In the third quarter of 2019, the U.S. experienced an outbreak of lung illnesses associated with electronic cigarettes that caused many deaths. The Centres for Disease Control and Prevention (CDC, 2020) state that since the introduction of the e-cigarette devices to the U.S. market, any youths and some older people have adopted vaping as a measure of cessation of smoking traditional cigarettes. Non-smokers are attracted to vaping due to the belief that vapors produced by e-cigarettes are less harmful as compared to the ordinary cigarettes. Vaping involves the inhalation and exhalation of aerosol in form of vapor produced by electronic cigarette devices that may contain nicotine, tetrahydrocannabinol (THC) as well as cannabinoid (CBD) oils, flavorings, or other chemicals. The device contains a battery that heats up the liquid contents in the cartridge, producing vapor like aerosol. Despite its popularity in the U.S., vaping is a major public health concern that has prompted the federal government as well as some states to initiate policies for regulating the sale of e-cigarettes.
The Consumer Advocates for Smoke-free Alternative Association (CASAA, 2020) state that the initial idea of this nicotine device was conceived by Joseph Robison, who secured its patent in 1930. In the 1960s, a device similar to the current e-cigarette, though not electronic, was developed by Herbert A. Gilbert. The device however, was not commercialized until early 1979 when Phil Ray in conjunction with Norman Jacobson, developed a commercialized type. According to CASAA (2020), this device operates through evaporation, a concept that has greatly contributed to the creation of modern e-cigarettes. In the 1990s, CASAA (2020) states that a renowned U.S. tobacco company was denied permission by the Food and Drug Administration (FDA), to release a commercialized variation of e-cigarette to the market, with the claim that the device was unapproved. Consequently, the advancement of e-cigarette technology stagnated. Hon Lik, a heavy smoker, pharmacist, and inventor created the first commercially successful e-cigarette device in Beijing. The electronic nicotine delivery devices were then introduced to different markets, including the U.S, Australia, Turkey, New Zealand, and Canada.
The older and young people have adopted vaping but it is more common among the youth than older people. Schaeffer (2019) notes that while older people smoke ordinary cigarettes than youths, more youths engage in vaping compared to older adults. The rate of vaping among adults is 9% while that of youths between ages 18 to 29 is 20%, as revealed in a 2018 Gallup poll. The number of youths and teenagers who try vaping increases annually. Schaeffer (2019) states that between 2017 and 2019, the number high school and college students who vaped had doubled. Similarly, the CDC (2020) found that there were more young patients than older ones in the recent national outbreak of EVALI (e-cigarette or vaping product use-associated lung injury) in the United States. Pineiro et al. (2016) argue that both males and females try vaping, though it is more popular in males than females. In an online survey consisting of 1815 participants, Pineiro et al. (2016) say that 66.8% of them were males.
Vaping products harm the environment. The e-cigarette devices contain single use plastic pods, hazardous batteries, as well as the heavy metals, such as lead and manganese, which are a potential threat to the environment. Truth Initiative (2019) posits that popular e-cigarette manufacturing companies like JUUL (Juice USB Lighting) lack recycling programs for their plastic products. Consequently, these plastic wastes are disposed improperly, thus polluting the environment. According to Martinovich (2019) the disposal of these devices is a major environmental concern, since nicotine residuals, heavy metals, as well as other toxic chemicals might leach into water bodies and the soil. Similarly, the waste of plastic pods can end up in rivers or oceans, resulting in contamination and posing a threat to the survival of sea animals.
Lithium ion- containing batteries present in e-cigarettes are hazardous. Martinovich (2019) says that major fires occurring at the sites of recycling are associated with explosion of these batteries. Additionally, Martinovich (2019) argues that the heated components of the electronic cigarettes can produce endocrine-disruptive chemicals (EDC), which according to the WHO, are associated with a wide range of health complications ,such as impaired reproductive functioning in all genders, heightened cases of breast cancer, irregular patterns of growth, and interruption of children’s neurodevelopmental system. While there is limited scientific information regarding the effect of e-cigarettes on the environment, proper usage and disposal of the device should be considered.
Epidemiological Research Data
E-cigarette users are more susceptible to lung illnesses than non-users. Research reveal that young people who vape are more likely to experience increased coughing, wheezing, as well as asthma flares, as compared to non-users (Aubrey, 2019). Vaping products contain toxic substances that potentially cause harm to the user’s lungs. Aubrey (2019) suggests that electronic cigarette users have a 30% increased likelihood of contracting lung illness compared with nicotine non-users. Adults who engage both in vaping and smoking instantaneously are at higher risk of developing respiratory diseases compared with those who use e-cigarettes only. The surge of the EVALI cases stimulated the CDC and the FDA to investigate the main causes of the disease. The CDC (2019) report that the commonly vaping substances used by the patients include THC and nicotine products that are considered toxic to health, with 82% of the patients reporting the use of products containing THC, while 57% reporting the usage of products that contain nicotine. THC has been identified as one of the substances contributing to the EVALI outbreak, following the reports from patients’ sample results. The THC substance was not present in the fluid samples of healthy individuals, thus, linking it to EVALI. Equally, the CDC (2020) found that Vitamin E acetate, which is an additive in some of the e-cigarettes that contain THC, has played a role in the outbreak, after the substance was detected in most of the patients’ lung fluid samples. When inhaled, the CDC (2020) argue that Vitamin E acetate interferes with the normal functioning of the lungs. According to CDC (2020), 2,807 cases of lung injuries linked to vaping, including death cases had been reported by all states as of February 18, 2020, with a total of 68 number of deaths being recorded by 29 states including the District of Columbia. Out of the total number of cases reported, 66% were male. All states reported cases of EVALI during the outbreak.
