At the American Center for the Study of Tobacco Products (ACSTP), researchers are working with psychologists to clarify how e-cigarettes work - and whether they are better for you than real cigarettes.
Vaping has the potential for encouraging misuse or dependency.
In the European Union, the regulatory framework establishes that vaping liquids may contain no more than 20 mg per mL. However, the real problem concerns how electronic cigarettes are designed. Vaping devices contain an element to heat and transform into aerosol a liquid containing a cocktail of solvents, flavorings and of course nicotine.
These devices come in different wattages, and some even permit smokers to increase their power in the settings; this means more vapor – and more nicotine. In short, users can circumvent the regulated restrictions on nicotine by simply turning up the power on their device.
But that’s not all. The ACSTP team found a disturbing behavior: when the vaping liquid is weak on nicotine, smokers tend to turn up the device power to compensate. As a result, they not only consume more nicotine, but the overheated liquid breaks down into toxicants, including the carcinogenic formaldehyde.
These behaviors are worrisome because electronic cigarette popularity is taking off, especially among young people. Preliminary data shows a sharp rise among high school students between 2017 in 2019, with 27.5% of high school students and 10.5% of middle school students reporting that they vape. Meanwhile, long injuries and even deaths associated with electronic cigarettes has highlighted how little we really know about their potential impact on user health.
Today proponents maintain that they are less harmful than traditional cigarettes because they serve as a transition to quitting nicotine altogether, and contain fewer dangerous contaminants. On the other hand, there are signs that they can be harmful if they underline smoker attempts to quit or even encourage non-smokers to start.
One of the problems complicating research is that devices and smokers vary so much. Just how much nicotine and toxicants are consumed depends on an algorithm of the vaping liquid content, user behaviors such as the rate at which they puff and for how long they inhale, together with the actual device design.
However, in one important conclusion in the behavioral research, the ACSTP team found that long-term electronic cigarette smokers can get more nicotine from one puff of a sophisticated electronic vaping device than they would typically get from a traditional cigarette. In other words, while the first electronic cigarettes emitted little or no nicotine, newer devices coming on the market are able to admit high quantities of nicotine.
This produces a risk because if the device doesn’t reduce cravings, smokers will use it, but if they do, there is real potential for abuse: they will work harder by puffing faster and deeper to compensate for the low nicotine delivery.
In my own practice I have seen clients tell me proudly that they have stopped smoking, but when I question them about how they did so, I discover that they have not stop smoking – they have simply converted to electronic cigarettes, a new habit sweetened by fruit and mint flavors. In light of the foregoing, there is a real risk in the common notion that vaping delivers little or no nicotine. Further, in the framework of actually stopping the addiction altogether, one of the problems with this switch is that it is so much more difficult to tell how much nicotine is being consumed; with traditional cigarettes, both the size of the current problem and the progress that is made can be clearly quantified.
The research is underway to see how users respond behaviorally to regulatory changes. Yet this does not change the fact that smoking in any form is an addiction, and addictive behavior is assigned that something deeper needs to be addressed.
Weir, Kirsten (2020). ‘Studying vaping behavior to improve public health’. Monitor on Psychology, 51(5), pp. 72-75.