Smoking, vaping, and the risk to young people

Smoking is harmful to our health for a number of reasons. The tobacco in cigarettes, cigars and pipe tobacco, contains poisons such as ammonia, acetone, carbon monoxide, cyanide and arsenic as well as over 4, 000 other chemicals, some of which are known to cause cancer. Smoking damages the lining of your arteries, leading to a build-up of fatty material (atheroma) which narrows the artery. This can cause angina, a heart attack or a stroke.

The carbon monoxide in tobacco smoke reduces the amount of oxygen in your blood. This means your heart has to pump harder to supply the body with the oxygen it needs.

The nicotine in cigarettes stimulates your body to produce adrenaline, which makes your heart beat faster and raises your blood pressure, making your heart work harder.

Smoking also makes the blood more likely to clot, which increases your risk of having a heart attack or stroke.

Which diseases are caused or made worse by smoking?

There are a number of conditions that can either be caused or made worse by smoking. Common conditions include:

• Lung cancer. More than 8 in 10 cases are directly related to smoking.

• Chronic obstructive pulmonary disease (COPD). More than 8 in 10 of the deaths from COPD are directly linked to smoking. People who die of COPD are usually quite unwell for several years before they die.

• Heart disease. This is the biggest killer from smoking with about 1 in 6 deaths from heart disease due to smoking.

• Other cancers - of the mouth, nose, throat, larynx, gullet (esophagus, pancreas, bladder, cervix, blood (leukemia, and kidney are all more common in smokers.

• The circulation. The chemicals in tobacco can damage the lining of the blood vessels and affect the level of lipids (fats) in the bloodstream. This increases the risk of atheroma forming (sometimes called hardening of the arteries). Atheroma is the main cause of heart disease, strokes, peripheral vascular disease (poor circulation of the legs), and aneurysms (swollen arteries which can burst causing internal bleeding). All of these atheroma-related diseases are more common in smokers.

• Sexual problems. Smokers are more likely than non-smokers to become impotent or have difficulty in maintaining an erection in middle life. This is thought to be due to smoking-related damage of the blood vessels to the penis.

• Rheumatoid arthritis. Smoking is known to be a risk factor for developing rheumatoid arthritis.

• Menopause. On average, women who smoke have a menopause nearly two years earlier than non-smokers, and fertility is reduced in smokers (both male and female).

Other conditions where smoking often causes worse symptoms include: asthma, colds, flu, chest infections, tuberculosis, chronic rhinitis, diabetic retinopathy, hyperthyroidism, multiple sclerosis, optic neuritis, and Crohn's disease.

Smokers who quit before the age of 45 have a life expectancy close to that of people who have never smoked. For people above this age, the gap widens, but smokers who quit over the age of 45 still enjoy considerable health benefits over people who continue to smoke.

Is passive smoking harmful?

Yes, passive smoking is harmful. A smoker inhales only 15% of the smoke from a cigarette, with the other 85% of it being absorbed into the atmosphere or inhaled by other people. The act of breathing in this secondary smoke is called passive smoking. 
Children are particularly vulnerable to the effects of passive smoking and those who live with smokers may become prone to chest, ear, and nose and throat infections, and to more serious conditions such as bronchitis and pneumonia.

Deciding to quit and really wanting to succeed are important steps in becoming a non-smoker. There are three stages to giving up smoking:

• Preparing to stop

• Stopping

• Staying stopped

It can take up to 3 months to become a non-smoker, although it usually takes less time, and although the physical craving for a cigarette often goes away in less than a week, the psychological craving can last longer.

Step 1: Preparing to stop

It is important that you stop smoking because you want to. Write down your reasons, and keep the list at hand over the next few months. Think of the benefits: less coughing, cleaner clothes, better breathing (for you and your friends and family), more money, and a lower risk of developing smoking-related illnesses.

When you have decided to stop, make a plan: choose a day to quit - ask your family and friends for their support. Plan a reward for the end of your first day, and the end of the first week, and the first month. The day before, get rid of cigarettes, ashtrays and lighters.

You can also talk to your doctor or pharmacist about nicotine replacement therapy or other medication now available to aid quitting. Used properly, these products can double the success rate of stopping smoking.

Step 2: Stopping

Your goal is to get through the first day without smoking. If you need to put something in your mouth, chew sugar-free gum or something healthy and non-fattening. Drink juice and eat fruit. If you feel a strong craving, try taking some deep breaths and delay giving in to the urge. It will usually pass in a couple of minutes.

If you need to do something with your hands, find something to fiddle with - a pencil, a coin - anything but a cigarette!

You may wish to ease the withdrawal symptoms with nicotine replacement therapy. Speak with your doctor or pharmacist about this and follow their instructions to make sure you use enough, for long enough.

Step 3: Staying stopped

Take it one day at a time. Each day congratulate yourself on having made it so far. Keep reminding yourself of your reasons for giving up, and what you are gaining by not smoking. Think positively, remain determined and reward yourself. At the beginning it may help to change your normal routine, to avoid situations that would normally encourage you to smoke, such as going to a bar.

Don't be tempted to smoke ‘just one cigarette’. This can easily lead to two or three cigarettes and you risk becoming a smoker again.

Are there side effects from quitting?

Nicotine affects the brain within seconds of inhaling cigarette smoke. It increases the heart rate and blood pressure, constricts the small blood vessels under your skin, causes changes in blood composition and metabolism, and increases the production of hormones. Nicotine can also affect your mood and behavior, so temporary symptoms can be experienced if nicotine is no longer going into the body. This can trigger irritability, difficulty in sleeping, anxiety, difficulty with concentration, restlessness, dizziness and an increased appetite. However, nicotine replacement therapy can be helpful in minimizing such symptoms.

