Vaping and Health Risks: Information for Healthcare Providers
By Joel Reeves, MPH, Tobacco, Vapor Product, and Marijuana Prevention Specialist / Spokane Regional Health District
Whether it is nicotine, flavoring, or marijuana, vaping is not safe. Vapor products are frequently championed as the safe alternative to combustible tobacco. When it comes to several cardiovascular and pulmonary health impacts associated with combustible tobacco use, vapor products are shown to have a less significant impact. However, vapor products can also pose additional or greater health risk for a variety of reasons when compared to combustible tobacco.
In contrast to combustible tobacco, serious health impacts from vapor product use can onset from short-term use. This increases the risk of vaping-related injuries and diseases among a younger age demographic. Since vapor products were introduced into the market in 2007, youth use has reached an all-time high, with 52 percent of 12th-grade students in Spokane County reporting having vaped in the 2018 Healthy Youth Survey. Results from the Monitoring the Future National Survey showed vaping among college youth increased from 5.2 percent to 26 percent and among non-college youth, increased from 7.8 percent to 21 percent from 2017 to 2018. These data demonstrate the importance of asking youth and young adults about vapor product use.
The health effects of nicotine, especially on youth, are well researched. Nicotine disrupts the balance of the neurotransmitters in the brain, creating a dependency on nicotine to maintain normal brain function. This disruption alters the way the brain develops. With nicotine now required for normal brain function, inadequate nicotine levels in youth users can lead to difficulties with learning, memory and attention. Nicotine also triggers a dopamine response, adding to its addictive nature.
The risk of experiencing negative health impacts from nicotine is greater in vapor product than combustible tobacco. As vapor products evolve, so does the efficacy in terms of how much nicotine is delivered to the end user. Of the 12 mg of nicotine in a typical cigarette, only 1 mg, or 8.7 percent, is absorbed by the user. Of the 41 mg of nicotine in a typical salt-based vapor product pod (e.g. JUUL), 31 mg, or 76 percent, is absorbed by the user. Users are receiving 30 cigarettes worth of nicotine per salt-based vapor product pod. It is not unusual for regular vapor product users to consume multiple salt-based vapor product pods per day.
The size of the inhaled particles has continued to decrease as vapor products have become more advanced. Ultrafine particles, some measuring less than one micron, allow for the inhaled aerosol to reach further into lungs, damaging alveoli and increasing the amount of dangerous chemicals that reach the bloodstream. Many of these dangerous chemicals, such as heavy metals, acetals, and volatile organic compounds, affect different systems and organs in the body. With more of the dangerous chemicals being able to reach the bloodstream with current vapor products, it is still unclear what the short- and long-term health consequences will be.
In Washington, the legalization of retail marijuana has led to a variety of vapor products that contain tetrahydrocannabinol (THC), the psychoactive chemical in marijuana, and cannabidiol (CBD), the other main active chemical in marijuana. Much like nicotine, vapor products containing either THC or CBD have higher concentrations of the active chemical and a higher absorption efficacy when compared to their combustible counterparts. Marijuana-based vapor products share the same risks as other vapor products regarding dangerous chemicals, volatile organic compounds and ultrafine particles. In addition, there is evidence that consuming these products can interfere with certain prescribed medications.
Healthcare providers play a pivotal role in addressing vapor product use. Electronic health records that document vaping separately from smoking are helpful in assessing the health impacts and trends that are evolving as the products change. When medical staff perform the screening, it may be necessary to ask about a variety of products. Youth who use certain vapor products, such as JUUL, may not identify as vapor product or e-cigarette users. Stay up to date on current research on vapor products and their health risks in order to educate patients.
The CDC maintains a website for healthcare providers with information about the current vaping-associated lung injury outbreak, resources, and links to current research articles. Be aware of the federally approved vapor product cessation methods and which methods require a healthcare provider referral.
Talk to the parents of youth that report vapor product use. The CDC also has a guide on how to Educate Your Young Patients About the Risks of E-Cigarettes. Parents often know less than youth or have been misinformed about the risks of vapor product use. It is the responsibility of healthcare providers, as a trusted source of information, to screen for vapor product use, educate on health risks, and refer patients to cessation resources to support a multidisciplinary approach to addressing this public health issue.