Call an Ambulance, Call an Ambulance! … but Not for Me: Why E-Cigs Aren’t It

by: Kaavya Thanigaivelan

“Ayy, can I hit your juul real quick?”

Nearly all students across the US have sat through a seminar or two learning about the harms of drugs and their impacts on our health. Smoking cigarettes causes lung cancers, they taught us, and don’t drink and drive. Yet, the use of these substances is still a prominent and somewhat normalized part of our communities—especially among the current youth. Extending to the current generation of youth, drug usage is increasingly prevalent. One of the more recent additions to the market is electronic cigarettes, which were initially advertised as an alternative option for those who smoke cigarettes but have now been found to be ineffective in that very intention. E-cigarettes were introduced into the market and popularized because of their potential to help smoking cessation but have instead become the forefront of a new wave of drug culture. 

A major player in e-cigarette distribution is the Food and Drug Administration (FDA), a federal agency of the US Department of Health whose efforts are geared toward protecting and promoting public health. The FDA is responsible for evaluating and regulating products, ranging from foods to tobacco to vaccines. The FDA also monitors certain advertisements and marketing strategies to ensure public safety.

Electronic cigarettes, or e-cigarettes, are classified under tobacco products by the FDA because they contain nicotine, a highly addictive chemical. Once ingested, whether through smoking, chewing, or secondhand inhalation, the nicotine is absorbed into the bloodstream relatively quickly. It then travels to the brain, where the nicotine binds to nicotinic cholinergic receptors, which are structures on the exterior of nerve cells that control neurotransmitter release and uptake. Nicotinic cholinergic receptors regulate the chemical dopamine, which is a neurotransmitter associated with the pleasure and reward system. The ingested nicotine enables a large rush of dopamine release, and when the rush subsidizes, a craving for more emerges. This loop can quickly spiral into an addiction.

E-cigarettes produce an aerosol containing nicotine, flavorings, and other chemicals that are inhaled by the user. These fumes contain harmful chemicals, a major portion of which are carcinogens. Regular cigarettes contain around 7,000 carcinogenic substances––a far more potent cocktail than e-cigarettes, but that doesn’t necessarily mean e-cigarettes aren’t harmful. Regardless of the source, smoking cigarettes and e-cigarettes alike both increase the probability of developing lung cancer. 

E-cigarettes were initially produced and advertised as an alternative to assist smokers to quit smoking cigarettes. However, e-cigarettes have yet to be approved by the FDA as a smoking cessation medication, and the CDC claimed that due to its recent introduction into the market, little can be said about the long-term health impacts of e-cigarettes. In fact, new findings in a recent study by Richard Wang, MD, at UCSF now suggest that e-cigarettes actually do not help smokers quit. 

Dr. Wang’s study used the approach of performing random effects meta-analyses over 64 papers to compute the association of e-cigarette usage and smoking cessation. These 64 papers, 55 of which were observational studies and 9 were randomized clinical trials (RCT), were found through extensive searches in scientific databases. The four focal analyses were on the effect of e-cigarette usage among people who smoke regardless of their motivation to quit smoking; people who smoke and are motivated to quit; people who use the e-cigarette daily and less-than-daily and smoke; and people who were provided e-cigarettes in RCTs as a method of therapeutic intervention compared with conventional therapy. 

As Wang et al report, it was found over the nine RCTs that e-cigarettes were more effective in smoking cessation than conventional therapy. Additionally, among the observational studies of smokers and smokers motivated to quit smoking, “e-cigarette consumer product use was not associated with quitting.” Daily usage and less-than daily usage were associated with more and less cessation, respectively. 

It’s important to highlight that the intention of the e-cigarette user is important—if the user does not intend on quitting smoking regular cigarettes but is using e-cigarettes simultaneously, this is known as dual-use. E-cigarette users are more prone to dual usage because of this low cessation rate. In conjunction with the statistics on e-cigarette demographics, those between the ages of 18 and 24 are the most likely to partake in dual-use.

However, a notable issue of packaging has emerged, where manufacturers use misleading packaging or designs to appeal to younger individuals. Many e-cigarettes were, and still are, advertised as products that help smokers quit smoking tobacco cigarettes. The packaging and features also tend to be colorful and fruity to appeal to younger individuals. 

Drug culture is difficult to influence and manage once it gains traction. The demographic of those who use e-cigarettes is shifting to younger populations and is currently seen most commonly used between the ages of 18 and 29. According to the CDC, “Nicotine can harm adolescent and young adult brain development, which continues into the early to mid-20s.” Thus, the use of these substances has larger neurobiological implications for developing brains. 

Efforts to raise awareness about drugs, reducing substance abuse, and improving public health are more effective when implemented in a preventative stance. Since the late 20th century, programs such as the Drug Abuse Resistance Program, commonly known as D.A.R.E., have been implemented in earlier years of schooling in the US. However, it was later found through meta-data analysis that the D.A.R.E. program was ineffective in reducing drug abuse. This indicates that further revision of similar preventative programs needs to be made.

Hence, it is incredibly important to be mindful of the effects that suggestive advertisements have on our youth alongside the media’s widening platform in order to navigate the realm of drug use.

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