A search for electronic cigarette stores in Birmingham quickly generates 30 listings on the Yellow Pages site. “If e-cigarettes could totally replace combustible products, it would appear—for a large volume of adults now smoking—that it would have some benefits from a public health perspective,” says Donna Arnett, PhD, professor and chair of the UAB Department of Epidemiology.
But research has shown that, instead, most smokers are dual product users. “They’re using e-cigarettes when they can’t smoke,” Arnett says, continuing the conundrum over the benefits and hazards of e-cigarettes.
The positive of e-cigarettes comes from producing a vapor instead of smoke. Using a battery-powered heating element inside the device, generally shaped like a tube, the e-cigarette turns a flavored, nicotine-laced liquid into a vapor inhaled by the user. Currently, neither the devices nor the juice are regulated.
As a result, no safeguards exist to ensure the contents contain nothing harmful, including the nicotine. “We know heavy metals have been found in some lower-cost, e-cigarette preparations,” Arnett says. “But nicotine is a poison too.”
60 milligrams of nicotine drunk orally is enough to kill a 150-pound adult, according to the CDC. Some e-cigarette refills pack as much as 72 mg. “So if an adult drank the whole refill at once, it could potentially be enough of a poison to kill them,” Arnett says.
Since e-cigarettes hit U.S. markets in 2007, people reported feeling strong enough adverse symptoms from e-cigarettes to call poison centers. That number has skyrocketed from one per month in September 2010 to 215 per month as of last February.
The CDC reported 42 percent of those e-cigarette-related calls involved adults over 20 years of age. “It’s not the vaping of the products that’s the known danger to adults,” Arnett says. “It’s accidently falling into the hands of someone who would drink it.”
Children are becoming more prone to that danger. More than half (51.1 percent) of the calls to poison centers surrounding e-cigarettes involved children under age five. “It’s a very small dose of ingested nicotine that can be poisonous to a child—one teaspoon for children under six,” Arnett says.
“The thing that worries me as a public heath advocate is that the flavors are really targeting children and adolescents, like bubblegum and chocolate,” Arnett says.
Though many e-cigarette flavors fit a more adult palette, such as black walnut, raspberry, and champagne, many would appear to be more enticing to a child’s taste buds, such banana and cookies and cream. “Here’s cool mint menthol listed on this site. And right under that is cotton candy,” Arnett says. “It’s hard to imagine an adult smoking cotton candy.”
Besides drinking the juice, children and adults can be harmed by absorption of the liquid through the skin and eyes. Meaning the bottles, which do not require childproof lids, need to be kept out of reach of children.
The prevalence of the devices among children is rising as well. According to the CDC’s 2013 National Youth Tobacco Survey, 4.5 percent of all high school students reported using e-cigarettes within the last 30 days. And use by high schoolers doubled between 2011 and 2012.
With the Surgeon General’s report finding that nicotine use has adverse effects on adolescent brain development, nicotine use by youth in any form—combusted, smokeless, or electronic—is unsafe. As a result, 41 states have outlawed the sale of e-cigarettes to minors so far, including Alabama, which set the age limit at 19.
Arnett says physicians should ask about e-cigarette use in the household. “People think the juice is harmless. They can be completely unaware of the danger to their children—or children visiting their home—by drinking or touching the colorful liquids,” she says.
Though there is not enough research to know what ill effects to adults can occur from consuming nicotine through e-cigarette vapor, Arnett allows that they may help with cessation. “These products may be useful to reduce combustible cigarette consumption. That’s the positive about them,” Arnett says. “We don’t really know about inhaled nicotine through e-cigarettes being harmful to adults, but we know combustibles are. So switching to e-cigarettes in theory should reduce the level of toxicity.”
A greater sense of safety may soon be at-hand for e-cigarettes. The government has begun seeking oversight of their production and distribution. “The FDA issued a proposed rule to extend authority to monitor and regulate e-cigarettes,” Arnett says. “I think regulations will happen within a year because of the confusion this is causing in the workplace and other areas where we have clean indoor air laws. And there’s lot of public pressure. But you can never predict with the government.”