E-cigarettes are easier for young people to develop into long-term smokers

E-cigarettes are easier for young people to develop into long-term smokers.  People used to think that e-cigarettes are a safe alternative to traditional cigarettes. Now, more and more evidences show that e-cigarettes are not only harmful, but may also produce the “Gateway Effect” of tobacco addiction—that is, the use of electronic cigarettes. Cigarettes can cause nicotine dependence on non-smokers and become smokers. Among this group of people, teenagers are the first victims.

On January 11, 2021, Dr. John Pierce, professor of public health at the University of California, San Diego, and his team published a study on the relationship between the use of e-cigarettes by adolescents and future tobacco use in Pediatrics. E-cigarettes will directly lead to youth addiction to tobacco in the future. This study is consistent with the conclusions of many previous studies in the public health community: young people are curious and prone to nicotine dependence without fully understanding their health hazards, and then develop into long-term smokers.

“Entry Effect” has become a consensus

The follow-up study by John Pierce’s team started in 2014. The research team selected adolescents and young people aged 12-24 as the study subjects and followed up annually for the next four years. Researchers have found that young people will increase their tobacco dependence as they age and try more and more types of tobacco products, up to 12 kinds.

In 2014, when the John Pierce team first investigated, 45% of respondents had tried at least one tobacco product. By 2017, this number had risen to 62%, and 72% of them tried e-cigarettes. The effect of tobacco dependence has gradually become apparent over time. In 2014, only 12% of smokers were daily smokers. One year later, this number rose to 50%. Among the mixed users of multiple tobacco products, e-cigarette users are three times more likely to become daily smokers than non-smokers.

“This is the first study to track changes in the rate of tobacco addiction over time. In these data, we found that the’entry effect’ formed by e-cigarettes allows non-smokers to become addicted to tobacco.” The first author of the study, Said Dr. John Pierce. They observed that no matter how many different tobacco products young people have tried, when they start to become dependent on nicotine, they will switch to traditional cigarettes.

This conclusion also predicts that the rapid increase in the use of e-cigarettes among American youth will lead to a substantial increase in the rate of tobacco addiction in the future.

The smoking rate, which has been declining, is being threatened by the emergence of new tobacco products such as electronic cigarettes.

E-cigarette smoking has become a trend among teenagers in the United States and Britain. In the streets and lanes, it is difficult to see people holding traditional cigarettes and vomiting smoke, replaced by colorless and odorless electronic cigarettes. After 2011, the number of young people smoking e-cigarettes has continued to rise. In 2018, the U.S. Department of Public Health Service determined it as an “epidemic” and called on all walks of life to take action on the deteriorating status quo. Currently, 3.6 million young Americans are still using e-cigarettes.

In fact, a number of international cohort studies have consistently confirmed that there is a strong correlation between the use of e-cigarettes by adolescents and young adults and the subsequent use of cigarettes. The proportion of e-cigarette users who switch to traditional cigarette smokers is often never smokers. Multiples of.

Previously, a follow-up survey of 2388 high school students in the United States found that as long as students who have used e-cigarettes, whether they use them occasionally or repeatedly, they are more likely to use traditional cigarettes after one year than those who never use e-cigarettes. The students are much older. Even students who have only used e-cigarettes 1-2 times are 2.88 times more likely to use traditional cigarettes one year later than never.

In 2018, the National Academy of Sciences, Engineering, and Medicine (NASEM) issued a research report on the effects of e-cigarettes on human health with detailed evidence, involving the identification and inspection of more than 800 peer-reviewed scientific studies, and a number of studies Point out that the use of e-cigarettes has increased the frequency and intensity of smoking among non-smokers in the future.

The results of some countries’s 2019 tobacco survey also found that in the past 5 years, the proportion of junior high school students who have heard of e-cigarettes and now use e-cigarettes has increased significantly, and middle school students who have never smoked e-cigarettes have seen more in the 12 months after exposure to e-cigarettes. Maybe try other tobacco products.

Public health scholars reminded that most of the research on “entry effect” comes from developed countries. The foundation of tobacco control in these countries is relatively good. In most low- and middle-income countries, the enforcement of the ban on the sale of cigarettes to minors is not effective, the tax rate and price of tobacco are relatively low, and cigarettes are widely used and culturally deeply rooted. E-cigarettes are more likely to switch to cigarettes, and the “entry effect” of e-cigarettes will be stronger. There are more than 300 million smokers in China, and more than half of them started smoking before the age of 20. The emergence of e-cigarettes has become a new way for young people to contact tobacco. Preventing young people and young people from being exposed to e-cigarettes will be the key to tobacco control in the future.

