ELECTRONIC CIGARETTE OVERVIEW
All e-cigarettes operate on a fairly simple principle: A liquid is converted to a vapor through the process of heating it. A battery sends an electric current to a wad of liquid-soaked wicking material that is tightly wrapped with a metal coil. Sending current to the coil causes the coil to heat up, much like a burner on an electric stove. Once the coil becomes hot enough, the liquid that is in contact with the coil also begins to heat up, eventually to the point the liquid becomes converted to a vapor. This vapor is then puffed or inhaled from the device. Because e-cigarette users are inhaling a vapor and not smoke, they often refer to themselves “vapers” to distinguish themselves from tobacco cigarette users.
E-cigarettes come in all shapes and sizes and can be roughly categorized according to their simplicity, flexibility, and capacity. Another important distinction between devices is whether they are a closed or open system. Closed system devices cannot be modified by the user. The battery, coil, and chamber holding the fluid are self-contained. The only flexibility is being able to switch fluid cartridges to change flavor or nicotine strength. In contrast, all aspects of open system devices can potentially be changed to suit the user.
Image courtesy of Clive Bates
1st Generation Devices
Because e-cigarettes were originally designed as a replacement product for traditional cigarettes, the early versions were deliberately made to resemble tobacco cigarettes. The most basic design in this class is the disposable. It is ready to use right out of the package. Everything needed (battery, coil, liquid) is sealed within the device. One only need to begin puffing on it for it to work. Typically good for 200-300 puffs, the device is simply thrown away when it no longer works. Their appearance and simplicity has earned them the nickname cig-alikes. A slightly more complex version of the disposable is the 1st generation device that has a rechargeable battery and replacement cartridges that contain the liquid. Most of the e-cigarettes in this class are considered closed systems.
2nd Generation Devices
These devices are more elaborate versions of the 1st generation devices. They are larger, have more powerful and longer lasting rechargeable batteries, have a tank (which is filled by the user) that can contain more fluid, and in many cases adjust for power level, vapor volume, and fluid type. One of the differences is that 1st generation devices are typically activated merely by puffing on them, while 2nd generation device have a power button that must be pressed to heat the coil. Unlike 1st generation devices, 2nd generation devices offer a larger variety of flavors and nicotine strengths chosen by the user for filling the tank. Because users can open the device and change the characteristics of how it operates (e.g., use a different style of coil, use a preferred liquid) these devices, and those listed below, are generally considered open systems.
3rd Generation Devices
These devices are the most powerful and flexible of all. Gone is any resemblance to a cigarette. The batteries come in a variety of shapes and sizes and are more powerful and longer lasting. The tank systems tend to be larger, requiring refilling less often. Third generation devices are preferred by hobbyists because they can customize their vaping experience. By controlling the battery power settings and the type of coil and wicking materials, the user can manipulate more precisely the flow, thickness, and volume of vapor produced.
Beyond the 3rd Generation
Once the forms became unlimited, new innovations began to appear. These innovations significantly improve power management and achieve temperature control, which reduces dramatically the problem of dry hits, a nasty tasting experience that comes from burning the wicking material because the liquid is used up or vaporized too quickly. Other safety innovations, such as reverse polarity, better battery quality, device over-temperature protection, and sophisticated digital displays (temperature, volts, watts, ohms) have also been added.
The liquids used in e-cigarettes, no matter what the device, typically include a combination of four main ingredients: propylene glycol (PG), vegetable glycerin (VG), flavorings, and (optional) nicotine. The combination and ratio of these ingredients depend on the preferences of the user.
Propylene glycol (PG) is manufactured in large quantities because it has a wide variety of uses from food products, to drugs, to entertainment. It imparts a little flavor of its own and keeps packaged food from drying out. In many oral and topical drugs it’s used as a stabilizer. In theater productions PG is used to simulate fog. E-cigarette liquids contain PG because it mixes well with flavoring ingredients, and when heated, produces a smoke-like vapor. Because it is a slight irritant, it also mimics the sensation of inhaling cigarette smoke.
