The vapor effect: A look at the rising vaping trend

By Ed Imbrogno

Photo Courtesy of Nova Next

The area feels spacious, almost as open as a football field. The air has a sweet scent of cherry that puts one almost completely at ease. A large chalkboard, centered on the back wall of the store, contains a multicolored list of what appear to be flavors. Placed against each other are two glass counters, as customers lean against them and sample the many flavored aerosols listed on the chalkboard. The contents inside the counter contain uniquely shaped devices that pair with the flavor cartridges on display atop the glass. In a corner of the room, two sofas occupy space in front of a TV, where customers can kick their shoes off and stay for a while as they inhale the vapors that the shop markets. Welcome to The Vapor Effect, in Cleveland Heights, Ohio, which matches this description and has a two-year history in the neighborhood.

The Vapor Effect, established in 2014, possesses many characteristics of the typical modern “vape store.” An encouragement for recreation paired with plenty of space to stand and socialize define the vaping market climate. Those who use electronic cigarettes — or “e-cigs” — crave a space where they can relax and inhale the tasty flavors themselves.

An e-cig uses a battery-powered heating unit that transforms chemicals into an aerosol vapor. This vapor contains multiple flavors that may or may not be infused with nicotine. Inhaling flavored vapor, especially with the option of skipping out on the nicotine, sounds much safer and tastier than traditional smoking.

E-cigs imitate the sensation of inhaling a cigarette as well as the recreational atmosphere that traditional smoking inspires. The popularity of vaping continues to increase as individuals believe they are safely partaking in a healthier activity that feels very much like smoking a more flavorful version of a cigarette. Yet there are several gray areas when it comes to e-cig use, including whether it is safer than conventional smoking and whether it may lead to the encouragement of conventional smoking.

“The sale of electronic nicotine systems (ENDS) has increased threefold” within the past seven years, according to Alayna P. Tackett and a team of researchers, in a 2015 article published in the journal of the Society for the Study of Addiction. “Approximately 86 percent of the population [in the United States] is aware of ENDS and 6 percent of adults use this product.”

Evan Meindl, a former resident of Cleveland, explained his experience with vaping over the last year. Meindl has tried both conventional cigarettes and e-cigs and notes how both have their positive and negative qualities in terms of use and overall feeling.

“I love the massive cloud output and many of the flavors. Definitely enjoy it, but not as much as smoking cigarettes,” says Meindl. He finds the stigma surrounding vaping to be unappealing, as those who vape usually are recognized as “hipsters.” Additionally, Meindl notes the inconvenience of having to charge the e-cig. He added that he does not believe that vaping is any healthier than conventional smoking.

Michael Hancock, an employee of The Vapor Effect, offered a different opinion from Meindl’s, saying that he believes that vaping is healthier than smoking.

Hancock said he has seen a rise in the vaping market and the number of e-cigs he sells over the two years that he has worked at the store. Additionally, the widespread accessibility of vapor and e-cigs may contribute to the increase in sales. E-cigs are everywhere, including online, at convenience stores and even at malls. Specialty vape stores continue to pop up all around the nation as well. Additionally, the variety of flavors that vaping offers, such as bubblegum and cotton candy, broaden the appeal to a larger demographic, many of whom might not like the taste of traditional cigarettes.

The trend reaches several age demographics, including both adults and young adults. It also causes concern for parents, as teen use of e-cigs currently soars. “The growing rate of vaping seems to be what’s keeping teen tobacco use stable. What’s more, vaping teens who vape may smoke too. A study released in January found that nonsmoking teens who start vaping are three times as likely as nonvapers to later smoke cigarettes,” says Janet Raloff, a writer for the website Science News for Students.

Some believe this increased risk of taking up conventional smoking in teens makes the use of e-cigs more risky in the end, as vaping may be a gateway substance for conventional smoking

But are there benefits to vaping? Yes, there are, according to A. J. Budney and a team of researchers, in an article published in the journal of the Society for the Study of Addiction in 2015. For example, a healthier alternative to smoking marijuana, or cannabis, is actually vaping it, as side-effects and illnesses such as bronchitis decrease. Evidence found in studies cited by the Budney article show that a decrease in tobacco cannabis use is inspired by those who vape cannabis.

