Traditional smoking remains one of the most common habits around the world. Once seen as something pleasurable, cool or even glamorous (especially in old Hollywood movies, where well-dressed and wealthy characters were constantly smoking during meals, conversations or moments of reflection, or when a “five-minute break” was necessary to them), this perception changes and starts being combated when its consequences are studied and understood, made possible by medicine’s advances.
However, at the same time tobacco use is discouraged by restrictions and public health campaigns, another trend gets popular among young people: vaping. The compact and discreet rechargeable device, capable of containing any replaceable essence, is now the preferred choice over regular cigarettes. That choice has been intensified by the fact that the medical community has not fully discovered the consequences of this new addiction yet, in contrast to traditional tobacco, which is already known as the global second-leading risk factor for deaths. Because of what was discussed, the question that remains is: is vaping just as bad as traditional smoking?
THE RISE IN VAPE CONSUMPTION
According to the Brazilian Health Regulatory Agency (ANVISA), electronic cigarettes entered the international market in 2003, and were first introduced to replace traditional cigarettes and to serve as an alternative to help tobacco smokers quit. Later, in 2009, their importation, marketing and advertising were prohibited in Brazil due to the lack of scientific data proving its safety, based on the fact that the World Health Organization (WHO) has not found any medical evidence showing that vaping is an effective strategy to stop smoking.
However, e-cigarettes have still found a way to being consumed by the Brazilian youth: on the authority of the Telephone Survey on Risk Factors for Noncommunicable Diseases in Times of Pandemic (Covitel)’s report, at least one in five people aged 18 to 24 is a vaper- a rate that represents 19,7% of the youth.
People that use vapes, differently from traditional smokers, don’t have to face cigarette packs covered with dramatic and scary, but true, images on the outside. Instead, they find colorful and modern packaging, similar to daily-use objects (like pens or USB sticks), which contribute to an innocent and harmless look. This attractive design, along with the possibility of choosing its flavors – with sweet and minty favored by the people, in contrast to the typical tobacco taste -, its longer durability, and the cost savings that worsens the addiction (since users don’t need to go to a store and repurchase it) are reasons why vape consumption’s statistics have been increasing year after year.
Therefore, the increase in vape usage can be understood as part of a strategy for the traditional nicotine industry to survive in the market, since traditional smoking has been stigmatized and socially unacceptable for being associated with an addiction. To stay in the market, big vape companies sell the idea of protecting people’s health by offering them innovative alternatives to consuming nicotine that are hypothetically less harmful than smoking cigarettes. Consequently, electronic and traditional cigarettes have been perceived as two different practices – despite their similarity in gesture and inhalation.
According to a study led by Mark Lucherini and published in the journal Sociology of Health & Illness about the habit of vaping, in the context of a process that has been trying to make smoking less common, people don’t consider smoking cigarettes and vapes equivalent. Differences in look, smell, taste and amount of smoke, along with its convenience, are some of the reasons why people don’t see vaping as an alternative way of smoking, a perception that is amplified by its modern working mechanism: evaporation, as opposed to “normal” cigarette combustion.
As a result, vapes break free from stereotypes of addiction, disease or an outdated habit – which traditional cigarettes have been associated with due to health campaigns – and start being linked to something stylish, fun, enjoyable and socially engaging, contributing to an increase in vaping rates among young people.
Besides that, electronic cigarettes are not only consumed by people who want to quit traditional smoking, as it was first predicted and announced by the smoking industry. As stated by the report “Electronic Cigarette: Good guy or bad guy?” and by the article “The electronic cigarette: the new cigarette of the 21st century?, the consumption of vapes is often combined with conventional cigarettes – it is not being used by people to quit traditional smoking, but to purposely substitute tobacco in places where smoking is prohibited, modulated by the need for nicotine. Because of that, more people are getting involved with the habit of using vapes – including previous non-smokers, as it will be discussed further – which also increases e-cigarettes consumption rates.
HEALTH IMPLICATIONS
As described in the report written by Knorst, Benedetto, Hoffmeister and Gazzana, vapes were first developed as a cigarette-replacement to help people quit smoking, delivering nicotine and other additives in a supposedly less harmful way by vaporizing. This “strategy” was considered necessary because the addiction of nicotine, according to the authors, is the greatest obstacle when it comes to quitting.