With similar properties as PG, vegetable glycerin (VG), which is almost exclusively derived from plants, is widely used as a food additive and in drug manufacture. It also imparts a sweet flavor and helps keep foods moist. It is used in e-cigarette liquids for much the same reason as PG. Because VG is thicker than PG, vapers use an e-cigarette fluid with a higher VG content when they want to exhale vapor plumes that are thicker and more voluminous.
Derived primarily from the tobacco plant (nicotiana tabacum), nicotine acts like a mild stimulant drug, with similar effects and intensity as caffeine. It has long been identified as the “active ingredient” in tobacco that imparts pleasurable effects for the user. It is used in e-cigarette liquid for obvious reasons. E-cigarettes are designed as a low-risk alternative to smoking. Because almost all e-cigarette users are current or ex-smokers who enjoy the effects of nicotine, nicotine is an important ingredient for many of them. A practical advantage over tobacco cigarettes, e-cigarette devices allow users to fairly precisely control the amount of nicotine they use. It should be noted that an estimated 15%-20% of e-cigarette fluid sold contains no nicotine at all and is used for other reasons, like enjoying the flavors or as a non-nicotine substitute for smoking.
Almost all flavoring ingredients used in e-cigarettes are the same ones used to add flavor to food and drinks. There are thousands of flavors and flavor combinations used in the food industry. The same is true for liquids manufactured for use in e-cigarettes. One medium sized company can easily have over 30,000 flavor/nicotine combinations available. Although just about any flavor can potentially used in an e-cigarette, the ones typically used can be broken down into some broad categories: fruit or fruit beverage; candy, soda, pastry; spice or savory; menthol or mint; bitter (coffee, whiskey) and tobacco.
Given the four basic ingredients above, the possibilities are nearly endless. E-cigarette liquids vary widely in their ratio of PG to VG. Industry prevalence is 70% PG to 30% VG which can be used in the widest variety of devices: however, some liquids can contain 30% PG and 70% VG, and still others can be 100% VG. This ratio varies primarily based on the desired amount of vapor a user prefers to produce. High PG ratios generate less vapor and more sensation on inhalation. High VG ratios generate more vapor volume and less sensation in the throat and mouth. Flavor is perhaps the most dominant characteristic of e-cigarette use that people enjoy. The taste is also important for many vapers who are attempting to make the switch from tobacco cigarettes. Although e-cigarettes come in tobacco flavors, these are less preferred by ex-smokers who no longer want to associate their e-cigarette use with tobacco use.
How the devices are used
What people who use e-cigarettes do with the vapor they draw from the devices depends on the person. The most basic puffing technique is similar to cigar smoking. The vapor is drawn into the mouth and immediately blown back out again.
The vast majority of vapers are ex-smokers, so they treat the vapor the same way they did cigarette smoke. For most, this means the vapor is taken into the mouth, and when a sufficient volume is reached, it is then inhaled and blown back out again. This is the most common puffing technique employed by e-cigarette users, and is sometimes referred to as mouth to lung vaping.
A minority of vapers uses a puffing technique that is similar to how a hookah or water pipe is used. In this method, the vapor is inhaled directly into the lungs in one continuous inhale. This technique allows for the maximum amount of vapor to be inhaled and expelled. An advantage of this technique is that because of the larger volume of vapor, more of it crosses the tongue and olfactory areas of the mouth, producing a more intense flavor. Combined with an e-cigarette fluid that has a high proportion of VG, this practice is sometimes used to produce an extremely large volume of vapor known as cloud chasing or volume vaping. This style of vaping typically involves liquids with low levels of nicotine or no nicotine.
A number of surveys have been conducted in the United States and United Kingdom to help characterize which groups of people are using e-cigarettes. These surveys ask different questions, which naturally produce different results. However, the data from these surveys is consistent enough to make some general conclusions. The vast majority of daily e-cigarette users are smokers or ex-smokers. This is unsurprising given the similarity of e-cigarettes to tobacco cigarettes. A large number of daily e-cigarette users are people who used to smoke, but now use e-cigarettes exclusively.
