It is important to split the health issues into their two distinct components-

Transcription

1 E Cigarettes One major point to make at the outset:- It is important to split the health issues into their two distinct components- -The health of the wider public in the context of new take up of e-cigariettes (studies in the USA indicate that 20% of youngsters have tried or have taken up their use without having smoked before):- - Uptake by existing smokers which in reality is the issue as regards their use on licensed premises. Positive aspects of E-cigarette use:- - Switch from much more harmful tobacco, - Smaller nicotine intake due to pattern of usage - ie no pressure to finish cigarette due to cost. Puff when needed. - Ability to reduce nicotine dosage in the e-cigarette fluid - No large groups outside premises late at night - noise nuisance - No smoking related litter. - No passive smoking - No fire safety issues Studies have shown e-cigarettes to be 60% more effective in weaning smokers off tobacco/nicotine than patches and gum. This is backed by my own experience in the pub where most users have gradually reduced the level of nicotine in their fluids. A Public Health England study concluded that there is a large potential for health benefits from switching from tobacco to other nicotine delivery devices. One review has found that overall electronic systems appear to deliver less nicotine than smoking. The UK NHS has found that toxic chemicals present in e-cigarette tests were at levels 1/1000th that of traditional cigarette smoke.

2 We need to be careful which agenda we are pursuing whether it is the loss of duty revenue disguised as health concerns; the legitimate health agenda which itself is not black and white. It is also worth looking at the substances involved with e-cigarettes compared with traditional tobacco products There are four active components in e-cigarettes:- - Water - Flavourings as are available from pharmacies and health food shops; menthol crystals are available from pharmacies - Nicotine at varying concentrations with the facility to reduce to zero - A Base fluid which will consist of either of -Propylene Glycol - the pharmaceutical grade which is the one used in e-cigarettes is on US FDA s Generally Recognised As Safe list. The World Health Organisation also consider it safe. or - Vegetable glycerin - widely available from supermarkets. Usual sources are palm oil, soy or coconut oil. The following is an article about the pros and cons of the liquid base alternatives propylene glycol and vegetable glycerin quote:- If you re a smoker looking to make the switch to electronic cigarettes, you re probably curious about what you ll be putting into your lungs instead of that dreadful tobacco smoke. Unfortunately, vaping terminology can be a bit confusing at first, so in this article I m going to try and explain the differences between the two most widely used e-liquid bases: propylene glycol (PG) and vegetable glycerin (VG). E-liquids contain four ingredients: a PG or VG base, nicotine, water and flavorings. The base, or carrier, holds the nicotine and flavor in suspension so your e-cigarette can produce those nice clouds of smoke-like vapor. Both propylene glycol and vegetable glycerin are non-toxic organic compounds and

3 generally considered safe for consumption. In fact, they are widely used as food additives in a variety of commercially available products. First, let s talk about PG-based e-liquid, because it s the most popular of the two. Due to the fact that propylene glycol is relatively thin in consistency, this kind of e-liquid is runnier than the VG variety, and is more easily absorbed by the polyfill fabric inside the cartomizer. The low density of the juice also means that gunk doesn t build up on the heating element of your e-cigarette as fast as it does when thicker vegetable glycerin liquid is used. Propylene glycol is a tasteless odorless substance, so it doesn t alter the flavor of the e-liquid in any way. It s also a powerful humectant, so while it will dry your mouth and throat if used consistently, PG also produces a stronger throat hit, similar to that of tobacco cigarettes. On the down side, propylene glycol is known to cause allergic reactions in some e-cig users. These can vary from minor reactions, like a tingling sensation in the throat, to serious irritations on various parts of the body. If you experience any unusual symptoms after vaping PG e-liquid, it s best to stop using it immediately and switch to vegetable glycerin. Vegetable glycerin is a considerably thicker solution, compared to propylene glycol. On its own, VG has a slight sweet taste which also makes the e-liquid sweeter and the flavors a little difficult to detect. While PG is know to give users a dry mouth, some vapers have complained about phlegm building up in their throat after using vegetable glycerin-based juices. You also get less of a throat hit when using VG. On the upside, because of its high consistency, VG e-liquids produce significantly more vapor and doesn t cause allergic reactions or irritations as often as propylene glycol. It s fair to say the vaping community is evenly divided when it comes to e-liquid preference. Some enjoy the smoking-like throat hit of vaping propylene glycol juices, while others prefer the thick plumes of vapor and the sweet taste of vegetable glycerin. It s hard to say which one of the two is the best, because it ultimately comes down to personal preference. I d suggest you start with a PG e- liquid, especially if you re looking for an experience close to smoking, and try out a VG juice along the way, just to see what you re missing out on. To get the best of both worlds, many vapers prefer a PG/VG mix, in different amounts. This way, they get a decent throat hit as well as pillowy clouds of thick vapor. - See more at:

