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e-cigarette

Analysis

E Cigarette Interview with Professor Riccardo Polosa

I think that e-cig is a good solution to reduce the use of traditional cigarettes and their associated risk. Other valid options for tackling nicotine dependence in smokers exist, but it is still a personal choice how to introduce nicotine in his/her body. Each individual smoker should find a best way to reduce or eliminate his or her own smoking. In theory, at least for westernized cultures, vaping is a far better option than smoking. And it could save millions of lives.

Polosa (2011)


 

Doctors favour junkies over smokers

… there’s a stubborn portion of the population that is hard-core addicted to nicotine and that rather than writing them off or pretending that lecturing them will make them kick, our public health is better off by working to minimize the risks their addictions pose to their health and safety. And there are ways to do that. Promoting smokeless tobacco is a big one, since so much of the mortal danger that nicotine addicts risk comes from the carcinogens in smoking. E-cigarettes, or tobacco vapourizers, are another major improvement over smoking. And in Sweden, where millions of smokers have switched to a under-the-lip pouch of tobacco called snus, lung cancer rates and heart disease rates have fallen to some of the lowest in Europe. Just as with Insite, there is solid evidence showing that these lower risk products lead to increases in public health.

Libin (2011)


 

Could E-cigs become the ultimate nicotine maintenance device?

E-cigs should be allowed to compete for the middle ground between highly toxic smoked tobacco products and smoking cessation medicines that have been demonstrated to be safe and effective for that purpose. Thus e-cigs are currently competing for the smoke-free nicotine maintenance market, primarily against other smokeless tobacco products such as snuff, snus and dissolvable tobacco products. How successful they are in competing in that market-place will depend upon whether manufacturers can mass-produce and market relatively low-cost, safe, reliable and user-friendly products with adequate nicotine delivery. They should be regulated to ensure that they do not deliver toxic chemicals unnecessary to their purpose (e.g. quality control measures should ensure no contaminants are in the liquid or vapor), and are as safe as technically possible (e.g. liquid should be in a child-proof container, and instructions for use should be clear and accurate).

Foulds and Veldheer (2011)


 

Electronic cigarettes as a method of tobacco control

… health professionals should be able to suggest to smokers who are unable or unwilling to use or continue to use effective aids to quit, and who are interested in e-cigarettes, that these are a better option than continuing to smoke. And although it is better not to use any form of nicotine long term, if patients must, e-cigarettes are a lower risk option than continuing to smoke.

Borland (2011)


 

… products that deliver nicotine quickly in a ine vapour instead of as harmful smoke could prove an effective substitute for ‘conventional smoking’. It will be important to get the regulatory framework for these products right, to encourage new products, which smokers can use as safer nicotine alternatives, to be made available in the UK. A tenet of behaviour change is that it is much easier to substitute a similar behaviour than to extinguish an entrenched habit (an example was the rapid switch from leaded to unleaded fuel). If more alternative and safe nicotine products can be developed which are attractive enough to substitute people away from traditional cigarettes, they could have the potential to save tens of thousands of lives a year

UK Government Behavioural Insights Team (2011)


 

E-Cigarettes – No Toxic Effects from Inhaled Propylene Glycol Aerosol

… even high concentrations of PG vapor don’t have any measurable harmful effects, which is fully consistent with its designation by the FDA as “generally recognized as safe” as a food additive for all food categories up to 2% (here). Just as important, there will be no impact on bystanders from “second-hand” exposure to e-cigarette vapor, if it occurs at all.

Rodu (2011)


 

Anti-smoking groups have also discounted warnings regarding the life-threatening effects of Chantix and thus find themselves in the absurd situation of calling for a ban on electronic cigarettes, which have killed no one, while promoting the continued availability of Chantix, which has been associated with more than 200 suicides.

Siegel (2011)


 

[electronic cigarettes] have received the thumbs up from Quitline, an incorporated charitable trust committed to helping New Zealanders quit smoking.

Chief executive Paula Snowden said electronic cigarettes were a much safer option for dispensing nicotine than smoking .

“It’s the smoke that kills you; taking nicotine without the smoke is a much safer option. Nicotine isn’t harmful on its own.”

Quitline (2011)


 

E-cig were used mainly by former smokers, much as NRT, as an aid to quit smoking, avoid relapse, deal with craving
E-cig were perceived as efficacious, useful, satisfactory
Almost all users preferred nicotine-containing e-cigs
E-cig provide high amounts of nicotine (as reflected by cotinine)
Efficacy?
Safety?