Another large group of daily e-cigarette users are those who also continue to smoke. These people are called “dual users.” The fact that there are a sizable number of dual users is also unsurprising. Some dual users are simply using e-cigarettes in places or situations where smoking is inappropriate, but continue to smoke cigarettes when they are able to. Other dual users are actively attempting to stop smoking, but continue to smoke while they experiment with e-cigarettes. This group usually winds up in one of three categories. Some decide that e-cigarettes are not for them, stop using them, and look for some other way to quit smoking. Some decide they don’t want to quit smoking completely, but see advantages in replacing many of their tobacco cigarettes with e-cigarettes, and continue to be a dual user. And finally, some people experiment with different types of e-cigarettes, find one they like, and quit smoking altogether.
By far, the smallest group of e-cigarette users are those who only use them occasionally (much like the people who only smoke occasionally), people who have been ex-smokers for months or years but try e-cigarettes out of curiosity or because they miss the effects of nicotine, and the smallest group of all (usually around around 1% or less in surveys), people who have never smoked. These people typically don’t inhale, don’t use nicotine, don’t use a tobacco flavor, and merely like the unique non-tobacco flavors of e-cigarettes.
Youth use of e-cigarettes
CASAA supports laws that prohibit underaged sale and urges strict enforcement of these laws. Nevertheless, youth have always had a knack for getting hold of and using products (e.g., cigarettes, alcohol, drugs) they are forbidden to have. The same is true of e-cigarettes. Young people are an especially curious bunch and many, especially those approaching adulthood, are naturally attracted to products and activities that are considered strictly for adults. So it is no surprise that many young people have tried e-cigarettes.
However, accurate estimates of how many underage youth are using e-cigarettes have been overshadowed by media hype, agenda-driven conclusions, and poor scientific methodology. The most common mistake made in youth surveys asks the questions, “Have you ever used an e-cigarette?” or “Have you used an e-cigarette in the past 30 days?” and then counts anyone who answered “yes” as an “e-cigarette user.” Although we may be interested in the number of young people who have ever tried an e-cigarette, these questions don’t distinguish between someone who only tried a single puff on a lark and someone who uses an e-cigarette multiple times daily. Both would answer “yes” to these questions. Asking questions about how often someone uses an e-cigarette gives us a better indication of who might be a “user.” Unfortunately, few surveys asked these more informative questions.
Many health authorities assert that e-cigarette use in youth has the potential to entice them into smoking cigarettes. This assertion is commonly referred to as the “gateway hypothesis”– namely, the notion that because of e-cigarettes, more youth will eventually wind up smoking than if e-cigarettes were not available. Although this idea seems superficially plausible, in truth it’s a fairly extraordinary claim. People quoted in newspaper articles claiming fear or concern about e-cigarettes acting like a gateway to smoking seldom explain the reasoning behind the claim or cite any credible evidence it is occurring. The most common evidence used in support of this idea is that youth who try e-cigarettes are many more times likely to try smoking. It is not at all surprising that someone who would be interested in e-cigarettes would also be interested in smoking, given their similarity, or that teenagers would try both, being novelty-seekers in general. It does not mean that trying one causes someone to try the other. Switching from a pleasant tasting and fragrant noncombustible device to an acrid, smelly, smoky, unhealthy alternative is a highly unusual and illogical sequence of events. In any case, there is no evidence that use of e-cigarettes is causing youth to smoke who otherwise wouldn’t.
Risks to e-cigarette users
Attempting to estimate accurately the health risks of any consumer product (food, beverages, prescription drugs, over-the-counter medications, herbal supplements, etc.) is an enormously complex process that involves reams of data from multiple fields of study and careful scientific analysis. For example, it took decades and thousands of scientific studies to be confident that cigarette smoking posed a significant threat to health. E-cigarettes have been on the market for approximately ten years, and only recently have been used by large numbers of people. This is obviously too short of time to account for all the potential health risks they pose. However, we know enough already about what e-cigarettes contain, how they work, and how they are used, to be very confident that e-cigarettes simply cannot be remotely as dangerous as cigarette smoking. The Royal College of Physicians, in their extensive review of the evidence in 2016, has said “the available data suggest that [e-cigarettes] are unlikely to exceed 5% [of the health risk] associated with smoked tobacco products, and may well be substantially lower than this figure.” The best available estimate of e-cigarette risk would be to compare it to another popular form of non-combustible tobacco use: smokeless tobacco. Strong epidemiological evidence puts the health risk of moist, pasteurized smokeless tobacco (also called snus) used in Sweden and the United States, at approximately 1% as risky as smoking.
