In the midst of a global pandemic, it seems odd to be asking my 18-year-old neighbor about the dangers of vaping. However, keeping a safe six-foot distance away and wearing homemade masks, we’re able to hold a decent conversation across the front lawn. My question is simple: Is vaping dangerous? His answer: “I don’t know, but I think it is safer than smoking a cigarette.”
Safer than smoking a cigarette. Is that like saying Safer than taking a selfie with a bull elk?
In what has been called a public health “miracle,” many health care professionals believe the United States was just one generation away from wiping out smoking tobacco almost completely. Decades of stop- smoking initiatives have decreased the smoking rate in adults from 42% in 1965 to 13.9% in 2017, and the number continues to fall. Now, it seems that the rise in popularity of vaping products, and the misinformation around them, may be on track to reverse that miracle.
(Not) A Smoking Cessation Tool
The first commercial e-cigarette was invented in 2003 by a Chinese pharmacist. The kicker? He claims that he invented the device after watching his father die of lung cancer and didn’t want to face the same fate. By 2007, the e-cigarette was patented in the United States. The summary of the product by the United States Patent and Trademark Office describes it as “an electronic atomization cigarette that functions as substitutes for quitting smoking and cigarette substitutes [sic].”
“But there is currently not enough data that shows e-cigarettes help people quit smoking to make this claim,” says Meghan Buran, MPH, senior professional research assistant in the Colorado School of Public Health. “They are not prescribed by medical professionals because they are not regulated by the FDA and have unknown risks.”
However, a quick Google search finds many anecdotal stories of people being able to quit thanks to e-cigarettes.
“People who have truly been able to quit smoking cigarettes because of e-cigarettes are not the norm by any means. Even if there are people who have been able to quit, there are not enough systematic reviews and meta-analyses to prove e-cigarettes helped, or that this strategy works on a population level,” says Buran.
“Although they may have quit smoking cigarettes, if they are continuing to use e-cigarettes in their place, they are still getting nicotine. Many times, these nicotine levels are higher than a traditional cigarette, making them more addictive.”
The bottom line? The medical community does not consider e-cigarettes as a smoking cessation tool. That doesn’t mean it’s impossible for some form of e-cigarettes to be used with some smokers, just that in their current form and with their current use, e-cigarettes aren’t the cessation tool put forward by the vaping industry.
“There is a world in which vaping products may be used as a way to stop smoking under the care of a physician,” explains Buran. “In this world, the products would be approved by the FDA, regulated, and the nicotine levels in the e-cigarette would be decreased over time until it reached zero.”
The Vaping Generation
Vaping is on the rise in U.S. youth, and it is not by a small amount. 11% of high schoolers reported using e-cigarette devices in 2016. Just three years later that number increased to 28%. Researchers from the FDA and CDC estimate that approximately one million teens use e-cigarettes daily, which is equivalent to one in every 17 high school students. The product of choice for more than half of the users is a sleek, small, USB-looking device called Juul.
“Juuls are especially scary because the liquid that is used in them can contain nicotine at incredibly high levels,” explains Buran. “If someone goes through two pods a day, that is the equivalent of smoking two packs of cigarettes in terms of nicotine levels.”
Because Juuls, like all other e-cigarette devices, are not regulated, they do not need to list their ingredients.
“Studies have shown that teens honestly do not think there is nicotine in Juuls,” says Buran. “They think that what they are doing is essentially harmless when in fact they are taking in enormous amounts of nicotine.”
Nicotine, a highly addictive chemical found in nearly all cigarettes and e-cigarettes, has been linked to heart disease and increased risk of strokes in the general population. In teens and young adults, however, nicotine is especially dangerous.
“Young people that use nicotine have a higher risk of developing psychiatric disorders and cognitive impairments because of the effect it has on their still-developing brains,” explains Buran. “Nicotine is incredibly addictive. It is also incredibly hard to quit. The sad part is most teens don’t realize that the products they are using, such as Juul, have high amounts of nicotine in them. They are becoming addicted without knowing it.”
Next Smoking Epidemic?
As the number of young adults and teens using e-cigarettes increases dramatically each year, public health experts are concerned we could be on the cusp of the next smoking epidemic in the United States.
“We were so close to being done with the tobacco epidemic,” says Buran. “Now we have a whole generation of people using these products and we don’t know what the long-term effects will be.”
One effect of vaping that is becoming more clear? Studies show that e-cigarette users are more likely to go on to use tobacco-based products like cigarettes. Some findings suggest that users are three times more likely to pick up a cigarette than non-users.
“We might not know the long-term effects of vaping itself, but we do know the long term effects of cigarettes,” says Buran. “E-cigarettes may be reversing the public health trend that has been taking place for decades.”
In addition to being a “gateway” habit of sorts, vaping products seem to be making smoking socially acceptable.
“It is common to see people vaping these days, in parks, at concerts, and even in school hallways,” says Buran. “Just a few years ago the idea of smoking anything was generally frowned upon. Now, vaping products are making it socially acceptable for young people.”
Fear Of The Unknown
The unknown effects of vaping and e-cigarettes keep many public health professionals up at night.
“The bottom line is that vaping is not harmless,” says Buran. “We know that vaping products have been linked to serious lung disease and even death in some cases. We don’t know if it leads to cancer or other serious, long term health problems like smoking does. We don’t know if it leads to other problems that we are not aware of yet. There are too many unknowns at this point.”
That’s the thing about long-term effects: It will likely take decades before we know the extent of vaping’s health effects.
“By that time, we may be dealing with multiple generations of people using e-cigarettes and have a new public health crisis on our hands,” says Buran. “My fear is that I will be looking back to today and saying we should have done more to stop this when we could.”