A generation after public health advocates started the fight for a ban on smoking in public places another battle over exposure to cigarette use has commenced. This time the dispute centres not on smoking but on vaping. Proponents of e-cigarettes claim that vaping is safer than smoking, both for the vapers themselves and those around them.
However, Professor Simon Chapman disputes these claims and in the article below cites a range of evidence which demonstrates that both primary and secondary exposure to vaping can pose serious health risks. He argues that therefore vaping should be subject to the same public policy response as tobacco use and banned in public places.
Simon Chapman writes:
Over the 30 years between the time we banned smoking in cinemas, buses and trains and when it was finally banned in all public indoor spaces, we saw many truly bizarre attempts to justify its continuation in offices, then in restaurants and finally in the last bastions, pubs and bars.
Tobacco industry sponsored “courtesy” campaigns told us that smokers would be considerate and not smoke near others. That worked so well. Then it was proposed that the laws of physics did not apply to smoke: it would simply not cross a magic line two metres from the bar so it couldn’t harm bar staff.
Breathing it 2.02 metres away for the rest of us was OK, apparently. Secondhand smoke from very wealthy gamblers in high roller rooms where smoking is sometimes still allowed (as when the Barangaroo casino opens) is not harmful to others. It’s only harmful when it comes from ordinary mortals’ cigarettes, apparently.
Significant toxicological impact
Today we are seeing the same sort of nonsense being rehearsed to twist the arms of state governments to allow vaping in spaces where smoking is banned. Vaping advocates first tried to argue that vape was as benign as exposure to steam in your shower, a sauna or from a kettle. The sometimes massive cumulonimbus-like billows you see blown by vapers consist of yes, water vapour, but also particles and nanoparticles of partially vapourised flavouring chemicals, propylene glycol (PG), nicotine and traces of metals shed from the battery-activated metal heating coil that vapourises this brew.
Despite their small mass, such particles may have significant toxicological impact because of their increased propensity for deep penetration into the pulmonary and cardiovascular systems.
Vaping has only been widespread in some nations for 6-8 years. Chronic respiratory and cardiovascular diseases typically have latency periods of 30 or 40 years between the beginning of exposure to noxious agents and the first clinical signs of disease.
So it is far too soon for anyone to be making calls that any apparent absence of health impacts from active or passive vaping means they are either benign or dangerous.
The recent 680 page door-stopper report on e-cigarettes from the US National Academies of Science, Engineering and Medicine repeatedly describes the extent and quality of the evidence about vaping as scant, immature and often of poor quality.
However, it noted that “there is conclusive evidence that e-cigarette use increases airborne concentrations of particulate matter and nicotine in indoor environments compared with background levels.”
Advice from Dow
The Dow chemical company which makes PG advises “Dow does not support or recommend the use of Dow’s glycols where breathing or human eye contact with the spray mists of these products is likely”. Compared head-to-head, cigarette smoke emits far more of most of these ingredients than does vape from an e-cigarette. But when you get lots of vapers in a room, particle concentrations can build significantly.
When researchers counted particles in the air of 4023 cubic meter room at a vaping convention on six occasions with between 59 and 86 people vaping, particle counts were 125-330 times higher than in the same room when it was empty, with concentrations higher than those recorded in bars where cigarette smoking was allowed.
E-cigarette advocates like to paint folksy scenes of one or two “considerate” vapers having a quiet and discreet vape in the corner of a pub. But occupational health and clean air regulations are not drafted to accommodate a little bit of asbestos or an occasional excess of carbon monoxide.
Policy challenges
Public policy needs to deal with the diverse densities of patrons who might vape indoors. If vaping were allowed indoors, would any restrictions apply? Would bar staff be required to limit the number of people vaping, or request or order them to be discreet or “considerate” with their exhalations as with the ineffective approaches that were once made to smokers? Will arguments occur about whether a plume is excessive? How might “clouding” be forbidden? Will airlines allow a maximum of five passengers to vape but not 50? Good luck with all of that.
Vaping advocates also claim that indoor vaping bans will cause former smokers who now vape to go outside, where exposure to sensory cues from exiled cigarette smokers will trigger their relapse back to smoking. This would be all the fault of non-smokers selfishly putting their own health and comfort ahead of vapers and contributing to their exiled stigmatisation.
Inconsistent claims
If e-cigarette emissions were really benign, indoor vaping advocates should take courage and call for vaping to be also allowed in classrooms, crèches, operating theatres and neonatal wards. If they know it’s harmless after just a few years of accumulated often poor evidence, why hold back redressing these heinous attacks on freedoms?
