The Journal of the Arkansas Medical Society Med Journal Sept 2019 FInal 2 | Page 6

by CASEY L. PENN
A New Battle in an Old War:
Tobacco Smoking Gives Way to Vaping
N
ew delivery system. Same old
tobacco stain. Those of us who lived
through Big Tobacco’s undoing in the 90s
may not want to believe it. As physicians, you
especially may be growing weary to see another
tobacco-related health crisis reemerging as
alternative forms of nicotine delivery have become
increasingly, and shockingly popular.
Most people understand that cigarette
smoking is harmful to their health. However, when
it comes to other forms of nicotine inhalation –
namely, vaping and e-cigarettes – knowledge of the
potential harm appears to be lacking, particularly
among young people.
According to the U.S. Centers for Disease
Control and Prevention, more than 28% of high
school students now use e-cigarettes on most
days. And that’s the ones we know about. Even as
the number of smokers has decreased, the number
of nicotine addicts is steadily rising due to the
invention and popularization of e-cigarettes, vaping
devices, and other electronic nicotine delivery
systems, or ENDs.
Vaping is defined “to draw in and exhale the
vapor from (an e-cigarette or similar device for
marijuana)” (dictionary.com). Unlike traditional
cigarettes, e-cigarettes do not produce tobacco
smoke. They produce an aerosol that is often
mistaken for simple water vapor. Jeffrey Roth,
MD, president of Clark County Medical Society
in Nevada authored a concise article* explaining
what’s really in the vapor of most e-cigarettes – and
it certainly isn’t just water. “Many of these particles
contain varying amounts of toxic chemicals, which
have been linked to cancer as well as respiratory
and heart disease,” wrote Dr. Roth. “Vaping devices
include not just e-cigarettes, but also vape pens
and advanced personal vaporizers (also known as
‘MODS’). E-cigarettes, which resemble smoked
cigarettes, and vape pens, which resemble large
fountain pens, are typically simpler in design
and less expensive than devices that have been
customized by the user.”
surveyed (grades 6-12) who perceived cigarettes
as harmful, 37.5% perceived “no” or “little” harm
from intermittent use of e-cigarettes. Further,
the study found that “youth with lower harm
perceptions were more likely to report current use.”
In 2016, U.S. Surgeon General Vivek Murthy,
MD, MBA, declared vaping an epidemic among
teens.*
The current U.S. Surgeon General Jerome
Adams* picked up the anti-vaping fight by also
declaring the problem an epidemic and issuing a
PSA featuring his own voice asking questions like
“Did you know the nicotine in e-cigarettes can
harm brain development?” and “Did you know
the nicotine in e-cigarettes can prime the brain for
addiction – especially while it is still growing?” His
answer? “It’s a fact.”
Current use trends by the National Youth
Tobacco Survey* (released by the CDC and the Food
and Drug Administration) reported that e-cigarettes
or similar devices, have become more commonly
used by our youth than cigarettes. CDC tobacco
data shows also that recent increases in the use of
e-cigarettes is driving increases in tobacco product
use among youth. The stats are alarming and show
an increase of roughly 1.5 million youth in just
one year: “The number of middle and high school
And the numbers are still rising. A 2018 study
published in the Journal of Adolescent Health found
that compared to just under 10% of students
Current E-cigarette Use among Youth
Arkansas 2018
Carroll
21.8
Benton
Madison
Washington
13.1
Crawford
Franklin
Boone
17.7
Newton
19.1
Johnson
17.3
Yell
Van Buren
17.0
Sevier
Jackson
10.3
Cleburne
White
19.3
Woodruff
24.0
Pulaski
Lonoke
10.9
Clark
10.8
Dallas
7.0
Jefferson
15.4
Cleveland
Hempstead
Nevada
5.6
10.0 Ouachita Calhoun
14.4
15.1
Bradley
Miller
9.2
17.9
Little River
Lafayette Columbia
Prairie
22.2
Saline
19.0
Grant
16.7
Union
19.5
Greene
17.1
Craighead
16.4
Mississippi
11.3
Poinsett
20.5
Cross
21.2
Crittenden
St. Francis
Perry
Hot Spring
21.3
Lawrence
23.7
Independence
Conway
18.3
Garland
Montgomery
19.8
12.7
Howard Pike
17.8
Sharp
23.2
Faulkner
Scott
23.5
Polk
14.4
Stone
20.0
Clay
22.1
Randolph
20.8
Fulton
Izard
24.0
Searcy
18.0
Pope
18.9
Logan
15.1
Sebastian
17.9
Baxter
23.6
Marion
21.9
Monroe
6.5
Arkansas
22.9
Lincoln
31.8
Desha
Drew
Ashley
Lee
Phillips
10.7
% used in last 1 year
State Rate: 16.8
Insufficient data
Chicot
Note: The counties marked "insufficient data" either had less than a
40% overall valid participation rate or less than a 25% valid participation
rate for one or more of the four grades surveyed (6th, 8th, 10th, or 12th).
0.1 - 10.9
11.0 - 14.3
14.4 - 17.1
17.2 - 31.8
Date: March 22, 2019
Source: Arkansas Prevention Needs Assessment (APNA) Survey, 2018
Map created by: Donald McCormick, MSHI
54 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 116