How quickly will I get the health benefits from quitting smoking?

Your blood pressure and pulse rate will quickly drop within an hour of stopping and carbon monoxide levels will return to normal within 2 days. Your sense of taste and smell will improve within a couple of days and the circulation (the movement of blood around your body) will improve within a few weeks.

After 1 month the appearance of the skin improves, owing to improved skin perfusion and by 3-9 months breathing improves and lung function increases by up to 10%.

After a year of stopping, the risk of a heart attack falls to about half that of a smoker, and 10 years later the risk of lung cancer falls to about half that of a smoker.

After 15 years the risk of heart attack falls to the same level that it would be for someone who has never smoked.

You might think that e-cigarettes are a new phenomenon but we can go back the best part of a century – to 1927 in fact – when a man named Joseph Robinson filed a patent in New York for an ‘Electrical Vaporizer’. This device would allow for a compound to be vaporized into a mouthpiece. Robinson’s patent was most likely for medicinal purposes but went nowhere and was forgotten about. In the 1980s and 90s, various patents for nicotine-based inhaling devices were filed, but it was left to a three-pack-a-day Chinese businessman called Hon Lik to start the race to what we now call e-cigarettes.

Lik had been trying to quit using conventional nicotine patches (and would watch his smoking father die from lung cancer) when in 2003 he filed a patent for a high-frequency piezoelectric device that vaporized a pressurized jet of nicotine-containing liquid. Its novelty lay in the fact that the nicotine was protected from being vaporized until it was heated, and its appearance looked like a tobacco-free cigarette producing a smoke-like vapor.
The first e-cigarette went on sale in China in 2004 and there have been at least half a dozen evolving generations of the device since then, with many different types of e-cigarette now being available. However, all of them – whatever their appearance – have three key elements: a battery (that can be rechargeable) that heats up an atomizer or coil, which then vaporizes an e-liquid or ‘juice’ into vapor that is then inhaled.

For most vapers, the e-liquid is the key to their satisfaction rating of whatever system they choose to use. There are four key components in these – glycerin, propylene glycol, nicotine (some preparations can be nicotine-free) and flavoring. The vegetable glycerin (VG) provides the vapor, and the thinner propylene glycol (PG) carries the flavor.

This VG/PG ratio determines the amount of vaping ‘cloud’ produced, as well as the flavor intensity. A higher VG score gives more cloud but less flavor, and a higher PG score gives less cloud but a bigger ‘hit’ and often more flavor. Many hardened smokers using e-cigarettes try to reproduce the throat ‘hit’ they feel when dragging hard on a conventional cigarette by increasing the level of PG in their device.

When vaping devices first appeared, the term ‘e-cigarette’ was appropriate since the vast majority had the appearance of a cigarette but with such a wide range of products now available the term is becoming somewhat obsolete. However, there is currently no agreed consensus as to a common terminology and so e-cigarettes are often now simply known as vapes.

The latest figures from The Centers for Disease Control and Prevention (CDC) suggest 4.5% of adults are currently using e-cigarettes. Although e-cigarettes could benefit some adults if used as a complete substitute for cigarettes since they don't contain any tobacco, the best smoker still remains a quit smoker, free of both smoking tobacco and using e-cigarettes.

Shockingly, the number of children using vapes in the US has risen dramatically. An article in the New England Journal of Medicine reported that in 2018, 1.3 million teenagers were using e-cigarettes, a 10% increase from the year before. This number was reported to be over 2.5 million in 2022.

Although it is illegal to sell vaping products to people aged under 18, many young people can buy these easily from sellers who do not enforce the law. Vaping adolescents appear to be heavily influenced by social media platforms and influencers, along with intensive marketing campaigns by tobacco companies and vaping businesses promoting brightly colored, highly flavored (such as bubblegum, watermelon and fruit flavors), cheap disposable vapes. Children also appear to be able to easily obtain illegal vapes, which often contain high levels of lead, nickel and chromium.

Because of the nicotine content and the unknown long-term harms, vaping carries a risk of harm and addiction for children, some of whom can vape hundreds of times a day. As of January 2020, there have been 2,668 deaths or hospitalizations for e-cigarette or vaping product use-associated lung injury (EVALI) reported to the CDC. Four hundred of these cases (15%) were in children less than 18 years of age.

Vaping using regulated and licensed products may be effective in helping adult smokers successfully quit smoking. However, the US Food and Drug Administration (FDA) has not approved vaping products as a smoking cessation method and does not consider them safe. For adults looking to quit smoking, other types of smoking cessation products should be considered (e.g., nicotine replacement therapy).

Vapes are inappropriate to be used in any form in children whose lungs and brains are still developing. Additionally, we still do not know whether there will be any long-term consequences of their use when young over the next twenty to thirty years. 
Some suggested ways to address concerns about vaping in young people include:

• restricting vape flavors

• regulating vape packaging and product presentation

• regulating point of sale displays

• restricting the sale of disposable vapes

• introducing an age restriction for non-nicotine vapes

• exploring further restrictions for other nicotine consumer products such as nicotine pouches

• preventing industry giving out free samples of vapes to children

In addition, the FDA has developed the Vaping Prevention and Education Resources Center, which provides tools to educators to help prevent and reduce e-cigarette use in school-age children.

Even taking all this into account however, the health advice regarding vaping is clear - young people, and anyone of any age who has never smoked, should not vape. If you are a smoking adult, swap to vaping. If you don’t smoke, don’t vape.