Unproven smoking cessation effect

E-cigarettes first entered the public’s field of vision with the image of helping to quit smoking. The business concept behind this product is very smart: the manufacturer claims that e-cigarettes can provide all the fun of traditional cigarettes, but will not bring any harm, and can help quit smoking. In some countries, many e-cigarette manufacturers’ advertisements also use “healthy, assisted smoking cessation” as a gimmick.

So far, neither the U.S. Food and Drug Administration (FDA) nor the China National Drug Administration has approved any e-cigarette product as a smoking cessation aid. The World Health Organization also clearly pointed out in the “Global Tobacco Epidemic Report 2019” that there is insufficient evidence that e-cigarettes help quit smoking, and the use of e-cigarettes as a smoking cessation aid is not recommended.

Many researches on the so-called e-cigarette assisted smoking cessation on the market have been found to be supported by the tobacco industry, forming biased and misleading conclusions. The most typical is that an original study based on the British government’s e-cigarette policy was accused of a large number of flaws, lack of solid and credible evidence, and may have been affected by the tobacco industry.

The National Academy of Sciences, Engineering, and Medicine (NASEM) and Cocharane, an international authoritative medical research group, have continued to pay attention to the research progress of e-cigarettes in recent years, and found that e-cigarette research has “large differences in indicators and little evidence of results” and “about e-cigarettes. There is limited evidence to promote the effectiveness of smoking cessation”.

The latest study of Cocharane review retrieved data from 13 countries, 50 scientific studies, and 12,430 adults as of January 2020, and comprehensive analysis found that e-cigarettes may have smoking cessation effects, but the level of evidence for this conclusion is limited to moderate credibility And the study did not find clear evidence that e-cigarettes can directly encourage smokers to quit smoking. The review analysis also found that people who use nicotine-containing e-cigarettes to quit smoking generally have symptoms such as throat sensitivity, headaches, and coughing.

The above-mentioned researchers admit that e-cigarettes can only increase the success rate of smokers who want to quit, and that e-cigarettes are ineffective for people who do not want to quit.

John Pierce’s team also found in another adult e-cigarette study that so-called e-cigarettes help people to quit smoking successfully, but they do not really quit smoking. Two-thirds of people just quit traditional cigarettes and continue to use nicotine. Electronic cigarette.

“These conclusions all show that e-cigarettes do not help quit smoking, on the contrary, e-cigarettes can promote nicotine dependence of smokers.” John Pierce explained.

In addition, it is currently impossible to judge the impact of e-cigarettes on nicotine replacement therapy and smoking cessation services. Some studies believe that e-cigarettes may be effective when used in smoking cessation clinics, but if they mistakenly believe that e-cigarettes can be used as a means of cessation for the public and large-scale use will affect the use of conventional and well-documented ways to quit smoking, including behavioral therapy and smoking cessation drugs Combine with two ways.

Scientists still need more conclusive evidence to study the impact of e-cigarettes. Public health scholars believe that due to the short appearance of e-cigarette products, and the fast product design and iteration speed, the current third and fourth generation products are quite different from the earlier products in terms of nicotine transmission. The research results of is no longer applicable to the current product.

Harmful use or underestimated

Compared with traditional cigarettes, the health effects of e-cigarettes are still a new topic. Although many popular opinions promote that e-cigarettes are less harmful, more and more studies have found that their health threats may be greatly underestimated.

Beginning in 2019, there have been cases of severe lung disease among adolescents with a history of “e-cigarette” use in many states in the United States, which are collectively referred to as E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). Symptoms of EVALI include cough, shortness of breath, and fatigue, which will gradually get worse over a few days or weeks, until it leads to dyspnea or hospitalization. The latest research shows that these cases are probably caused by the addition of vitamin E acetate to e-cigarettes containing tetrahydrocannabinol (THC), but the real cause is still under investigation.

Brandon Larsen, a top surgical pathologist and national lung pathologist from the Mayo Clinic in the United States, conducted a biopsy on 17 e-cigarette lung disease patients in 2019 and found that the lung damage caused by e-vapor smoke is most likely to be the direct result of toxic chemical fumes. Caused by toxicity or tissue destruction. All patients showed symptoms of acute lung injury and lung infection, and two of them died.