Etter & Bullen presentation (2011)
[Nobody seems to have told them that nicotine liquid tastes vile]


 

I would like to see smokers have more access to things like this, alternatives that are safer … We’ve got to get people off the cigarette smoke.

Glover – Director of Auckland University’s Centre for Tobacco Control Research (2011)


 

The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate.

Cahn and Siegel (2011)


 

Electronic nicotine delivery systems: a research agenda

… the first priority is to characterize the safety profile of these products, including in long-term users. If these products are demonstrated to be safe, their efficacy as smoking cessation aids should then be tested in appropriately designed trials. Until these studies are conducted, continued marketing constitutes an uncontrolled experiment and the primary outcome measure, poorly assessed, is user health.

Etter, Bullen, Flouris, Laugesen and Eissenberg (2011)


 

As the e-cigarette delivers only nicotine in a mist of propylene glycol, without the other 4,000 or so other chemicals in tobacco smoke, it is far safer than smoking.

The risks to smokers of pure nicotine, delivered in doses seen with the e-cigarette and NRT products, are extremely low. Animal studies suggest that the use of long-term (20 hours a day, five days a week during a two-year period) inhaled nicotine is safe.

In animal studies propylene glycol does not appear to pose a significant hazard via inhalation of the vapour. The compound appears to be safe when used as a food preservative or in cosmetics. It has also been used on children as an aerosol germicide in the United States in the 1940’s without adverse effects. However, the effects of inhaled propylene glycol on the lungs are unknown.

Unwanted outcomes could include young people using these products and becoming nicotine dependent and existing smokers using them to maintain their addiction in environments where they cannot smoke rather than quitting entirely.

New Zealand Ministry of Health (2011)


 

The e-cigarette provides a safer alternative for smokers. No deaths have yet been reported from e-cigarette use.

End Smoking NZ (2011)


 

Findings suggest that regardless of nicotine content, electronic cigarettes may provide an effective means of relieving acute tobacco craving in at least some smokers.

Darredeau, Campbell, Temporale & Barrett page 104 (2010)


 

I believe that the current state of knowledge about potential hazards and the risks of these causing harm are adequately addressed by the GPSR [General Product Safety Regulations] regulatory framework. The thing we are certain of on current evidence is that it is far safer than traditional tobacco based nicotine delivery systems.

UK Trading Standards, Head of Product Safety (2010)


 

Novel Nicotine Delivery Systems and Public Health: The Rise of the “E-Cigarette”

The ENDS tested so far have demonstrated poor quality control; toxic contaminants, albeit at low levels; misrepresentation of the nicotine delivered; and insufficient evidence of overall public health benefit. Ongoing, rigorous safety testing is needed, including determining real-world use patterns and further laboratory testing across device constructions to determine actual systemic nicotine delivery and exposure to harmful constituents.

Cobb, Byron, Abrams and Shields (2010)


 

E-Cigarettes: A Rapidly Growing Internet Phenomenon

Health professionals need to monitor the biological, social, and addictive effects of e-cigarettes and be aware of their rapid dissemination online. National health surveys that track trends in tobacco use also should inquire about e-cigarette use. Although the safety and efficacy of e-cigarettes is uncertain, we believe that clearly counseling patients against e-cigarette use, as well as other tobacco use, is prudent.

Yamin, Bitton and Bates (2010)


 

ASH … recognise that whilst efforts to help people stop smoking should remain a priority, many people either do not wish to stop smoking or find it very hard to do so. For this group, we believe that products should be made available that deliver nicotine in a safe way, without the harmful components found in tobacco. Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe.
Therefore, e-cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are likely to be a safer alternative to smoking. In addition, e-cigarettes reduce secondhand smoke exposure since they do not produce smoke.

ASH UK briefing (2010)


 

Critique of the WHO TobReg report on e-cigarettes

If tobacco smoking is the elephant in the room, electronic cigarettes are like a buzzing insect. The natural instinct is of course to kill the buzzing insect first, just in case it might be harmful. This hostile analogy however, ignores the fact that smokers who like to smoke smoke either tobacco or e-cigarettes, and a move to e-cigarettes implies a move away from tobacco for the smoker concerned. If the real aim is to end cigarette smoking, banning e-cigarettes is not a sensible first move and could be counter-productive.

