We do not allow e-cigarettes or “vape” cigarettes due to recent data regarding their harmful effects. We can offer several different smoking cessation options.
Research On Vape Smoking
Michelle Lofwall, MD, Editor
On January 22nd, 2015, the New England Journal of Medicine (NEJM) published Hidden Formaldehyde in E-Cigarette Aerosols[ 1], a detailed and provocative Letter to the Editor by Jensen and colleagues from Portland State University. They explain that e-cigarette liquids contain chemical flavorants and nicotine, and often also contain propylene glycol and/or glycerol. In the vaporizing process (known as “vaping”), these chemicals can form formaldehyde hemiacetals, which are undesirable formaldehyde-releasing agents (FRA), the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), lists formaldehyde as a known Group 1 human carcinogen.
Interestingly, there are published “cancer potency values” for formaldehyde and many other known carcinogens that can be used to estimate incremental cancer risk based on individualized variables, such as the amount of formaldehyde exposure from a particular source such as cigarette smoke and body weight. Since no one had considered e-cigarette cancer risk through exposure to FRAs, Jensen and colleagues sought to quantify the amount of FRAs inhaled as people smoked through low and high voltage e-cigarette devices. They made the assumption that inhaling FRAs from vaped e-cigarette liquid had the same risk per unit of formaldehyde as compared to the risk of inhaling gaseous formaldehyde in cigarette smoke and compared the long term cancer risk of e-cigarettes to regular cigarettes.
The good news is that no FRAs were detected when low voltage devices were used. The bad news is that high voltage e-cigarettes contained such high levels of FRAs that the estimated lifetime cancer risk from long-term vaping was between 5-15 times higher (the variability is based on alternative methods of calculation) than long-term cigarette smoking of 1 pack per day. If these results are accurate in reflecting the immediate toxic exposure of high voltage e-cigarette vaping (and notably, they do not address other potential health risks such as heart and lung disease), there are serious public health consequences looming, particularly if e-cigarettes continue to be largely unregulated, highly available, inexpensive, and broadly marketed to youth as well as to adults, regardless of their current tobacco use.
This situation (i.e., ongoing unregulated exposure to an addictive substance without clear messages of potential carcinogen/health risk) seems somewhat oxymoronic as there are great policy changes underway aimed at improving population health, largely through changing health care provider and system behavior and payment (e.g., improving collaborations, increasing transparency, changing provider payment incentives)[ 2]. How can population health possibly improve if more of the population is voluntarily increasing their exposure to potential carcinogens?
Recognizing that the prevalence of e-cigarette use is increasing in the United States (US), the FDA has ongoing workshops discussing the impact of e-cigarettes on individual health and a proposed rule to regulate e-cigarettes as it does other tobacco products. Hopefully, there will be more conclusive answers enabling public policy to be aligned with the Department of Health and Human Services and US health providers’ efforts to improve health care and ultimately our population health.
[ 1]Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH. Hidden formaldehyde in e-cigarette aerosols. The New England journal of medicine. 2015;372(4):392-4. Epub 2015/01/22.
[ 2]Burwell SM. Setting Value-Based Payment Goals – HHS Efforts to Improve U.S. Health Care. The New England journal of medicine. 2015. Epub 2015/01/27.