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Knowns and Unknowns about e-Cigarettes and Teens

February 03, 2015

Photo of e-cigs showing their variety Photo ©istock/ kitiara65

The recent Monitoring the Future survey of students’ drug use and attitudes revealed that adolescents have taken to e-cigarettes in a big way. When asked in early 2014, 17.1 percent of high school seniors and 16.2 percent of 10th graders reported using e-cigarettes in the previous month (see infographic, bottom). We are still wrestling with whether or not e-cigarettes pose a danger, but their popularity among youth combined with society’s past experiences with tobacco and other addictive substances demands that we urge caution around these products.

E-cigarettes are being aggressively marketed as glamorous devices that empower users—such as by giving them the freedom to “vape” in public places where cigarette smoking is banned or taboo. And even though sellers are often careful not to make explicit health claims, another part of the “freedom” being sold is, implicitly, the freedom to enjoy the smoking experience without fear of long-term health consequences such as death from cancer or heart disease.

Those who know the history of cigarette marketing in America will experience a sense of déjà vu. Freedom was the concept used in the 1920s and 1930s to market cigarettes to women, a vast then-untapped market for what had previously been only a male pleasure. Cigarette smoking was sold to women as an image to help them feel liberated and empowered.

Although the vapor produced by e-cigarettes contains no tar—the main cause of lung cancer—it may contain other potentially harmful chemicals. There are currently no regulatory controls over these products, most are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself. And that is to say nothing of the risks of nicotine exposure. Whether or not e-cigarettes turn out to have fewer physical health harms than traditional cigarettes, it is still ridiculous to describe any product containing an addictive substance as “freeing.”

E-cigarette fluids vary widely in their nicotine concentrations, and the amount a user is exposed to probably depends on a range of factors (like how many puffs they take, how deeply they inhale, and how long they hold it), but there is clearly a potential for these products to promote addiction—especially when users start in their teens. Recent research in rodents suggests nicotine may even promote addictive behavior by altering gene expression: A 2011 study by Eric R. Kandel and colleagues at Columbia University found that nicotine exposure increased mice’s sensitivity to cocaine’s rewarding effects via an epigenetic pathway; if the same holds true in humans, nicotine could serve as a gateway to abuse of other substances.

Apart from the possible dangers of nicotine, e-cigarette use is normalizing and even glamorizing smoking behavior, which had been successfully stigmatized through public-health campaigns of the past decades. The MTF survey found that many kids who are using e-cigarettes are also smoking traditional cigarettes. It would be tragic if e-cigarettes re-opened the door to teen tobacco use, which has been slowly but surely declining since the late 1990s.

As scientists, we should be cautious and not sound alarm bells prematurely. It will be good if future research shows e-cigarettes are indeed helpful aids for smokers who have trouble quitting otherwise. But if vaping is hooking new users on nicotine—young people and those of any age who had never smoked before—then that could pose a serious problem. We should not allow e-cigarettes, with their promised “freedoms,” to rewind public health to the 1920s.

See text description belowPast month use, 8th grade - Cigarettes: 4.0%, e-Cigarettes: 8.7%; 10th grade - Cigarettes: 7.2%, e-Cigarettes: 16.2%; 12th grade - Cigarettes: 13.6%, e-Cigarettes: 17.1% (Only 14.2% of 12th graders view e-cigarette use as harmful, which is less than 5 students in the average class)

 

This page was last updated February 2015

Comments

e-juice

100% of the juice I buy is mad right here in America. Haven't smoked a cancer stick in over a year now. When I first made the switch to vaping I had a cough for over a month - it was my lungs clearing out all the crap from cigs. I feel 100x better now then I did when I smoked.

Also, 99% of the studies on vape products are on those crappy e-cigs - the ones that "look like cigs." I personally would like to see it on a top selling e-juice's (made right here in 'Merica) on a popular RDA (.5, .8, 1.0, 1.5, 2.0 ohms aka resistance) using a MOD with a VCT4 or 5 battery (or one comparable).

Regulate, don't condemn

"...their popularity among youth combined with society’s past experiences with tobacco and other addictive substances demands that we urge caution around these products."

