VAPING MYTHS AND REALITIES Myth: E-cigarettes produce a harmless water vapor.
Myth: E-cigarettes are safe and do not contain toxins.
Reality: E-cigarettes produce an aerosol that has nicotine, harmful chemicals, and toxins known to cause cancer (and other health issues). These chemicals and toxins include formaldehyde, lead and nickel, among others.
Reality: E-cigarettes are not risk-free. They still deliver nicotine (sometimes at high levels) and low levels of toxins and chemicals, many of which are present in tobacco products.
Myth: E-cigarettes can help people quit tobacco.
Reality: Nicotine is a highly addictive drug and is one of the main ingredients in e-cigarettes and tobacco products.
Reality: E-cigarettes are NOT approved by the US FDA to help people quit tobacco. Many people switch to e-cigarettes from traditional cigarettes, but switching is not quitting. Scientific studies are mixed about whether e-cigarettes help people quit using tobacco and nicotine.
proaches that have been used in the past for marketing conventional tobacco products to youth and young adults.” Not only does the marketing of flavors get youth started in using tobacco products, those who use flavored tobacco have greater odds of using multiple tobacco products. Furthermore, recent studies show that youth who start using e-cigarettes are more likely to move on to using conventional cigarettes and other combustible forms of tobacco. In January 2020, the U.S. Food and Drug Administration issued an enforcement policy on certain unauthorized flavored e-cigarette products that appeal to youth. However, this policy exempts menthol-, tobacco-, and non-flavored ENDS products and includes only prefilled, cartridge-based products. Disposable or refillable flavored e-cigarettes, plus the 15,000+ existing flavored e-liquids, remain on the market. This resulted in a boom in the market for disposable products, such as Puff Bar, which are priced more affordably for youth than Juul. Since we cannot rely on effective regulation of these products, preventing initiation and promoting cessation of their use is a critical step in protecting youth from addiction and future health effects. Providers can play a key role in addressing this public health epidemic. What can my practice do to help reduce youth vaping?
There are proven strategies that work to protect youth from tobacco product use, which can be applied to ENDS as well. Providers can help support both individual and population level solutions towards curbing vaping. When working with patients, Ask, Advise and Refer: Ask patients about their ENDS product use, including discreet devices such as JUUL and Suorin, when screening patients for the use of any tobacco products. Advise patients about the harms of ENDS products, especially to the developing adolescent brain, and help dispel myths and the misleading advertising that portrays these products as “safer.” Some free materials are available here: nobutts-catalog. org/collections/vape. Refer for cessation services, such as those offered by the California Smokers’ Helpline (1-844-8-NO-VAPE) or by the free, youth-centered, quit-vaping mobile program called This is Quitting (thetruth.com/articles/hot-topic/quit-vaping) and encourage patients to quit. 42 | The Bulletin
Myth: E-cigarettes are not addictive.
Myth: Big Tobacco is not involved in making e-cigarettes. Reality: By 2021, Big Tobacco will sell the majority of e-cigarettes in the US, and sales will overtake traditional tobacco revenue.
Providers also can help advocate for the implementation of evidence-based, population-level strategies, such as including ENDS in smoke-free indoor air policies and restricting youth access to ENDS in retail settings, through retail licensing and enforcement programs. Participation by health providers in policy initiatives brings credibility that ENDS products are harmful for health, especially among adolescents. While there are regulatory and market-driven barriers to reducing youth vaping, a coordinated effort between health providers, educators, parents and communities can make a significant impact on the local level. References
1. Tobacco Product Use Among Middle and High School Students — United States, 2011-2018. Morbidity and Mortality Weekly Report (MMWR), February 2019. 2. Zhu S-H, Lee J, Zhuang YL, Braden K, Cole A, Wolfson T, Gamst A (2019). Tobacco use among high school students in Santa Clara County: Findings from the 2017-2018 California Student Tobacco Survey. San Diego, California: Center for Research and Intervention in Tobacco Control (CRITC), University of California, San Diego. 3. Craver R. Analyst projection: E-cigs will overtake traditional tobacco revenue at Reynolds in 2021. Winston-Salem Journal, 2013. 4. https://www.hhs.gov/about/news/2018/12/18/surgeon-general-releases-advisory-e-cigarette-epidemic-among-youth. html 5. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Increase in use of electronic cigarettes and any tobacco product among middle and high school students — United States, 2011–2018. MMWR Morbid Mortal Wkly Rep. 2018;67(45). 6. U.S. Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Atlanta, GA, 2016. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html#one 7. Willett JG, Bennett M, Hair EC, et al. Recognition, use and perception of JUUL among youth and young adults. [published ahead of print April 18, 2018]. Tob Control.
