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Dr. Rose B. Ganim: The perils of e-cigarettes

  • The U.S. surgeon general says e-cigarettes are a public health threat to youth. DREAMSTIME/MAYO CLINIC



For the Gazette
Friday, November 09, 2018

Electronic cigarettes have been in the news a lot this year. These battery-operated products are generally used to deliver a nicotine-containing aerosol for inhaling from an e-liquid that is often infused with a flavoring. Some adults regard them as a smoking cessation aid, but their dominant growth market is teenagers who are attracted by countless flavors and trendy delivery devices.

The Food and Drug Administration has estimated that more than two million middle and high school students were users of e-cigarettes in 2017. Surveys also show that 80 percent of young people do not associate any harm with their regular use.

Parents and health officials are rightly concerned as adolescent exposure to nicotine raises issues around its impact on brain development. Nicotine is the chemical in tobacco products that makes them addictive and pleasurable.

The Centers for Disease Control and Prevention notes that it is “difficult for consumers to know what e-cigarette products contain” and that “e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances,” including, it says, “nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.”

The population health impact of the long-term use of e-cigarettes is unknown. It often takes 20 years or more for the risks of cumulative exposures to become evident in a population, so all the current users are actually engaged in a large health experiment without realizing it. 

The CDC states unequivocally in its information about e-cigarettes that they are “not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.”

It also notes that “scientists still have a lot to learn about whether e-cigarettes are effective for quitting smoking” and that they are “not currently approved by the FDA as a quit smoking aid.”

E-cigarettes may, the CDC says, “help non-pregnant adult smokers if used as a complete substitute for all cigarettes and other smoked tobacco products.”

Emerging studies suggest certain elevated health risks to daily users who continue to use traditional cigarettes.

E-cigarettes consist of a cartridge that forms the mouthpiece and holds the e-liquid. This is usually nicotine extracted from tobacco and mixed with a base that contains a stabilizing compound as well as a flavoring such as mint or chocolate. There are many different brands of e-cigarettes on the market and their amounts of nicotine vary as well as flavorings.

The user sucks on the mouthpiece and this helps activate a battery that heats a coil that helps convert the e-liquid into a liquid aerosol that can be inhaled or “vaped.” This nicotine-delivery system does not produce the tar-containing smoke made by combustible cigarettes and its aerosol contains far fewer chemicals than is found in the smoke of combustibles.

Depending on the size of the battery-operated device, its use may be more discrete than a traditional cigarette.

Cigarette smoking is the most common risk factor for lung cancer, and lung cancer is the leading cause of cancer death for both men and women in the United States, something I know first-hand as a thoracic surgeon.

There has been a decrease in the number of lung cancer deaths as the number of smokers in the U.S. has declined, but will this continue?

The percentage of high school students who smoked cigarettes in the past 30 days declined from 15.8 percent in 2011 to 7.6 percent in 2017, according to government statistics, while the percentage of high school students who reported they used e-cigarettes in the last 30 days increased more than seven-fold to 11.7 percent compared to 1.5 percent in 2011.

The CDC says that e-cigarettes are now the most commonly used tobacco product among U.S. youth.

FDA Commissioner Dr. Scott Gottlieb has called e-cigarette use among teens an epidemic and has said that some teen users are “at risk of transitioning to and risking addiction to cigarettes.”

Massachusetts launched a campaign this summer to help parents educate their middle and high school students about the risks associated with e-cigarettes.

The federal government, too, has stepped up its youth tobacco prevention campaign, “The Real Cost,” to educate the nearly 10 million youth ages 12 to 17 that it says have ever used e-cigarettes or are open to trying them about potential risk.

The CDC notes on its website, “Tobacco use is started and established primarily during adolescence.”

It advises, “If you’ve never smoked or used other tobacco products or e-cigarettes, don’t start.”

Dr. Rose B. Ganim is a thoracic surgeon at Baystate Medical Center and Assistant Professor of Surgery University of Massachusetts Medical School – Baystate.