Is vaping the same as smoking?

Health effects from use of electronic cigarettes translation

“Is vaping the same as smoking? Is vapour the same as smoke?
And if one thinks so, what scientific evidence could ever justify that vaping should/ or could be included in the Smokefree Laws?

The Danish Ministry of Health^[1] – has recently (23rd of February 2015) sent out a law proposal, concerning the regulation and legislation on vapour based products for inhalation – also known as e-cigarettes. The law proposal^[2] is more or less a full-blown implementation of the Tobacco Products Directive, EU-directive 2014/14/EU, interpreted in the strictest way possible. The law proposal has been sent out in a public hearing, to those stakeholders who the Ministry found should be heard in advance. The hearing period ends 20th of March 2015 – and the follows a possible re-write of the proposal, before it is presented before the danish parliament (Folketinget).

Furthermore, the danish law proposal suggests that vapour (from vaping devices/e-cigarettes) and smoke (from burning tobacco) should be regarded as the same, by including vapour in the Danish Smokefree Law (read more about the Danish Smokefree Law in the english resume^[3]). The danish Smokefree Law is more or less the same as the FCTC Guidelines for regulations regarding tobacco products and their use.

If this were to be the case, it could result in fewer smokers wanting to try switching from smoking to vaping, deterring them from even considering the switch, since for heavy smokers there would be no benefits/perks, when smoking and vaping are compared – if they are treated in the same way, regarding where you could use them.

We suspect, that if vapour was to be included in the Smokefree Law, it would be near impossible to get it taken out again, when scientist eventually agree, that vaping is far less dangerous for your health, and that passive vapour could/should and would not be considered a danger for bystanders.

As far as we now know, there is no scientific evidence, to justify this inclusion – and therefore we ask of you to read the Ministrys background text and their reasoning, for making this inclusion, under the Smokefree Law.

Does the Ministrys reasoning make any sense? Please read the translation on the following pages, and be kind as to inform your danish colleagues, and us as a consumer organisation, about your views. The Danish Vapers Association are worried, that danish implementation of the TPD will result in fewer smokers switching from tobacco to vaping, and unfortunately that some present vapers might return to smoking tobacco again.

The literature we have read suggests that it would not be of any benefit or based on any science to include vaping under the Smokefree Law – and that banning vaping where ever smoking is prohibited can not be justified scientifically.

There are no danish tests or scientific papers, so we have had to rely on primarily english papers

From Public Health England: “Electronic cigarettes A report commissioned by Public Health England” – page 14, third paragraph:

“Electronic cigarettes do not produce smoke so the well-documented effects of passive
exposure of others to cigarette smoke[9, 10] are clearly not relevant. Exposure of nonsmokers to electronic cigarette vapour poses a concern, though laboratory work
suggests that electronic cigarette use in an enclosed space exposes others to nicotine
at levels about one tenth generated by a cigarette, but little else[78]
The health risks of passive exposure to electronic cigarette vapour are therefore likely to be extremely low.” ^[4]

And from english National Centre for Smoking Cessation and Training (NCSCT) – leaflet on E-cigarettes – Guidelines, produced in partnership with Public Health England – page 2, last bulletpoint on the Executive Summary:

“Low levels of toxicants and carcinogens have been detected in electronic cigarette liquid and vapour although these are much lower than those found in conventional cigarette smoke and are not considered to pose any passive inhalation risk.” ^[5]

And from the paper by Igor Burstyn – “Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks” – in the conclusion on page 1:

“Conclusions: Current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients) creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep any adverse health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern.” ^[6]

And from the review done by Konstantinos E. Farsalinos and Riccardo Polosa:
“Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review” – page 79, second paragraph:

“Although evaluating the effects of passive vaping requires further work, based on the existing evidence from environmental exposure and chemical analyses of vapor, it is safe to conclude that the effects of EC use on bystanders are minimal compared with conventional cigarettes.” ^[7]

For more information we are available to be contacted, both via email, and telephone, and we can be convinced to do skype meetings as well.

Contact information: Danish Vapers Association – Dansk e-Damper Forening (DADAFO)

Kim Dabelstein Petersen – President

Email: formand@dadafo.dk or president@dadafo.dk

Telephone (DADAFO): +45 3045 7516

Telephone (private): +45 7583 1550

Skype:dabelstein_petersen

David Mackenhauer – Vicepresident

Email: naestformand@dadafo.dk or vicepresident@dadafo.dk

Telephone (DADAFO): +45 3045 7517

Skype: david.mackenhauer

Peter Stigaard – Treasurer

Email: kasserer@dadafo.dk or treasurer@dadafo.dk

Skype: live:peter.stigaard

Conflict of interest/Disclaimer: DADAFO, Danish Vapers Association, is an independent consumer organisation, receiving no funds from either the tobacco, pharmaceutical or e-cigarette industries. We are volunteer based, and perform on a pro bono basis.

