Sarah Cannon - November 19, 2018

5547-FinalThe use of electronic cigarettes (e-cigarettes) is on the rise, but are e-cigarettes any different from regular cigarettes? Cathy Simmons, RN, BSN, Lung Cancer Nurse Navigator at Sarah Cannon Cancer Institute at Medical City Healthcare in Dallas, Texas, addresses common questions about e-cigarettes, including the misconceptions, side effects and more.

What is an e-cigarette?

E-cigarettes are battery-powered devices that heat a liquid, known as e-liquid, into an aerosol that people then inhale and exhale. E-cigarettes usually contain nicotine, the addictive drug found in cigarettes and other tobacco products, as well as flavoring and other chemicals. E-cigarettes are also known as “e-cigs, e-hookahs, vapes, vape pens, tank systems, or mods.”

Are e-cigarettes regulated?

In August 2016, the U.S. Food & Drug Administration (FDA) extended “its regulatory authority to all tobacco products, including e-cigarettes, cigars, and hookah and pipe tobacco, as part of its goal to improve public health” as part of the Family Smoking Prevention and Tobacco Control Act. As a result, “manufacturers of newly regulated tobacco products that were not on the market as of February 15, 2007, will have to show that products meet the applicable public health standard set by the law. And those manufacturers will have to receive marketing authorization from the FDA.” At this time, the deadline for review has been extended to 2022. People must be 18 years or older to purchase e-cigarettes.

What should people know about e-cigarettes & vaping?

Research has shown that e-cigarette aerosol often contains substances that can be harmful. One of these substances is diacetyl, a buttery flavoring used in “popcorn, caramel and dairy products.” If a person eats diacetyl, it is safe; however, when workers at a microwave popcorn factory became ill, it was discovered that inhaling diacetyl causes bronchiolitis obliterans, otherwise known as popcorn lung.

Young people are using e-cigarettes at an increasing and alarming rate. Between the years 2011-2015, the U.S. Surgeon General found that the use of e-cigarettes amongst high school students increased 900%, with more teens using e-cigarettes than conventional cigarettes. In recent history, the use of cigarette smoking in high school students had actually decreased; however, that number has increased drastically with the introduction of e-cigarettes.

In an effort to address the rising rate of e-cigarette use in youths, the FDA announced in September 2018 that it sent warning letters and issued fines to retailers who illegally sold e-cigarette products to minors. In addition, warning letters were sent to online retailers that “are selling misleadingly labeled and/or advertised e-liquids resembling kid-friendly food products such as candy and cookies.” The FDA also sent letters to JUUL, Vuse, MarkTen XL, blu e-cigs and Logic, the most commonly-used brands, asking that they provide plans within 60 days that detail how they propose limiting the access and the use of their products amongst youths.

What are common misconceptions about vaping?

The biggest misconception is that vaping can help people quit smoking. Presently, e-cigarettes are not approved by the FDA as a quit smoking aid, and so far the research shows that there is limited evidence to support that e-cigarettes are effective in helping smokers quit. In fact, most people who use e-cigarettes think that they are helping them quit smoking. Unfortunately, these same people commonly use e-cigarettes in conjunction with conventional cigarettes. A 2015 study from the Centers for Disease Control and Prevention showed 58.8% of people who were using e-cigarettes were doing so in combination with regular cigarettes. When people are ready to quit smoking, there are several FDA-approved aids that are both safe and effective.

Is vaping different than smoking cigarettes?

Conventional cigarettes, cigars and pipe tobacco are made from dry tobacco leaves and other substances that are added for flavor and to make the experience more pleasurable. The smoke from these products is a complex mixture of chemicals produced by burning the tobacco. 70 of these chemicals are known to cause cancer, including nicotine (the addictive substance), formaldehyde, lead, arsenic and benzene.

Vaping is different from conventional cigarettes because there is no burning or combustion of the tobacco. According to the American Cancer Society, consequently, e-cigarette smoke “contains fewer toxic and cancer-causing chemicals than cigarettes and can be less harmful than smoking regular cigarettes. However, there is not enough research at this time to determine the short-term and long-term side effects of vaping. In a statement released in February 2018, the American Cancer Society states, “Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes, but the health effects of long-term use are not known.”

Additionally, when a person vapes he or she may inhale some droplets of the e-liquid as a byproduct. The inhalation of these droplets can be very harmful to the lungs. However, there is not enough research at this time to better define that risk. Also, a study from Johns Hopkins Bloomberg School of Public Health revealed that certain e-cigarette heating coils leaked “potentially dangerous” level of metals.

Also, there is currently no standardization or regulation from the FDA surrounding e-cigarettes. For example, a person may select an e-cigarette product that claims to be nicotine-free; however, early research in 2014 showed that certain products labeled nicotine-free actually did contain nicotine. According to the American Lung Association, studies have even shown that some e-cigarettes even contain an ingredient used in anti-freeze as well as formaldehyde.

Is vaping “safer” than smoking cigarettes?

At this time, e-cigarettes may be considered less harmful than regular cigarettes. However, e-cigarettes have only been on the market for 11 years, are not currently regulated by the FDA and usually contain nicotine even when marketed as nicotine-free.

What are the side effects associated with nicotine?

Side effects of nicotine include suppressed appetite, increased heart rate and blood pressure as well as potential insulin resistance, leading to type 2 diabetes with chronic nicotine exposure. Long term nicotine use may also lead to lung disease, effecting the bronchioles of the lung, causing chronic bronchitis. Other side effects may include impairment of prefrontal brain development when nicotine is used in adolescence.

Do you have any tips for discontinuing vaping?

The tips for quitting vaping are similar to those for people who want to quit smoking. First, people should speak with their doctor to develop a plan of how and when to quit. A plan may include:

  • Nicorette gum or a nicotine patch
  • Methods to help with cravings, such as chewing on bubble gum and sucking on sugarless hard candy
  • Keeping items like carrot sticks, cinnamon sticks, straws and toothpicks handy to put into their mouths when they’re craving an e-cigarette
  • Having something like a stirrer available to roll between their fingers when they have a craving, as they’re accustomed to holding an e-cigarette
  • Finding a support person or someone they trust and will call when they have an urge to smoke
  • There are also free apps available to help people quit, including QuitSTART, NCI QuitPal and QuitGuide App