Lies, damned lies & statistics
Analysis
E Cigarette Interview with Professor Riccardo Polosa
I think that e-cig is a good solution to reduce the use of traditional cigarettes and their associated risk. Other valid options for tackling nicotine dependence in smokers exist, but it is still a personal choice how to introduce nicotine in his/her body. Each individual smoker should find a best way to reduce or eliminate his or her own smoking. In theory, at least for westernized cultures, vaping is a far better option than smoking. And it could save millions of lives.
Polosa (2011)
Doctors favour junkies over smokers
... there’s a stubborn portion of the population that is hard-core addicted to nicotine and that rather than writing them off or pretending that lecturing them will make them kick, our public health is better off by working to minimize the risks their addictions pose to their health and safety. And there are ways to do that. Promoting smokeless tobacco is a big one, since so much of the mortal danger that nicotine addicts risk comes from the carcinogens in smoking. E-cigarettes, or tobacco vapourizers, are another major improvement over smoking. And in Sweden, where millions of smokers have switched to a under-the-lip pouch of tobacco called snus, lung cancer rates and heart disease rates have fallen to some of the lowest in Europe. Just as with Insite, there is solid evidence showing that these lower risk products lead to increases in public health.
Libin (2011)
Could E-cigs become the ultimate nicotine maintenance device?
E-cigs should be allowed to compete for the middle ground between highly toxic smoked tobacco products and smoking cessation medicines that have been demonstrated to be safe and effective for that purpose. Thus e-cigs are currently competing for the smoke-free nicotine maintenance market, primarily against other smokeless tobacco products such as snuff, snus and dissolvable tobacco products. How successful they are in competing in that market-place will depend upon whether manufacturers can mass-produce and market relatively low-cost, safe, reliable and user-friendly products with adequate nicotine delivery. They should be regulated to ensure that they do not deliver toxic chemicals unnecessary to their purpose (e.g. quality control measures should ensure no contaminants are in the liquid or vapor), and are as safe as technically possible (e.g. liquid should be in a child-proof container, and instructions for use should be clear and accurate).
Foulds and Veldheer (2011)
Electronic cigarettes as a method of tobacco control
... health professionals should be able to suggest to smokers who are unable or unwilling to use or continue to use effective aids to quit, and who are interested in e-cigarettes, that these are a better option than continuing to smoke. And although it is better not to use any form of nicotine long term, if patients must, e-cigarettes are a lower risk option than continuing to smoke.
Borland (2011)
... products that deliver nicotine quickly in a ine vapour instead of as harmful smoke could prove an effective substitute for ‘conventional smoking’. It will be important to get the regulatory framework for these products right, to encourage new products, which smokers can use as safer nicotine alternatives, to be made available in the UK. A tenet of behaviour change is that it is much easier to substitute a similar behaviour than to extinguish an entrenched habit (an example was the rapid switch from leaded to unleaded fuel). If more alternative and safe nicotine products can be developed which are attractive enough to substitute people away from traditional cigarettes, they could have the potential to save tens of thousands of lives a year
UK Government Behavioural Insights Team (2011)
E-Cigarettes - No Toxic Effects from Inhaled Propylene Glycol Aerosol
... even high concentrations of PG vapor don’t have any measurable harmful effects, which is fully consistent with its designation by the FDA as “generally recognized as safe” as a food additive for all food categories up to 2% (here). Just as important, there will be no impact on bystanders from “second-hand” exposure to e-cigarette vapor, if it occurs at all.
Rodu (2011)
Anti-smoking groups have also discounted warnings regarding the life-threatening effects of Chantix and thus find themselves in the absurd situation of calling for a ban on electronic cigarettes, which have killed no one, while promoting the continued availability of Chantix, which has been associated with more than 200 suicides.
Siegel (2011)
[electronic cigarettes] have received the thumbs up from Quitline, an incorporated charitable trust committed to helping New Zealanders quit smoking.
Chief executive Paula Snowden said electronic cigarettes were a much safer option for dispensing nicotine than smoking .
"It's the smoke that kills you; taking nicotine without the smoke is a much safer option. Nicotine isn't harmful on its own."
Quitline (2011)
E-cig were used mainly by former smokers, much as NRT, as an aid to quit smoking, avoid relapse, deal with craving
E-cig were perceived as efficacious, useful, satisfactory
Almost all users preferred nicotine-containing e-cigs
E-cig provide high amounts of nicotine (as reflected by cotinine)
Efficacy?
