RAPID RISE IN E-CIGARETTE USE MIRRORS THE OPIOID EPIDEMIC
2020 has been a devastating year, with the world ravaged by the COVID-19 pandemic in multiple arenas from health to economics to social interactions and engagement. As a pediatric subspecialist evaluating children at Rady Children’s Hospital-San Diego, I am struck by the enormity of the impact of COVID-19 in the world of those I care for. For those whose family members have died or suffered significant health decline from COVID-19, the consequences of the pandemic have been catastrophic. For those whose caregivers have lost their jobs and livelihood, the impact has been similarly devastating. For those fortunate to have avoided these prior two outcomes, social distancing has wreaked havoc on education, team sports and events, family gatherings, play dates, etc.
Of course, my main concern as a pediatric health professional is the health and well-being of children and adolescents, and from that perspective, perhaps we are lucky in that most of our youth have been personally spared the morbidity and mortality associated with COVID-19 infection. Nevertheless, there are notable risk factors that can change that dynamic. One prominent risk factor for worse health outcomes is youth engaging in smoking and/or vaping. Both behaviors weaken the body’s natural defenses against COVID-19 through a number of different mechanisms and by affecting a number of different systems, including the pulmonary system (lungs) and the immune system.
The rapid rise in the use of e-cigarettes has very much been borne of the same cloth as that of the opioid epidemic — through promotion of the “safety” of the product in question. In the case of prescription opioids, physician prescribers were led to believe that these prescription medications were not addictive, when, in fact, quite the opposite was true. Initially created to help smokers quit smoking and to provide a “safer” alternative to smoking owing to reduced exposure to many toxic carcinogens, e-cigarettes have been advertised as a “safer” alternative to smoking. While initial data may have suggested increased smoking quit rates among those using e-cigarettes, more recent data suggests no differences in rates of quitting among those using e-cigarettes as compared to those who do not, and, more concerningly, an increased likelihood to not only continue smoking but also to add a new “addiction” to vaping such that users now both smoke and vape. Beginning in summer 2019 — with the recognition of E-cigarette or Vaping use-Associated Lung Injury (EVALI) among adolescents and young adults in particular, now understood to be the consequences of lung exposure to substances in vaping f luid, and the recognition that signs of lung damage are more prevalent among e-cigarette users than initially believed — one has to question whether the path forward and suffered by initial prescription opioid users (one of addiction and misuse) will be a future suffered by vaping users when the full long-term consequences of vaping are analyzed.
While e-cigarettes are not meant to be used by youth, marketing campaigns promoting candy-like f lavors and colorful devices have nonetheless attracted youth to vape. In recognition of increasing vaping behaviors among youth, since December 2019, we have been collecting data on vaping behaviors among adolescents at Rady Children’s. Prior to the COVID-19 pandemic, we screened 4,422 adolescents, and since it began, we have screened 10,749 adolescents. Prevalence of vaping as reported by our adolescent patients was 2.7 percent prior to COVID-19. Since the arrival of COVID-19, the prevalence of vaping has been 1.8 percent — a decrease of 33 percent.
While the absolute percentage reduction is small, the reduction in vaping behaviors appears to be real. Potential contributors include the cost of vaping, which can be significant in the setting of the pandemic-induced economic crisis, receipt of public health messaging regarding the increased risk for worse COVID-19 outcomes if one smokes or vapes, and the widespread prevalence of quit services. Further, with the rapid rise in EVALI cases only six months prior to the first COVID-19 case reported in the United States (Jan. 21, 2020), numerous public health advisories at multiple levels (national, state and local) began anti-vaping campaigns in the hopes of stemming predictions of future notable numbers of youth contracting EVALI with its adverse long-term consequences.
I am happy to see this small but significant downward trend in vaping behaviors among our youth. And I remain hopeful that the negative effects of COVID-19 on vaping will remain and persist beyond the pandemic. As a new dawn emerges with the promise of an effective COVID-19 vaccine on the horizon and an expected “return to life,” I hope that we do not similarly see a new awakening in vaping behaviors.
If anything, COVID-19 has reminded us that there is much in life to live for outside of the experience offered in an atomizer, a pod and the vaping cloud that ultimately dissipates with significant leftover hazards that just aren’t worth it. They never were, but frankly, now, that’s even more so.
Huang