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Institute for Global Tobacco Control

Vaping Q&A: IGTC Director on E-Cigarettes and Tobacco Alternatives

Vaping-related illnesses and deaths have drawn national attention since they first were documented in late 2019. More than 2,700 cases of lung disease and 60 deaths associated with e-cigarette use have been recorded in all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands) as of January 21, 2020, according to the CDC.

Joanna CohenThe illnesses and deaths emphasize that there are risks associated with vaping, says Joanna Cohen, PhD, Bloomberg Professor of Disease Prevention and director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

In this Q&A, Cohen shares her thoughts on myths behind vaping, what’s in e-liquids, how e-cigarettes are marketed to young people, and other issues.

What caused the sudden surge in illnesses and deaths related to vaping?
Health authorities have made progress in identifying what is causing the severe respiratory illnesses and deaths related to vaping. The data show that vitamin E acetate, which has been found in some vaping products that contain tetrahydrocannabinol (THC), is linked to most cases. However, it is believed that other chemicals in either THC-containing or non-THC products may still play a role in some of the lung injuries.

How would people know if their vaping cartridges are safe?
Vaping is not safe.

The propylene glycol and/or vegetable glycerin that form the basis of e-liquids are generally regarded as safe for ingestion, but we do not yet know the effects when inhaled. The Surgeon General has concluded that nicotine in e-cigarettes can harm the developing brain. Little is known about inhaling flavor chemicals, but some ingredients used as flavorants are clearly harmful when inhaled. And there can be many other kinds of chemicals in the liquids people vape.

People are using vaping devices to vape other substances, including THC. There are no regulations yet on what the e-liquids contain, and there could be contaminants.

No one should be vaping unless they are a cigarette user trying to quit using cigarettes.

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Go deeper into the dangers of vaping with this fact sheet from the Centers for Disease Control

What’s your advice for people who used to smoke traditional cigarettes and have switched to vaping since it was supposed to be safer? Should they go back to tobacco?
The only group who should use vaping products are cigarette smokers who are trying to quit smoking, or former smokers who have successfully switched to vaping. If you fully switched and no longer smoke cigarettes, congratulations! Now, it’s important to try to get off vaping products as well because these products are not safe.

If you are in the midst of trying to quit smoking, do not go back to using cigarettes. However, you should monitor yourself for the symptoms associated with the outbreak related to e-cigarette use. The CDC has advice for the public.

Why are flavors in e-cigarettes being targeted for regulations?
Flavors are a focus of regulations because flavored products appeal to youth. Most youth who vape use a flavored product.

How has vaping been marketed to children and young people?
Youth have been exposed to marketing for e-cigarette products through a range of channels, including social media/social influencers, product displays in stores, and ads outside of stores.

E-Cigarette Policy Scan

What laws on e-cigarette sales to young people exist?
The Public Health Law Center tracks e-cigarette laws at the state level. There are laws related to vendor licenses, product packaging, taxes, and sales to minors. A handful of states currently ban the sale of flavored e-cigarettes (e.g., Massachusetts, Rhode Island, and Washington), some through emergency orders. Over 250 localities in the U.S. have placed some sort of restrictions on the sale of flavored e-cigarettes.

The FDA requires a warning on liquid nicotine. And, at the beginning of the year, the FDA issued a policy to prioritize enforcement of unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint.

There is now a federal law that prohibits the sale of tobacco products, including e-cigarettes, to people under the age of 21. Previous to this national law, 19 states have raised their tobacco sales age to 21.

The Institute for Global Tobacco Control tracks e-cigarette policies at the country level.

What are some common myths/perceptions about vaping that are refuted by evidence?
One common myth is that vaping is safe. E-cigarettes have been available for just over 10 years, and there is evidence that these products can result in negative effects on our lungs, breathing, and cardiovascular system. E-cigarettes are NOT safe. Cigarettes are also not safe; in fact, they are extremely lethal. So if cigarette smokers have tried various approaches to quitting smoking, unsuccessfully, it is felt at this time that they can try to use e-cigarettes to help them quit cigarettes.

What should schools do about young people and vaping? Pediatricians? Parents?
No one other than cigarette smokers trying to quit smoking should be using e-cigarettes.

Schools should prohibit vaping … but realize that when they find a student who is vaping, that student needs their help to get off e-cigarettes. The same with parents and pediatricians. They should advise kids not to use e-cigarettes, and then provide help and support to quit if their child or patient is using these products.

What’s Big Tobacco’s role in e-cigarettes?
All major tobacco companies own e-cigarette brands. For example, Altria has a 35% stake in Juul, and RJ Reynolds Vapor company is a subsidiary of RJ Reynolds American and markets the Vuse line of e-cigarette products.

E-cigarettes fit well into Big Tobacco’s playbook. Tobacco companies have been promoting “safer” tobacco products since the 1970s and even earlier, so their customers could choose alternative products without having to quit. Unfortunately, we’re seeing the same thing happen with e-cigarettes; so far, most e-cigarette users are also using cigarettes.