What Are E-Cigarettes? Are They FDA Approved & Safe?

    The effects of combustible cigarettes on health are quite devastating. The use of combustible cigarettes is responsible for approximately 480,000 deaths in the United States per year due to tobacco-related cancers, strokes, heart disease and emphysema. So, are you curious what e-cigarettes are?

    To encourage smokers to quit the use of cigarettes, or at least decrease the health effect of combustible cigarettes, e-cigarettes and ENDs (electronic nicotine delivery system) products have been considered as a less harmful alternative for nicotine delivery. For ease of use, ENDs are manufactured to look like conventional cigarettes, cigars, or pipes.

    E-cigarettes are battery-powered devices that work by heating a liquid mixture of nicotine, fruity flavoring, propylene glycol, vegetable glycerin and other ingredients to produce an aerosol, known as vapor, instead of the traditional smoke from tobacco products. Some of the ENDs products include vapes, vaporizers, vape pens, electronic cigarettes, or e-cigarettes. These products are non-combustible tobacco products and make use of a liquid that is heated to create the aerosol that the user inhales. The use of e-cigarettes is commonly called “vaping.” Vaping is a popular trend among young adults, making it the most popular form of tobacco use in the United States.

    E-cigarettes come in different shapes and sizes; some are made to look like the regular traditional cigarette and cigars, while others resemble USB sticks and the everyday pens. Unlike the traditional cigarettes that come in just tobacco and menthol flavor, e-cigarettes come in a variety of flavors such as vanilla, strawberry, apple, to suit the taste of the user and there has been rising concern about its use in young people as a single refill contains as much nicotine as 20 cigarettes.

    While ENDs products will help to significantly reduce the addiction and burden of cancer and other health issues associated with combustible cigarettes, its use may give rise to a new wave of addiction, especially in young adults. The major appeal of e-cigarettes among young people is the wide selection of flavors.

    Classification Of E-Cigarettes

    The 2007 introduction of e-cigarette products was designed to look like regular cigarettes. Over time, there was an evolution to the aesthetics of e-cigarettes introducing diversity in the shape, size and look of these ENDs products. This led to the classification of e-cigarettes into the first, second and third generation described below.

    A first-generation e-cigarette looks like a conventional cigarette; it is disposable after a single-use. A second generation e-cigarette is usually pen-shaped, called vape-pens, larger than the first generation, and can be recharged. A third-generation is quite different, as it does not resemble regular cigarettes and often larger, with modified batteries. These devices are reusable, refillable and some parts of it can be replaced.

    Component Of E-Cigarettes

    E-cigarettes are made of multiple parts. These include:

    – Mouthpiece: inside this mouthpiece is the spot that comes in contact with the smoker. It is a plastic cup containing material. The mouthpiece is fixed to the end of a tube

    – Atomizer: this is where the liquid is heated and the vapor is released to the user to be inhaled

    – Battery: this provides power to be able to fascinate the heating element

    – Sensor: when the device is sucked on by the user, the sensor activates the heater

    – Solution: this is the liquid and the main component of the e-cigarette. Sucking on the mouthpiece results in vaporization by the heating element, that the user then vapes or inhales

    Chemical Compositions Of E-Cigarettes

    The chemical composition of the liquid usually varies from one manufacturer to the other; however some of the well-known compositions include:

    – Nicotine: this is a highly addictive product and the major compound in an e-liquid. Its use in pregnant women has been associated with developmental injury in growing fetuses. It also affects the development of the brain of individuals below the age of 25

    – Propylene glycol: an anti-freezing agent, which is also used in food preservation. It can also be used as an artificial smoke in fog machines and as a paint solvent. Other compositions include ethylene glycol, polyethylene glycol, glycerol and concentrated flavors. Although considered less harmful to smoke from regular cigarettes, the aerosol of e-cigarettes contains some carcinogenic particles, which includes acrolein (a herbicide, also known as a weed killer. Its use can result in irreversible lung damage), carcinogens (which includes formaldehyde and acetaldehyde), diacetyl (this is linked to a condition called “popcorn lungs” or bronchiolitis obliterans), diethylene glycol (a toxic antifreeze chemical which is also linked to lung cancer), benzene (a volatile compound found in car exhausts). 

    The absence of tar in e-cigarettes, compared to regular cigarettes, has made it seem a lot safer. However, it still contains some heavy metals such as cadmium, which is a metal found in traditional cigarettes and causes breathing problems and disease. Other heavy metals include tin, lead and nickel.

    Health Effects Of E-Cigarettes

    The long term effect of the use of ENDs and the e-cigarette is largely unknown and it is not clear if they are truly effective in helping addicted adults quit the smoking of traditional cigarettes, but it is known to contain a lower level of toxic substances as compared to traditional cigarettes. In fact, research in 2016 found that the use of e-cigarettes does not make traditional tobacco smokers quit; rather, they resort to “dual-use”, using both the traditional combustible tobacco cigarettes and e-cigarette.