Safety?
Etter & Bullen presentation (2011)
[Nobody seems to have told them that nicotine liquid tastes vile]
I would like to see smokers have more access to things like this, alternatives that are safer ... We've got to get people off the cigarette smoke.
Glover - Director of Auckland University's Centre for Tobacco Control Research (2011)
The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate.
Cahn and Siegel (2011)
Electronic nicotine delivery systems: a research agenda
... the first priority is to characterize the safety profile of these products, including in long-term users. If these products are demonstrated to be safe, their efficacy as smoking cessation aids should then be tested in appropriately designed trials. Until these studies are conducted, continued marketing constitutes an uncontrolled experiment and the primary outcome measure, poorly assessed, is user health.
Etter, Bullen, Flouris, Laugesen and Eissenberg (2011)
As the e-cigarette delivers only nicotine in a mist of propylene glycol, without the other 4,000 or so other chemicals in tobacco smoke, it is far safer than smoking.
The risks to smokers of pure nicotine, delivered in doses seen with the e-cigarette and NRT products, are extremely low. Animal studies suggest that the use of long-term (20 hours a day, five days a week during a two-year period) inhaled nicotine is safe.
In animal studies propylene glycol does not appear to pose a significant hazard via inhalation of the vapour. The compound appears to be safe when used as a food preservative or in cosmetics. It has also been used on children as an aerosol germicide in the United States in the 1940’s without adverse effects. However, the effects of inhaled propylene glycol on the lungs are unknown.
Unwanted outcomes could include young people using these products and becoming nicotine dependent and existing smokers using them to maintain their addiction in environments where they cannot smoke rather than quitting entirely.
New Zealand Ministry of Health (2011)
The e-cigarette provides a safer alternative for smokers. No deaths have yet been reported from e-cigarette use.
End Smoking NZ (2011)
Findings suggest that regardless of nicotine content, electronic cigarettes may provide an effective means of relieving acute tobacco craving in at least some smokers.
Darredeau, Campbell, Temporale & Barrett page 104 (2010)
I believe that the current state of knowledge about potential hazards and the risks of these causing harm are adequately addressed by the GPSR [General Product Safety Regulations] regulatory framework. The thing we are certain of on current evidence is that it is far safer than traditional tobacco based nicotine delivery systems.
UK Trading Standards, Head of Product Safety (2010)
Novel Nicotine Delivery Systems and Public Health: The Rise of the "E-Cigarette"
The ENDS tested so far have demonstrated poor quality control; toxic contaminants, albeit at low levels; misrepresentation of the nicotine delivered; and insufficient evidence of overall public health benefit. Ongoing, rigorous safety testing is needed, including determining real-world use patterns and further laboratory testing across device constructions to determine actual systemic nicotine delivery and exposure to harmful constituents.
Cobb, Byron, Abrams and Shields (2010)
E-Cigarettes: A Rapidly Growing Internet Phenomenon
Health professionals need to monitor the biological, social, and addictive effects of e-cigarettes and be aware of their rapid dissemination online. National health surveys that track trends in tobacco use also should inquire about e-cigarette use. Although the safety and efficacy of e-cigarettes is uncertain, we believe that clearly counseling patients against e-cigarette use, as well as other tobacco use, is prudent.
Yamin, Bitton and Bates (2010)
ASH ... recognise that whilst efforts to help people stop smoking should remain a priority, many people either do not wish to stop smoking or find it very hard to do so. For this group, we believe that products should be made available that deliver nicotine in a safe way, without the harmful components found in tobacco. Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe.
Therefore, e-cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are likely to be a safer alternative to smoking. In addition, e-cigarettes reduce secondhand smoke exposure since they do not produce smoke.
ASH UK briefing (2010)
Critique of the WHO TobReg report on e-cigarettes
If tobacco smoking is the elephant in the room, electronic cigarettes are like a buzzing insect. The natural instinct is of course to kill the buzzing insect first, just in case it might be harmful. This hostile analogy however, ignores the fact that smokers who like to smoke smoke either tobacco or e-cigarettes, and a move to e-cigarettes implies a move away from tobacco for the smoker concerned. If the real aim is to end cigarette smoking, banning e-cigarettes is not a sensible first move and could be counter-productive.