4 The constituents of cigarette and tobacco product smoke. In contrast the chemicals in cigarette smoke are much more worrying for good reason. The following summary is taken from an article that appeared in Medical News Today) Experts say that cigarette smoke contains over 4,000 different compounds. A significant number of them are toxic (poisonous) and can damage our cells. Many of them are carcinogenic. Below is some information on a few compounds found in tobacco smoke, the most abundant ones, tar, nicotine and carbon monoxide are at the bottom of this list: Acetaldehyde Acetone Acrolein Acrylonitrile 1-aminonaphthalene 2-aminonaphthalene Ammonia Benzene Benzo[a]pyrene 1,3-Butadiene - this chemical is used in resins and glues. It is believed to be a carcinogen. Experts say it is likely that it facilitates the absorption of other dangerous chemical into the bronchial tubes. - this chemical is used in solvents. It irritates the eyes, nose and throat. Long-term exposure can damage the liver and kidneys. - commonly used in herbicides and polyester resins. It is also used in chemical warfare. Acrolein is an ingredient in tear gas. It is very poisonous and irritates the eyes and upper respiratory tract. - also known as vynil cyanide. Experts believe it is a human carcinogen. It is used in synthetic resins, rubber and plastics. - in ingredient in weed killers. It is a known carcinogen. - this substance causes bladder cancer. It is banned in industrial uses. - it is known to cause asthma and raise blood pressure. Ammonia is used in cleaners. - used in gasoline, causes several cancers, including leukemia - this chemical is found in coal tar pitch, and creosote. It is a known carcinogen, especially for lung and skin cancers. It can also undermine human fertility. - it is used in latex, rubber and neoprene products. Experts believe it is most likely a carcinogen.

5 Butyraldehyde Cadmium Catechol Chromium Cresol Crotonaldehyde Formaldehyde Hydrogen Cyanide Hydroquinone Isoprene Lead - this chemical affects the lining of the lungs and nose. It is used in solvents and resins. It is a powerful inhalation irritant. - a known carcinogen. It damages the brain, kidneys and liver. Cadmium is used in non-corrosive metal coatings, storage batteries, pigments, and bearings. - it elevates blood pressure and irritates the upper respiratory tract. It can also cause dermatitis. Catechol is used as an antioxidant in oils, inks and dyes. - known to cause lung cancer. It is used in wood treatment, wood preservatives, metal plating and alloys. Those involved in welding have the greatest risk of exposure. - acute inhalation can cause throat, nasal and upper respiratory irritation. It is used in disinfectants, wood preservatives and solvents. - a warning agent in fuel gasses. Experts say it messes up the human immune system. It can also cause chromosomal changes. - part of the resin used in foam insulation, plywood, fiberboard and particleboard. It can cause nasal cancer, as well as damaging the digestive system, skin and lungs. - some US states use this chemical in their gas chambers for executions. It weakens the lungs and causes fatigue, headaches and nausea. It is used in the production of acrylic plastics and resins, and can also be a fumigant. - has a detrimental effect on the central nervous system. Also causes eye injuries and skin irritation. It is used in varnishes, motor fuels and paints. - similar to 1,3-butadiene. It causes skin, eye and mucous membrane irritation. It is used in rubber. - lead damages the nerves in the brain, as well as the kidneys and the human reproductive system. Lead intake can also cause stomach problems and anemia. It is a known carcinogen and is particularly toxin to children. Lead is used in paint and metal alloys. Methyl Ethyl Ketone (MEK) - depresses the human nervous system, irritates the eyes, nose and throat. MEK is used in solvents.

