Are e-cigarettes really harmless? Are they even more harmful to teenagers?

E-cigarettes, as a substitute for tobacco, also serve a role in smoking cessation. In July and August 2019, the American Society of Clinical Oncology (ASCO) conducted an online survey of 4,000 Americans aged 18 and older.

The survey results showed that among American youths aged 18-22, 20% believed that "e-cigarettes are harmless"; this belief was even more prevalent among the slightly older millennial group (ages 22-38), with a rate as high as 24%. In contrast, only 5% of Americans aged 55-72 agreed with this view, and it dropped to just 1% among those over 73.

As of October 15, 2019, 49 states in the U.S. (all except Alaska) and the District of Columbia had reported 1,479 cases of lung injuries associated with e-cigarette use to the Centers for Disease Control and Prevention (CDC), with 33 confirmed deaths across 24 states.

Are e-cigarettes really harmless?

Currently, the answer appears to be no. While e-cigarettes do not contain harmful components like tar and particulate matter, the nicotine and toxic chemical fuels present in e-cigarettes can adversely affect health.

The ASCO survey also revealed that the perception of "smoking is harmful to health" is deeply ingrained regarding traditional cigarettes, which may explain the higher popularity of e-cigarettes among teenagers. Nicotine is highly addictive and can impair brain development in adolescents.
 

Unappealing cigarette packaging abroad

Additionally, some e-cigarettes in the U.S. have been found to contain tetrahydrocannabinol (THC) and cannabinoid oils, with THC being the most psychoactive component of cannabis. This is a strictly regulated substance in the U.S., and its inclusion in e-cigarettes raises legal concerns, effectively turning them into drug delivery devices. Therefore, the dangers of e-cigarettes among teenagers may be greater than those of traditional cigarettes.

CDC data supports this conclusion; among the 1,479 cases of lung injury, 1,358 had age and gender data available. The median age of patients was 23, with an age range of 13 to 75. Seventy-nine percent of the patients were under 35 years old.

On October 2, the New England Journal of Medicine published a study titled "Pathology of Vaping-Associated Lung Injury." This study analyzed lung tissue damage in 17 e-cigarette users (vapor inhalers). Researchers found lung damage and inflammatory responses caused by exposure to toxic chemicals in the samples.
 
Most cases exhibited acute lung injury centered around the airways (Figure A), often accompanied by severe bronchiolitis, significant mucosal edema, sloughing of bronchiolar epithelium, and surrounding tissue (Figure B). All cases showed foam-like or vacuolated macrophage accumulation in alveolar vacuoles, along with vacuolation of lung cells (Figure C). Four cases were severely injured, showing diffuse alveolar damage and hyaline membrane formation (Figure D), with two patients resulting in death.

It is important to note that tar is the most harmful component in traditional cigarettes. However, e-cigarettes do not contain tar, so why is there still such severe lung damage? This is because e-cigarettes add various chemicals to create different flavors, such as candy and mint, which, to some extent, increases their appeal to teenagers.

Some studies indicate that these additives are not as "harmless" as they seem. A study conducted in February of this year found concentrations of up to 34% of cinnamaldehyde (a component that can damage bronchial cells) in some e-cigarettes. Researchers have begun to categorize the chemicals contained in e-cigarettes. However, with thousands of products available, fully understanding them is a daunting task.

In response to the series of lung injuries, the U.S. Food and Drug Administration (FDA), which regulates tobacco products including e-cigarettes, announced plans to remove all flavored e-cigarettes except for original tobacco flavor from the market. Products removed will need to obtain "pre-market authorization" before returning to the market. Several states in the U.S. had already begun banning e-cigarettes prior to this announcement, including multiple retailers like Walmart that have also announced the removal of e-cigarettes from their shelves.

Following the occurrence of e-cigarette-related deaths in the U.S., on October 14, South Korea reported its first suspected case of lung disease caused by the use of liquid e-cigarettes. The Korea Disease Control and Prevention Agency received its first suspected case of lung disease, including cough and difficulty breathing, linked to the use of liquid e-cigarettes. The patient had previously been a smoker and had been using liquid e-cigarettes continuously for the past six months. #p#分页标题#e#

Therefore, on October 23, South Korea's Minister of Health and Welfare, Park Neung-hoo, strongly recommended that the public stop using such e-cigarettes until the test results regarding their dangers are released, especially urging teenagers to cease use immediately. To assess the harmfulness of liquid e-cigarettes, the government has established a special investigation team to confirm whether there are other suspected cases among severe lung injury patients, and the results of the analysis of harmful components in liquid e-cigarettes will be published in the first half of next year.

However, this recommendation to stop using e-cigarettes is not mandatory and relies on smokers' self-discipline. The South Korean Ministry of Welfare plans to amend the National Health Promotion Law to ensure that relevant departments can take measures such as confiscation and banning sales promptly when e-cigarettes negatively impact public health.

In recent years, the number of manufacturers and consumers of e-cigarettes and other new tobacco products in China has also rapidly increased. However, there is currently no specific regulatory system or effective measures targeting e-cigarettes, and the situation of e-cigarettes inducing consumers, especially minors, to become addicted to smoking is also objectively present. However, given China's stance on drugs, e-cigarettes will not contain tetrahydrocannabinol, so this can be assured.

Furthermore, the National Tobacco Monopoly Administration is closely monitoring the market development of e-cigarettes and other new tobacco products, and is working on researching legal regulatory policies and feasible regulatory methods. This includes clearly incorporating heated tobacco products into the monopoly management category, legally combating illegal trade and circulation of heated tobacco products; strengthening policy and legal research related to e-cigarettes; and issuing a notice prohibiting the sale of e-cigarettes to minors.

The notice requires market entities not to sell e-cigarettes to minors. Local tobacco monopoly administrative departments are urged to supervise various market entities not to sell e-cigarettes to minors, especially in conjunction with special actions around schools, to prevent minors from being harmed by e-cigarettes.

It must be said that the numerous issues arising from e-cigarettes, especially the harm to teenagers, have reached a critical point that must be addressed, and global bans on e-cigarettes have only just begun.