Vaping: What we know so far — & what we don’t

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When e-cigarettes hit the market 10 years ago, they were advertised as a clean, safe alternative to traditional smoking. To some extent, that’s likely true; they do seem cleaner and safer, and they may prove helpful to smokers who are trying to quit. That said, they may also carry some health risks of their own. If this evaluation sounds noncommittal, it is—scientists and federal regulators are still duking it out, and the research on e-cigarettes (vaping) is in its early stages. Here’s what we know so far:

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What are e-cigarettes?

E-cigarettes were designed as a way for people to hold and inhale something that looks and feels like a cigarette without being exposed to tobacco smoke and its indisputable health risks. E-cigarettes are battery-powered devices that contain a liquid cartridge. When heated, the cartridge releases a vapor that the user inhales.

Here’s what the vapor contains:
  • Nicotine (usually—some e-cigs do not contain this)
  • Propylene glycol, a synthetic chemical that also shows up in some foods and toiletries, and other chemicals
  • Flavorings and coloring; these vary by brand
Here’s what the vapor does not contain:
  • Tobacco

The Food and Drug Administration (FDA) has only just started the process of regulating e-cigarettes, so manufacturers have been operating without much oversight. This means that some e-cigs may contain higher nicotine doses than it says on their packaging. The FDA has not approved e-cigarettes as a smoking cessation aid.

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How many young people are vaping?

E-cigarettes are in use, but maybe not as commonly as you might think. That’s according to a 2015 survey of 6,300 college students.

Using or not using e-cigarettes?
 85%  Never used, 
 10%  Have used, but not in last 30 days, 
 5%   Any use in last 30 days.

Source: American College Health Association–National College Health Assessment, Fall 2015; anonymous, randomized survey.

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Could e-cigarettes harm my health?

 At this point, researchers are sounding reasonably confident that e-cigarettes are less harmful than traditional smoking—but the research is far from complete. And e-cigarettes are unlikely to be completely safe.

The Framework Convention Alliance, an international organization focusing on eliminating tobacco-related harm, acknowledges the many areas of dispute regarding e-cigarettes. Nevertheless, it concludes, “e-cigarettes are almost certainly considerably less hazardous for individuals than cigarettes.”

If young people vape instead of smoking traditional cigarettes, they will avoid the harsh health effects caused by smoking tobacco, according to a 2016 study in Nicotine & Tobacco Research. These include cancers and heart disease caused by inhaling tar, a substance released as tobacco burns.

That said, no one can realistically tell you that vaping isn’t harmful at all. “The use of e-cigarettes cannot be labeled ‘safe,’ because that implies no risk. Any time you inhale anything into lungs, even air, you incur some level of risk,” says Steve Lux, a former senior health educator at Northern Illinois University (who supports the use of e-cigarettes for smoking cessation).

In people who would not otherwise smoke, using e-cigarettes could potentially contribute to health problems, researchers acknowledged in the Nicotine & Tobacco Research study.

The nicotine in some e-cigs has the potential to harm brain development in people in their early twenties, according to the World Health Organization. It’s conceivable that vaping could aggravate respiratory diseases, such as asthma and bronchitis.

Again, e-cigarettes vary in their ingredients, so their health effects likely vary, too. And relative to traditional smoking, e-cigarettes are the safer choice.

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Do e-cigarettes help smokers quit or create new smokers?

This is a point of contention among health professionals.

Vaping may be helpful in smoking cessation

Researchers are trying to figure out whether or not these devices can help people quit smoking altogether. The current evidence is mixed. E-cigs containing nicotine may be more effective for quitting smoking than a nicotine patch, according to a 2014 study published in Addiction. A 2016 analysis of multiple studies, however, found that e-cigarette use was associated with reduced rates of smoking cessation (The Lancet Respiratory Medicine).

In this context, it may be reasonable to try e-cigarettes as a smoking cessation aid—with caution. “I think that all smokers who are exploring options for quitting should look into the use of nicotine e-cigarettes as one of the many options that exist today,” says Steve Lux, a former senior health educator at Northern Illinois University. 

Vaping does not appear to be creating new smokers

The 2016 study in Nicotine & Tobacco Research explored whether vaping could create new smokers. The researchers (looking at a cohort of people born in 1997) found that although e-cigarette use has risen, traditional cigarette smoking has continued to fall. This suggests that vaping is not creating a new wave of smokers. 

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Could my vaping harm people around me?

E-cigarettes don’t contain smoke, but they do create secondhand emissions. It’s still unknown what effect these emissions may have.

