By Ritu Chandra, M.D.
Electronic cigarette (e cigarette) use or ‘vaping’ is the new epidemic in tobacco use. Vaping products look like cigarettes and are typically disposable, such as e-hookahs, vape pens, and refillable tank-like or personal vaporizers. These devices heat a solution of nicotine and other additives that produce a vapor that is inhaled without combustion. The basic structure includes a chamber with juice of nicotine, a heater that heats and vaporizes the juice and a battery.
The use of e-cigarettes is growing exponentially. Use of e-cigarettes is highest among current cigarette smoking adults in the U.S. and has increased from 9.8% in 2010 to 21.2% in 2011 to 32% in 2012. The use is highest in the 18-24-year-old age group and in those with less education. The use by middle and high school students more than doubled from 2011 to 2012.
E-cigarettes have been on the market for approximately 10 years, and at this time, the manufacture of e-cigarettes is completely unregulated. Proposed legislation calls for oversight from the FDA and/or Consumer Protection Safety Commission, but this has passed as yet. Also, no conclusive data exists on the long term effects of e-cigarette use.
As a pediatrician, I feel that e-cigarettes are a mixed blessing. We have worked for decades to decrease the burden of death and disease from tobacco. In the healthcare field, we have had the vision to build a generation that rejects tobacco. We have been doing a tremendous amount of work for decades, to get legislation passed for smoking bans, laws against advertising cigarettes to youth, laws against sale of tobacco to youth, clean air laws, etc. But, with the introduction of e-cigarettes we feel that all of that progress is being undone.
As with most things, pros and cons exist regarding e-cigarettes:
What I like about e-cigarettes:
- Less adverse health effects than combustible cigarettes: the amount of nicotine is usually less than that in a cigarette, but the nicotine content is very variable.
- The vapor is less harmful than cigarette smoke but not harmless because it does contain nicotine, Nitrosamines, heavy metals and propylene glycol and there is concern regarding exposing bystanders.
- For those already using combustible tobacco or cigarettes and are unable or unwilling to stop, I support moving to the exclusive use of less harmful alternatives, such as e-cigarettes, with the goal of eventually stopping all tobacco use. Prudently regulated, e-cigarettes hold promise as a means to move current smokers towards smoking cessation and away from the devastating burdens of disease and death caused by combustible tobacco products such as cigarettes, cigars, or hookahs.
- E-cigarettes may help smokers move towards decreasing their cigarette smoking or even help them with quitting. Several observational studies suggest that e-cigarettes can help adult smokers quit smoking.
What I do not like about e-cigarettes:
- Undermines the vision of a society that rejects tobacco
- They are re-normalizing the image of smoking.
- The sweetness and multiple flavorings (pina colada, pancake, maple syrup, etc) in e-cigarettes are very appealing to youth, and more youth are getting introduced to nicotine use.
- For those wanting to quit smoking, the e-cigarettes promote continued nicotine use (i.e. another source that may contribute to tobacco usage and addiction).
- The unrestricted advertising of e-cigarettes is targeted to appeal to youth and mislead the public.
- E-cigarette users are undermining smoke free and clean air laws.
- Manufacturing and safety standards are unregulated at this time, including: child-proof packaging of e-liquids and cartridges, accurate labeling of ingredients and nicotine content. Some e-cigarettes have actually accidentally caught on fire due to faulty batteries.
- E-juice may contain marijuana and promote marijuana use because often the vapor does not have the smell of marijuana.
- E-cigarettes are less expensive than cigarettes and hence more likely to appeal to youth. The average price is $10, and the tanks can be refilled relatively inexpensively.
- E-cigarette users perceive that the second hand vapor is less offensive to non-smokers; therefore, new users are more likely to pick up e-cigarettes.
- E-cigarette use might be a gateway into nicotine dependence and cigarette use.
As a pediatrician, I strongly advocate for having more stringent laws related to the manufacture, sale and use of e-cigarettes. I would support:
- Enforcement of laws so that e-cigarettes do not target or appeal to youth- no candy flavorings
- No sale to youth younger than 18 years of age
- Advertising materials and packaging do not provide misleading information to the public
Current Laws and Regulation
- As of May 2014, 34 states have prohibited the sale of e-cigarettes to minors.
- As of April 29, 2014, three states (North Dakota, New Jersey, and Utah) and 172 local governments have included e-cigarettes in their indoor air laws and smoking bans.
- The U.S. Department of Transportation has proposed a ban on the use of e-cigarettes on planes, but that rule has not been finalized. Several airlines have prohibited smoking e-cigarettes on their aircraft on their own accord.
In conclusion, to vape or not to vape: try e-cigarettes it if you are a current smoker and you are trying to stop or cut down on smoking and do not feel that you can stop tobacco use altogether at this time. But, anyone who is not currently using tobacco products is cautioned about using vaping because it can lead to tobacco dependence and other long-term health consequences.