Meta-Analysis on the Teenage Vaping Epidemic The outbreak of an infectious disease is commonly known as an epidemic, smallpox, polio, and measles are just a few epidemics that have affected America in the past. Fortunately, the advancement of modern medicine helps to prevent against epidemics. Hand washing and vaccines are some of the most commonly practiced prevention techniques used against the outbreak of an epidemic. Today, a different epidemic is taking place all over america, one that is not an outbreak of an infectious disease, and one that has no vaccines to prevent it. This epidemic is the outbreak of teenage vaping. Each year, 480,000 deaths are a direct result of smoking related illnesses. As an attempt to help smokers quit, electronic cigarettes were introduced to the market over a decade ago. E-cigs, vape pens, mods, and JUUL’s are some of the common electronic cigarettes used for vaping. The release of these products has created an industry worth over 2.5 billion dollars (Paynich). While electronic cigarettes are safer than tobacco products, they introduce exposure of contaminants through an aerosol mixture (Burstyn). The Center for Disease Control and Prevention’s research shows the number of middle school and high school students who began vaping between 2017 and 2018 has rose significantly. The number of high school students who began using vape products rose 78% and the number of middle school students who began vaping rose 48%. Approximately 20.8% of high school students (3.05 million), and 4.9% of middle school students (570,000), use vape products. In 2016, the National Youth Tobacco Survey collected data from teenagers regarding the use of these products. The collected data showed that 39% of teenagers began vaping due to family and friends who used these products, 31% of teenagers began vaping because the flavored products drew them in, and 17.1 % of teenagers began vaping because the products were safer than actual tobacco products (Paynich). While these products are advertised to be safer than smoking cigarettes, there are still health risks that come with using electronic cigarettes. With the sudden increase in teenagers using electronic cigarettes, one of the biggest questions to be asked is: Why? As stated previously, teenagers may be introduced to vaping due to family and friends who use, the flavors, and because they think it is a safer alternative to cigarettes(Paynich). Unfortunately, users of electronic cigarettes may be making the decision to vape because they are not fully informed and do not have a complete understanding of the risks of using these products. Two studies conducted at The University of San Diego compared the risk perception of electronic cigarettes between users, smokers, dual users, and nonusers. The studies suggest that users of electronic cigarettes are more likely out of the rest to have a lowered risk perception of the products they are using, which could be a direct result of the marketing of these vape products. This study also shows that users also have the highest likelihood of responding to on-ad warnings of the risks of vaping(Farrell & Hamby). This study is important when looking at the numbers of teenagers using vape products, without the proper information about the dangers of these products, teenagers are making a decision to use them (Farell & Hamby). On September 6 2019 in the midst of an epidemic of vaping related respiratory illnesses among teens, the US Center for Disease Control and Prevention warned against the use of electronic cigarettes. The warning followed 450 reported cases and 5 deaths related to the use of electronic cigarettes (News at a glance). While there is no definitive diagnosis for all the vaping related illnesses, there are health effects that are derived from the chemicals inside the vape liquids. The study, published by the International Journal of Occupational Medicine and Environmental Health, conducted experiments using “ mouse lung cells, human embryonic stem cells, mouse neural stem cells, human pulmonary fibroblasts, and in vivo mouse models” to show the correlated health effects against the cytotoxicity of vaping liquids. The evidence of exposure to contaminants was shown to “induce oxidative stress, inflammatory responses in lung epithelial cells and in the mouse lung, to alter ciliary function and induce cytokine release in lung epithelial cells” (Jankowski et. al). These changes can cause chronic airway inflammation. In the study, nicotine inhaled through electronic cigarettes can be shown to affect nicotine receptors, in turn causing the “influx of calcium into the cell which increases protein kinase C-alpha (PKC-α) and extracellu- lar signal-regulated kinase (ERK) and activates a cascade of reactions responsible for: inducting airway hyper reactivity, airway remodeling, mucin production and apoptosis, emphysematous changes, and increased airway resistance in response to methacholine” (Jankowski et. al). A second study published by the International Journal of Occupational Medicine and Environmental Health, was performed using a questionnaire to show the short term effects of using electronic cigarettes. The results indicated electronic cigarettes were “responsible for mouth and throat irritation, dry cough, headache, nausea, dyspnea, and vertigo” (Jankowski et. al). It is important for the public to know about the health risks involved with using electronic cigarettes, especially the youth of America, as more cases of teenagers falling ill occur each week as a result of the use of these products. Teenage users of electronic cigarettes can be mesmerized by the array of flavor options there are to choose from, but what they can’t choose is the chemicals that make up the vape juices and the contaminants that are inhaled. The chemical makeup of the liquids used in electronic cigarette products vary, but most include propylene glycol, nicotine, water