JIDAM
ORIGINAL ARTICLE
eISSN 2582 - 0559
“An Official Journal of IDA - Madras Branch”©2019.
Available online
INCREASING INCIDENCE OF USAGE OF
E-CIGARETTES - AN UNHEALTHY TREND
Visale Thangadurai , Dr.Sabitha Sudarsan , Varshini Subramani
Department of Periodontology,
Sri Venkateswara Dental College and Hospital, Chennai, India.
To access & cite this article
ABSTRACT
Website: jidam.idamadras.com
INTRODUCTION: The many hazards of nicotine
smoking is well understood. To counter this habit, the
electronic cigarettes or e-cigarettes were introduced. These
e-cigarettes come with their own bag of hazards. Despite
it being marketed as a ‘harm-reduction’ alternative to
smoking-label, it is viewed by many as a ‘poor substitute’ for
conventional smoking. Recent reports lay great emphasis
on the increasing popularity of vaping especially amongst
adolescents and teenagers worldwide. In order to face this
new challenge, healthcare professionals and dentists alike
will need to become familiar with the available scientific
Address for correspondence:
literature concerning e-cigarettes and vaping. To add
credence to the aforementioned facts, an online survey
was conducted to assess the various perspectives of this
current behavioral fad.
Visale Thangadurai
51/A, 4th cross, Bharathy nagar,
Puthur, Trichy - 620017.
AIM: To characterize e-cigarette usage and to summarize
e-mail id: drvisale96@gmail.com
its effects on the users.
MATERIALS AND METHODS: An online
questionnaire survey was conducted among initial vapers,
previous smokers and dual users.
RESULTS: Use of electronic cigarettes worldwide is
seen to be on the rise. This article highlights the use of
e-cigarettes by smokers to quit combustible cigarettes and
an attempt to study the hazards of vaping.
Received
: 07.08.2019
KEYWORDS: e-cigarette, vaping, smoking hazards.
Accepted
: 10.09.2019
Published
: 27.09.2019
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Visale et al : Increasing Incidence of Usage of E-Cigarettes
INTRODUCTION:
Public Health Science policy and practice dedicated
to addressing tobacco use, and thereby reducing
Smoking has been primarily practiced as a
the morbidity and mortality it causes. Today,
route of administration for recreational drug use, as
tobacco control, by virtue of its numerous hazards,
the combustion of products, vaporize, consequently
has become a priority area for the World Health
delivering chemical substances into the respiratory
Organization (WHO). The WHO on its part is seeking
system, where they are rapidly absorbed and
to rein in smokers and other nicotine users through
transported into the circulatory system and finally
its Framework Convention on Tobacco Control.
reaching the bodily tissues.
Use of e-cigarettes or vaping is a relatively recent
ELECTRONIC CIGARETTES:
phenomenon that is quickly gaining the interest of
many long-time tobacco users. Today, e-cigarettes
Electronic cigarettes or e-cigarettes are
(vape) have become a preferred alternative for
battery operated devices
(Fig
1) 2 that people
nicotine usage among many smokers because of
resort to, to simulate the experience of smoking a
their near realistic look, feel and taste compared
cigarette.3 They generally work by heating a liquid
to traditional cigars. Though many claim that
which generates an aerosol or vapor that is inhaled
e-cigarettes are a safer alternative, it still holds that
by the user. Thus, today the usage of e-cigarettes is
they do contain potentially harmful contaminants
commonly referred to as “vaping”.
that could in the long run prove to be hazardous to
both general and dental health.
E-cigarette is a recent innovation by the
Chinese pharmacist Hon Lik. After their initial
HISTORY OF SMOKING:
introduction into the market, it slowly gained
popularity especially amongst the youth, leading to
Smoking can be traced back to 5000BC,
an exponential boom. Till date, the majority of users
finding a place in many different cultures globally.
still smoke tobacco even though the e-cigarette was
In the earlier days, smoking was related to various
presumed to replace the nicotine laden conventional
religious ceremonies - as offerings to deities, as
cigarettes.
cleansing rituals, spiritual enlightenment and for
its hallucinogenic properties. Later however, the
practice of smoking, especially tobacco, quickly
spread its tentacles across the world, thus slowly
but silently becoming a form of social activity.
Gradually however it came to be viewed as a deadly
health hazard leading the cause for myriad of
diseases - such as bronchogenic carcinoma, cardiac
Fig 1- Electronic cigarettes
problems, respiratory problems, erectile dysfunction
and birth defects,[1] thus propelling many countries
HOW DO E-CIGARETTES WORK?
to seek ways to discourage its denizens to give up
this health hazard. Later however, tobacco related
substances like cannabis, opium, marijuana, dried
The majority of e-cigarettes are designed (Fig 2)4 as
reptile skin, incense sticks and various other herbal
follows:
pastes in addition to their medicinal values, were also
sought for their intoxicating properties. In the current
• A cartridge/reservoir to store the liquid - generally
scenario, smoking has come to be regarded as a
containing varying amounts of nicotine, flavoring
global menace as many countries report an alarming
agents and other chemicals.
increase of its usage, especially amongst teenagers
and adolescents.
