Electronic cigarette: wolf in sheep's clothing.
Myths and truths about Electronic Cigarettes and Electronic Smoking Devices
The World Health Organization (WHO) considers smoking an important public health problem and one of the main preventable causes of death.
Many smokers, when asked about their addiction, state that if they could go back in time, they would not have started smoking and that they would like to quit, but that they have great difficulty in quitting and/or remaining abstinent.
One of the factors that make smoking cessation difficult is nicotine dependence. In this context, a Chinese pharmacist named Hon Lik created the electronic cigarette as a form of nicotine replacement. The commercialization of these electronic smoking devices has been disseminated through the internet and also by direct sale to consumers in several countries, even in locations where this is prohibited by law.
The growing use of these devices, especially by adolescents, has generated a lot of concern and to talk about this subject, the 7th International Freemind Congress brought Dr. Paulo Corrêa, who is a Pulmonologist, president of the Smoking Commission of the Brazilian Society of Pulmonology and coordinator, in Brazil, of a process to prevent smoking initiation in young people called Education Against Tobacco.
With a lecture entitled: Electronic cigarette: wolf in sheep's clothing. Myths and truths about Electronic Smoking Devices, dr. Paulo brings relevant information that shows that there are still many studies on the subject, but that what we already have clearly shows the risk involved in the use of this equipment and the lies that the industry has used to promote its products.
Here's some of what he said. You can also watch the lecture in full at https://bit.ly/3dsU3eB and download the presentation from the Freemind website.
To begin with, we need to know how to call electronic devices to smoke, as this changes depending on the language and countries. In English, they are known as electronic nicotine delivery systems and are abbreviated as ENDS. Americans also call them personal vaporizers or advanced personal vaporizers and in Spanish-speaking countries they usually call electronic nicotine delivery systems with the abbreviation SEAN and, in Brazil, we know them as DEFs.
Many people started using electronic cigarettes thinking that "smoking a backyard product" was acting against the tobacco industry. But what happens in reality is that the big tobacco industries, such as Phillips Morris, British American Tobacco and others, have already bought the home e-cigarette industries and they predict that in 2023 the sales of e-cigarettes will reach the same level as conventional cigarettes and that the profitability of conventional cigarettes will fall, while that of electronic cigarettes will rise.
In 2014, the California Department of Public Health already stated that the aerosol in e-cigarettes was not just water vapor, but contained at least 10 chemicals in its composition and that they could cause cancer, birth defects or other reproductive harm.
In 2019, an article published in Mexico's Revista de Investigatión Clínica already stated that more than 80 compounds (including known toxicants, e.g., formaldehyde, acetaldehyde, metallic nanoparticles, and acrolein) were found in e-liquids and aerosols.
Most existing studies investigating e-cigarette exposures sought to quantify specific and known constituents in e-liquids, especially those present at high levels in combustible cigarettes, such as tobacco alkaloids, polycyclic aromatic hydrocarbons, and formaldehyde.
Another article, published in 2021 in the journal Chemical Research in Toxicology, brings a seminal study showing an undirected analysis to explore the full range of chemicals, both in e-liquid and in DEF aerosols, using the liquid chromatography method – high-resolution mass spectrometry (LC-HRMS) + chemical fingerprinting.
The researchers used four popular brands for the study – Juul, Vuse, Blú – which are the cigarettes that sell a lot in the United States and are in the hands of large companies, and the nicotine salt, known as Mi-Salt.
The result showed that caffeine was detected in samples of 2/4 commercial e-cigarettes products analyzed: e-liquids and/or Vuse and Mi-Salt aerosols (Smok), in addition to also identifying 3 industrial chemicals and a pesticide, in a total of almost 2,000 chemicals - most of them unidentified!!
Another factor to take into account is the nanoparticles. Before, it was said that the cardiovascular risk of conventional cigarettes had to do with carbon monoxide. Conventional cigarettes have a mass of very small particles that are like a million times thinner than a strand of hair and that are called nanoparticles - 10-9m.
When you increase the amount of nicotine, as in Juul or Suorin cigarettes, for example, that top curve you have an increase in the mass of nanoparticles, which are biologically active and trigger inflammatory processes, being responsible for an acute cardiovascular risk, with the possibility of angina, heart attacks and strokes.
