Connecting the Use of E-Cigarettes to Cancer
Tobacco product (cigarettes, cigars, e-cigarettes, chewing tobacco and pipe tobacco) use is the leading cause of preventable disease, disability and death in the United States accounting for about 1 in 5 deaths. Preventing tobacco product use among youths is critical to decreasing the death and disease associated with it because nearly all tobacco product use begins during youth or young adulthood with approximately 9 in 10 adult smokers starting before the age of 18 years. In recent years tobacco products have evolved to include various smoked, smokeless and electronic products. Given the rising use of e-cigarettes in the high school population I want to discuss e-cigarettes and highlight the health consequences associated with their use.
E-cigarettes come in many shapes and sizes. Most have a battery, a heating element and a place to hold a liquid. E-cigarettes produce an aerosol by heating the liquid that usually contains nicotine but may also contain THC and/or CBD along with flavorings and other chemicals that help make up the aerosol. Users inhale the aerosol into their lungs. Bystanders can also breath in the aerosol when users exhale into the air. E-cigarettes are known by many different names and are called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).” Some e-cigarettes are made to look like regular cigarettes, cigars or pipes. Some resemble pens, USB sticks and other everyday items. The term vaping is synonymous with e-cigarette use. Typically e-cigarettes are used to deliver tobacco but they can be used to deliver marijuana and other drugs.
The e-cigarette aerosol that users breath from the device and exhale contain harmful substances including: nicotine, ultrafine particles that can be inhaled deep into the lungs, flavorings such as diacetyl, a chemical linked to serious lung disease, volatile organic compounds and heavy metals such as cadmium, lead, nickel and tin.
While e-cigarettes are probably less harmful than tobacco cigarettes and contain fewer toxic chemicals than the deadly mix of over 7,000 chemicals found in smoke from regular cigarettes but that does not mean e-cigarettes are safe. E-cigarette aerosols contain many toxic compounds including nicotine, heavy metals such as lead and cancer causing agents. Since e-cigarettes are so new we are just beginning to characterize their toxic compounds and the impact they have on health.
What We Know Now
E-cigarettes are fairly new and scientists are still learning about their long-term health effects but there are several things that we do know:
- The nicotine in most e-cigarettes is highly addictive and is toxic to adolescent brain development which continues into their mid-20’s.
- Nicotine is a health danger to pregnant women and their developing fetuses.
- The aerosol from e-cigarettes contains cancer-causing chemicals. Recently there have been multiple reports of a severe pulmonary disease termed “e-cigarette or vaping associated lung injury (EVALI)”.
- Currently there have been over 2,000 cases of vaping associated lung injury reported with 48 deaths and one person successfully undergoing a lung transplant.
If that wasn’t enough a recent study has shown that the risk of respiratory disease including emphysema and chronic bronchitis is increased with the use of E cigarettes and is independent of the risks associated with smoking tobacco cigarettes.
2019 CDC Survey
A 2019 CDC survey highlights the growing use of tobacco products in middle and high school youths:
- 40.5% of middle and high school youths (10.9 million) reported ever having tried a tobacco product. E-cigarettes were the most commonly ever used tobacco product at 35%.
- Overall 23% of middle and high school reported current tobacco use with 55% reporting the exclusive use of e-cigarettes with cigarettes accounting for 4.3% of use. Of those using e-cigarettes, 68.8% used a flavored product.
- Since 2014 e-cigarettes have been the most commonly used tobacco product among US youths. During the 2017-2018 time frame current e-cigarette use increased 77.8% in high school students and 48.5% in middle school students.
- Given that the current rate of cigarette smoking among adults has declined to 13.7%, youth tobacco product use is of great concern given the long-term health consequences.
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What Can We Do?
Everyone can help protect youths from the harms of tobacco products, including e-cigarettes. Parents and educators can learn about the different types of e-cigarettes available, including discreet devices shaped like USB flash drive (JUUL). Parents and others who influence youths can set an example by being tobacco free and communicating that nicotine can lead to addiction and can harm the developing brain and affect learning, memory and attention. Schools can adopt and enforce tobacco-free campus policies that include e-cigarettes and reject industry-sponsored prevention programs. The FDA should have regulatory authority over all tobacco products. Concerned citizens and health care workers should lobby state legislators to restrict the sale of ALL tobacco products (including e-cigarettes) including a minimum age of purchase of 21 years and prohibiting the sale of all flavored tobacco products.
1) CDC - Tobacco
2) CDC - Volume in High Schools
3) Cullen KA, et al. e-Cigarette Use Among Youth in the United States, 2019. JAMA. 2019; 322:17.
4) Layden JE, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. NEJM. 2019; September 6.
5) Bhatta DN, Glantz SA. Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Study. American Journal of Preventive Medicine; 2019. December.
6) Longo DL. The Health Effects of Electronic Cigarettes. NEJM;375;14:1372-1381.