• An atomizer for igniting.
• An in-built battery to serve as power source.
TOBACCO CONTROL:
• A customized mouth piece that the person uses
Tobacco control is a field of International
to inhale.
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Visale et al : Increasing Incidence of Usage of E-Cigarettes
•
It has been claimed that the majority of toxic
risks of using e-cigarettes. A Cochrane review,8
chemicals found in tobacco smoke are almost
however found no serious adverse effects reported
non-existent in e-cigarette aerosols, but can
in clinical trials. Consequentially, today, it is thought
contain other toxicants and traces of heavy metals
that e-cigarette usage can expose individuals to
at permissible levels.
certain hazards; aside from toxicity, there are also
risks of misuse or accidents such as can happen when
contacting liquid nicotine. Risk of battery explosion
cannot be ignored.
E-cigarettes create vapors consisting of
ultrafine particles of propylene glycol and glycane,
negligible amounts of toxicants, carcinogens, heavy
metals and metal nanoparticles and other harmful
particles
(Fig
3).2 Till date, there is a dearth of
conclusive information regarding environmental
issues in relation to e-cigarette production and usage.
Future scenario evidence supporting use
of e-cigarettes as a gateway to tobacco smoking in
later life is mixed and contradictory. Though current
research suggests e-cigarettes as less harmful than
Fig 2- Components of electronic cigarettes
cigarettes, it is only logical to assume that nicotine
in any form is highly addictive. Also, the most recent
USE OF E-CIGARETTES:
Cochrane review has substantiated that though there
is evidence that e-cigarettes can help smokers quit the
From the time it was introduced into
the
habit in the long term, it is not devoid of potentially
market, there has been a noted escalation in
the
harmful impacts.
sales of e-cigarettes. Today there are several million
users globally, with the United States (US) & United
To add credit to the above said data, an online
Kingdom (UK) recording a peak.5 Most users give
survey targeting first time smokers/ chronic smokers/
a previous history of smoking while many report
vapers/ dual smokers was conducted to assess the
several reasons for its use.
slow but steadily increasing use of e-cigarettes. The
respondents filled a questionnaire form to provide
• Recreational use
authentic data.
• To abstain from/quit smoking
• Vaping is a healthy alternative to smoking
• They are odor free
• Less hazardous.
However there exists today a small percentage of
“vapers” who have expressed dissatisfaction and
safety concerns while vaping.6
Fig 3- Nanoparticles present in smoking vapors
ADVERSE EFFECTS OF VAPING:
METHODOLOGY
Though there is literature 7 that supports the
evidence that e-cigarettes may be safer than tobacco
An online questionnaire consisting of about
cigarettes, its safety is yet to be ascertained. In July
25 questions was created using Google forms. The
2014, a WHO report cautioned about the potential
link was circulated among vapers in Chennai city
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Visale et al : Increasing Incidence of Usage of E-Cigarettes
population, over a period of 1 month. The questions
•
Curiosity
(43.3%) was the major lead to the
were mostly close-ended with range of possible
usage of e-cigarettes, whereas 33.3% considered
e-cigarettes as less harmful than regular cigarettes
answers, and a few open-ended questions to obtain
while 20% wanted an alternative for smoking.
unexpected and valuable information.
Peer recommendation was a steer to the usage of
e-cigarettes in 3.3% of the surveyed population.
INCLUSION CRITERIA: vapers, previous
(Chart 1)
smokers but current vapers, dual users (both regular
cigarettes and e-cigarettes.
•
Only 13.3% of the study population had tried
nicotine replacement therapies and it was only in
EXCLUSION CRITERIA: only smokers, people
the form of nicotine chewing gum. Despite the
who had knowledge about vaping but had not vaped
availability of Nicotine patches, Nicotine inhaler,
Nicotine Tablets/ lozenges and Nicotine mouth
yet.
spray, none had tried them. (Graph 4)
The questionnaire was filled by
54
•
Despite the usage of e-cigarettes,
43.3%
respondents comprising of vapers/smokers/dual users
considered regular conventional cigarettes
and others. Taking into account, the inclusion and
as being more addictive. While
23.3% felt
exclusion criteria, 30 respondents were filtered and
e-cigarettes to be more addictive, 33.3% owed a
the responses were subjected to statistical analysis.
similar effect to both. (Graph 5)
Data for this study were entered in Microsoft Excel
•
Of the numbers surveyed, 46.7% resorted to the
and analyzed in the SPSS statistical package version
usage of e-cigarette as a means to wean away
20.0. Descriptive statistics were computed for all
from regular smoking and were successful; but
variables. An association between knowledge about
53.3% denied the same. (Graph 6)
e-cigarettes and addiction to vaping versus age
group, gender and smokers were determined using
•
While 33.3% of the study population felt that
Pearson’s chi-square test. Results were considered
‘tobacco consumption had dramatically decreased
since using e-cigarettes’, while an equal number
statistically significant when the p-value was <0.05.