Laugesen (2010)
Cancer risk in humans reduced by e-cigarettes
E-cigarette use reduces risk of cancer by supplanting the smoking of tobacco cigarettes
Health New Zealand (2010)
US court judgement
"I am not convinced that the threat to the public interest in general or to third parties in particular is as great as FDA suggests. Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes have endangered anyone. Nor has FDA cited any evidence that electronic cigarettes are any more an immediate threat to public health and safety than traditional cigarettes, which are readily available to the public."
- Judge Leon (2010)
Electronic nicotine delivery systems: emerging science foundation for policy
Since they were first marketed in China in 2004, electronic nicotine delivery systems (ENDS) have spread globally like wildfire. Their proponents, who refer to the products as “electronic cigarettes” or “E-cigs”, argue that by delivering nicotine to the lung, they are more effective and acceptable than nicotine replacement medicines, and should be readily available as cigarette substitutes...
- Henningfield and Zaatari (2010)
NJoy e-Cigarette Health Risk Assessment
The Njoy e-cigarette offers the consumer an interesting alternative to traditional tobacco cigarettes. While we will not advocate the use of any product, nor certify that a product is totally safe, the Njoy device appears to limit a consumer's exposure to a few compounds of low toxicity, while delivering a metered dose of nicotine and flavor additives. Because combustion by-products, nitrosamines, and microbial toxins were not found in the aerosol of the e-cigarette, the risks associated with the use of the Njoy product appear to be low in comparison to the risks of traditional cigarettes.
Exponent Health Sciences (2009)
Marketers of electronic cigarettes should halt unproved therapy claims
... WHO knows of no evidentiary basis for the marketers' claim that the electronic cigarette helps people quit smoking. Indeed, as far as WHO is aware, no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy.
WHO does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid. The only way to know is to test.
The World Health Organisation (2008)
Dr. Phillips from tobaccoharmreduction.org
Studies
Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation
The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit
Polosa; Caponnetto; Morjaria; Campagna and Russo (2011)
Acute pulmonary effects of using an e-cigarette: impact on respiratory flow resistance, impedance and exhaled nitric oxide
E-cigarettes assessed in the context of this study were found to have immediate adverse physiologic effects after short term use that are similar to some of the effects seen with tobacco smoking, however the long term health effects of e-cigarette use are unknown but potentially adverse and worthy of further investigation.
Vardavas, Anagnostopoulos, Kougias, Evangelopoulou, Connolly and Behrakis (2011)
Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series
This is the first time that objective measures of smoking cessation are reported for smokers who quit successfully after using an E-cigarette. This was accomplished in smokers who repeatedly failed in previous attempts with professional smoking cessation assistance using the usual nicotine dependence treatments and smoking cessation counselling.
Caponnetto, Polosa, Russo, Leotta and Campagna (2011)
Variability Among Electronic Cigarettes in the Pressure Drop, Airflow Rate, and Aerosol Production
There was significant variability between and within brands in the airflow rate required to produce aerosol, pressure drop, length of time cartridges lasted, and production of aerosol. Variation in performance properties within brands suggests a need for better quality control during e-cigarette manufacture.
Williams and Talbot (2011)
Mining data on usage of electronic nicotine delivery systems (ENDS) from YouTube videos
YouTube videos provide a valuable resource for studying ENDS usage. Longer puff duration may help ENDS users compensate for the apparently poor delivery of nicotine from ENDS. As with conventional cigarette smoking, ENDS users showed a large variation in puff duration (range =1.9–8.3 s). ENDS puff duration should be considered when designing laboratory and clinical trials and in developing a standard protocol for evaluating ENDS performance.
Hua, Yip and Talbot (2011)
Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA
Given the large increase in awareness and ever use of ENDS during this 1-year period and the unknown impact of ENDS use on cigarette smoking behaviours and long-term health, continued monitoring of these products is needed.
Regan, Promoff, Dube and Arrazola (2011)
Electronic-Cigarette Smoking Experience Among Adolescents
Overall, 444 (10.2%) students responded as having seen or heard of e-cigarettes. Twenty-two (.5%) students reported as having used an e-cigarette. The contact routes of information on e-cigarettes were the Internet (249, 46.4%), friends (150, 27.9%), television (59, 11.0%), books (50, 9.3%), and others (29, 5.4%). The following factors were determined to be statistically significant predictors of e-cigarette experience: male gender, perception of peer influence, satisfaction in school life, and cigarette smoking experience.
