Stephen Baldassarri, MD, MHS, assistant professor of medicine (pulmonary, critical care and sleep medicine), investigates nicotine addiction, e-cigarette use, and the potential harm reduction for adult cigarette smokers who switch to e-cigarettes.
Below Baldassarri discusses the basics of e-cigarettes, how e-cigarettes compare to conventional cigarettes, and the future of vaping and smoking.
E-cigarettes are battery-operated devices that heat and aerosolize a liquid solution that typically contains nicotine, and sometimes other drugs, such as tetrahydrocannabinol (THC). The products contain a battery and a metal heating element that convert a liquid—called e-liquid—into an aerosol that is inhaled by the user. E-liquids contain a simple mixture of chemicals but become much more complex and toxic when heated. The toxic chemicals emitted in e-cigarette aerosols and inhaled can lead to adverse health effects. It is important to know that e-cigarettes are substantially less toxic and likely less harmful when compared with conventional cigarettes on a puff-for-puff basis.
E-cigarettes can deliver nicotine rapidly to the brain and to a similar degree as compared with conventional cigarettes. E-cigarettes can also be dosed very frequently. Thus, like conventional cigarettes, e-cigarettes are highly addictive. The amount and speed of nicotine delivery depend on the characteristics of the product and how a person uses the device. The addictive potential also depends on the underlying vulnerability of the user. Individuals with preexisting mental health disorders, chronic pain, stress, or other medical conditions may be at higher risk of developing addiction.
Cigarette smoking remains the leading cause of preventable death in the United States. Smoking causes heart and lung disease and various types of cancer. Smoking is a much higher risk activity than vaping. Cigarettes produce much greater levels of toxic chemicals and expose users to them more as compared with e-cigarettes.
Chronic vaping carries health risk, but the long-term consequences of this remain incompletely understood. It is important to note that while smoking and vaping both carry significant health risks, smoking appears to be more dangerous based on our current state of knowledge.
Yes. Several clinical studies have shown that e-cigarettes can promote smoking cessation for individuals who are motivated to stop smoking conventional cigarettes. It is important to note that physicians should always preferentially offer established treatments for smoking cessation such as conventional nicotine replacement therapy (i.e., nicotine patch, gum, lozenge, etc.) and the prescription medications varenicline and bupropion.
For patients who choose to use e-cigarettes for smoking cessation, it is important that they switch completely to e-cigarettes and not smoke conventional cigarettes at all. Continued smoking, even at low levels, may not reduce harm.
We understand the dangers of conventional cigarette smoking, and over the next several years we will learn more about the adverse health effects of chronic e-cigarette use. We will also seek to develop treatments for vaping addiction, which is emerging as a more common clinical problem.
Continued public health education and awareness will hopefully allow us to see a continued reduction in cigarette use, and eventually a reduction in e-cigarette use.
For more information on Baldassarri or his work, Yale faculty and staff can view a video of his talk “Clearing the Haze: E-Cigs, Vaping, and Smoking,” given at the Department of Internal Medicine Medical Grand Rounds on August 3, 2023.
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