Basic e-cigarette chemistry
One need only know a few basic scientific facts to understand why this judgment is correct. Smoking involves taking a solid (tobacco) and turning it into a gas (smoke) through the process of lighting it on fire and burning it (combustion). The combustion process radically changes the chemical composition of tobacco. Many components are destroyed, but thousands of new chemicals are created along with an array of tiny solid particles. Many of these chemicals (and particles) are known to harm the human body. The chemicals, some of which are classified as carcinogens (known or suspected to cause cancer), damage cells in the body, and the tiny solid particles lodge in various areas of the body where they also cause damage. Combustion is the major source of harmful air pollution with vehicles burning gasoline and diesel, homes burning oil or wood to heat them, and factories burning everything from garbage to coal.
E-cigarettes do not involve the process of combustion. A liquid (described above) is heated just to the point of turning it into a gas (vapor). This process alters the chemical composition of the liquid very little. No new chemicals are created and no tiny solid particles are generated. Therefore, the risks of using e-cigarettes must be limited to whatever chemicals already exist in the liquid and the process of turning it into a vapor. This simple comparison, what’s in cigarette smoke versus what’s in e-cigarette vapor, strongly suggests the difference is dramatic in terms of risk to health. However, this comparison gives us only a rough estimate of how risky e-cigarette use is in its own right. To be more precise about the risks of e-cigarette vapor, we need to compare its chemicals against some generally accepted safety standard that tells us what concentration of these chemicals is high enough to suspect risk.
Igor Burstyn of Drexel University reviewed over 9000 different measurements of the chemicals in e-cigarettes from a wide variety of sources. He specifically looked at contaminants associated with a risk to health, and compared the values observed to the standards set for occupational workplace safety. The results showed that the amount of these contaminants an e-cigarette user is deliberately exposed to through vaping, if it were an involuntary exposure in a workplace, taking place over decades, would not justify any attention. Indeed, the values obtained were between 1% and 5% of the levels needed to cause a health concern in a workplace. However, Burstyn was cautious about the common ingredients PG and VG. There is no established level of exposure for these ingredients that represents a threat to health, because before e-cigarettes, inhaling a vapor of PG or VG was such a rare event, there was no need to establish a standard. It is commonly understood that PG and VG are generally benign substances. But only recently have large numbers of people been inhaling them. In other words, we have no good reason to suspect inhaling PG or VG is harmful, but because this is a new kind of exposure, the cautious thing to do is the same thing we do with new drugs that are given to large numbers of people. We watch the users carefully and look for signs and reports to see if any negative health effects are emerging.
Methods of evaluating risk
Although chemical analysis of e-cigarette vapor, and the likelihood that these chemicals are not causing harm, is a solid foundation for evaluating potential risks, the story is incomplete without looking at the effects these devices are having on people in the real world. After all, this is what we are truly interested in. What happens to people when they use e-cigarettes? Scientists have amassed a lot of data that comes from people who use e-cigarettes. This information comes in the form of self-reports (surveys asking about use, symptoms, and other negative consequences as well as positive consequences) and medical data (reports from doctors and other health professionals about what they’ve observed in e-cigarette users). What we’re looking for is a clear pattern of symptoms or illnesses that occur in e-cigarette users, a pattern that is not found in people not using them. Because e-cigarettes have not been around for long, this kind of evaluation can only detect what is called short-term or acute effects.