Laugesen (2010)


 

Cancer risk in humans reduced by e-cigarettes

E-cigarette use reduces risk of cancer by supplanting the smoking of tobacco cigarettes

Health New Zealand (2010)


 

US court judgement

“I am not convinced that the threat to the public interest in general or to third parties in particular is as great as FDA suggests. Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes have endangered anyone. Nor has FDA cited any evidence that electronic cigarettes are any more an immediate threat to public health and safety than traditional cigarettes, which are readily available to the public.”

– Judge Leon (2010)


 

Electronic nicotine delivery systems: emerging science foundation for policy

Since they were first marketed in China in 2004, electronic nicotine delivery systems (ENDS) have spread globally like wildfire. Their proponents, who refer to the products as “electronic cigarettes” or “E-cigs”, argue that by delivering nicotine to the lung, they are more effective and acceptable than nicotine replacement medicines, and should be readily available as cigarette substitutes…

– Henningfield and Zaatari (2010)


 

NJoy e-Cigarette Health Risk Assessment

The Njoy e-cigarette offers the consumer an interesting alternative to traditional tobacco cigarettes. While we will not advocate the use of any product, nor certify that a product is totally safe, the Njoy device appears to limit a consumer’s exposure to a few compounds of low toxicity, while delivering a metered dose of nicotine and flavor additives. Because combustion by-products, nitrosamines, and microbial toxins were not found in the aerosol of the e-cigarette, the risks associated with the use of the Njoy product appear to be low in comparison to the risks of traditional cigarettes.

Exponent Health Sciences (2009)


 

Marketers of electronic cigarettes should halt unproved therapy claims

… WHO knows of no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking. Indeed, as far as WHO is aware, no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy.

WHO does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid. The only way to know is to test.

The World Health Organisation (2008)

E Cigarette Medical Studies

A list of recent studies in to the effects of using electronic cigarettes. We will endeavour to keep this list as current as possible. If you find a relevant study we have missed, please send through the link via our contact page.  Source : ecigalternative.com

Recent Studies

Various Factors Influencing Ecigarette Nicotine Yield
This study found depending on puff conditions and product features, 15 puffs from a personal vaporizer can provide far less or far more nicotine than a single tobacco cigarette. However, influences can be predicted well by a mathematical model of the relevant physics. Published September 2014.

Diacetyl, Acetyl Propionyl And Eliquids
Summary notes on a study evaluating the presence of diacetyl and acetyl propionyl in e-cigarette liquids. 74.2% of the samples contained either diacetyl or acetyl propionyl, but on average within safety limits – although some eliquids had higher levels. The authors also point out tobacco cigarette smoke contains levels 100 times higher for diacetyl and 10 times higher for acetyl propionyl compared to e-cigarette vapor average daily exposure. Published September 2014.

Particulate Metals And Organic Compounds
With the exception of nickel, zinc and silver, the use of e-cigarettes demonstrates a remarkable decrease in secondhand exposure to all metals and organic compounds according to this study. With regard to Ni, Zi and Ag; the report says implementing quality control protocols would further minimize the emission of metals. Published August 2014.

Electronic Nicotine Delivery Systems (PDF)
A report from WHO examining what it states is emerging evidence on the health impacts of electronic nicotine delivery systems (ENDS) use. It says ecigs “represent an evolving frontier, filled with promise and threat for tobacco control”. It also states, “The evidence and recommendations presented in this report are therefore subject to rapid change”. Published August 2014.

NOTE: This report has been criticised by Dr. Konstantinos Farsalinos, who says the organisation continues to “maintain an overcautious approach and present one-sided evidence”. Clive Bates says it is a modest improvement on WHO’s previous extremist views, but still involves a hugely disproportionate regulatory response. Professor Gerry Stimson, Emeritus Professor at Imperial College London, says WHO is once again exaggerating the risks of e-cigarettes.

Effectiveness Of Ecigs In Quitting Smoking
A cross-sectional population study (5863 people) of the effectiveness of e-cigarettes as a quit smoking aid has found ecig users were more likely to report abstinence than either those who used other nicotine replacement therapies or no aid. Published August 2014.

Briefing On Ecigarettes For Policy Makers
A briefing on e-cigarettes and related policy issues by Clive Bates, who was previously involved with ASH (Action on Smoking and Health). In the UK. Mr. Bates points out vaping could save up to a billion lives in the 21st Century. Published July 2014

Ecig Benefits Outweigh Potential Harm
A Queen Mary University (UK) study has found that despite gaps in knowledge, current evidence concerning e-cigarettes doesn’t justify the devices being more strictly regulated than, or even as strictly as, tobacco cigarettes. The study presents evidence from 115 references. Published July 2014.

