A Breath of Fresh Carcinogens: Secondhand E-Cigarette Use

A cloud of scattered mist circles about as the scent of tropical fruit lingers in the air. While this ambiance might be expected in the context of a fairytale, it is also commonly experienced in social venues, residences, stores, and schools as the product of e-cigarette use, also commonly known as vaping [1]. Vaping, a relatively contemporary analog to smoking, is the process of inhaling and exhaling aerosol by heating a liquid solution, which is often flavored, to a high enough temperature inside of an e-cigarette [2]. Secondhand vaping is an effect of vaping caused by the passive inhalation of exhaled aerosol vapor from a nearby e-cigarette. This aerosol vapor consists of nicotine, ultrafine particles, and carcinogens like lead and formaldehyde, which can cause lung disease [3] [4]. To understand the prevalence of secondhand vaping in the United States, it is important to also contextualize the use of e-cigarettes. According to the National Health Interview Survey conducted in 2018, about 11.9% of people aged 18-44 reported using e-cigarettes regularly [5]. At a little over one in ten, it is apparent that the use of e-cigarettes has become widespread, especially among the younger generation. Hence, the potential safety risks it poses to both those who vape and those who passively inhale its aerosol byproduct have become more prevalent.


Due to the lack of media coverage and awareness campaigns, some may believe that the effects of secondhand vaping are insignificant. This is probably true when exposed to very little of the substance in very low frequencies. However, according to a study published in the National Academies Press in 2018, “There is conclusive evidence that e-cigarette use increases airborne concentrations of particulate matter and nicotine in indoor environments compared with background levels.” [6]. Interpreting indoor environments to mean within homes, schools, and social venues, prolonged exposure to greater than normal amounts of atmospheric nicotine and other harmful substances as a result of secondhand vapor is potentially unsafe. To this end, according to another study published in 2022, when exposed to secondhand vapor over a five year period (2014-2019), the researchers observed that, “Prevalence of secondhand nicotine vape increased from 11.7% to 15.6%...” [7], supporting the first study’s conclusion. They also discerned that the prevalence of wheeze, bronchitis symptoms, and shortness of breath also increased by 2.6%, 6.6%, and 1.6% respectively, observing a stronger association in non-smokers and non-vapers. If there is a notable increase in these symptoms over a period of five years, imagine their progression over the next five, ten, or even twenty years.


Is secondhand vaping more dangerous than secondhand smoking? For one, aerosol is composed of small liquid droplets whereas tobacco smoke contains solid and semi-solid substances, resulting in different rates of deposition. To distinguish between their effects in an indoor environment, a study compared and evaluated airborne markers and biomarkers in homes with all non-smokers, e-cigarette smokers, and cigarette smokers. The study found that, “airborne markers were statistically higher in conventional cigarette homes than in e-cigarettes homes (5.7 times higher)”; however, “concentrations of both biomarkers among non-smokers exposed to conventional cigarettes and e-cigarettes’ vapor were statistically similar (only 2 and 1.4 times higher, respectively)” [8]. It appears that while nicotine detected in the environment was significantly higher with cigarettes, the nicotine residue detected in the body from both cigarettes and e-cigarettes was similar. The researchers in this study proposed that because e-cigarettes did not require combustion — which is achieved at higher temperatures — to be used, they produced fewer chemical compounds than conventional cigarettes. Hence, while aerosol from e-cigarettes is relatively less dangerous than cigarette smoke, it still poses a risk to those who inhale it.


Unfortunately, discussing preventative measures to reduce one’s contact with secondhand vapor becomes difficult as this depends more on the person using the e-cigarette than the people affected by the secondhand vapor. However, taking steps towards distancing oneself from secondhand vapor, especially if pregnant or suffering from a respiratory condition, is an effective way of minimizing exposure. Besides abstaining from vaping completely, there are also ways for e-cigarette users to mitigate the secondhand effects. It would be wise not to vape in the presence of pregnant people, children, and people with allergies and lung conditions as they are at a higher risk for adverse effects. Moreover, not using flavored juices or using products with less nicotine might lessen some of the chemical residue contained within inhaled secondhand aerosol, posing a smaller risk to others. Finally, recalling that the lower temperature of engagement alleviates the potency of the residue of e-cigarettes compared to that of conventional ones, finding a device that does not require as much temperature or power might also decrease harmful chemicals that may be exhaled as vapor [3]. While these suggestions are useful to relieve some of the dangerous effects passerbys may have to endure, the only way to ensure the safety of all from the threat posed by secondhand vapor is to somehow dissuade e-cigarette users from vaping entirely.

To this end, as more and more people become aware of the widespread toll that e-cigarette use has taken on the health of the nation, both the number of people who vape and those who subsequently inhale secondhand vapor will hopefully decrease significantly in the near future.


References


1. Majmundar, A., Allem, J.-P., Cruz, T. B., & Unger, J. B. (2019). Where do people vape? insights from Twitter data. International Journal of Environmental Research and Public Health, 16(17), 3056. https://doi.org/10.3390/ijerph16173056

2. E-cigarettes: Facts, stats and regulations. Truth Initiative. (2021, June 15). Retrieved June 6, 2022, from https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations#What-is

3. Santos-Longhurst, A. (2020, April 23). Secondhand vape exposure: Effects, who's at risk, and more. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health/second-hand-vape

4. Health risks of e-cigarettes and vaping. Health Risks of E-Cigarettes and Vaping | American Lung Association. (2020, July 13). Retrieved June 6, 2022, from https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung

5. Centers for Disease Control and Prevention. (2020, April 30). Electronic Cigarette Use Among U.S. Adults, 2018. Centers for Disease Control and Prevention. Retrieved June 6, 2022, from https://www.cdc.gov/nchs/products/databriefs/db365.htm

6. National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. https://doi.org/10.17226/24952.

7. Islam, T., Braymiller, J., Eckel, S. P., Liu, F., Tackett, A. P., Rebuli, M. E., Barrington-Trimis, J., & McConnell, R. (2022). Secondhand nicotine vaping at home and respiratory symptoms in young adults. Thorax. https://doi.org/10.1136/thoraxjnl-2021-217041

8. Ballbè, M., Martínez-Sánchez, J. M., Sureda, X., Fu, M., Pérez-Ortuño, R., Pascual, J. A., Saltó, E., & Fernández, E. (2014). Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers. Environmental Research, 135, 76–80. https://doi.org/10.1016/j.envres.2014.09.005


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