Lately it seems like everywhere I look, someone is vaping as they walk by, stand outside a store, or roll up in the car next to me at a stoplight. It’s not surprising: e-cigarette use, or vaping, has become remarkably popular in recent years. About 6% of adults in the US now report vaping . That’s about 15 million people, double the number from just three years ago. Of course, regular cigarettes are known to cause cancer and a host of other health problems.

    While considered less harmful than smoking tobacco, vaping isn’t risk-free. We know some, but not all, of its risks. We also know vaping is increasingly popular among teens and young adults, and this makes the recent FDA announcement authorizing sales of three additional vaping products surprising.

    A surprise announcement from the FDA

    In its announcement, the FDA authorized the R. J. Reynolds Vapor Company to market and sell its Vuse Solo device with tobacco-flavored vaping liquid to adults.

    The FDA denied marketing authorization for 10 flavored products made by the same company. It also reports having denied more than a million flavored vaping products from other companies.

    By the way, the agency emphasizes it is not actually approving these vaping products, or declaring them safe. The announcement states that marketing authorization will be reversed if

    • the company directs advertising to younger audiences
    • there is evidence of "significant" new use by teens or by people who did not previously smoke cigarettes
    • R. J. Reynolds does not comply with extensive monitoring requirements.

    Why did the FDA take this action?

    The decision was reportedly based on data from the company — unfortunately not provided in the press release — demonstrating these products would benefit individuals and public health. How? By helping smokers quit.

    Some studies have suggested that e-cigarette use can be modestly helpful for smokers trying to quit. For example, an analysis of 61 studies found that e-cigarette use was more effective than other approaches to quitting smoking. The study authors estimated that out of every 100 people who tried to quit smoking by vaping, nine to 14 might be successful. When only using other methods, such as nicotine patches or behavioral counselling, only four to seven smokers out of 100 might quit. A separate study suggests vaping may help smokers who aren’t able to quit reduce the number of cigarettes smoked per day — at least for six months, the duration of the study.

    Does vaping harm health less than smoking cigarettes?

    Despite claims that vaping is less harmful than smoking cigarettes and that it might help smokers quit, concern about its risks is well deserved.

    • Nicotine addiction. Whether in cigarettes or vapes, nicotine is highly addictive. And the amount of nicotine in many vaping products is much higher than in regular cigarettes. Side effects include reduced appetite, increased heart rate and blood pressure, nausea, and diarrhea.
    • Harm to lungs and heart. Vapors from e-cigarettes may contain cancer-causing toxins, metals, and lung irritants. Vaping raises risk for lung diseases , such as emphysema, asthma, chronic bronchitis, and chronic obstructive pulmonary disease. It’s also linked to an increased risk of heart attacks . Even secondhand exposure to e-cigarette vapors may trigger asthma .
    • Severe, potentially fatal lung injury. In 2019, doctors began seeing people who had recently vaped and developed shortness of breath, cough, fever, and extensive lung damage. Dubbed EVALI (e-cigarette or vaping product use-associated lung injury), more than 2,800 cases and 68 deaths were reported. The condition has been linked to vapors containing THC and a form of vitamin E (called vitamin E acetate) used as a thickening agent when vaping THC. Cases have fallen markedly since 2020. Possibly because of falling case numbers, the FDA announcement of new vaping products didn’t even mention EVALI, which seems odd. If you do vape, see these recommendations to reduce the risk of EVALI.
    • Health risks during pregnancy. Nicotine can damage a baby’s developing brain and lungs; some flavorings may be harmful as well. As a result, experts recommend that people who are pregnant not vape.

    For teens and children, vaping has additional risks

    An alarming number of middle-school and high-school age kids report vaping, despite the nationwide prohibition against selling e-cigarette products to anyone under age 18 (21 in some states). Its popularity is partly related to the marketing of flavors known to appeal to minors, such as bubblegum and berry-flavored products. According to one national survey , approximately 85% of teen vaping involved non-tobacco flavored products.

