Understand the health hazards of vaping

01/21/2020
E-cigarettes are marketed as healthy alternatives. However, evidence suggests that early age e-cigarette use leads to heavier smoking as an adult.

E-cigarettes and vaping has been all over the news in recent months as the health risks linked to these products is becoming better understood. According to the Massachusetts Department of Public Health, nearly 20% of high school youth in the state use nicotine products. Teens use e-cigarettes much more (three times) than cigarettes or smokeless tobacco combined (11.4%). Vaping related injuries have eclipsed more than 2,500 as of December 2019 based on data released by the Centers for Disease Control and Prevention.

The Commonwealth of Massachusetts passed (November 2019) sweeping new laws to restrict the sale of some flavored tobacco and vape products. Under the regulations, which take effect on June 1, 2020, flavored tobacco products, including chewing tobacco and menthol cigarettes, will only be allowed for purchase at smoking bars where they must be used on-site. The new restrictions follow similar regulations that took effect for flavored nicotine e-cigarettes in 2018. CHA primary care physicians Lenna Finger, MD, and David Roll, MD, shared some of their concerns linked to vaping. Watch the video below. 

Cambridge Health Alliance Senior Clinical Pharmacist Specialist Gina Stenhouse, PharmD, BCPP, responded to a series of questions from members of the community linked to e-cigarettes. Gina is an expert in pain management and understands how these products can impact youth development.

Are e-cigarettes/vaping better or worse than regular cigarettes?

E-cigarettes are marketed as healthier alternatives than traditional cigarettes. However, there is little evidence for this and in fact, evidence suggests that early age e-cigarette use leads to heavier smoking as an adult. While we know the extensive negative effects of regular cigarettes, we don’t know the extent of the contents within e-cigarettes and the harm they may cause. Chronic smokers who switch to e-cigarettes, will not only be exposed to the harms of nicotine but also the unknown adverse effects from the additives contained in them.1

What health impacts do e-cigarettes have on children compared to adults?

E-cigarettes can affect the developing brain particularly the areas responsible for memory, attention, and learning. There is evidence that adolescents that use e-cigarettes are more likely to smoke as an adult. The nicotine in these products also primes the brain to become addicted to other harmful substances like cocaine. 2,3

What is in these products? How is it different than regular cigarettes?

Due to different manufacturing practices, each product varies in its contents. The most common ingredients in the aerosols and liquid of e-cigarettes are glycerol, propylene glycol, and nicotine. Ingredients like acrolein, formaldehyde, acetone, acetaldehyde, and heavy metals have been found in smaller amounts. Most ingredients in the flavorings have not undergone safety testing.1

Ingredient Risk
Glycerol and propylene glycol Change in the surface lining of cells of the upper airways (Local squamous metaplasia)
Aldehyde compounds (e.g. formaldehyde, acetaldehyde)  Increases the risk of cancer (Carcinogenic effect)
Heavy metals (e.g. chromium, nickel, lead)  Carcinogenic effect, inflammation, and damage 

Unlike traditional cigarettes, there has been less research on the long-term use and negative consequences of e-cigarettes so they may appear to be safer. While e-cigarettes may have fewer carcinogens than traditional cigarettes, they may contain more nicotine and other harmful ingredients. One JUUL, an e-cigarette brand, pod contains the equivalent amount of nicotine as twenty conventional cigarettes. Additionally, defective e-cigarette batteries can cause fires and explosions.1,3

Why are e-cigarettes and vaping products suddenly causing so many health concerns?

From August to December 2019, there have been 2,506 cases involving hospitalization for Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI). Vitamin E acetate was the ingredient associated with the most EVALI cases.4 However, there remain unknowns and research on the health impacts is still ongoing.

What are the symptoms related to the current mystery pulmonary disorder in the news?5

  •  Respiratory symptoms - cough, shortness of breath and chest pain
  • Gastrointestinal symptoms - nausea, vomiting, stomach pain and diarrhea
  • Nonspecific symptoms - fever, chills and weight loss

Is second-hand vapor dangerous?

The effects of second-hand exposure are unknown, however, the ingredients in the e-cigarette aerosols are harmful. As a result, it is recommended to avoid vaping indoors or around children.1

How can I tell if my child is vaping and what can parents do if we are concerned about our child's use?

For parents, it’s important to make note of any changes in your child that might indicate the use of e-cigarettes. Some signs of vaping might include mood swings or agitation, shortness of breath, weight loss, abnormal coughing/throat clearing and poor performance at school or in athletics.6 Remember, some e-cigarettes may look like a small flash drive and can be easy to miss. They have sweet flavors like watermelon, bubblegum and peppermint so be on the lookout for these scents on clothing hair and other belongings.

If you discover that your child has been using an e-cigarette or vaping product here are a few steps you can take to try to help them quit.

  • Before the talk, read more about the risks and know the facts. Remember to try to be patient and calm too. Furthermore, set a positive example and make your home tobacco-free by setting a good example.
  • Find the right moment to start the conversation and listen instead of lecture. Ask questions to better understand why your child is vaping (e.g., anxiety, peer pressure). Don’t forget to ask for support from other family members, school counselors, or healthcare providers to reinforce the message.
  • Finally, keep the conversation going by sharing facts, resources and some of the health risks related to these products. Encourage your child to make healthy choices and try to think about the long-term negative effects e-cigarettes can have.

Below are some resources that might help you and your family.

You can find a CHA doctor near you by calling 617-665-1305 or visiting www.challiance.org/cha/find-a-doctor.

References

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.