Public health has a serious new mystery

Published: Wednesday, October 2, 2019

By BEVERLY CLARK
Times-News Columnist

When my grandson visited this summer, he introduced me to a television series called “Stranger Things.” He said that the show was scariest during the first season, so he watched it with me. But he assured me that I could watch the remaining two seasons without him. He’s so thoughtful. I finished the popular science fiction TV show and enjoyed the story, but personally found a few scary moments beyond what he predicted.

As news continues to unfold about electronic cigarettes, I’m reminded of the TV series which centers around a strange, scary creature that is growing, creating fear and hurting people. The questions seem the same. Where did this creature come from and why now? Who will be affected? Can we prevent further harm? Is everything related or are there several different factors?

E-cigarettes have been publicly available in the United States for more than 10 years. Although we won’t know the long term effects of them for some time, until recently we hadn’t seen ill effects from short term use. The rapid increase in illness and death believed to be caused by these products has created serious concern among the public health community. What has caused this and how can we prevent further harm?

E-cigarettes and other similar products collectively known as Electronic Nicotine Delivery Systems, or ENDS, are not simply harmless water vapor as some believe. Not even water vapor with nicotine.

They contain many harmful substances including ultra-fine particles that can be inhaled deep into the lungs and cause damage, flavoring such as diacetyl, a chemical linked to a serious lung disease, volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead.

Many e-cigarettes are designed with replaceable “pods” that contain nicotine. These pods are now available containing cannabidiol (CBD), believed by some to help with a variety of conditions including pain. Because there is no regulation of these products, many of these CBD e-cigarettes have tested positive for THC, the active ingredient in marijuana. E-cigarettes that intentionally contain THC have been ordered from other states. This THC could be found during an employer’s routine drug screening and result in disciplinary action. Young people are now known to smoke pods containing alcohol or other drugs. All of these uses cause serious concern among public health officials.

Lack of oversight of e-cigarettes makes it difficult for consumers to know what a product contains. When tested, even products that state a particular level of nicotine can vary widely. Pods found on the blackmarket have been tested and found to contain illicit and synthetic drugs such as opioids and fentanyl. Remember the flavorings I mentioned in e-cigarettes? That is often the only scent present no matter what drug is vaped.

The flavoring used in these products brings up another point worth considering. Most people believe that flavorings approved by the Food and Drug Admin-istration (FDA) are safe. However, the FDA approved those flavors for food. It is unknown what effect they may have when inhaled into the lungs. For example, the chemical diacetyl I mentioned earlier is a component of microwave popcorn packaging, and the scent hangs in the factory air of the manufacturers who make the popcorn. That chemical has been linked to a serious and irreversible lung condition among those workers known as popcorn lung.

Those who have experienced lung injuries connected to electronic cigarettes range in age from teens upward. According to the Centers for Disease Control of the hundreds of people with the lung illness, a majority (67 percent) are between the ages of 18 and 34, although some have been younger. Not only are young people at risk of this current lung illness, they are more likely to suffer long term lung damage as a result of inhaling the chemicals in electronic cigarettes because their lungs are still developing.

Use of electronic cigarettes has increased significantly in the past few years. According to the North Carolina Youth Tobacco Survey use of e-cigarettes among high school students saw an increase of almost 900 percent between 2011-2017. In Henderson County 39 percent of ninth graders reported using an e-cigarette in 2017. 

The most popular e-cigarette by far for teens is called a Juul (jewel), and teens refer to using the product as Juuling. The Juul doesn’t emit a large vapor as other e-cigarettes do, so it’s easy to use without detection. Parents often think it is a computer flash drive. The cartridge of a Juul contains nicotine salts, which is different from most other e-cigarettes. One pod is about the equivalent of a pack of cigarettes, and some teens are using multiple pods per day.

Adults and others often don’t realize the danger of e-cigarettes for those who don’t use them, including small children. In addition to the chemicals emitted by them in the vapor cloud, e-cigarettes can break, spilling the liquid, sometimes called juice, onto the skin. High levels of nicotine in the liquid can be absorbed through the skin, eyes or mouth and cause serious illness.

Electronic cigarettes originated as an effort to provide an alternative to those who wanted to quit smoking cigarettes. They have not been proven as a safe alternative yet but have emerged as a new threat to our young people and potential danger for all ages.

Until we know more about the health risks of these products, consider refraining from using e-cigarettes or vapes. If you have recently used them and experience unusual symptoms, see your healthcare provider. Anyone who uses e-cigarette or vaping products should not buy the products, refills or pods off the street or modify them in ways not intended by the manufacturer. Youth, young adults, and women who are pregnant should not use e-cigarette products. Keep e-cigarettes and vaping products out of the reach of children.

You can find more information about e-cigarettes and smoking cessation under the Community Interest link at https://www.hendersoncountync.gov/health/page/tobacco-prevention-cessation-resources.

Beverly Clark is the health promotion coordinator for Henderson County Department of Public Health.

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