Breaking Down the E-Cigarette Epidemic

The American Lung Association’s chief medical officer discusses e-cigarette use and answers common questions surrounding this increasing epidemic.
BY Kristie L. Kahl
PUBLISHED August 27, 2019
One in 4 young adults have become e-cigarette smokers – an epidemic that comes with many unanswered questions, according to Dr. Albert Rizzo.

CURE’s sister publication, MD Magazine, recently sat down with Rizzo, who is the chief medical office of the American Lung Association, to discuss e-cigarette use among adolescents and young adults in the United States.

Recent data from the CDC showed that high school students’ e-cigarette use is up about 78% from 2017 to 2018. As such, the FDA has declared an epidemic in the space. Could you talk more about what is actually driving this epidemic?
The concern we have as a public health organization, the American Lung Association, is that the e-cigarettes and the delivery of nicotine is developing another generation of people who are going to be addicted to a tobacco product. In this case, the electronic cigarette.

Nicotine is a very addicting drug. It's been brought to the market without any real testing or regulation. There are a lot of unknowns about the devices. And certainly, I think the reason children, in both middle school and high school, are using it is because they don't know much about it. They think it might be safer than cigarettes. They're attracted by the flavors – many of these devices are labeled as bubble gum, Captain Crunch, unicorn. So, a lot of the tactics that the cigarette industry used for many years until they were regulated are now being used by the cigarettes to attract youth to the e-cigarette.

There's been studies showing that individuals who use an e-cigarette are more likely to go on to use a true regular cigarette. So, that's our concern from a public health standpoint. The epidemic and the rise of individuals in high school and middle school using it is a bad sign up for the 3.8 million youth who are now users of e-cigarettes – 1 in 4in this country right now that are of those age groups.

And maybe if you can dispel the rumor right now for us, is vaping safer than smoking?
It's commonly thought to be the case. We know, first of all, we don't know a lot about e-cigarettes because we don't know what's in each product. There are hundreds of products, if not thousands of flavors. There are some that are cartridges and some that are self-made. There's some that can be manipulated. So, each e cigarette is almost different from the other e-cigarette.

The concern is that without knowing what is in there, we can't be absolutely be sure how safe they are. To paraphrase a tobacco researcher in California: if tobaccos are the most dangerous, that's like jumping out of a 40-story building, and if e cigarettes are safer, it might be like jumping out of a 30-story building. The end result may be the same. So, relatively safer than cigarettes is not a hard bar to beat because that's the most dangerous and kills about half a million people each year due to tobacco related illnesses.

Regarding the secondhand smoke and the aerosol associated with these devices, what kind of effect are we seeing from those?
The term vaping doesn't mean that you're just having water vapor come out when you see that plume of smoke. We know that when the chemicals are heated in these devices, there are metals… So, all these chemicals when they're burned, we really don't know what happens to them. Same thing with the flavorings. They're not meant to be burned and then inhaled.

The bottom line is if you think about it, your lungs were not developed to inhale substances that were combusted or burned. It irritates the airway. And unfortunately, some of the very small particles called the ultra-fine particles are so small, they get deep into the lungs, they actually get into the blood vessels and contributors the rest of the body leading to other parts of the body being affected as well.
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