Scientific evidence exposes harmful effects of e-cigarettes on health

I recently had a conversation with my friend’s daughter, whom I’ve known since she was born. Now a vibrant and ambitious 15-year-old, she’s ready to make her mark on the world. Our discussion took an interesting turn toward the activities teenagers engage in at parties, and eventually, we delved into the topic of vaping, which has become a prevalent practice in such gatherings. Concerned, I asked her if she was aware of the harmful effects associated with vaping. To my surprise, she questioned, “But uncle, how can something as harmless as vanilla-flavoured vapour be dangerous?” The truth is, vaping can be incredibly dangerous and can cause irreparable damage to the health and careers of a lot of youngsters.

The harmful effects of vaping or e-cigarettes often go unnoticed by the majority of people, particularly the younger generation who view it as a fashion statement. There is a prevailing misconception that vaping is a safer alternative to traditional tobacco smoking. This perception has been strategically crafted and disseminated through various channels, ranging from advertisements and blogs to popular media platforms like OTT shows. Vaping has been cleverly positioned as a trendy and socially acceptable habit, downplaying its potential dangers and promoting it as a means to quit smoking cigarettes. There are even books advocating the notion of Stop Smoking, Start Vaping!

It’s not just water vapour

So what are e-cigarettes and why it is presumed to be an alternative to smoking? E-cigarettes, also known as electronic nicotine delivery systems (ENDS), come in various forms and are referred to by different names such as e-cigs, e-hookahs, mods, vape pens and vapes. These devices typically consist of a cartridge filled with a liquid, a heating element, and a rechargeable battery. The heating element or atomiser heats the liquid to produce a vapour that can be inhaled through a mouthpiece. Users inhale this aerosol or vapour into their lungs and bystanders may also inadvertently inhale it when the user exhales into the air. Many smokers perceive e-cigarettes as a healthier alternative because they believe they are inhaling water vapour instead of tobacco smoke. This notion is false.

The aerosol that e-cigarettes produce is far from harmless water vapour. It contains a range of harmful substances, including nicotine, flavourings like diacetyl which is a chemical linked to serious lung disease, ultrafine particles, and other chemicals that vary based on the specific e-liquid used. These ultrafine particles and chemicals can deeply penetrate the lungs, presenting significant risks to human health. The aerosol generated by e-cigarettes contains particulate matter with a diameter smaller than 2.5 microns (PM2.5), known to be detrimental to respiratory health. Furthermore, e-cigarette vapor contains cancer-causing chemicals and heavy metals like nickel, tin, and lead. E-liquids can also be oil-based and may contain substances such as tetrahydrocannabinol (THC), the primary psychoactive component found in cannabis. Determining the exact content of e-cigarette products is challenging for consumers. For instance, some e-cigarettes marketed as nicotine-free have been found to contain nicotine upon testing.

Lessons to be learnt

For us, in India there is a valuable lesson to be learned from the vaping epidemic in countries and regions like US, Australia and Europe. A notable event was the e-cigarette or vaping product use-associated lung injury (EVALI) outbreak in the US in 2019. This outbreak resulted in the hospitalization of thousands of Americans, particularly teenagers and young adults, leading to long-lasting lung damage and pulmonary dysfunction for many survivors. In February 2023, The American Thoracic Society (ATS) released a report highlighting this issue and calling for stricter regulation of vaping products by the US Food & Drug Administration (FDA) to prevent another EVALI outbreak. The report, authored by a 26-member expert panel, emphasized that vaping fluids containing hemp-derived delta-8 tetrahydrocannabinol (THC)-O acetate could potentially cause EVALI. When heated, this substance has the potential to yield ketene, a potent pulmonary toxin that can cause severe damage to the alveoli and alveolar capillaries.

In addition to its detrimental effects on lung health, e-cigarettes can also impair blood vessel function, consequently increasing the risk of heart disease. Furthermore, these devices have been found to have adverse effects on immune functioning, reproductive organs, and even brain development. The harm caused by e-cigarette use extends beyond the respiratory system and encompasses various aspects of overall health and well-being.

Such damaging impacts on the human body underscore the critical importance of understanding the risks associated with vaping products and the need for collaboration amongst various stakeholders to tackle this menace effectively. In January 2020, the Society for Adolescent and Medicine released a new policy statement formulated by a collaborative group of Adolescent Medicine Providers from India, Canada, the US, and the UK. The statement put forth recommendations aimed at preventing e-cigarette use and safeguarding youth from the harms associated with e-cigarettes.

Among the suggestions made by the collaborative group includes the prevention of e-cigarette use by advocating for policies and regulations to restrict the marketing and sales of e-cigarette products to young individuals. Supporting public health-led education campaigns, educational curricula for schools, community programs and the importance of increasing research efforts to develop evidence-based guidelines for the prevention and cessation of e-cigarette use among adolescents and young adults was also

emphasised.

It is evident that e-cigarettes cannot be considered safe. It is also not a safe alternative to traditional cigarette smoking. It is imperative to actively disseminate accurate information regarding the genuine risks associated with vaping, dispelling misleading notions. The long-term health effects of vaping remain inadequately understood, with studies consistently expressing concerns about potential risks linked to its usage. Surprisingly, even in countries like India where e-cigarettes are banned, they continue to be easily accessible through local shops and online stores. Therefore, it becomes crucial to enforce strict implementation of such bans, ensuring that vaping products or e-cigarettes do not end up in the hands of our vulnerable children and youth.

The writer is Additional Director, Pulmonology and Critical Care Fortis Healthcare, Noida