Doctors Attitudes Towards Vaping
Two thirds  physicians surveyed last year felt electronic cigarettes are a helpful aid for smoking cessation and 35% recommended them to their patients. Published July 2014

ECF Big Survey 2014 Results
Data from a survey of more than 10,000 vapers carried out by Electronic Cigarette Forum (ECF) is gradually being released. The 75 question survey had a 97% completion rate. Published July 2014.

Reclassification Of Nicotine Eliquids Under CLP Recommended (PDF)
A report by toxicology consultants, which has been verified by Professor Riccardo Polosa, Professor Bernd Mayer and Dr Jacques Le Houeze states eliquids with typical nicotine concentrations should be reclassified as CLP category 4 (the lowest); the same classification as washing up liquids. Currently nicotine eliquids have been classified as CLP category 2 or 3; alongside strychnine and formaldehyde. CLP is the set of regulations covering classification, labelling and packaging of substances and mixtures in the EU. Published July 2014.

Eliquids And Inhalation Toxins (PDF)
A summary of a study headed by by Dr. Konstantinos Farsalinos evaluating sweet-flavored eliquids for the presence of Diacetyl and Acetyl Propionyl. Published June 2014.

Glantz Letter “Misleading, Without Scientic Foundation”
A letter to the World Health Organisation in May (see earlier entry below) signed by 53 nicotine specialists and health professionals was criticised by anti-ecig crusader Stanton Glantz and a number of others. The 53 original signatories have returned fire; deconstructing Glantz’s arguments. Published June 2014.

Myocardial Function – Tobacco vs. Ecigarettes (PDF)
A recent study found that while smoking causes a delay in myocardial relaxation, ecig use had no immediate effects. Published June 2014.

Effects Of E-cigarette Use On Exhaled Nitric Oxide
A study recently published in Toxicology and Applied Pharmacology that concluded based on nitric oxide (FeNO) levels, e-cigarettes are not safer than tobacco cigarettes and lung function is impaired has been labelled “arbitrary and completely wrong” by Dr. Konstantinos Farsalinos. Published June 2014.

E-Cigarette Vs. Nicotine Inhaler
A study comparing e-cigarettes with nicotine inhalers in terms of perceived benefits, harms, appeal, and role in quitting has found more subjects would use ecigs to make a quit attempt. Vaping devices gained a much higher total satisfaction score than inhalers. Published May 2014

Statement From Specialists In Nicotine Science And Public Policy (PDF)
Dozens of health professionals, including Australia’s Dr. Coral Gartner, have signed an open letter to Dr Margaret Chan, the Director General of the World Health Organisation (WHO) with their concerns regarding the body ignoring the importance of tobacco harm reduction strategies such the use as electronic cigarettes. The letter states among other points that it is counterproductive to ban the advertising of e-cigarettes and other low risk alternatives to smoking. The communication states these products could be among the most significant health innovations of the 21st century and could save hundreds of millions of lives. Published May 2014.

ASH Scotland E-cigarette Briefing (PDF)
ASH Scotland current views on vaping and ecigarettes. Published May 2014.

Ecigarettes Boost Quitting Success Rates
A survey carried out by University College London has found smokers are approximately 60% more likely to report succeeding quitting smoking if they use e-cigarettes than if they use willpower alone or nicotine replacement therapies such as patches or gum. Published May 2014 in the journal Addiction.

High Voltage Vaping And Carbonyl Compounds
A recent study measured twelve carbonyl compounds in ecig vapors where battery output voltage was gradually increased from 3.2 to 4.8 V. It found vapour did contain some toxic and carcinogenic carbonyl compounds; but these varied between eliquids and were at much lower levels than cigarette smoke when lower voltages are used. High voltages significantly increased toxic compounds. Published May 2014.

Ecigarette Vapor And MRSA
A study presented in May at the 2014 American Thoracic Society International Conference states while e-cigarette vapor appears to boost the virulence of dangerous and medication-resistant bacteria such as MRSA, it’s to a lesser degree than cigarette smoke.

Ecigs A “Much Safer Source Of Nicotine” (PDF).
A report commissioned by Public Health England states electronic cigarettes offer “vast potential health benefits”, but requires appropriate regulation, careful monitoring, and risk management. “However the opportunity to harness this potential into public health policy, complementing existing comprehensive tobacco control policies, should not be missed.” Published May 2014.

