Less than 10 years ago, e-cigarettes hit the market and instantly lured in customers. The medical community soon leapt into action to better understand the impact of e-cigarettes. What they have learned is that the chemical flavorings and additives in e-cigarettes — as well as the e-cigarette device itself — can cause damage that while less harmful than conventional cigarettes, they are not safe.
Rhonda Williams is the chronic disease prevention chief at the Vermont Department of Health where she is responsible for the tobacco control and prevention program. Shehelps us better understand the impact of e-cigarettes.
What is an e-cigarette?
Williams: Electronic cigarettes, also known as e-cigarettes, e-vaporizers, or electronic nicotine delivery systems, are battery-operated. The battery heats a liquid solution to a high enough heat or temperature that it produces an aerosol. This aerosol is what people inhale, and it typically contains nicotine, flavorings, and other chemicals.
They can be called a few different names: vape pens, e-cigarettes, e-pipes, e-hookahs, mods, and tanks. As the name suggests, they can resemble a traditional tobacco cigarette, called cig-a-likes, or pipes, or even everyday items like a pen, or a USB memory stick. Other devices, especially those with fillable tanks, may look quite different.
There are more than 460 e-cigarettes brands currently on the market.
What do “vaping” and “JUULing” refer to?
Williams: Vaping refers to the act of using an electronic cigarette, since it produces what looks like vapor. What is even more popular is JUUL, or JUULing. Developed in 2015 and introduced to the market in 2016, JUUL is now the most popular brand of e-cigarette. JUUL dominates with more than 70% of market share.
People started using the term JUULing to refer to the act of using the product or copycat products designed to look like a JUUL. So, similar to the word vaping, but very particular to this type of electronic cigarette. . JUUL products are cleverly designed, which is why teachers, school administrators and parents may have difficulty noticing their use. They’re easy to disguise and to carry around and use.
What makes e-cigarettes dangerous or toxic?
Williams: The level of danger depends on who is using the e-cigarette. The 2016 Surgeon General’s report on e-cigarettes in youth is very specific and clear. They should not be used by youth, young adults, and those who are pregnant. For adults with chronic conditions including asthma, COPD, bronchitis, some heart conditions, use could have greater impact on health, due to the chemicals, the coating on the lungs, and particulates.
It’s a common misperception that vapor is just water, and therefore harmless. It isn’t just vapor though, it’s an aerosol. Aerosols contain tiny particulates and chemicals, some of which are toxic. So, youth and adults who are around e-cigarette users also get exposed to what’s in the aerosol.
Studies show that you can see the exposure to heavy metals and several cancer-causing chemicals through hair, saliva or blood samples. A 2018 study in Pediatrics found exposures to toxins in adolescents who used e-cigarettes, and that tobacco and fruity flavors appear to contain the most chemicals. People don’t necessarily realize that exposure is occurring. It’s a misperception in part because the smoke or aerosol doesn’t smell like tobacco smoke. It can smell like fruit, cotton candy, or chocolate, but nonetheless, these are chemicals.
What’s in the e-cigarette aerosol?
Williams: Well, while they contain far fewer toxins than the 7,000 chemicals in tobacco smoke, it can contain these cancer-causing substances: heavy metals like lead, volatile organic compounds, and chemicals that have been specifically identified in the e-liquid and/or in the aerosol.
Once the e-liquid goes through the chamber and is heated up and becomes an aerosol, it can have chemicals that are leached from that coil. Those chemicals include cadmium, lead, nickel, and diacetyl. One study in fact found that more than 75% of the e-cigarettes tested contained diacetyl, which is known as a chemical that causes lung disease, or more commonly “popcorn lung”.
The aerosols can also contain ultra-fine particulates that lodge into the lungs and the bloodstream. A 2018 study found double the risk of heart attacks among daily e-cigarette users.
Do e-cigarettes contain nicotine?
Williams: Studies show that most e-cigarettes do contain nicotine. Nicotine is highly addictive. It’s also toxic to developing brains, so adolescents and young adults into their mid 20s. Nicotine is toxic to developing fetuses.
Even dermal (on the skin) exposure can be harmful, especially for children. The New England Poison Control Center developed a curriculum on e-cigarettes to try to prevent these potential harms and reduce exposures. They, like other poison control centers in the U.S., saw a rapid increase in exposures with the introduction of e-cigarettes. Sometimes the e-liquid will spill, or get into an eye, and this results in an emergency room visit. There have been deaths, unfortunately, due to exposure to nicotine, including a toddler in Upstate New York, who got a hold of an e-cigarette.
Do e-cigarettes help people quit smoking?
Williams: Twenty-one percent of adult Vermonters report that they used e-cigarettes in their latest quit attempt. What we see in our data is a growing trend of individuals trying to quit using e-cigarettes. We know it’s a really difficult journey to successfully quit. It can take multiple attempts, and it’s a significant success when someone quits. So, for those who are able to quit using e-cigarettes, that’s great news.
There are two randomized control trials that show some effectiveness in using e-cigarettes to quit, but a 2018consensus report released by the Academies of Sciences, Engineering and Medicine of more than 800 studies concluded that the evidence is insufficient to recommend e-cigarettes as a cessation aid. Moreover, there is a risk that people will not switch to e-cigarette use completely, thereby becoming dual users and being exposed to higher nicotine and chemical levels.
How else can people get help quitting smoking?
Williams: There’s free, 24/7 accessible supports for Vermonters, whether you are a tobacco user, or have a family member or friend who you would like to help. Our quitline in Vermont is run by a respiratory health hospital, and they are committed to helping every person who calls including teenagers and those wanting to quit e-cigarettes. If you’re trying to quit, the Vermont Department of Health is here for you. We offer free text support, counseling, and nicotine replacement therapy (patch, gum, lozenge) that is delivered to your home. Also, we recommend for people to talk to their doctor who can help with trying a new approach or quit method. It’s all about finding the right combination that works for you.
What is your takeaway message about e-cigarettes?
Williams: I think one of the major takeaways is that, while e-cigarettes are less harmful, they’re not safe. And they, in fact, can be dangerous for youth who often don’t realize the potential for high nicotine exposure and the risks that creates for addiction. So, think about your role and how you can talk about that, especially to prevent youth from ever starting. Whether you work in a school, work in a clinic, or you are a parent, we should be talking about this.