Electronic cigarettes, or e-cigarettes, vaporize a liquid that often contains nicotine and flavorants. Although e-cigarettes are less harmful than tobacco cigarettes, the e-cigarette vapor contains several ingredients and chemical impurities such as nicotine, propylene glycol, glycerol, aldehydes, nitrosamines and metals at concentrations that can be detrimental to health. Inhalation of these substances can lead to irritation of and/or damage to the respiratory tract, palpitations and an increased risk of developing cancer. These health effects are, however, less severe than those associated with smoking tobacco, which include lung cancer, heart attack and stroke, pulmonary emphysema, chronic obstructive pulmonary disease (COPD), and oral, tongue, esophageal, stomach and bladder cancer.
The Dutch National Institute for Public Health and the Environment (RIVM) performed a survey on e-cigarette users, performed measurements and assessed the risks. The study was performed on behalf of the ministry of Health, Welfare and Sport (VWS) because of the substantial increase in e-cigarette users, and the uncertainties surrounding the health effects of e-cigarette use. In this study, the RIVM assessed the possible health risks associated with exposure to the substances in e-cigarette vapor. In 2015, the RIVM will assess the possible health effects resulting from exposure to the compounds present in exhaled vapor.
Findings regarding users
The survey on Dutch e-cigarette users showed that the main reasons for e-cigarette use were that people presumed it to be less harmful than regular cigarettes, and to help them to quit smoking. Of the many brands and models available, refillable e-cigarettes were the most popular. Virtually all users had smoked tobacco prior to using e-cigarettes and most were dual users continuing to smoke tobacco in addition to e-cigarettes. There were large behavioral differences between 'vapers', for instance there were large variances in the number of puffs reported per day.
E-liquid and vapor compositionConsiderable differences were observed in the composition of different kinds of e-liquid available on the Dutch market and that of the resulting vapor. In some cases, the amount of nicotine in the e-liquid did not match the declared amount on the packaging. The concentration of some compounds was found to be higher in the vapor than in the liquid. Aldehydes are formed when the e-liquids are heated, and metals are released from the atomizer. Propylene glycol and glycerol function as a 'carrier liquid' for nicotine and flavorants.