LITERATURE REVIEW

Electronic cigarettes (E-Cigs) are rising in popularity around the world as an alternative
to traditional smoking 1. E-Cigs are often hailed as being a safe way to ingest nicotine without
the risks associated with cigarette smoking 1. E-Cigs produce a vaporized form of nicotine by
heating propylene glycol or vegetable glycerol until they become aerosolized, and along with
them the nicotine and any added flavorings 2. The vapor is then inhaled, alongside nicotine 2.
Although many people use E-Cigs as a means of quitting their smoking habits, E-Cigs
do not decrease nicotine dependence 1. In fact it appears that E-Cigs are just as addictive as
traditional cigarettes 1. The primary population using E-cigs are college students, making up
more than a quarter of the E-cig smokers 1. Although the risk associated with E-Cigs appears to
be low, the long term risks are not yet known 3.
In contrast, traditional cigarettes have been well established to have negative health
effects 4. Traditional cigarette use is associated with cancer, cardiovascular disease, and all-
cause mortality 4. Furthermore, cancer mortality remains even after smoking has been
suspended, although the risk of cardiovascular disease was reduced 4.
According to a study done by Staudt et al, (2018) acute inhalation of E-Cig aerosols
dysregulates normal human lung homeostasis in a limited cohort of healthy never-smoked
individuals (n=10). Subjects inhaled 10 puffs of E-Cig (4 to 24 mg nicotine per puff), waited 30
min, then another 10 puffs; n = 7 were randomized to E-Cig with nicotine and n = 3 to E-Cig
without nicotine to assess biological responses in healthy, naive individuals. These observations
have implications to new E-Cig users, nonsmokers exposed to secondhand EC aerosols and
cigarette smokers using E-Cigs to quit smoking. 5
News coverage of e-cigarettes can give conflicting information that may shape public
perceptions. Participants who viewed negative headlines reported increased beliefs about
harms (B=0.164, p=0.039) and lower beliefs about benefits of e-cigarette use (B=-0.216,
p=0.009), compared with those in the positive headlines condition (n= 2056). 6
Future: Health professionals should be cautious recommending E-Cigs over traditional
cigarettes. Additional studies must be completed to determine the safest use patterns to lower
risk to airway biology. 5 Free e-cigarettes were not superior to usual care (P=0.20) or to other
free cessation aids (P=0.43). The addition of e-cigarettes did not provide a benefit as a
cessation aid. 7
References:

1.Qanash S, Alemam S, Mahdi E, Softah J, Touman A, Alsulami A. Electronic cigarette

among health science students in Saudi Arabia. Annals of Thoracic Medicine.
2019;14(1):56. doi:10.4103/atm.atm_76_18.

2. Vansickel AR, Eissenberg T. Electronic Cigarettes: Effective Nicotine Delivery After

Acute Administration. Nicotine & Tobacco Research. 2012;15(1):267-270.
doi:10.1093/ntr/ntr316.

3. Notley C, Ward E, Dawkins L, Holland R. The unique contribution of e-cigarettes for

tobacco harm reduction in supporting smoking relapse prevention. Harm Reduction
Journal. 2018;15(1). doi:10.1186/s12954-018-0237-7.

4. Jones MR, Tellez-Plaza M, Navas-Acien A. Smoking, Menthol Cigarettes and All-Cause,

Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition
Examination Survey (NHANES) and a Meta-Analysis. PLoS ONE. 2013;8(10).
doi:10.1371/journal.pone.0077941.

5. Staudt MR, Salit J, Kaner RJ, Hollmann C, Crystal RG. Altered lung biology of healthy
never smokers following acute inhalation of E-cigarettes. Respiratory Research.
2018;19(1). doi:10.1186/s12931-018-0778-z.

6. Tan AS, Lee C-J, Nagler RH, Bigman CA. To vape or not to vape? Effects of exposure
to conflicting news headlines on beliefs about harms and benefits of electronic cigarette
use: Results from a randomized controlled experiment. Preventive Medicine.
2017;105:97-103. doi:10.1016/j.ypmed.2017.08.024.

7. Halpern SD, Harhay MO, Saulsgiver K, Brophy C, Troxel AB, Volpp KG. A Pragmatic
Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation. New England Journal
of Medicine. 2018;378(24):2302-2310. doi:10.1056/nejmsa1715757.