Ecigs Not A Gateway To Children Smoking (PDF)
In another report commissioned by Public Health England, the authors state they could not identify any evidence to suggest that non smoking children who tried e-cigarettes were more likely to then try tobacco. Published May 2014.

Ecigs Benefit Asthmatic Smokers
A study of asthmatic smokers has found those who used electronic cigarettes regularly showed objective and subjective improvements in asthma outcomes, and goes on to state: “This study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.” Published in International Journal of Environmental Research and Public Health, May 2014.

Formaldehyde Release In E-cigarette Vapor
A study to be published in Nicotine and Tobacco Research states e-cigarette vapor can be the source of carcinogens, but the devil is in the detail according to Dr. Konstantinos Farsalinos. Published May 2014

E-Cigarette Awareness and Perceived Harmfulness
A study on awareness and perceived harmfulness of ecigarettes among U.S. adults has found 77% of respondents were aware of e-cigarettes and off this, only 51% believed e-cigarettes were less harmful than cigarettes. The study was published in American Journal of Preventive Medicine, May 2014. (The study results have caused concern in the vaping community and among some pro-vaping health professionals that misinformation campaigns are having an impact on public perception).

Safety Evaluation And Risk Assessment Of Electronic Cigarettes
A systematic review by  Dr. Konstantinos E. Farsalinos and Riccardo Polosa states currently available evidence indicates electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who make the switch from tobacco to ecigs. Published April 2014.

Use Of Electronic Cigarettes In Great Britain (PDF)
An ASH survey shows electronic cigarette use among adults in Britain has tripled over the past two years and according to the associated study’s lead author (and as with the study that follows this item); there is no evidence to suggest ecigarettes are renormalizing smoking. Published April 2014.

Trends In Ecig Use In England (PPT)
A study by researchers from University College London
has found the use of ecigarettes by those who have never smoked is negligible. Evidence also indicates ecigs are not ‘renormalizing’ smoking – and they may be contributing to a reduction in smoking prevalence. Published April 2014.

Ecigs Among The Least Harmful Nicotine Delivery Products
A study that sought to estimate the harm level of various forms of nicotine delivery products rated cigarettes as the most harmful (overall weighted score of 100) and ENDS (electronic nicotine delivery systems) were rated among the least harmful. Published in European Addiction Research, April 2014.

AASCP Position Statement (PDF)
In a position statement released by the Australian Association of Smoking Cessation Professionals (AASCP), the body provides some support for ecigarettes and states the final decision to use the devices “belongs to the individual smoker, who should weigh up the risk and benefits and make a decision for their circumstances.” It also mentions there is no evidence to support concerns ecigs are a gateway to smoking or normalise smoking. Published April 2014.

Nicotine Not The Great Satan?
It appears some of nicotine’s bad reputation may be unfounded. As has been suspected for some time, it seems it’s a combination of chemicals that make tobacco so addictive – in fact it’s been shown to be “almost impossible” to get laboratory animals hooked on nicotine on its own. Of course, humans may be another story; but perhaps the degree of addiction is amplified when nicotine is consumed through smoking. Furthermore, nicotine also appears to have some therapeutic properties. Published March 2014.

Royal College Of Physicians’ Stance
Switching completely from tobacco to e-cigarettes achieves much the same with regard to health as does quitting smoking and all nicotine use completely says the Royal College Of Physicians. The body goes on to say even in the absence of regulation, the risks to ecig users and others is low. Published March 2014.

“A Moral And Ethical Duty” To Provide Ecigarettes
In an open letter published on The Montreal Gazette; the medical director of the Smoking Cessation Clinic at the Montreal Chest Institute and other health professionals have voiced their support for the authorization of the sale of ecigs in Canada. In his letter, Dr. Gaston Ostiguy mentions states there is a “moral and ethical duty to provide these products to addicted smokers.”

Ecig Gateway Effect Claims Deconstructed
A study by Professor Stanton Glantz and Dr Lauren Dutra on teenage smoking and ecig use has been thoroughly debunked by Clive Bates, who called the document “false, misleading and damaging”. Mr. Bates was previously director of Action on Smoking and Health (ASH-UK). Published March 2014.

