When a friend introduced Yetto to vaping three years ago, he thought that e-cigarettes might be the answer. “I started using vape with the idea that this has got to be healthier than actual smoking because there’s no tobacco element to it,” says Yetto. But e-cigarettes usually contain nicotine, which is what makes tobacco so addictive. Still, many people believe that e-cigarettes or vaping can be a means to quit smoking. According to a report published in October in the journal Addiction, an estimated 50,700 to 69,930 smokers in England quit by using e-cigarettes as a cessation tool. Now the rash of serious lung illnesses and many deaths traced to vaping in the United States has consumers like Yetto and health professionals raising red flags about the potential dangers of e-cigarettes.
What Are the Known and Unknown Dangers of Vaping?
E-cigarettes have been around only for about 11 years, so many of the long-term risks are still unknown. The devices are used to heat a liquid into a vapor that is then inhaled. What is actually in that mist isn’t so clear. Smokefree.gov reports that the products may contain flavoring chemicals (like diacetyl, which is linked to lung disease), metals (such as lead), and other cancer-causing chemicals. Even e-cigarettes that claim to be nicotine-free may contain it. “Most of the vaping products are marketed as relatively safer than smoking, but they are not without risks,” says Albert Osei, MD, a postdoctoral research fellow in the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins Medicine in Baltimore. A study that Dr. Osei and colleagues published this year in the American Journal of Medicine demonstrated that people who used both e-cigarettes and combustible cigarettes had higher rates of cardiovascular disease than those who smoked only cigarettes. In a separate paper published in October in BMC Pulmonary Medicine, Osei and his team found that e-cigarette users between ages 18 and 24 had a 39 percent greater risk of asthma compared with those who did not vape. Ironically, with health worries about vaping on the rise, many e-cigarette users may consider going back to regular smoking, thinking that it’s actually less dangerous, according to Enid Neptune, MD, an associate professor of medicine at Johns Hopkins Medicine. “Some young people are thinking cigarettes may be safer than vaping now, and that’s not a message we want to promote,” says Dr. Neptune, who specializes in chronic obstructive pulmonary disease (COPD) and has a history in advocacy for tobacco control.
Is Vaping Hard to Quit?
E-cigarettes may not only pose a serious health threat, but they may be difficult to give up. “When smoking cigarettes, you may have one or two and then not smoke again for a while. But with vaping, people can do it constantly,” says Patricia Folan, RN, the director of the Northwell Health Center for Tobacco Control in Great Neck, New York. “They’ve become accustomed to such high levels of nicotine because these products can be so easily used all day long.” But Folan sees signs that more e-cigarette users are trying to kick the habit. She notes that the Northwell smoking cessation program has seen a jump in calls from e-cigarette users who are concerned and want to quit. “More and more, we have people signing up for our programs to try to quit their e-cigarette and vaping use,” says Folan. “We’ve been hearing particularly from parents of teens in the community who say their kids just can’t stop using these products.”
