Thursday, May 21, 2015

Q&A with John Winickoff, MD, MPH: The Dangers of E-Cigarettes and Nicotine Products

John Winickoff, MD, MPH
Jonathan Winickoff, MD, MPH, a primary care physician at MGHfC.

What are e-cigarettes and how do they differ from other tobacco and nicotine products?
Electronic cigarettes, or e-cigarettes, are battery-powered devices that deliver nicotine into the body by inhalation, similar to the way a traditional cigarette delivers nicotine to the body. The nicotine comes as a liquid in a cartridge that attaches to a device, which then converts the nicotine into vapor. Nicotine is the addictive substance in traditional cigarettes, e-cigarettes and many other products. Using an e-cigarette is also called "vaping" because users inhale the nicotine vapor.

Does that mean e-cigarettes are safer than other tobacco and nicotine products?
Research to date indicates that some e-cigarettes might be safer when compared with combusted tobacco, but they are not safe. E-cigarettes are dangerous because the user inhales the drug, which is nicotine, and many other substances directly into the lungs. The nicotine and other substances in e-cigarettes are not regulated. The advertising surrounding e-cigarettes can make them seem healthy because of the fruit flavors and the fact that the aerosol is described as a harmless “mist” or “vapor.” There are more than 400 electronic products available, from e-cigarettes to vape pens to electronic hookah pipes.

The advertising for e-cigarettes can also seem appealing to teens because of the celebrities, supposed glamour and the ability to personalize e-cigarettes with flavored liquid and different cartridge designs. This advertising can make it appealing to teens who most likely would not have been tempted to try tobacco and nicotine products in the first place.

How does nicotine affect teens’ developing brains and bodies? Are those effects different from those of other tobacco and nicotine products?
Nicotine, including nicotine aerosol, has stronger effects on a teen’s developing brain. The brain, especially the area related to judgment, doesn’t fully develop until around age 25, so e-cigarettes create a perfect storm for addiction in teens' brains. The reward center in a teen’s developing brain has a stronger response than an adult’s brain to tobacco and nicotine products. This means teens can become addicted in a shorter amount of time and with a smaller amount of nicotine. It’s also harder for teens to quit once they become addicted because the pathways in the brain related to addiction are formed sooner and are strengthened by the nicotine.

The teen years are for taking risks, which is normal. Some risks, however, are more foolish than others. From what I know about brain development, using e-cigarettes and other tobacco and nicotine products is a foolish risk. Once teens start, they have less of a choice and less control over their bodies because of the nicotine addiction. The earlier teens start using these nicotine containing products, the greater the chance of them being controlled by it.

There are other products available with nicotine in them and those products seem safe. What’s the difference between those and the nicotine in an e-cigarette?
The difference is that the nicotine in e-cigarettes isn’t approved or regulated by the U.S. Food and Drug Administration (FDA). For example, the nicotine that is approved and regulated is in products designed to help people quit, like nicotine patches, gum or nasal spray. The nicotine enters the body in a controlled way in certain approved doses. Because the nicotine in e-cigarettes isn’t regulated, the number of toxins might be significantly higher and the dose of nicotine unknown. The lack of regulation means e-cigarette companies don’t have to disclose the e-cigarette’s ingredients. A few tests conducted by the FDA on one e-cigarette brand conducted found anti-freeze as one of the ingredients. It’s not only an issue of poor quality control, but also one of marketing to youth to try to get them hooked on nicotine.

What efforts have been made in Massachusetts to help reduce teen tobacco and nicotine product use?
Since 2005, more and more towns in Massachusetts have raised the legal sales age for tobacco and related products to 21. There are currently 58 cities and towns in Massachusetts that have raised the tobacco sales age to 21, and House Bill 2021 is helping to increase the number of towns to do the same.

Raising the sales age to 21 is designed to protect teens’ developing brains for a bit longer, so it’s harder for them to become addicted because the access is reduced. There are fewer 15-17-year-olds who have access to 18-year-olds who could potentially buy tobacco and nicotine products for them. Fewer teens in this age group also have connections to 21-year-olds, which would also make access more difficult in high school. Additionally, many colleges are moving toward smoke-free campuses, so that also makes it harder for teens to have access to these harmful products.

What can parents do to help teens who are thinking about trying e-cigarettes or who have already started using e-cigarettes and other products?
Parents should have clear rules against experimenting with tobacco and nicotine products and clear consequences if their teens do experiment with them. Parents should be clear with their teens on how they stand on the issue of using tobacco and nicotine products. They shouldn’t just assume teens won’t experiment. There is literature that found when parents express disapproval of a particular behavior, like using tobacco and nicotine products, it was associated with teens not using those products. Parents can also support raising the sales age to 21 in their communities.

If parents are smokers or users of other tobacco products, try to quit. There’s no age at which quitting is a lost cause.There are many resources to help people quit, including 1-800-TRY-TO-STOP, which is a free quit-line, and the smokefreetxt program, in which people can text QUIT to IQUIT. Doctors can also help with lifesaving medications and strategies to cut down on and quit using tobacco products. Parents can also try not to use tobacco products where children live, while driving or in the presence of children. The risk of teens using tobacco products doubles if parents also use those products.

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