There are also mental health benefits. According to Ratika Sharma and coauthors, in a 2017 article published by the International Journal of Environmental Research and Public Health, those suffering from mental illness may experience benefits from vaping as chemicals in the brain alter, reducing the symptoms of depression and anxiety. Additionally, some who vape feel as though they have become a part of a community, thus lowering feelings of loneliness and seclusion.

Most prominently, vaping could serve as nicotine replacement therapy for those who are trying to quit smoking. Tackett and her coauthors note that people should to choose to vape without nicotine if they wish to use e-cigs as an effective way of breaking their smoking habit. Even the smallest amount of nicotine could continue the addiction.

Vape stores could advertise these benefits to increase their growing businesses. Hancock mentioned other ways of attracting new customers: expansion plans for the Vapor Effect include adding a pool table in the shop’s open space to further the recreational atmosphere. Perhaps they will even expand their two Cleveland stores outside the area, to meet the needs of the rising demographic of those who vape in surrounding regions.

While vaping has made the sensation of smoking healthier, safer and better tasting, a review of the scientific research shows that much progress must occur for there to be a day when a completely healthy alternative to tobacco smoking becomes available. Much research is focused on the balancing of health benefits compared to conventional smoking against the uncertainties and unknowns that arise when something is new.

Is vaping better for health than smoking, or do the lighter and tastier vapors that we inhale fool us into believing that? According to Randy D. Danielson, in a 2016 article from The Clinician Review, many believe that vaping is safer, as users have the option of smoking without tobacco. E-cigs only heat a liquid, rather than tobacco. As a result, many assume that less harmful substances are entering the body.

Yet, the Food and Drug Administration fully recognizes the vapor used in e-cigs as tobacco. The FDA continues to propose several constraints on those who vape, similar to those for conventional cigarette use, as well as restricting sales of e-cigs to those above 18 years of age.

“Some research on e-cigarettes has emerged…but there are few definite answers about their effect on health,” Danielson notes in the Clinician Review article. This uncertainty makes the use of e-cigs appear as the lesser of two evils when compared to cigarette smoking, though it is still an activity that has negative implications.

Danielson also states that the substances found in e-cigarette vapor, specifically propylene glycol, can cause many symptoms that arise in conventional smokers. These include throat irritation, dizziness, headache and vocal cord inflammation. Additionally, the oxidation and heating of propylene glycol creates harmful aldehyde substances. Recent studies recorded by Konstantinos E. Farsalinos and researchers, published by the Society for the Study of Addiction in 2015, have even discovered that commonly used, high-powered e-cigs have the capability of releasing aerosols with higher levels of aldehydes than cigarette smoke.

In addition to these harmful substances, the addictiveness and harmful symptoms of the nicotine that can still be added to the vapor could greatly decrease the appeal of e-cig use. Despite the knowledge about the potential harm of propylene glycol and the addition of nicotine, the risk that vaping may cause larger health concerns, such as cancer, remains largely unstudied due to the short time period that e-cigs have been on the market.

This ambiguity on bigger health concerns continuously stumps doctors and smokers alike. Laura Crotty Alexander, a pulmonologist cited in an article in the journal Environmental Health Perspectives in 2014, says she answers questions about smoking frequently. However, over the last couple of years, she has noticed a rise in the number of questions about vaping that she gets from her patients.

“I didn’t have the answers. As a physician and a researcher, that was very frustrating,” she said in the article for Environmental Health Perspectives. Alexander states that patients often ask her if electronic cigarettes are safer than conventional cigarettes.