Although considered less dangerous and toxic than traditional ones (by not burning tobacco), electronic cigarettes can still cause severe health problems to smokers due to the cartridge’s questionable constitution and the amount of nicotine in it – varying according to its producer. When it comes to the substances contained in vapes, a study led by the Department of Health Behavior, Division of Cancer Prevention and Population Sciences has repeatedly found harmful and toxic substances – such as formaldehyde, acetaldehyde and heavy metals -, and synthetic flavors, whose active and passive inhalation’s consequences are not fully known by medicine yet.
The formulation behind vapes is known as usually following a general pattern. But the study affirms that it still varies between brands because of the lack of appropriate regulation and quality control over electronic cigarettes. Because of that, the nicotine level in e-cigarettes is inconsistent and may not match the concentration indicated by the producer, which makes consumers unaware of what they are using, worsening their addiction to the chemical and complicating the prediction of possible consequences.
However, a few of those consequences have already been identified and diagnosed by science. As reported by the medical article “A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist.” , among all the clinic cases related to vape consumption, 53% of them were caused by traumatic injuries (due to its malfunction), 24% by respiratory complication – which includes lung injury, pneumonia, emphysema and pneumothorax, stimulated by the inflammatory response to the inhalation of vapor -, and 12% by poisoning, due to the high levels of nicotine contained in electronic cigarettes.
Moreover, vapes are also often seen as a cheaper option, but this apparent advantage is capable of harming users’ health more than they realize, since one electronic device can be equivalent to many traditional cigarettes and be consumed faster. For example: in Brazil, one pack carrying 20 cigarettes is found around R$6,50 at the lowest, which lasts anywhere from 200 to 300 puffs, and an usual vape pod costs around R$ 130,00 and delivers up to 40.000 puffs.
Comparing those capacities and prices, it is shown that, when a person specifically consumes the mentioned device, they are smoking approximately 134 cigarettes that each has 300 puffs – an amount that represents 6.7 packs of “normal” cigarettes and would have cost around R$ 867,00, a price that is six times higher would take longer to be smoked entirely.
This money saving can be considered as a “benefit” for smokers and, as a result, significantly influences smokers decisions. In addition, another perceived advantage of vapes is their convenience because, differently from traditional cigarettes, they have a discreet design, don’t smell bad, work on their own – thereby dispensing a secondary object’s use, like a match or a lighter -, and are easier to hide and buy. For this reason, vaping turns to a habit in a smoker’s daily life – and can even be combined with traditional smoking -, leading to a higher nicotine intake, which worsens their dependency on electronic cigarettes and, consequently, causing greater harm to their health.
SOCIALLY SPEAKING
To understand the context behind vaping, the reasons why young people start to do it, and its consequences, Alice Schulman, a 18 year-old journalism student at Faculdade Cásper Líbero, was interviewed and taken as an example. In her own words, Alice has been using e-cigarettes for a year and a half, and was influenced by her friends at high school. Since then, the student has highlighted how her social life has improved – since vaping has become a common topic in her social environment – and how it helps her relieve her anxiety, which she believes is related to its addiction.
Although mainly designed to help traditional smokers quit, vapes have been catching the attention of a specific age group who wasn’t used to cigarettes: teenagers, like Alice, when she began smoking. According to the Brazilian psychologist Mariana Saldanha – a specialist in treating dependency and addiction problems, who was exclusively interviewed for this article -, this phenomenon can be understood as a strategy from the smoking industry to cause addiction in young users, since they can be considered more immature than other age groups and, consequently, are more attracted to appealing/fashionable products.
Saldanha also emphasizes the major role that social media plays in influencing teenagers to smoke, mainly through the exposure of social moments when vaping is portrayed as cool or dynamic. An example of this is teenagers posting pictures smoking surrounded by large amounts of vapor, or videos doing tricks – like the “ghost” inhale, easily learned via the internet.
Furthermore, because vapes are shared online and in person in teenagers’ social environments, the specialist analyses that the device is a cohesive element among adolescents. In her words, it’s naturally human to desire belonging in any social group – and that feeling is intensified during youth, when people are more immature and still learning how to manage their feelings. Driven by this urge, teenagers begin using e-cigarettes to socialize more easily and to feel included in their external social context – a strategy that works, because vaping is visually and olfactorily appealing, as Alice Schulman pointed out when discussing its consequences on her social life.