“Vaping involves exhalations, containing mainly water vapor, but also containing small amounts of other substances that may or may not have a negative effect,” says health educator Steve Lux. But traditional tobacco studies indicate that passive smoking in social situations is a lot less risky than living with a smoker, he says. This is not a license to vape anywhere: Many campuses and other institutions ban the use of nicotine-containing substances, including e-cigarettes.

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Why don’t we have better answers on how e-cigarettes may affect health?

Vaping hasn’t been around long enough for us to see its long-term effects. If e-cigarettes can potentially contribute to serious illnesses—such as cancer, lung disease, or heart disease—we won’t see that for years. Researchers can study how e-cigarette vapors affect the cells of lab animals, which may offer some insight but can’t show us exactly how vaping affects people in the long term. 

In addition, we don’t have much data on people who vape and do not also smoke (or never smoked) traditional tobacco products. Potentially, those people could serve as a control group, helping scientists untangle the relative influence of vaping versus traditional smoking on health. Among people who do both, that’s hard to figure out.

Lastly, some researchers are studying how e-cigarettes may help people quit smoking altogether. For these claims to hold water, the products’ (relative) safety and effectiveness have to be proven through a series of clinical trials.

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Are e-cigarettes regulated by the government?

Starting in August this year, the Food and Drug Administration (FDA) began evaluating all e-cigarette products that are on the market. Each product will go through a new application process to determine whether or not it can continue to be sold.

While the FDA is working through a mighty high stack of applications, manufacturers can keep selling e-cigarettes. All this can take two to three years.

If manufacturers can’t show that their product has therapeutic benefits (e.g., helping smokers quit), that e-cigarette will be regulated as a tobacco product.

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Could I get addicted to e-cigarettes?

Nicotine is a highly addictive substance, whether you find it in traditional cigarettes or in e-cigarettes. The amount of nicotine in e-cigarettes can vary by product and manufacturer. There are no data yet on whether vaping leads to nicotine addiction.

Ready to quit? You can do this

November 17 is the Great American Smokeout, and there’s extra support available for quitting smoking.

Trying to quit without a plan can leave you without a way to cope when you get cravings. You’re more likely to succeed with a structured approach, says, a governmental resource for all things tobacco-free. Ask your health care provider for tools and strategies that have been evaluated in studies and shown to be successful. To get started, click on these links:

Principles for successfully quitting

Steps in your tobacco liberation movement include:
  • Choosing the date you’re ridding yourself of tobacco.
  • Telling friends and family about it for support and to make you accountable.
  • Giving your environment a makeover:  Remove cigarettes, ashtrays, and anything that makes you think about smoking. Find alternatives to help you replace the habit, especially when you have cravings (e.g., healthy snack food, such as carrots or popcorn, or an assortment of delicious teas).
To quit permanently, your strategy has to be sustainable:
  • Look for life changes that you can live with; for ideas, check out former smokers’ strategies.
  • Make a list of things that are important to you and aim to keep doing them after quitting. This might mean spending more time with friends or pursuing your own goals, like joining the track team.

Quitting strategies that work

In studies, these tobacco cessation approaches have been shown to be helpful. For professional support, talk to a doctor or counselor about what has been shown to work best.

  • “Motivational interviewing” is a specialist counseling approach that helps you come up with your own solutions. In a 2015 Cochrane review of 28 studies, motivational interviewing with health professionals was more successful in helping people quit smoking than traditional health advice. Single, brief sessions appeared effective for quitting.
  • Dialectical Behavioral Therapy (DBT) is a form of cognitive behavioral therapy (CBT). The “dialectical” piece refers to two valid but opposing thoughts: (e.g., “I want to quit smoking” and “I would feel calmer right now if I had a cigarette”). DBT helps us understand our own stress triggers and develop effective self-soothing techniques. Mindfulness techniques are a foundational skill of DBT.
  • Nicotine replacement therapy (e.g., gum) or prescription medications (e.g., bupropion). In studies, using one of these two substances helped 80 percent more people to quit compared to a placebo, according to the Cochrane Collaboration, which reviews medical research.
  • Stress-busting alternatives help you avoid “just one” cigarette when you have a bad craving. One cigarette tends to lead to more, according to the Mayo Clinic.
  • Text-message, Twitter, or email program for regular quitting tips and support. Cessation programs delivered through Twitter can help keep people on track, evidence suggests.

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Steve Lux, former senior health educator, Northern Illinois University.

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