cigarette vapour exposure negatively effecting the health, and safety, of  the workplace. Published January 2014.
  • Cytotoxicity evaluation of ecig vapor extract: A 2013 study designed to evaluate the cytotoxic potential of 21 eliquids compared to the effects of cigarette smoke found e-cig vapour is significantly less cytotoxic compared to tobacco.
  • Ecigarette toxicants study: Levels of selected carcinogens and toxicants in vapour from electronic cigarettes have been found to be 9 to 450 times less than tobacco cigarettes in 12 brands studied; leading the researchers to conclude “substituting tobacco cigarettes with e-cigarettes may substantially reduce exposure to selected tobacco-specific toxicants”. The study was first published online on March 6, 2013.
  • Is Passive Vaping A Reality?: This study sought to identify and quantify the chemicals released on a closed environment from the use of e-cigarettes – the findings? There’s little to be concerned about with regard safety. This research again confirms the type and quantity of chemicals released are by far less harmful to human health compared to regular tobacco cigarettes. In fact, it “could be more unhealthy to breath air in big cities compared to staying in the same room with someone who is vaping.”
  • Indoor Vapor Air Quality Study: Data at Clarkson University’s Center for Air Resources and reviewed by an independent toxicologist indicates electronic cigarettes produce very small exposures to byproducts relative to tobacco cigarettes. The study has been peer reviewed and will appear the Journal of Inhalation Toxicology.
  • E-cigarettes: harmless inhaled or exhaled: Report from Health New Zealand stating e-cigarette vapours do not contain substances known to cause death in the quantities found.
  • Society for Research on Nicotine and Tobacco (PDF): This research acknowledges that no drug is safe, but the emissions associated with the e-cigarette brand tested appear to be “several magnitudes safer” than tobacco smoke emissions.
  • E-cigarette Vapor And Cigarette Smoke Comparison: High nicotine e-liquids were vaporised in a series of experiments and the emissions compared to tobacco smoke. The study results indicate “no apparent risk to human health from e-cigarette emissions based on the compounds analyzed”.
  • Propylene Glycol Safe: Monkeys and rats were exposed continuously to high concentrations of propylene glycol, a common component of e-liquids for periods of 12 to 18 months. Results of the research state “air containing these vapours in amounts up to the saturation point is completely harmless”.
  • E Cigs as Smoking Cessation Devices: Does the Research Show That They Work?
  • A Longitudinal Study Of Ecig Users: This study concludes that electronic cigarettes may hep with preventing the relapses of former smokers and may even help current smokers to quit cigarettes. It also found that dual users, who were still smoking at the point of follow-up, had decreased their tobacco cigarette consumption by 5.3 cigarettes a day. Published January 2014.
  • The Importance Of Flavours In Eliquids: A study, headed by Dr. Konstantinos Farsalinos, finds that flavours play a major role in the overall experience of dedicated vapers which supports the hypothesis that flavoured e-liquids are important contributors in reducing or eliminating the smoking of tobacco cigarettes. Published December 2013.
  • Second Hand Vapor Study (PDF): A new study shows that even though e-cigarettes are a source of second-hand exposure to nicotine; it’s far, far less than that associated with second hand cigarette smoke. Additionally, when tested, e-cigarette second-hand vapour did not contain combustion related toxicants. Lead author was Maciej Goniewic from the Roswell Park Cancer Institute in Buffalo, N.Y. Published in Oxford Journal, December 2013.
  • A Longitudinal Study Of Electronic Cigarette Users: A study of 477 e cigarette users by researchers from the University of Auckland and University of Geneva has arrived at the conclusion that “E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers” Published October 2013.
  • Ecigs Not A Gateway To Smoking: The study is yet to be published, but according to research presented at the annual meeting of the American Association for Cancer Research (October 2013), the use of e-cigarettes by teens does not lead to smoking tobacco in the vast majority of cases.
  • Efficiency and Safety of an Electronic Cigarette as Tobacco Cigarettes Substitute: In a 12-month trial of e-cigarettes to evaluate smoking reduction/abstinence in 300 smokers not intending to quit; complete abstinence from tobacco smoking was documented in 10.7% and 8.7% at week-12 and after a year respectively. For the group receiving the higher dose nicotine cartridges, the tobacco cigarette cessation rate was 13% after a year. The study was published on PLOS One on June 24, 2013.
  • Impact of ecigarettes on schizophrenic smokers: Researchers from the CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research center in Italy determined the use of e-cigs decreased tobacco cigarette consumption in schizophrenia sufferers who were smokers – and without significant side effects. Published January 2013.
  • Effect of ecigs on smoking reduction and cessation: A study showing the use of e-cigarettes substantially decreased cigarette consumption without causing significant side effects in smokers who had no intention to quit. Published in 2011.
  • Electronic Cigarettes As a Smoking-Cessation Tool: The findings of this study indicate “e-cigarettes may hold promise as a smoking cessation method” and that further research should be carried out.
  • Electronic cigarettes: achieving a balanced perspective: This 2012 paper argues that while more research is needed on the cost–benefit of e-cigs and appropriate regulation, the harms so far have been overstated relative to the potential benefits. The paper mentions a study that found of more than 2000 former smokers in this survey, 96% reported that the e-cigarette helped them to stop smoking.