Another important fact to point out is that the wide variety of vapes in the smoking industry can effortlessly turn the device into a luxury and distinctive item among its users – an effect previously seen in the history of traditional cigarettes. During the 20th century, cigarettes (from brands like Malboro) and cigars were often seen as something expensive, due to their commerce in upscale locations such as resorts, hotels, restaurants, and their appearance on Hollywood TV, a view emphasized if cigarette holders were included as well.
Nowadays, this is no longer the case, as traditional smoking is not seen as glamorous or cool, but vaping is. Because of that, expensive electronic cigarettes have been created and sold in the market, with higher prices reflecting their better functionality and vapor quality, which increases their consumer’s desire. Consequently, those who can spend more on entertainment (which is seen as nonessential) are also showing their financial power to society, turning vapes into a status symbol and potentially causing a feeling of exclusion to those who cannot afford them, with, for example, some existing vapes costing up to R$700,00.
MENTAL HEALTH IMPLICATIONS
When asked about quitting vaping, the interviewed student Alice Schulman said that she had tried before – since she feels concerned about the long-term side effects of it -, but all those attempts were unsuccessful as she considers it a hard choice. This situation, as described by the psychologist Mariana Saldanha, can be classified as an example of a Substance Use Disorder: common among vape users, it is when a person consciously knows that a specific habit is harmful, but still keeps doing it because of a lack of self-control over the habit, explained, in this case, by the large nicotine intake (worse than that from traditional cigarettes) and the incorporation of vaping into daily routine.
According to the specialist, the Substance Use Disorder is detailed as a consequence of the electronic cigarette addiction, which users consume looking for the relief provided by its first inhalation, calming them. Because of that, the habit becomes integrated into the users’ daily life – whenever they feel negative emotions or boredom -, leading individuals to unlearn how to manage their own feelings by providing an apparent sense of balance, which makes quitting harder in the future. This consequence is caused by the high levels of nicotine – which is classified by the Brazilian Medical Association as a psychoactive drug – contained inside tobacco and vapes, which classifies this addiction as a disease, according to the World Health Organization’s International Classification of Diseases (ICD-11: 6C4A.2).
Besides the vape consumer’s incapacity of dealing with their emotions, nicotine abuse also implicates other issues in the mental health field. On the authority of the medical report “The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro – Portugal”, the addiction to nicotine makes users unable to accomplish personal and professional obligations, which includes daily occupations, performance at work and even relationships, since it affects the person’s cognitive and psychosocial health like any other drug.
Other minor, but shocking, consequences were also pointed out by the study: it found out that addicted individuals were identified as people who tend to direct their interests to everything that is, somehow, related to the substance acquisition and consumption. Because of this, a lack of motivation to explore new interests and activities has been observed among them, showing that they have more limited free time and difficulty when given the chance to experience new things in life. Moreover, as shown by the report, addicts often have to deal with problems in their interpersonal relationships, such as rudeness and struggle to listen and dialogue with others, caused by a deficit in their communication skills.
Lastly, the research links vaping to negative effects on users emotional regulation skills. Symptoms like irritability, stress, anxiety and impulsivity were revealed among addicts, which many of them confessed feeling easily discouraged and being often unsatisfied with their daily activities. The study also describes issues with memory, concentration, conflict management and even problem solving as consequences of substance addiction, like nicotine.
IN CONCLUSION
Now that we recognized vaping for not being just as bad as traditional smoking, but even worse, and effectively not helping traditional smokers to quit, the persistent question now is: how to stop the habit?
In the words of Saldanha, the first step is for the person to recognize their addiction to vapes and, because of that, seek professional help, such as psychotherapy and medicines. During the treatment, she emphasizes that the patient needs to identify in which place vaping occupies – if it is just a daily habit, or if it replaces their emotional management -, and to understand the possible consequences of quitting, so they can be prepared for it.
Moreover, the psychologist also highlights that a progressive decrease is rarely positive when it comes to quitting. When asked about the best strategies for a person to successfully quit vaping, she points out that stopping the habit immediately is better than gradually doing it, and that they must avoid people, places, and any other actions that would possibly lead to vaping again, while they try to find new interests – like hobbies. In conclusion, she also mentions how social media can be used for good and help those who are trying to quit vaping by demystifying its supposed benefits.
If that is your case, remember: you are not alone, and you can do it. You are stronger than you think!
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The article above was edited by Marina di Bernardo Babichak.
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