Electronic cigarettes (e-cigarettes) hit the market in 2003 when Chinese pharmacist Hon Lik created the first-ever commercialised device after losing his father to lung cancer. Hon himself was also a heavy smoker, and after his own failed attempts to quit, he was inspired to create something that would help with his cravings for ‘real’ cigarettes.
An e-cigarette contains a variety of components that essentially heat an e-liquid (which is put into the device and often contains flavours and nicotine) and creates an aerosol that is inhaled into the body and out into the air. When compared to a traditional cigarette, e-cigarettes appear to pose less harm, but in reality, vaping doesn’t come without risks.
Nicotine and the Young Brain
We’ve known for many years now that nicotine is both a highly addictive and harmful drug. Both human and animal studies have shown that nicotine itself can adversely affect many organs in the body. ”Its biological effects are widespread and extend to all systems of the body including cardiovascular, respiratory, renal and reproductive systems. Nicotine has also been found to be a carcinogenic in several studies.”1 When it comes to the effects on the brains of young people, we know that nicotine has a significant impact within the prefrontal cortex.
In our school seminars, we explain that the prefrontal cortex is the area of the brain in charge of things such as consequence prediction, social and emotional behaviour and processing, reasoning, decision making, conflict resolution, reward expectations, processing of outcomes and behaviour self-regulation. For young people, this area of the brain is still under development and will be until they’re 25-30 years of age. Since this area is still developing, it is particularly vulnerable and sensitive to the effects of nicotine.
Studies have shown that nicotine consumption during adolescence increases the risk of developing psychiatric disorders and cognitive impairments later in life2, as well as long-term changes in brain function relating to reward pathways, learning, memory and mood3, and can cause permanent susceptibility to nicotine addiction. With all of that being said, how much nicotine is actually present in an e-cigarette?
According to Stanford Medicine, one standard pack of 20 cigarettes contains around 20mg of nicotine. One JUUL pod contains around 41.3mg of nicotine (around 41 cigarettes), one Puff bar contains 50mg of nicotine (around 50 cigarettes) and 1 Suorin pod contains around 90mg of nicotine (around 90 cigarettes). While many people take anywhere from four days to two weeks to consume a pod, there are some who consume anywhere from 1-2 pods in a single day. On a young person’s brain, this amount of nicotine can have quite a significant effect.
Why are Young People Choosing to Vape?
Although vaping may have originally started as a way for smokers to quit traditional combustible cigarettes, the market has rapidly evolved to include a much wider client base.
While some young people do choose to use e-cigarettes as a way to help them quit smoking, some e-cigarette companies are choosing to market their products in ways that are highly engaging among young people.
Take the JUUL for example. JUUL is an e-cigarette company that was founded in 2015 and sells e-cigarettes and e-cigarette products. One of their early campaigns featured bright, vibrant colours alongside an attractive young female using their product.
Some companies are taking similar approaches and are marketing lolly-flavoured e-juices with bright, attractive packaging and eye-catching social media campaigns. Flavours such as gummy bears, sour worms, pink lemonade, pancakes, bubble gum, cookies and cereal covered churros are all available online and in some retail shops.
A 2019 study looked at why young people enjoyed using the JUUL e-cigarette and the top three answers were: “it gives me a buzz” (52%), “I like the flavours” (43%) and “my friends use it” (36%).
Many young people also believe that vaping is safe, and that e-cigarettes essentially produce flavoured water vapour. While, in fact, these devices produce an aerosol that can contain harmful chemicals and ultra-fine particles which is then inhaled into the lungs and out into the environment. While it may seem that e-cigarettes are a safer alternative to traditional cigarettes, the reality is, no one knows enough about e-cigarettes to make those claims. There haven’t been enough studies or adequate findings to say for certain that e-cigarettes are better or even safe to use in the first place.
In Australia, it is illegal to sell e-cigarettes and e-cigarette products to anyone under the age of 18. Australia also boasts an extremely high number of young people (96.6%) who have never tried tobacco before. A concern voiced by educators and researchers is that vaping is re-normalising smoking to young people in Australia. The Cancer Council, along with their Tobacco Issues Committee chair, Libby Jardine, stated that “We’ve made huge progress in tobacco control in Australia and we wouldn’t want to see any of that good work undone by a product that looks to hook young people through lolly flavours.”
Is Vaping a Good Alternative to Smoking?
In short, no one can say for certain if vaping is a good alternative to smoking tobacco. Regular tobacco cigarettes contain around 7,000 chemicals, many of which are toxic. There’s no doubt that vaping exposes you to fewer chemicals than traditional cigarettes, but we don’t know exactly what all those chemicals are and what effect they are having on people.
In 2019, the Centre for Disease Control and Prevention (CDC) recognised a new illness associated with vaping which was named: E-Cigarette or Vaping Associated Lung Injury (EVALI). Since then, more than 2,800 cases have been reported in the United States and 68 deaths have occurred. For the most part, the cases appear to predominantly affect people who either used modified e-cigarettes or black market/modified e-liquids. This was especially true for vaping products that contained THC. It was also found that Vitamin E acetate was a chemical of concern among people with EVALI.
Vitamin E acetate is a thickening agent which is often used in THC vaping products and was found in all the lung fluid samples of EVALI patients examined by the CDC. Unlike the U.S., Australia has not had an outbreak of EVALI, and according to Associate Professor Irving (Director of Respiratory and Sleep Medicine at the Royal Melbourne Hospital), it’s unclear if there has ever been a reported case of EVALI in Australia. However, he does warn that since vaping is on the rise in Australia, it is something that could possibly become seen here. Associated Professor Irving also explained that when Vitamin E breaks down at high temperatures, it generates a toxic substance that can cause acute lung injury. This can also happen in a variety of other ‘safe’ substances that are added to e-liquid such as aromatic organic compounds, which in their natural form may be completely safe, but turn unsafe when vaped and heated at high temperatures.
With such a limited understanding of e-cigarettes and their effects, the Australian Government Department of Health does not currently classify vaping as safe. Even though they do not produce tar-like conventional cigarettes (which is the main cause of lung cancer), many scientists are concerned that e-cigarettes could increase risk of lung disease, heart disease and cancer. It is very difficult to assess the safety of e-cigarettes and e-liquids due to a variety of reasons, such as the wide variety of devices and liquids which are available on an ever-growing market, labels that can be incomplete, incorrect or misleading, and users (or sellers) modifying devices and liquids in ways which may cause more harm. Overall, until more is known about vaping and its effects, it’s best to seek other alternatives to smoking cessation.
1 Mishra, Aseem et al. Harmful effects of nicotine
Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology vol. 36,1 (2015): 24-31. doi:10.4103/0971-5851.151771
2 Goriounova, Natalia A, and Huibert D Mansvelder. Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function
Cold Spring Harbor perspectives in medicine vol. 2,12 a012120. 1 Dec. 2012, doi:10.1101/cshperspect.a01212
3 Slotkin, Theodore A. Nicotine and the adolescent brain: insights from an animal model
Neurotoxicology and teratology vol. 24,3 (2002): 369-84. doi:10.1016/s0892-0362(02)00199-x