E-cigarettes: A Physician’s Dilemma


A few months ago, I was visiting my family during a reunion and came face-to-face with what I now refer to as the “e-cigarette dilemma.” A family member in his mid-50s who has smoked since his teens, was using an e-cigarette, and has been doing so for the last year. I certainly was glad to see the “vaping” (the term used for e-cigarette use) family member cutting down on tobacco (in fact, he has not smoked a regular cigarette in a long time), and congratulated him on his efforts.

But suddenly, the questions about e-cigarettes that have come to me as matters of policy became quite personal. Do I think that using an e-cigarette is a healthier option than smoking a traditional cigarette? Can I say that the use of an e-cigarette is healthy? What do we know about the effects of e-cigarettes on those exposed to the vapor?

What is known is that use of tobacco products is the source of many preventable deaths across the globe. Smoking causes more than 480,000 deaths each year in the U.S. Nearly 18 in every 100 U.S. adults age 18 or older, or 42.1 million adults, currently smoke cigarettes.

Yet, while traditional cigarette smoking has decreased from 20.9 percent in 2005, other uses of tobacco/nicotine products are on the rise. In fact, e-cigarettes are marketed as smoking cessation devices or alternatives to traditional cigarettes. A 2014 study showed that e-cigarette use was especially prominent among current and former cigarette smokers. In 2014, 12.6 percent of adults had tried an e-cigarette even one time, and the majority was young adults ages 18-24.

What is particularly worrisome is the increased use of e-cigarettes by youth. While they may be smoking traditional cigarettes less, substantial increases were observed in e-cigarette use among middle and high school students from 2011 to 2014 (an estimated 2.4 million e-cigarette youth users). Per the Centers for Disease Control and Prevention, use of tobacco in any form, whether combustible, noncombustible, or electronic, is unsafe. Further, nicotine exposure during adolescence might have lasting adverse consequences for brain development and causes addiction, which may lead to sustained use of tobacco products.

Currently, the Food and Drug Administration (FDA) regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. In 2015, the FDA issued a proposed rule to cover additional tobacco products such as e-cigarettes. The recommendation to have e-cigarettes regulated as a tobacco product is strongly supported by the American College of Physicians and the American Academy of Pediatrics, among others. These recommendations are based upon the following:

  • E-cigarettes are NOT an FDA-approved “quit tobacco” device.
  • E-cigarettes are NOT a safe alternative to other forms of tobacco.
  • E-cigarettes may be particularly attractive to youth due to their novelty.
  • Recent studies show that use of e-cigarettes may encourage traditional cigarette use by teens.
  • The number of calls to poison centers involving e-cigarettes rose from one per month in September 2010, to 215 per month in February 2014.

So, while e-cigarette use has skyrocketed, much remains unknown about the effects on our health, as no data exists yet regarding long-term risks. While I applaud my family member and others for pursuing ways to cut back or quit tobacco use, long-term studies are needed to determine the safety of e-cigarettes. Research is vital to inform healthcare providers about the health effects of the substances found in e-cigarettes, and whether use of e-cigarettes definitively decreases the use of traditional cigarettes, or not.
Per the Centers for Disease Control and Prevention, use of tobacco in any form, whether combustible, noncombustible, or electronic, is unsafe.



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