Cho, Shin and Moon (2011)
Electronic Cigarettes Deliver as Much Nicotine as Tobacco Cigarettes
... experienced users (all of them former smokers), in real life conditions (not in a laboratory) get a dose of nicotine similar to the dose that smokers usually get from tobacco cigarettes.
Etter and Bullen (2011)
Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation: A Prospective 6-Month Pilot Study
Conclusion: The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit
Polosa, Caponnetto, Morjaria, Papale, Campagna and Russo (2011)
Analysis of Electronic Cigarette Cartridges, Refill Solutions, and Smoke for Nicotine and Nicotine Related Impurities
Nicotine was shown to be delivered using electronic cigarette devices although the amount of nicotine delivered will be greatly impacted by the ‘‘smoking’’ habits of the consumer. Significant labeling issues were found to exist with products in the market place with respect to product labeling accuracy. Some products were found to contain high concentrations of nicotine when labeled not to contain nicotine.
Trehya, Yea, Hadwigera, Moorea, Allgirea, Woodruffa, Ahadia, Blacka & Westenbergera (2011)
Collection of Studies on Propylene Glycol - http://www.vapersclub.com/pg.php
Smoking Cessation with E-Cigarettes in Smokers with a Documented History of Depression and Recurring Relapses
The most important message from this case series is that these individuals were able to quit and to remain abstinent for at least 6 months after taking up an electronic cigarette. This is the first time that objective measures of smoking cessation are reported in smokers, suffering from depression, who quit after experimenting with the e-cigarette. This is quite outstanding in consideration of the fact that this result was accomplished by highly addicted smokers who repeatedly failed professional smoking cessation assistance without the support of recommended nicotine dependence treatments and smoking cessation counselling.
Caponnetto, Polosa, Auditore, Russo & Campagna (2011)
Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes
Even with a relatively small sample of formal participants (N = 15), there were pervasive themes including the language and culture of vaping; social and informational support among vapers and their use of Internet resources (learning about e-cigs); the learning curve to using e-cigs and the numerous modifications (“mods”) available for e-cigs and personal vaporizers; motives and perceived benefits of using e-cigs versus cigarettes including cigarette-like enjoyment, cost, restored sense of taste and smell, and improved breathing and exercise tolerance; rapidly reduced nicotine tolerance and dependence; and a strong interest in e-cig–related research and policy.
McQueen, Tower and Sumner (2011)
Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?
Electronic cigarettes are designed to mitigate tobacco-related disease by reducing cigarette consumption and smoking rates. The evidence reviewed in this article suggests that electronic cigarettes are a much safer alternative to tobacco cigarettes.
Cahna and Siegel (2011)
Safety Assessment of Electronic Cigarettes in Smokers
... a trace amount of acroelin was detected in the vapour collected from a single filter cartridge, it was less than the minimum amount in mainstream smoke from a single tobacco cigarette. During the use of the electronic cigarette, the daily consumption of tobacco cigarettes decreased significantly.
Miura, Kikukawa, Nakao, Tokai, Izumi, Fujii and Hojo (2011)
The Electronic Cigarette: Acute Effects on Mood and Craving
The electronic cigarette can be effective in reducing nicotine-related withdrawal symptoms and desire to smoke after 5 minutes of use.
The nicotine content does not seem to be of central importance and other smoking-related cues (e.g. taste, vapour resembling smoke) may be sufficient to reduce discomfort associated with tobacco abstinence in the short term.
The smokers tested here were only deprived of tobacco smoking for one hour and were tested after 5 minutes of using the e-cigarette. Whether the above conclusions extend to more severely-deprived smokers and over a longer time period remains to be determined.
Dawkins, Kent and Turner (2010)
Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial
The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed.
Bullen, McRobbie, Thornley, Glover, Lin, Laugesen (2010)
Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration
Relative to a tobacco cigarette, 10 puffs from either of these electronic nicotine delivery devices (E-cigarettes) with a 16 mg nicotine cartridge delivered little to no nicotine and suppressed craving less effectively (see Bullen et al).6 Importantly, these results were from two specific products tested under acute conditions in which puff number was controlled...