E-cigarettes have been used by millions of people, some for many years, and no serious health effects have been found. Some people have reported minor symptoms like throat irritation or coughing, but these tend to go away when they continue using e-cigarettes, or by adjusting the ratio of PG, VG, or nicotine level. In contrast, many smokers who have switched to vaping have reported the remission of symptoms like coughing and shortness of breath. Out of the millions of users worldwide, there have been no reports of anyone suffering significant or permanent health damage as a result of using a properly functioning e-cigarette in the way it was intended to be used. (This does not include accidental poisonings or catastrophic device failure like battery explosions. These problems are separate safety considerations. For now, we’re only considering the risks from inhaling e-cigarette vapor on the usual day-to-day basis.) Because this information is based on millions of users, and the near absence of serious problems reported, we can be fairly confident that using an e-cigarette poses few health risks in the short term.
Trying to determine if a new product like e-cigarettes poses long-term risks, the kind that only emerge after decades of use, is a process of making predictions based on incomplete information. It is most certainly possible that in 20 or 30 years e-cigarette use could become identified as causing some negative health outcomes. It is equally possible that no negative health outcomes will be identified, or even that e-cigarettes confer health benefits. How much confidence should we have in either of these predictions? Zero. Because we do not (and cannot) have the information required to have any confidence in them. So what do we do? We start with what we do know and then make some educated guesses about the possible ways e-cigarette use could create long-term risks. For example, one of the things we already know is that when some inert substances are heated to a certain temperature, they can break down into harmful chemicals. If these chemicals have not been associated with short-term harm but are known to cause long-term harm, then we have an educated guess in which we would have more confidence, but only if this process is a common feature of e-cigarettes. If it is, then we have a legitimate scientific hypothesis. The problem with this hypothesis is that it can only be tested with data that we can’t possibly have at present. That is, the only way to know if it’s true is to wait 30 years to see if the predicted harm emerges.
This is the inherent problem in nearly all research studies that try to identify possible routes of long-term harm in e-cigarette use. Assuming these studies are properly conducted (most are not) and they’ve managed to create laboratory conditions that mimic how things work in the complex real world (most do not), and they’ve found something that suggests a possible route to long-term harm, then what they have found is a hypothesis about something that might cause harm. In the media and the press releases of scientists, however, it is strongly implied what they have found is evidence of harm. A hypothesis is not evidence, though.
What we’re seeing in the media today is a series of educated (and many not-so-educated) guesses about the long-term risks of using e-cigarettes. Properly trained scientists know better than to be confused by claims in splashy headlines. They know the results from single studies can only point the way to further research (at best) and can’t be definitive in their conclusions regarding long-term harm. Despite the headlines making unjustified claims of harm, what research really shows is that there is no credible reason to strongly suspect e-cigarettes pose significant long-term health risks, yet. This is not the same as saying it is impossible for there to be any long-term risks (because we can never be sure until long-term use has occurred), only that it appears that long-term risks are unlikely.
This puts e-cigarettes squarely in the same position as other new products released on the market. Consider new prescription drugs, cell phones, and artificial sweeteners. It was fairly clear what these things were and how they worked. No short-term harms were identified, nor were there any convincing reasons to suspect they had a high likelihood of causing long-term harm. So, they were allowed on the market with the full knowledge that it was possible that they could eventually cause some long-term harm. We allow this because there would never be a new drug or product ever released if we had to be certain there would be no long-term risks, and because new products like these stand a high degree of probability of improving people’s lives compared to the potential risks. This is especially true of e-cigarettes: They are not just giving us convenience or a calorie-free way to sweeten our coffee, but they are giving us a way to replace an activity highly dangerous to health.
Risks to bystanders
We know from the Burstyn study how low the risks are for those who directly inhale e-cigarette vapor. Bystanders have far less exposure to e-cigarette vapor for three simple reasons: (1) what an e-cigarette user exhales has less volume than what they inhale because some of the vapor remains inside the body; (2) what the user exhales is immediately diluted by (mixed into) the ambient air; and (3) vapor is made of liquid droplets that evaporate fairly quickly. Using Burstyn’s estimate as a guide, a bystander would have to be in a room with 100 to 1000 e-cigarette users to inhale in one breath a similar amount of vapor an e-cigarette user inhales in a single puff. This makes exposure risks to bystanders virtually zero in any real-life situation.
