The electronic cigarette is becoming more and more popular, and much of the appeal is based on ideas that it causes no harm to your health. But as science catches up with this growing trend, it’s clear that e-cigarettes don’t come without risk.
As more studies link e-cigarettes to issues like respiratory distress, MRSA and carcinogenic and asthmatic aerosols, the Food and Drug Administration (FDA) has decided to step in and take major action. The latest ruling now gives FDA authority over the sales, marketing and manufacturing of all tobacco products, meaning the agency can halt e-cigarette manufacturers from making unproven health claims and marketing to kids.
What’s more is that the Trump Administration is pushing for a nationwide ban of all flavored e-cigarette products. The American Lung Association hails this decision as a long-awaited step to protect public health, particularly since e-cigarette use is skyrocketing among middle school and high school students.
Organizations such as the American Vaping Association are not surprisingly unhappy. They point to evidence such as findings from one 10-year smoking study, which suggest that vaping may help cigarette smokers cut back. “The increasing prevalence of electronic cigarette use in England has paralleled an increasing successful quit rate, a study in the British Medical Journal shows. An editorialist says causation ‘remains unclear,’ however.”
In addition, the results show “quit rates went from roughly 11 percent to 19 percent as the prevalence of e-cigarette use among smokers increased from negligible amounts to 21 percent by the end of the study. Over that time, the use of prescription-based nicotine-replacement therapy dropped significantly.”
Another British Medical Journal study highlighted that 49.3 percent of recent quitters previously used e-cigarettes. That 2017 study also indicated that 65.1 percent of e-cigarette users were more likely to attempt to quit, versus the 40.1 percent of non-users.
The Latest Ban On E-cigarettes
In May 2016, the FDA made an unprecedented move to crack down on the largely unregulated vaping industry, banning the sale of them to children under 18.
The agency’s Center for Tobacco Products released its final rule giving the FDA authority over all tobacco products, including not only e-cigarettes, but also cigars, little cigars, hookah and pipe tobacco.
The new legislation sets the nationwide minimum age of sale of tobacco products at 18 years of age. It also prohibits distribution of free samples of e-cigarettes and all other tobacco products.
In September 2019, the Trump Administration released a statement that the FDA intends to finalize a new compliance policy that would prioritize enforcement of unauthorized non-tobacco-flavored e-cigarettes.
The intention is to continue to “clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use.” The ultimate goal is to ban sales of all flavored e-cigarettes.
In June 2019, San Francisco became the first major U.S. city to ban sales of e-cigarettes. Then in early September, Michigan became the first state to prohibit sales of most flavored e-cigarettes. These prohibitions were put in place mostly “to curb the underage vaping epidemic.”
The Trump Administration has stated that their decision comes in response to the latest findings from the National Youth Tobacco Survey, which shows a continued rise in the disturbing rates of youth e-cigarette use. The majority of youth e-cigarette users cite that they commonly use popular fruit, menthol, candy and mint flavored ENDS products. Another reason for new legislation is the growing number of reports of severe lung illnesses related to vaping, as well as six reported deaths.
New policy means that the FDA will be holding e-cig retailers and manufacturers accountable for marketing and sales practices that encourage use among adolescents. The agency has now issued more than 8,600 warning letters and more than 1,000 civil money penalties (fines) to retailers, both those selling online and in brick-and-mortar stores. JUUL Labs Inc. was one such detailer.
Dozens of e-liquid products have now been removed from the market — including some resembling kid-friendly juice boxes, cereals, and candies. Social media influencers that promote these products are also being fined. Additionally, the Administration has invested in campaigns to educate youth about the dangers of e-cigarette use, some which will be carried out in both private and public schools nationwide.
Is Electronic Cigarette Flavoring Really Harmless?
The Centers for Disease Control and Prevention (CDC) has identified as many as 450 people who have suffered from symptoms of the vaping-related illness — such as wheezing, seizures and respiratory distress — many of whom are young people.
While the newest bans are targeted mostly at flavored e-cigarettes, the FDA has stated that if the ban pushes young people towards consuming tobacco-flavored-vaping products, the administration will take additional steps to cut down on sales.
There are thousands of varieties of flavored electronic cigarettes in the United States. In order to create these flavors, manufacturers use flavoring compounds such as diacetyl, acetoin and 2,3-pentanedione, which can wreak havoc on the respiratory system.
Here’s a quick explanation of the three most commonly used flavoring compounds in the electronic cigarette:
Diacetyl — Diacetyl is a yellow/green liquid chemical that is used to achieve a buttery flavor. Many studies have found that industrial exposure to diacetyl has been associated with bronchiolitis obliterans, a severe respiratory illness producing fibrosis and obstruction of the small airways. Spirometry abnormalities (fixed airflow obstruction) and respiratory symptoms have also been linked to diacetyl exposure.
