Vaping

Vaping

October 2023

The epidemic  of vaping 

Call it the desire to look hip or being unable to resist the temptation  of getting a high, youngsters are rapidly falling prey to the habit of  vaping. Dr Riya Gupta warns youngsters of the risks of vaping and  shares methods on how to overcome it 

Man has been addicted to intoxicants  

for as long as human memory can  recall it. 

From the Somras mentioned in the ancient  texts to the current-day liquors, humans have a  strange fascination for various forms of socially  permitted inhalants. Most consider it a part  of adulting and a rite of passage. Others do it  to show off and appear trendy and hip. Yet,  others develop this habit because it gives them  a temporary kick and relief from stress.  

Vaping is the new entrant in the long list of  addictive substances which have gripped the  younger generation. It is an act of inhaling  and exhaling vapour containing nicotine and  flavouring substances produced by a device  called e-cigarettes (also known as electronic  cigarettes, Vape Pens, or Pen Hookahs). 

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How did vaping develop?  

Tobacco use has a history of about 8,000 years.  It gained widespread popularity in Europe and  China after it was claimed to have medicinal  properties. Initially in India, it was used as  a product to be smoked (hookah) and then  gradually smokeless forms like Paan, Khaini  were introduced. 

To create a more accessible form of tobacco,  cigarettes were developed. 

But slowly the ill effects of tobacco use on  human health were recognised, which led to  wide campaigns against cigarette smoking.  Cigarettes were thought to be harmful because  of incomplete combustion of cigarette products  at the cigarette bud. 

To overcome this, HTP’s (heated tobacco  

products) and e-cigarettes were developed. In  HTP’s, the tobacco was heated not burnt. It was  marketed in the form of IQOS: ‘I quit ordinary  smoking.’ 

The underlying intention of the tobacco  industry was to diversify its revenue streams  and hook a new generation of users to its  products as they understood that they would  eventually go out of business after their current  customers have either quit or passed away. 

The tobacco industry then developed  e-cigarettes (the first e-cigarette was developed  in China in the year 2003). These e-cigarettes  are marketed as ‘Harm reduction products’  (not risk-free products). 

The main component of e-cigarettes is called  e-liquid, which contains nicotine. 

Why is nicotine addictive? 

Nicotine is the chemical in tobacco that keeps  you addicted to smoking. When a person  smokes a cigarette, the nicotine reaches the  brain within seconds of taking a puff. In the  brain, nicotine increases the release of brain  chemicals such as dopamine. When we eat  something delicious, like an apple, the brain  releases dopamine. Dopamine makes a person  feel good. Other things that we can do to release  dopamine are reading books, walking, and  listening to music. The amount of dopamine  released through food is always more than  with other activities. That is, if you go two  days without food and activities, your body will  crave food rather than activities. This is known  as ‘survival of hierarchy.’ 

However, with nicotine, the amount of dopamine  released is more than what is released from food  or any other activity. Now, because nicotine  releases more dopamine than food does, the  body thinks that nicotine is more important  

E-cigarettes as as harmful as any other tobacco product

than food. This is how nicotine hijacks the first  spot in our survival of hierarchy. The person  thinks that they will die if they don’t consume  tobacco. This is an extreme case of addiction. It  is not only a bad habit but also a brain disease  which can increase with casual use. 

Research shows that adolescents are more  vulnerable to nicotine addiction because they  are still in their developing stage, and their  brains are highly susceptible to a false sense of  dopamine released by nicotine. 

By 21 years of age, the brain becomes more  mature and survival of hierarchy becomes  more permanent and less susceptible to getting  hijacked. In fact, by the age of 21, it becomes  comparatively more difficult to remove these  harmful substances from the survival hierarchy. 

This addiction process is well understood by  cigarette companies and they take advantage of  this. 

What are e-cigarettes? 

E-cigarettes are nothing but a fancier form of  cigarettes. 

An e-cigarette consists of three parts: 

1. Cartridge 

2. Heating element or atomizer 

3. Rechargeable battery 

The cartridge contains an e-liquid (consisting  of propylene glycerol, nicotine, and flavours  derived from Vitamin E-acetate). Some of the  added substances are chemical compounds  such as propylene oxide, acrolein, acetaldehyde,  formaldehyde, acetamide, metal particles  (copper, nickel, and silver) and silicate particles. 

A myth circulating among most of the  population is that e-cigarettes are not as harmful  as conventional cigarettes. But the truth is that  these e-cigarettes are just as harmful. 

