World No Tobacco Day & Vaping: An epidemic claiming adolescent lives; How to find out if your child is vaping?

On this “World No Tobacco Day” (May 31), it is important to spread awareness about a new trend in smoking tobacco, i.e., ‘Vaping’, its harmful effects and how to quit vaping. Vaping is considered 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/ Pen Hookahs)

How did vaping develop?

Tobacco use has a history of about 8000 years. Tobacco gained widespread popularity in Europe and China after it was claimed to have medicinal properties. In India, it was used as a product to be smoked (hookah) and then gradually in smokeless forms (like Paan, Khaini), then slowly moved to the smoking of bidi and cigarettes.

The harmful effects of tobacco use on human health led to wide-scale campaigns against cigarette smoke. However, the underlying fear of revenue loss and business shut down a new generation of products such as HTPs (Heated Tobacco products). In 2003, E-cigarettes were launched and 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 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 numerous neurotransmitters, such as dopamine which helps regulate mood. Nicotine is a highly addictive substance.

For example, the brain releases dopamine when we eat something delicious, like an apple. Dopamine makes a person feels good. Other things we can do to release dopamine are reading books, walking, listening to music etc.

Dopamine released through food is always more than other activities. So if you go two days without food and activities, your body will crave food rather than activities. This is known as Survival of Hierarchy.

Intake of tobacco products makes the brain think nicotine is more important than food. This is how nicotine hijacks the first spot in our Survival of Hierarchy, leading to tobacco addiction resulting in brain disease.

Research shows adolescents are more vulnerable to nicotine addiction because they are still developing. By 21 years of age, the brain becomes more mature, resulting in less susceptibility to getting hijacked. On the contrary, removing these harmful substances from their survival of hierarchy becomes comparatively more difficult.

What are E-cigarettes?

E-cigarettes are nothing but a fancier form of cigarette. E-cigarettes consist of 3 parts:

1. Cartridge
2. Heating Element or Atomizer
3. Rechargeable Battery

The Cartridge contains E-liquid (consisting of Propylene Glycerol, Nicotine, and flavours derived from Vitamin E acetate). Some 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 people is that E-cigarettes are not as harmful as conventional cigarettes. But the truth is that these E-cigarettes are just as dangerous as traditional cigarettes. The E-liquid in these devices is converted to aerosol and not to as commonly believed vapour.

Lack of awareness, a desire to stay in the ‘cool’ group and getting attracted to the packaging have increased usage of vaping products amongst adolescents. According to The Lancet, 2019, worldwide vaping sales reached $15.7 billion in 2018 and are expected to reach $40 billion by 2023; according to National Youth Tobacco Survey, in 2022, 2.14 million high school students reported using E-cigarettes.

E-cigarette companies market their product as “No Tobacco product”, but the E-liquid contains nicotine; thus FDA still considers it a tobacco product. E-cigarette companies have a targeted marketing approach; the advertisement cast is mostly young models wearing trendy clothes. However, colourful, artistic, and calm backgrounds also attract young people to buy their products.

What are the Harmful Effects of E-Cigarettes and Vaping?

1. Lung Diseases: In 2019, the Centre for Disease Control coined EVALI (E-cigarette or vaping product use associated with lung injury). Another harmful effect was diacetyl in E-cigarettes causing “Popcorn Lung Injury”, which worsens breathing. Damage to the lung tissue can lead to other health complications. Young adolescents who try vaping early in their teens have a higher chance of getting heart disease.
2. Heart Health: Aerosols impair the blood vessels’ function by making the blood vessels stiff, decreasing the blood flow throughout the body and increasing the risk of blood clotting or heart attack.
3. Oral And Dental Diseases: The sweet flavours of E-cigarettes seem attractive but can lead to tooth decay and gum problems. Vaping has been found to lead to oral cancer.
4. Fertility issues: Vaping causes hormonal imbalances leading to delayed egg production in females and erectile dysfunction in males.
5. Cancer: E-cigarettes contain many carcinogenic substances. If the E-liquid in the E-cigarette overheats, it forms formaldehyde, a cancer-causing substance. Vaping can cause cancer from head to toe.
6. Covid infection: COVID-19 has shown how vital lung health is. Vaping damages the respiratory and immune systems, leading to increased chances of COVID infection.
7. Other side effects:
   • Stomach issues – increase in heartburn and acid reflux;
   • Central Nervous System – Nicotine in E-liquid hijacks and rewires adolescent brain; and,
   • E-cigarettes have also been found to increase chances of Diabetes and disturb the sleep-wake cycle.
8. Side Stream Smoke: It is very common to think that only the person vaping (first-hand smoke) is at a high risk of disease. However, the aerosols exhaled by the vaper can easily be inhaled by those around them (known as second-hand smoke).
   Second-hand smoke can lead to asthma, coronary heart disease, lung cancer and many other diseases. It can even lead to premature death.
   Third-hand smoke is the toxic residue of aerosols that stick to the surface and dust after the smoke clears. This can react with other harmful environmental chemicals to form toxic chemicals. This is a potential health hazard to small kids and pets.

Does vaping decrease stress?

Vapers often report that vaping helps them relieve stress. However, adolescent vapers report increased stress as they develop regular vaping patterns, and tobacco cessation can help them reduce stress.

