Vaping and Electronic Cigarettes (E-cigs)

Electronic Cigarettes (e-cigs) and other “vaping” devices (such as JUUL or Suorin) are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn chemicals, including highly addictive nicotine, into an aerosol that is inhaled by the user. Most e-cigs are manufactured to look like conventional cigarettes, cigars, or pipes. Some resemble everyday items such as pens and USB memory sticks, and are known as tanks, vape pens, vaporizers, and e-pipes.

• As the FDA mulls whether to approve various vaping products to continue to be available on the market, Wisconsin Public Radio invited UW-CTRI Director of Clinical Services Dr. Doug Jorenby to be a guest on its program “Central Time.”
  • To listen to a recording of the broadcast from September 8, 2021, click here
• On September 9, 2021, the FDA ruled on some products, but delayed their decision on others
• As states mull laws to raise the age to buy tobacco to 21, matching the federal Tobacco 21 law for enforcement purposes, CBS 58 in Milwaukee spoke with UW-CTRI Associate Director of Research Dr. Megan Piper about youth vaping.

  

Approximately 4.5% of American adults vape. In 2020, 221.9 million units of e-cigarette products were sold in U.S. retail stores nationwide. This is an increase of 173.7% from 2015.

Vape sales increased dramatically during the pandemic. According to the CDC Data Brief on March 21, 2021:

• Vape sales increased by 32.0% between September 6, 2020 and March 21, 2021.
• National e-cigarette unit sales have exceeded pre-EVALI outbreak levels, the highest sales ever.
• Following FDA’s flavor enforcement policy in February 2020, national total e-cigarette unit sales increased by 48.8% from February 23, 2020 to March 21. 2021.

For more national stats, see the CDC page.

To Quit

• Text READY to 200-400
• Call 800-QUIT-NOW (800-784-8669)
• For more on how youth can ditch nicotine, click here

COVID-19, Smoking, and Vaping

According to the CDC, being a current or former cigarette smoker increases your risk of severe illness from COVID-19. Here is what the research tells us.

Youth Vaping and Smoking

The FDA, in partnership with the CDC, released new data from the 2020 National Youth Tobacco Survey (NYTS), which shows 1.8 million fewer U.S. youth are currently using e-cigarettes compared to 2019.

The decline reported in 2020 is encouraging news; however, FDA officials said they remain very concerned about the 3.6 million U.S. youth who currently use e-cigarettes and the agency acknowledges there is work that still needs to be done to curb youth use.

In 2020, 19.6% of high school students (3.02 million) and 4.7% of middle school students (550,000) reported current e-cigarette use. Among current e-cigarette users, 38.9% of high school students and 20.0% of middle school students reported using e-cigarettes on 20 or more of the past 30 days; 22.5% of high school users and 9.4% of middle school users reported daily use. Among all current e-cigarette users, 82.9% used flavored e-cigarettes, including 84.7% of high school users (2.53 million) and 73.9% of middle school users (400,000).

• Wisconsin High School Students
• Wisconsin Middle School Students

Why is youth vaping a concern?

• According to a study in Pediatrics, children who vape are exponentially more likely to smoke cigarettes daily when they are young adults.
• Nicotine alters the adolescent brain. It increases their risk for:
  • • Impulsivity.
    • Mood disorders.
    • Stunted learning and recall.
    • Diminished enjoyment of activities they normally adore.

• Vaping devices with THC can be deadly.
  • In the United States:
    • As of February 18, 2020, a total of 2,807 hospitalized EVALI cases or deaths have been reported to CDC from all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands).
    • Sixty-eight deaths have been confirmed in 29 states and the District of Columbia (as of February 18, 2020).
    • Most of these deaths have reportedly involved vaping THC with vitamin E acetate.
  • Illinois and Wisconsin: Hospitalizations from Vaping “Street” Products
    • Latest tally of cases and deaths in Wisconsin

