Recently, the CDC published its 2014 National Youth Tobacco Survey – which looks at smoking in middle and high school students in the US. As a physician, but more as a parent of a newly minted teenager, the results were of great interest – and concern. While cigarette use declined in high school students, e-cigarettes and hookah use tripled – and surpassed cigarette use for the first time. E-cigarettes are not regulated by the FDA or subject to current tobacco marketing laws – allowing companies to market directly to teens with flavors more like candy than tobacco – something traditional tobacco companies have not been able to do since the 1970s.
The increase is not surprising – e-cigarettes are marketed as safer, they are easier to access and less expensive than cigarettes. The real question, and one that comes up frequently in the office, is if they can help people quit smoking regular cigarettes, and are they safer?
Are e-cigarettes safer?
There is not great data available yet. What we do know is that the vapor produced contains particles that can irritate the lungs, and that it contains chemical byproducts such as formaldehyde – but in much lower concentrations than traditional cigarettes. They also contain nicotine, the same addictive drug in cigarettes. Nicotine affects brain development, may promote tumor growth and interfere with chemotherapy. Nicotine also constricts blood vessels and increases blood pressure. That increases stresses on any plaque buildup in a blood vessel – a precursor to heart attack and stroke.
Do e-cigarettes help you quit?
Again, the studies are still in progress. There is some data that smokers who switch to e-cigarettes refrain from tobacco longer than those who try to quit while still using tobacco. Neither the World Health Organization or the American Heart Association recommend e-cigarettes as a smoking cessation method. There is no information yet as to whether those who switch to e-cigarettes quit nicotine completely, or have simply switched from one addiction to another.
How does this affect us?
So, while we await studies to more definitively address the safety question, what am I telling patients about safety? Obviously, the best choice is not using any nicotine product. If you are deciding between tobacco and e-cigarettes, it is reasonable (but not proven) to assume there is a lower lung cancer risk with e-cigarettes, but no data on oral or head and neck cancer. However, since there is nicotine in both products, I advise people that there is still similar heart disease risk. There is also no path to stopping e-cigarettes, unlike other nicotine replacement methods like the nicotine patch – which gradually reduces the dose delivered. Studies are ongoing, so hopefully we get good information to make healthy decisions. In the meanwhile, the FDA is seeking ability to regulate these products, and limit their marketing to children.
The path to wellness begins with a proper diagnosis