Similarly, the effects of vaping continue to perplex physicians the world over, as laboratory studies are responsible for most of the information gathered about vaping, rather than real-life studies. Several findings indicate that vaping still might cause life-threatening illnesses such as lung cancer; however, the risk of contracting cancer from conventional smoking is higher, says Dr. David Streem, a medical doctor in the department of Psychiatry and Psychology at the Cleveland Clinic. Fewer harmful substances are being inhaled into the body when someone vapes, as tobacco is optional and the chemical makeup is different in terms of substance volume. Despite the lower health risks, health professionals still say, for the most part, that they cannot recommend vaping due to the hazards of the propylene glycol.

A recent study performed in Flanders, Belgium, soliticed the attitudes toward vaping of doctors who are general practitioners. The results of observations and testing that these professionals gathered — including Dinska Van Gucht and Frank Baeyens, who published their findings in the Harm Reduction Journal in 2016 — indicate that vaping does seem to be less harmful than traditional smoking. However, the survey of these health professionals shows that they still do not recommend using e-cigarettes to their smoking patients, despite the healthier implications of vaping.

Local general practitioner Streem said he thinks similarly to the doctors in Belgium and researcher Laura Crotty Alexander. He, too, noticed the rise in questions he received while he lived in Cleveland.

In an attempt to find the best advice for his patients, Streem collaborated with Dr. Jason Jerry and Dr. Gregory B. Collins on a research article for the Cleveland Clinic Journal of Medicine in 2015. In an interview in 2017, Streem stated that the best way to educate yourself about a topic is to write about it.

Streem noted how difficult it is to find data on the long-term effects of vaping, as it’s hard to find someone who has only vaped and never smoked. The benefits are almost subjective, to the person practicing vaping.

Some vape for recreation, others vape to stop their addiction to smoking. However, Streem disagrees with the idea that vaping can be used for nicotine replacement therapy. He says that those who are trying to quit smoking should look for a safer alternative.

“We don’t know enough about vaping to say whether it helps patients quit smoking,” he said. “Nicotine is not safe… If a patient continues to smoke but supplements with a nicotine vaporizer, is that safer than consuming a similar amount of nicotine through tobacco smoke only?”

Streem captures this “lesser of two evils” complex surrounding vaping through metaphor.

“Whether it’s as profound a cause of lung cancer as inhaling tobacco smoke is unclear, but it seems to me that comparing the two is rather like discussing whether you’d prefer being shot with a 9 mm or a .357. One is probably better than the other, but I’d much rather not get shot at all.”

.

References

Arnold, C. (2014). Vaping and health: What do we know about e-cigarettes? Environmental Health Perspectives, 122(9), 244–249 doi:10.1289/ehp.122-a244

Bean, S., & Smith, M. J. (2015). A vaping matter: E-cigarette use in health care organizations. Hastings Center Report, 45(6), 11–12. doi:10.1002/hast.512

Biener, L., Song, E., Sutfin, E., Spangler, J., & Wolfson, M. (2015). Electronic cigarette trial and use among young adults: Reasons for trial and cessation of vaping. International Journal of Environmental Research and Public Health, 12(12), 16019–16026. doi:10.3390/ijerph121215039

Budney, A. J., Sargent, J. D., & Lee, D. C. (2015). Vaping cannabis (marijuana): parallel concerns to e-cigs? Society for the Study of Addiction , 110(11), 1699–1704. doi:10.1111/add.13036

Budney, A. J., Sargent, J. D., & Lee, D. C. (2015). Confirmation of the trials and tribulations of vaping. Society for the Study of Addiction , 110(11), 1710–1711. doi:10.1111/add.13155

Chaloupka, F. J. (2014). Tobacco control policy and electronic cigarettes. JAMA Pediatrics, 168(7), 601. doi:10.1001/jamapediatrics.2014.349

Cox, B. (2015). Can the research community respond adequately to the health risks of vaping? Society for the Study of Addiction , 110(11), 1708–1709. doi:10.1111/add.13085

Danielson, R. D. (2016). Vaping: are its “benefits” a lot of hot air? Clinician Reviews, 15–16. Retrieved March 9, 2017.