8 Key Steps to Help You Stop Vaping
Folan points out that guidelines specifically for quitting e-cigarettes are still being developed. Helping young vapers also poses unique challenges because therapies to quit smoking have not been extensively researched in this population. “The products we have to help adults stop smoking are not nearly as effective in adolescents and teenagers,” says Neptune. “Right now we can only recommend the products that are validated in adults. We have to revisit and develop products that will have equivalent effects in young people.” Based on the evidence we do have, here are some steps that individuals can take to break their vaping addiction. Think about all the reasons to quit. The rapidly growing number of related illnesses and deaths reported may be reason enough to get many people thinking about stopping vaping. Besides the additives that vaping products contain, nicotine raises blood pressure and leads to spikes in adrenaline — both factors that can trigger a heart attack. “Vaping didn’t seem to be anything bad to me. But I’d be a fool now to say there’s no chance of it doing something bad to me,” says Yetto. “I’m breathing something into my lungs that doesn’t need to be there.” He adds that he wants to maintain his health for the long-term to be there for his wife and his two young children. Then there is the expense associated with vaping. A study published in 2016 in Tobacco Prevention & Cessation found that individual spending on e-cigarettes was as high as more than $250 per month, with a median of around $50 to $75 spent per month. People stricken with serious lung illness related to vaping also face hospitalization costs that can be astronomical. Reach out for help. Getting direction from professionals who have a history with smoking cessation is a good move toward quitting. The National Institutes of Health’s Smokefree.gov website offers ideas on developing a quitting plan, an online text app with reminders related to the plan, and a mobile phone app to track cravings and experiences. If individuals need to speak to someone, the service maintains a 24-hour help line. The American Lung Association provides tools, tips, and support for e-cigarette users and people who want to help someone stop. The Truth Initiative calls itself America’s largest nonprofit public health organization dedicated to making tobacco use a thing of the past. It offers programs such as BecomeAnEX, which includes interactive guides and tools, and an online community of thousands of smokers and ex-smokers. The program was developed by Truth Initiative in collaboration with Mayo Clinic. MedlinePlus, a service of the U.S. federal government, gives broad ideas on sources to seek out, including cessation programs from local hospitals, health insurance companies, employers, and local health departments. It also lists the “quit lines” for the National Cancer Institute, the American Cancer Society, and 1-800-QUIT-NOW, which helps you find state programs. Work with experts and set a quit date. While online sources, hotlines, and apps help, face-to-face advice with a doctor or cessation expert can be the most effective method. Work with a specialist and consider setting a date to quit by. Folan says that setting a quit date is not for everyone because it makes some people too anxious. But it can also motivate some people to commit to a quitting plan. Learn about medications and nicotine replacement options. Dr. Neptune calls the nicotine patch the “anchoring drug” for nicotine replacement therapy. The patch is placed on the skin and delivers a low-level stream of nicotine around the clock. Folan cautions that the patch isn’t always enough when a nicotine craving strikes. In those cases, an individual can also try a nicotine lozenge, gum, inhaler, or nasal spray along with or without the patch. Yetto, for example, is trying to only use nicotine gum but finds it least effective in the morning when his nicotine craving is the greatest. “It was really nice to wake up and take the first puff off the vape,” he says. “Your body is just coming back online and you need that kickstart. I would like to vape or smoke, but in goes the gum.” Determining a patient’s nicotine intake can be tricky for doctors. Nicotine amounts vary from product to product; and it can be difficult to gauge how much a person is vaping as opposed to smoking, which can be measured in terms of the number of cigarettes smoked daily. According to Folan, the two questions that healthcare providers usually ask are: How much do you smoke and how soon after waking do you smoke? “If you vape within five minutes or less of waking, that’s usually an indication that you are quite addicted and you need more nicotine products,” she says. A person trying to stop may also consider a medication that can help suppress the urge to smoke, such as Zyban or Wellbutrin (both forms of buproprion) or Chantix (varenicline). A study published in 2016 in the Journal of the American Medical Association found that the nicotine patch worked just as well as Chantix for smoking cessation. But the most effective approach largely depends on the individual. Find replacement activities. It can be useful to make a list of activities to distract you when the urge to vape strikes. It might be something as simple as taking a walk, calling a friend, drinking water, brushing your teeth, or taking a shower. “If smoking was always the first thing you did under stress, try something else; take deep breaths, [for example,] and move on,” Folan says. Have a positive support team. Osei stresses the value of a good social support team and encourages people to seek out friends, family, and professionals who can help them meet their goal. “Teachers and cessation experts have an important role,” he says. “It is a concerted effort.” Support groups with other people who have quit or are trying to can also be invaluable. Avoid negative influences. While accentuating the positive, don’t forget to eliminate the negative. “Distance yourself from unsupportive people, from places where you’ve vaped, or from people who still vape,” says Folan. Expect setbacks and don’t give up. Yetto sees himself quitting nicotine completely eventually but admits that those who are addicted always seem to be quitting. “Nicotine is a weird little gremlin I always have with me,” he says. “I want to kick it altogether, but when I’m fading, I need to get some.” “People do relapse,” Folan says. “You just have to keep trying.”
