Electronic cigarettes and vaping have been growing in popularity amid claims they are safe. Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigarettes or e-cigs), and e-pipes are some of the many terms used to describe “electronic nicotine delivery systems” (ENDS). We hear different stories when it comes to their safety. Some argue that it helps people who smoke cigarettes to cut back or even quit. Still, since e-cigarettes and vaping contain nicotine, making them tobacco products, and there is strong data showing that while potentially less harmful than cigarettes, that doesn’t point to a health benefit. It’s no wonder people are confused about the physical impacts.
ENDS are noncombustible tobacco products. These products use “e-liquid” that contain flavorings, additives, and may contain nicotine. The liquid is heated during use, creating an aerosol that is inhaled.
There are many variations of devices and the market is growing. Some are manufactured to look like conventional cigarettes, cigars, or pipes, some resemble pens or USB flash drives.
Cigarette smoking is a uniquely dangerous addiction. Cigarettes are the number one cause of preventable death in the United States, killing 480,000 people every year. The Harvard Medical School shares:
“That’s more deaths than HIV, heroin, methamphetamine, cocaine, alcohol, motor vehicle accidents, and firearms combined. Smoking increases the risk of stroke, heart attack, COPD, asthma, diabetes, and most cancers. The free radicals in cigarette smoke physically age the human body. On average, smoking reduces your life span by at least 10 years. “
Cigarettes impact the body by producing tar that remains in the system and wreaks havoc on many essential functions. E-cigarettes do not produce the same tar by-product as cigarettes, so are less lethal in that sense. But, e-cigarettes and vaping do introduce other additives to the body that can cause serious health concerns:
- Ultra-fine particles that can cause heart disease, affect the circulatory system, and enter the bloodstream
- Flavorants such as diacetyl, a chemical linked to serious lung disease and were found in higher concentrations in fruit flavored products
- Volatile organic compounds including bacterial and fungal toxins that cause asthma and obstructive lung disease. They were found in 1/4 of single-use e-cartridges and 3/4 of e-liquids.
- Heavy metals, such as nickel, tin, and lead
In addition to these ingredients, e-cigarettes still contain nicotine, which is highly addictive and a cause for concern in itself. Vaping nicotine has been linked to:
- Insulin resistance leading to type 2 diabetes from chronic nicotine exposure
- Suppressed appetite
- Increased heart rate and blood pressure
- Lung disease, affecting the bronchioles
- Chronic Bronchitis
- Impairment of prefrontal brain development in adolescents
The FDA also announced that they are investigating reports of seizures after using e-cigarettes.
Over time, the FDA has restricted how tobacco companies are able to advertise and promote their products. This is in an effort to promote public health, educating youth and the general public of the risks of tobacco and cigarette use. Since 1971, TV commercials, billboards, and radio ads can no longer be used by tobacco companies to advertise their products. Printed ads in magazines are restricted to ensure they are only placed in age appropriate mediums. Newer restrictions that started in 2000 also restrict how close advertisements can appear to schools, playgrounds, and sports events. Even the format and colors used in advertisements are restricted to avoid appealing to youth.
Until recently, e-cigarettes were not restricted under the same laws as cigarettes.
In August 2016, the FDA finalized a rule extending its reach in the regulation of the sale and marketing of all tobacco products, including e-cigarettes (electronic cigarettes, all cigars (including premium ones), hookah (also called waterpipe tobacco), pipe tobacco, nicotine gels, and dissolvables that did not previously fall under the FDA’s authority. Prior to this, products were freely sold and advertised at the discretion of the manufacturers. Youth were often enticed to use the products with splashy, colorful advertisements and imagery.
The National Public Health Agency found a 78% increase in e-cigarette use by teens from 2017-2018. As a result of the dramatic increase of usage by youth, in November 2018, the FDA increased the regulations over e-cigarettes (especially the flavored products) even further. In addition to changes in policy aimed to strengthen age-verification and restrict sales at various retailers (including online), the due date for manufacturers to submit their pre-market applications has been bumped up a year (to August 2021). The adjustment to the timeline for when manufacturers need to be compliant with regulations was a clear effort on the FDA’s part to highlight the potential dangers of ENDS products.
Some people argue that vaping and e-cigarettes are beneficial in helping people curb smoking and even quit. But, the evidence is unclear, with only marginal evidence showing that using cigarette substitutes such as vaping and e-cigarettes aids people in quitting over the long term. Even while researching for this post, it was clear that some of the evidence that showed positive benefits for the “harm reduction” argument of e-cigarettes and vaping in place of cigarettes was skewed; some studies are backed by the manufacturers of the products themselves and do not highlight the potential dangers of the product. It should be made clear: ENDS products are not cleared by the FDA as medical smoking cessation devices. The FDA has only cleared a few products in that category and include nicotine patches, gums, and lozenges, that when used as directed, are shown to help people quit smoking.
Dr. David Christiani, Professor of environmental genetics at the Harvard T.H. Chan School of Public Health in Boston says, “I don’t think e-cigarettes are safe for anyone, especially kids. Parents should be very concerned. For one, [people] are still exposed to a nicotine delivery that is highly addictive and can lead to use of combustible tobacco products. Two, people may be inhaling biological toxins and carcinogens unknowingly.”
As a physician I’ve too often seen vaping used as an alternative to cigarettes, not a mechanism to quit, especially when they can be used indoors without the taboo of cigarettes. Patients rarely realize the continued detriment they cause. Rather than substituting one product for another, I recommend those who need help quitting smoking or using tobacco products can call: 1-800-QUIT-NOW or visit www.smokefree.gov.