Farsalinos, K. E., Voudris, V., & Poulas, K. (2015). E-cigarettes generate high levels of aldehydes only in ‘dry puff’ conditions. Addiction, 110(8), 1352–1356. doi:10.1111/add.12942

Fearon, I. M., Eldridge, A., Gale, N., Shepperd, C. J., Mcewan, M., Camacho, O. M., Proctor, C. J. (2017). E-cigarette nicotine delivery: data and learnings from pharmacokinetic studies. American Journal of Health Behavior, 41(1), 16–32. doi:10.5993/ajhb.41.1.2

Gucht, D. V., & Baeyens, F. (2016). Health professionals in Flanders perceive the potential health risks of vaping as lower than those of smoking but do not recommend using e-cigarettes to their smoking patients. Harm Reduction Journal, 13(1). doi:10.1186/s12954–016–0111–4

Hindocha, C., Freeman, T. P., Winstock, A. R., & Lynskey, M. T. (2015). Vaping cannabis (marijuana) has the potential to reduce tobacco smoking in cannabis users. Society for the Study of Addiction, 111(2), 375–375. doi:10.1111/add.13190

Heydari, G., Ahmady, A., Chamyani, F., Masjedi, M., & Fadaizadeh, L. (2017). Electronic cigarette, effective or harmful for quitting smoking and respiratory health: A quantitative review papers. Lung India, 34(1), 25. doi:10.4103/0970–2113.197119

Hyden, W. V., & Brown, S. L. (2016). E-cigarettes and vaping: Risk reduction and risk prevention. Texas Public Health Journal, 69(1), 13–16.

Jerry, J. M., Collins, G. B., & Streem, D. (2015). E-cigarettes: Safe to recommend to patients? Cleveland Clinic Journal of Medicine, 82(8), 521–526. doi:10.3949/ccjm.82a.14054

Lam, D. C., Nana, A., & Eastwood, P. R. (2014). Electronic cigarettes: ‘Vaping’ has unproven benefits and potential harm. Official Journal of the Asian Pacific Society of Respirology, 19(7), 945–947. doi:10.1111/resp.12374

O’Connor, R. J. (2012). Non-cigarette tobacco products: what have we learned and where are we headed? Tobacco Control, 21(2), 181–190. doi:10.1136/tobaccocontrol-2011–050281

Pearson, J. L., Richardson, A., Niaura, R. S., Vallone, D. M., & Abrams, D. B. (2012). E-Cigarette awareness, use, and harm perception in US adults. American Journal of Public Health, 102(9). Retrieved March 9, 2017.

Raloff, J. (2016, July 29). Teen vaping soars past cigarette use. Retrieved March 09, 2017, from https://www.sciencenewsforstudents.org/article/teen-vaping-soars-past-cigarette-use

Raloff, J., & Mole, B. (2016, September 17). Vaping may harm the lungs. Retrieved March 09, 2017, from https://www.sciencenewsforstudents.org/article/vaping-may-harm-lungs

Raloff, J. (2016, July 12). FDA announces plans to regulate e-cigarettes and more. Retrieved March 09, 2017, from https://www.sciencenewsforstudents.org/article/fda-announces-plans regulate-e-cigarettes-and-more

Schripp, T., Markewitz, D., Uhde, E., & Salthammer, T. (2012). Does e-cigarette consumption cause passive vaping? Indoor Air,23(1), 25–31. doi:10.1111/j.1600–0668.2012.00792.x

Sharma, R., Wigginton, B., Meurk, C., Ford, P., & Gartner, C. (2016). Motivations and limitations associated with vaping among people with mental illness: A qualitative analysis of reddit discussions. International Journal of Environmental Research and Public Health, 14(1), 7. doi:10.3390/ijerph14010007

Tackett, A. P., Lechner, W. V., Meier, E., Grant, D. M., Driskill, L. M., Tahirkheli, N. N., & Wagener, T. L. (2015). Biochemically verified smoking cessation and vaping beliefs among vape store customers. Society for the Study of Addiction, 110(5), 868–874. doi:10.1111/add.12878