Acetoin — Acetoin is another compound that is used for its buttery flavor. It is one of the 599 additives used in cigarettes, and it is present in the electronic cigarette, too. Acetoin is an irritant to the eyes, skin, mucous membrane and lungs; it is toxic when inhaled over time, even in small amounts. It is one of the compounds that is under review by the National Toxicology Program, which states that acetoin metabolizes similarly to diacetyl and increases the risk of oxidative stress and lung damage.
2,3-Pentanedione — This is a controversial flavoring agent used in electronic cigarettes because the National Institute for Occupational Safety and Health reported that inhaling the compound causes respiratory tract epithelial damage and fibrosis to lungs in animal studies. It also causes genetic changes in the animal’s brain.
In the past, food industries that expose their employees to flavoring chemicals have received a lot of attention because of the increased risk of developing lung disease in some workers. A popcorn production plant in Missouri, for example, used diacetyl to give popcorn its buttery taste. Workers routinely handled or were exposed to open vessels containing flavorings or chemical ingredients. Workers mixed several chemical ingredients, including diacetyl, in large pots and then applied heat in the production process, which increased the amount of flavoring chemicals that got into the air.
Studies conducted by the National Institute for Occupational Safety and Health found that working as a mixer of butter flavorings and heated soybean oil was associated with higher diacetyl vapor and had a lower level of forced expiratory volume in one second (an important measure of lung function) than those who did not work with butter flavorings.
Employees who worked as mixers for more than 12 months displayed more shortness of breath, showed more chest symptoms and poorer lung function (this is why eating microwavable popcorn can be problematic for your health, too). So many workers developed severe lung disease at the facility that exposure to flavoring chemicals like diacetyl became known as “popcorn lung.”
According to the CDC, the flavoring industry has actually estimated that over 1,000 flavoring ingredients have the potential to be respiratory hazards due to possible volatility and irritant properties.
In 2015, Environmental Health Perspectives published a study that evaluated 51 types of flavored electronic cigarettes that were sold by leading brands and were appealing the youth, including Cupcake, Cotton Candy and Fruit Squirts. Of the three most common flavoring chemicals, diacetyl, acetoin and 2,3-pentanedione, at least one was detected in 47 of the 51 unique flavors tested. Diacetyl was detected above the laboratory limit, being present in 39 on the 51 flavors.
Acetoin was present in 23 and 2,3-pentanedione in 46 flavors. Researchers concluded by stating that urgent action is recommended to further evaluate this potentially widespread exposure to respiratory disease-inducing compounds through flavored electronic cigarettes.
So here’s the point, don’t be enticed by the fancy and fun flavors of electronic cigarettes, especially if you were never a smoker. Although it seems harmless, you are not inhaling fresh air — you are inhaling chemicals that can affect your respiratory system and lung capacity … and it’s just not worth it.
A Safer Way to Quit Smoking?
Reaching for an electronic cigarette to quit smoking isn’t necessarily a healthier option, especially considering vaping often produces carcinogenic compounds like benzene and formaldehyde. And the research is mixed when it looks at how effective the devices are in aiding people quit smoking traditional cigarettes.
Researchers found that almost all of the 2.6 million adults using the electronic cigarette in Great Britain are current ex-smokers who are using the device to help them quit or to prevent them from going back to cigarettes. The Director of Health and Wellbeing at Public Health England, Professor Kevin Fenton, said “e-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm.”
On the flip-side, a study in The Lancet found using an e-cigarette only helped about 7 percent of people quit smoking.
There have been few studies that investigate the biological effects of smoking electronic cigarettes. We know that some flavoring chemicals can increase the risk of developing respiratory conditions, but what about the other ingredients? If the e-cigarette contains nicotine, you are still at risk of experiencing high blood pressure and an elevated heart rate. Components of the vapor can also become embedded in the lungs, causing inflammation and leaving the lungs vulnerable to infection.
A 2017 article suggests “a single exposure to e-cigarette (e-cig) vapor may be enough to impair vascular function.” An hour of five-minute e-cigarette exposure narrows arteries by 30 percent and decreases the blood vessel’s ability to widen. In other words, exposure to the vapor in e-cigarettes in the long-run causes your blood vessels to age twice as fast compared to the blood vessels of those who are not exposed to the vapor. The negative effects of chronic use of e-cigarettes also include aortic stiffness, which plays a pivotal role in strokes.
One main ingredient used in electronic cigarettes is propylene glycol, a synthetic liquid that is also used to make antifreeze and artificial smoke and fog used for fire-fighting trainings and theatrical productions. Propylene glycol may be deemed safe for use in food, but who knows what effect it has when vaporized and inhaled into the lungs.
It’s true that the electronic cigarette serves as an alternative habit for people who are trying to quit smoking. But electronic cigarettes are not harmless — they contain chemicals that come with a host of health issues, especially when heated and inhaled. Consider other proven methods to quit smoking. Some of these include mindfulness meditation and group relaxation training. Consider joining the American Lung Association’s Freedom From Smoking program.