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Vaping and E-Cigarettes: Prospect and Perils in Smoking Cessation

Dr. Taylor Hays explores the history and ramifications of e-cigarettes, revealing how vaping is now dangerously popular with the generation that was supposed to kill cigarettes.
August 18, 2021
J. Taylor Hays, MD

“One mL JUUL pod contains 56 milligrams. You can extract about 20 milligrams from a pack of cigarettes...probably more than that. Tobacco use among high school and middle aged students has declined remarkably over the last decade. But then in 2018, we saw almost an 80% increase in the prevalence of cigarette use in high school students. And in 2019, we now have 1:4 12th graders currently using e-cigarettes and 1:10 middle schoolers. And those numbers seem to be rising all the time.


We've seen a steady decline in the use of traditional tobacco cigarettes in adults from somewhere, and now among all adults, the prevalence is more like 14-15% in the United States. That represents about 35-40 million people because of the growth in the population of the US. We've also seen an uptake of electronic cigarettes in adults.

What fueled this increase? One was the marketing done by this unregulated industry: the marketing of electronic cigarettes to kids that took the form of a lot of common consumer products that kids like: candy, gum, whipped cream, apple juice.

The other thing that has fueled this has been the marketing of a product called JUUL, in particular, which is a company that marketed an electronic cigarette product that looks like an external drive from a computer. And so parents and adults didn't know what these were and kids took them up in remarkable numbers.


The common features of all electronic cigarette devices includes a heating element that usually is a metal coil, and that heating element needs a battery. And then the other component is electronic liquids. These liquids typically contain nicotine. But as you know from the news, they can contain other drugs as well, particularly marijuana extracts, or THC.

The newest models of electronic cigarettes look nothing like cigarettes. They look like boxes or vape pens. They have refillable models and the vessel that contains the liquid can be refilled with different liquids. You can also interchange all of the parts. You can interchange the power source. You can use different coils in these and you can use different mouthpieces. You can actually modify the voltage and amperage with which they deliver the e-liquid.


The JUUL pods contain about one and a half to two and a half package equivalents of nicotine. So if you smoke a pod a day of JUUL, a high school student doing that is consuming about the same amount of nicotine as he or she would get from a pack and a half to two packs of cigarettes in that day. That means they're becoming nicotine dependent very quickly.


So for clinicians, our advice and the nicotine dependence center is to say if someone is committed to quitting smoking cigarettes, we advise the use of what is known to be effective and safe. That is the combined approach of behavioral therapy or counselling, plus approved medications. And there are seven approved pharmacotherapies for smoking cessation in the US. We don't advise the use of electronic cigarettes.

Most of our professional societies have said that they don't recommend e-cigarettes, although some have said if you have to advise a switch, the switch needs to be complete for adults and we'd never advise pregnant women or children to use e-cigarettes. The reason we take this approach is really the precautionary principle. And that principle is this. The introduction of a new product or process whose ultimate effects are disputed or unknown should be resisted.


There's still a promise that e-cigarettes might help us in the future, but we're going to have to work through this current issue of the diseases and negative health impacts that e-cigarettes have had on lung injury. We need to come up with new technologies that are proven to be safe for our patients before we can recommend them."

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