Vaping: the safe smoke?

Posted on 25th November 2019

Maurice Swanson, chief executive, Australian Council on Smoking and Health, says there is strong and accumulating evidence that using e-cigarettes can have serious, immediate health effects on the lungs, heart and blood vessels.

“While e-cigarettes haven’t been around for very long, it is important to remember that it took many decades of research for the true health effects of traditional cigarettes to be determined,” he says.

“Because e-cigarettes are so new, there is a lack of evidence examining the effects of e-cigarettes on oral health.

“However, the e-cigarette aerosol inhaled is not harmless. E-cigarettes contain nicotine, heavy metals, toxic chemicals, and other carcinogens, which could have potential negative effects on oral health.

“There is also little evidence that e-cigarettes are effective in assisting smokers to quit – and may even depress quitting rates. Most smokers who use e-cigarettes to give up smoking continue to use both traditional cigarettes and e-cigarettes, and as a consequence, do not significantly reduce their risk of the major diseases caused by smoking. The best way to protect your health is to quit smoking and vaping entirely.”

Vaping risks

On top of the risks commonly associated with smoking, e-cigarettes pose additional health concerns. “There have been many documented cases of oral and facial trauma caused by explosions from e-cigarette device malfunctions,” Maurice explains. “The potential for facial injury is a harm unique to e-cigarettes compared to smoking and an example of how e-cigarettes may be accompanied by new and unexpected risks.

“E-cigarette products are also manufactured in unregulated environments with no quality control over production, content or consumer information,” he adds. “Quality varies considerably, and the risk depends not only on the type of device, but factors such as the flavour, brand and way the e-cigarette is used. There is no way to guarantee safety of these products.”

Dr Maryam Jessri, discipline lead in oral medicine at the Oral Health Centre of UWA, says vaping is a relatively new phenomenon and therefore the exact extent and long-term side effects of exposure (first and second hand) remain unexplored.

“However, there is accumulating data indicating significant injury to the lungs,” she says. “This injury is objectively apparent through clinical [JE Layden et al, NEJM 2019], radiographic [Henry TS et al, NEJM 2019] and even histopathologic [YM Butt, et al., NEJM 2019] studies of individuals with a history of vaping.

“The literature detailing the possible effects of vaping on oral cavity is not as extensive; nevertheless, early studies and case reports indicate a positive association between vaping and oral cancer.

“Here at the Oral Health Centre of UWA, we have initiated an original study focusing on the molecular and phenotypic changes of the oral cavity cell lines in response to vaping,” she adds. “We aim to publish the data in early 2020.”

Who vapes?

Dr Michelle Jongenelis, senior research fellow at the Melbourne Centre for Behaviour Change, says evidence from the recent National Drug Strategy Household Survey indicates that compared to all other age groups, young adults aged 18 to 24 are the most prevalent users of e-cigarettes in Australia.

“Evidence from my research suggests that about half of young adults believe e-cigarettes are less harmful than tobacco cigarettes and about a quarter don’t know how harmful they are compared to tobacco cigarettes,” she says.

“It is definitely a concern if a young adult who has never smoked decides to take up vaping based on the misperception that they are harmless or ‘not as bad’ as tobacco cigarettes. E-cigarettes do contain harmful chemicals and vaping has also been found to increase risk of traditional tobacco cigarette smoking among never smokers.”

Maurice adds there is alarming evidence from the United States and Canada that the marketing and availability of e-cigarettes has resulted in an epidemic of use among young people.

“In the US, the use of e-cigarettes by middle school students increased by 48%, and in high school students by 78% comparing 2017 and 2018,” he says.

“Canada has also recently allowed the marketing of Juul e-cigarettes, and published survey data showing that for the first time in 30 years, the youth smoking rate has increased in Canada, with e-cigarettes being the likely cause.”

He adds that despite having stricter regulations, the latest Australian survey shows that in 2017, 48% of students aged 12 to 17 who had used e-cigarettes reported they had never smoked a tobacco cigarette.

“These findings add to other convincing evidence that e-cigarettes are an on-ramp to the use of traditional cigarettes for children and young people,” he says. “The major international tobacco companies own all the top e-cigarette brands and these companies have a vested interest in continuing to promote smoking behaviour and products among young people.”

Why do people vape? 

“I started vaping to help me quit cigarettes. To me it somehow felt ‘fresher’; it didn’t have the horrid smell, no ash, no dirty ash trays and was a lot cheaper as well. After vaping for a week, I tried smoking a cigarette and I couldn’t even finish it. I did also believe it was healthier than cigarettes as well. I didn’t have all the information, but I believed if I bought the liquids from authorised vendors it wouldn’t have any added nasties and would be safe.”

“My husband originally swapped to vaping to try to quit smoking. It worked but now almost three years later he is still vaping. Although his vape juice no longer contains nicotine, it’s the bad habit of ‘hand to mouth’ that he’s struggling to kick now. It’s the only thing I nag him about, and purely because it’s unregulated and untested, so I really have no idea what he’s actually smoking.”

“My husband started vaping to quit smoking and I would say he even uses it more than he ever used to smoke, and it smells horrid. I have a health background, and I can’t believe how naïve people are being about the sheer lack of long-term studies.”

“I occasionally vape with the vape pens you buy from the newsagents when I am out having a social drink. As an ex-smoker, my friends still smoke and after a couple of drinks, I have a tendency to have a smoke – and cigars are very expensive. I don’t think they are a better option than cigarettes as I believe vape juice isn’t regulated so the chemicals in them are unknown.”

“I felt vaping was healthier in the sense that there are far less toxins and poisonous chemicals – only nicotine – and it is definitely cheaper. One bottle of juice is around $35, which can last months, compared to a packet of cigarettes, which you can spend over $100 on, depending how much you smoke.”