What is an E-Cigarette or Vaping?
A vape or e-cigarette is a battery-operated device that heats up a liquid chemical into an aerosol that is then inhaled.
This is often called vaping. E-liquids or “E-juice” do not contain tobacco. However, most of these products contain substantial amounts of nicotine which is the addictive substance also found in cigarettes. Other chemicals and metals are found in e-liquids. Some of these chemicals are the same ones found in tobacco cigarettes.
Vaping has not been proven to be a helpful quitting aid. Nicotine replacement therapy such as patches, inhalers and gum do not heat nicotine so using these products to manage cravings does not expose the user to the types of chemicals that are found in tobacco and vaping products.
It’s just water vapour right? False! E-cigarettes may be less harmful than tobacco cigarettes, but that does not make them safe!
A Puff of Truth
A recent study found that vaping youth had a number of chemicals that could be detected in bodies.
- Youth who were vaping had up to 3 times as many chemical organic compounds in their bodies as non-vaping youth.
- Those who smoked and vaped (dual user) had up to 3 times as many than those who were only vaping.1
If you don’t smoke, don’t vape.
Types of E-cigarettes
Common terms for e-cigarettes include:
- vapes
- tanks
- mods
- JUUL, SMOK, VYPE, LOGIC
- pods
- e-hookah,
- e-pipe
- vape pen
Vaping tanks are devices that can be refilled when empty and can be parts modified. They may allow the user to turn the heat up or down. Turning the heat up creates larger vapour clouds, but is known to also increase the amount of nicotine and chemicals inhaled. There are also products specifically on the market to vape cannabis.
JUUL
JUUL is a product which looks very similar to a USB stick and can be very small.
- Each pod contains as much nicotine as a pack of cigarettes.
- JUUL always contains Nicotine - high amounts using a liquid of Nicotine Salts.
- The less harsh nature of this product, high nicotine content and fruity flavours put youth at risk for quickly becoming addicted..
- This product has captured half of the e-cigarette market in the U.S and the FDA has sounded the alarm about the numbers of youth and young adults using JUUL.
- JUUL’s websites lists the following ingredients in the pods: Glycerol, propylene glycol, natural oils, extracts and flavour, nicotine and benzoic acid.
What is in E-Liquids (E-Juice)?
Most e-liquids include a mixture of:
- propylene glycol
- vegetable glycerin
- nicotine
- flavour ingredients
It is not just harmless water vapour, but an aerosol. Many vaping websites state that propylene glycol, vegetable glycerin and flavourings have been considered safe food additives by the FDA. Many flavour chemicals are recognized as safe for eating, but there is no evidence to show that they are safe when heated and inhaled into the lungs.
E-liquids do not contain tobacco. However, most of these products contain nicotine which is the addictive substance also found in cigarettes and derived from tobacco leaves. A new form of nicotine has been developed called, nicotine salts and is used in vape pods. This new form is a mixture of freebase nicotine (from tobacco plant) mixed with an acid. The body can easily and quickly absorb this form of nicotine.
Some products are labeled as having zero nicotine, but many are not correctly labelled and do in fact contain some nicotine. Even when labelled as containing nicotine, some e-juice has been found to have a greater amount of nicotine than what is listed on the label.
E-liquids also contains a number of chemical compounds and metals. Some of these are the same ones found in tobacco cigarettes. When the ingredients in e-juice are heated, they break apart into toxic organic compounds such as:
- acrylonitrile
- acrolein,
- propylene oxide
- acrylamide
- crotonaldehyde.
Metals such as nickel, tin, and lead have been found in e-juice. This is likely because the e-liquid comes into contact with the metal coil used to heat the liquid into an aerosol.
Thousands of Flavours are marketed and sold for use in e-liquids. Flavours in tobacco products were found to appeal to youth and this appears to be the case with vaping flavours. Flavouring chemicals carry their own health risks for the user. When some ingredients are heated they undergo chemical changes. The Flavour and Extract Manufacturers Associations warns that their flavours were not designed to be heated and inhaled and state some flavours are known to cause respiratory damage. For example, saccharides are used to make e-liquid flavours that are sweet, but this ingredient can degrade and produce furans and aldehydes that are known to cause respiratory irritation. Cinnamaldehyde is used to make cinnamon flavoured e-liquid but has been shown to be toxic to living cells. In laboratory research, some studies have shown that lung cells exposed to the vaping aerosol of e-liquids that include several flavour chemicals mixed together, appear to cause more damage than vaping aerosols with one flavour chemical.
Health Concerns for Youth
Addiction
Youth who do not use tobacco are beginning to experiment with vaping believing that it is safer. Nicotine is highly addictive, especially for the growing teen brain. It may lead to difficulty concentrating, problems with impulse control and there is evidence that nicotine addiction can lead to use of other drugs. For more about the health concerns for youth and Nicotine, visit https://e-cigarettes.surgeongeneral.gov/
Transition to Tobacco Cigarettes
The evidence is showing that vaping increases the risk of youth and young adults of ever using tobacco products. Also, there is moderate evidence showing that vaping increases the use and frequency of combustible tobacco products like cigarettes among youth and youth adults.
