Use of electronic nicotine devices and vaping devices is on the rise. In 2018, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, currently use e-cigarettes according to the U.S. Surgeon General.
Recently, there have been increasing reports of respiratory illness and several deaths related to use of these products. Medical officials are still researching the link between vaping and lung disease.
At Atrium Health, we recognize this is a public health concern and have made tobacco cessation a priority. Two experts, Daniel Howard, MD, pulmonary disease and critical care medicine specialist, and Chelsea Cain, FNP, tobacco treatment specialist, discuss health concerns around use of e-cigarettes and vaping.
Question 1: Let’s start with the basics. What are Electronic Nicotine Delivery Systems (ENDS) and how do they work?
Answer 1 | Dr. Howard: ENDS – also called electronic cigarettes, e-cigarettes, vaping devices or vape pens – are battery-powered devices that heat a liquid into an aerosol so it can be inhaled directly into the lungs. Most ENDS contain nicotine and an aerosolizing agent, such as glycerol or glycerin, and sometimes include other additives like CBD, THC and vitamins.
Q2: Are ENDS safe?
A2 | Dr. Howard: Ends are not FDA-approved and should not be used as a treatment to help people quit cigarette smoking. ENDS contain liquid nicotine, which causes dependence and addiction. The e-liquid or “juice” is not water vapor but a nicotine solution with many of the same toxins and carcinogens found in traditional cigarettes, as well as other ingredients such as vegetable glycerin, propylene glycol, flavorings, and sweeteners.
While some of these ingredients are FDA-approved to be used in food, it should not be assumed that inhaling the product into the lung is safe. There are thousands of flavorings for the devices. Each flavor has a unique makeup of chemicals and may pose its own health risk. Additionally, there is danger in secondhand inhalation of vapor and chemicals created by ENDS.
Q3: Are ENDS addictive? Should those who are smoking cigarettes turn to ENDS to quit?
A3 | Cain: ENDS contain very high concentrations of nicotine, increasing the addiction potential. According to the website of one e-cigarette brand, “one 5% strength pod is designed to replace one pack of cigarettes in both amount and nicotine strength.”
Nicotine addiction can occur with any type of nicotine product and ENDS are not FDA-approved to quit smoking. For smokers who want to quit, a combination of medication and counseling is the most recommended form of treatment to increase chances of quitting.
Q4: What products are approved to help quit smoking?
A4 | Cain: There are a variety of existing FDA-approved products to help those looking to quit, including chewing gum, skin patches and lozenges.
Atrium Health offers evidence-based classes that teach you how to quit, coping strategies, and behavior changes to reduce your nicotine intake. We offer a series of three, 90-minute group classes that are taught by a Tobacco Treatment Specialist and are free to the public. You may also schedule an individual appointment with one of our Tobacco Treatment Specialists.
Q5: Do ENDS cause cancer or illnesses?
A5 | Dr. Howard: The cancer risk from use of these devices in unknown, but ENDS have been shown to contain some of the same carcinogens and toxins that are present in traditional cigarettes.
Acute, sporadic adverse reactions to ENDS have been reported in the medical literature for several years but never received widespread attention. Recently, there has been recognition of many cases of severe lung injury and several deaths in persons who have used ENDS and vaping devices.
In addition to the respiratory problems, subjects have had gastrointestinal symptoms, fatigue and fever.
The exact cause of severe illness and death related to these devices is unknown, but adding THC and vitamin E derivatives to vapes has been implicated with some of the most severe cases.
Q6: How prevalent is use of ENDS in our community?
A6 | Cain: Data from the 2018 Youth Drug Survey – a countywide youth drug survey in Mecklenburg County led by The Center for Prevention Services – is consistent with the national trend that by age 16, roughly 1 in 5 youths are using e-cigarettes.
Q7: Why are youths considered more vulnerable to using ENDS?
A7 | Cain: ENDS are being marketed with different flavors, like mango and watermelon, which are more appealing to youths than tobacco flavor. ENDS are the newest trend and there is an appeal to youth to be trendy. These products leverage technology and have a perception that they must be safe. Adults have a misconception these products will help them quit cigarettes and children learn from those around them. The 2018 Youth Drug Survey revealed that if parents disproved of ENDS, they would less likely to start.
Teens are curious and do not realize these products have nicotine in them and addictive like cigarettes. Without more research and data, we do not know the long-term health effects of using ENDS on youths as they continue to develop.
Q8: What should parents, adults and teens know and be on the lookout for?
A8 | Dr. Howard: All individuals should look out for symptoms of chest pain, shortness of breath and nausea after using these devices. In youth, nicotine products of any sort have been associated with memory loss, inability to focus, and greater impulsivity. Parents should be aware that these devices are easily disguised as a flash drive.
Parents should try to keep open dialog with their children about these products and inform their children of the potential danger. If you recognize any of the above symptoms, please get in touch with your healthcare provider. We urge everyone to refrain from using these products.
For more information on vaping, watch our Facebook Live with expertise from Jeffrey Cleary, MD, a pediatric pulmonologist at Levine Children's Hospital and Jaspal Singh, MD, an adult pulmonologist at Atrium Health's Carolinas Medical Center.