Eissenberg (2010)
A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects
Own brand significantly increased plasma nicotine and CO concentration and heart rate within the first five minutes of administration whereas NPRO EC, Hydro EC, and sham smoking did not. Own brand, NPRO EC, and Hydro EC (but not sham) significantly decreased tobacco abstinence symptom ratings and increased product acceptability ratings. The magnitude of symptom suppression and increased acceptability was greater for own brand than for NPRO EC and Hydro EC.
Vansickel, Cobb, Weaver and Eissenberg (2010)
No harm found in e-cigarette mist
Health New Zealand (2009)
Surveys
Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA
In this US sample, awareness of ENDS [electronic nicotine delivery systems - ecigs] doubled from 16.4% in 2009 to 32.2% in 2010 and ever use more than quadrupled from 2009 (0.6%) to 2010 (2.7%). Ever use of ENDS was most common among women and those with lower education, although these were not the groups who had heard of ENDS most often. Current smokers and tobacco users were most likely to try ENDS. However, current smokers who had tried ENDS did not say they planned to quit smoking more often than smokers who had never tried them.
Regan, Promoff, Dube and Arrazola (2011)
Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives
Until we have more evidence on the safety and efficacy of e-cigs for smoking cessation, smokers should be advised to use proven treatments (e.g. counselling and FDA-approved medicines). However, for those who have successfully switched to e-cigs, the priority should be staying off cigarettes, rather than quitting e-cigs.
Foulds, Veldheer and Berg (2011)
Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy
Only one never smoker used nicotine-containing e-cigarettes, a finding that could reflect the fact that under-age consumers were ineligible for the survey, or that contrary to the hypothesis expressed by some authors, e-cigarettes do not facilitate initiation to nicotine use in young never smokers.
Of interest, current smokers who used the e-cigarette had fewer respiratory symptoms than smokers who did not use it ... This difference is substantial, as it is larger than the minimally clinically important difference for this questionnaire ... and very close to the difference ... previously reported between patients with moderate and severe COPD.
Etter and Bullen (2011)
The primary finding was a 6-month point prevalence of smoking abstinence among the e-cigarette users in the sample of 31%. This compares favorably to the average 6-month point prevalence of smoking abstinence of 17.8% in prior studies and to the 6-month point prevalence of smoking abstinence of 11.9% in the pooled data from these studies.
Electronic Cigarettes as a Smoking Cessation Tool - Siegel, Tanwar and Wood (2011)
9% of smokers in the UK have tried electronic cigarettes and third of those continue to use them (around 312,000 users).
52% of smokers have heard of ecigs but haven't tried them.
The main thing smokers want from new "NRT products" is affordability.
People who smoke more than 20 cigarettes a day and women were most interested in new ways to satisfy desire to smoke where it's not allowed and that would be a primary motivator for using ecigs. This would also be the main reason for recommending them to other smokers. Recommendations for use as a quit smoking product were least likely.
What smokers tell us about e-cigarettes - Dockrell, ASH UK (2010)
Respondents (73 current and 8 former users) lived in France, Canada, Belgium or Switzerland. Most respondents (77%) were men; 63% were former smokers and 37% were current smokers. They had used e-cigarettes for 100 days (median) and drew 175 puffs per day (median). Participants used the ecigarette either to quit smoking (53 comments), to reduce their cigarette consumption (14 comments), in order not to disturb other people with smoke (20 comments), or in smoke-free places (21 comments). Positive effects reported with ecigarettes included their usefulness to quit smoking, and the benefits of abstinence from smoking (less coughing, improved breathing, better physical fitness). Respondents also enjoyed the flavour of ecigarettes and the sensation of inhalation. Side effects included dryness of the mouth and throat. Respondents complained about the frequent technical failures of ecigarettes and had some concerns about the possible toxicity of the devices and about their future legal status.
Ecigarettes were used mainly to quit smoking, and may be helpful for this purpose, but several respondents were concerned about potential toxicity.
Electronic cigarettes: a survey of users Etter (2010)
Online Forum Poll by Consumer Advocates for Smoke-free Alternatives Association (2009)
All respondents previously smoked and 91% had attempted to stop smoking before trying ecigarettes. Most respondents resided in the USA (72%) and 21% were in Europe. About half (55%) were 31-50, while 32% were >50 years old. Most (79%) of the respondents had been using e-cigarettes for <6 months and reported using them as a complete (79%) or partial (17%) replacement for, rather than in addition to (4%), cigarettes. The majority of respondents reported that their general health (91%), smoker’s cough (97%), ability to exercise (84%), and sense of smell (80%) and taste (73%) were better since using e-cigarettes and none reported that these were worse. Although people whose e-cigarette use completely replaced smoking were more likely to experience improvements in health and smoking caused symptoms, most people who
\nsubstituted e-cigarettes for even some of their cigarettes experienced improvements.
