According to the statement, the toxicity of e-cigarettes remains poorly understood, partly because most manufacturers have not publicly disclosed the full list of ingredients. Since the exact composition of the products within the devices is not known, it is difficult to predict or determine the health effects on the lungs and heart. Other than nicotine or THC, e-liquids contain vegetable glycerin and propylene glycol, which are on the US Food and Drug Administration’s “generally regarded as safe” list. However, these compounds were not intended to be inhaled and have not been tested to determine how inhaling them affects users. When heated, these compounds often break down into other chemicals such as formaldehyde, which is a known carcinogen.
“Furthermore, a person’s lung development continues into the early 20s, so adolescents who vape are at risk for stunting or altering their lung development and may not reach full lung function.”
Previous studies have found that people who use e-cigarettes have an increased risk for respiratory health issues, including wheezing and coughing, asthma and lung infections. Additionally, studies have found that young adults who use e-cigarettes experience arterial stiffness, impaired blood vessel function and increased blood pressure and heart rate. This evidence suggests that this could lead to cardiovascular disease in people who use e-cigarettes over the long term.
“While adolescents who use e-cigarettes may not feel that vaping is affecting them at the moment, it is increasingly clear that the chemicals contained within e-cigarette aerosols are harming cardiovascular cells, leading to changes that promote the development of heart disease over time ,” Wold said. “It usually takes decades before people who smoke combustible cigarettes develop cardiovascular disease and/or chronic-obstructive pulmonary disease, and the same may be true of vaping. A reduction in adolescent vaping rates likely may help to improve long-term cardiopulmonary outcomes among this group.”
Studies have found that while some people may consider e-cigarettes as an aid to stop smoking combustible cigarettes, many people end up using both products regularly. The statement emphasized it is important to distinguish between tobacco cessation and nicotine cessation. One study from the United Kingdom, where the amount of nicotine in e-cigarettes is much lower than in the US, found e-cigarettes may be more effective than nicotine patches at combustible tobacco cessation (18% vs. 10%, respectively). However, the study found e-cigarettes were four times less successful in reducing nicotine consumption (20% for e-cigarettes compared to 81% for nicotine patches).
“The customizability of e-cigarettes, including power levels, e-liquid content and the abundance of flavors, appeals to young people and it also makes regulation of these products difficult,” Wold said. “While the FDA has issued a policy against mint and fruit flavors of e-liquids that are known to appeal to youth, for some product types, menthol flavored products are still available. Additionally, there is no regulatory standard limiting the concentration of nicotine in e-liquids in the US Some devices have been found to have nicotine levels of 59 mg/mL. In comparison, the European Union limits nicotine concentration in e-liquids to less than 20 mg/mL, an amount comparable to that of standard combustible cigarettes.”
The statement recommended steps be taken to remove all flavored e-cigarettes, including menthol-flavored e-cigarettes, from the market. Additional public health and policy recommendations include:
† Implement better measures to reduce youth access to e-cigarettes, including strict age verification at place of sale and prohibiting marketing of e-cigarettes directed toward youth.
† Provide more education for youth and their parents regarding the confirmed and potential health risks of e-cigarette use.
† Establish vaping curricula for medical students to inform the next generation of health care professionals.
† Ensure hospital-based vaping-cessation programs exist for adolescents and adults.
† Regulate the marketing of e-cigarette products in traditional, online and social media platforms that are popular among youth.
† Incorporate e-cigarettes into smoke-free air policies.
Media contact: Amy Colgan, Wexner Medical Center Media Relations, Amy.Colgan@osumc.edu