I have just returned from my trip to Italy and Israel. In both countries I saw young people smoking, but the prevalence seemed less than that which I’ve noted in the past. (Clearly an observation which I cannot proffer as a scientific fact.) What I did not observe was the use of electronic cigarettes. I know, however, that vaping has become more prevalent here in the US. And sure enough, an article was featured in the October 6 issue of the New England Journal of Medicine on the prevalence and health effects of electronic cigarettes. So here are some of the salient facts that were in the article:
Electronic cigarettes are a very effective delivery system. The inhalation of the aerosol from a nicotine containing e-cigarette leads to peak nicotine concentration in the blood within five minutes. This is about the same as that which occurs when a regular cigarette is inhaled. There are a limited number of types and brands of cigarettes available in the US, but that cannot be said for e-cigarettes. In 2014, there were an estimated 466 brands and 7,764 unique flavors of e-cigarette products. Apparently this huge (I do so hate to use that term now!) number makes research on potential health effects quite difficult.
And the prevalence of e-cigarette use is indeed increasing. In 2010, a total of 1.8% of US adults reported having used e-cigarette at some time, and the rate rose to 13% by 2013. Tobacco smokers were among those most likely to be current users of e-cigarettes, but a third of current e-cigarette users had never smoked tobacco or were former tobacco smokers. And there is an increasing experimentation with and use of e-cigarettes among persons younger than 18 years of age. In 2013, an estimated 263,000 middle school and high school students who had never smoked a conventional cigarette reported having used e-cigarettes. The use in this age group continues to increase, with 16% of high school students in 2015 reporting any use within the preceding 30 days. The authors of the article feel that reasons for increasing use of the cigarettes by minors include “robust marketing and advertising campaigns that showcase celebrities, popular activities, evocative images and appealing flavors such as cotton candy. E-cigarettes are marketed on the Internet and social media outlets.”
The financial rewards of this tobacco product are enormous. (I have to add this: do you think there will be a brand that will be marketed as trump e-cigarettes?). The US market for e-cigarettes is now estimated to be worth $1.5 billion, and that’s projected to grow by 24.2% per year through 2018. Global sales are predicted to reach $10 billion by 2017.
So what are the health effects? Well, after many pages of stats and explanations about the constituents of the liquids and aerosols in the products, the authors state that “for long term smokers who are unable to give up cigarettes smoking altogether it is speculated that the use of the e-cigarettes rather than tobacco cigarettes may be associated with better short term and long term health outcomes, but clinical and epidemiologic data on health outcomes are not yet available.” They feel that there are many challenges to getting significant research results due to the striking diversity of the flavorings and e-cigarette liquids. They do feel that there may be concern about the effects on health of the aerosol constituents produced by their flavorings.
The chief public health concern is that e-cigarette use is growing among minors and young adults and this can promote nicotine addiction (and future use of tobacco cigarettes) in individuals in these age groups who might otherwise have been healthy non-smokers. As usual, we will have to wait for more data, but clearly it behooves us to discourage minors and young adults from vaping, even if it tastes like candy!