Agreed. As with any product intended for people ages 18 and over, caution should be taken. Although these devices are still unregulated, most states are invoking common sense and prohibiting the sale of vapor products to minors. Beyond that precaution, there is not much we can do. Minors are already able to get their hands on more harmful products like cigarettes and alcohol quite easily. We cannot condemn a potentially life-saving product because minors are able to get their hands on them.

"...another part of the “freedom” being sold is, implicitly, the freedom to enjoy the smoking experience without fear of long-term health consequences such as death from cancer or heart disease."

And why shouldn't it be? Results from recent studies are shining new light on the health impacts of e-cigarettes.

- http://www.sciencedirect.com/science/article/pii/S0273230014002505

This 2014 study compared select HPHCs (harmful and potentially harmful constituents) present in e-cigarette vapor, conventional cigarette smoke and ambient room air. They found that the amount of harmful particles in the e-cigarette vapor was akin to the amount in a breath of air. In contrast, conventional cigarette smoke emitted 1500 times more harmful particles than e-cigarette vapor. Furthermore, the nicotine content of the e-cigarette vapor was 85% less than in cigarette smoke.

In 2012, the results of a study into whether e-cigarettes have an acute effect on cardiac function was presented to the European Society of Cardiology. The researchers found that e-cigarettes do not have an acute damaging effect on the heart.

"The researchers found that smoking one tobacco cigarette led to significant acute myocardial dysfunction but electronic cigarettes had no acute adverse effects on cardiac function." -- European Society of Cardiology

Now, I understand that this only deals with *acute* adverse effects. More time and more research is indeed needed to determine whether these products have adverse effects on the heart over long-term usage. However, these short-term studies are showing promise.

In the words of Dr. Konstantinos Farsalinos, “It is too early to say whether the electronic cigarette is a revolution in tobacco harm reduction but the potential is there. It is the only available product that deals with both the chemical (nicotine delivery) and psychological (inhaling and exhaling ‘smoke’, holding it, etc) addiction to smoking, laboratory analyses indicate that it is significantly less toxic and our study has shown no significant defects in cardiac function after acute use.”

"There are currently no regulatory controls over these products, most are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself."

Unfortunate, but true. As an e-cigarette user myself, I am careful to only purchase products through reputable sources based in the United States. This industry could benefit from federal regulations, but not regulations that impede further research and innovation into these products.

"Whether or not e-cigarettes turn out to have fewer physical health harms than traditional cigarettes, it is still ridiculous to describe any product containing an addictive substance as “freeing.”"

First off, as indicated by studies previously cited, e-cigarettes are being shown to have far fewer adverse health effects than traditional cigarettes.

Second, most e-cigarettes do indeed contain nicotine, which is an addictive substance. However, there are e-cigarettes available with absolutely no nicotine content. Being involved in the industry myself, I have met countless people who made the transition from a heavy smoking habit over to e-cigarettes. Over time, they brought their nicotine intake down to nothing. Many of them still use e-cigarettes with no nicotine content at all.

Furthermore, nicotine is addictive, but not a carcinogen. Traditional cigarette smoke contains 43 known carcinogens. Being able to satisfy one's nicotine craving without exposing oneself to carcinogens is indeed "freeing."

"...if the same holds true in humans, nicotine could serve as a gateway to abuse of other substances."

The "gateway" theory is just that, a theory. As research into the causes of addiction continues, more evidence is being found that addiction is based in the person, not the substance. Some people are more predisposed to addiction than others. Substances like alcohol, marijuana or nicotine could be "gateways" to those individuals. To others who are not as predisposed to addictive behaviors, these substances may not have any sort of "gateway" effect.

Nicotine is present in traditional cigarettes, which are easily available and far more harmful. It is also present in smoking cessation products such as gum, lozenges and patches. The fact that nicotine could serve as a gateway to some individuals is no reason to condemn e-cigarettes.

These products do (usually) contain nicotine, and they should be federally regulated as such. However, the FDA's proposal to regulate them as tobacco products is outright wrong. They are not tobacco products. They contain no tobacco and current research shows that they are far less harmful than tobacco. Regulate these products and try to keep them out of the hands of minors, but don't condemn a product that could potentially save the lives of millions of smokers.

E-Cigs Are Quietly Dangerous

E-cigarettes is the latest trend for teens that are looking to look cool. The risks of nicotine exposure is very important and needs to be looked into a little deeper. Great article

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