    It’s important to know that

    • nicotine negatively affects the developing brain
    • the high exposure to nicotine and other toxic chemicals through vaping may be particularly harmful to kids because of their smaller body size
    • the addictive potential of nicotine may mean that kids who vape are more likely to become cigarette smokers.

    The bottom line

    For nonsmokers and teens, there is no controversy: don’t start smoking and don’t vape.

    If you’re an adult smoker trying to quit, be aware that the balance of risks and benefits and the long-term health consequences of vaping are uncertain. We need more solid research to help people make decisions. Meanwhile, the FDA has come down on the side of a limited authorization to help adult smokers quit. We’ll know only in retrospect if that was the right move.

    I and many people I know, kicked the habit for good by switching to vaping, and slowly reducing the nicotine levels to 0mg. It’s a solution that works because it feels similar to smoking. Just as we shouldn’t be saying vaping is without risks, we really shouldn’t be discouraging it as an alternative to smoking too harshly. Lives are at stake, and there is an active misinformation campaign (I think from the tobacco industry) which is getting people to say “vaping is just as bad”. That is a lie and it will lead to more deaths from tobacco use.

    Pamela A Caldwell

    April 15, 2019

    I am a FORMER cigarette smoker of 30 years. A pack per day of Marlboro lights. At age 50, I finally had enough. Quitting cold turkey and stop smoking aids never worked. I quit overnight when I found the correct VAPE MOD, along with the CORRECT NICOTINE EJUICE FLAVORED. I have been cigarette free for 2.5 years!!!

    Me too. I smoked a pack and a half a day of Marlboro Lights. Switched to vaping and slowly worked my way down in nicotine. Now I vape a mix of one half .03% and 0%. Almost to total 0. I haven’t had a cig in 3.5 years. It works if you are committed to quitting. Patches, gum and lozenges did nothing for me.

    Mark Stave

    February 28, 2019

    I note that the data concerning the relative safety of e-cig over smoking cannot be categorzed as ‘seemingly’ safer than smoking – the data is varied and robust – the health risks are on the order of 3% those of smoking. I also note that Nicotine has limited health effects, comparable to caffeine. Finally, I note that Harvard has had numerous ethical issues related to funds from drug companies (see E.G – https://www.propublica.org/article/pharma-ties-at-harvard-medical-school), and suggest that the support of Big Pharma’s expensive smoking cessation drugs (not shown to be more effective than placebo) relates more to those ethical issues than any public health concerns

    John R. Polito

    February 27, 2019

    Dr. Shmerling, you state that “Many people try to quit cold turkey, but success rates are quite low. ” In fairness, possibly the most comprehensive population-level quitting method snapshot ever, the July 2018 Weaver (PLoS One) study, concluded the opposite. There, cold turkey more than doubled e-cigarette, gradual weaning, nicotine replacement therapy (NRT: nicotine patch, gum and lozenge), and varenicline (Chantix) and bupropion (Zyban) rates. Except for e-cigarettes and varenicline not yet being on the market, it’s a finding mirrored in the May 2006 Doran (Addictive Behaviors) study. I’d be interested in hearing your thoughts on why cold turkey or unassited quitting is prevailing in nearly all recent real-world quitting method surveys. Thanks for the blog.

    John R. Polito NIcotine Cessation Educator

    Robert Shmerling

    February 28, 2019

    Hi, John – thanks for your interest and comment – I think the reason unassisted quitting prevails is selection bias: studies looking at nicotine replacement or other measures are typically starting with study participants who have already failed unassisted smoking cessation in the past. If you’ve successfully quit on your own already, you won’t enroll in a trial. The enrollment process selects for people who may be less successful at smoking cessation going forward regardless of the type of intervention.

