Non-combustible cigarettes have been on the market for a decade, but prevalence of use has increased drastically over the last couple of years.
Devices are known as ENDS (electronic nicotine delivery systems) but are better known as Juul, mods, pods, vape pens, e-pens, e-pipes, e-hookah or e-cigars. Verbs like "vaping" and "juuling" are now a part of our lexicon. In these battery-powered devices, inhalation prompts a heating element to heat liquid-filled cartridges and release a chemical aerosol. They may resemble devices such as USBs, phones or pens, making them easy to use discreetly.
With ongoing data showing sharp increases in usage trends, the FDA and medical community now consider the use of these products an epidemic. Top concerns include lung disease and the overall risk of addiction. News headlines this fall have included reports of more than 1,800 cases of serious illnesses and three dozen deaths directly related to vaping. Long-term effects of these products, regardless of whether a person experiences a serious illness or not, will remain unknown for many years.
There are several common misconceptions about the safety of e-cigarettes:
Common misconception #1: The cartridges (aka pods or e-juice) contain little/no nicotine.
The truth: JUUL does not currently make any pods or "e-juice" that are nicotine free. In fact, one JUUL pod (approximately 200 puffs) contains as much nicotine as an entire pack of cigarettes. Even if labelled "nicotine-free," this may not be the case as there is no FDA regulation yet on the products.
Common misconception #2: They do not contain dangerous ingredients.
The truth: Ingredient lists for the cartridges include anti-freeze, diethylene glycol, formaldehyde and other carcinogens. The aerosol that is inhaled also contains heavy metal particles. To make things worse, the inhaled particles are "ultrafine" and are able to get deeper into the lungs than traditional cigarette smoke. It is thought this may be the reason why the use of the products has resulted in such serious illnesses.
In addition, products are available which may contain other substances including THC, the component of marijuana that causes the user to feel "high." While these may be legally sold in dispensaries in some states, they are otherwise obtained through illegal and unregulated means, such as on the black market or from individual dealers, greatly increasing the risk to users of unknown contents in the products.
Common misconception #3: There are no risks to those around e-cigarette users.
The truth: The surgeon general has reported the secondhand smoke of vaping contains numerous toxic substances. Research continues to accumulate showing all secondhand smoke is harmful to those around the user, including vaping, hookah and marijuana smoke.
In addition, the cartridges contain concentrated nicotine that can look appealing to small children (for example, it may be pink and smell like cotton candy). However, if a child directly ingests the liquid nicotine, it can cause life-threatening symptoms. Calls to Poison Control Centers following accidental liquid nicotine ingestion by children more than doubled from 2014-15.
There have also been issues with the batteries in the devices. From 2015-17, there were more than 2,000 vaporizer battery explosions reported. Injuries include burns, lost teeth, blindness and two deaths.
Vaping products are the most commonly used tobacco products among youth. Recently released data now shows that one in four 12th-graders and nearly one in 10 eighth-graders report having used a vaping product in the last 30 days. Nicotine can be especially harmful to the young developing brain (our brains continue to develop up to age 25) including being more susceptible to addictive substances. Attention and mood disorders are also more likely to co-occur in nicotine users. Teens report their most common reason for vaping is use by family and friends. In addition, flavors such as cotton candy, crme and mint, as well as easily concealable devices, are factors that appeal to teens.
We still have a lot to learn about these products and research is ongoing; in the meantime, a whole new generation is becoming addicted to nicotine.
Are these products completely safe? Definitely not.
Safer than traditional combustible cigarettes? The jury is still out on that one; currently there is not enough supporting evidence for this claim.
Please take time to talk with your children about the risks of vaping and always remember to be a good role model.
Do you or your teen want to quit vaping or smoking?
Here are a few resources:
Text DITCHJUUL to 88709 to use the first-ever free text-to-quit vaping service.
Call 1-800-QUITNOW for individual counseling over the phone.
The Lung Association's Freedom from Smoking program offers group counseling.
Not on Tobacco (NOT) is the American Lung Association's teen smoking cessation program.
Always remember you can talk to your medical provider for additional support.
For more information on vaping, visit American Lung Association (lung.org), The Truth Initiative (thetruth.com), American Academy of Pediatrics' Richmond Center online and healthychildren.org.
Blount is a pediatrician with SSM Health Medical Group in Jefferson City. She is board certified in pediatrics. Her interests include well-child care, health literacy, education and advocacy.