When electronic cigarettes first came about they became a big hit and a useful
tool for people to quit smoking. However in 2019, a puzzling lung condition
came up that predominantly affected young people, particularly those that
vaped. This ultimately left many questioning the safety of e-cigarettes.
Named e-cigarettes/vaping use-associated lung injury or Evali for short. The
average age for those affected by this mysterious condition was 24 years.
Respiratory complaints, such as a cough, shortness of breath and chest pain, as
well as stomach problems, fever, chills and weight loss were amongst the
common symptoms reported associated with this condition.
After some considerable investigated it is now known that Evali is not caused
by regulated commercial nicotine e-cigarettes. Instead, the condition has been
linked to products sold as THC-containing e-liquids. THC (Tetrahydrocannibinol) is the active ingredient in cannabis and is expensive that some sellers were cutting their products with vitamin E acetate to make the e-liquid look like it contained more THC than it did. Vitamin E acetate although an ingredient in some foods and skincare products it is harmful when inhaled.
Once the risk from vitamin E acetate was identified, cases of Evali declined dramatically. But this hasn’t changed many people’s perception of e-cigarettes, with many still concerned about their safety and hesitant to try vaping.
Concerns about the dangers of e-cigarettes, in part because of Evali is still being discouraged for people who want to start vaping to quit smoking despite
statements from Public Health England and the US Centers for Disease and
Control Prevention who state that e-cigarettes have the potential to benefit
smokers who switch to vaping.
There has been some confusion where most people thought that Evali was
linked to specific types of nicotine e-cigarettes and not to cannabis or THC-
containing products. Despite all this in recent surveys nearly half of US and a
third of British respondents considered nicotine e-cigarettes to be as harmful if
not more harmful than normal cigarettes.
Just as COVID began dominating the news cycles the many misconceptions
about the safety of e-cigarettes and the confirmation of the cause of Evali was
little to be heard. And until now many discussions on e-cigarettes have only
focused on the risk to young non-smokers. This means the potential benefits of
e-cigarettes to people who smoked and those around them are often ignored.
Research shows nicotine e-cigarettes can aid people to quit smoking and may
be more effective than nicotine-replacement therapy. In studies testing e-
cigarettes as a way to quit smoking, there was no actual evidence that people
using e-cigarettes were more likely to experience serious health issues. Second-
hand smoke from cigarettes kills 1.2 million people per year whereas e-
cigarettes are thought to pose few risks to bystanders.
It’s also worth noting that e-cigarettes typically only contain nicotine, not
tobacco, which is found in cigarettes. Although nicotine is an addictive
substance, tobacco smoke contains carbon monoxide, tar and toxic chemicals –
including benzene, arsenic and formaldehyde. These are the substances that are typically known to cause cancer and other heart and lung diseases. The harm from cigarettes largely comes from burning tobacco – not from the nicotine. E-cigarettes deliver nicotine without burning anything.
There is still a lot of uncertainty around e-cigarettes long term effects given that
they haven’t been around for long so it is very unlikely that they are completely
The liquid and vapour used in e-cigarettes contain some potentially harmful
chemicals also found in cigarette smoke, but at lower levels. In addition, there
are concerns about the effect of nicotine on the adolescent brain development.
Although, as pointed out in a recent paper, studies showing that nicotine causes
changes in the brain have only been tested on animals. The authors of the paper article argue it is still unknown whether the same effect will be seen in humans. There are also worries that e-cigarettes could be another pathway to nicotine addiction – especially if people who would never have started smoking begin vaping.
In reality, because e-cigarettes are relatively new, uncertainty about their
longer-term effects will undoubtedly persist for some time.
What we do know is that smoking excessively harms people from
disadvantaged groups, including those from lower-income groups and people
with mental health conditions. Not only is smoking linked to many harmful
diseases, it’s also killed more people than COVID – infact the numbers are around 720,000 deaths in the US since March 2020. The evidence we have so far shows that e-cigarettes can be an effective way to help people successfully quit smoking – and are likely to have far fewer health risks than cigarettes. When we communicate about the risks of e-cigarettes, we need to be clear about which e-cigarettes, who might be at risk, and who might benefit the most. The people who stand to benefit the most from vaping – mainly people who smoke – have a right to be receiving accurate, evidence-based information, too.