The e-liquid in these devices is converted to  aerosol and not to vapour as commonly believed.  

Vaping is the new craze in the younger generation 

Lack of awareness, a desire to stay in the ‘cool’  group, and getting attracted to the packaging  have led to an increase in the usage of vaping  products among adolescents. 

According to The Lancet, 2019, worldwide  vaping sales reached $15.7 billion in 2018  and they are expected to reach $40 billion by  2023. According to the National Youth Tobacco  Survey, 2022, 2.14 million high school students  are reported to use e-cigarettes. 

E-cigarette companies market their product as  a ‘No tobacco product,’ but the e-liquid contains  nicotine; hence the FDA still considers it a  tobacco product. 

E-cigarette companies have an approach of  targeted marketing wherein the advertisements  cast young models wearing trendy clothes.  Colourful, artistic, and calm backgrounds also  attract people to buy their products. 

What are the harmful effects of E-cigarettes  and vaping? 

• Lung diseases: In 2019, the Centre for  Disease Control coined the term, EVALI  (e-cigarettes-or-vaping product-use associated lung injury).’ The harmful effect  was due to diacetyl present in e-cigarettes  causing ‘Popcorn lung injury,’ which makes  breathing worse. 

Damage to the lung tissue can lead to a chain of  other health complications. Young adolescents  who try vaping early in their teens have a higher  chance of getting heart disease 

• Heart health: Aerosols impair blood vessel  function by making the blood vessels  stiff, thereby decreasing the blood flow  throughout the body and increasing the  risk of blood clotting or heart attack. 

• Oral and dental diseases: The sweet  flavours of the e-cigarettes seem to be  

attractive but this can lead to tooth decay  and gum problems. Vaping has also been  found to lead to oral cancer. 

• Fertility issues: Vaping causes hormonal  imbalances leading to delayed egg  production in females and erectile  dysfunction in males. 

• Cancer: E-cigarettes contain many  carcinogenic substances. If the e-liquid  in the e-cigarette overheats, it forms  formaldehyde, which is a cancer-causing  substance. Vaping can cause any cancer  from head to toe.  

• COVID infection: COVID-19 has shown  how important lung health is. Vaping  damages not only the respiratory system  but also the immune system, leading to  increased chances of COVID infection. 

• Others side effects: Stomach issues:  Increase in heartburn and acid reflux.  

Central Nervous System: Nicotine in e-liquid  hijacks and rewires the adolescent brain.  E-cigarettes have also been found to increase  the chances of diabetes and disturb the sleep  cycle. 

Does vaping decrease stress? 

Vapers often report that vaping helps them  relieve stress. However, adolescent vapers report  an increase in stress levels as they develop a  regular pattern of vaping, and subsequently,  tobacco cessation can help them reduce stress. 

Nicotine creates an immediate sense of  relaxation, so people vape in the belief it  reduces stress and anxiety. This feeling is  temporary and soon gives way to withdrawal  symptoms and increased cravings. Vaping  reduces the withdrawal symptoms but does not  

reduce anxiety or deal with its reasons. 

Thus, the apparent relaxation effect of vaping  only reflects the reversal of the tension and  irritability that develop during nicotine  depletion. This is confirmed in the daily mood  patterns described by vapers, with normal  moods during vaping and worsening moods  between vaping. 

Far from acting as an aid for mood control,  nicotine dependency seems to exacerbate stress. 

Which is more dangerous, conventional  cigarettes or e-cigarettes? 

People considering e-cigarettes as a form of  tobacco cessation are being misguided and  should not use these products. E-cigarettes  are marketed as less harmful alternatives to  conventional tobacco products. However, all  tobacco products are equally harmful. 

How do I know if my child is vaping? In 2020, The Centers for Disease Control and  Prevention (CDC) stated that one in five high  school students used e-cigarettes. 

This statistic is very alarming, especially for  parents or caregivers. 

According to research published in JAMA  Paediatrics, February 2021, these are some of  the tell-tale signs that your child is hooked: • Fruity or candy-like smell from the mouth • Unexplained cough 

• Mouth sores 

• Increased thirst 

• Nose bleeds 

• Throat clearing 

• Increased irritability 

• Mood swings 

Above all this, e-cigarettes are very easy to carry  and they look like normal USB drives which  children can easily hide in their pockets or bags. 

