Almost daily, news outlets are reporting on the alarming increase in lung illnesses and deaths resulting from vaping. As the Centers for Disease Control and Prevention (CDC) and researchers across the country talk to patients and collect data, parents of young people who vape are looking for answers.
We asked board-certified oncologist Dr. Arati Patel, Medical Director of the Thoracic Oncology Program at CalvertHealth Medical Center, board-certified family medicine physician Dr. Amanda Cardella at CalvertHealth Primary Care and CHMC Health Educator Amy Dowling to help our community decipher fact from fiction, and help parents and children better understand the health risks associated with vaping.
What is in E-cigarettes?
When e-cigarettes were introduced in the United States in 2006, they were marketed as a healthy alternative to smoking tobacco. These devices were developed for use by adult smokers who were addicted to nicotine and were looking for a way to taper off of their nicotine habit and quit smoking for good.
There are three main components in most e-cigarettes according to Dr. Patel: nicotine, a base solution such as propylene glycerol and a flavoring. E-cigarette devices, some of which resemble a USB flash drive, have a heating element which aerosolizes the ingredients into a vapor.
“Depending on the type of device used, the amount of product in the
e-liquid and inhalation of the user, nicotine intake can vary widely among smokers,” said Dr. Patel.
In addition, e-cigarettes also contain several chemicals such as formaldehyde, a known carcinogen, heavy metals, benzene, organic compounds and acrolein, which can immediately damage the lungs and result in long-term consequences to the user’s health.
Although some of the flavorings used in e-cigarettes are safe when they are ingested into the stomach, it is unclear whether they are safe when vaporized and inhaled into the lungs.
Gateway to Addiction
According to the nonprofit Truth Initiative, one of American’s largest public health organizations committed to helping youth reject tobacco in all forms, 63 percent of users ages 15-24 did not know that JUUL products always contain nicotine. What parents and teens don’t realize, according to Dowling, is these products are the gateway to addiction to nicotine and possibly other dangerous substances.
Adolescents are more likely to take risks with their health and safety because the part of the brain responsible for decision-making and impulse control has not yet fully developed.
“Young people are highly susceptible to nicotine because their brain receptors are still forming connections up to the age of 25,” Dowling said. Each time a new memory is created or a new skill is learned, stronger connections, or synapses are built between brain cells. Adolescent brains build these synapses faster than adults and as addiction is a form of learning that is why adolescents can get addicted to nicotine and other substances faster and more easily than adults.
“It is a critical time for brain development and I think a lot of
times parents don’t think about the consequences of vaping,” said Dowling.
Adolescent Mental Health Concerns
A young person addicted to nicotine may lose the ability to concentrate, problem-solve and perform well in school. “Students who vape take a puff of JUUL and 30 minutes later their brains are telling them they need more.
According to the CDC, young people are more likely to use tobacco products if they see people their age or a parent using these products. According to
Dr. Patel, young people expect positive results from smoking such as coping with stress better, or losing weight; however, there is a strong relationship between youth smoking products with nicotine and depression, anxiety and potentially long-term mental health concerns.
Young people using e-cigarettes with nicotine may lose interest in activities that they used to love. They may be irritable and may experience personality changes, above and beyond what could be explained by going through puberty.
Risk of Tampering with Devices
E-cigarette devices and their cartridges or pods can be tampered with in
order to add unregulated, illegal and untested substances such as those associated with the active ingredient in marijuana, according to Dr. Cardella. Tetrahydrocannabinol (THC) oil or cannabidiol (CBD) oil can be added to
e-cigarettes.
“Not only are our young people being exposed to nicotine, but they may also be unknowingly exposed to illegal and dangerous substances,” said Dr. Patel.
What We Know Today
EVALI is the name given by the CDC to the dangerous, newly identified lung disease linked to vaping. The name EVALI is an acronym that stands for e-cigarette or vaping product use-associated lung injury and is associated with nearly 2,000 hospitalizations and a growing number of deaths reported to the CDC from 49 states, with nearly 40 percent of the patients younger than 20 years old.
According to the CDC, all EVALI patients have reported a history
of using e-cigarettes or vaping products. Most patients, but not all, report a history of using THC-containing products.
“The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to the most cases and play a major role in the outbreak,” as reported on the CDC’s website.
According to physicians working with the Mayo Clinic, in most circumstances, people who are hospitalized due to vaping injuries present with symptoms that resemble lung injuries seen with direct exposure to toxic chemical fumes and poisonous gases.
“What we are seeing with vaping is alarming because the toxins found in e-cigarettes are significantly impacting respiratory and general health over a much shorter period of time than traditional cigarette use,” said Dr. Patel. “Physicians have also observed inhalation injuries, chemical burns and injuries caused when e-cigarette devices malfunction and explode.”
In addition to the respiratory distresses and increased risk of lung infection, young people who vape are also experiencing fatigue, headaches, fever and gastrointestinal illnesses such as nausea, vomiting
and diarrhea.
“What we are seeing with
e-cigarettes is alarming because the toxins are different than traditional tobacco cigarettes and are impacting lung function rapidly,” said Dr. Patel.
What We Don’t Know
According to the CDC, “no one compound or ingredient has emerged as the cause of the lung injuries in the cases of hospitalizations and deaths associated with vaping to date – the only commonality among all cases is that patients report use of e-cigarettes, or vaping products.
It is also possible there is more than one cause of the outbreak according to the CDC, and, therefore, many different substances and product sources are still under investigation.
With long-term use, according to Dr. Patel, there also is potential concern for developing cancer, as formaldehyde and acetaldehyde can form when the propylene glycerol within the device is heated and aerosolized. Both Drs. Patel and Cardella agree physicians still don’t know enough about
all the toxins that are produced when e-cigarette ingredients are heated and converted to vapor,
but, “we do know that some are known to cause cancers,” said Dr. Patel.
Because the specific compounds or ingredients causing lung injury are not yet known, according to Dr. Patel, Dr. Cardella and Dowling, the only way to assure that teens are not at risk is to recommend that they refrain from use of all e-cigarette, or vaping products.
What Parents Can Do
After years of steady decline in smoking among teens, data is showing the number of teen smokers is on the rise. This is directly linked to the popularity of e-cigarettes among youth who are attracted by the varieties of flavorings.
“I tell students they are the guinea pigs when it comes to e-cigarettes,” said Dowling, who teaches Calvert County Public School students about the dangers of smoking through the Tobacco Road Show, a program which demonstrates the dangers of teen smoking. Although the long-term effects are unknown, she said, “We are already seeing severe lung disorders and even deaths from these unregulated products.”
She encourages parents to become better educated and to talk with their children about the health risks, because they may think vaping is safer than cigarettes. It’s also helpful to talk about what kind of peer pressure they are experiencing to try e-cigarettes and help them develop what to do or say when they encounter friends who are vaping.
For more tips on talking with your children about the harmful effects of vaping and strategies to quit, visit: CalvertHealthMedicine.org/Lung