Public Health Issues and Interventions
Vaping is currently a major public health concern. When e-cigarettes were first introduced, they were considered as safer tools for cigarette smoking cessation. However, researchers indicate that the prolonged use of e-cigarettes potentially exposes victims to a wide range of health issues (Teijlingen, 2019). Some of these issues include heart attacks, seizures, cancer, and harm on youth brain development that is caused by nicotine, which interferes with the brain cell activity, reducing the levels of attentiveness, memory, and learning (Wein, 2019). . CDC (2020) warns that youths, young adults, and pregnant women should avoid using e-cigarette products since they are susceptible to vaping related illnesses. The surging rates of youths who vape as well as the lung injuries linked to vaping have been have been major health concerns. Consequently, in November 2019, the American Medical Association (AMA) in conjunction with the Public Health Officials addressed a letter to the White House advocating for the complete ban of all vaping products that fail to meet the FDA approval (AMA, 2020). Moreover, educational and preventative programs, such as the American Lung Association’s INDEPTH (Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health) have been put in place to help youths and teenagers to quit vaping (American Lung Association, 2020). The free text message program by the Truth Initiative organization also assists users of e-cigarettes to quit vaping.
Diagnosis and treatment of illnesses related to vaping are still unclear. The CDC (2020) notes that a precise test for EVALI lacks at present, and assessment should be conducted using clinical judgment. The entity recommends that the healthcare providers ask patients with known or suspected EVALI if they vape, obtain chest imaging, and consider outpatient treatment for stable cases. They should also test for influenza and administer antimicrobials and antivirals accordingly, cautiously prescribe corticosteroids for outpatients, suggest evidence-based treatment approaches to assist patients quit vaping, and emphasize the need for annual influenza vaccinations for individuals who are aged 6 months and above. Moreover, hospitalized patients must be considered clinically fit for 24-48 hours before being discharged, and must be offered a follow-up to ensure wellness (CDC, 2020). Health organizations such as the World Health Organization (WHO) and Food and Drug Administration (FDA) do not approve the usage of e-cigarettes because of the health risks associated with the vapor contents. The CDC urges clinicians to report all potential cases of lung injury related vaping to the local health department for further examination.
Policies on e-cigarettes are being implemented by the federal, state, and local governments. Following the EVALI epidemic, BBC (2020) states that the U.S. announced a nationwide ban of some vaping flavors including mint and fruit flavors. According to Bach (2020), several states such as New York, Massachusetts, and New Jersey have banned the sale of flavored e-cigarettes. The ban seeks to protect the welfare of youths and teenagers who are typically attracted to the toxic flavorings present in the e-cigarettes.
Banning the sale of some flavored vaping products will negatively impact e-cigarette manufacturing companies. According to Truth Initiative (2020), most youths and teenagers try vaping due to the availability of flavors such as mint and fruit tastes. Banning these e-cigarettes will negatively impact the sales of e- companies like JUUL, which ranks top in the sales of flavored e-cigarettes (AMA, 2020). The reduction in sales will in turn impact the nation’s economy adversely.
Media platforms contribute significantly to the promotion of vaping. Several e-cigarette companies advertise their products on platforms such as TVs, internet, and social media. A considerable number of teenagers and youths initiate vaping due to the influence of media vaping activities. With the heightened number of teenagers and youths using electronic devices like smartphones presently, Digitale (2020) says that more teens and young people are likely to vape as a result of social media vaping advertisements.
While most people turn to vaping as a safer way of quitting conventional smoking, they are exposed to other health risks associated with toxic vapors. Although youths are engaging in convention cigarette smoking less frequently, majority of them are presently involved in the usage of nicotine; a tobacco product, than the past decade. Physicians argue that vaping is substantially increasing the numbers of teens using nicotine, which results to addiction in the long run, thus failing its initial purpose of cessation of cigarette smoking (Wein, 2019; CASAA, 2020). Unfortunately, there exists limited research information regarding the dangers of vaping both on human health and the environment. The research conducted after the EVALI outbreak linked THC-containing products to the disease. Therefore, people are advised by the CDC to refrain from the use of e-cigarettes containing THC, and that Vitamin E acetate must not be added to electronic cigarettes.
Vaping is the inhalation of aerosol produced by heated liquids contained in electronic nicotine delivery devices. Surveys reveal it is more popular among the youths than older people. While e-cigarettes are popularly considered as safe tools for the cessation of conventional smoking, emerging research indicates that the devices contain toxic chemicals that expose individuals to health risks. The CDC has linked the recent EVALI outbreak in the U.S to THC-containing products and Vitamin E acetate. The heightened numbers of EVALI cases from all states as well as the number of youths engaging in vaping has resulted to bans on flavored e-cigarettes across the country by the federal government, several states, and localities. While it is unclear about the environmental effects of vaping, proper usage and disposal of vaping devices should be considered. The CDC and FDA recommend that e-cigarettes containing THC should not be used, and youths, as well as pregnant women, must avoid using e-cigarettes.
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