Glycerol Does Not Cause Lipoid Pneumonia
In March 2014, another story started doing the rounds of the media relating to a person who had contracted lipoid pneumonia and glycerol based eliquids were pointed to as the culprit. Dr. Konstantin Farasalinos details why glycerol cannot cause lipoid pneumonia.

Impact Of EU Ban On Higher Nicotine E-cigarettes On Smoking. (PDF)
The EU Tobacco Products Directive (TPD), which will limit nicotine eliquid levels to 20mg/ml, will curb the use of e-cigarettes says a report from London Economics. It estimates the TPD will result in the deaths of an additional 105,000 people a year in Europe. Published February 2014.

Real-World Effectiveness Of E-Cigarettes: A Population Study
This study found e-cigarette users were more likely still to be abstinent than either those who used NRT (Nicotine Replacement Therapies) bought over-the-counter or used no aid at all. Published February 2014 (abstract).

The Effects Of Nicotine On Human Health 
According to the American Council On Science And Health, the relative risk of mortality from lifetime use of various tobacco and nicotine products is comparatively low. “Electronic cigarette vapor appears chemically incapable of causing cancer
as cigarette smoke has done.” The report, Nicotine And Health, was published in January 2014.

Contaminants In Ecig Eliquids And Workplace Health Risks (PDF)
A study that reviewed available data on chemistry of ecig aerosols and eliquids found no evidence to suggest vaping produces inhalable exposures to contaminants that justify concerns relating to the health and safety of workplaces. Published January 2014.

A Longitudinal Study Of Ecig Users
A study carried out by has concluded electronic cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers. It also found in dual users who were still smoking at the point of follow-up had decreased their tobacco cigarette consumption by 5.3 cigarettes a day. Published January 2014.

Nicotine Myth Busting
Not a study or formal report as such, but I found this interview with nicotine expert Dr Jacques Le Houezec quite enlightening. Dr. Le Houezec busts a few myths surrounding nicotine and offers some advice on storage and related issues – valuable info for vapers.

Ecigs Do Not Stiffen Arteries (PDF)
Researchers from Onassis Cardiac Surgery Center in Greece have found that while smoking just 2 tobacco cigarettes caused significant stiffening of the aorta, no difference was observed after the use of e-cigarettes by both smokers and vapers. Published December 2013.

The Importance Of Flavours In Eliquids
A study headed by Dr. Konstantinos Farsalinos finds flavours play a major role in the overall experience of dedicated vapers and support the hypothesis that flavoured eliquids are important contributors in reducing or eliminating the smoking of tobacco cigarettes. Published December 2013.

Second Hand Vapor Study (PDF)
A new study (Published in Oxford Journal, December 2013) shows while e-cigarettes are a source of second-hand exposure to nicotine; it’s far, far less than that associated with second hand cigarette smoke. Additionally, e-cigarette second-hand vapor did not contain combustion related toxicants tested for. Lead author was Maciej Goniewic from the Roswell Park Cancer Institute in Buffalo, N.Y.

Smoking Kills, and So Might E-Cigarette Regulation
Gilbert Ross MD, is medical and executive director of the American Council on Science and Health. In this special report on The American, he states “simple common sense would dictate that inhaling the fewer, less harmful ingredients of e-cigarettes as compared to inhaling the thousands of chemicals in the smoke from burnt tobacco, many of which have been shown to be carcinogenic, is highly likely to be healthier.” Published November, 2013.

Regulation: When Less Is More (PDF)
Presentation slides from Clive Bates (of the Counterfactual) concerning the dangers of over-regulating ecigarettes. Mr Bates urges positivity about the vast potential about ecigs, to put the (minor) risks in perspective and regulate as though the 1 billion who are predicted to die from tobacco related illnesses in the 21st century matter most. Presented at The E-Cigarette Summit, Royal Society, London in November 2013.

Research on Safety of Electronic Cigarettes (PDF)
Dr. Konstantinos Farsalinos’ comprehensive presentation on existing data relating to the safety of ecigarettes. Presented at The E-Cigarette Summit, Royal Society, London in November 2013.

Nicotine Safety in the Context of E-Cigarette Use (PDF)
Contrary to popular belief, the fatal overdose level for nicotine may be far higher than the generally accepted 50 to 60 mg (adult) says Dr. Jacques Le Houezec. This research was presented at the The E-Cigarette Summit, Royal Society, London in November 2013.

A Longitudinal Study Of Electronic Cigarette Users
A study of 477 ecigarette users by researchers from the University of Auckland and University of Geneva has arrived at the conclusion that “E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers” Published October 2013.

