In the wake of six deaths and 380 cases of confirmed and probable lung disease across the US, the Trump administration has called for banning most flavored e-cigarettes because of their huge appeal to young people.
The Centers for Disease Control and Prevention is looking closely at the different flavored nicotine juices and other substances users may be vaping in e-cigarettes to determine how the aerosol might be affecting users’ lungs.
On Sept. 12, 2019, the CDC lowered the number of confirmed and probable cases from more than 400 to 380. The number was lower, the agency said, because it is no longer reporting “possible cases.”
The mystery and concern remain. And, many smokers who use these devices to quit are concerned that a valuable tool may be taken away from them.
There’s much more that researchers need to know. These devices have a short history. As an engineer who studies how people use tobacco products, I believe that users’ behavior is key to understanding the positive and negative health effects resulting from e-cigarettes. After all, their intent was to help people stop smoking, the number one cause of preventable death in the U.S.
The way users puff, how long they puff and what they puff all play a role. We do not yet know how this behavior affects how much of each substance vapers consume over the course of their daily lives, but we have reason to believe it is significant.
Researchers and physicians also need to know what substances are being vaped and also various device designs. The FDA maintains a list called harmful and potentially harmful constituents, or HPHCs, based on data related to traditional cigarette smoking, but less is known about the effect of product designs. Users can tamper with the various modular devices, which could change their effects. Teens may be particularly likely to toy with devices.
The FDA is currently updating the list to include ingredients that might be found in e-cigarettes. Nicotine is already on the list, as well as various metals and other non-nicotine substances.
The liquids used to deliver the nicotine could be a problem. The base [e-liquids], typically made of a combination of vegetable gylcerine and propylene glycol, may alone cause inflammatory response in the lung, even if flavor additives are banned.
And with regard to flavors, it is important to understand that the toxicity of a substance may be different if it is inhaled versus ingested. For example, vanilla flavoring may be deemed safe for eating, but it may not be safe for vaping. Some flavorings decompose when heated and generate molecules that are not in the base e-liquid.
Would reducing the intake of flavorings also reduce harmful effects? And how much of these additives can be consumed before harmful effects materialized? Or, alternatively, how much must be reduced before health benefits can be realized?
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