The tobacco product landscape continues to evolve to include smoked, smokeless, and electronic products, such as e-cigarettes
. E-cigarettes, which entered the U.S. marketplace around 2007, are designed to deliver nicotine, flavorings, and other additives via an inhaled aerosol. They are known by many different names, including “e-cigs,” “ehookahs,” “mods,” and “vape pens.”
While smoking e-cigarettes may pose fewer health risks than smoking regular tobacco cigarettes—the leading cause of preventable death in the United States—it is by no means harmless. E-cigarettes still contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—which increases the risk of high blood pressure and diabetes. Many also include flavoring agents that may cause a chronic lung disease called bronchiolitis obliterans. And the aerosol that is inhaled and exhaled from e-cigarettes can potentially expose users and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled into the lungs.
E-cigarettes also can have a significant impact on oral health. A study supported by the American Dental Association Foundation determined that vaping sweet e-cigarettes can increase the risk of dental cavities. Scientists evaluated e-cigarette aerosols and found that they have similar properties to high-sucrose, gelatinous candies and acidic drinks. Additionally, the nicotine in e-cigarettes reduces blood flow, restricting the supply of nutrients and oxygen to the soft tissues of the mouth. This can cause the gums to recede and exacerbate periodontal diseases. Reduced blood circulation also inhibits the mouth’s natural ability to fight against bacteria, which can accelerate infection, decay, and other problems. There have even been reports of e-cigarette explosions and fires in the oral cavity while vaping.
For adults, e-cigarettes may have the potential to reduce health risks for current smokers if they completely transition from cigarettes to e-cigarettes; however, most adults who vape also smoke cigarettes. According to a 2018 National Academy of Sciences, Engineering, and Medicine report, there is moderate evidence that vaping increases the frequency and intensity of cigarette smoking in the future.
Youth Vaping “Epidemic”
Many e-cigarettes come in kid-friendly flavors, and a new type of e-cigarette
has become increasingly popular among young adults due to its minimal exhaled aerosol, reduced odor, and small size, making it easy to conceal. Many of these products look like a USB flash drive, with a typical cartridge, or “pod,” containing as much nicotine as a pack of 20 regular cigarettes.
The U.S. Surgeon General
called the recent surge in youth vaping an “epidemic” and issued an advisory
emphasizing the importance of protecting children from a lifetime of nicotine addiction and associated health risks.
Any e-cigarette use among young people is unsafe, even if they do not transition to cigarette smoking. Nicotine exposure during adolescence can harm the developing brain, which continues to develop until around age 25. Nicotine also impacts adolescents’ learning, memory, and attention, and it can increase their risk for future addiction to other drugs.
A 2019 report from the U.S. Centers for Disease Control and Prevention (CDC)
indicated that overall tobacco use among youth is rising, driven by a spike in e-cigarette use. From 2017 to 2018, the CDC found no significant change in the use of combustible tobacco products by teens, but e-cigarette use increased 77.8% among high school students and 48.5% among middle school students. In 2018, there were 1.5 million more current youth e-cigarette users than in 2017, according to the CDC. Among youth, e-cigarettes are the most commonly used tobacco product, ahead of cigarettes, cigars, smokeless tobacco, hookah, and pipes. And e-cigarettes are the most commonly used product in combination with other tobacco products.
In 2018, more than 3.6 million middle and high school students nationwide said they regularly use e-cigarettes, according to the 2018 National Youth Tobacco Survey. From 2017 to 2018, the number of high schoolers who reported vaping increased 78 percent. Almost half of Massachusetts high school students reported having vaped at least once, according to the 2015 Massachusetts Youth Risk Behavior Survey.