Healthy Living

Vaping may lead to increased nicotine consumption

Close up on a man exhaling vapor from an electronic cigarette
Close up on a man exhaling vapor from an electronic cigarette

The swirl of unknowns about the effects of vaping instill Dawn Sabin, a tobacco cessation counselor at Mercy Medical Center in Cedar Rapids, with a passion.

That’s because she’s aware of a statistic just now gaining mainstream attention: Most people who use electronic cigarettes (including youth) end up using both traditional and electronic cigarettes.

This includes people who turn to vaping to stop combustible smoking. These so-called “dual-users” end up receiving even more of the addictive chemical nicotine, according to the Journal of Substance Abuse. Which means even more nicotine than when they were just smokers.

This leads to a higher risk of heart attacks and other conditions, Sabin said, and a greater addiction.

“E-cigarettes are not harmless, and they are not risk-free,” Sabin said, who was trained by the Mayo Institute. “They just have not been studied long enough. They are not an evidence-based, approved way to quit smoking.”

Sabin reels through more statistics to drive home her point:

• Almost 11 million American adults are using e-cigarettes every day.

• More than half of those users are under the age of 35.

• Overall, one in every 20 adults is using e-cigarettes.

“We are talking millions of people, using a nicotine delivery service that is unregulated and unstudied,” she said.

Not everyone shares Sabin’s passion. The American Cancer Society’s official statement on e-cigarettes declares them to “contain fewer toxic and cancer-causing chemicals than cigarettes” because they do not involve burning cigarettes and the particulate matter that is inhaled.

Its strongest caution: “Long-term health effects are still unclear.”

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A recent statement on e-cigarettes read, “The American Cancer Society recognizes our responsibility to closely monitor and synthesize scientific knowledge about the effects of all tobacco products, including e-cigarettes and any new products derived from tobacco. As new evidence emerges, the ACS will promptly report these findings to policy makers, the public and clinicians.”

Other small studies show that vaping may be effective in long-term smoking cessation, even if there may be a period of dual use during the effort to quit combustible smoking altogether.

“Not only does it substitute many of the physical, psychological, social and cultural elements of cigarette smoking, but it is pleasurable in its own right, as well as convenient and cheaper than smoking,” said Caitlin Notley from University of East Anglia’s Norwich Medical School, in a study funded by Cancer Research UK. “Our study group also felt better in themselves — they noticed better respiratory function, taste and smell.”

But Sabin’s concerns extend beyond the e-juice and addictive nicotine itself. She said the flavorings used in e-juice contain chemicals proven to destroy lung tissue or to scar lungs. Many of the chemicals in e-juice are made overseas and are unregulated, Sabin said.

The studies assessing risk are based on ingesting the e-juice, not inhaling it, Sabin said, which means any risks are underestimated. And there can be confusion over labeling and the meaning of terms like “imports lab.”

To Sabin, the intense marketing of e-cigarettes today is similar to the marketing of combustible tobacco 50 years ago, minimizing risks and emphasizing fun and glamour. In addition, she says, the same companies that used to own tobacco companies are now behind many e-juice corporations.

Both Sabin and the American Cancer Society are concerned about the epidemic of vaping among youth. Statistics show that e-cig use has grown 900 percent among high school students from 2011 to 2015.

“They’re still getting nicotine, and nicotine alters the function and growth of the brain,” Sabin said.

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The American Cancer Society concurs, noting that nicotine use is connected to reduced impulse control, lowered ability to learn and pay attention, increased mood disorders, and higher risk of addiction to other forms of tobacco and drugs.

Sabin said she’ll consider vaping as a smoking cessation tool when research supports it. “Most of the time, people just end up going back to cigarettes, and they end up with a much stronger addiction. I would like a medically regulated device that’s been studied, including its chemical composition,” she said. “A medical and evidence-based device that didn’t have all of those chemicals. But for certain, I want my patients to fundamentally quit all of these products.”

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