Expert Pitch

It is no secret that vaping — inhaling nicotine, flavorings and other chemicals from an electronic cigarette (e-cigarette) — is growing in popularity, particularly among young people. A recent nationwide survey from the American Society of Clinical Oncology found that one in five young Americans thinks vaping is both harmless and non-addictive. The study also found that many also believe flavored e-cigarettes carry less risk than regular cigarettes and other tobacco products.

However, this seems to be far from the case. According to the Centers for Disease Control and Prevention, as of October 31, 2019, more than 1,888 lung injury cases and 37 deaths have been associated with the use of e-cigarette products.

To learn more about vaping use and its effects on health, we turned to Andrea King, PhD, professor of psychiatry and behavioral neuroscience and director of the Clinical Addictions Research Laboratory at UChicago Medicine. King studies tobacco addiction and treatment, including the use of e-cigarettes. She is also co-leader of the Cancer Prevention and Control research program at the UChicago Medicine Comprehensive Cancer Center and director of the tobacco treatment program Courage to Quit.

Last year, we saw a 78% rise in tobacco use in high schoolers and a 48% increase in middle schoolers. These spikes have been linked to e-cigarettes and vaping. In your opinion, what do you think contributes most to the growing prevalence of tobacco use in our youth?

This increase is due to what some health officials are calling an “epidemic” in the use of e-cigarettes by youth. While combustible smoking, or the use of traditional cigarettes, has been steadily declining over the past two decades, that decline is slowing down and the use of e-cigarettes, hookah, little cigars and other tobacco products has been rising sharply. E-cigarettes are highly attractive to adolescents due to their flavors, easy to conceal use, and carry the perception (mistakenly) that they are not harmful.

The CDC reports that higher amounts of nicotine are inhaled in e-cigarettes than traditional cigarettes. Could this make vaping more addictive than traditional smoking methods? Would this have to change, or modify, the methods for quitting compared to traditional tobacco products?

Yes, the most popular e-cigarette, JUUL, and other nicotine-salt pod devices like it, provide the user with very high nicotine levels without the harshness of combustible smoking that would normally slow the rate of uptake in youth in the past. Kids are getting addicted to nicotine within weeks of use, which was less the case in the past with other tobacco products. We can use methods shown effective in helping smokers quit, but it may be that quitting vaping needs different treatments and none have yet been developed. On top of this, the medications shown to help double or triple the odds of successful smoking cessation are only approved for persons age 18 years and older.

Do you think the recent health scares regarding vaping will affect people’s decision to pick it up and encourage users to quit?

I am hearing occasional reports of more e-cigarette users wanting to quit and having concern about the recent health scares. Since we don’t know the exact causes of these hospitalizations and deaths, it is certainly advisable for people to refrain from the use of these devices. They are not regulated and there are many unknowns about them, so I hope the news of these health risks will thwart some young people from experimenting or continuing to use them. Only time will tell.

As a researcher of Cancer Prevention and Control at the University of Chicago Comprehensive Cancer Center, what are your thoughts on a new study in mice linking cancer with vaping?

This is a very interesting study and with further research, we may find that vaping includes its own unique harms and separate pathways and mechanisms linking it to cancer, emphysema/COPD and cardiovascular disease. Researchers are actively examining the constituents of e-liquids and their aerosols to discover how chronic use of e-cigarettes may affect physiological states that lead to risk for diseases and health problems. We will know more once more findings are published.

Many of the recent vaping-related lung illnesses and deaths have been linked specifically to vaping products with THC (the main active ingredient in cannabis). What does the current research say about THC use in vaping products? How does it compare to nicotine use?

While many of these cases have included the use of THC in vaping, not all have, so these findings are not limited to THC, at this point, and that is important for people to know. Some physicians have told me that illnesses and deaths before this summer may have been associated with e-cigarette use as well, but because many health practitioners do not routinely ask about vaping, those earlier cases were likely not identified as linked to e-cigarette use.

What would you like the public to know with regard to vaping addictions and encouraging teens/youth to quit?

In terms of teens/youth, I routinely encourage parents and guardians to keep the lines of communication about vaping open and to listen first to why e-cigarettes are so attractive. Encourage them to stop using if they have started. Check resources online (teen.smokefree.gov), talk to your pediatrician, or contact smoking cessation programs in your area to get help. Illinois enacted Tobacco 21 legislation in July 2019, which means that anyone under age 21 cannot legally purchase tobacco products in our state. We hope this is one part of finding solutions to the problem and decreasing the use of vaping products in our kids. Otherwise, we may have a whole new generation addicted to nicotine and at much higher odds of using combustible tobacco in addition to e-cigarettes.

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