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By Sandee LaMotte and Susan Scutti CNN
(CNN) E cigarettes are increasingly being used as a nicotine alternative as smokers seek ways to kick their habit. But their use has been surrounded by debate, focusing on the lack of evidence regarding the harms associated with their long term use, as well as their potential to act as a gateway into smoking among teens.
The latest salvo: A study of nearly 70,000 people found that daily e cigarette use can double the risk of heart attack. If the user continues to smoke regular cigarettes each day along with e cigarettes, the combined risk goes up five times.
“The new study shows that the risks compound,” added Glantz, who directs the UCSF Center for Tobacco Control Research and Education. “Someone who continues to smoke daily while using e cigarettes daily has an increased risk of a heart attack by a factor of five.”
E cigarettes work by heating a pure liquid called e juice composed of flavorings, propylene glycol, glycerin and often nicotine until it vaporizes. The resulting vapor is much less offensive to many, both smokers and non smokers.
[Related: E Cigarettes could double your risk of a heart attack]Science and public policy have bounced back and forth for over a decade, as different studies produce different and sometimes contradictory results. Let’s take a look at the debate over the years:
2003 headline: Invention of e cigarettes
Three pack a day smoker Hon Lik, a 52 year old Beijing pharmacist, created the first successful electronic cigarette after his father, another heavy smoker, died of lung cancer. By 2007, e cigarettes were marketed in Europe and the United States by manufacturer Ruyan as a way to safely stop smoking tobacco.
Hon was not the first person on record to have the idea for an electronic non tobacco option. Herbert A. Gilbert filed for a patent in 1963, in an era when tobacco smoking was widely accepted and the health risks were less apparent. e cig brands, NJOY and Smoking Everywhere, that found “very low” amounts of nicotine in cartridges labeled as nicotine free. In July,
an FDA news release discouraged the use of e cigarettes, saying they contain carcinogens and an ingredient used in antifreeze, diethylene glycol.
Another concern of the FDA’s: E cigarettes are often marketed and sold to youngsters who, intrigued by the many flavors such as chocolate, bubble gum and mint, might easily adopt a smoking habit as a result of trying the devices.
Vape supporters counter that diethylene glycol was found at a very low, nontoxic level of 1% and that the carcinogens are at the same levels as other FDA approved nicotine cessation products, like patches and gum.
By the end of the year, Amazon and Paypal restricted the sale of e cigs on their websites.
2011 headline: Interest in vaping for smoking cessation is high
Science began to ramp up studies on the topic. Several studies found that interest in e cigarettes was high among the American public: Google searches for e cigs were higher in the US than any other nation.
A questionnaire of 3,500 e cigarette users found that most vaped because they though it less toxic and cheaper than tobacco, and would help them quit or cut down on tobacco smoking. Most ex smokers (79%) in the study were afraid they would relapse if they stopped using e cigarettes. The study didn’t examine the safety of the product.
Another, much smaller email study of 216 e cigarette users found that 31% were tobacco free at six months, and 66% were able to cut back on the number of conventional cigarettes they smoked. A still smaller study of 40 smokers also found that adding e cigarettes helped smokers reduce the number of traditional cigarettes they smoked each day.
2012 headline: E cigarette use doubles in adolescents
The US Centers for Disease Control announced that e cigarette use among middle and high school students doubled between 2011 and 2012, mirroring a similar increase in adult use. Most alarming for policy makers: CDC concerns that vaping among adolescents may serve as a gateway to tobacco use.
To measure nicotine delivery, United Kingdom researchers tested 16 e cigarettes with an automatic smoking machine and found wide variations in nicotine levels per puff, ranging from 0.5 to 15.4 milligrams. In contrast, the typical level from a tobacco puff ranges from 1.54 to 2.60. The wide variation between e cigarette brands led researchers to question how well they can function as a nicotine replacement device.
2013 headline: Do e cigs really help smokers quit?
Several 2013 publications showed minimal evidence that e cigarettes help smokers quit. A cross sectional study of 1,836 tobacco smokers found a significant association with e cig use and “unsuccessful quitter” status but none with “quitter” status.
Another study of callers to state tobacco quitlines found e cigarette users significantly less likely to be tobacco free seven months after they first tried vaping, compared with participants who never tried e cigarettes.
A New Zealand Health Research Council study of 657 smokers found e cigarettes modestly effective in helping smokers quit. Interestingly enough,
it didn’t seem to matter whether they contained nicotine. But the results were similar to FDA approved nicotine patches.