With delightful irony, the 2016 Global Forum on Nicotine held in Warsaw, banned ENDS use by delegates in the conference rooms. The organisers’ plea that delegates in public areas “please be discreet and considerate. Use low powered devices as it helps to keep the amount of vapour created to a minimum” could not have been more revealing.
NSW Health Minister Brad Hazzard tweeted over the weekend that NSW would not be allowing vaping where smoking was banned. This is prudent, responsible health policy that will be very welcomed by the 85% of adults who don’t smoke.
Simon says
“The Dow chemical company which makes PG advises “Dow does not support or recommend the use of Dow’s glycols where breathing or human eye contact with the spray mists of these products is likely”
So the use of propylene glycol in nicorette quickmist is ok then because big pharma says it’s ok ?
Link
http://www.medicines.org.au/files/pcpnicqm.pdf
Quote
“DESCRIPTION
NICORETTE® QuickMist contains nicotine. 0.07 mL contains 1mg nicotine, corresponding to 1 mg nicotine/spray dose.
NICORETTE® QuickMist in addition to the active contains: propylene glycol, anhydrous ethanol, trometamol, poloxamer 407, glycerol, sodium hydrogen carbonate, levomenthol, mint flavour, cooling flavour, sucralose, acesulfame potassium, hydrochloric acid and purified water.
The mouth spray contains small amounts of ethanol (alcohol), less than 100mg per spray. “
Margaret, Big Pharma doesn’t say it’s OK. The TGA reviewed the evidence on safety (whare are the risks of using the standardised product as formulated under normal conditions of use) and efficacy (does it help smokers quit) and passed it. We don’t know how much PG vapers inhale with their (average) 200 inhalations/day (up to 600) but looking a chat lines about inhalable NRT, comments about using it about 4 times a day can be found. Likely to be rather different? I’m not a huge fan of the data on efficacy for NRT (see https://theconversation.com/drugs-gums-or-patches-wont-increase-your-chances-of-quitting-89767) so don;t look to me to defend that. And the US National Academies of Science, Engineering and Medicine’s 2018 report on ecigs described the evidence about ecigs being good fr cessation as:
Conclusion 17-2. There is moderate evidence from randomized controlled trials that e-cigarettes with nicotine are more effective than e-cigarettes without nicotine for smoking cessation.
Conclusion 17-4. While the overall evidence from observational trials is mixed, there is
moderate evidence from observational studies that more frequent use of e-cigarettes is associated with increased likelihood of cessation. https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf.
“Moderate evidence” is below both conclusive and substantial evidence.
Simon
I was under the impression that the FDA is considering Vaping products as reduced risk products as compared to known toxic smoke from cigarettes
I also believe the NASEM Report was to identify areas that need further research that is why they say low, medium high etc
Quote “With support from the Center for Tobacco Products of the Food and Drug Administration (FDA), the National Academies of Sciences, Engineering, and Medicine convened an expert committee to conduct a critical, objective review of the scientific evidence about e-cigarettes and health. The resulting report, Public Health Consequences of E-Cigarettes, provides an overview of the evidence,
recommends ways to improve the research, and highlights gaps that are priority focus areas for future work. ”
NASEM also say
“Overall, e-cigarette aerosol contains fewer numbers and lower levels of toxicants than smoke from combustible tobacco cigarettes.
&
Across a range of studies and outcomes, e-cigarettes appear to pose less risk to an indi- vidual than combustible tobacco cigarettes. ”
Link
https://www.nap.edu/resource/24952/012318ecigaretteHighlights.pdf
Margaret, yes of course. I hope you were not assuming that I somehow was suggesting that NASEM’s report was the last word we need on ecigs, and that all further research can now stop and policy be based on what we know or don’t know now. The NASEM report is just the best compilation of what we know now. I totally agree that ecigs “appear” to pose less risk that cigarettes. Our view of just how less risk risky will improve over time as we see longitudinal data on whether or not long term use causes problems. But it hardly follows from that that ecigs should be allowed to be used in areas where smoking is banned, the entire focus of my article.
Thanks for the article.
For me, there are also concerns about the impact of nicotine on dopamine activity in the brain. https://www.psychologytoday.com/conditions/nicotine
Why contribute to the development of compulsive behaviours in human beings for commercial profit of a few big companies like Phillip Morris who will undoubtedly supply the nicotine needed for vaping?