Are vape pens, or e-cigarettes, ever the better option?

There’s a lot of confusion about electronic cigarettes, also known as vape pens or vapes, and whether vaping is better than smoking combustible, or traditional, cigarettes.

To put it simply, vaping is better than smoking traditional cigarettes. If you’re a cigarette smoker, there’s no question that switching to e-cigarettes is a step in the right direction.

That doesn’t mean e-cigarettes are harmless.

But for a cigarette smoker, especially a smoker who has failed to quit with federally approved products or counseling, switching to vaping will be a move to improve overall health.

Think of it this way: If smoking traditional cigarettes could be compared to eating a dozen donuts a day, switching to e-cigarettes might be similar to eating a few donut holes instead. That’s not saying eating donut holes is good for you, but it’s better than a dozen donuts. And if you don’t eat donut holes already, you definitely shouldn’t start — it won’t do anything positive for your health.

Do vape pens help adults quit smoking traditional cigarettes?

E-cigarettes aren’t approved by the U.S. Food and Drug Administration as a device for helping people quit smoking. However, in research studies, vaping tends to help more people quit than FDA-approved products, such as nicotine patches, lozenges or gum.

• For every 100 people who try to quit smoking traditional cigarettes with e-cigarettes, about 10 to 14 are able to quit. In many of those cases, people are still using e-cigarettes after quitting traditional cigarettes.
• For every 100 people who try to quit smoking traditional cigarettes with nicotine patches, lozenges or gum, about six people are able to quit. Far fewer people continue to use these products after quitting cigarettes.

Why is vaping a better choice for adults who smoke traditional cigarettes?

Overwhelmingly, the dangers from traditional cigarettes come from the toxicants that accompany the nicotine. The nicotine is what creates the addiction and sustains it, but it's the method of getting that nicotine that causes the majority of the harm.

It’s on a spectrum: You have traditional cigarettes at one end, being the dirtiest product, and nicotine-replacement therapy products on the other end, being the cleanest nicotine-delivery products. E-cigarettes fall in the middle, but closer to the nicotine replacement therapy products.

Traditional cigarettes

When you use traditional cigarettes, you're burning tobacco leaves and inhaling smoke into your lungs. This creates toxic substances that can cause cancer and harm the lungs and heart.

E-cigarettes

E-cigarettes have a much lower toxicity than traditional cigarettes, but they aren’t completely harm-free. Rapid nicotine delivery from e-cigarettes increases heart rate and blood pressure and can impair functioning of blood vessels. E-cigarettes also contain propylene glycol, glycerin and flavorings. When heated, they create an aerosol that can contain cancer-causing toxicants and other chemicals that can irritate the lungs.

Nicotine replacement therapy products

A slow-delivering nicotine lozenge, patch or piece of gum can also increase heart rate and blood pressure to a lesser degree.

Is nicotine in vape pens harmful?

Nicotine is addictive, and for young people, it appears to have effects on the developing brain. Based on animal studies and a few human studies, when young people use nicotine:

• It may increase the chance of addiction.
• It may alter brain structures, leading to likelihood of greater impulsivity, inattention and memory problems.

As a result, young people may have reduced inhibitions, greater risk-taking behaviors, problems in school and mental health struggles, including anxiety and depression.

While I support adult smokers switching to these products to improve their health, the lives of young people are put at risk by e-cigarettes.

Why are vape pens so addictive?

E-cigarettes have high addiction potential largely because of how they deliver nicotine. Beginning in 2016, e-cigarette manufacturers adopted well-known tobacco industry techniques and began adding acids to the nicotine e-liquid to create nicotine salts. This reduced the harshness of the e-cigarette aerosol and allowed the nicotine to absorb more in the lungs than the throat. It also allowed manufacturers to increase nicotine concentration from .5% or 1% to 5%. The result was a very palatable, very addictive product that could deliver high doses of nicotine in smaller, more discreet devices.

Stopping the deadly legacy of tobacco use and nicotine addiction

When you inhale nicotine, it also gets to the brain very quickly, in about six to eight seconds. People who’ve never smoked develop signs of nicotine dependence when they start using e-cigarettes.

Nicotine replacement therapies, on the other hand, are designed to be non-addictive by curbing your cravings and reducing withdrawal over time. When nicotine is delivered through lozenges, it has to dissolve in your saliva and the nicotine is absorbed slowly in your mouth and your gut before the bloodstream takes it to the brain. When it’s delivered through patches, it has to be absorbed into your skin before it gets into the bloodstream and, eventually, to the brain. Because there’s not a sharp spike in nicotine, the addiction potential is low.

Should I be concerned about secondhand e-cigarette aerosol/vapor?

People should treat e-cigarettes like they treat traditional cigarettes in terms of clean indoor air laws or vaping in their homes. Don’t vape in your home around children or people who don't want to be exposed to e-cigarette aerosol, because it does contain nicotine as well as other toxicants.

Research shows that kids whose parents vape in the home have significantly higher levels of nicotine in their blood and urine compared with kids who live in non-smoking and non-vaping homes, and similar to kids exposed to secondhand cigarette smoke at home.