E-Cigarettes 101: What It Means for Your Patients’ Health


E-Cigarettes 101: What It Means for Your Patients’ Health

In the past decade, e-cigarettes have become increasingly popular. These portable, often-rechargeable devices allow users to consume nicotine or cannabinoids without the smell or stigma of cigarettes. But are these safer than traditional cigarettes?

At a recent AACVPR webinar, Brenna VanFrank, MD, MSPH, medical officer at the Centers for Disease Control and Prevention Office of Smoking and Health, said while there’s not enough research for experts to know exactly how e-cigarettes affect patients, it’s important for cardiac and pulmonary rehabilitation professionals to understand how they work and why people use them.

“The bottom line is we just don’t know—there’s no evidence yet to see whether e-cigarette use has an effect on clinical cardiovascular outcomes,” she said. “We should be moving people toward full recovery of tobacco use disorder and dependence.”

E-cigarettes are battery-powered devices that heat a liquid into an aerosol, which is then inhaled. The e-liquid inside the device typically contains cannabinoids or nicotine, but can contain other illicit drugs. These liquids are put into the device either directly into a tank or via a “pod.” While these devices have been around since the early 2000s, in recent years they’ve had a resurgence thanks to products like JUUL.

What’s particularly worrying about e-cigarettes is usage among young people. According to CDC data, in 2018 more than 3.6 million U.S. middle and high school students used e-cigarettes—a majority of whom did not use any other tobacco products. Research shows e-cigarette usage among young people has dramatically increased over the past nine years, which coincides with the usage of rechargable e-cigarette products like JUUL.

E-cigarettes are also popular among young adults. A 2018 National Health Interview Survey shows 7.6% of 18-24-year-olds use e-cigarettes, compared to 4.2% of 25-44-year-olds.

VanFrank said what’s disconcerting is the fact that many of these e-cigarette users were not using it as a means of cessation from combustible cigarettes. Meaning e-cigarettes were their first exposure to nicotine in general. A 2016 report from the Behavioral Risk Factor Surveillance System survey found that 44.3% of young adult current e-cigarette users were not smokers prior to using the device.

For those working in the cardiac and pulmonary rehabilitation space, this is important to know. VanFrank said she wants rehabilitation professionals to start approaching tobacco cessation conversations from a “product agnostic” view. Using best practices from traditional tobacco cessation, professionals can start curbing e-cigarette usage before it even happens.

“I would challenge all of us to think about treatment in a product agnostic way,” she said. “There are unique aspects to different products, particularly for the psychosocial behaviors, but given the expansion of tobacco products, I would challenge us to think about coming to treatment in a way that we don’t have to start over every time a new product emerges.”

She pointed to the DSM-5 Criteria for Tobacco Use Disorder. Regardless of the actual product, professionals should be asking important questions about status and duration of use, frequency and intensity.

It is also important to educate the masses. There are many evidence-based interventions that health officials know work. Increasing the price of e-cigarette products, instituting smoke-free policies, cessation access, media campaigns and increased licensure are ways to deter people from using the product in the first place.

“The suggestion and the evidence that is emerging is that contemporizing these public health measures that we know work to include e-cigarettes is the way to move,” she said. “With smoke-free policies, we incorporate e-cigarettes so that it’s not smoke-free, it’s tobacco-free.”