(33.3%) felt that
‘tobacco consumption had
dramatically increased since using e-cigarettes’.
RESULTS:
From the remaining, 16.7% had not smoked for
several weeks while 16.7% had not smoked for
•
The study population consisted of 24 males and 6
several months. (Graph 7)
females, who were using e-cigarettes.
•
Concerning the recommendations of e-cigarettes
•
About 80% of the study population were in the
as a predictable alternative to quit/cut down
age range of 15-25 years, while 20% were 26-35
on conventional smoking, 66.7% of the study
years. (Graph 1)
population tends to agree with this concept, while
33.3% turned down the recommendation. Among
•
As regards, the rate of smoking in years, it was
the
66.7%,
40% was extremely successful,
shown that 83.3% of the study population were
55% was not very successful and 5% was very
smokers whereas
16.7% were not previous
unsuccessful in abstaining from smoking.
smokers (Graph 2). Among the smokers, 56%
had a previous history of smoking for 3-5 years
•
Regarding the side effects of vaping, 46.7% of
and 44% were smoking for the past 6-10 years.
the study population did not experience any
side effects in e-cigarette usage, while
53.3%
•
Although the entire study population was using
experienced various side effects such as headache
e-cigarettes, only
33.3% used e-cigarettes on
(37.5%), vomiting
(37.5%) and feeling sick
a regular basis, while the remaining 66.7% use
(18.8%). ‘Hair fall and sinusitis’ were the other
them rarely.
side effects stated. (Chart 2)
•
When asked about the knowledge of vaping,
•
At this juncture, it would only be fitting to the
50% of the study population confessed to having
context to comment on the adverse feelings felt
got to know about vaping through their peers,
by the e-cigarette users - this amounted to 33.3%
43.4% through advertisements and 3.3% through
of surveyed population; 40% felt ‘too much hype’
journals. (Graph 3)
and 20% felt that ‘it could act as a launching pad’.
(Graph 8)
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inflammation and senescence of periodontal
fibroblast.10 Added to this vaping is increase in
inflammation, oxidative stress, altered cell response,
an impaired host response and dysregulated repair
mechanism leading to poor oral health.11
Our questionnaire pilot study established
the fact that though e-cigarettes did not contain
concentrated nicotine as do conventional cigarettes,
there was irrefutable evidence about the health
hazards associated with vaping. Till date majority
of published studies on the health consequences of
e-cigarettes have focused on the effects of vaping
mostly on the cardiovascular system/pulmonary
system, given the strong links associating nicotine
usage and diseases of these organ systems. Our study
has some limitation - first larger sample size would
prove to be more credible; being a cross-sectional
study clinching causality between regular vaping and
poor oral health could not be defined; moreover as it
is self-reported it is subject to information bias.
CONCLUSION:
DISCUSSION:
It has globally been perceived that usage
of e-cigarettes is considered a safer alternative
Effects of smoking have been well established
to conventional cigarettes as it contains fewer
and recognized over the previous decades. Today
chemicals and toxicants. However, many studies1,5
electronic cigarettes (e-cigarettes) are emerging as an
have substantiated the fact that e-cigarettes do
alternative popular mode of nicotine consumption. It
definitely cause adverse health effect-more so in
is now well acclaimed that nicotine use in any form
the oral cavity. At this juncture it is worth bearing
leads to general health hazards with concurrent poor
in mind that though e-cigarettes use “vapors”, it
oral health.
cannot be denied that it still carries with it a noted
mortality rate. Though e-cigarette possess some
Poor oral health and consequent tooth loss
of the (supposed) good features, it harbors some
impacts quality of life and is a significant health
potentially concerning (ugly) ones. Our main goal
concern.9 An alarming increase in deterioration of
should be stringent tobacco control and the evolution
dental health as result of nicotine use has garnered
of younger generation which is aware of the myriad
much attention and efforts are on to curtain to an
health and oral hazards linked to this (lesser evil) and
optimum extent, the usage of nicotine in any form.
choose to abstain from it.
Thus, it has come to be viewed that though usage of
e- cigarettes lessens the health burden it in no way
FINANCIAL SUPPORT AND
mitigates various other toxic aftermath of nicotine.
SPONSORSHIP:
Nicotine, one of the main constituents of e-cigarettes
plays a stellar role in tooth loss due to its ability to
Nil
reduce tooth mineralization through altered genetic
signaling and activation of inflammatory pathway. 10
CONFLICTS OF INTEREST:
There is emerging evidence that suggests
There are no conflicts of interest.
other components of e-cigarettes promote oral
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Visale et al : Increasing Incidence of Usage of E-Cigarettes
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