E-cigarettes (EC) are battery-powered devices used to smoke or ‘vape’ a flavoured solution containing varying concentrations of nicotine, an addictive chemical found in cigarettes. 

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It is estimated that there are more than 400 different brand names available. E-liquids are now available in over 7,000 unique flavours, including children-friendly ones like cherry, bubblegum, and chocolate. 

E-Vapour has been shown to contain lead, cadmium, nickel, formaldehyde, and hydrocarbons, among other chemicals. 

The rapidity with which it is introduced into the body, age of first exposure and the dosage administered, all add to determine the potential risk of a person being addicted to it throughout life.

There is an increasing trend of youth and adolescents in many countries getting hooked to ECs. In the United States, a 2018 study suggests that about 21% high-school and 5% middle-school students were reported to have used e-cigarettes in the past 30 days, which represents an increase of 1.5 million youth from 2017 to 2018. This rising trend is also noticeable in European Union countries.

The use of EC adversely impacts the entire human body. The cartridges used in EC contains about as much nicotine as a pack of 20 regular cigarettes.

The other main health concerns about ECs are the potential for toxic aldehyde emissions, such as formaldehyde, acetaldehyde, propanal, and acrolein, which are known to be formed following heating of the EC liquids. 

There are great apprehensions regarding safety in pregnant women who are either users or are exposed to the passive EC aerosol due to higher sensitivity of stem cells to EC vapour, as compared to mature cells. 

Tests by the US-Food and Drug Administration have demonstrated the presence of diethylene glycol in some ECs, which can lead to mass poisoning and deaths if inadvertently substituted for propylene glycol in consumer products. 

EC is popularly perceived as a smoking cessation aid, but its efficacy and safety as a quitting aid have not yet been established. Smokers’ efforts to quit smoking may be undermined by the promotion of smoking cessation products because these reduce their confidence in their ability to quit on their own by implying that it cannot be achieved successfully without the use of these aids.

Moreover, a considerable number of ex-smokers who have stopped cigarette-use with the aid of EC, continue using the latter product, thus sustaining nicotine dependence. 

In a survey carried out between July 2010 and June 2011, 70.4% of those surveyed reported having used EC as a way to obtain nicotine in smoke-free spaces, indicating that ECs were being used to satisfy nicotine addiction during periods of forced abstinence.

The International Association for the Study of Lung Cancer does not recommend the use of e-cigarettes for treating nicotine dependence.

The Indian Medical Association considered EC as an unhealthy and disguised form of tobacco addiction, with serious long-term health effects and unfit to be used for tobacco cessation.

In this new era of multimedia marketing, EC is advertised through all forms of media and the internet, with youth being the main target group. These products are marketed as safer alternatives or harm reduction products in a glamorous manner, so as to make them attractive under the guise of being less harmful. 

The industry tactics of attracting as potential customers, persons who may not have wished to experiment with conventional cigarettes, as well as hold people captive who are trying to quit smoking by trapping them in new web of nicotine addiction, is a worrying trend. 

The monitoring of these products differs from one country to the other. In Britain, these were regulated as medicines from 2016 to ensure their quality and safety. On the other hand, their sale has been completely banned in 25 countries, including Singapore, Norway, and Brazil.  Market authorisation is required in 17 other countries. In the US, ECs that are marketed for therapeutic purposes are currently regulated by the US-FDA and Center for Drug Evaluation and Research. 

Based on currently available scientific and research data, there should  be complete prohibition or strict supervision of ECs in the greater interest of protecting public health.

Author is from the prestigious Armed Forces Medical College and heads Department of Lab Medicine at Base Hospital, Guwahati