6 Nickel - a known carcinogen, nickel also causes bronchial asthma and upper respiratory irritation. Nitric Oxide - this is a major contributor to smog and acid rain. It is made by gasoline combustion. Scientists say it is linked to a higher risk of developing Alzheimer's disease, Parkinson's disease, Huntington's disease and asthma. NNN, NNK, and NAT - NNN and NNK are known carcinogens and NAT might be one. The three compounds are unique to tobacco. NNN may also cause reproductive problems. NNK is closely linked to lung cancer risk. Phenol - this highly toxic substance is harmful for the central nervous system, cardiovascular system, respiratory system, the kidneys and liver. It is used in resins in plywood and construction materials. Propionaldehyde - irritates the respiratory system, skin and eyes. It is used as a disinfectant. Pyridine - irritates the eyes and upper respiratory tract. It also causes nervousness, headaches and nausea. Experts say it might cause liver damage. This substance is used in solvents. Quinoline - it is used for stopping corrosion and also as a solvent for resins. It is a severe eye irritant, is harmful to the liver, and causes genetic mutations. Experts believe it may be a carcinogen. Resorcinol - irritates the eyes and skin. It is used in resins, adhesives (glue) and laminates. Styrene - irritates the eyes, may slow down reflexes, and causes headaches. It is linked to a higher risk of leukemia. This substance is used in fiberglass, pipes, plastic and insulation materials. Toluene - causes confusion, memory loss, nausea, weakness, anorexia, and drunken movements. It is also associated with permanent brain damage. The chemical is used in resins, oils and solvents. Nicotine - this is not carcinogenic. However, it is highly addictive. Smokers find it very hard to quit because they are hooked on the nicotine. Nicotine is an extremely fast-acting drug. It reaches the brain within 15 seconds of being inhaled. If cigarettes and other

7 Carbon Monoxide Tar tobacco products had no nicotine, the number of people who smoke every day would drop drastically. Without nicotine, the tobacco industry would collapse. Nicotine is used as a highly controlled insecticide. Exposure to sufficient amounts can lead to vomiting, seizures, depression of the central nervous system, and growth retardation. It can also undermine a fetus' proper development. - this is a poisonous gas. It has no smell or taste. The body finds it hard to differentiate carbon monoxide from oxygen and absorbs it into the bloodstream. Faulty boilers emit dangerous carbon monoxide, as to car exhausts. If there is enough carbon monoxide around you and you inhale it, you can go into a coma and die. Carbon monoxide decreases muscle and heart function, it causes fatigue, weakness, and dizziness. It is especially toxic for babies still in the womb, infants and indifividuals with heart or lung disease. - consists of several cancer-causing chemicals. When a smoker inhales cigarette smoke, 70% of the tar remains in the lungs. Try the handkerchief test. Fill the mouth with smoke, don't inhale, and blow the smoke through the handkerchief. There will be a sticky, brown stain on the cloth. Do this again, but this time inhale and the blow the smoke through the cloth, there will only be a very faint light brown stain. Because tar is listed on packs, it is easy to believe that it is the only harmful part of cigarettes. But some of the most dangerous chemicals in tobacco smoke are present as gases, and do not count as part of tar. This means that cigarettes with less tar still contain all the other toxic chemicals. From a Cancer Research UK study:- A cigarette when it burns releases a dangerous cocktail of about 4,000 chemicals including more than 70 cancer-causing chemicals, hundreds of other poisons, Nicotine, a highly addictive drug, and many additives designed to make cigarettes taste nicer and keep smokers hooked.

8 Cancer-causing chemicals in tobacco smoke Tar - a mixture of dangerous chemicals Arsenic - used in wood preservatives Benzene - an industrial solvent, refined from crude oil Cadmium - used in batteries Formaldehyde - used in mortuaries and paint manufacturing Polonium a highly radioactive element Chromium - used to manufacture dye, paints and alloys 1,3-Butadiene - used in rubber manufacturing Polycyclic aromatic hydrocarbons - a group of dangerous DNAdamaging chemicals Nitrosamines - another group of DNA-damaging chemicals Acrolein - formerly used as a chemical weapon Other chemicals Other poisons in cigarette smoke Hydrogen cyanide - used as an industrial pesticide Carbon monoxide - found in car exhausts and used in chemicals manufacturing Nitrogen oxides - a major component of smog Ammonia - used to make fertilisers and explosives More poisons Tar Tar is a term that describes a collection of solid particles that smokers inhale when they light a cigarette. It is a mixture of lots of chemicals, many of which can cause cancer. When it settles, tar forms a sticky, brown residue that can stain smokers teeth, fingers and lungs. Arsenic Arsenic is one of the most dangerous chemicals in cigarettes. It can cause cancer as well as damaging the heart and its blood vessels. Small amounts of arsenic can accumulate in smokers bodies and build up to higher concentrations over months and years. As well as any direct effects, it can worsen the effect of other chemicals by interfering with our ability to repair our DNA. Fish and seafood can be major sources of arsenic, but in a form that is less toxic and more readily removed from the body. In contrast, tobacco smoke contains arsenic in a more dangerous form. Benzene