Ecigs Not A Gateway To Smoking
The study is yet to be published, but according to research presented at the annual meeting of the American Association for Cancer Research (October 2013), the use of ecigarettes by teens does not lead on to smoking tobacco in the vast majority of cases.

E-Liquids Shown To Have Low Cytotoxicity (PDF).
The results of testing of 20 e-liquids has revealed the majority of the vapor samples were found to have no adverse effects on cardiac cells. Even on the several that did have some effect (two of which were tobacco derived), the worst was 3 times less toxic compared to cigarette smoke. Published October 2013 in the International Journal of Environmental Research And Public Health.

Nicotine Levels Selection and Patterns of Electronic Cigarette Use
Another study from Dr. Konstantinos E. Farsalinos that concludes nicotine levels seem to play a crucial role in achieving and maintaining smoking cessation in a group of motivated subjects. The study involved 111 participants who had completely substituted smoking with electronic cigarette use for at least 1 month. Published September 2013

Vaping: coronary circulation and oxygen supply (PDF)
Recent research indicates electronic cigarette use does not affect the oxygenation of the heart. Lead by principle investigator Dr Konstantinos Farsalinos; results of the research were presented at the European Society of Cardiology annual congress in Amsterdam in August, 2013.

Eliquids: No Health Concerns
A study by Professor Igor Burstyn of Drexel University School of Public Health based on a review available data has confirmed chemicals generally found in ecig eliquids pose no health concerns. Published August 2013 (PDF).

MHRA Ecigarette Research
The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) carried out extensive research on ecigarettes, arriving at the conclusion there was little concern that e-cigarettes can harm users by delivering toxic nicotine levels and little evidence of non-smokers taking up electronic cigarettes. The link above takes you to the general page on nicotine containing products and the findings mentioned are contained in 3 documents (all PDF) here, here and here. Published in June 2013.

Dual Use – Siegel Vs. Chapman
Dr. Michael Siegel, a Professor in the Department of Community Health Sciences, Boston University School of Public Health has challenged Australia’s Dr. Simon Chapman on the topic of dual use. Dr. Chapman maintains there are no health benefits associated with smoking reduction. Dr. Siegel counters this claim – and has some particularly harsh words relating to Chapman’s attitude towards electronic cigarettes and dual use. Published June 2013.

Efficiency and Safety of an Electronic Cigarette as Tobacco Cigarettes Substitute
In a 12-month trial of ecigarettes to evaluate smoking reduction/abstinence in 300 smokers not intending to quit; complete abstinence from tobacco smoking was documented in 10.7% and 8.7% at week-12 and after a year respectively. For the group receiving the higher dose nicotine cartridges, the tobacco cigarette cessation rate was 13% after a year. The study was published on PLOS One on June 24, 2013.

Evaluation of Electronic Cigarette Use And Liquid Consumption
This 2013 study challenges an EU proposal that would result in eliquids containing more than 4 milligrams of nicotine per milliliter being banned unless approved as medicinal products. The link above will take you to the International Journal of Environmental Research and Public Health abstract. Commentary from one of the study researchers, Dr Konstantinos Farsalinos, can be viewed here.

Cytotoxicity evaluation of ecig vapor extract
A 2013 study designed to evaluate the cytotoxic potential of 21 eliquids compared to the effects of cigarette smoke found ecig vapor is significantly less cytotoxic compared to tobacco. At this stage, the study notes are paid-access only, but comments on the study by Dr. Michael Siegel, can be viewed here. Additional commentary from the study’s lead author, Dr Konstantinos Farsalinos, can be accessed here.

Vaping profiles and preferences
1,347 vapers were surveyed in an effort to characterize e-cigarette use, users and effects. Results generally showed respondents found ecigarettes to be satisfying to use; cause few side effects; considered healthier than smoking, resulted in improve cough/breathing and lowered levels of craving. The survey was hosted at the University of East London. Published March 2013.

Ecigarette toxicants study
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes have been found to be 9 to 450 times less than tobacco cigarettes in 12 brands studied; leading the researchers to conclude “substituting tobacco cigarettes with e-cigarettes may substantially reduce exposure to selected tobacco-specific toxicants”. The study was first published online on March 6, 2013.

Ecigs – therapeutic medical device.. or not?
An in-depth look at the politics behind the push for e-cigarette regulation and the case for electronic cigarettes  being neither a tobacco product or a medical device; therefore not requiring such controls.

