Clearing the air: E-cigarettes, vaping raise public health concerns

A man smoking an e-cigarette
Given that brain development continues into the early and mid-20s, exposure to nicotine and other harmful chemicals is setting them on a path that may not only impact their developing brains, but could lead to addiction, or even worse, lung cancer.

The idea that the only people vaping e-cigarettes are current smokers trying to quit is not true, especially in the last several years. According to the American Cancer Society, electronic cigarette use has grown a staggering 900 percent among high school students in recent years. Currently, an alarming one-in-six high school students admits to using e-cigarettes. Given that brain development continues into the early and mid-20s, exposure to nicotine and other harmful chemicals is setting them on a path that may not only impact their developing brains, but could lead to addiction or, even worse, lung cancer.

Atlanta Mayor Keisha Lance Bottoms recently signed legislation for a broad ban on smoking and vaping in restaurants, bars, workplaces and additional places in Atlanta that takes effect Jan. 2, 2020. This is a great first step, but as an oncologist, parent and member of the American Lung Association's Expert Medical Advisory Panel, I'm committed to elevating the discussion about the dangers of vaping in order to give young people, parents and others a better understanding of potential, negative ramifications.

Dangers such as nicotine, chemicals abundant in e-cigarettes

The aerosol inhaled from vaping contains a mixture of chemicals, including nicotine, formaldehyde and acrolein. In 1987, the U.S. Environmental Protection Agency classified formaldehyde as a probable human carcinogen under conditions of unusually high or prolonged exposure. Since that time, studies have suggested that formaldehyde exposure is also associated with certain types of cancer. Acrolein, which is commonly used as a weed killer, can cause irreversible lung damage, while the aerosol in and of itself can irritate the lungs, throat and eyes.

But vaping is not just affecting those who partake. In 2016, the Surgeon General concluded that those exposed to second-hand emissions, including nicotine, ultra-fine particles, flavorings such as diacetyl (a chemical linked to serious lung disease), volatile compounds such as benzene that are typically found in car exhaust, and heavy metals like nickel, tin and lead, are at increased risk of developing lung cancer.

Popcorn lung and flavored e-cigarettes

While it may seem cool to some teenagers and others to try the latest e-cigarette flavors, there are additional risks associated with flavors, most prominently exposure to diacetyl. When inhaled, diacetyl causes bronchiolitis obliterans, more commonly referred to as popcorn lung, which is a scarring of the tiny air sacs in the lungs that results in the thickening and narrowing of the airways. You may recall that in the 1990s, many popcorn manufacturers removed diacetyl from their products due to harmful chemicals suspected to cause cancer.

In a recent study, researchers at Harvard found that 39 of 51 e-cigarette vapors contained diacetyl. The study also revealed that two other harmful chemicals, pentanedione and acetoin, were present in 23 and 46 of 51 flavors tested, respectively. Both are linked to adverse health effects.

While diacetyl is the most discussed health risk when it comes to flavorings, there are other risk factors that need to be considered. Most notably, the U.S. Food and Drug Administration considers food flavorings as "generally" safe for ingestion, but most certainly not for inhalation.

Long- and short-term ramifications

Health risks associated with vaping are still being evaluated, but there is a growing body of evidence that the chemicals in these products are very dangerous. Recently, the World Health Organization (WHO) said electronic cigarettes and heated tobacco products are a real danger to public health and unequivocally do not help reduce cancer. Like WHO, I am advocating that the regulation of these products include:

  • Impeding the promotion of e-cigarettes and heated tobacco products
  • Reducing potential health risks to users and non-users
  • Prohibiting unproven health claims from being made about these products
  • Protecting existing tobacco-control efforts from commercial and other vested interests of the tobacco industry

I'm also calling for the implementation of educational programs and additional research into potential risks associated with vaping. And, we must band together to stop companies form targeting our youth. Although studies show short-term effects on various physical functions, we haven't seen enough evidence to truly understand long-term ramifications. The surest way to avoid problems is not to vape.

Patricia Rich, MD, is the Medical Oncology Director of the Cancer Treatment Centers of America (CTCA) Lung Cancer Institute and Vice Chief of Staff at CTCA Atlanta in Newnan, Ga. Dr. Rich is a member of the American Lung Association's Lung Cancer Expert Medical Advisory Panel, which provides strategic advice on critical lung cancer science and lung cancer-related issues.