Some people vape as a self-medication to ease the feeling of stress. However, contrary to these beliefs, research has shown that smoking increases anxiety and tension. Nicotine creates immediate relaxation, so people vape believing it reduces stress and anxiety. However, this feeling is temporary and soon gives way to withdrawal symptoms and increased cravings; vaping minimises the withdrawal symptoms but does not reduce anxiety or deal with why someone feels that way.

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 a mood control aid, nicotine dependency exacerbates stress.

Which is more dangerous: conventional cigarettes vs E-cigarettes?

People considering E-cigarettes as a form of tobacco cessation are misguided and should not use these products. While, E-cigarettes have been marketed as a less harmful alternative to conventional tobacco products, all tobacco products are equally dangerous.

How do I know if my child is vaping?

In 2020 CDC stated that 1 in 5 high school students used E-cigarettes. This statistic is very alarming, especially to the parents or the caregivers. Research published in JAMA Paediatrics (February 2021) states that there are some tell-tale signs:

1. Fruity or candy-like smell
2. Unexplained cough
3. Mouth sores
4. Increased thirst
5. Nose bleeds
6. Throat clearing
7. Increased irritability
8. 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 quit vaping?

It is imperative to understand Tobacco/ Nicotine dependence is a chronic disease that requires repeated interventions and multiple attempts to quit.

1. Supportive Dear ones: If your loved one is a vaper, it is vital to understand that they are not only addicted but also suffering from brain disease. You must be non-judgmental and supportive and remember never to make them feel guilty in their vaping cessation journey.
2. Antioxidant Therapy: Every puff of E-cigarette smoke exposes a smoker to more than 10^15 free radicals leading to a rise in oxidative stress of the person. A diet rich in antioxidants, vitamins and minerals is recommended. Fruits like guava, grapes and spices like turmeric will help reduce tobacco-related oxidative stress.
3. Mantra for Successful Tobacco Cessation (WMACD): Willpower to prepare yourself in maintaining to no vaping routine. Motivation – identify your motivation to quit. Assurance – keep trust and confidence in yourself. Commitment – Create a desire to quit and build a powerful thought to quit. Declaration – Declare to vendors, family, colleagues, and friends that you are committed to quitting.
   Furthermore, after adapting to the new routine, reward yourself by eating your favourite food, watching a movie, playing a video game, having a massage, doing some exercises, listening to music, learning an instrument, sketching etc.
4. Setting a Quit Date: START your cessation journey today with a tobacco cessation specialist. Set a quit date, ideally within two weeks. Tell your family, friends and co-workers about quitting and ask for support. Anticipate challenges to the upcoming quit attempts (withdrawals, cravings, and triggers) and prepare to deal with these. Remove triggers such as tobacco products, ashtrays and souvenirs from the environment and make the home smoke-free. Finally, track your progress and talk to your tobacco Cessation Specialist to help you quit.
5. 7D’s to Quit Tobacco
   • Drink Water: 8 to 10 glasses of water a day to overcome cravings and withdrawal symptoms.
   • Deep Breathing Exercises: 10 cycles of Pranayam. Three times a day to kick off stress and cravings away.
   • Delay: Increase the time between each vaping by at least 1 hour.
   • Distract: Engage in your favourite hobby
   • Diet (Dietary management of Withdrawal Symptoms):
     • Food Cravings – Diet diversity and micronutrient adequacy
     • Sleeplessness – a well-balanced diet that includes milk and dairy products is effective for improving sleep quality
     • Constipation – a diet rich in soluble and insoluble fibre sources like whole cereals, millets, pulses, fruits, and vegetables
     • Eating habits – a small quantity of frequent meals. Try to eat any fruit as an evening snack
   • Discuss: Share problems with your family members, friends, and your tobacco cessation specialist
   • Drugs (SNRTs): We must have watched the advertisement for NRTs (Nicotine Replacement Therapy). This should be used under the supervision of a certified tobacco cessation specialist.
   • Others
     • Physical activity throughout the cessation journey has been shown to reduce weight gain associated with withdrawal symptoms.
     • Laughter Therapy/Oxytocin Breathe – Stress is a significant problem, due to which some adolescents start vaping. But laughter therapy is an effective non-pharmacological therapy to reduce stress. Laughter therapy enhances pleasure hormones like dopamine, serotonin, and oxytocin. This includes – 4 times clapping of hands, Prananyam, Stretching of hands, And laughing in the rhythm of ho-ha-ha.

What are the benefits of quitting vaping?

1. After 20 minutes: Blood Pressure and pulse drop to normal. Hands and feet start to warm up.
2. After 8 hours: The carbon monoxide level in the blood drops to normal. You feel more energised.
3. After 24 hours: The chance of heart attack decreases.
4. After 48 hours: Sense of smell and taste improves. Nerve endings start to regrow.
5. After 72 hours: Bronchial tubes relax.
6. After 2 weeks to 3 months: Circulation, lung function and stamina improve.
7. After 1 month to 9 months: Coughing and shortness of breath decrease. Celia regrows in the lungs.
8. After 1 year: The risk of heart disease drops to half that of a smoker.
9. After 5 years: The risk of stroke and cervical cancer is the same as that of a non-smoker. Risks of oral cancer of the mouth, throat, oesophagus, and bladder are cut in half.

Quitting vaping will significantly reduce the risk of dangerous diseases such as lung cancer and heart disease. As an adolescent, deciding what kind of life you want to lead is imperative, a life enslaved by nicotine or a life full of accomplishment and success.

STAY HEALTHY, KEEP SMILING