So what do all these studies mean?
The papers compiled above indicates that while nothing is better than breathing clean air, the vapor derived of e-juice in e-cigarette devices is magnitudes safer than analog cigarette smoke (as well as safer than air pollution in large cities). Regarding the research on second-hand vapour, some scientists and health experts conclude that there is no real need for concern. And as far as the question about the actual effectiveness of e-cigs as smoking cessation devices, the studies indicate that e-cigarettes are at least as effective as nicotine patches.

Updates Cancerous effects:
Electronic cigarette vapour appears chemically incapable of causing cancer as cigarette smoke has done. E-cigarette vapor contains toxicants concentrations averaging less than one percent of the concentrations in tobacco cigarette smoke.

Taxation efforts:
Governments looking to recoup future excise losses on declining tobacco sales could be tempted to tax e-cigarettes. This would make electronic cigarettes less price-competitive and would have the unwanted side effect of protecting tobacco sales.

Respiratory effects:
These randomized controlled trials followed participants for six and 12 months, and found no serious adverse events attributable to electronic cigarettes.

Lung function:
Lung function was not signifcantly decreased in 15 smokers using e-cigarettes, or in 15 never-smokers inhaling the vapour of e-cigarettes or inhaling smoke; lung function was, however, significantly decreased seven percent by active tobacco smoking.

Cardiovascular:
Arterial stiffness is not increased from vaping.
Red and white blood cells are not increased in the peripheral blood in the first hour after an e-cigarette either actively or passively inhaled.
Nicotine administered by electronic cigarette can relieve chronic idiopathic neutrophilia.

Brain effects:
Nicotine in e-cigarettes reduces the urge to smoke and improves mood, working memory, and prospective memory

QUESTION 1. : DO E-CIGARETTES LEAD CHILDREN INTO SMOKING?
On the evidence to date, the answer is no. The percentage risk of never smokers using e-cigarettes (whether adolescents or adults) is near zero
  • Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarettes substitutes: A systematic review: A total of 114 studies are referenced in this paper, with 97 directly related to e-cigarettes or their ingredients. The review covers all aspects, from chemical to clinical studies, including studies evaluating the potential effects of selected ingredients of e-cigarettes such as propylene glycol and glycerol. It includes discussion about the effects of nicotine and findings from studies evaluating passive exposure to e-cigarette aerosol. This is the first extensive e-cigarette review published in a peer-reviewed medical journal. The main themes of the paper are: discussion about nicotine and its effects-toxicity, presentation of chemical studies, cytotoxicity studies, clinical-case report studies and surveys, passive vaping studies and miscellaneous issues such as e-cigarette use by specific subpopulations (patients with respiratory disease or psychiatric conditions), accidental nicotine exposure, electrical accidents and fires and use by youngsters and non-smokers. Discussion about mistakes in methodology and mis-interpretation of findings is also included.
  • Long-term effects of inhaled nicotine: A study where rats were given inhaled nicotine at twice the amount of heavy smokers, which found “increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. Throughout the study, however, the body weight of the nicotine exposed rats was reduced as compared with controls. In conclusion, our study does not indicate any harmful effect of nicotine when given in its pure form by inhalation.”
                                                                                                                                                                            Written 28/1/14 ; Last updated 16/2/14
Source : onvaping.com [the original link is broken and has been removed as at 06 January 2017]