For Vapers, Frightening Health Consequences are Quickly Emerging

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By Ellen Rome, M.D., MPH, and Humberto Choi, M.D., Cleveland Clinic

E-cigarettes and vaping are relatively new, but many have thought of them as a harmless alternative to smoking.  But now, reports of serious respiratory illnesses likely tied to vaping are popping up across the country, including young patients being put on mechanical ventilators to breathe. The CDC is reporting hundreds of possible cases nationwide, including in Ohio. There have even been several deaths reported, potentially linked to vaping.  Unfortunately, we have seen similar cases here at Cleveland Clinic.

As these illnesses come into focus, physicians are quickly trying to learn more, as still little is known of the long-term effects of vaping.  Along with these serious cases, anecdotal evidence reveals some of their impact mirrors that of traditional cigarettes. Recently, a young woman came to us at Cleveland Clinic reporting breathing difficulties. A CT scan showed inflammation in both lungs, but no signs of cancer or other sicknesses that typically cause this kind of inflammation. Only when the woman – in her twenties – explained that she had just started vaping two months ago did doctors ascertain the source of her problem.

In addition, the youngest group of vapers today have brains that are still developing incredibly critical functions such as self-control, emotional maturation, and reward processing. Strong data suggests that nicotine exposure during teen years disrupts the brain’s neurotransmitter systems, leading to long-term changes in cognitive development and even decreased memory capacity.

Humberto Choi, M.D., Pulmonologist at Cleveland Clinic, and Ellen Rome, M.D., Head of Adolescent Medicine at Cleveland Clinic Children’s

Youth addiction

The “vaping” craze surrounding e-cigarette use is also leading people, especially our youth, down the path of nicotine addiction.

As we know from decades of cultural experience and scientific research, once you begin using any nicotine-based product, it can be extremely difficult to stop. Our society is at a critical moment in which we need to learn from our history with cigarettes and act accordingly, especially with our future generations in mind.

For those of you who think vaping is a harmless alternative to smoking, think again. The most popular e-cigarette on the market contains almost three times the nicotine as a single pack of cigarettes. But unlike cigarettes, which are smoked one-by-one and have a clear starting and stopping point, e-cigarettes can be puffed on continuously – further adding to the danger of addiction.

While it’s true that these devices don’t contain tar and tobacco, the high nicotine content gives an alarming number of teens and young adults their first exposure to the highly addictive stimulant. According to the 2018 National Youth Tobacco Survey, 78 percent of high schoolers have used e-cigarettes, as have 48 percent of middle schoolers.

To make matters worse, thanks to the alluring marketing tactics and flavors of e-cigarettes, America’s youth are – in many cases, unwittingly – becoming addicted to nicotine. A study from the Truth Initiative  found that only about one-third of 12th graders are aware that Juuls, a brand of e-cigarettes, contain nicotine – and many are outraged when they learn the truth.

The Centers for Disease Control and Prevention and the Food and Drug Administration are now urging people who vape not to buy products off the street, and seek medical attention if they have trouble breathing or chest pain. But it’s clear to medical practitioners like us that our society must tackle the e-cigarette epidemic in the same manner as we have successfully fought traditional cigarettes.

Tips to tackle vaping

Many of the tactics that worked so effectively on cigarettes can, and should, be deployed in the fight against vaping. Here are four proven avenues to cessation that should be enacted immediately:

  • Take away the taste. E-cigarettes appeal to many young users because they come in popular flavors, such as mint, mango, and menthol. Our team at Cleveland Clinic supports the Federal Drug Administration proposed guidelines in this area, which call for most flavors to be eliminated; the proposal is currently under review.
  • Raise prices. Severely taxing the sale of cigarettes has helped reduce usage throughout the nation. Similar pricing initiatives could have the same impact on e-cigarettes.
  • Raise the legal age. Kudos to Ohio for recently becoming the fourth U.S. state to raise the age to 21 for legally purchasing cigarettes, cigars, vaping devices, and other tobacco products. We encourage other states, as well as the federal government, to include vaping products as they consider adopting similar Tobacco 21 statutes.
  • Magnify via marketing. Mass media marketing campaigns are effective in spreading the word about a product as dangerous as e-cigarettes. Teens will listen, especially if fellow teens are involved in the creative process.
  • Help users stop. As with most addictions, nicotine can be tough to kick on your own. Cleveland Clinic and other facilities around the U.S. have established smoking cessation programs that can be easily modified for any nuances related to e-cigarettes.

Perhaps most importantly, as parents and adult influencers, we need to serve as role models for our youth. Adults, it’s simple: don’t vape. If you don’t engage in vaping yourself, it’s more likely that teens will follow your lead.

We can, and should, put a stop to the rapid increase in vaping and e-cigarette use. Our society battled the scourge of cigarette smoking for decades. Let’s take what we’ve learned and apply it to this new form of nicotine addiction.

The lives of millions of teens and young adults may depend on us taking action … now.

Ellen Rome, M.D., MPH, serves as Head of the Center for Adolescent Medicine at Cleveland Clinic Children's Hospital and as a Professor of Pediatrics at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Humberto Choi, M.D.  is a pulmonologist at Cleveland Clinic specializing in thoracic oncology, and a medical intensivist. He is the Medical Director of the Respiratory Institute Smoking Cessation Program.