By Helena Theoharis
The cloud of smoke you see wafting out of vehicles and projecting into communal areas is no longer just from cigarettes. It also comes from a shiny and often colorful, yet discreet, e-cigarette. ENDS (electronic nicotine delivery systems), e-cigarettes and vape pens were first introduced in 2003. Since then, sellers have advertised the product as an alternative to smoking and an agent to help persons quit smoking.
While e-cigarette manufacturers and distributors market e-cigarettes as both a cigarette cessation tool and a healthier alternative to cigarettes, there are no long-term studies that offer this conclusion. And because e-cigarettes have not been around for a long time, there is no research speaking to the long-term impact of e-cigarette use on addiction and health. Various agencies are conducting this research, but the data is years away.
Currently, e-cigarettes are not approved by the FDA as a tool to aid nicotine/tobacco cessation. Besides the addictive component of nicotine, research has found e-cigarettes contain harmful ingredients such as formaldehyde, acrolein, nickel and chromium – all of which can cause lung damage.
“Those who use e-cigarettes are four times more likely to start smoking cigarettes.”
Many e-cigarettes contain flavorings such as mint, cotton candy, cherry, cinnamon and chocolate. While not all flavorings have been studied, certain flavors have been found to produce concerns. For example, cinnamon flavor was determined to contain cinnamaldehyde, which leads to decreased movement of cilia in the lungs, leaving them more susceptible to retaining bacteria and unable to adequately clear airways. Vanilla and butter flavoring have been found to trigger an inflammatory response in white blood cells, leading to concerns about the impact on the health of pulmonary tissue.
Per Ilona Jaspers of UNC, “We don’t know yet how the effects of e-cigarette use might manifest in 10 or 15 years… We may see new diseases in e-cigarette users that are usually not associated with smoking cigarettes.”
A New Generation of Smokers
While previous years showed a decline in overall tobacco use, this trend reversed in 2018, with an increase of 27.1 percent amongst high school students and 7.2 percent of middle school students. In comparison, 2017 North Carolina rates of e-cigarette showed a rate of 16.9 percent of high school students (16.8 percent in 2015) and 5.3 percent of middle school students (7 percent in 2015). E-cigarette use trends show teens tend to prefer flavored e-cigarettes (68 percent in 2018 versus 61 percent in 2017).
The increase of teen use sheds alarming light on not only the immediate risk of nicotine use, but also the potential for nicotine addiction, the impact of addiction on other conditions and the transition from e-cigarettes to other tobacco products. In fact, those who use e-cigarettes are four times more likely to start smoking cigarettes.
“The perception that e-cigarettes are less harmful leads to use, and use leads to addiction.”
FDA commissioner Scott Gottlieb, MD, speaks to the concern of youth nicotine addiction: “If we’re to break the cycle of addiction to nicotine, preventing youth initiation on nicotine is a paramount imperative … with the data show[ing] that kids using e-cigarettes are going to be more likely to try combustible cigarettes later.” The Surgeon General concluded that e-cigarette aerosol is not safe, and youth use is considered to be a public health concern.
E-cigarettes and the Brain
E-cigarettes are marketed in such a way that makes them look desirable and not harmful.
For teens whose planning and decision-making center of their brain (the prefrontal cortex) isn’t fully developed until the age of 25, they are highly susceptible to persuasive advertising.
When introduced to the brain, nicotine triggers a floodgate of the feel good neurotransmitter, dopamine. If dopamine could talk, it might say this very loudly, “We are feeling good now! You want to keep doing this!” As the youth brain is still under construction and driven more by emotions, the impact of nicotine can lead to a cascade effect on a teen’s developmental processes. The more one uses nicotine products, the more the brain desires and demands the substance.
Under the influence of a nicotine-stimulated brain, decision making skills become heightened toward seeking pleasure and reward. This reward-seeking pattern can then impact one’s decision to engage in other substances and or behaviors that seek to support that substance use; this in turn, can lead to the substance use becoming priority over other life factors.
It’s highly likely the use of e-cigarettes will place youth at risk for attention-processing difficulties and possible increased likelihood of experiencing depression and anxiety. If teen e-cigarette users then transition to smoking cigarettes, they are more likely to have panic attacks, anxiety disorders and depression as well as being three times more likely to use alcohol, eight times more like to smoke marijuana and 22 times more likely to use cocaine.
According to a study conducted by the Stanford University School of Medicine, young people who use JUUL “fail to recognize the product’s addictive potential, despite using it more often than their peers who smoke conventional cigarettes.” The same study showed that teens didn’t understand that addiction equated to them having a difficult time stopping use and continuing to smoke longer than they wanted.
The perception that e-cigarettes are less harmful leads to use, and use leads to addiction.
Helena Theoharis is a licensed professional counselor and certified tobacco treatment specialist with the Nicotine Dependence Program at Mission Hospital. Along with her co-workers, Sharon Rohrer, RRT, RCP, AE-C, CTTS, and Donna Borowski, LPN, CIC, CTTS, the Nicotine Dependence Program seeks to assist persons struggling with nicotine addiction.