How to help vapers 

It is very important to understand that tobacco  or nicotine dependence is a chronic disease that  requires repeated interventions and multiple  attempts to quit. 

If any of your loved ones is a vaper, it is important  to understand that they are not only addicted  but are also suffering from brain disease. 

You will have to be non-judgemental and  supportive, and remember never to make them  feel guilty in their vaping cessation journey.  Resist telling them what to do, understand their  motivation, listen with empathy, and empower  them (work with your friend to set achievable  goals). 

Set a goal 

• Cultivate the willpower to prepare yourself to  maintain a no-vaping routine. 

• Identify your own motivation to quit. • Maintain trust and confidence in yourself. • Create a desire to quit and resolve to do so. • Set a quitting date—ideally within two weeks. • Tell your family, friends, and co-workers  about quitting and ask for support. 

• Anticipate challenges to the upcoming  quitting attempts (withdrawals, cravings, and  triggers) and prepare to deal with them. • Remove triggers such as tobacco products,  ashtrays, and souvenirs from your environment,  and make your home smoke-free. 

• Track your progress and talk to your tobacco  cessation specialist to help you to quit. 

Steps you can take 

• Drink eight to ten glasses of water a day to  overcome cravings and withdrawal symptoms. • Do deep breathing exercises, such as 10 cycles  of pranayama, three times a day, to kick stress  and cravings away. 

• Increase the time between each vaping at  least by one hour. 

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• Engage in your favourite hobby to distract  from the need to vape. 

• Have a well-balanced diet that includes  milk and dairy products, which is effective in  improving sleep quality. 

• Include soluble and insoluble fibre sources  like whole cereals, millets, pulses, fruits, and  vegetables to avoid constipation. Have small  quantities of frequent meals, and try to eat any  fruit as an evening snack. 

• Share problems with your family members,  friends, and your tobacco cessation specialist. • Take your prescribed medicine under the  supervision of your certified tobacco cessation  specialist. 

• Physical activity throughout the cessation  journey has been shown to reduce weight gain  associated with withdrawal. 

• Other non-pharmacological therapies are  guided imagery, breathing techniques, music  therapy, spiritual practices, and environment  modification. 

Benefits of quitting vaping 

• After 20 minutes, blood pressure and pulse  drop to normal, and hands and feet start to  warm up. 

• After eight hours, the carbon monoxide level  in the blood drops to normal. You feel more  energised. 

• After 24 hours, the chances of a heart attack  decrease. 

• After 48 hours, the senses of smell and taste  improve, and nerve endings start to regrow. • After 72 hours, bronchial tubes relax. • After two weeks to three months, circulation,  lung function, and stamina improve. • After one month to nine months, coughing  and shortness of breath decrease, and cilia  regrow in the lungs. 

• After one year, the risk of heart disease drops  to half that of a smoker. 

• After five years, the risk of stroke and cervical  cancer is the same as that of a non-smoker.  

The risk of oral cancer of the mouth, throat,  oesophagus, and bladder is cut to half. • After 10 years, lung cancer risk is half that  of a smoker. The risk of pancreatic cancer is  roughly the same as a non-smoker. 

• After 15 years, the risk of heart disease is that  Laughter therapy 

of a non-smoker, and the risk of death is nearly  the same as that of a non-smoker. 

As an adolescent, it is very important to decide  what kind of life you want to lead—a life enslaved  by nicotine or a life full of accomplishment and  success. 

Stress is a major problem due to which some adolescents start vaping. However, laughter  therapy is an effective, non-pharmacological therapy to reduce stress. It can enhance  pleasure hormones like dopamine, serotonin, and oxytocin. 

Laughter therapy includes: 

• Clapping of hands four times 

• Pranayama 

• Stretching of hands 

• Laughing to the rhythm of ho-ha-ha  

Throw-away exercise (basically, throw away all your stress) 

• Sit straight. 

• Take a deep breath. 

• Put your arms straight. 

• Take your arms near your ears. 

• With a deep breath, try to take all your stress in your fist. 

• With a deep breath, keep on tightening your arms. 

• With a deep breath, take your arms behind your head. 

• Just straighten your hands and, with a jerk, just throw away all your tension. • Throw it away in such a way that the sound “Ahh” emanates from your mouth. • Repeat this exercise three times a day before going to bed at night. 

Dr Riya Gupta is a dental surgeon and a certified tobacco cessation specialist based out  of Lucknow ( UP). She is committed to providing personalised patient care through  quality service and communication through leading newspapers and magazines