or ethanol, flavoring, and other additives (Jankowski et. al). The inhalation of propylene glycol has been shown to cause acute respiratory effects with a threshold limit volume of 50mg/㎥ over the course of 8 hours as reported by the Health Council of the Netherlands (Burstyn). Exposure of propylene glycerol is 1-6mg/㎥ for a user vaping 5-25mL of electronic cigarette liquid. The amount of propylene glycol exposure ranges with nicotine levels due to the fact less propylene glycol will be included in liquids with higher percentage of nicotine(Burstyn). With extreme daily use of electronic cigarettes, the level of propylene glycol consumption can lead to exposure amounts close to that of the threshold limit value. Nicotine is the most common chemical found in electronic cigarettes, with a threshold limit volume of 0.5mg/㎥ over the course of 8 hours. The use of electronic cigarettes with 2mg of nicotine over the course of 8 hours would place exposure at the threshold limit, and higher nicotine levels would place exposure over the threshold limit. Inhalation of nicotine over the threshold limit does not pose a harm unlike propylene glycol, although nicotine is highly addictive causing increased usage of these products and making it harder to quit (Burstyn). Common contaminants of electronic cigarettes are polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, and volatile organic compounds. Polycyclic aromatic hydrocarbons (PAH), include carcinogenic as well as non carcinogenic contaminants. There have been levels of pyrene, a non carcinogenic, found in some electronic cigarette liquids and only one reported case of chrysene found. The exposure of PAHs are not on the basis of threshold limit volumes, but levels are to be kept as low as possible (Burstyn). Tobacco-specific nitrosamines (TSNA) are another carcinogenic contaminant to be found in vaping liquids. These contaminants are derived from the nicotine of the tobacco leaf, and are commonly found in to smokeless tobacco products like snuff and chewing tobacco. Similar to PAHs, TSNAs do not have a threshold limit volume and exposures are to be kept as low as possible. The amount of TSNAs found in electronic cigarette liquids varies, but 90% were found to have quantities measured in μg/L, 1/1000 of the concentration found in smokeless tobacco products. Volatile organic compounds (VOC) are other forms of contaminants in electronic cigarette liquids with a threshold limit volume of 1mg/㎥. Only one case reported VOC levels in excess of the threshold limit volume, reaching exposure of 1.73mg/㎥. As seen in table 2, the majority of VOCs concentrated during inhalation were <1% of the threshold limit volume, with the exception of acrolein which reached 2% of the limit, and formaldehyde which ranged between 0-3% of the limit (Burstyn). A study, published by the International Journal of Occupational Medicine and Environmental Health, showed levels of cytotoxicity that varied by flavor of vape juice. Cinnamon and chocolate reported with the highest amount of cytotoxicity, sweet flavors reported with the highest levels of diacetyl and acetyl propionyl, and cherry flavors reported with the highest amount of benzaldehyde (Jankowski et. al). Looking at the data, it is clear that chemicals and contaminants should not be inhaled and exposed to the lungs, and do have the potential at certain quantities to cause illness. It is also worth noting a study published by the New England Journal of Medicine found that out of just 41 of the patients with reported vaping related illnesses, only 17% reported vaping only nicotine products and 80% reported vaping black market THC products containing tetrahydrocannabinol, the active ingredient in marijuana(News at a glance). The FDA is currently investigating juices containing THC due to the amount of users coming down will illnesses related to vaping THC products. The FDA has found that THC is being diluted with vitamin E acetate, and medium triglycerides and is still currently performing investigations on how these products affect the health of users (Commissioner). With the number of teenagers who are falling sick to respiratory illnesses related to vaping, it is important that awareness is spread. Teenagers who have never smoked cigarettes are using electronic cigarettes because they are not aware of what chemicals and contaminants make up the liquid and the risks they have on their health. This vaping epidemic, while not traditional, is a serious problem affecting teenagers across america and hopefully through more thorough studies can be stopped altogether.
References: Burstyn, I. (2014). Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health, 14(1), 1–27. https://doi.org/10.1186/1471-2458-14-18 Commissioner, O. of the. (n.d.). Respiratory Illnesses Associated with Use of Vaping Products. Retrieved from https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products. Farrell, J. R., & Hamby, A. M. (2019). Vaping Viewpoints: A Multi‐Segment Understanding of E‐Cigarette Risk Perceptions. Journal of Consumer Affairs, 53(2), 545–571. https://doi-org.libproxy.plymouth.edu/10.1111/joca.12203 Jankowski, M., Brożek, G., Lawson, J., Skoczyński, S., & Zejda, J. (2017). E-smoking: Emerging public health problem? International Journal of Occupational Medicine and Environmental Health. doi: 10.13075/ijomeh.1896.01046 News at a glance. (2019). Science, 365(6458), 1062–1063. doi: 10.1126/science.365.6458.1062 Paynich, V. (2019). The Youth VAPING Epidemic: How park and recreation agencies are helping to fight e-cigarette use among America’s teens. Parks & Recreation, 54(6), 44–50. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=136885543&site=ehost-live
1 Comment
Matt Cheney
12/3/2019 02:50:54 pm
Nicely done! The research is clear and well presented, and the use of illustrations makes this visually interesting.
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