The terminology in this fast changing landscape can be confusing with so many new products coming out on the market. Some of the most common terms for the electronic vaping devices we are discussing are e-cigarettes, e-hookahs, vapes or vape pens.
For a list of all the terminology associated with vaping, see https://www.e-cigarette-forum.com/forum/threads/electronic-cigarette-terminology-and-slang.285856/
For purposes of this discussion, we will use the term “e-cigarettes”.
An alarming number of young people who have never used conventional cigarettes are now using electronic vaping devices. Center for Disease Control numbers indicate that between 2011-2013,
e-cigarette use among youth doubled. Between 2013-2014, vaping among middle and high school students tripled.
According to the 2015-16 California Healthy Kids Survey, in the Tamalpais High School District, 23% of 9th graders and 45% of 11th graders have used electronic cigarettes or other vaping devices (use within the past 30 days is 10% for 9th graders and 13% for 11th graders).
E-cigarettes are easy to hide and can be virtually odorless, with very little "smoke" emitted that dissipates quickly. Because it can be hard to detect, vaping is occurring on school premises. This year, “JULLING”, as discussed below, has become especially popular at our high schools.
E-cigarettes with Nicotine
An e-cigarette is a handheld battery operated device which heats a flavored liquid (“e-liquid or e-juice”) which then creates an aerosol that is inhaled by the user and emitted into the environment. It is incorrect to refer to this emission as a vapor because it contains many chemicals and particulate matter. Particulate matter is a mixture of extremely small solid and liquid particles suspended in air. Many of the chemicals and particulate matter that are emitted are hazardous.
The e-liquid is usually made of nicotine, propylene glycol and flavorings. The exact composition varies from product to product. Some e-cigarettes are disposable and others are rechargeable and refillable. There are more than 7,000 marketed flavors, from tobacco to cherry.
The invention of the modern e-cigarette is usually credited to a Chinese pharmacist. E-Cigarettes began flooding U.S. markets in 2006 and 2007. Most e-cigarettes are still made in China. Today there are hundreds of brands of e-cigarettes with global sales in excess of $7 billion. The number of e-cigarettes sold has increased every year. As of 2015, 80% of all e-cigarette sales in convenience stores were products made by tobacco companies. Customized devices are also commonly made with components sold online and in vaping stores.
Toxins. Although it is generally agreed that e-cigarettes expose users to fewer chemicals than tobacco, e-cigarettes do not emit only water vapor, as the makers would have you believe. Harmful chemicals such as nicotine, formaldehyde, carbonyls, metals (including chromium, nickel, tin, silver, cadmium, mercury and aluminum) and organic volatile compounds have been identified. Particulate matter, especially from the heavy metals is potentially damaging to the lungs. Tests have found that e-cigarette liquid and aerosol can contain higher levels of metals than regular cigarettes. Because e-cigarettes are relatively new, the long term effects of e-cigarettes are unknown. Also, some e-cigarettes that have claimed to be nicotine-free actually do have nicotine.
Second hand exposure. The long term effects of second hand exposure also are unknown at this time. The chemicals in these e-cigarette aerosols remain in the environment, re-emit for varying periods of time and also are capable of reacting with other chemicals to create additional substances known to be carcinogenic.
Lack of Regulation and Approval as a “Quit Device”. E-cigarettes have been unregulated until recently. In August 2017, the FDA extended its regulatory powers to include e-cigarettes so regulation has just begun. The FDA has not approved e-cigarettes as a device for quitting tobacco and several studies have indicated that e-cigarettes use actually is linked to lower odds of quitting.
What do E-Cigarettes look like? E-cigarettes come in a multitude of sizes and shapes. The main components are a mouthpiece, a cartridge (tank), a heating element/atomizer, a microprocessor, a battery and a possible LED light at the end. E-cigarettes have quickly evolved. The first generation e-cigarettes look like tobacco cigarettes (with variations in size) and are so called “cigalikes”. The second generation e-cigarettes are larger and look less like tobacco cigarettes. The third generation devices include mechanical mods (devices or attachments) and variable voltage devices. The fourth generation devices include “sub ohm tanks” and temperature control devices. The power source is the biggest component of an e-cigarette which is frequently a rechargeable lithium-ion battery. These lithium batteries have been known to overheat or explode. Also, some liquid cartridges can leak when handled.
Nicotine is Addictive. Nicotine is an incredibly powerful addictive drug, no matter how it is used. It is one of the most addictive known substances on a level comparable to heroin and cocaine. It stimulates the regions of the cortex associated with reward, pleasure and reducing anxiety. The nicotine content in e-cigarettes is more than adequate to sustain nicotine dependence. Some people get addicted in just a few weeks. Others develop cravings over several months.
When nicotine intake stops, withdrawal symptoms include cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain and difficulty concentrating.
Youth More Susceptible. Youthful experimentation with e-cigarettes can lead to lifelong addiction. The younger the child is when they start using nicotine, the more likely they’ll be addicted. Youth are sensitive to nicotine and can become dependent easier than adults.
Although, as mentioned above, e-cigarettes have not been around for enough time for longitudinal studies about the long term health effects, we do know much about the effects of nicotine. Because of nicotine addiction, about three out of four teen cigarette smokers end up smoking into adulthood. Teens who use e-cigarettes are more inclined to become smokers than those who do not. The majority of young people who vape also smoke cigarettes and use hookahs which are discussed below.