These are highly motivated and passionate e-cigarette users who may have different experiences than average e-cigarette users or smokers, and thus the estimates cannot be extrapolated to all smokers or e-cigarette users. However, the results still suggest that very few e-cigarette users are not using them to replace cigarettes and there are many switchers and current smokers who could have the reported experience. Unfortunately e-cigarettes have been banned in some jurisdictions (e.g., Canada, Victoria (Australia)) where switching from cigarettes to e-cigarettes was documented. The lack of available and legal e-cigarettes may cause some users to resume smoking.
Electronic cigarettes (e-cigarettes) as potential tobacco harm reduction products: Results of an online survey of e-cigarette users - Heavner, Dunworth, Bergen, Nissen and Phillips (2009)
Read more on these results at: http://www.ecigarettedirect.co.uk/research/free-electronic-cigarette-cha...
In a survey of more than 250 electronic cigarette smokers, smokers and non-smokers, only 28% of respondents believed that smoking electronic cigarettes was more unhealthy than electronic cigarettes.
58% gave an emphatic no, while just under 30% remained unsure.
The numbers were rather different for non-smokers only, with 32.6% agreeing that the electronic cigarette was more dangerous than cigarettes. A minority (15.1%) did not believe the claim, while more than 50% were unsure. Smokers were more sceptical, with only 10.9% believing it was more dangerous, although again more than 50% were uncertain.
Perhaps unsurprisingly, those who had already converted to the electronic cigarette had a different story to tell, with all 89 respondents agreeing that the electronic cigarette was safer than cigarettes.
What do the public think about public health groups smoking claims? - Dunworth (2009)
Toxicology Reports
Analysis of eliquid samples from Ecig Wizard
The generic RY4 sample has a wide range of peaks, including some that are identified as various glycol esters. With a few exceptions (none of which are present) glycol esters are generally considered non-hazardous.
West Yorkshire Analytical Services (2011)
Flavour Art (Italy) test results on flavours for cytotoxicity
ClearStream Protocol (2011)
In Vitro Analysis of the Pro-Sensitising Potential of Heaven juice 9 mg Virginia + Perique
The aim of the test is to evaluate that the tested product or raw material does not cause pro-sensitising effects on the involved cell model. For every product intended to come into direct and prolonged contact with the skin, it is important to consider, beside the irritating potential, even the sensitising potential in order to predict the general safety of the finished formula to avoid risks for the consumers. ... the sample ... does not show any stimulating potential on the immune cellular response mediated by monocyte/macrophage.
Analisi Biologiche e Chimiche Tossicologia, Ricerche e Servizi (2010)
Cytotoxicity Evaluation - Sigaretta elettronica "io posso/ Yes I can"
On the bases of the results here shown, the condensed smoke obtained by simuating the use of the product: did not show cytotoxic effects at all tested dilutions on fibroblasts.
Analisi Biologiche e Chimiche Tossicologia, Ricerche e Servizi (2010)
Semi-quantitative deformulation of Safecigs 'Menthol 18mg'
None of these components were detected: cathechol, hydroquinone, phenol, o-cresol, resorcinol, carbon monoxide, benzene, benzo(a)pyrene, styrene, naphthalene, anthracene, chrysene, fluorene, or pyrene. This qualitative investigation of the data suggests that tar and carbon monoxide are not present in the liquid sample ...
CHEMIR Analytical Services (2010)
Determination of acrolein and other carbonyls in cigarette smoke using coupledsilica cartridges impregnated with hydroquinone and2,4-dinitrophenylhydrazine
TheHQ-DNPHcoupled cartridgewasconnected to the electronic cigarette (The Plemium Smoker, EPI International Co., Ltd., Tokyo Japan) and air was drawn through at a flow rate of 500 mL/min. DNPH-cartridges for low-level carbonyl analysis were used. After collection, the coupled cartridge was kept for 10 min or 16 h at room temperature and was eluted with acetonitrile containing 0.1%phosphoric acid in the reverse direction to air sampling. The eluatewas analyzed by HPLC operating in the gradient mode. For comparison,a DNPH-cartridge was used simultaneously for collection.
