A puff here. A drag there. Refill. Repeat as needed.
While the resulting puffs may look the same, there are multiple differences between smoking e-cigarettes and traditional tobacco products.
In December 2018, the results of the 2018 Monitoring the Future [MTF] survey were announced by the National Institute of Drug Abuse [NIDA]. The study was conducted at the University of Michigan’s Institute for Social Research, which has provided an annual standard of substance-related behaviors in middle and high school students since 1975.
Overall, the study found multiple decreases in substance use among students.
Tobacco use among teens plummeted to only 3.6 percent of high schools reporting daily use compared to the 22.4 percent reported two years ago; alcohol use dropped to 17.5 percent from the 26 percent reported five years ago. A decline in opioid abuse also was documented.
However, one category saw increases in use from middle school through high school: vaping.
Researchers found an increase of about 1.3 million more high school vapers in 2018 than in 2017. The recorded vaping increase was the largest annual jump in the use of any substance, including marijuana, in the project’s history.
Last year, 37.3 percent of high school seniors reporting “any vaping” in the past 12 months, compared to 27.8 percent in 2017. The percentage of high school seniors who reported vaping nicotine during the month just prior to the survey also nearly doubled from 11 percent to about 21 percent.
Surveyed eighth- and 10th-graders reported that vaping devices and liquids are “fairly easy” or “very easy” to purchase, with 45.7 percent and 66.6 percent holding that opinion, respectively.
In the Rockwood School District, education about vaping begins as early as elementary school, since the topic was added to the fifth-grade D.A.R.E program.
“We’ve definitely seen an increase in vaping,” Anna Greenwood, project coordinator with the Rockwood Drug Free Coalition, said. “We’ve seen it a little bit at the middle schools, but it’s mostly been at the high school level. A lot of advertising for these vape products is geared toward people their age, and also, there’s this misconception that these products don’t contain any nicotine, when really, most of them do and there’s no regulation from product to product.”
According to the Centers for Disease Control [CDC] Surgeon General’s report titled “E-Cigarette Use Among Youth and Young Adults,” the most commonly cited reasons by teens and young adults for using e-cigarettes are the available flavoring/taste, curiosity and “low perceived harm compared to other tobacco products.”
Vapes, juice and Juuling? Oh my!
E-cigarettes are known by many different names and come in a variety of different models and designs. They are sometimes referred to as “e-cigs,” “e-hookahs,” “vape pens,” “vapes,” and “electronic nicotine delivery systems” [ENDS], to name a few.
The goal of the products is to deliver the user direct doses of nicotine, or to vape other drugs like marijuana.
“It’s essentially a different method of nicotine delivery compared to combustible tobacco products, like cigars, cigarettes, etc.,” explained Dr. Bobby Shah, a pulmonologist at St. Luke’s Hospital. “That’s the fundamental difference between the two. From there, there are a lot of potential differences, and therein lies the problems with nicotine replacement products like e-cigarettes.”
E-cigarettes are electronic devices that produce aerosol by heating a liquid [also referred to as “juice”] that contains nicotine. The liquid also contains flavorings and brand-varying additives to help make the aerosol. Users inhale e-cigarette aerosol into their lungs, similar to smoking a cigarette, and exhale the aerosol back into the air.
Vaping vs. tobacco
Despite the term “vape,” e-cig aerosol is not just water vapor.
One of the main selling points of e-cigarettes is the ability to inhale a variety of flavors. For example, Juul’s nicotine liquid refills [“pods”] come in an array of flavors, including Mint, Mango, Cool Cucumber and Creme. The pods also come in more classic flavors like Virginia Tobacco and Menthol.
But flavoring isn’t the only ingredient in the e-fluid. According to the manufacturer, each Juul pod also contains the same amount of nicotine as 20 cigarettes.
According to the CDC, nicotine can heavily impact brain development in individuals under the age of 25 in addition to being a highly addictive substance.
Shah seconded those concerns.
“Outside of brain control, brain regulation and brain development, there are going to be effects on physical growth, puberty onset, those types of things,” Shah said. “There’s also, obviously, the risk of addiction. You’re replacing one addiction with another. There is some positive data that shows that tobacco use is going down among children, whereas vaping is going up. So, we’re basically trading one addiction for another.”
According to NIDA, an estimated 66 percent of surveyed teens who vape believed there was “just flavoring” in the aerosol, while just 13.2 percent were aware of the presence of nicotine.
Despite high levels of nicotine, e-cigarette aerosol generally contains fewer harmful chemicals and other materials like tar than smoke from burned tobacco products. Still, the CDC says e-cig aerosol can include ultrafine particles – inhaled directly into the lungs – such as volatile organic compounds, cancer-causing chemicals and even metals like tin, nickel and lead.
“[With] these products, or with any other products that serve as a form of nicotine delivery, there’s the potential for lung complications [caused by ingredients in the vape liquid],” Shah said. “Whether it’s the preservatives or the other flavors, the odors, there’s scientific proof that they can cause damage to the lungs, too. There are studies showing lung biopsies in these patients showing emphysema-like changes, even though they never smoked a single cigarette.”
While e-cigarette liquid can share some chemicals that have been determined to be safe such as in-food preservatives, Shah warns that the stomach can process and digest more substances than the lungs and that vaping may change the safe nature of those products.
“A lot of the chemicals used in these products have research showing that they’re safe when used in a different form,” Shah said. “For example, polyethylene glycol or formaldehyde are chemicals that have been used as food preservatives for ages, and in those forms, they’ve been proven to be safe, but there’s no research to show that when they’re heated and combusted that they’re still equally safe.”
The long-term effects of vaping
Although the addictiveness and long-term harm of nicotine on the human body has been well-documented, Shah said there is not a lot of research about the impact of long-term use and second-hand “smoke” when it comes to vaping.
“These products are still fairly new on the market,” Shah said. “So, what it means long-term, down the road for people who are exposed to these things in a second-hand form, is still questionable.”
The ratios of additives, preservatives and ingredients in e-cig liquid vary greatly from brand to brand, which also make long-term effects hard to determine. Some chemicals present in e-cigarette fluid include polyethylene glycol, glycerol phosphate, formaldehyde and others.
“… there’s no quality control and there’s no assurance from one product to the next,” Shah said. “At the end of the day, though, there is good research that shows these products are still safer than tobacco for the individuals using them. It’s just a matter of the impact on society, the impact on brain and lung development; it’s a matter of the impact on if it really helps [people] quit smoking, and those have yet to be shown.
“I would say there’s a misconception or misperception that these products will be safe long-term,” Shah said. “I think people don’t understand that we’re not certain about that.”