E-cigarettes Questions & Answers: The Facts

  1. What is in the exhaled vapour and is it harmful to other people?

In the exhaled vapour there’s some vapour base (an ‘excipient’ like propylene glycol), a little nicotine, some water vapour and some flavours that might impart an aroma.  There may be some breakdown products or traces of contaminants.  The things that lead to concern about second hand tobacco smoke are either absent, undetectable or present in very low concentrations. The most comprehensive review so far concludes that active vaping poses near negligible risk, and that second hand exposure would be ‘orders of magnitude’ less.

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.


  1.  Does nicotine cause cancer or other health effects?

No.  There is no evidence that nicotine causes cancer – and it is really for those that make the claim to show that there is. It’s the smoke – the smouldering particles of organic material and hot toxic gases – that does the damage.  Professor John Britton, who is Director of the UK Centre on Tobacco and Alcohol Studies and heads the Royal College of Physicians Tobacco Advisory Group, compares the health risks of nicotine to caffeine.

“Nicotine itself is not a particularly hazardous drug,” says Professor John Britton, who leads the tobacco advisory group for the Royal College of Physicians.

“It’s something on a par with the effects you get from caffeine.

“If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths in people who are alive today. It’s a massive potential public health prize.”  (BBC, Feb 2013)

Like caffeine, nicotine has effects on the cardiovascular system: raising heart rate and blood pressure.  There is also concern that it has impact on foetal development. The harms caused by smoking have often been confused with nicotine and it is inherently hard to study the impact of nicotine itself in smokers because there are so many other substances the smoker is exposed to at the same time.  Fortunately, there has been extensive research into the health risks of nicotine because of its use in a licensed medical product, NRT.

The Royal College of Physicians Tobacco Advisory Group surveyed the literature in 2007 (RCP, Harm reduction in nicotine addiction) and concluded the chapter on medicinal nicotine:

  • Extensive experience with nicotine replacement therapy in clinical trial and observational study settings demonstrates that medicinal nicotine is a very safe drug.
  • Adverse effects are primarily local and specific to the mode of delivery used.
  • NRT does not appear to provoke acute cardiovascular events, even in people with pre-existing cardiovascular disease.
  • There is no direct evidence that NRT therapy is carcinogenic or influences the risk of other common smoking-related diseases in humans.
  • Evidence on the safety of NRT during pregnancy is limited, but suggests that NRT does not increase the risk of major developmental anomalies or reduce birth weight. However, NRT may increase the risk of minor musculoskeletal anomalies. Further evidence on these effects is needed.
  • Evidence on the safety of long-term use of NRT is lacking, but there are no grounds to suspect appreciable long-term adverse effects on health.
  • In any circumstance, the use of NRT is many orders of magnitude safer than smoking


Health benefits? There is also evidence nicotine may have health benefits, for example in reducing weight, protecting against Parkinson’s disease and improving cognitive function – see CASAA’s page on this for sources.

Detriment of withdrawal and craving. Withdrawal from nicotine use may be disruptive and unpleasant – and such has a negative effect on health and wellbeing.  So use of nicotine in people who quit smoking has the health benefit of avoid at least some of the withdrawal and craving.  That is one reason why the prospects for e cigarettes are so promising: it can provide many of the benefits people perceive in smoking, but with few of the impacts, while avoiding the unpleasant experience of quitting completely – and at lower cost.  That value proposition gets stronger as each month goes by.


  1.  Does introduction of e-cigarettes have the effect of increasing smoking?

No – there is no evidence to support this. People who don’t like vaping for other reasons try to use this argument to suggest that a product that is many times less risky than cigarettes can somehow become more dangerous, because it somehow prevents people from quitting.  The same sort of people used the same arguments to get Swedish snus banned in the EU in 1992, even though it is probably 98-99% less risk. The snus ban wasn’t applied in Sweden, which now has by far the lowest rates of smoking in the EU and lowest rates of smoking related disease. In Sweden, people used snus to quit smoking, to displace cigarettes or instead of starting to smoke (see letter from experts: why is EU banning Europe’s most effective response to smoking?).   On e cigarettes, the survey data is now coming in and showing pretty much the same thing – take this one The Guardian reporting on the survey by ASH (UK)

But Ash’s survey, carried out by YouGov, suggests this is not happening and that people are using e cigarettes to kick their tobacco habit instead.

“The dramatic rise in the use of electronic cigarettes over the past four years suggests that smokers are increasingly turning to these devices to help them cut down or quit smoking. Significantly, usage among non-smokers remains negligible,” said Deborah Arnott, Ash’s chief executive. (Guardian)


Clive Bates former Director of ASH (Action on Smoking and Health) UK.

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