Posted: February 10, 2020
The below op-ed was written by Melinda Ickes (UK CON), Jim Pauly and Beth Magner. It was published in the Lexington Herald-Leader on Feb. 6, 2020.
We are hard pressed to open a newspaper or turn on the news and not hear the latest statistics on vaping.
According to the Centers for Disease Control, there have been 2,409 cases of e-cigarette, or vaping, product use–associated lung injury (EVALI) in the U.S. Of these cases, 52 resulted in death.
While product use for these cases includes both nicotine-containing products (64 percent) and THC-containing products (86 percent), the CDC notes there has not been one single compound found to be the main cause of these outbreaks. Vitamin E acetate, used most commonly as a thickening agent in THC-containing vaping products, has been linked to some of these cases. This risk is supported by previous research that suggests when Vitamin E acetate is inhaled, it may interfere with normal lung functioning. Even though much of the focus has been on THC containing products, the risk for those using e-cigarettes with nicotine cannot be overlooked.
Many users are unaware that e-cigarettes are considered a tobacco product, although they are regulated as such by the FDA. Vaping is the use of an electronic cigarette (or e-cigarette) product that works by heating e-liquids to form an aerosol, which is then inhaled. It is not water vapor, but aerosolized particles, which can also exacerbate respiratory symptoms among non-users who are exposed to secondhand aerosol, similar to secondhand smoke. E-cigarettes can contain various substances including flavorings, toxic chemicals, and typically nicotine.
What is extremely concerning is that e-cigarettes are now the most commonly used tobacco product among adolescents, with over 5 million U.S. middle and high school students reporting use of e-cigarettes in 2018. The growth of e-cigarette use among Kentucky middle and high school students has also skyrocketed, with 14 percent of our 8th graders and 27 percent of our high school seniors reporting current, past 30-day e-cigarette use. The teen brain is still developing and is very sensitive to nicotine.
A teen’s exposure to psychoactive substances can easily cause dependency, mood disorders, and reduced impulse control. In addition, use of e-cigarettes has been associated with future use of other tobacco products. According to the Surgeon General, current youth e-cigarette users are four times more likely to use combustible cigarettes.
It is important to note that nicotine affects many parts of the brain including the areas responsible for impulsive decision-making and logical thinking. Regardless of the delivery method, nicotine exposure can harm the respiratory system, learning, memory, and attention, as well as other behaviors.
Parents and caregivers need to watch for signs of teen e-cigarette use. Know how to identify the various names for e-cigarettes, which include e-cigs, vape pens, pods, e- hookahs, tank systems, mods and electronic nicotine delivery systems (ENDS). E- cigarettes can also be found in a variety of forms, some of which look like traditional cigarettes or cigars, while the newer generations look like pens or USB drives. One of the most popular brands of e-cigarettes is JUUL, which is a pod-based system.
Pod-based e-cigarette systems are made up of two components: a power source, which contains the battery than can be charged through a USB port, and a pod or cartridge. A cartridge can provide at least 200 puffs and comes in a variety of different flavored e- juices, all with an alarming amount of nicotine. Each JUUL pod is packed with 59 milligrams per milliliter of nicotine, which is equal to the amount of nicotine found in a pack of cigarettes. Other pods may contain even more nicotine.
As tobacco cessation efforts move forward, healthcare providers must consider more detailed inquiries about tobacco use in their patients – patients of all ages. Providers should be knowledgeable on the variety of names and presentations of e-cigarettes to understand what patients might be using. Healthcare providers also need to be vigilant in asking young people about their use, especially if they are experiencing any of the following symptoms:
- Respiratory symptoms, including cough, shortness of breath, or chest pain;
- Gastrointestinal symptoms, including nausea, vomiting, stomach pain, or diarrhea;
- Nonspecific constitutional symptoms, like fever, chills, or weight loss;
- Healthcare providers should also be equipped with resources to help young people quit vaping and using all tobacco products. More information on available resources can be found through the KY State Tobacco & Prevention Program. Kentucky has also invested in My Life, My Quit that will connect young people to a “quit coach” who will provide free, confidential, real-time support. Each teen can get five sessions of personalized support through live texting, phone, or online chat.
As research continues to emerge exploring e-cigarettes as a substitute for adults who already smoke tobacco products, there is no benefit for anyone to start using vape products if they do not currently use tobacco products. It is important to note that vaping is not FDA approved as a smoking cessation or tobacco treatment aid.
The risks posed with e-cigarettes are unnecessary and avoidable, and it is time to do our part in stopping this epidemic. We have a chance to speak up for our young people and advocate for strong flavor bans, comprehensive smoke-free community policies that include e-cigarettes and funding for prevention and treatment.
Melinda Ickes is an associate professor of health promotion in the UK College of Education and is a faculty associate in the UK College of Nursing with the BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) Research Team. Jim Pauly is faculty at the UK College of Pharmacy and Beth Magner is a PharmD and UK College of Pharmacy community resident.