BrandonWright

Quinn

Consumer perception of inhaled vapor products is an emerging science that has public and personal health implications for users. It is important for users to have an understanding of both the absolute and relative risks of these products so that they may make an informed decision before using them.

Many people across Oklahoma and across the nation are choosing the electronic alternative in lieu of the traditional combustible cigarette. Much of the appeal to current smokers seems to be coming from perceived decreased comparative harm associated with the use of e-cigarettes over combustible tobacco. Some are even using e-cigarettes as part of a self-driven cessation program, using decreasing “doses” of nicotine.

Interestingly, some studies have found this to be an effective means for achieving cessation when paired with behavior-modification therapy. This has led some in the medical community to question using these products with decreasing concentrations of nicotine with the end goal being total cessation. The idea is that this would be a tertiary treatment strategy used when other nicotine-replacement therapy and pharmacologic intervention has failed to achieve independence from nicotine-containing products, namely cigarettes. It is important to mention that the FDA does not currently advocate the use of these products for the goal of total cessation nor does any recognized medical advisory body which sets forth best practices in this field. This is, at least in part, due to a lack of understanding of the long-term health effects of these products.

While the long-term health effects of combustible cigarettes have been pretty well established, the long-term effects of electronic cigarettes are still being discovered. Some studies have demonstrated that users of e-cigarettes have increased risk for various heart and lung conditions including heart attacks and the development of chronic obstructive pulmonary disease. Further evidence is emerging that chemicals in the e-cigarette product vapor may impair certain enzymes in the lungs that have been implicated in lung cancer.

It is likely that as the scientific community continues to study these products that more health issues are likely to be found to be associated with the use of these products. This emerging evidence will continue to inform best practices as it pertains to medical advising and the regulatory framework of the e-cigarette industry.

There is an emerging public health concern surrounding an increase in the appeal of e-cigarettes to young people, including those who have not used any form of cigarettes in the past. Much of the appeal seems to be due to the ease of use of these products in addition to the decreased social acceptance of combustible tobacco; this is especially true among urban teenage populations.

This increase in adolescent use of e-cigarettes has resulted in public health officials urging increased regulatory requirements in the e-cigarette industry. Much of this push by public health officials has been due to the emerging evidence that these products may not only be causing harm, but they may also be facilitating the transition of many users to combustible tobacco products.

Recent studies published through the Journal of the American Medical Association have pointed toward the use of e-cigarettes by adolescents as a precursor to combustible cigarette use. Given these findings, some cities are considering using their regulatory authority to prevent the sale of these products in the interest of protecting the health of the public. San Francisco — the city that is home to the laboratory which produces the popular product Juul — has taken the bold step of banning the sale of certain e-cigarette products in the city while the FDA is taking steps to further regulate certain aspects of the industry such as requiring the use of warning labels and restrictions on certain additives.

As the scientific community continues to study the effects of the e-cigarette, it is likely that the regulatory framework of this industry will be modulated as to best protect the health of all people. It is important that this industry is subject to necessary regulation now so as to best protect the health of the public and prevent future health problems for individuals.

At a minimum, people should have access to the most up-to-date information as it pertains to the health effects of these products so that they may make a more informed decision. For help quitting nicotine-containing products call 1-800-QUIT-NOW for free guidance and products such as nicotine patches, lozenges and gum.

Brandon Quinn, MPH is a second year medical student at Oklahoma State University College of Osteopathic Medicine.

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