    Although some e-cigarettes have been marketed as containing zero nicotine, a trace quantity of nicotine has been found in it. Nicotine of course is highly addictive and has been shown to affect pregnant women and developing fetuses. It can also be toxic to the developing brain of young adults up to 25 years old, especially in areas of the brain responsible for attention and learning. Acute toxicity can also result from nicotine exposure in young children. The use of nicotine can also result in emotional disorder and impulse control. Vaping or the use of e-cigarettes in a 2019 statistics was linked to severe lung disease cases and by February 2020, 68 deaths were attributed by the Centers for Disease Control and Prevention (CDC) to the use of e-cigarettes. New research also suggests that the users of e-cigarettes are at increased risks for asthma and chronic obstructive pulmonary disease (COPD). The use of e-cigarettes can also cause serious unintended injuries as a result of defective e-cigarettes batteries exploding during charge. For non-smokers, the use of e-cigarette can pose a serious health risk. Caution should be taken if exposed to the use of e-cigarettes in enclosed spaces, as bystanders can also inhale the aerosol. 

    Effects Of E-Cigarettes On Pregnancy

    During pregnancy, it is advised to quit all kinds of tobacco products, including the use of e-cigarettes. The aerosol of e-cigarettes is considered to contain less harmful ingredients compared to other tobacco products, especially regular cigarettes and is also not safe for use. The use of e-cigarettes is contraindicated during pregnancy as the product still contains nicotine, which can be harmful to both mother and child, interfering in the proper development of the brain, lungs, heart and immune system of the fetus. Research also suggests that vaping affects the implantation process of a fertilized embryo despite the presence of a high level of progesterone- also known as “pregnancy hormone” and is responsible for sustaining a healthy pregnancy.

    Are E-Cigarettes FDA Approved?

    E-cigarettes are classified by the (Federal And Drug Administration) FDA as tobacco products. FDA, along with the CDC has been working tirelessly to provide answers to the question about ENDs products, to educate the public on its use,  to develop the guidelines for  safety and overall enforcing the law, designed especially to eliminate its use in the hands of kids. Although considered less harmful, e-cigarettes are not currently approved by the FDA to help quit smoking. There is no sufficient evidence to support its use in pregnant smokers, despite many adults who have however reported the use of e-cigarettes in a bid to stop smoking.

    The US FDA is yet to determine the safety of vaping and the incidents of respiratory illness associated with its use. Touted as a healthier choice as compared to the traditional combustible cigarettes, e-cigarettes have resulted in the rapid rise of nicotine addiction in young adults of middle and high school age due partly to the irresponsible act of the manufacturers who targeted young people in their marketing.

    Restricting The Access Of E-Cigarettes To Young Adults

    On August 8 2016, sales of e-cigarettes and other ENDs products to people below the age of 18 were made illegal in the United States. Retailers were taxed with the responsibility of requiring age verification before selling tobacco products to individuals under the age of 27. A ban was also placed on the distribution of free tobacco samples and also banned from being sold in vending machines. The age of e-cigarettes and ENDs products were later reviewed on December 20 2019 and raised to 21 years old.

    Keeping a close watch on the manufacturing, import, packaging and distribution of e-cigarettes, ENDs products and its components, the FDA has issued more than 1,100 warning letters by September 2018 to both online and offline stores for sales of the tobacco products to minors. At the beginning of 2018, a law was passed stating that all “covered tobacco products” should have a warning about nicotine addiction. Shops and stores where the e-liquid nicotine is created, modified, or mixed are considered legally as both manufacturers and retailers and therefore required to fulfill the responsibility of both roles.

    Regular inspection of the manufacturing facilities is also routinely carried out to ensure that the manufacturer is complying with the regulations set aside by the FDA. 

    To further discourage the use of tobacco products among the youth and particularly teenagers, the FDA created a Youth Tobacco Prevention Plan which aims to educate the young adults about the possible dangers of the viral trend of using e-cigarettes.

    Marketing Of E-Cigarettes Targeted At Young Adults

    There is no clear regulation on the marketing of e-cigarettes, unlike the limitations of marketing of other tobacco products. It is concerning that companies target two major consumer groups, namely students and young adults. Vaping is made to look like a “cool” new activity that is “the in” thing to do, in order to become socially acceptable. These companies particularly make advertisements that appeal to students and non-smokers, by giving a false notion that smoking allows for an independent lifestyle. E-cigarettes manufacturing companies claim to help adults quit smoking by simply encouraging adults to “make the switch”, as a way to appear mature and trendy.

    What Research Says About E-Cigarettes

    Research on the effect of e-cigarettes is inconclusive. However, several studies on animals carried out have provided some insights into the possible long term effect of e-cigarettes use. Mice were exposed to an aerosol of e-cigarettes for a period of time and then their lung samples were taken and tested. A slide of mice lung tissue shows the macrophages (immune cells) clogged with fat. The macrophages not only help the body fight infection, but it also helps to dissolve the lungs surfactant which coats the lungs and facilitates gas exchange. Vegetable glycerin and propylene glycol contained in e-liquid, effectively dissolves the lung surfactant recycled by macrophages. Further experiments revealed that although the affected mice still seemed healthy, their ability to fight off infections when exposed to the flu virus, reduced drastically.

    ENDs products and e-cigarettes have only been around for a decade. There is no conclusive research on its use and long-term health effect, especially in pregnancy. There is however data to support that use of ENDs products and e-cigarettes are associated with respiratory illnesses and lung disease. Its alarming use amongst young people is a cause for concern, as it can result in nicotine addiction, which affects the brain development of individuals below the age of 25. The FDA has placed strict regulations on the manufacturing, marketing and distribution of ENDs products and its components.

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