    Survey data suggest that efforts to quit “cold turkey” are often unsuccessful at achieving sustained cessation — but that’s not the same as saying it’s better or worse than nicotine replacement treatment. Most people considering nicotine replacement systems, other prescription medications or other measures have already failed at least some attempt to decrease or stop on their own. So, the comparison of interest is not unassisted cessation vs. nicotine replacement vs. vaping – the key question is: what is the next best step for those who cannot quit on their own?

    I strongly support any safe method of smoking cessation that works: quitting on your own is certainly worth a try.

    One comment about the study by Weaver you reference (Weaver SR et al. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015-2016. PLoS One. 2018 Jul 9;13(7):e0198047): it used a 30-day quit rate as the primary outcome which is really not adequate.

    Commenting has been closed for this post.

    Does vaping help quit smoking?
    Those using a vaping product as part of their quit attempt in local, stop smoking services have some of the highest quit-success rates – between 59.7% and 74% in 2019 to 2020. Vaping has plateaued in adults and young people since the last PHE report in March 2020. more
    Can vaping help you quit smoking?
    A rechargeable e-cigarette with a refillable tank delivers nicotine more effectively and quickly than a disposable model and is likely to give you a better chance of quitting smoking. If you're a lighter smoker, you could try a cigalike, vape pen or pod system. more
    Is vaping a good way to quit smoking?
    A rechargeable e-cigarette with a refillable tank delivers nicotine more effectively and quickly than a disposable model and is likely to give you a better chance of quitting smoking. If you're a lighter smoker, you could try a cigalike, vape pen or pod system. more
    Is it easier to quit vaping than smoking?
    E-cigarettes are closely associated with tobacco cigarettes and for obvious reasons: Both are popular among teens, both contain highly addictive nicotine, and both can ruin health and potentially the brain development of adolescents. One big difference: It's harder to quit vaping than traditional cigarettes. more
    Is it easier to quit smoking or vaping?
    E-cigarettes are closely associated with tobacco cigarettes and for obvious reasons: Both are popular among teens, both contain highly addictive nicotine, and both can ruin health and potentially the brain development of adolescents. One big difference: It's harder to quit vaping than traditional cigarettes. more
    What happens when you quit smoking and start vaping?
    Within 24 hours of quitting smoking and starting vaping, your body will have gotten rid of all of the residual carbon monoxide in your system. But your lungs, too, will begin to detoxify as they work on removing toxic debris and mucus that had accumulated while you were smoking. more
    Can diabetics smoke vape?
    Here's a summary of their advice: Avoid e-cigarettes if you don't already smoke. If you're currently a nonsmoker, there's no reason to start puffing e-cigarettes, given their potential complications with type 2 diabetes. Used appropriately, e-cigarettes may be a good transitional choice to help you quit smoking. more
    Is vaping harder to quit than smoking?
    E-cigarettes are closely associated with tobacco cigarettes and for obvious reasons: Both are popular among teens, both contain highly addictive nicotine, and both can ruin health and potentially the brain development of adolescents. One big difference: It's harder to quit vaping than traditional cigarettes. more
    Is vape smoke the same as cigarette smoke?
    A: Overall, there's not much difference between smoking and vaping. Commonly, smoking was thought to be more harmful because the product is being burnt and smoke inhaled into the lungs. But we're finding very similar damage from heating up vaping solutions and inhaling that vapor into the lungs. more
    Is it harder to quit smoking or quit vaping?
    E-cigarettes are closely associated with tobacco cigarettes and for obvious reasons: Both are popular among teens, both contain highly addictive nicotine, and both can ruin health and potentially the brain development of adolescents. One big difference: It's harder to quit vaping than traditional cigarettes. more
    Is it harder to quit vaping or smoking?
    E-cigarettes are closely associated with tobacco cigarettes and for obvious reasons: Both are popular among teens, both contain highly addictive nicotine, and both can ruin health and potentially the brain development of adolescents. One big difference: It's harder to quit vaping than traditional cigarettes. more

    Source: www.health.harvard.edu

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