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Are eCigarettes a Safer Smoking Alternative?

Driving through town or walking in a strip mall, you can’t go far without bumping into a storefront full of pen-sized contraptions and colorful bottles of liquid displayed around signs claiming “smoke-free,” “stink-free,” “tobacco-free” electronic cigarettes, or eCigarettes.

Smokers purchase the chamber, which resembles a large pen, and liquid concentrations in varying degrees of intensity, from 0-24, indicating the lowest to highest amounts of nicotine.  The liquids also come in various flavors, from traditional tobacco- and menthol-flavored, to piña colada and cortadito, a Miami favorite.

While claims of a less-offensive smoking experience are true, thanks to the aromatic flavors, the safety of eCigarettes has been the topic of debate at medical meetings and in governmental hearings.  Many in these circles are calling for studies to determine the health effects of eCigarettes, while manufacturers and store owners point to smokers’ decreased nicotine usage after switching from tobacco to vapor.

“eCigarettes may be effective in replacing the nicotine that smokers crave,” said Doctors Hospital [1] pulmonologist Ruben Peñaranda, M.D. [2],  “But, we don’t know enough yet about their safety.  They may still be dangerous.”

In fact, Dr. Peñaranda and his colleague Brenda Gonzalez, M.D. [3], say known cancer-causing chemicals, or carcinogens, are found in the inhaled vaporized liquid. These chemicals include nitrosamines [4] and diethylene glycol [5].

Additionally, the Food and Drug Administration, in 2009, released findings that indicate inconsistency in the amount of nicotine found in the liquids that are vaporized.  Some labeled “nicotine-free,” the research [6] showed, had trace amounts of nicotine in them.  And the amount of nicotine in liquids labeled “high” exceeded the amount of nicotine allowed in current FDA-approved nicotine-replacement products such as nicotine inhalers.

These inconsistencies, due to the lack of regulation, Dr. Gonzalez says, further cast doubt on eCigarettes’ safety.

“Some of our patients quit smoking tobacco cigarettes by switching to eCigarettes,” she said, “But I’ve also had patients complain of irritation in their throats and airways after smoking these.  I only prescribe FDA-approved nicotine replacements, because they’re backed by evidence and safety regulations.”

At a retailer in Miami Springs, the owner explained the appeal of eCigarettes using his own experience.  Nine months after switching over from tobacco cigarettes, he “vapes” less frequently than he smoked, and the concentration of nicotine his body craves has decreased, too.  Plus, he says, eCigarettes are more economical, costing 90 percent less annually for a pack-a-day smoker.

There’s growing concern over the appeal of eCigarettes to children and teenagers, too.  The Centers for Disease Control and Prevention, last week, released findings [7] that show that the percentage of eCigarette use among middle and high schools students in the U.S. has more than doubled since 2011.  Smoking usually begins in this age group, the CDC says, and these new products, with their appealing flavors, may introduce a new health risk to teens or lead to increased tobacco use later in life.

Javier Pérez-Fernandez, M.D. [8], medical director of pulmonary services at West Kendall Baptist Hospital [9], agrees with these concerns.

“Electronic cigarettes, in most cases, are made by the same companies that manufacture tobacco cigarettes, and they contain nicotine, which is addictive,” he said.  “They open the door to the use of cigarettes and long-term nicotine addiction.”

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Baptist Health hospitals and outpatient centers follow tobacco-free policies on their premises and have added electronic cigarettes to those policies.