Today, countries around the world are recognizing World No Tobacco Day. 2023 marks the 36th anniversary of this global event. It was first started to encourage smokers to try and go an entire 24 hours without smoking in the hope that would put them one step closer to quitting altogether. May 31st has since been an opportunity for everyone to learn more about how smoking affects society, from lung health to the environment.
The world has made a lot of progress on smoking over these decades. According to the Global Burden of Disease research tool, smoking rates have gone down about 30% since 1990. Here in the United States, only about 12% of adults smoke these days, down from around 28% in the late 1980s. Unfortunately, the public health community is starting to see that focusing on tobacco products may not be enough anymore. The lungs of the world have started to face a new threat over the past few decades: vaping.
You have probably heard of electronic cigarettes, e-cigs, vape pens, or similar things. Whatever we call them, they are a growing concern for anyone interested in lung health. Vapes were intended to be a safer alternative to traditional tobacco cigarettes. They have also sometimes been used to help people stop smoking. After all, they just produce vapor, right? There is no tar, no smoke particles, no toxic fumes. Vape pens use an electronic heating element to literally vaporize a liquid, often called vape “juice.” This liquid usually contains nicotine, flavors, and other ingredients. When it is vaporized, it can easily be inhaled into the lungs. The idea was that by slowly lowering the amount of nicotine in the liquid, people would become less dependent on it and eventually break the habit. Unfortunately, the more we learn about vaping, the less true any of that seems to be.
Despite the name, the mist that vape pens produce is not just water vapor. Depending on the juice used, it can contain almost any number of chemicals, including some that have been found to cause cancer. It can also contain chemicals found in cigarette smoke, including metals like nickel and lead. There is not much regulation of vape pens yet, so even pens labeled as being nicotine-free have been found to have nicotine in them. Because it is so hard to know what is in these things, the risks are literally unknown. However, now that vape pens have been widely available for a couple of decades, researchers can start looking at the long-term effects these chemicals have on the lungs.
Last October, studies funded by the National Institutes of Health found that vaping for only three months caused similar injury to the cells that line blood vessels as smoking tobacco. This injury can lead to a higher risk of future heart problems, just like smokers have. This past January, people who vape were also found to have higher levels of inflammation in the lung tissue itself compared with not only never-smokers but cigarette smokers as well. Inflammation in the lung can lead to several lung problems, including COPD, asthma, and pulmonary fibrosis. In fact, just before the COVID-19 pandemic, there was an outbreak of what was called “e-cig/vape-associated lung injury,” or EVALI. Almost 3,000 people, mostly teens and young adults, were hospitalized when the Centers for Disease Control and Prevention (CDC) stopped tracking the information to focus on COVID-19. Sixty-eight people died and at least one more needed a double-lung transplant to survive. While many of these cases were related to a particular additive that is no longer used, this outbreak speaks to the danger of putting ANYTHING that isn’t air (or medication) into your lungs.
This is particularly concerning for our kids. Vape pens come in many shapes and sizes. Many are designed to look like things like inhalers or portable computer drives, which makes them easy to hide. Vape flavors are often advertised with kid-friendly names like “Papa Smurf,” “Red Hot Gummies,” and “Hulk.” Even though one must be 18 (or in some places 21) years old to buy vape products, they are appealing enough and easy enough to find that over 2.5 million students in the United States have admitted to using a vape in the last 30 days. That includes 14% of high schoolers and 3% of middle school students. That may not seem like a lot, but it really scares a public health advocate like me. Considering that kids often do not pay attention to nicotine levels and just go for flavor, they are at high risk of overdose. In fact, Dr. Karen Wilson of the American Academy of Pediatrics said in a 2019 National Public Radio interview, “We’re seeing kids that are using four pods a day, and this is the equivalent of four packs of cigarettes a day. I mean, it is an astounding amount of nicotine being delivered in these products.” Younger siblings are also at risk of finding the juice cartridge and drinking it for the flavor. In 2023 alone, there have already been 2,600 calls to local poison control centers for these situations so far.
All in all, vapes do not have a lot going for them. They have never been shown to be an effective tool to quit smoking. They contain unknown amounts of chemicals that can be different from brand to brand. They seem to cause similar long-term risks as smoking, and they are putting our next generation at risk. Have you had any experience with vape pens/e-cigs? Let us know in the comments!