9 Benzene is a solvent used to manufacture other chemicals, including petrol. It is well-established that benzene can cause cancer, particularly leukaemia. It could account for between a tenth and a half of the deaths from leukaemia caused by smoking. Tobacco smoke contains large amounts of benzene and accounts for a big proportion of our exposure to this poison. The average smoker inhales about ten times more benzene than the average non-smoker. And some studies have estimated that the amount of benzene that a person inhales through second-hand smoke over their lifetime could increase their risk of cancer. Cadmium Cadmium is a metal used mostly to make batteries. The majority of cadmium in our bodies comes from exposure to tobacco smoke. Smokers can have twice as much cadmium in their blood as non-smokers. Studies have found that the amounts of cadmium present in tobacco smoke are capable of affecting our health. It is a known cause of cancer, and can also damage the kidneys and the linings of the arteries. Our bodies have proteins that mop up harmful chemicals like cadmium, but the amounts in smoke can overload these proteins. Cadmium can also prevent our cells from repairing damaged DNA. Because of this, it can make the effects of other chemicals even worse. Formaldehyde Formaldehyde is a smelly chemical used to kill bacteria, preserve dead bodies and manufacture other chemicals. It is one of the substances in tobacco smoke most likely to cause diseases in our lungs and airways. Formaldehyde is also a known cause of cancer. It is believed that even the small amounts in second-hand smoke could increase our lifetime risk of cancer. Tobacco smoke is one of our major sources of formaldehyde exposure. Places where people smoke can have three times the normal levels of this poison. Polonium-210 Polonium is a rare, radioactive element and polonium-210 is its most common form. Polonium strongly emits a very damaging type of radiation called alpharadiation that can usually be blocked by thin layers of skin. But tobacco smoke contains traces of polonium, which become deposited inside their airways and deliver radiation directly to surrounding cells. The lungs of smokers can be exposed to four times more polonium than those of non-smokers and specific parts may get a hundred times more radiation. One

10 study estimated that someone smoking one and half packs a day receives the equivalent amount of radiation as someone having 300 chest X-rays a year. Chromium Chromium is a metal used to make metallic alloys, dyes and paints and comes in different types. Chromium III or trivalent chromium is most commonly used. It is available as dietary supplements and is harmless. On the other hand, chromium VI or hexavalent chromium is very toxic, is found in tobacco smoke, and is known to cause lung cancer. It allows other cancercausing chemicals (such as polycyclic aromatic hydrocarbons) to stick more strongly to DNA and damage it. 1,3-Butadiene 1,3-butadiene or BDE is an industrial chemical used in rubber manufacture. Some scientists believe that of all the chemicals in tobacco smoke, BDE may present the greatest overall cancer risk. It may not be as good at causing cancer as some of the other chemicals listed here, but it is found in large amounts in tobacco smoke. Polycyclic aromatic hydrocarbons Polycyclic aromatic hydrocarbons or PAHs are a group of powerful cancercausing chemicals that can damage DNA and set cells down the road to becoming tumours. One of these chemicals - benzo(a)pyrene or BAP - is one of the most widely studied of all tobacco poisons. BAP directly damages p53, a gene that normally protects our bodies against cancer. Nitrosamines Nitrosamines are a group of chemicals that can directly damage DNA, like polycyclic aromatic hydrocarbons (PAHs). They are found in small amounts in food. But tobacco products, including those that are chewed rather than smoked, are by far our largest source of exposure to these chemicals. Even though they are found in relatively small amounts in cigarettes, they are very strong cancer-causing chemicals. Acrolein Acrolein is a gas with an intensely irritating smell and is one of the most abundant chemicals in cigarette smoke. It belongs to the same group of chemicals as formaldehyde and acetaldehyde, both of which can cause cancer. Until now, it wasn t clear if acrolein causes cancer as well, but recent experiments

11 suggest that it can. We now know that acrolein can cause DNA damage that is similar to the damage seen in lung cancer patients. Since smoke contains up to 1,000 times more acrolein than other DNA-damaging chemicals, it could be a major cause of lung cancer. Acrolein also stops our cells from repairing DNA damage, like arsenic and cadmium. And like hydrogen cyanide, it kills the hairs that normally clean our lungs of other toxins. Other chemicals Some of the other cancer-causing ingredients of tobacco smoke include: metals, such as nickel, lead, cobalt and beryllium. While you may be exposed to some of these metals through domestic items or food, inhaling them in tobacco smoke is worse, because they are easily absorbed by the lungs. acetaldehyde, which is also formed in your tissues when you drink alcohol - it is responsible for many nasty hangover symptoms hydrazine, a very toxic chemical used mainly in rocket fuel Hydrogen cyanide Hydrogen cyanide is a poisonous gas. Of all the chemicals in tobacco smoke, it does the most damage to the heart and blood vessels. Hydrogen cyanide does not cause cancer, but it increases the risk of other chemicals causing cancer by damaging cilia. These are tiny hairs lining the airways that help to clear toxins away. By killing cilia, hydrogen cyanide causes other dangerous chemicals to be stuck in the lungs and airways. Carbon monoxide Carbon monoxide is a colourless gas with no smell. It is formed when we burn carbon-based fuels, such as gas in cookers or petrol in car engines. It can make up as much as 3-5% of tobacco smoke. Carbon monoxide sticks to our red blood cells in place of oxygen. This lowers our blood s ability to transport oxygen and deprives our tissues and organs of this vital gas. Like hydrogen cyanide, it kills cilia and reduces our lungs ability to clear away toxins. This means that while carbon monoxide does not cause cancer directly, it makes it easier for other chemicals to do so. Nitrogen oxide Nitrogen oxide is a gas found in car exhaust and tobacco smoke. Our bodies use it in very small amounts to carry signals between cells. But in large amounts, it is a major air pollutant. It directly damages lung tissue and

