To Vape or Not to Vape?

By Bart Green, DC, MSEd, PhD; Kevin Rose, DC, MPH; Claire Johnson, DC, MSEd, PhD

Smoking can be harmful in so many ways. Not only are there a multitude of negative health consequences from smoking, but recent research even shows a connection between smoking and back pain.¹ Thus, any aid that can help people stop smoking is of interest to doctors of chiropractic and their patients.

However, what happens if the aid causes new problems? The health impact, useand safety of electronic cigarettes (e-cigarettes) are still under investigation. We offer a brief overview on this important public health issue for the practicing chiropractor.

1. What Is Vaping?

When someone smokes traditional cigarettes, they inhale the smoke of burning tobacco. However, someone using an electronic device, such as an electronic cigarette, inhales vaporized chemical liquids – thus the term vaping.

The liquids in e-cigarettes often contain nicotine or other drugs, as well as scents or flavors to increase the pleasure of the experience. E-cigarettes are now the most commonly used smoking product by U.S. youth² and the number of users continues to rise.

2. What Are the Arguments in Favor of Vaping?

Vaping is considered an option to reduce the harmful effects of traditional tobacco cigarette smoking and as an aid to help people quit. The thought is that e-cigarettes might help someone step down to lower levels of addictive substances (e.g., nicotine) and reduce the amount of carcinogens inhaled. Some studies have shown the use of e-cigarettes may help some people to reduce or stop smoking.³

3. What Are the Potential Harms of Vaping?

Although e-cigarettes do not use burning tobacco, they still contain harmful substances. Issues with vaping include:

• Intake of vaporized substances in e-cigarettes may be harmful.^4-6
• E-cigarettes have vapors that can include formaldehyde, acetaldehyde and metal nanoparticles.⁷
• E-cigarette devices could potentially be used to intake illegal or other potentially harmful drugs,⁸ such as synthetic drugs or cannabis.^9-10
• Secondhand vapors are harmful to those who are exposed.^4-5
• There is potential harm with short-term use, although the effects of long-term use on health are unknown.
• Targeting minors with bright colors and candy flavors, and re-establishing the culture that smoking is "cool" or "safe," may entice youth to start or continue smoking.
• The potential exists for physical danger from e-cigarettes (e.g., explosions and burns).

4. What Can Doctors of Chiropractic Do?

As part of your efforts to encourage patients to lead healthy lives, you can share educational materials with patients who currently use e-cigarettes for smoking cessation or patients who ask about the safety concerns of vaping. Helpful educational activities include: posting information in your waiting room, handing out fliers, including links in your emails or social media pages, and participating in smoking cessation activities in your community.

Resources you should share with patients include the following [hyperlinks to each resource appear in the digital version of this article]:

• The U.S. Surgeon General has on youth and e-cigarettes.
• The American Heart Association has a fact sheet on e-cigarettes and public health.
• The Centers for Disease Control and Prevention (CD) has a website with information for patients.
• The American Lung Association has a statement on e-cigarettes.
• The American Public Health Association has a policy statement on the regulation of e-cigarettes.

As health care providers, we have both the responsibility and the opportunity to assist our patients in achieving maximum health. Studies are currently underway that will help us better understand how doctors of chiropractic can more effectively assist our patients with smoking cessation.^11-12

Educating our patients about the potential harms of vaping will help them make an informed choice about health behaviors.

5. So, Is Vaping Good or Bad?

Although vaping is touted as an aid for smoking cessation to help those who are addicted to tobacco, this does not mean vaping is harmless. Harms may be experienced by the person vaping, as well as those who are inhaling the vapors secondhand. The best thing for the health of our patients is that they refrain from smoking at all – electronic or tobacco.

References

1. Green BN, Johnson CD, Snodgrass J, et al. Association between smoking and back pain in a cross-section of adult Americans. Cureus, 2016 Sep 26;8(9):e806.
2. Singh T, Kennedy S, Marynak K, et al. Characteristics of electronic cigarette use among middle and high school students - United States, 2015. MMWR Morb Mortal Wkly Rep, 2016 Dec 30;65(5051):1425-1429.
3. Hartmann-Boyce J, McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev, 2016 Sep 14;9:CD010216.
4. Pankow JF, Kim K, McWhirter KJ, et al. Benzene formation in electronic cigarettes. PLoS One, 2017 Mar 8;12(3).
5. Hess IM, Lachireddy K, Capon A. A systematic review of the health risks from passive exposure to electronic cigarette vapour. Public Health Res Pract, 2016 Apr 15;26(2).
6. Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: limited research and unresolved safety concerns. Toxicology, 2016 Jul 15;365:67-75.
7. Drug Facts: Electronic Cigarettes (e-Cigarettes). Washington, DC: National Institutes of Health, National Institute on Drug Abuse, May 2016.
8. Blundell MS, Dargan PI, Wood DM. The dark cloud of recreational drugs and vaping. QJM, 2017 Mar 9.
9. Giroud C, de Cesare M, Berthet A, et al. E-cigarettes: a review of new trends in cannabis use. Int J Environ Res Public Health, 2015 Aug 21;12(8):9988-10008.
10. Budney AJ, Sargent JD, Lee DC. Vaping cannabis (marijuana): parallel concerns to e-cigs? Addiction, 2015 Nov;110(11):1699-704.
11. Gordon JS, Istvan J, Haas M. Tobacco cessation via doctors of chiropractic: results of a feasibility study. Nicotine Tob Res, 2010 Mar;12(3):305-8.
12. Rose KA, Kizhakkeveettil A, Kadar GE, Losack M. Combining spinal manipulation with standard counseling for tobacco cessation: results of a feasibility randomized clinical trial. J Chiropr Med, 2017 Mar;16(1):41-48.