• The TRUTH Campaign highlighted the environmental risks of vaping
• Among youth — who use e-cigarettes at higher rates than adults do — there is substantial evidence that e-cigarette use increases the risk of transitioning to smoking conventional cigarettes. Smoking remains the leading cause of preventable disease and death in the United States.
  • A study in the Journal of the American Medical Association found youth who vaped e-cigs were nearly 4 times more likely to smoke. Current use of electronic cigarettes increased among middle and high school students from 2011 to 2015. About 5 of every 100 middle school students (5.3%) reported in 2015 that they used electronic cigarettes in the past 30 days—an increase from 0.6% in 2011. 16 of every 100 high school students (16.0%) reported in 2015 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011.
• Long-term health effects of vaping are unknown.
  • Researchers at Marquette and reporters at the Milwaukee Journal Sentinel collaborated to test popular e-cig juices: Lab Tests of E-cigs Reveal Harmful Chemicals
• Schools: Find resources to ensure tobacco-free schools here.

What is JUUL?

• JUUL is a type of e-cigarette that has surged in popularity since its introduction in 2015.
• According to an article in JAMA Pediatrics, use of JUUL among teens increased again in 2019.
• It is known for its unique use of nicotine + benzoic acid + flavors that deliver a smoother experience than other vaping devices while mimicking combustible cigarettes in their delivery of nicotine.
• JUUL has suspended sales of sweet flavors in the United States.
• According to the journal JAMA Pediatrics, half of Juul’s Twitter followers are under the age to legally buy nicotine products.
• Kids have referred to use of the product as “juuling.”
• JUUL Fact Sheet from Tobwis.org
• JUUL Fact Sheet from the Office of Smoking and Health

Does Vaping Lead to Quitting Smoking? 

• According to a Cochrane review of published research, it is unclear if e-cigs are an effective way to quit smoking.
• According to a UW-CTRI editorial in JAMA Open Network, there is still a lot we don’t know about vaping. Further research is needed.
• In a UW-CTRI study, vaping can reduce nicotine dependence, but it is unclear if patients would quit vaping.
• Another UW-CTRI study found that participants who both smoked and vaped were more likely to quit vaping than to quit smoking.
• A British study published in the New England Journal of Medicine found e-cigarettes were more effective for smoking cessation than nicotine-replacement therapy (18% quit vs. 9%), when both products were accompanied by behavioral support.
• In its report, “Nicotine Without Smoke: Tobacco Harm Reduction,” the Royal College of Physicians in the United Kingdom recommended promoting both quit-smoking medications and e-cigarettes as a way to help people avoid the harms caused by smoking combustible tobacco products. The FDA has not made such recommendations.

UW-CTRI Research on Vaping

UW-CTRI is analyzing its second study on smoking and vaping. The first UW-CTRI study on smoking and vaping found no clear evidence that vaping e-cigs reduced smoking or lowered carbon monoxide levels in participants. The second study did find that dual users of e-cigs and regular cigarettes smoked fewer cigarettes per day, but were taking in the same amount of nicotine. UW is also conducting a study on the acute and long-term effects of vaping.

There is still much about vaping we don’t know, including the interaction between smoking and COVID-19. UW-CTRI has called for more research.

Regulation

On May 5, 2016, the FDA asserted authority to regulate all tobacco products, including vaping devices. On August 8, 2016, those regulations took effect.

The FDA continues to examine vaping products and enforce laws and regulations.

To view a list of vaping regulations by state, click here.

Taxes on Vaping

Wisconsin recently joined other states in taxing vaping products.

Other Fact Sheets on E-cigs

• Electronic-Cigarettes-Infographic-CDC
• For Employers: National Business Group on Health
• Printer-friendly version of UW-CTRI’s fact sheet
• For Nurses: Vaping Infographic from Georgetown School of Nursing
• For parents: teens and quitting vaping

Citations

1) WHO 2014 Report on E-Cigarettes. Conference of the Parties to the WHO Framework Convention on Tobacco Control, Sixth session, Moscow, Russian Federation, 13–18 October 2014.

2) National Health Interview Survey, 2015 data