Electronic cigarettes, also known as electronic nicotine delivery systems (ENDS) or e-cigarettes, are often designed to look and feel like cigarettes. They have become increasingly popular in Ireland over the past number of years. While they are often presented as a healthy alternative to smoking, e-cigarettes cannot be said with certainty to be safe. While the vapour exhaled by the e-cigarette smoker is free of tar, and other harmful toxins in ‘normal’ cigarettes, it does contain nicotine — an extremely addictive substance. There is also no reliable information on product quality for e-cigarettes at this time.
There are no properly conducted scientific studies to prove that e-cigarettes are an effective aid for sustained smoking cessation, or that they have a reliable safety profile over time. The HSE will continue to keep this evidence under review.
Below are some frequently asked questions regarding e-cigarettes. The answers have been provided by the Health Service Executive.
Q: What is an electronic cigarette?
A: An electronic cigarette, e-cigarette, or ENDS (electronic nicotine delivery system) is a device whose function is to vaporise and deliver to the lungs of the user a chemical mixture typically composed of nicotine, propylene glycol and other chemicals, although some products claim to contain no nicotine. Often designed to look and feel like a cigarette, an e-cigarette usually consists of a battery, a cartridge containing a liquid of nicotine and other chemicals, a heating element and a mouthpiece. When the user draws on the mouthpiece it activates the heating element, which vaporises the liquid, and the vapour is then inhaled.
Q: Are electronic cigarettes safe?
A: At present we cannot say that e-cigarettes are safe.
The World Health Organization (WHO) is of the view that the safety of electronic cigarettes has not been scientifically demonstrated and the potential risks they pose for the health of users remain undetermined. Furthermore, scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver and it is very difficult for consumers to find out what is actually delivered by the product they have purchased(2).
Q: What is in the vapour that electronic cigarretes emit?
A: We estimate that there are over 90 types of products on the market and we are unsure of the content of the cartridges in these products and of the aerosol. There is no reliable information on product quality for e-cigarettes at this time.
Q: Are non-users at risk from electronic cigarettes?
A: The aerosols produced by various e-cigarette products have been shown to contain large amounts of propylene glycol, nicotine, flavours, tobacco-specific nitrosamines, volatile organic compounds, acetone, formaldehyde, acetaldehyde, benzo(a)pyrene and particulate matter, as well as silicate and various metal particles (2). Several of these constituents are carcinogenic (cancer-causing). Although levels of most substances measured are lower in the mist of electronic cigarettes than in conventional cigarette smoke, they do pollute indoor air. Four of the metals measured (sodium, iron, aluminium and nickel) are present at higher levels than those known in cigarette smoke; five others (copper, magnesium, lead, chromium, manganese) are present in the same amounts; and two (potassium, zinc) at lower levels. Nickel and chromium are carcinogenic, and lead is suspected to be carcinogenic.
Substances emitted into indoor air when electronic cigarette are used may be inhaled by non-users present in the same room. Therefore, adverse health effects for third parties due to second-hand exposure cannot be excluded.
Q: Are electronic cigarettes an effective way to quit smoking?
A: There are no properly conducted scientific studies to prove that e-cigarettes are an effective aid for sustained smoking cessation, or that they have a reliable safety profile over time. The HSE will continue to keep this evidence under review.
Q: Are there any plans to regulate electronic cigarettes?
A: Yes. The EU Tobacco Products Directive has considered the role of Electronic Cigarettes and recommends that they be regulated as a nicotine delivery device. This regulatory process is ongoing
Q: What should smokers do who wish to quit smoking?
A: Until such time as electronic cigarettes are deemed to be safe and effective by a competent regulatory authority, smokers should be advised to use other forms of properly regulated nicotine replacement therapies and other such medications as advised by their doctor. In addition, they should seek the help of their doctor, pharmacist, dentist or local smoking cessation adviser for advice on how to quit smoking, visit www.quit.ie or call the National Smokers Quitline at 1800 201 203.
Q: How should healthcare establishments deal with electronic cigarettes?
A: Apart from the health risks outlined above, there is a legitimate concern that, because e-cigarettes resemble ordinary cigarettes, their use may promote smoking. Accordingly, they should be prohibited in the same way that tobacco products are. Patients and members of the public should be advised that we cannot say that they are safe and so they may not be used within the bounds of any health service campus.
Q: I have been told I cannot smoke in a hospital/HSE facility. Does the Hospital/Health Service have the authority to enforce such a policy?
A: Yes. The HSE is now updating the National Tobacco Free Campus policy to reflect that in the absence of any regulation, the use of Electronic Cigarettes (e-cigarettes) is not permitted within HSE facilities or on HSE campuses. As and from 1st May 2014, Electronic Cigarettes should not be advertised, promoted or sold in any healthcare establishment. In addition, their use by patients, staff and visitors is prohibited in all healthcare settings and campuses until further notice. The HSE will continue to provide smoking cessation counseling and tobacco dependence treatments to help service users deal with their nicotine dependence and to support quitting. Concern around the growing use of E-Cigarettes is worldwide. A number of states in the US including New York and Los Angeles have banned the use of E-Cigarettes in outdoor areas and a number of countries have banned E-Cigarettes.
Q: Have any Countries banned E-Cigarettes?
A: Yes. The use of e-cigarettes is illegal in a number of countries.
- The most notable of these countries is Brazil. Here, neither the selling of or advertising of the e-cigarettes is allowed. This ban is due to health concerns as assessed by the countries health agency, Anvisa which found the cigarettes “lacking enough information” to qualify them as healthy products.
- The other country where the same case applies is Canada. The ban here is also due to “unsatisfactory information” from the manufacturers of these cigarettes concerning there their health risk.
- Panama has totally banned the sale and importation of the cigarettes. The reason for doing so is based on the findings of FDA.
- Singapore also doesn’t allow the distribution and importation of these products. The reason for their illegality is that the motive behind the manufacture of the cigarettes was to attract more people (especially the young) into smoking.
- Lebanon recently banned E-Cigarettes with effect from 21st September 2011. As such, it is important to know this if you are planning a visit
References
- Tobacco Free Initiative. Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS): World Health Organization; 2013.
- Katrin Schaller, Linda Ruppert, Sarah Kahnert, Christina Bethke, Urmila Nair, Martina Pötschke-Langer. Electronic Cigarettes–An Overview. Heidelberg: 2013.
- Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet. 2013.