Cough/Wheeze
There is moderate evidence that vaping causes increased coughing and wheezing in youth. It also worsens asthma symptoms.
Dry Nose and Throat Irritation
One of the main ingredients in e-juice is called propylene glycol. It is a chemical that absorbs moisture. It can cause the sensitive lining of the nose to dry out. Bloody noses and throat irritation can also be a problem.
Dental Problems
Studies of online posts by vapers show one of their top complaints is a dry mouth. Saliva helps wash away bacteria in the mouth. Over time, people who vape could be at increased risk for dental and oral problems. This includes periodontal disease or gum disease, which is an infection of the tissues that hold your teeth in place.
Germs and Infectious Diseases
Sharing a vape? Then you are likely swapping some spit and maybe other nasty stuff! Cold and flu viruses, mono and the bacterium that causes strep throat (group A streptococcus) are all passed through saliva.
Nicotine Poisoning
Nicotine is a toxic substance and too much can lead to serious health issues and even death. Nicotine poisoning is a risk if the e-juice is ingested, touches skin or if too much is inhaled.
Small children are most at risk for nicotine poisoning. Just like other toxic substances, all e-juice and vaping products should be out of reach and locked up as the bright packaging and fruity flavours get the attention of small children. Know the signs of nicotine poisoning and get medical help right away if it is suspected.
Long-term Health Effects
Many of the toxic chemicals found in e-cigarettes have been linked to various types of cancer. The long-term health effects of vaping may not be known for many years. Those vaping may be putting the health of their heart, lungs and other organs at risk.
Allergic Reactions
The ingredients in e-juice can cause allergic reactions for some people. Signs or symptoms could be similar to other allergic reactions such as difficulty breathing, hives, and feeling unwell.
Device Safety Concerns
There have been reports of explosions related to batteries in e-cigarettes and issues with charging cords. Caution should be used with batteries, altering of products and use of charging cords.
Promotion of Vaping
Vaping is now a multi-billion dollar industry and all major tobacco companies have vaping brands. JUUL alone is worth about $18 billion. Slick advertising, fruity flavours and messages that convey fun and safe are contributing to the growth of use among youth.
The advertising for e-cigarettes is very similar to the messages and themes used by the Tobacco Industry to make smoking seem normal or to make some products seem less harmful.
Youth are also allured into becoming reviewers of products in video reviews on platforms like youtube. These unofficial spokespeople do not always state that they have received money to review and even endorse a product. This increases the promotion of vaping among young people and it makes it appear more popular than it really is..
What is the situation?
There has been a dramatic increase in youth vaping in Canada. Dr. David Hammond and colleagues conducted online research with youth aged 16-19 and found a dramatic increase in vaping for Canadian youth between Aug/Sept 2017 and Aug/Sept 2018.
During those two time periods, groups of youth from Canada, England and United States filled out online surveys about their use of tobacco cigarettes, vapes and cannabis. The youth reported whether they had ever vaped even once, in the past 30 days, in the past week or had vaped 15 days or more in the last 30 days.
In each of these categories, there was an increase in vaping by Canadian youth. In the first group of youth in 2017, 8.4% reported vaping in the last 30 days. In the group surveyed in 2018, this jumped to 14.6%. This research also showed an increase in cigarette smoking and cannabis use for these Canadian youth.
This seems to match what school staff, parents and public health staff in our region have experienced in recent months. The increase took place over the time that vaping products with nicotine could legally be sold in Canada. Starting in May 2018, many vaping brands came onto the market and were heavily promoted.
To read more about this research, visit https://www.bmj.com/content/bmj/365/bmj.l2219.full.pdf
The Ontario Student Drug Use and Health Survey outlines recent data, but was collected and released prior to the legalization of nicotine in Canada.
Starting the Conversation
Has your family talked about vaping? What it means and the risks? It’s a good idea to discuss substance use and how it can affect health and future goals. It’s good to be critical and practice thinking about the motivation of companies that sell these products – especially given the past history of tobacco companies, who now own vaping brands. These resources will help get the conversation started:
Talking with your teen about vaping: https://www.caringforkids.cps.ca/handouts/vaping
Parents Matter: Strategies for Parents to Prevent or Delay Alcohol and Other Drug Use: http://www.rethinkyourdrinking.ca/parents/
Government of Canada Vaping Information: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html
References
Ontario Student Drug Use and Health Survey
Public Health Ontario: Current Evidence on E-cigarettes: https://www.publichealthontario.ca/-/media/documents/literature-review-ecigarettes.pdf?la=en
Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys: https://www.bmj.com/content/bmj/365/bmj.l2219.full.pdf
Public Health Consequences of E-Cigarettes: http://nationalacademies.org/hmd/Reports/2018/public-health-consequences-of-e-cigarettes.aspx
Canadian Dental Association: https://www.cda-adc.ca/en/services/essentials/2015/issue4/files/assets/basic-html/page34.html
Surgeon General Report on E-cigarettes: https://e-cigarettes.surgeongeneral.gov/resources.html
Canadian Paediatric Society Position Statement on E-cigarettes: https://www.cps.ca/en/documents/position/e-cigarettes