Texas A&M School of Dentistry

Healthy Living

More questions than answers with ‘vaping’ craze


Sleek, tobacco free and with odorless vapors, are e-cigarettes the perfect drug? Are they safe?

It seems there’s an electronic cigarette out there for everyone. Some are housed in chic pen-shaped canisters to make refilling easy, with customizable kits and carrying cases. There are disposable varieties for those who don’t want the fuss of maintenance. The vapors they produce don’t smell, and the tip emits a blue LED light. The flavor choices are endless. Don’t like traditional tobacco flavor? Try black walnut or green tea menthol.

05experts-ecigarette“The use of e-cigarettes has the potential to renormalize smoking,” says Dr. K. Vendrell Rankin, professor and associate chair in public health sciences, who is director of Texas A&M Baylor College of Dentistry’s Tobacco Treatment Services clinic. “You’re sort of an ostracized person, an outlier, if you’re a smoker. If you’re using e-cigarettes, you have TV commercials, you have celebrity endorsements; it’s the in thing.”

E-cigarette manufacturers are known for their bold advertising reminiscent of the tobacco industry’s glory days. Some even have celebrity backing — pop culture icons like Bruno Mars, Avicii and Jenny McCarthy are just a few to endorse select brands.

E-cigarette use, or “vaping,” a reference to the nicotine, flavor and other chemicals converted into an aerosol that users inhale, has grown to staggering numbers. The Centers for Disease Control and Prevention estimate that 21 percent of U.S. adults who smoke conventional cigarettes have used e-cigarettes. The number is disturbingly high for teens: In 2012, 10 percent of high schoolers used e-cigarettes at least once, and a total of more than 1.78 million middle and high school students reported trying them that year.

There’s no doubt the tobacco-free, battery-operated devices are all the rage. But are they safe?

“I think the biggest myth is that the difference is between safe and safer,” says Rankin. “Yes it probably is safer, but it’s not risk free.”

Since the U.S. Food and Drug Administration doesn’t yet regulate e-cigarettes, the nicotine content can vary widely among the more than 250 brands on the market, ranging from .5 to 15.4 milligrams, according to a recent study from the Annals of the American Thorasic Society. A conventional cigarette, by comparison, yields a more predictable 1.54 to 2.6 milligrams of nicotine. Even e-cigarettes with labels that say zero nicotine may not be entirely nicotine free.

Safety concerns surrounding e-cigarettes sprang to the fore in early April, when the CDC released a study showing poison center phone calls related to the devices had jumped from just one a month on average in September 2010 to 215 a month in February 2014.  The liquid used in reusable e-cigarettes contains nicotine, which poses a health risk to adults and children alike when it is ingested or comes into contact with the skin.

And what about the impact of secondhand vapor? While studies have demonstrated e-cigarette vapor exposes non-users to nicotine, more research is needed to show the exact health risks.

Understanding the potential repercussions of e-cigarettes may require a little lesson in history. From the time cigarette use began to increase in the U.S. in the 1920s, it took more than 30 years for concerns regarding lung cancer to surface. It wasn’t until 1998 that the Tobacco Master Settlement Agreement revolutionized the way the tobacco industry markets, packages and sells cigarettes.

By contrast, the first e-cigarettes came to the market in China in 2004, when they were created by pharmacist Hon Lik. Since e-cigarettes weren’t put through the rigorous testing and trials required for pharmaceutical companies to market them for use in smoking cessation, they were picked up for commercial use.

“Are they safe?” asks Rankin. “We don’t know. The reason we don’t know is because we don’t have 100 years of experience. We have about 10 years of experience.

“It does impair lung function. We know it’s less than with cigarette smoking, but we still don’t know what the long-term effects would be after 50 to 100 years.”

When Rankin is in the college’s third floor clinic, she talks with patients about e-cigarette use. A pattern has emerged.

“I see a lot of patients who are using the e-cigarette to either reduce the amount they smoke or to quit smoking, and they don’t want tobacco counseling,” says Rankin. “This is so close to mimicking a cigarette that they’re not getting help with the behavioral issues, so the transition from smoking to not smoking is not happening because there are no coping mechanisms.

“If patients are using them for cessation, I really try to encourage them to get some behavioral support.”

Those who seek the college’s services offered through the tobacco cessation program meet with Elain Benton, a dental hygienist and counselor at the center.

“The first thing that I ask them is, ‘What is your purpose with using them? Is it replacing cigarettes, or are you tapering down until you quit?’” says Benton. “I ask, ‘What do you know about them? What milligram are you using?’ A lot of them don’t even know. That’s the scary part.”

For patients whose goal is quitting nicotine use entirely, Benton will recommend a combination of nicotine replacement products such as a nicotine patch or prescription medication in combination with gum or lozenges, so that when breakthrough cravings occur, the patient has enough nicotine to resist using tobacco products.

But getting patients to choose pharmaceutical nicotine replacements can be an uphill battle. Nicotine from the average cigarette or e-cigarette reaches the brain within 10-12 seconds, says Rankin.

“None of the nicotine replacement products deliver it that rapidly,” she says.

“I think in many peoples’ minds it’s, ‘I have quit smoking,’” Rankin says, referring to e-cigarette use. “You have quit smoking cigarettes, but you’ve transferred your nicotine acquisition to another form, which is probably safer but not safe. Safe is not using nicotine at all.”

What are electronic cigarettes?

Manufactured to look like conventional cigarettes, cigars or pipes, these battery-operated devices turn nicotine, flavor and other chemicals into an aerosol form that users inhale.

Source: U.S. Food and Drug Administration

—Jenny Fuentes