Uchiyama, Inaba, Kunugita (2010)
Carbonyls in E-cigarettes
Uchijama (2010) describes a new method to measure carbonyls and demonstrates this with analyses of cigarette smoke and electronic cigarettes. Instead of using only 2,4-dinitrophenylhydrazine (DNPH) as used by most laboratories, Uchijama trap the carbonyls using a cartridge of silica impregnated with both Hydroquinone (HQ) and DNPH. This gives the first published data on e-cigarette carbonyl emissions.
Summary.
1) Uchijama, using a HQ-DNPH cartridge, instead of the usual DNPH method, records an increase 6.4 to 9.3 ug/L for the e-cigarette, an increase of one-third (not 30 fold as in the text).
2) When adjusted to ug/L or mg/m3, Uchijama’s results are in line with tobacco company measurements of cigarette emissions.
3) The concentrations of acrolein and acetaldehyde are much less for e-cigarettes than for tobacco cigarettes and are low for e-cigarettes for formaldehyde also.
Laugesen (2010)
Batch Test results on liquid from eSmoke.net
Precision Testing Labs, Inc (2009)
Chemical Analysis Report by San Rafael Chemical Services for Elight
First page (2009)
Second (2009)
Third (2009)
Toxicology testing of NJoy & Smoking Everywhere cartridges
Nicotine is present in both products. The Smoking Everywhere Electronic Cigarette cartridges listed as containing no nicotine in some cases had very low amounts of nicotine present. Tobacco specific nitrosamines and tobacco specific impurities were detected in both products at very low levels. DEG [diethylene glycol] was identified in one cartridge, Smoking Everywhere 555 High.
US FDA (2009)
Technical Review and Analysis of FDA Report: “Evaluation of e-cigarettes”
... the report “Evaluation of e-cigarettes” suffers from several limitations, that taken together result in it failing to adequately support the FDA claims of potential adverse health consequences from the use of NJOY e-cigarette products tested as compared to other FDA-approved nicotine containing products.
Exponent Health Sciences (2009)
Certificate of Analysis for Totally Wicked ESmoking Liquid
Scientific Analysis Laboratories Limited (2009)
Characterization of Liquid “Smoke Juice” [Johnson Creek] for Electronic Cigarettes
A liquid “smoke juice” formulation used in electronic cigarettes was tested by gas chromatography mass spectrometry (GC-MS) to identify the ingredients in the mixture and their relative concentrations. In addition, vapor produced from an electronic cigarette containing this smoke juice was assayed to compare the relative smoke composition to that of the liquid.
Alliance Technologies (2009)
Analysis of Components from Gamucci Electronic Cigarette Cartridges
On balance, the Gamucci Ltd ‘Regular’ nicotine solution appears to offer a much safer alternative to the traditional cigarette.
Using this nicotine solution, the artificial smoke generated by the Electronic Cigarette does not appear to contain the toxic cocktail of toxic carcinogenic compounds found in traditional tobacco smoke. Some 600+ chemicals have been identified in traditional tobacco smoke, of which many are carcinogenic.
The primary aerosol forming solvent (Propylene Glycol) used in the preparation of the nicotine solution is listed as a suspected respiratory toxicant. should look at changing the aerosol forming solvent from the suspected respiratory toxicant ‘Propylene Glycol’, to an even safer solvent such as Glycerol.
LPD Laboratory Services (2009)
Characterization of Regal [Inlife] Cartridges for Electronic Cigarettes
A liquid formulation used in electronic cigarettes was tested by gas chromatography mass spectrometry (GC-MS) to identify the major ingredients in the mixture and their relative concentrations. In addition, vapor produced from an electronic cigarette containing this product was assayed by GC-MS and gas chromatography with a flame ionization detector (GC-FID) to compare the relative smoke composition to that of the liquid. Propylene glycol, ethylene glycol and nicotine were observed in this product but diethylene glycol was not.
