8 truths about e-cigarettes and whether they are harmful?

Regarding whether electronic cigarettes are harmful, different perspectives can lead to completely different conclusions. Most of the evidence on the reduction of harm caused by e-cigarettes is based on research and published articles from the UK health system.
Based on long-term scientific research on e-cigarettes, in 2018, the UK began allowing e-cigarettes to be sold in hospitals and providing e-cigarette lounges for patients, in order to encourage smokers to switch from traditional tobacco to e-cigarettes and ultimately quit smoking. In 2019, the global tobacco regulatory agency STOP (Stopping Tobacco Organizations and Products) reported that the UK was listed as the best country to take action in tobacco control.
On March 5, 2020, the UK health system released the "8 Truths about e-cigarettes"
The following is the full translation of an article from the UK Department of Public Health:
Electronic cigarettes are not absolutely harmless, but their harm is far less than cigarettes. Our suggestion remains that smokers should switch completely to e-cigarettes, but if you are not a smoker, then do not try e-cigarettes.
This article clarifies some of the most common misunderstandings surrounding e-cigarettes and provides basic facts and claims.
1. Regular nicotine e-cigarettes are not associated with lung disease in the United States
Last August, severe cases of lung injury began to occur across the United States. In the following months, a total of 68 people in the United States died from this lung injury, but the cause of the disease could not be immediately identified at that time.
This outbreak of special lung disease only affects specific populations, and the proportion of new cases has rapidly reached a turning point. Based on these facts, we wrote a letter to the medical journal The Lancet and explained that a batch of "inferior" illegal cannabis e-cigarette products may be the culprit.
However, in response to this special outbreak of lung disease, regulatory agencies around the world have begun to demand the removal of nicotine e-cigarette products from the market, while cigarettes are still available for purchase. This greatly hinders smokers who want to switch to e-cigarettes.
Afterwards, the relevant authorities in the United States gradually recognized that vitamin E acetate added to e-cigarette products was the main cause of this lung disease. According to UK regulations, e-cigarettes containing nicotine must not contain vitamin E acetate.
2. Switching to e-cigarettes can improve vascular health
A controversial research report published by the Journal of the American Heart Association once stated that the risk of heart disease among e-cigarette users is no different from that of smokers - the report has recently been withdrawn by the Journal of the American Heart Association because the study did not take into account that almost all e-cigarette users are still cigarette users or have been.
A randomized controlled trial published in December 2019 evaluated the effects of e-cigarettes on blood vessels in smokers who switched to e-cigarettes, and the results were as follows:
Those smokers who completely switched to e-cigarettes achieved significant improvements in vascular health, almost approaching the level of the healthy 'control group'. In the future, larger scale and longer time span research will further enhance the confidence of e-cigarette users.
3. Electronic cigarettes pose far less harm than cigarettes
Only one-third of adults in the UK know that the harm of smoking e-cigarettes is far less than smoking. However, the fact is that research by the National Academy of Sciences, Engineering, and Medicine (NASEM) in the United States has found that e-cigarettes are far less harmful than traditional cigarettes.
A 2015 independent report by the UK Department of Public Health concluded that "although smoking e-cigarettes may not be 100% safe, e-cigarettes do not contain most of the chemicals that can cause cigarette related diseases, and the harm of the chemicals they contain is also very limited
More research is needed on the 'relative harm' of e-cigarettes. Last month, the UK Department of Public Health commissioned an international expert group to write the heaviest report in the e-cigarette series.
The expert group consists of past report authors and other international experts, and the team is currently conducting extensive systematic reviews (including a security review) in order to make the most authoritative assessment in 2022.
4. It's not nicotine that causes cancer, it's cigarette smoke
40% of smokers and those who have quit mistakenly believe that nicotine causes cancer, while evidence suggests that nicotine poses the least health risk. Although nicotine is the cause of addiction for smokers, the thousands of other chemicals contained in the burning process of cigarettes are the main culprits causing all the harm.
5. Electronic cigarettes can assist in quitting smoking and have significant effects
In February 2019, the National Institutes of Health (NIHR) in the UK funded a large-scale clinical trial. This clinical trial involved nearly 900 participants and found that e-cigarettes were twice as effective as nicotine replacement therapy (NRT) in helping smokers quit smoking.
An independent study by University College London (UCL) found that e-cigarettes help 50000 to 70000 cigarette users in the UK quit smoking every year.
6. Electronic cigarettes do not have second-hand smoke issues
There is evidence to suggest that exposure to second-hand cigarettes is harmful to physical health, which is why British law prohibits smoking cigarettes in closed public places and workplaces. However, these laws do not include e-cigarettes, and organizations can develop their own regulations on e-cigarettes.
The main components of electronic cigarette liquid are nicotine, propylene glycol, glycerol, and various seasonings. Unlike cigarettes, e-cigarettes do not emit sidestream smoke into the atmosphere, but only release aerosols.
The 2018 report by the UK Department of Public Health found that there is currently no evidence that smoking e-cigarettes poses a health hazard to people around them. In the 2022 report, the UK Department of Public Health will review the relevant evidence again. People with asthma and other respiratory diseases may be allergic to a range of environmental irritants, and the UK Department of Public Health has recommended that organizations consider this and adjust relevant regulations as appropriate.
7. The proportion of young people smoking in the UK will not increase due to e-cigarettes
The latest report found that there is no evidence to suggest that e-cigarettes cause an increase in the number of teenagers smoking. The survey shows that the proportion of e-cigarette users among young people is extremely low, and these users are mostly those who already smoke cigarettes. It should also be pointed out that the smoking rate among young people in the UK is continuously decreasing.
A study in 2019 lifted concerns that e-cigarettes may lead to a rebound in smoking rates. The UK Department of Public Health will continue to monitor trends in the use of e-cigarettes and cigarettes among young people. We have recently conducted a new study on the difference in the effects of adding seasonings on adolescent e-cigarettes and adult e-cigarettes.
8. Improving electronic cigarette regulations is very important
The UK has established comprehensive electronic cigarette regulations. According to the 2016 Tobacco and Related Products Regulations, electronic cigarette products containing nicotine must meet minimum quality and safety standards, as well as packaging and labeling requirements, and provide consumers with necessary information to make informed decisions.
In the UK, e-cigarette related advertising has been strictly restricted, and manufacturers are also required to report detailed information of all products to the UK Medicines and Health Products Authority.