“It seems to be some kind of direct chemical damage, similar to the damage you might see when exposed to toxic chemical fumes, toxic gases or toxic substances.” Brandon Larsen said.

Since e-cigarettes do not produce smoke generated by the burning of tobacco, consumers generally consider them safer than smoking. This seemingly “safe” illusion is very attractive to consumers, but consumers have not been told what chemical substances are contained in e-cigarettes and the specific content of each chemical substance.

In addition to e-cigarettes generally containing nicotine, the e-cigarette inhaled and exhaled by users may also contain a variety of harmful and potentially harmful substances, including ultrafine particles that can penetrate deep into the lungs, and volatile diacetylene additives that can cause lung diseases. Organic compounds and carcinogens, as well as heavy metal carcinogens such as nickel, tin and lead. The Hong Kong Smoking and Health Commission commissioned the Hong Kong Baptist University to test 13 types of electronic cigarettes on the market and found that they contained a variety of harmful substances, including formaldehyde, polycyclic aromatic hydrocarbons (PAHs) and polybrominated diphenyl ethers (PBDEs), among which formaldehyde and polycyclic aromatics Hydrocarbons are known carcinogens. Polybrominated diphenyl ethers can interfere with thyroid secretion and affect reproduction and fetal development.

The scientific community has confirmed that e-cigarettes may affect multiple organs and systems throughout the body, of which the respiratory system is the most affected. E-cigarette aerosols can increase the production of inflammatory factors in the respiratory tract, leading to chronic inflammation of the airways, which in turn reduces the human lung function. This adverse effect is very similar to the pathogenesis of COPD caused by smoking. A study of South Korean high school students found that students who use e-cigarettes are 2.7 times more likely to develop asthma than never users, and are 15.4 times more likely to take sick leave for 4 days or more due to asthma than never users. . A study of e-cigarette use and respiratory diseases among adolescents in Hong Kong, China had similar results.

In January 2021, a study published in the medical journal “Circulation” investigated the smoking and health status of more than 7,100 American adults, of which about 2% only smoke e-cigarettes, about 30% only smoke traditional cigarettes, and about 10% Smoke both types of cigarettes. The study found that in people who smoked both cigarettes and only smoked cigarettes, the levels of five markers of inflammation and oxidative stress were the highest. People who only smoke e-cigarettes have lower levels of inflammation and oxidative stress than the former two, but the results are similar. This result shows that replacing some traditional cigarettes with electronic cigarettes cannot effectively prevent inflammation caused by smoking cigarettes, but replacing cigarettes with electronic cigarettes can significantly reduce the risk of inflammation caused by smoking.

In addition, the toxicity of various flavoring agents and their interaction with e-cigarette solvents has gradually attracted attention. There are as many as 8,000 flavors of electronic cigarettes. At first it was thought that flavoring agents would be as non-toxic and harmless as food additives. But then researchers realized that even commonly used food additives may cause serious harm to the lungs. A 2016 study found that flavoring agents interact with e-cigarette solvents and show strong cytotoxic effects on human lung cells directly exposed to e-cigarette liquid.

Electronic cigarettes are also related to cancer. The first study on the correlation between e-cigarettes and cancer was published in October 2019. This study on mice showed that long-term exposure to electronic nebulized liquids containing nicotine increases the risk of cancer. Researchers found that e-cigarette vapor caused DNA damage in the lungs and bladder, and inhibited DNA repair in lung tissue. In an experiment over 54 weeks, 22.5% of 40 mice exposed to nicotine-containing e-cigarette vapor developed lung cancer, and 57.5% developed bladder precancerous lesions. None of the 20 mice exposed to nicotine-free e-cigarettes developed cancer.

In June 2020, the Science sub-Journal published an article that e-cigarettes can change the oral flora and cause gum disease or oral cancer. Researchers at Ohio State University warned that after using e-cigarettes for a few months, whether it is nicotine-containing or non-nicotine-containing e-liquid, it will have a significant impact on the oral microbial flora, which may cause gum disease, tooth loss and other risks, and Easily induce oral cancer.

People have reason to be vigilant about e-cigarettes. Although the overall content of harmful substances is relatively lower than that of ordinary cigarettes, e-cigarettes will release harmful chemicals and cause damage to human health. There is no evidence that these products can reduce tobacco-related The risk of disease. With the rapid prevalence of e-cigarettes, more and more public health experts call for the government to intervene as soon as possible to prevent young people from using e-cigarettes to become addicted to tobacco.

(source:internet, reference only)

Disclaimer of medicaltrend.org