Risks of using nicotine
Nicotine is one of the most investigated drugs in history. We know a great deal about what this drug is, how the human body processes it, and why it exerts the many psychological and physiological effects that it does. Classified as a mild stimulant drug, nicotine increases alertness, aids in concentration, elevates mood, and in some circumstances can have relaxant effects. Among scientists there is near universal agreement that nicotine is not a particularly harmful drug. It does not cause cancer or significantly contribute to any major illnesses in large numbers of people. However, it cannot be said that nicotine is completely benign. Like all drugs (including aspirin) there is the potential for health risks for those who use it regularly. In healthy adults, the risks are minimal and similar to another mild stimulant drug that is widely consumed: caffeine. However, there are some medical conditions that make the use of mild stimulants more risky. Nicotine affects the cardiovascular system (temporarily increases heart rate and blood pressure) which makes it a concern for people with heart disease. (Caffeine is also discouraged for the same reason.) There is suggestive evidence that nicotine can adversely affect fetal development, so pregnant women should avoid using it. In general, nicotine is not problematic for the vast majority of healthy adults.
Nicotine and addiction
When people use the word addiction they are typically using it to describe something that is undesirable and harmful. We all know of people who have become so involved with using a drug (heroin, alcohol, cocaine, etc.) or engaged in an activity (gambling, excessive shopping, etc.) such that it appears to have completely taken over their lives. They have squandered their health, alienated their family and friends, lost jobs, been in trouble with the law, and have come to financial ruin. Other people, often called heavy users, only suffer some of these consequences, but their drug use or activity is clearly recognized as a problem, at least by others around them.
Now consider the quiet day-to-day use of a low-risk nicotine-containing product. These people go about their lives, using nicotine, while experiencing virtually none of the problems listed above. It should seem odd to you that the word addiction is being used to describe such a wide range of behaviors with dramatically different consequences. So it’s difficult to understand what people are saying when they use the phrase nicotine addiction. What they might mean is that all of these activities appear to involve some loss of autonomy. That is, an addicted person has lost the ability to freely decide to use these drugs or engage in these activities. Words like “dependency,” “loss of control,” or “compulsion” are often used to describe this state.
As one explores these concepts further, they begin to break down and create more questions than answers. For example, if loss of autonomy (i.e., loss of control) is one of the defining features of addiction, then how are some people able to suddenly and completely take control over their addictive behaviors? This commonly happens with all of the drugs and activities listed above. People, without intervention or treatment, just suddenly stop with no obvious outward cause. In the case of cigarette smoking, they are also able to stop temporarily for personal and external reasons, like refraining on the Jewish Sabbath or obeying restrictions on use in certain areas such as movie theaters.
This kind of problem is what makes defining addiction as it might apply to the use of e-cigarettes extremely difficult to sort out. Rather than attempt to define what “nicotine addiction” is, and whether you should take steps to avoid whatever it is, a more practical approach is to examine the likely consequences on your mental state when using e-cigarettes on a day-to-day basis. After all, this what people are actually interested in: what, specifically, they can expect to happen to them if they use e-cigarettes. The vague warning “you might become addicted,” for reasons discussed above, isn’t particularly informative or helpful. We will rely on the anecdotal evidence of our members, the thousands of e-cigarette users we’ve spoken to, as well as the few scientific research papers we’ve seen on the topic to help address this question.
Ex-smokers who have switched to vaping report they feel less attracted to and less dependent on vaping compared to smoking. That is, they feel less craving and fewer withdrawal symptoms compared to when they were a smoker. For those smokers who wanted to quit using nicotine altogether, it is common to report that quitting smoking seemed very difficult, whereas quitting vaping was much easier. Part of the reason for this may be that vaping allows you to slowly reduce your nicotine intake over time to the point where you can simply eliminate it. (Some ex-smoking vapers continue to vape, but no longer use nicotine.) So considering one feature associated with nicotine dependence, you can expect to have some strong desires to use an e-cigarette from time to time, but not as severe or as often as people do when consuming nicotine through the act of smoking.