Background and reason for the inclusion of vapour products under the Smokefree Law, as presented by the Danish Ministry of Health:

DK: Uddrag fra “Forslag til lov om fremstilling, præsentation og salg af elektroniske cigaretter m.v.” – Baggrund – side 21-22 i høringsforslaget:

ENG: Excerpts from “Proposal for law regarding manufacture, presentation and sale of electronic cigarettes” – Background – page 21-22 in the hearing proposal:

DK: Original text is shown in gray italic  –  ENG: Translated english text in normal letters.

2. Baggrund
2.1. Vurderinger af helbredseffekter af brug af elektroniske cigaretter

2. Background

2.1 Evaluation of the health effect of using electronic cigarettes.

Ifølge Sundhedsstyrelsen er det endnu ikke muligt at vurdere de potentielle sundhedsskadelige virkninger ved af brug af elektroniske cigaretter med eller uden nikotin, idet der på nuværende tidspunkt kun foreligger få kliniske undersøgelser af humane helbredseffekter.
Det gælder ikke mindst ved længere tids brug. I forhold til de foreliggende
undersøgelser på området bemærker Sundhedsstyrelsen, at undersøgelserne er
forholdsvis usikre, bl.a. som følge af små undersøgelsespopulationer, men at undersøgelserne ikke indikerer, at brug af elektroniske cigaretter er absolut ufarligt for hjertekarsystemet, og der er således et behov for flere studier, herunder særligt langtidsstudier.
Det kan således ikke afvises, at der er skadelige helbredseffekter ved brug af
elektroniske cigaretter, der udleder damp, som i vidt omfang indeholder nikotin, propylenglykol og i mange tilfælde aromastoffer i form af f.eks. vanilje, jordbær, chokolade
eller tobak.

According to “Sundhedsstyrelsen” (Danish Health and Medicine Authority^[8]) it is not yet possible to evaluate the potential health-damages from the use of electronic cigarettes, with or without nicotine, since currently there are only a few clinical examinations of human health-effects.

This is at least the case with the effects of long-term usage. In accordance to the currently available evidence the Sundhedsstyrelsen notes that the evidence is relatively unsure, partly because the small population involved, but also that the material doesn’t indicate that usage of electronic cigarettes is absolutely harm-free for the cardiovascular system, and thus there is a need for more studies, amongst others particularly long-term studies. It is thus not possible to dismiss that there are damaging effects from the usage of electronic cigarettes, which emit vapor, and which in a broad spectrum contains nicotine, propylene-glycol and in a lot of cases aromas such as vanilla, strawberry, chocolate or tobacco.

Sundhedsstyrelsen kan dog konstatere, at de fleste væsker til elektroniske cigaretter
indeholder nikotin i en blanding af propylenglykol og/eller glycerol (glycerin), vand og
smagsstoffer, samt at disse også findes i elektroniske cigaretter uden nikotin. Propylenglykol og glycerol er bl.a. kendt for at irritere luftvejene, ligesom stofferne kan virke udtørrende på slimhinder i øjne og mund. Sundhedsstyrelsen oplyser endvidere, at der er fundet eksempelvis formaldehyd og acetaldehyd i væskerne. Særligt fundet af formaldehyd er bekymrende, da dette er et kræftfremkaldende stof. Sundhedsstyrelsens
overordnede vurdering er således, at der er potentielle helbredsrisici forbundet med
flere indholdsstoffer end blot nikotin i brugen af elektroniske cigaretter.

“Sundhedsstyrelsen” can confirm that most liquids for electronic cigarettes contain nicotine in a mixture of propylene-glycol and/or glycerol (glycerine), water and aromas, and that these ingredients are also present in electronic cigarettes without nicotine. Propylene-glycol and glycerine are amongst others known to irritate the respiratory system, just as they can act to dry up the mucous membranes in both eyes and mouth.
“Sundhedsstyrelsen” furthermore informs that for example formaldehyde and acetaldehyde has been found in the liquids. Especially the finding of formaldehyde is worrying since this is a carcinogenic compound. “Sundhedsstyrelsen” overall evaluation is that there are potential health-risks involved with several of the ingredients other than just nicotine in the usage of electronic cigarettes.

