5 Things About e-Cigarettes

E-cigarettes have become increasingly popular in the United States since their introduction in 2007. Reported use has dramatically increased among adults and, alarmingly, youths,¹ as well. Sales of e-cigarettes, other vaping devices, and e-liquids have increased nearly 1400% over the last decade.

The CDC reported 3.6 million US youths were using e-cigarettes in 2018. From 2017 to 2018, the number of high school age users surged by 78%, increasing from 11.7% to 20.8%, and the number of middle school age users grew by 48%, from 3.3% to 4.9%. Manufacturers of e-cigarettes have been criticized for creating an abundance of flavors that can be especially appealing to adolescents. There are currently more than 460 brands of e-cigarettes or similar vaping devices and more than 7700 flavors² of e-liquids.

1. Adolescents who use e-cigarettes are more likely to smoke combustible cigarettes

Youths who use e-cigarettes or vapes were found not only to have a higher chance of smoking combustible cigarettes but also to increase future use of both products,³ according to a study in Nicotine & Tobacco Research by the Rand Corporation. The study surveyed more 2000 adolescents between 16 to 20 years old about their e-cigarette and tobacco use. Participants completed 3 annual surveys, allowing researchers to assess the effects of e-cigarette use over time. The study demonstrated that e-cigarettes are gateway nicotine products that could lead to tobacco use.

“Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future," Michael Dunbar, lead author of the study and behavioral scientist at RAND, said in a statement. "This study also suggests that teens don't substitute vaping products for cigarettes. Instead, they go on to use both products more frequently as they get older.”

2. E-cigarette use linked to increased heart attack risk and emotional stress

E-cigarettes can increase the risk of heart attack, cause emotional distress, and lead to coronary artery disease (CAD), according to findings in a recent study presented at the 2019 American College of Cardiology 68th Annual Scientific Session.

Users of e-cigarettes were 34% more likely to have a heart attack, 25% more likely to have CAD, and 55% more likely to report emotional distress than nonusers.⁴ Researchers conducted cross-sectional analysis on data from the CDC’s 2014, 2016, and 2017 National Health Interview Survey. A total of 96,467 respondents were asked about cigarette or other tobacco product use, e-cigarette use, and their frequencies of using either product.

“Until now, little has been known about cardiovascular events relative to e-cigarette use. These data are a real wake-up call and should prompt more action and awareness about the dangers of e-cigarettes,” Mohinder Vindhyal, MD, assistant professor at the University of Kansas School of Medicine, Wichita and the study’s lead author said in a statement.

3. Users of e-cigarettes have experienced seizures

Recent reports have shown that some users of e-cigarettes have been experiencing seizures, Pharmacy Times reported. FDA Commissioner Scott Gottlieb, MD, and Principal Deputy Commissioner Amy Abernethy, MD, PhD, said that no link has currently been found but wanted to communicate the potential safety concerns associated with e-cigarette use.⁵

The FDA acknowledges that seizures have been shown to result from nicotine poisoning, which can occur when individuals accidently or intentionally swallow e-liquids containing high nicotine concentrations.⁵

Further reported cases of seizures resulting from e-cigarette use are required to establish a strong link between them. “We are actively seeking additional reporting. We’re encouraging health care professionals, consumers, parents, teachers and other concerned adults, as well as youth and young adult users to be aware of this potential health issue and report any past or future incidents of seizures following e-cigarette use to the FDA,” Gottlieb and Abernethy said in a statement.

4. CDC blames Juul for contributing to youth e-cigarette crisis

The CDC has accused Juul of playing a major role in the youth e-cigarette epidemic, CNBC reported. A CDC survey found that e-cigarettes showed the most significant increase in use among students compared to cigarettes and other tobacco-related products. Brian King, PhD, MPH, deputy director for research translation in the CDC's Office on Smoking and Health, said the rise in e-cigarette use corresponds to growing sales of Juul's products.

The CDC, FDA, US surgeon general, and public health officials have warned that the growing trend in e-cigarette or vaping use among youths can reverse 20 years of progress made in lowering teen smoking rates.

"These survey results are deeply troubling. They add to mounting concerns that the rise in youth use of e-cigarettes, especially Juul, is vastly expanding the number of kids addicted to nicotine, could be leading kids to and not away from cigarettes,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

5. Health officials want next FDA commissioner to continue crackdown on e-cigarettes

Public health officials have urged the Trump administration to strengthen efforts to curb the increasing use of e-cigarettes among adolescents, according to Kaiser Health News. They say that the issue is nearing a public health crisis and believe the FDA’s efforts to create a solution haven’t done enough.

Gottlieb, who is resigning as FDA commissioner on Friday, April 5, launched a major campaign to regulate e-cigarettes and curb the epidemic of rising teen use during his time serving the position. While Gottlieb has received praise for challenging the tobacco and e-cigarette industries, health officials say they want to see more federal action.

Reference

1. Berry KM, Fetterman JL, Benjamin EJ, et al. Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Netw Open. 2019;2(2):e187794. doi:10.1001/jamanetworkopen.2018.7794.

2. Zhu SH, Sun JY, Bonnevie E, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23:iii3-iii9. doi: 10.1136/tobaccocontrol-2014-051670.

3. Dunbar MS, Davis JP, Rodriguez A, et al. Disentangling within- and between-person fffects of shared risk factors on e-cigarette and cigarette use trajectories from late adolescence to young adulthood. Nicotine Tob Res. 2018. doi: 10.1093/ntr/nty179.

4. Vindhyal MR, Ndunda P, Munguti C, Vindhyal S, Okut H. Impact on cardiovascular outcomes among e-cigarette users: a review from National Health Interview Surveys. Presented at: 68th American College of Cardiology Scientific Session and Exposition; March 16-18, 2019; New Orleans; LA. Abstract A-19151.

5. Statement from FDA Commissioner Scott Gottlieb, MD, and Principal Deputy Commissioner Amy Abernethy, MD, PhD, on FDA’s ongoing scientific investigation of potential safety issue related to seizures reported following e-cigarette use, particularly in youth and young adults [news release]. Silver Spring, MD: FDA; April 3, 2019: fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm635157.htm. Accessed April 5, 2019.