Early cardiovascular damage is seen in most young cigarette smokers; those most sensitive die at relatively early ages. Among youth who persist in cigarette smoking, one third will die prematurely from smoking. Teens who smoke are not only immediately short of breath, they may end up as adults with lungs that will never grow to full capacity. Such damage is permanent and increases the risk of chronic obstructive pulmonary disease (COPD). COPD is a debilitating, progressive disease which can not be reversed; when developed at very young age (in ‘30s) it eventually becomes an end stage lung disease.
Marketing to Youth. Big tobacco markets e-cigarettes to young people with strategies including cartoon characters and candy flavors. The devices come in designs and in colors that are attractive to young people. Candy fruit and alcohol flavors add to the appeal. Multiple websites share various tricks and tips for users. The industry also encourages the myth that smoking makes you thin, an especially appealing message to young girls.
JUULING (pronounced “jeweling”) recently has become popular at Bay Area high schools. A JUULE is a vaping device that looks less like an e-cigarette or pen and more like a flash drive or cell phone. It is a rectangular prism with a hole for a capsule which also acts as a mouthpiece at one end. It has a charging dock that plugs into a USB port.
Of concern is that JUULs can accomodate an especially high nicotine strength which is more addictive. This is because of its use of nicotine salts found in the tobacco leaf rather than free-base nicotine and its juice chemistry and delivery system. Introduced with four flavors: tobacco, mint, fruit and creme brulee, more flavors are being added. A JUUL package with four flavors and a charger sells for $49.99 with free delivery.
Dripping. One in four high school students who have used e-cigarettes also have tried this dangerous vaping method. Dripping involves dropping e-cigarette liquid onto the hot coils of a device to produce a thicker more flavorful smoke and stronger throat hit. It may expose users to higher levels of nicotine and to harmful non-nicotine toxins such as formaldehyde, a known carcinogen. See
Vaping with Marijuana
There is also a multitude of personal vaping devices for marijuana: desk top vaporizers (which are not portable or discreet), portable vaporizers (which are usually small enough to fit in a pocket and are used for vaporizing dry herbs), vaporizer pens (mostly for wax and oil concentrates versus dry herbs) and e-cigarettes (mostly for vape juices). Vaping e-liquids (also known as tinctures) combine a flavor and a concentrate with pre-filled tincture cartridges. With less smell, vaping liquids is more discreet than burning herbs.
E-cigarettes also can easily be modified into an electronic pipe (e-blunt or e-joint). If dry herbs are used, a dry herb cartridge attachment is used. If vaping is in the form of THC concentrate (hash oil, wax, budder, BHO, full-melts), a concentrate cartridge or a glass globe attachment is used.
Those most likely to vaporize marijuana with e-cigarettes include males and younger students. According to a 2015 survey by Yale University published in Pediatrics, approximately 27% of high school e-cigarette users have used electronic devices for products containing THC (marijuana, honey oil, dabs, etc.). Dual use (of marijuana and tobacco) is common and initial use of any of these products increases the likelihood of future use of another.
Marijuana smoke contains more chemicals and a greater amount of carcinogens than tobacco smoke according to the American Lung Association. For a comprehensive discussion about the health risks of marijuana use by teens, see our October newsletter at http://eepurl.com/chCv4n.
Combining Nicotine and Marijuana. Gaining in popularity is a “Spliff” which is a cigarette rolled with a mixture of tobacco and marijuana. This mixture produces its own high: tobacco increases the vaporization efficiency creating more available THC (the active ingredient of marijuana) so that the user feels the effects of marijuana more quickly. This results in a special kind of head rush with the tobacco stimulating adrenaline production.
A hookah is a water pipe - a single or multi-stemmed instrument for vaporizing and smoking flavored tobacco or sometimes marijuana. The vapor or smoke is passed through a water basin (often glass) before inhalation.
While many hookah smokers consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. Hookah smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking - including the frequency of puffing, depth of inhalation and length of the smoking session, hookah smokers absorb higher concentrations of the toxins found in cigarette smoke.
Hookah smoke contains multiple toxic chemicals that come from the burning of the charcoal, tobacco and flavorings. Hookah smokers inhale many chemicals that can cause cancer (oral, lung, stomach, esophagus and gastric), clogged arteries, heart disease, lung disease (impaired pulmonary function, chronic bronchitis and emphysema), decreased fertility and other health problems. Hookah smoking increases the amount of carbon monoxide in a person’s body to eight times their normal level.
Compared to smoking one cigarette, a single hookah session exposes users to more carbon dioxide and similar levels of nicotine.
A typical hour long hookah smoking session involves 200 puffs while smoking an average cigarette involves 20 puffs. A typical hookah session delivers 1.7 times the nicotine dose of one cigarette and the nicotine absorption rate in daily waterpipe users is equivalent to smoking 10 cigarettes per day.
Second hand smoke. Second hand smoke from hookahs poses a serious risk for nonsmokers because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah. Second hand smoke from hookahs contains significant amounts of carbon dioxide, aldehydes, ultrafine particles and respirable particulate matter (particles small enough to enter the lungs). Studies have found that the concentrations of particulate matter in the air of hookah bars were in the unhealthy to hazardous range according to EPA standards. The air in hookah bars also contains significant amounts of toxic chemicals that are greater than for cigarettes.
Addiction to and dependence on hookah. Many hookah smokers, especially frequent users, have urges to smoke and show withdrawal symptoms after not smoking for some time; thus it can be difficult to quit. The signs and symptoms of addiction and dependence are very similar to the signs of cigarette addiction.