Controversial Use of E-cigarettes and Vaping- A "Heated" Debate

Posted November 04, 2018 by Sandy Kohut, RRT, BSAS Lead Lung Navigator

Electronic Nicotine Delivery Systems (ENDS) first entered the US market around 2007. Wells Fargo Securities analysts now claim that these products have grown into a $4.4 billion industry. These products have many names including e-cigarettes, vapes, vaporizers, vape pens, hookah pens, and e-pipes among others. Most use a heating mechanism to turn liquid into a vapor that is then inhaled as an aerosol. E-cigs differ from traditional cigarettes because they do not “burn” or contain the 7,000 chemicals present in traditional combustible cigarettes. The tobacco industry continues to develop and market new nicotine delivery devices and without question, the controversy over these products is still a heated debate.

Advocates of e-cigs suggest that these products may prevent people from starting to smoke or help current smokers quit smoking traditional cigarettes. They believe electronic cigarettes may be less harmful than combustible cigarettes.

Opponents of e-cigs believe these products prolong or have no effect on smoking cessation, have adverse effects on respiratory health and serve as a gateway to conventional cigarettes, particularly in adolescents and young adults.

So what are the facts? Are they safe? Do they help people quit smoking? Unfortunately, we still don’t know all these answers. Since they have only been on the market for a short time, it is hard to know the long term health effects of e-cigs. But the FDA is taking strides to regulate these products. Researchers are beginning to study the long term effects and are encouraging studies that determine if they can be used as a tool for smoking cessation. There is widespread opposition to use among the adolescent and young adult population.

Until recently, these electronic products were largely unregulated and the contents were unknown. On May 10, 2016, the FDA passed a ruling to regulate all electronic delivery systems in a manner similar to tobacco products. The FDA began to oversee the manufacturing, importing, packaging, labeling, advertising, promotion, sale and distribution of these products and began to limit the sales to minors. Beginning in early 2018, these products were required to include a nicotine addiction warning statement on the labels.

E-cigarettes and other electronic devices are used by more than 2 million middle school and high school-aged adolescents. The FDA has expressed serious concern over the increased risk in this population since nicotine use in adolescents and young adults may “re-wire” their brain and lead to years of addiction. With flavors like bubble gum, vanilla, strawberry, peanut butter, key lime pie, and many others,  it is thought that the manufacturers of these products are trying to market to the younger consumers. In a 2014 survey of young adults, 81% cited appealing flavors as the reason they started using the products. With unique devices that look like pens and USB devices, it is easy for teens to hide these devices from parents and teachers. Many of these consumers will use e-cigs as a gateway to other tobacco products. In 2016, the former U.S. Surgeon General, Dr. Vivek Murthy, deemed e-cigs unsafe for teens and adolescents.

Although these products have developed a bad reputation because of the prior lack of regulation and marketing aimed at youth, e-cigarette use among adults is viewed differently. According to the January 2018 British Journal of Medicine in, the limited evidence available suggests e-cigs containing nicotine may help people quit smoking. Evidence also suggests that e-cigs are safer than traditional cigarettes and the FDA is continually working hard to make them safer. If people are considering using electronic devices as a smoking cessation tool, they should have a careful discussion with their health care provider first. At this time, the FDA does not recognize e-cigs as a smoke cessation tool. But that may change as the ongoing studies are published. For now, most people who successfully quit use a combination of nicotine replacement products (patch, gum, lozenges) or a medication (Chantix or Wellbutrin) along with a structured smoke cessation program.

Summa Health offers smoking cessation classes free of charge to anyone wanting to quit. To pre-register for classes at please go to summahealth.org/quitsmokingnow or call 234.312.5226. 

Resources

1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2688346
2. https://www.reuters.com/article/us-health-smokers-vaping-idUSKBN19A2FD
3. https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm
4. https://www.nap.edu/read/24952/chapter/1
5. https://www.bmj.com/content/360/bmj.j5543