Appeal

Smokers report switching to electronic cigarettes for several different reasons. Electronic cigarette users have reported “improved sense of taste and smell, ability to be physically active, and less coughing and breathlessness”; e-cigarette users have stated that electronic cigarettes have improved their quality of life, and that any negative effect from their use can be dealt with when and if it arises.8 In a different survey, e-cigarette users reported benefits such as absence of lingering stench or taste, as well as decreased expense, when compared with traditional tobacco cigarettes.11 Cost is a big motivating factor for many smokers looking for a way to quit or cut back. E-cigarette advertisements often try to draw in consumers with the promises of saving money without giving up their nicotine fix.5 Makers of the NE-WHERE brand report that one of their e-cigarettes is equivalent to smoking two packs of traditional tobacco cigarettes.7 The cost of tobacco cigarettes in Maryland, for example, is approximately $7.93 for a pack, and eight packs cost $63.44. But the cost is $39.95 for four e-cigarettes, which are claimed to be the equivalent of eight packs of tobacco cigarettes.12,13 Many consumers may see this as a cost-saving incentive.

Short-term effects on the body

It is broadly assumed that e-cigarettes are healthier for the individuals using them because the e-cigarette does not actually burn, and theoretically, the user is not inhaling any harmful smoke or byproducts into his or her lungs.14 The reported short-term side effects from the use of electronic cigarettes include dry mouth, dry cough, throat irritation, dizziness, headache, and nausea, which can be the same side effects that accompany traditional tobacco cigarettes.14 A few short-term studies are available, which have looked at the effects on different areas of body, such as pulmonary function, cardiac function, and complete blood counts.15,16,17,18,19,20 The validity of these studies have been called into question due to small sample size. In 2013, Flouris et al examined the acute impact of active and passive e-cigarette smoking on serum cotinine (a nicotine metabolite) and lung function and then compared it with traditional cigarette smoke. The study included 15 participants, and methodologies included spirometry and biochemical analysis via blood. The researchers reported that electronic cigarettes generated smaller changes in lung function, but effects on serum nicotine levels were similar to the conventional cigarettes.17 The research is intriguing, but no long-term studies have been completed


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Challenges

Quality control and regulatory status is problematic surrounding e-cigarettes. The FDA does not regulate electronic cigarettes. The courts ruled that because the electronic cigarette is not a tobacco product, it cannot be regulated according to the 2009 Family Smoking and Tobacco Control Act.21 Those who would have it regulated as a nicotine delivery device are unable to do so because the e-cigarettes are not sold and marketed as a smoking cessation device. E-cigarettes are not classified as nicotine replacement therapy (NRT); therefore they bypass all the legislation and regulations that would apply.11 However, the FDA does have a proposal that would expand its regulations to include the electronic cigarettes. Under this new proposal, manufacturers would be required to register with the FDA, report ingredients, market only after FDA review, and be able to make claims of reduced health risk only after the FDA confirmed claims with scientific evidence. Also, the FDA under the new proposal would require a minimum age with identification restrictions to prevent sales to minors, and health warning labels would also be required.22 The FDA tested two different brands of electronic cigarettes and found variances in the amount of nicotine claimed to be in the product and the actual concentration. The nicotine that was found in the vapor was a fraction of what was in the cartridge.23,24 This variability leads to questions surrounding the amount of actual nicotine delivery via vapor and suggests poor quality control. One study indicated more concerns related to labeling fidelity with multiple brands.25 Three brands (NJOY, Smoking Everywhere, and CIXI) were analyzed, and nicotine content labels were compared with the actual nicotine content of the cartridges. Some cartridges labeled “contains nicotine” actually did not contain nicotine, and some labeled “nicotine free” contained nicotine.25 Often nicotine cartridges were found to contain lower levels of nicotine than the labels indicated.25,9 This research implies that it is unknown what amount of nicotine the user will be receiving.