12 causes inflammation in the lungs. Normally, our bodies produce small amounts of nitrogen oxide, which causes our airways to expand. The large amount of nitrogen oxide in tobacco smoke changes things in two ways: When smokers are smoking, it expands their airways even further, making it easier for their lungs to absorb nicotine and other chemicals. When they are not smoking, it shuts off their internal nitrogen oxide production line, causing their airways to constrict. This is one reason why regular smokers often have difficulty breathing. Ammonia Ammonia is a gas with a strong, irritating smell, and is used in some toilet cleaners. Some studies have found that ammonia enhances the addictive power of nicotine. It changes nicotine into a gas that is more readily absorbed into the lungs, airways and bloodstream. Like carbon monoxide and hydrogen cyanide, ammonia also kills cilia. More poisons Tobacco smoke also contains many other poisons that produce harmful effects. These can be carried throughout the body via our blood vessels. As well as hydrogen cyanide and ammonia, gases like sulphur dioxide also kill cilia (protective hairs) in our lungs. This stops them from being able to clear away other harmful chemicals. Chemicals like hydrogen sulphide and pyridine irritate our airways. Toluene can damage brain cells and interfere with their development. More on NNN, NNK and NAT These nitrosamine carcinogens are formed from nicotine and related compounds by a nitrosation reaction that occurs during the curing and processing of tobacco. They are called tobacco-specific nitrosamines because they are found only in tobacco products, and possibly in some other nicotine-containing products. The tobacco-specific nitrosamines are present in cigarette smoke and to a lesser degree in "smokeless" tobacco products such as dipping tobacco and chewing tobacco. They are present in trace amounts in snus, a Swedish style snuff that is not fermented (a type of curing) and is pasteurized. They are among the most important carcinogens in cigarette smoke, along with combustion products and other carcinogens. Among the tobacco-specific nitrosamines, 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanone (NNK) and N'-nitrosonornicotine (NNN) are the most carcinogenic.

13 NNK and its metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are potent systemic lung carcinogens in rats. Tumors of the nasal cavity, liver, and pancreas are also observed in NNK- or NNAL-treated rats. NNN is an effective esophageal carcinogen in the rat,[1] and induces respiratory tract tumors in mice, hamsters, and mink. A mixture of NNK and NNN caused oral tumors when swabbed in the rat oral cavity. Thus, considerable evidence supports the role of tobacco-specific nitrosamines as important causative factors for cancers of the lung, pancreas, esophagus, and oral cavity in people who use tobacco products. Metabolism and chemical binding to DNA (adduct formation) are critical in cancer induction by NNK and NNN. Human metabolism of NNK and NNN varies widely from individual to individual, and current research is attempting to identify those individuals who are particularly sensitive to the carcinogenic effects of these compounds. Such individuals would be at higher risk for cancer when they use tobacco products or are exposed to secondhand smoke. Identification of high-risk individuals could lead to improved methods of prevention of tobacco-related cancer, and improved risk valuation for insurers. European legality E-cigarettes are widely legal in Europe. In Austria they are clasified as medical products, likewise in Denmark if containing nicotine. Finland has banned them but not the non-nicotine variety. In Switxerland the sale of e-cigarettes is banned but the use of them is legal. Summary First of all I should make it clear that I have no vested interests. I am not involved with the e-cigarette industry, I am not a smoker and never have been and I do not use e-cigarettes. I put this paper together because the arguments against e-cigarettes have in some quarters become quite shrill and I thought that for the purposes of the discussions on the Fife Licensing Forum it would be good to introduce more balance to the arguments. This has been prompted by my experiences of customer use, which, in the context of the pub, have been wholly positive. This comes back to the opening statement and the need to differentiate between take up by children and young perons and the use of these devices as a means of quitting smoking.