Alliance Technologies (2009)
Characterization of Regal [Inlife] Cartridges for Electronic Cigarettes – Phase II
A liquid formulation used in electronic cigarettes was tested by gas chromatography mass spectrometry (GC-MS) to identify and determine relative concentrations of 4 Tobacco Specific Nitrosamines (TSNAs) and 8 Tobacco Specific Impurities (TSIs). The 4 nitrosamines were N-Nitrosoanabasine (NAB), NNitrosoanatabine (NAT), N-Nitrosonornicotine (NNN) and 4-(Methylnitrosoamino)- 1-(3-pyridinyl)-1-butanone (NNK). The 8 Tobacco Specific Impurities were Nicotine 1 –oxide, Myosmine, Anatabine, 1-Methyl-3-nicotinoylpyrrolidine, Nornicotine, Anabasine, β-Nicotyrine and Cotinine. None of the TSNA compounds were found in this sample, but 2 of the 8 TSI’s were found.
Alliance Technologies (2009)
Analysis for Hertfordshire County Council on ecig.co.uk liquid
One bottle of “e-Juice XX HIGH 36mg/ml rated Nicotine Solution” was supplied for analysis by “Hertfordshire Trading Standards” to confirm the components currently found within the Nicotine Solution formulation, and consider what is the appropriate Legislation for dealing with the product.
Solutions of this type can be used in an electronic cigarette which replicates the action of smoking, producing a tobacco aromatized smoke which when inhaled quickly delivers the nicotine to the lung.
The Electronic Cigarette cartridges do not contain “Tobacco” as such, but are formulated using a refined tobacco leaf extract, where the extract used in manufacture may typically contain >= 95% Nicotine. The ES cartridges should therefore be exempt from the current Tobacco Legislation.
Nicotine is classified as a poison and is on the “Poisons List A”, however, there are “No special restrictions to any purchasing group”. It is therefore appropriate to deal with the ES cartridges under the CHIP Regulations.
LPD Laboratory Services (2009)
Chemical Composition of “Instead” Electronic Cigarette Smoke Juice and Vapor
Two different liquid formulations (Instead Zero and Instead High) used in electronic cigarettes were tested by gas chromatography with a flame ionization detector (GC-FID) to identify the major ingredients in the mixture (nicotine, glycols, and glycerin) and their relative concentrations. In addition, vapor produced from an electronic cigarette containing each formulation was also assayed with GC-FID to compare the relative smoke composition in the vapor to that of the liquid. Propylene glycol, nicotine and glycerin were observed in the high formulation for both liquid and vapor, but diethylene glycol and ethylene glycol were not. Only proplylene glycol and glycerin were observed in the Blue Zero formulation for both liquid and vapor samples. An estimate of the nicotine content was found to be 1.3% in the product.
Alliance Technologies (2009)
Liberty Stix Analysis
Propylene glycol and nicotine were the major components detected from the vapor/fog of a lighted cigarette.
Evans Analytical Group (2009)
Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol
Ruyan® e-cigarette is designed to be a safe alternative to smoking. The various test results confirm this is the case. It is very safe relative to cigarettes, and also safe in absolute terms on all measurements we have applied. Using micro-electronics it vaporizes, separately for each puff, very small quantities of nicotine dissolved in propylene glycol, two small well-known molecules with excellent safety profiles, – into a fine aerosol. Each puff contains one third to one half the nicotine in a tobacco cigarette’s puff. The cartridge liquid is tobacco-free and no combustion occurs.
Health New Zealand Ltd (2008)
Analysis for The Electronic Cigarette Co (UK) Ltd [TECC]
On balance, the nicotine solution cartridges appears to offer a much safer alternative to the traditional cigarette. Apart from the required toxic Nicotine, the samples tested appear to be fairly clean and free from other potentially toxic chemicals.
Using this type of nicotine solution, the artificial smoke generated by an Electronic Cigarette would not appear to contain the toxic cocktail of toxic carcinogenic compounds found in traditional tobacco smoke. Some 600+ chemicals have been identified in traditional smoke tobacco, of which many are carcinogenic.
The primary aerosol forming solvent (Propylene Glycol) used in the preparation of the nicotine solution is listed as a ‘suspected respiratory toxicant’.
‘The Electronic Cigarette Co (UK) Ltd’ should look at changing the aerosol forming solvent from the suspected respiratory toxicant ‘Propylene Glycol’, to an even safer solvent such as Glycerol.
LPD Laboratory Services (2008)
Super Smoker toxicity report
from the toxicology laboratory, Catholic University Leuven (2007)
Crown7 Materials Characterization Report by Analyze Inc (2007)