Hertil kommer, at elektroniske cigaretter oftest bruges med nikotinholdige væsker. Nikotin
er et særdeles afhængighedsskabende og farligt stof, der kan forårsage alvorlig
forgiftning, herunder livstruende forgiftning, i forbindelse med forkert eller uforsigtig
omgang med den nikotinholdige væske. For børn kan nikotin være livstruende ved indtagelse af meget små mængder. For produkter af dårlig kvalitet kan der forekomme
væskeudsivning, således at brugere – eller brugernes børn og børnebørn m.v. – får den
nikotinholdige væske på huden. Hudkontakt med nikotin kan føre til forgiftning. Der er
dermed en betydelig umiddelbar risiko forbundet med brug og håndtering af elektroniske
cigaretter med nikotin.

Furthermore electronic cigarettes are most often used with nicotine-containing liquids. Nicotine is a very addictive and dangerous substance, which can cause serious poisonings, including life-threatening poisonings, when it is handled in a wrong or incautious way. For children nicotine can be life-threatening by intake of even very small quantities. For products of a bad quality there can be leaking of liquid, such that the users – or the users children or grandchildren etc. – can get the nicotine containing liquids on the skin. Skin contact with nicotine can lead to poisoning. Therefore there is a significant risk involved with the usage and handling of electronic cigarettes with nicotine.

Elektroniske cigaretprodukter med et batteri af dårlig kvalitet kan eksplodere ved brug
og forårsage alvorlig personskade og/eller brand. På samme vis kan væsken til elektroniske cigaretter erodere beholderen (patron, tank), hvis beholderen er af dårlig kvalitet.
Dette kan udgøre en sundhedsrisiko, da farlige stoffer fra beholderens materiale
kan blande sig med den væske, der fordampes og dermed kommer ned i brugerens
lunger.

Electronic cigarette products with a battery of bad quality can explode on usage, and cause serious damage to persons and/or fires. In the same way the liquid for electronic cigarettes can erode the container (cartridge, tank), if the container is of poor quality. This can lead to a health-risk, since dangerous substances from the material of the containers can mix with the liquid that is evaporated and thus end in the users lungs.

I forhold til anvendelsen af elektroniske cigaretter som rygestopmiddel kan Sundhedsstyrelsen ved gennemgang af undersøgelser om anvendelsen af elektroniske cigaretter som rygestopmiddel eller alternativ til rygning konstatere, at der ikke er klare indikationer på, at elektroniske cigaretter med nikotin har en effekt på rygestopforsøg. Samtidig tyder undersøgelserne på, at elektroniske cigaretter ikke altid er et kortvarigt overgangsprodukt  på vejen til et fuldstændigt rygestop og en vej ud af nikotinafhængighed, men at rygere ofte fastholdes i deres nikotinafhængighed. Det er Sundhedsstyrelsens vurdering, at dette er med til at øge risikoen for, at brugerne enten fastholdes som rygere eller bliver rygere igen.

With regards to the usage of electronic cigarettes as a smoking cessation product “Sundhedsstyrelsen”, by review of papers regarding the usage of electronic cigarettes as a smoking cessation product or as an alternative to smoking, note that there are no clear indications that electronic cigarettes with nicotine has an effect on cessation attempts. And furthermore the studies indicate that electronic cigarettes are not always a short term transition product on the way to complete cessation, and a road out of nicotine dependence, but that users are often stuck in their nicotine-dependence. It is then “Sundhedsstyrelsen”s evaluation that this increases the risk of the users to be stuck as smokers or become smokers again.

Elektroniske cigaretter udleder damp (emission), som påvirker omgivelserne og kan
medføre, at personer ufrivilligt kan blive udsat for damp (emission). Det vil sige såkaldt
passiv eksponering i lighed med passiv rygning ved røg fra røgtobak. Sundhedsstyrelsen
oplyser, at regelmæssig brug af elektroniske cigaretter kan forurene omgivelserne
med nikotin, uanset, at brug af elektroniske cigaretter forurener luften mindre end ved
rygning. Som det er tilfældet i forhold til helbredseffekterne for brugere af elektroniske
cigaretter, så foreligger der ifølge Sundhedsstyrelsen fortsat også et usikkert grundlag
til at vurdere helbredseffekterne for personer, der bliver udsat for passiv eksponering af
damp (emission) fra elektroniske cigaretter.

Electronic cigarettes emit vapor, which impacts the environment and can thus lead to persons unwillingly being exposed to these emissions. That is to say a so-called passive exposure equivalent to that of passive exposure from smoke in lit tobacco. Sundhedsstyrelsen informs that regular usage of electronic cigarettes can pollute the environment with nicotine, regardless, that the usage of electronic cigarettes pollute the air less than by smoking. As is the case with regards to health-risks for users of electronic cigarettes there is, according to the Sundhedsstyrelsen, still an uncertain basis to evaluate the health-risks for person exposed to passive vapor from electronic cigarettes.

---