Worldwide tobacco consumption provokes over 7 million deaths annually; 600 thousand are caused by exposition to second-hand smoke (passive smokers). In the Americas, its consumption accounts for 18% of the deceases related to noncommunicable diseases and over 80% deaths by lung, bronchi or trachea cancers.
In Mexico, it is estimated that deaths related to tobacco use rise up to 43 thousand people per year (8.4% of total deaths). According to the 2016-2017 National Drug, Alcohol and Tobacco Consumption Survey (ENCODAT 2016-2017), 17.6% of the population aged between 12 to 65 years smoke tobacco, which is equivalent to 14.9 million smokers in the country. Around 6.4% smokes daily, while 11.1% does it occasionally.
Consuming tobacco increases the risk of developing cancer, cardiovascular and pulmonary diseases (such as emphysema or chronic obstructive pulmonary disease, COPD), among others. Concerns about the effects of tobacco on health have led consumers to look for alternatives to its consumption. Seventy four percent (73.6%) of Mexican smokers have considered to stop smoking; over half (56%) have tried in the last year.
In Mexico, 7.8% of smokers have tried to stop smoking using traditional medicine or smoke-free tobacco products, such as e-cigarettes. This trend has been years on the market, and the general opinion is that they are a good alternative to replace tobacco use and avoids their effects on health. Nevertheless, there is no conclusive evidence that e-cigarettes are an effective method to stop smoking, especially in comparison to treatments established for this purpose.
E-cigarettes are devices that work with batteries, through which the consumer inhales a vapor that contains nicotine. This vapor is produced by heating a liquid inside the device, which is then inhaled by the consumer. The only smoke produced is the one by the consumer when exhaling the vapor previously inhaled.
E-cigarettes contain nicotine, main substance of tobacco that causes addiction, as well as flavorings, additives and occasionally metals such as chrome, lead, aluminum, iron and cadmium, which are potentially carcinogen. Negative effects of nicotine are widely documented, although its effects have not been identified when inhaled as a spray. Although the level of nicotine varies depending of the product, its consumption is similar to that of tobacco cigarettes.
It is worrying that consumers think that e-cigarettes are safer and healthier than those with conventional tobacco. Effects of e-cigarettes on health have not been widely studied. However, there is evidence that leads to consequences on health at a short-term. Some immediate physiological effects associated to high exposure to e-cigarettes are irritation of the mouth and throat and dry cough.
In relation to cardiovascular diseases, an increase in heart rate after e-cigarette use has been observed. Besides, a negative impact has been found on blood pressure in the short term, as there is an increase in both diastolic and systolic pressures as a nicotine effect, although evidence is limited in the long term.
A recent study found that e-cigarette flavorings affect blood vessel function. There was inflammation at a cellular level that might progress to cardiovascular disease, including heart attacks and stroke.
Unlike e-cigarettes, second-hand smoke is only originated by that exhaled by the consumer. However, this vapor still contributes to air pollution and, even if it is lower than that of tobacco cigarettes, it exceeds the recommended level. Children, pregnant women, elderly and patients with respiratory diseases might be at risk if inhaled regularly.
One of the most relevant risks is that the use of e-cigarettes encourages nicotine consumption on adolescents and children. They are more attractive to these age groups, as these refer to be less damaging than other tobacco products and are available on several flavors and scents. Likewise, there is the possibility that adolescents begin to smoke due to exposure to e-cigarettes. In Mexico, 6.5% of adolescents aged between 12 to 18 years (938 thousand) refer to have tried it sometime, and 160 thousand currently use them (1.1%).
In respect to adults, perception of them being ‘less harmful’ than tobacco products makes them a replacement instead of using them as a method to stop smoking. In Mexico, 1.1% of the population use e-cigarettes (975 thousand Mexicans), its use is greater in men than in women. Nearly 6% of the population has tried it once, which accounts for 5 million Mexicans.
In 2015, the World Health Organization (WHO) emitted a report to encourage all countries to ban e-cigarette sale. In Mexico, its sale is banned (including vaporizers and e-cigarettes). According to the Federal Commission for the Protection against Sanitary Risk (COFEPRIS), no e-cigarette has a health registration, as it has not been proved that they are safe nor they help to stop smoking.
The best advice to stop smoking is to seek support on efficient methods, provided by a health professional. However, only 3.5% of Mexican smokers seek support, according to the 2016-2017 ENCODAT. If you decide to stop smoking, get an appointment with your doctor to get the most appropriate method to achieve your goal.
American Cancer Society statement on e-cigarettes https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html
American Heart Association Newsroom. Tobacco aside, e-cigarette flavorings may harm blood vessels. ATVB Journal Report 2018. Available from: https://newsroom.heart.org/news/tobacco-aside-e-cigarette-flavorings-may-harm-blood-vessels
Callahan-Lyon P Electronic cigarettes: human health effects Tobacco Control 2014. https://tobaccocontrol.bmj.com/content/23/suppl_2/ii36.info
Comisión Federal para la Protección contra Riesgos Sanitarios. Alerta Sanitaria: Cofepris alerta sobre cigarros y similares a productos de tabaco que son comercializados de forma ilegal. Secretaría de Salud 2017. Available from: https://www.gob.mx/cms/uploads/attachment/file/313222/8_Alerta_Sanitaria_tabaco_y_e-cigarettes_27Abril2017.pdf
Comisión Federal para la Protección contra Riesgos Sanitarios. ¿Es legal comercializar cigarrillos electrónicos? Revista Cofepris 2016. Available from: http://revistacofepris.salud.gob.mx/images/no6/secciones/cuentanos.pdfNational Academy of Sciences. Public health consequences of e-cigarettes. The National Academies Press 2018. Disponible desde: https://www.nap.edu/read/24952/chapter/1
Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, Nena E. E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives. Frontiers in Public Health. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879739/
Secretaría de Salud. Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco: Reporte de Tabaco 2016-2017. Secretaría de Salud 2017. Available from: https://drive.google.com/file/d/1Iktptvdu2nsrSpMBMT4FdqBIk8gikz7q/view