SMOKING : SLOWLY TAKING YOUR BREATH AWAY
VAPING : THE LESSER EVIL ? AUTHOR SarahBeth Hartlage , MD , MS
ELECTRONIC CIGARETTE USE
Electronic cigarettes entered the tobacco market in 2003 , and their use has skyrocketed in the years since . Also known as an “ e-cig / pod system / vape pen ,” the trade designation is an Electronic Nicotine Delivery System ( ENDS ). Each device consists of a power source , an atomizer and a cartridge or tank for the “ e-liquid ” to be vaped . The composition of the liquid can vary , but it generally contains a base of glycerin and propylene glycol , plus nicotine , flavorings and other additives . Nicotine doses can vary tremendously , from 0 to 60mg / mL .
ENDS were initially designed to physically resemble traditional cigarettes , and they were billed as an aid in smoking cessation or to skirt smoke-free laws . Indeed , the proportion of adults who use ENDS is highest in the group of former cigarette smokers who quit within the last year ( as high as 57 % in one survey ). The usefulness of ENDS as an aid in smoking cessation is questionable at best . While some users do successfully wean their nicotine dose over time , many simply transition to vaping as a permanent destination .
ELECTRONIC CIGARETTE USE IN YOUNG PEOPLE
Today , many users preferentially choose vaping over cigarette smoking ; these users have never been regular cigarette smokers prior to using the ENDS . Modern devices look less like a cigarette and are used recreationally . Users cite perceived cleanliness ( less lingering smell ) and a belief that ENDS are healthier than smoking . This is particularly troublesome in young people .
The CDC and FDA maintain an annual National Youth Tobacco Survey , a cross-sectional study that includes around 15,000 middle and high school students . Although tobacco and nicotine use has been on an overall decline for decades , ENDS use remains high among teens . In 2020 , 19.6 % of high school students and 4.7 % of middle school students reported current ENDS use . 82.9 % of these were using flavored e-cigarettes , with fruit flavors , menthol , mint and candy flavors all popular .
The legal age for purchasing tobacco products was raised from 18 to 21 in December 2019 . This prohibition applies to ENDS and the associated fluids , but these products remain relatively accessible over the counter . Other regulatory avenues in many areas include specifically adding ENDS to smoke-free laws , requiring specific licensure to sell ENDS , and excise taxes . Limitation of ENDS flavoring and marketing to youth was a specific point of emphasis for Dr . Jerome Adams , 20 th Surgeon General of the US .
RISKS OF ELECTRONIC CIGARETTE USE
The dangers of cigarette smoking have been extolled by a long line of physicians and scientists . What , then , are the risks associated with ENDS use – is it truly safer than smoking ? One broad category of adverse events is thermal injury . The nicotine liquid must be heated for inhalation , which can lead to burns on the face , hands or oropharynx . Several case reports exist of battery explosions ,
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