Educating Patients on the Risks of Vaping
By Jennifer Larson, contributor Mar 14, 2018
How much do your patients know about the risks of electronic cigarettes? Especially the younger ones?
A growing body of research suggests that e-cigarette use is more harmful than many people believe it to be. In fact, your patients may not realize the potential harm associated with vaping—a challenge that physicians and advanced practitioners may be called to address.
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The appeal to tweens and teens
High schools no longer have smoking lounges or other designated smoking areas, but today's adolescents who want to get an easy nicotine hit are finding it easy to work around the logistical challenges. They can just use a vaping device.
"Electronic cigarettes are marketed to promote smoking cessation or reduced cigarette smoking in adults," noted the authors of a study titled "Adolescent Exposure to Toxic Volatile Organic Chemicals from E-Cigarettes" recently published in Pediatrics. "However, social influence and marketing strategies for these products have clearly had an effect on children as well, because more teenagers now use e-cigarettes than traditional cigarettes."
According to statistics from the Centers for Disease Control and Prevention (CDC), more than 2 million middle and high school students were current users of e-cigarettes in 2016.
The companies that manufacture vaping devices tend to advertise them as sleek, enjoyable and stylish, especially newer devices like the Juul, which looks like a USB flash drive. These rechargeable devices use pods of "juice" in kid-friendly flavors like mint, fruit punch and mango. Users recharge them with a USB charger, just like they would with a smartphone.
So, it's not surprising that they appeal to preteens and teens, noted Brian Primack, MD, PhD, dean of the University Honors College and a professor of medicine and pediatrics at the University of Pittsburgh.
Their appeal, unfortunately, has broader implications beyond just the harms associated with vaping. Young people who use e-cigarettes are much more likely to pick up smoking regular tobacco cigarettes than non-users, according to a recent study that Primack co-authored in the American Journal of Medicine.
"They're the getaway drug of choice for that age group," he said.
Adolescents tend to believe that e-cigarettes are less harmful than regular cigarettes, a belief that has some truth in it. "By using aerosolized nicotine rather than combusting tobacco, e-cigarettes do produce fewer toxins than smoking cigarettes," wrote the Pediatrics study authors.
"But the concern is that this belief leads them to try e-cigs, become addicted to nicotine and then switch their addition to far more harmful cigarettes," said Jonathan Foulds, PhD, professor of public sciences and psychiatry at Penn State College of Medicine, referring to a recent report from the National Academies of Science.
That's just want the cigarette industry hopes for, said Primack.
"It's a way of getting nicotine into young people and continuing the habit in young people and in our society in general," he said.
Why would teens make the switch from a sweet-tasting, mango-flavored vapor to a regular combustible cigarette with a tobacco flavor?
Research suggests that it's not a hard sell. Vaping devices, especially older ones, tend to deliver the nicotine hit a little more slowly than a cigarette, so the user is able to develop a tolerance to the side effects, making the device an "ideal transition vehicle."
"E-cigarettes also mimic many powerful behavioral cues of cigarette smoking, including inhalation, exhalation, and holding the implement," Primack et al wrote.
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Not just blowing hot air: More hazards of e-cigarettes
Experts don't want people to get the idea that e-cigarettes are somehow "safe." The Pediatrics study noted that while vapor from an e-cigarette may be less hazardous than the smoke from a cigarette, the e-cigarette vapor still contains harmful chemicals.
In fact, the researchers identified numerous volatile organic compounds that they found to be carcinogenic.
"[E]-cigarettes contain additives and solvents, including propylene glycol and/or glycerol, which can form carcinogenic compounds when heated. These and other toxic chemicals may be inhaled through the vapor produced," wrote the Pediatrics study authors.
According to the American Journal of Medicine study, the high rate of transition from e-cigarette use to combustible cigarette use "suggests that clinicians who encounter e-cigarette-only users should counsel them about the high rate of transition, even if those patients had not previously smoked cigarettes."
Another recent study that analyzed e-cigarette use in adolescents, in Preventing Chronic Disease, recommended "educational campaigns could target harm perceptions associated with e-cigarettes."
Based on these recent studies, and the fact that research suggesting the value of e-cigarettes as a smoking cessation strategy is "mixed," Primack recommended that physicians carefully consider how they address the risks associated with electronic nicotine delivery systems—with adults and adolescents.
"They really should have a strong message that these are not considered safe and effective ways of stopping smoking," he said.
Foulds noted that evidence suggests that medicines like varenicline will be more useful that an e-cigarette in helping someone quit smoking.
● E-Cigarette Use Among Youth and Young Adults – U.S. Surgeon General
● Vaporizers, E-Cigarettes and other Electronic Nicotine Delivery Systems – FDA
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