Electronic cigarettes (e-cigs) or vape pens may ultimately prove to be worse than regular cigarettes and other forms of smoked tobacco. Largely unregulated and untested, the harm caused by e-cigs may not show up for years.

About 10 million Americans regularly use vaping products. It is estimated that millions more teenagers use them occasionally. Teenagers comprised more than 20 percent of the total users in a 2016 survey.

Q. How do vape pens and e-cigarettes work?

A. Vape pens are plastic and/or metal devices about the size of a large pen, flash drive/USB drive or an oral thermometer. E-cigs look like a cigarette or small cigar. There are more than 460 types of these devices on the market today. A liquid that contains nicotine, additives and usually a flavoring (called “juice”) is added to the device. A battery system inside the device heats the liquid, turning it to vapor or aerosol that can be inhaled (called vaping). In many types, puffing activates the battery-powered heating device to produce vapor.

E-cigs have a rechargeable or disposable battery and disposable liquid cartridges, so there’s no tank to refill. Vaping pens or vaporizers use a rechargeable module combined with interchangeable liquids. They are usually larger than an e-cig and have a longer battery life. In most vape pens, the liquid can be switched in and out for more variety in flavors.

Q. I’m trying to quit smoking. Is vaping a healthier way to cut back?

A. Theoretically yes. The potential advantage – nicotine-free flavorings and no smoke – is liberally used by the industry to sell their product. To be healthier you would need to choose a nicotine-free flavoring to reduce and eventually stop your nicotine addiction. It has worked for some people and to a varying degree of success for others. The most effective use of vaping to quit nicotine is to use the device exclusively. However, most adults do not stop smoking cigarettes and continue to use both products. Known as “dual use,” it is not an effective or healthy way to quit.

Smoking even a few cigarettes a day can be dangerous. To protect your health, it is very important to stop nicotine in all forms. If you’re ready to quit smoking, visit Be Well Arkansas website or call 833-283-9355. You’ll learn about free options to help you quit smoking and maintain a tobacco-free life. At this site, you can chat with a wellness counselor, get a doctor referral for medications, sign up for motivational text messaging, get smoke free apps and more. This is a healthy alternative that uses proven, evidence-based ways to help you quit. And, you won’t have to buy vaping products.

Q. Should I be worried if my 16-year-old son has started vaping?

A. Yes, you should. Here’s why: the brains of children (until about age 24) are still forming. Early exposure to nicotine can reduce brain activity and reduce the ability to concentrate and remember things. Other risks include mood disorders and permanent problems with impulse control, according to the National Institute on Drug Abuse.

Nicotine addiction almost always starts before one’s early 20s. Very few people start smoking after the age of 25. If your son becomes addicted to tobacco (remember, some vaping liquids can provide twice as much nicotine as a cigarette) at such a young age, his chances of being free of nicotine throughout his life are slim to none.

Many kids who start vaping eventually progress to real cigarettes. It may be the gateway drug to nicotine addiction. While it’s certainly possible to stop nicotine, most ex-smokers say they still crave a cigarette. According to Medscape, multiple studies in different cultures have shown that teenagers who regularly use vaping products are more likely to eventually switch to smoking tobacco products. Because nicotine activates the brain’s rewards circuits and reinforces pleasure, vapers are at a higher risk for addiction to alcohol and other drugs.

Vaping is now the most commonly used form of tobacco among teenagers. According to the Centers for Disease Control and Prevention, nearly 4 million middle and high school students used vaping products in the past month, including 5 percent of middle-schoolers and 21 percent of high schoolers. In 2017, about 3 percent of U.S. adults used vaping products.

The sweet flavorings attract teenagers and give the false impression that the product is harmless. Teenagers are becoming addicted to nicotine before they realize what’s happening. In a 2018 study, 80 percent of teens said they would not use the product if the flavorings weren’t available. Teens, who may have never smoked a cigarette, are attracted because inhaling the vapor is not harsh like burned tobacco. And, vape pens can and are being used to deliver marijuana and other drugs.

Q. Isn’t it healthier to inhale vapor rather than smoke? At least there’s no secondhand smoke.

A. Vaping does produce secondhand “smoke” and it may be as dangerous as cigarettes’ secondhand smoke. Bystanders can inhale this “vape smoke” when the user exhales. Vape smoke can cling to household surfaces and clothing – often referred to as thirdhand smoke. It just smells different than tobacco smoke.

There’s been almost no testing of the side effects or long-term consequences of the vapor. What research that has been done is decidedly negative. Because it’s vapor, it can go deeper into your lungs than smoke. Some of the ingredients used in flavorings are known to impair lung function. Does that increase your chances of lung cancer? No one knows that yet. The industry is only about 10 years so. Because the product is so new and it can be sold without product testing, we don’t know its health impact. But how can vaporized chemicals sucked deep into your lungs be good for you? Also, the higher levels of nicotine increase adrenaline in your heart. This elevates blood pressure and the risk for heart disease, heart attack and stroke.

If you must have nicotine, vaping keeps you from having to inhale tobacco smoke and numerous chemicals into your lungs. But Juul, the most popular vaping manufacturer, sells vaping liquids with twice the concentration of nicotine compared to a regular cigarette.

Q. The flavoring ingredients are made from vegetable products so they’re not dangerous, right?

A. Wrong. The flavoring ingredients, while safe to take orally, have not been tested for safety when heated into vape smoke. The nearly 8,000 e-liquid flavorings now on the market have not been tested as combustibles. We don’t know what damage they may cause in five, 10 or 20 years.

We do know that the chemicals that are produced during the vaporizing process contain known cancer-causing and toxic chemicals.

Also, the incidence of children being poisoned by the flavorings continues to increase. Makers of the flavoring liquids package them to look (and smell) like juice boxes, cookies, candies, whipped cream and other sweet foods that children like. Even a very small amount can poison a small child or a pet. Arkansas has twice the rate of nicotine poisonings as the national average. In a five-year period more than 8,000 children suffered nicotine poisoning in the United States. Most poisonings happened to children under the age of three. Nicotine-laced flavorings can also cause poisoning by being absorbed through the skin.

If you use a refillable vape pen, keep the pen, empty cartridges and liquid bottles out of the reach of children and pets. The National Poison Control Center says the symptoms of nicotine poisoning include nausea and vomiting, dizziness, tremors, sweating and rapid heartbeat. Severe poisoning can cause seizures or even death. Seizures can happen within 20-30 minutes of swallowing nicotine products.

Q. Are vaping devices inspected and regulated for safety?

A. Until 2018, they were an unregulated product. Most are manufactured in China, a country that does not have the same safety laws or safe manufacturing practices that American manufacturers must follow.

There’s been very little study of the long-term safety or health risks of using these products. The federal Food and Drug Administration (FDA) first began regulating vaping devices as a tobacco product in 2016. The rule that manufacturers must first submit an expensive “premarket tobacco application” before they can sell their products was delayed until 2022.

An additional health risk is that the heating coil that generates the vapor can deposit into your lungs highly toxic metals like lead, chromium, nickel, cadmium and manganese. Vaping products can cause unintended injuries such as fires and explosions if handled improperly. Most explosions happen when the battery is being charged. Poor quality batteries are often made without the overcharge protection.

Most of the concern from Congress and the medical community is focused on targeting under-age sales tactics, such as packaging and advertising that targets young people. Only recently has the FDA prohibited the sale of vaping products to minors. They have also started to regulate the manufacture, packaging, labeling, advertising and importation of these devices.

Regulation can have an impact. For example, in states that have more and stricter tobacco control policies, such as no indoor smoking or higher tobacco taxes, have the lowest rates of vaping.

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