Valerie Pavilonis

Amid the recent outbreak of vaping-related illnesses across the country, researchers have begun to question two previously lauded aspects of e-cigarettes: Are they actually safer than traditional cigarettes, and are they effective for smoking cessation?

Following the beginning of the crisis in April 2019 and the first death in August, the Centers for Disease Control and Prevention has confirmed 1,479 cases of vaping-related lung injury with a total of 33 deaths, including one in Connecticut. As of last week, the CDC is tentatively calling the disease EVALI — an acronym for “e-cigarette or vaping product use-associated lung injury.” Although recent studies have attempted to identify the long-term health effects of vaping and compare them to those of combustible tobacco products, researchers have struggled to reach any definitive conclusions.

“These vaping-related lung injuries are a national public health crisis,” said Connecticut Department of Public Health Commissioner Renée D. Coleman-Mitchell. “We continue to work with the CDC and other partners to find out the specific root cause of these troubling lung injuries. While the investigation continues, I am asking Connecticut residents not to use e-cigarette or vaping products that contain THC. I also want to remind everyone that as a matter of public health, there is no safe tobacco product.”

One research review published in The BMJ on Sept. 30 examined hundreds of studies published from 1980 to 2019 on the effects of combustible tobacco products and e-cigarettes in humans, animals and in vitro experiments. The review found that both chronic and short-term e-cigarette use generate pulmonary toxicity and may decrease immune function, thereby increasing susceptibility to bacterial and viral lung infections.

The authors found that literature on the use of e-cigarettes for smoking cessation is “limited and mixed.” For example, one study concluded that e-cigarettes are more effective at helping smokers quit than other nicotine replacement products, such as gum or patches, but others show that many adult e-cigarette users continue to smoke traditional cigarettes.

Still, scientists are unclear on the long-term public health risks of using e-cigarettes.

“Decades of chronic smoking are needed for development of lung diseases such as lung cancer or chronic obstructive pulmonary disease, so the population effects of e-cigarette use may not be apparent until the middle of this century,” the review stated. “Current knowledge of these effects is insufficient to determine whether the respiratory health effects of e-cigarettes are less than those of combustible tobacco products.”

Despite the reputation that using e-cigarettes can be used for smoking cessation, the Food and Drug Administration has yet to approve any electronic nicotine delivery system — or ENDS — as marketable for helping smokers quit, according to Michael Felberbaum, a senior media representative for the FDA.

“There is … the terrible risk of having millions of new Americans become lifelong addicts to a new class of products that are not safe,” said FDA Acting Commissioner Ned Sharpless.

The FDA has recently increased regulations on e-cigarette producers, and it is continuing to support research into the health effects of vaping.

Juul Labs, the manufacturer of the most popular vaping product in the United States, has faced backlash for its role in commercializing e-cigarettes, appealing to youth and contributing to the prevalence of EVALI. Juul has responded by reducing its social media presence, strengthening online age verification protocols and refraining from lobbying the federal government. Most recently, on Oct. 17, they indefinitely suspended the sale of fruit- and dessert-flavored products.

“We must reset the vapor category by earning the trust of society and working cooperatively with regulators, policymakers and stakeholders to combat underage use while providing an alternative to adult smokers,” said K.C. Crosthwaite, the company’s new CEO and former executive at the tobacco company Altria.

Juul media representatives did not respond to a request for comment.

Smoking causes more than 480,000 deaths each year in the United States.

 

Ako Ndefo-Haven | ako.ndefo-haven@yale.edu