A key question is how likely are you to be troubled by these occasionally strong desires? How disruptive are they likely to be in your ability to function in life and on your psychological well being? From what we’ve heard and read, the answer is “not very.” Like the person who is dependent on that one glass of wine after work (because they feel uncomfortable and complain if they don’t have it), they might fully admit to having a dependency on it, but in the grand scheme of their life, they aren’t particularly troubled by it. Likewise, we concede there may be something called “nicotine addiction” when it comes to e-cigarette use. But as addictions go, this one seems to have so few negative consequences such that the term is virtually meaningless and therefore not particularly informative or helpful.
E-cigarettes and smoking cessation
Public health and government officials are often quoted claiming “there is no evidence that e-cigarettes help people quit smoking.” The assertion is patently absurd. There are perhaps as many as 1 million e-cigarette users in the U.S. who have used e-cigarettes and now no longer smoke. Thousands of people have reported they have quit smoking because of e-cigarettes in the testimonials section of this website. According to survey data, hundreds of thousands more have been estimated to have done the same. It is mind boggling to claim that hundreds of thousands of people are somehow confused or wrong about how e-cigarettes have helped them become ex-smokers. The people who are not convinced that e-cigarettes help people quit smoking are simply not thinking like good scientists and have a highly biased conceptualization about what smoking is and how people become ex-smokers. They tend to think of smoking as a medical problem akin to a disease for which a cure should be sought. This limits the type of research they find acceptable in determining if e-cigarettes have value in helping people quit smoking.
If you handed out a standardized, one-size-fits-all e-cigarette (as health providers do with nicotine patches) to people who expressed an interest in quitting smoking, you could find out scientifically whether this particular version of an e-cigarettes is an effective stop-smoking aid. This would not answer the real world question of what would happen if e-cigarettes, with all the complex variety noted above, were made generally available to smokers. Would large numbers of smokers, able to freely select the type of device that works best for them, use them to quit smoking? This natural experiment is happening, and the results are conclusive. Yes, people will use them to quit smoking. However, it takes a different kind of research to determine which smoker preferences match well with which kind of device to maximize success.
The world is as complex as the people in it, and it is difficult to understand and completely account for the many factors that may influence someone’s attempt to quit and what factors may lead to success. For example, in a recent CASAA survey of members, 11% of people reported trying e-cigarettes with no intention to quit smoking and wound up quitting in spite of their lack of intention to do so. Because the type of research needed to answer these kinds of questions hasn’t been done, no one can say with any confidence that any one type of e-cigarettes will help any particular person quit smoking. But we urge smokers to consider e-cigarettes because they have worked for a great many people, and cigarette smoking has such heavy health costs, we believe they virtually have nothing to lose by trying.
E-cigarette battery fires and explosions
Lithium ion batteries are used in everything from e-cigarettes, to cell phones, to laptop computers, to the Boeing 787 Dreamliner. What the batteries in all these devices have in common is that they very rarely catch fire or explode. E-cigarettes are a relatively new product, so when their batteries catch fire or explode it makes headlines. Many times these incidents are the result of improper charging (using the wrong adapter) or storage (carrying a battery in a pocket with other metal objects). But, how common is it for e-cigarette batteries to explode? According to The U.S. Fire Administration, between 2009 and 2014 there were a total of 25 incidents of fire and explosions involving e-cigarette batteries, leading to nine injuries and no deaths. In comparison, the Consumer Product Safety Commission has issued 40 recalls since 2002 on laptop and notebook computers due to fire and burn hazards. Lithium ion battery fires and explosions, for the most part, are of little concern for the vast majority of those who use an e-cigarette, laptop, cell phone, or take a flight on a Boeing 787. The industry that makes these batteries is working to make them safer. CASAA is working with others to develop battery safety guidelines for e-cigarette users. Meanwhile, there is no reason to think this problem is especially confined or more highly concentrated in vaping devices.