The Youth E-Cigarette Epidemic - BRIGID Magazine

Tuesday, December 4, 2018

The Youth E-Cigarette Epidemic

Youth use of e-cigarettes, aka vaping, has reached
epidemic levels, reversing the decline of tobacco
products in recent years. | Image: Itay Kabalo
According to a report released by the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention, the number of youth using e-cigarettes has risen dramatically. Among teenagers in high school, e-cigarette use this year has increased to 20.8 percent (just over 3 million students) from 1.5 percent (220,000 students) in 2011. This means that about 1 in 5 high school students currently use e-cigarettes.

"These new data show that America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation in nicotine addiction," said HHS Secretary Alex Azar.

Though tobacco and nicotine use had been declining among youth in recent years, the rise of the e-cigarette has reversed that trend. "Although e-cigarettes have the potential to benefit adult smokers if used as a complete substitute for combustible tobacco smoking, the use of any form of tobacco product among youths, including e-cigarettes, is unsafe," according to the Morbidity and Mortality Weekly Report for November 16, 2018.

E-cigarettes, short for electronic cigarettes, are battery-powered devices that deliver vaporized nicotine, flavouring, and other contents to the smoker. E-cigarettes entered the U.S. marketplace in 2007, and by 2014 they were the most popular tobacco product among American youth. E-cigarettes are now a multi-billion dollar industry. Tanusree Jain, in an article for Maclean's, stated:

Today, some of the most popular e-cigarette brands are owned by Big Tobacco, leading to the industry’s partial transformation into Big Vape.

The practice of smoking e-cigarettes, or e-cigs, is usually referred to as "vaping" — named for the vapour that is released while smoking.

E-cigarette and vape liquid ("vape juice") companies often hire
"vape models" or "vape girls" to promote their products on
Instagram and other social media sites. | Image: Max Pixel
E-cigarettes are inconspicuous devices that have been heavily marketed to teens and young adults in recent years, with e-cig and vape liquid companies paying Instagram models, YouTubers, and rappers to display their products in sexy and appealing ways. Some e-cigarette companies even offer college scholarships to students who will use their products, talk about them with friends, and write essays on the benefits of vaping over regular cigarette use.

ZampleBox, a YouTube channel whose about section states that they're "out to change the world by making vaping more fun, easy and accessible," released a video in March on how to become a vape model, promoter, and influencer. In the video, the host, Chris, interviews several vape models at ECC 2018 — which stands for Electronic Cigarette Convention. The ECC formed in 2012 "as the vapor products industry's first trade show and expo," according to its website.

It's safe to say that vaping has become emblematic of today's youth culture — and a part of youth culture that has arguably been aggressively and forcefully shaped by companies who care little about the health of young people.

Though a great deal has been written about the benefits and apparent safety of electronic cigarettes and other vaping products, the science is clear: Vaping may be safer than smoking cigarettes, but that doesn't make it safe.

In the Annual Review of Public Health for 2018, Stanton A. Glantz and David W. Bareham wrote:

Since e-cigarettes appeared in the mid-2000s, some practitioners, researchers, and policy makers have embraced them as a safer alternative to conventional cigarettes and an effective way to stop smoking. While e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, they still expose users to high levels of ultrafine particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risks, which account for more than half of all smoking-caused deaths, at rates similar to conventional cigarettes.

Vaping may be safer than smoking cigarettes, but that doesn't make it safe.
Long-term health effects of using e-cigarettes remain unclear.
Image: Antonin FELS
Though some health experts promote e-cigs as smoking cessation devices, vaping is instead ushering in millions of new smokers and tobacco and nicotine product users every year. Smoking cessation rates have fallen, and e-cigarettes have been deemed a gateway to cigarette smoking by some researchers.

In theory, e-cigarettes confer lower health risks than combustible tobacco cigarettes, but since they are relatively new, long-term health effects are not yet known.

In a consensus study report by The National Academies of Sciences, Engineering, and Medicine, the authors broke down the evidence that we currently have into varying degrees of strength: conclusive evidence, substantial evidence, moderate evidence, limited evidence, insufficient evidence, and no available evidence.

Highlights of the evidence regarding public health consequences of e-cigarettes include:

  1. "There is conclusive evidence that exposure to nicotine from e-cigarettes is highly variable and depends on product characteristics (including device and e-liquid characteristics) and how the device is operated." 
  2. "There is substantial evidence that nicotine intake from e-cigarette devices among experienced adult e-cigarette users can be comparable to that from combustible [regular] tobacco cigarettes."
  3. "There is conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances."
  4. "There is substantial evidence that except for nicotine, under typical conditions of use, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes."
  5. "There is substantial evidence that e-cigarette aerosol contains metals. The origin of the metals could be the metallic coil used to heat the e-liquid, other parts of the e-cigarette device, or e-liquids. Product characteristics and use patterns may contribute to differences in the actual metals and metal concentrations measured in e-cigarette aerosol."
  6. "There is limited evidence that the number of metals in e-cigarette aerosol could be greater than the number of metals in combustible tobacco cigarettes, except for cadmium, which is markedly lower in e-cigarettes compared with combustible tobacco cigarettes." 
  7. "There is substantial evidence that e-cigarette aerosols can induce acute endothelial cell dysfunction, although the long-term consequences and outcomes on these parameters with long-term exposure to e-cigarette aerosol are uncertain."
  8. "There is substantial evidence that components of e-cigarette aerosols can promote formation of reactive oxygen species/oxidative stress. Although this supports the biological plausibility of tissue injury and disease from long-term exposure to e-cigarette aerosols, generation of reactive oxygen species and oxidative stress induction is generally lower from e-cigarettes than from combustible tobacco cigarette smoke."
  9. "There is substantial evidence that some chemicals present in e-cigarette aerosols (e.g., formaldehyde, acrolein) are capable of causing DNA damage and mutagenesis. This supports the biological plausibility that long-term exposure to e-cigarette aerosols could increase risk of cancer and adverse reproductive outcomes. Whether or not the levels of exposure are high enough to contribute to human carcinogenesis [cancer formation] remains to be determined."
  10. "There is conclusive evidence that intentional or accidental exposure to e-liquids (from drinking, eye contact, or dermal [skin] contact) can result in adverse health effects including but not limited to seizures, anoxic brain injury, vomiting, and lactic acidosis."
  11. "There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults." 

The report authors remind readers that the health effects of regular cigarette smoking did not emerge for several decades. They suggest that this could be the case with electronic cigarettes as well.

by Kristen Hovet

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