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How Hard Is It to Quit Vaping?
E-cigarettes were meant to help people quit smoking, but now Americans are having a hard time putting down the vapes
Close to 1,300 people in the United States have recently experienced lung injuries from vaping, and 26 people have died from these injuries. This string of illnesses and deaths is prompting bans on e-cigarette sales in cities like San Francisco and states like Massachusetts. The number of injuries is raising questions about the long-term implications of vaping, and over two-thirds of vapers say they plan to quit — an ironic turn of events, considering e-cigs were positioned as a tool to help people quit smoking. But how hard is it to stop?
Cigarette use reached its lowest rate ever recorded in 2017, but throughout the past decade, e-cigs have amassed a usership of nearly 11 million U.S. adults, over half of whom are under 35. And with flavors like strawberry cheesecake and pina colada, vaping has found a foothold with teenagers.
Though vaping was initially billed as a lesser evil compared to cigarettes, due to the fact that e-cigs contain less toxic chemicals, recent research has shown that vaping comes with unique dangers. People using e-cigs as a means to quit smoking traditional cigarettes tend to vape for longer durations than the time they spend using other cessation methods, like nicotine patches. And although e-cigs deliver less nicotine (the addictive substance in cigarettes) per puff than cigarettes, studies have found that experienced vapers may take more hits and deeper inhales, resulting in a similar amount of nicotine exposure.
“They’re inhaling it more deeply and holding it in longer than our traditional combustible cigarette smokers,” says Jennifer Folkenroth, the national senior director of tobacco programs for the American Lung Association (ALA). “E-cigarette users are dosing their brain significantly more frequently throughout the day.”
Newer vapes have also been shown to administer as much nicotine as a traditional cigarette. One cartridge from JUUL — the leading e-cig brand in the United States — contains as much nicotine as 20 cigarettes. Even worse is the fact that many people do not understand that vape cartridges contain nicotine, and not simply water vapor and flavoring, and therefore could be addictive. A 2014 study surveyed 1,247 young adults ages 18 to 34 and found that nearly half didn’t know if vapes contained toxic chemicals.
The dependency on the e-cigarette is actually stronger and has been more challenging to navigate breaking free from.
Because e-cigarettes are a fairly new phenomenon, data is scant on the ways vaping differs from traditional cigarettes in terms of both addiction and cessation, says Megan Jacobs, the managing director of product for the Innovations center at the nonprofit Truth Initiative, which promotes smoking prevention and cessation programs. Both products contain nicotine, which is highly addictive. How difficult it is to quit one over the other is hard to say. “We have a long history of science around cigarettes that we don’t have around vaping,” Jacobs says. “We’re collectively trying to learn what that addiction profile is and how hard it is to quit. We know it is extremely difficult to try to quit smoking. We’re seeing a lot of those same things when it comes to vaping.”
In their smoking cessation programs, the ALA says it is observing people exhibiting a greater difficulty when quitting vaping compared to combustible cigarettes, Folkenroth says. “The dependency on the e-cigarette is actually stronger and has been more challenging to navigate breaking free from.”
The attractiveness of vape flavoring seems to play a role in frequency of use and nicotine retention. In a small 2017 study of 14 people, researchers found that the body’s exposure to nicotine was significantly higher when people vaped strawberry flavored e-liquid compared to tobacco-flavored liquid, suggesting that flavor may play a role in how nicotine is absorbed in the body.
Because vaping is largely more socially acceptable than traditional cigarettes, Folkenroth says people believe that vaping is a less serious habit. “Research is showing that e-cigarette users are having a lower risk perception than the risk perception had with traditional cigarettes,” she says. “This is making them more vulnerable to the addiction itself and allowing them to justify the product, emotionally and psychologically.”
While many adults started vaping as a way to wean themselves off of traditional cigarettes, teens are developing nicotine addictions from vaping itself. “These are people who have never smoked tobacco products before,” says Dr. Albert Osei, a postdoctoral research fellow at Johns Hopkins School of Medicine. “Especially in this young age group, over time, we risk having a generation of young people who are addicted to nicotine.”
Unsurprisingly, quitting comes with social pressures for teens. “The young people who are vaping are vaping to fit in,” Jacobs says. “We’re hearing over and over again that the social pressure around vaping is tremendous in a way that social pressure around smoking is not.” If all your friends are JUULing in the bathroom in between classes, saying no becomes that much harder.
In order to encourage young e-cigarette users to ditch their vapes, Truth Initiative developed This Is Quitting, a text hotline offering tips on how to quit vaping, like identifying the triggers leading a user to take a puff (such as driving, feeling stressed, or going out to celebrate). Since the program launched in January, 55,000 vapers between the ages of 13 and 24 have enrolled. After two weeks of receiving a once-daily text message through This Is Quitting, over 60% of users reported that they vape less or not at all, Jacobs says. At two months out, roughly 25% of those enrolled had not vaped at all in the last week, and 12.5% have not vaped at all since enrolling.
Similarly, the ALA created their own conversation guide for parents to broach the topic of vaping with their kids.
While nicotine patches, gum, and lozenges have been approved by the FDA to help smokers quit combustible cigarettes, no such concrete cessation method has been found to help vapers quit, says Osei. “The issue with electronic cigarettes is research is still ongoing concerning how individuals can quit.”
This lack of clarity has posed challenges for the ALA when guiding e-cig users through nicotine replacement therapy, Folkenroth says. When combustible cigarette users say they smoke one pack a day, Folkenroth can start them at a specific nicotine patch dose. “When I have an e-cigarette user and I ask how much do you use, they’re not as confident in telling me — some days it’s two pods, other days it’s one,” she says. “And because they’re unregulated products, you don’t know how much nicotine is actually in them,” meaning the government provides no oversight into the ingredients and manufacturing of vape pods.
What is known, however, is that vapes aren’t proven cessation devices and frequently, e-cigarette users also use combustible cigarettes, Folkenroth says. “Switching to e-cigarettes does not mean quitting. The fact is, the FDA has not found any e-cigarettes to be safe and effective in helping smokers to quit.”