By Amy H. Smith

Rowan County Health Department

Currently, one in every five deaths in the United States can be attributed to tobacco use, making it the leading cause of preventable death. There are 42 million adults in America that currently smoke, however, 69 percent of all users say that they would like to be able to quit. Of those who are able to quit, a majority used nicotine replacement therapy to do so.

In 2006-2007, e-cigarettes were introduced in the United States. Despite the different names (vape pens, e-hookah, personal vaporizers, etc.) and appearances, all e-cigarettes have basically the same function. The basic component consists of a power source (a lithium battery), an e-liquid (which typically contains varied amounts of nicotine and other chemicals), and an atomizer that heats up the e-liquid to form a vapor. E-cigarettes can be purchased as a disposable or as a rechargeable unit and are currently in a “third generation” phase as it relates to types, sizes and the ability to customize them to one’s liking. There are also e-hookahs and e-pipes that work the same way as e-cigarettes do by emitting a vapor once the e-liquid is heated to a certain temperature.

Studies in the United States show that the typical e-cigarette user is a current or a recently former smoker. They are typically a non-Hispanic, white female of a higher education and socioeconomic status. Statistics also have shown that e-cigarettes are being used more by younger adults than by older individuals.

So why are people using e-cigarettes, e-hookahs, e-pipes, and/or vape pens? Most individuals perceive these devices as being less dangerous than cigarettes; and because of this, many people are using these products as a way to reduce the amount they are currently smoking or to help them quit smoking altogether. Also after the initial costs, e-cigarettes are cheaper than the typical tobacco cigarette, which is an incentive for many to “switch” to vaping. For some individuals, they claim that curiosity has led them to try these products, especially after they have seen all the advertisements for these products endorsed by celebrities.

In the United States between 2009 and 2013, there has been an increase in e-product use of 15 percent in adults (King et al., 2013; Pearson et al., 2012; Pepper et al., 2014; Regan et al., 2011; Zhu et al., 2013). In 2013, 90 percent of all adults in our country have heard about e-cigarettes and one in every two adult smokers has used an e-cigarette.

In 2013, the U.S. Centers for Disease Control and Prevention (CDC) saw nearly 250,000 youth who had never smoked tobacco before, try e-cigarettes — a threefold increase since 2011. The CDC also found evidence that about three out of four teen smokers go on to smoke tobacco as an adult, due to their addiction to nicotine (the primary ingredient in a majority of e-cigarettes). North Carolina saw a 352 percent increase in current high school users of e-cigarettes between 2011 (1.7 percent) to 2013 (7.7 percent).

At this time, the U.S. Federal Drug Administration (FDA) has not yet finalized proposed regulations for e-cigarettes. Earlier this month, a group of concerned United States Senators and other public health organizations highly urged the FDA to quickly finalize these regulations. In addition to that, they are also encouraging the FDA to adopt stronger warning labels that would point out the health consequences of using e-products and the high risk of nicotine addiction.

Without the FDA regulations, e-products are allowed to “skirt around” the regulations that conventional cigarettes currently follow, making it easier for e-products to be purchased by minors. This concerns many state lawmakers, and as a result, 41 states and one territory have adopted laws to prohibit sales to youth. As of June 13, 2013, North Carolina law prohibits the sale of “vape products,” including electronic cigarettes, to minors (those under the age of 18), prohibits self-service and vending machine sales of “vapor products,” and regulates internet sales. 

Without FDA regulations in place, there is also the issue of the “unknown” to you, as the consumer, of how much and which ingredients you may be vaping. At this time, manufacturers are not required to disclose product ingredients to the public; and because of this, there is real concern that some brands may contain levels of nicotine significantly higher than what is found in a regular pack of cigarettes.

Currently, public health experts only have a fraction of the information on e-cigarettes compared to that of conventional cigarettes. Although e-cigarettes do not burn tobacco or emit as many harmful chemicals into the environment, it is the “unknown” and the not knowing what the long-term effects may be that scare health officials about this booming, billion-dollar industry.

The facts that we do know, however, are as follows:

There are over 8,000 flavors for e-cigarettes and products being sold online and in stores, everything from cotton candy, watermelon, white chocolate, and brandy to Mountain Dew, and even Campbell Soup flavors.

Flavored liquids for e-products are most likely not in a child-proof container which may lead to ingestion, hospitalization, and/or death, especially for younger children who perceive the liquid as a type of candy due to its scent, color and smell.

Less than one tablespoon of many e-liquids on the market can kill an adult and as little as one teaspoon could kill a child.

The side effects of e-liquid ingestion can include nausea, vomiting, increased heart rate, high blood pressure, agitation, coma, and/or death.

In the United States, some poison control centers have seen their call volume increase as much 700 percent due to exposures to the e-liquid.

By the end of September, Carolina’s Poison Control had seen 114 human exposures to e-cigarettes and nicotine liquid in North Carolina in 2014, compared with eight similar exposures in all of 2011.

E-liquids can deposit high levels of nicotine into one’s skin if they are not handled properly. They can also be inhaled and/or cause eye irritation if mishandled.

The nicotine levels in e-products range from 26.8 to 43.2 micrograms per 100 milliliter puff. According to the FDA, tests also show that the consumer that purchases nicotine-free cartridges is still getting a low dose of nicotine, despite the claims.

The FDA has found that some e-cigarettes contain diethylene glycol, an ingredient used in antifreeze, which is toxic to humans.

Pregnant women can transfer nicotine to their developing fetus, which can be toxic.

E-products cause inflammation of one’s lungs and they have the potential to cause asthma attacks and allergies.

E-products can constrict one’s blood vessels.

Prolonged exposure to nicotine may be linked to an increased risk of atherosclerosis, or the hardening of one’s arteries, which causes heart attacks.

Bystanders and the environment are exposed to some levels of nicotine and other additional toxins through vaping.

E-products may re-normalize smoking and become a gateway to smoking tobacco products

Even though vaping may be the lesser of two evils, when it comes to smoking a regular cigarette, there are still too many unknowns about which we may not know until the damage has been done to the vapor’s own body or to that of a loved one. Parents need to realize that the nicotine found in e-products is very addictive, and it has been shown to affect brain development both in children and in teens. There is also a great fear that e-products will lead to traditional tobacco use as children become older. As parents, you need to discuss the unknown dangers of these enticing products with your children.

The warning is this: If you don’t smoke, don’t start vaping. As you can see, there are no known health benefits, and the risks should outweigh one’s curiosity. If a person does smoke and is trying to quit, there are seven FDA-approved prescription and non-prescription products that are available, such as nicotine gum and/or the patch. As far as e-products being an effective cessation aid, there is still very limited evidence that supports that.

Erika Sward, the assistant vice president of the American Lung Association states, “E-cigarettes are guilty until proven innocent.” As of right now, the only information that we really have on e-cigarettes is coming from the big tobacco companies. Yes, e-products are less toxic than regular cigarettes, but less toxic definitely does not mean healthier.

Amy H. Smith is health education specialist/wellness coordinator for the Rowan County Health Department.