HEALTHAGENDA

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E-cigarettes and your health: what you need to know

Some people believe e-cigarettes have less health risks than conventional cigarettes and can help if you want to quit smoking. But how much do we know about vaping?

Health Agenda magazine
January 2019

For people who are trying to cut down on or give up cigarettes, vaping – inhaling the vapour from an electronic cigarette – is sometimes seen as a useful tool. But some experts suggest that is still a lot that’s unknown about the long-term side effects, or whether vaping can assist people quit nicotine.

What is vaping?

E-cigarettes are small battery-operated devices that don’t contain tobacco and heat the liquid inside them but don’t burn it. This liquid is known as e-liquid or e-juice.

"There’s no carbon monoxide in e-cigarettes and you don’t get tar," says Simon Chapman, Emeritus Professor at the Sydney School of Public Health at the University of Sydney. Tar is tobacco residue and it has "a lot of carcinogenic and toxic material and irritants, which is inhaled into the lungs", he says.

Vaping in Australia

In Australia, the National Drug Strategy Household Survey reports use of e-cigarettes has increased significantly in recent years. The percentage of smokers aged over 18 who had tried e-cigarettes increased from almost 18% in 2013 to 31% in 2016.

A US study published in PLOS One journal found the most common reasons people vape include social image and to help quit smoking cigarettes.

In Australia, the sale and use of liquid nicotine in e-cigarettes is illegal. Instead, e-cigarettes sold in Australia may contain liquid solvents propylene glycol or sweet-tasting glycerin and are usually infused with flavourings.

What are the potential risks of vaping?

A comprehensive review, by the US National Academies of Sciences, Engineering and Medicine, looked at more than 800 studies. It found that overall, even e-cigarettes with nicotine contain fewer numbers and lower levels of toxic substances than conventional cigarettes, and are likely to be less harmful. But it also found they are not risk free and the long-term effects are unclear.

"The theory is that because there’s no dangerous stuff from tar, e-cigarettes are a lot less dangerous," says Prof Chapman.

But "e-cigarettes have only been around in common use for a maximum of 10 years. So the data on the health consequences of long-term e-cigarette use is simply not there," he says.

When it comes to cigarette smoking, the chronic diseases – things like heart disease, respiratory disease or cancer – usually show up years later.   

One of the potential risks, according to Prof Chapman, is that of the estimated 8,000 flavourings available to infuse the e-liquid, none have been approved for inhalation as vapour, only for ingestion as food flavouring.

Another issue raised by Prof Chapman is the many variations in e-cigarettes and the e-liquids they contain. The vaporising process involves rapid heating by batteries and some e-cigarettes allow users to adjust the temperature at which the mixture is heated for taste and heat preferences. Each mixture also contains different concentrations of ingredients.

Prof Chapman says all this variation makes it very difficult to accurately measure the health impacts. "There’s no standardised product that you can be confident in making predictions about."

A study led by the University of Birmingham in the UK found vaporised e-liquid disables important protective cells in the lungs, which help to remove dust, bacteria and allergens that have entered the organs. The study’s co-author, Professor David Thickett, says, "The public must be aware these devices are not harmless."

The National Health and Medical Research Council reports that there’s also the danger of the batteries in an e-cigarette exploding, with more than 200 reported cases of e-cigarettes overheating, catching fire or exploding in the US and UK.

Do e-cigarettes contain nicotine?

Although nicotine in e-cigarettes is illegal in Australia, NSW Health says e-cigarettes "may contain nicotine, even when they claim not to", so users may not know what they’re buying.

Nicotine is an addictive substance, so using e-cigarettes that may contain nicotine could become addictive.

Can vaping help people quit smoking?

Vaping advocates argue that using vaping as an alternative to traditional cigarettes can help people quit smoking.

According to a recent CSIRO review, although many former smokers prefer using e-cigarettes as their chosen method for quitting, the effectiveness of this method compared with other smoking cessation methods is not yet known.

Prof Chapman says the data available on this is mainly anecdotal and is generally from people who have succeeded in quitting cigarettes. Prof Chapman says "by far the biggest category" of smokers are dual users – those who use both conventional and e-cigarettes.

The same CSIRO review found there was not enough convincing evidence that e-cigarettes are an effective way to quit smoking.

The outlook

The bottom line, say health experts, is that there is currently no long-term data on the health effects of e-cigarettes, so there may be a lot we still don’t know about vaping's potential benefits, risks or long-term side effects.

If you need help quitting smoking, contact Quit on 13 78 48.

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