E-cigarettes – What are they & what are the risks?
The term e-cigarettes covers a variety of products that use an internal battery to turn a viscous solution of chemicals, flavors and nicotine or marijuana, often called “juice” into an aerosol the user can inhale. E-cigarettes are neither healthy nor harmless.
E-cigarettes were introduced to the American market in 2007. They are known by a variety of names: e-cigarettes, vapes or Electronic Nicotine Delivery systems (ENDs) The designs have evolved from early models that replicated traditional cigarettes to large “tank” designs. Early models had a smaller battery, were preloaded with a nicotine solution and disposable. Tank designs allow users to customize the juice, customizing nicotine levels, their choice of flavorings and have larger, lithium battery which produces large “clouds”.
Currently there are over 450 different brands of e-cigarettes and 7,500 flavors. Major tobacco companies own or have a share in many e-cigarette companies.
In 2015 e-cigarette models began being redesigned. These e-cigarettes look nothing like a combustible or traditional cigarette. The fore runner, Juul, is often mistaken for a USB drive. Each is small enough to be concealed in the users hand with brand names that are not reflective of vaping or e-cigarettes at all.
But are e-cigarettes safer than smoking? Nicotine alone poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. Nicotine decreases immune response and has a negative impact on reproductive health. Nicotine affects cell proliferation, oxidative stress, apoptosis, and DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents.1
While e-cigarettes generally emit lower levels of dangerous toxins than combusted cigarettes, second hand aerosol is not harmless.2 In addition to nicotine, e-cigarette aerosols can contain propylene glycol, glycerin, flavorings, heavy metals, ultrafine particulate, and cancer-causing agents like acrolein.3 The long-term effects of exposure to these substances, even at low concentrations, are unknown.
Who is Using E-cigarettes?
Current results from youth surveys show that e-cigarette use is highest among youth. National rates for youth use of e-cigarettes by high schoolers surged from 11.7% in 2017 to 20.8% in 2018, a 78% increase.4
Why has this become an epidemic? E-cigarette advertising is unrestricted. E-cigarettes are aggressively marketed using similar tactics used in the past by tobacco companies. The tobacco industry is no longer permitted to use these strategies because of their appeal to youth. Tactics include: candy-flavored products; youth-resonant themes such as rebellion, glamour, and sex; celebrity endorsements; and sports and music sponsorships.5, 6
The high rate of e-cigarette use is cause for concern as nicotine is a highly addictive substance and may have harmful effects on developing adolescent brains.7 New data are showing that e-cigarettes have the potential to addict youth to nicotine and increase their uptake of tobacco products.8
What is being done?
Locally, Alaska passed a youth access bill making it illegal to sale or provide access to those under the age of 19. Additionally the bill includes language to allow for oversight of e-cigarette retailors by mandating a separate business license, designating them a retailor of tobacco products and under oversight by the State of Alaska Tobacco Enforcement Office. In passing the Statewide Workplace Clean Air Law Alaska includes e-cigarette language to prevent exposure to second hand aerosol from vaping.
Additionally youth serving agencies, school administrators, nurses and tribal administrations are actively engaging with youth and adults to educate on health harms and advocate for updates to policies to include e-cigarettes and vaping as contraband items, as well as identify and implement strong counter tobacco programs for violations of the policy.
Nationally e-cigarettes are deemed to be a tobacco product since most contain nicotine and are under the Food and Drug Administration’s (FDA) jurisdiction. The FDA began overseeing e-cigarettes in 2016 and began preparing to apply regulations to require e-cigarettes. In 2017 the agency said it would push back a requirement that vape companies submit applications to continue selling their products until 2022.
In 2018 the Campaign for Tobacco Free Kids and the American Academy of Pediatrics sued the FDA over the delay.9 In June, 2019, the FDA responded with a proposal that would have e-cigarette makers submit applications within 10 months to keep their products on the market with an additional plan to ban most flavored e-cigarettes from retail stores within four months.10
Where can I learn more?
Here are few sites that provide in depth, valuable information on e-cigarettes:
2. Goniewicz, M.L., et al., Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control, 2014. 23(2): p. 133-9.
3. Schober, W., et al., Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int J Hyg Environ Health, 2014. 217(6): p. 628-37.
5. Legacy, Vaporized: E-cigarettes, advertising, and youth. 2014.
6. U.S. Department of Health and Human Services, Reports of the Surgeon General. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. 2012, Centers for Disease Control and Prevention: Atlanta, Georgia.
7. U.S. Department of Health and Human Services, The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. 2014, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: Atlanta, Georgia.
8. Leventhal, A.M., et al., Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. Jama, 2015. 314(7): p. 700-7.