Impact of ecigarettes on schizophrenic smokers
Researchers from the CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research center in Italy determined the use of ecigs decreased tobacco cigarette consumption in schizophrenia sufferers who were smokers – and without significant side effects. Published January 2013.

Electronic cigarettes: achieving a balanced perspective
This 2012 paper argues that while more research is needed on the cost–benefit of ecigs and appropriate regulation, the harms so far have been overstated relative to the potential benefits. The paper mentions a study that found of more than 2000 former smokers in this survey, 96% reported that the e-cigarette helped them to stop smoking.

ASH UK Ecigarette Briefing
Given there is little real-world evidence of e-cigarettes causing harm to date; particularly when compared to smoking, UK anti-tobacco group ASH believes if properly regulated, ecigarettes should be made available as part of a harm reduction approach to tobacco. The briefing contains various statistics related to vaping and points out between 2009 – 2011, Google searches using the terms ‘electronic cigarette’ increased
by fifty fold in the UK. The briefing is in PDF format.

E-cigarette Vapor And Cigarette Smoke Comparison
High nicotine e-liquids were vaporized in a series of experiments and the emissions compared to tobacco smoke. The study results indicate “no apparent risk to human health from e-cigarette emissions based on the compounds analyzed”.

Is Passive Vaping A Reality?
This study sought to identify and quantify the chemicals released on a closed environment from the use of e-cigarettes – the findings? There’s little to be concerned about with regard safety. This research again confirms the type and quantity of
chemicals released are by far less harmful to human health compared to regular
tobacco cigarettes. In fact, it “could be more unhealthy to breath air in big cities compared to staying in the same room with someone who is vaping.”

Indoor Vapor Air Quality Study
Data at Clarkson University’s Center for Air Resources and reviewed by an independent toxicologist indicates electronic cigarettes produce very small exposures to byproducts relative to tobacco cigarettes. The study has been peer reviewed and will appear the Journal of Inhalation Toxicology.

E-cigarettes: harmless inhaled or exhaled
Report from Health New Zealand stating e-cigarette vapors do not contain substances known to cause death in the quantities found.

Society for Research on Nicotine and Tobacco (PDF)
This research acknowledges that no drug is safe, but the emissions associated with the e-cigarette brand tested appear to be “several magnitudes safer” than tobacco smoke emissions.

Electronic Cigarettes As a Smoking-Cessation Tool
The findings of this study indicate “e-cigarettes may hold promise as a smoking-cessation method” and that further research should be carried out.

Electronic Cigarettes Do Not Damage The Heart
Electronic cigarettes appear to have no acute adverse effects on cardiac function according to research by cardiologist Dr Konstantinos Farsalinos.  He says based on currently available data, ecigs are safer and substituting tobacco with electronic cigarettes could in fact be beneficial to health.

Principles to Guide AAPHP Tobacco Policy
The American Association of Public Health Physicians recommends electronic cigarettes as a safer smoke-free tobacco/nicotine product.

Athens University Ecig Study Challenged
Dr. Michael Siegel questions a University of Athens study claiming e-cigarettes can cause lung damage.

Propylene Glycol Safe
Monkeys and rats were exposed continuously to high concentrations of propylene glycol, a common component of eliquids for periods of 12 to 18 months. Results of the research state “air containing these vapors in amounts up to the saturation point is completely harmless”.

Effect of ecigs on smoking reduction and cessation
A study showing the use of ecigarettes substantially decreased cigarette consumption without causing significant side effects in smokers who had no intention to quit. Published in 2011 (PDF).

Tobacco harm reduction as a human right
Approximately one-quarter of all lifelong smokers will die in middle age (between 35 and 69) as a result of smoking and the authors of this 2006 paper (PDF) urge tobacco harm reduction being viewed as a human right.

Tobacco cigarette addiction – it’s not just the nicotine
Nicotine is the major neuroactive compound of tobacco, but according to this 2005 paper; on its own it has weak reinforcing (addictive) properties. It appears other compounds found in tobacco smoke when combined with nicotine  produce the intense reinforcing properties of cigarette smoking that lead to addiction.”

Long-term effects of inhaled nicotine
An experiment where rats breathed in a chamber with nicotine at a concentration twice found in heavy smokers for 20 hours a day, 5 days a week over a 2 year period found no harmful effect of nicotine when given in its pure form by inhalation. Published in 1996.