By studying the dose-response effect of exposure, it was possible to verify that a small increase in nanoparticles promotes a large increase in cardiovascular risk.
Demystifying the myths related to DEFs:
Myth 1 – "It's just water vapor"
In conventional cigarettes it is already known that there are more than 7,000 chemical substances and it was possible to see from the studies presented that electronic smoking devices have about 2,000 chemical substances (for now!).
So: "is it just water vapor?" This is a LIE!
Myth 2 – "False distinction between smoking and vaping"
Several advertisements use appeals stating that electronic cigarettes are healthy, that they do not disturb the environment, that they have no side effects, that they do not cause the smoker to cough, etc. See that this is the same advertisement that the conventional cigarette industry did 92 years ago, in 1930.
It is not true that there is no combustion: Studies prior to Prasse's detected the combustion-related byproducts of benzene and toluene in e-cigarette aerosols.
Observations of changes in H/C ratios and hydrocarbon-like condensate content after the use of DEFs suggest that combustion-like processes occur during the use of DEFs, despite temperatures lower than combustible cigarette smoke.
If it has hydrocarbon, it has combustion! So is there a distinction between smoking and vaping? No! So, myth 2 is a lie!
Myth 3 – "It's treatment to quit smoking"
And here, our myth 3: the industry says that it is a treatment to quit smoking - it is a lie!! Electronic cigarettes are cigarettes! It is not a treatment to be able to quit smoking!
Hon Lik himself, who created the electronic cigarette to quit smoking, says that he is a dual user - he continues to smoke conventional cigarettes in addition to electronic cigarettes, even after selling his company to Imperial Tobacco.
A recent article from April 2022 brings global evidence compiled by the Australian government showing that people who have never smoked and who use DEFs are three times more likely to try conventional cigarettes and to become regular smokers of conventional cigarettes; So this should be a big concern, because these are people who didn't smoke and who are being attracted to vapes.
Myth 4 – "Those who start smoking vape do not smoke conventional cigarettes"
Our myth 4 is that those who start smoking vape do not smoke conventional cigarettes: It's a lie! Early smoking initiation was associated with several bad things: heavy daily consumption, longer duration of smoking, greater nicotine dependence, and lower cessation success.
Breslau, in a famous work published in the American Journal of Public Health, showed something extremely worrying: the earlier you start smoking, the greater the difficulty in quitting smoking. So, the fact that electronic smoking devices have very attractive aspects (some looking like lipsticks, colored and others very feminine, for example) is something very worrying.
Another interesting study , published in Pediatrics, showed that the use of electronic devices in early adolescence carries a risk of dual use of tobacco and marijuana in mid-adolescence, that is, it is a gateway: the moment you learn to smoke, you start smoking other things.
Myth 5 – "Vaping Doesn't Produce Second-Hand Smoke"
The secondary current is formed by the smoke that the smoker exhales and 85% comes out of the end of the lit cigarette (side smoke). Now that it is known that the e-cigarette aerosol is produced by combustion at temperatures lower than those that occur in conventional cigarettes, and that they are full of volatile organic compounds, it is impossible to agree with the industry that says that there is no second-hand smoke in the use of electronic smoking devices.
So, myth 5 that vaping doesn't produce second-hand smoke is a lie!
Myth 6 – Vaping Doesn't Produce Third-Hand Smoke (THS)
Tertiary smoking happens when the smoker uses conventional cigarettes or electronic cigarettes, and the substances present in nicotine and smoke are deposited on the furniture, exposing pets and children, for example. You have exposure both through the skin and, for example, when a child who is playing with a toy, puts it full of tobacco chemicals in his mouth and swallows it. It can also occur when a window is opened and the deposited particles are resuspended.
Then Vaping doesn't produce third-hand smoke? It's a lie!
Conclusions:
- It's not just steam water – it's almost 2,000 chemicals
- The distinction between smoking and vaping is false: electronic cigarettes are cigarettes
- Non-smokers who use DEFs are 3X more likely than non-users to become regular smokers of conventional cigarettes
- Electronic cigarette is NOT cessation treatment
- Vaping ProducesS-econd-Hand Smoke and THS
