In March of 2019, the FDA released a proposed ban on flavored cigars, flavored vape juice (excluding menthol or mint) and Menthol cigarettes. Flavored cigarettes, other than menthol, have been banned since 2009.
This followed various actions the FDA had taken to regulate vape juice and ensure that only approved ingredients were being used in their manufacturing. The FDA has only had official authorization for all nicotine-related products to fall under their jurisdiction since 2016. E-cigarettes and vape juice didn’t hit the U.S. market until 2009 and became mainstream around 2012. They have been, and continue to be, under much scrutiny as to their safety and possible health consequences.
Dr. Scott Gottlieb, the FDA Commissioner, has taken a strong stance regarding flavored e-cigarettes, vape juice, and cigars due to an alarming number of teens who have started using these products – despite their use being illegal under the age of 18. Banning Menthol cigarettes is viewed as a bold step, but possibly one with backlash.
Why the distaste for flavors and menthol?
Statistics about e-cigarette use among U.S. youth:
(per the FDA website)
- Among middle and high school students, 3.62 million were current users of e-cigarettes in 2018.
- E-cigarette use, from 2017 to 2018, increased 78 percent among high school students (11.7% to 20.8%) and 48 percent among middle school students (3.3% to 4.9%) from 2017 to 2018.
- According to a 2013-2014 survey, 81 percent of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use. This includes 82% of e-cigarette users, 79% of hookah users, 74% of cigar users and 69% of smokeless users.
The reason why flavors are preferred is because they act as a buffer to the bitterness, burning sensation, and harshness by improving the taste and lessening the burn as the smoke goes down the throat. This makes flavored e-cigarettes, vapes, or cigars far more attractive to first-time users.
Commonly available flavors are vanilla, cherry, watermelon, berry, bubblegum, mint, menthol, cinnamon, various candy flavors, and regular tobacco flavor.
Statistics about menthol cigarettes:
(per the FDA website)
In the U.S.:
- More than 19.5 million people are current smokers of menthol cigarettes.
- 8 percent of African American smokers, 46 percent of Hispanic smokers, 39 percent of Asian smokers, and 28.7 percent of White smokers smoke menthol cigarettes.
- Youth who smoke are more likely to smoke menthol cigarettes than older smokers. More than half of smokers ages 12-17 smoke menthols.
Menthol cigarettes have a long history in the United States. They were first introduced in 1924 by an Ohio man named Lloyd “Spud” Hughs. By 1932, Spud cigarettes had become the fifth most popular cigarette in the country. That caught the attention of Brown and Williamson tobacco company, who then created Kool cigarettes in 1932. In 1956, the first filter-tipped cigarettes, Salem, hit the market.
The cooling sensation of menthol as you smoked created the illusion that it wasn’t doing as much damage to you as regular cigarettes. After all, your mouth and throat felt cool, not irritated. Currently, about 35% of the cigarette market comes from Menthol cigarettes.
Menthol, or mint, is also used in hookahs, dip, chew, snuff, e-cigarettes, and cigars. It has also been noted that cigarettes containing menthol appear to be harder to quit.
E-cigarettes/vaping: safe or not?
When E-cigarettes or vape devices hit the market, they were considered an alternative to cigarette smoking. Smoking in public had become taboo due to second-hand smoke, and people didn’t like the smell left on their clothes or in their cars and homes. E-cigarettes created more of a slight steam effect, rather than smoke; had little to no odor; didn’t cause second-hand smoke so they could be smoked in public without dirty looks; and were becoming a great way for some to quit the habit entirely. Sounds like a win-win, right?
Unfortunately, there wasn’t a lot of information out there regarding the chemicals used vs what was in a traditional cigarette. First, many had the opinion it was completely safe, while others felt it was at least healthier than smoking a cigarette.
What chemicals are used in the flavoring?
The e-liquids commonly used in e-cigarettes and vaping are a combination of propylene glycol and vegetable glycerin. They form the base of the liquid to which the flavoring and the nicotine are added.
Aldehydes, an organic compound usually associated with aromas, along with other additives, are used for flavoring. These ingredients are approved for use in food; however, being safe for food is not the same as being safe for smoking or vaping. You may have read about or heard of food flavorings such as vanillin, cinnamaldehyde, and benzaldehyde. To put in simpler terms, they are added ingredients that add the flavor of vanilla, cinnamon, and almond to certain foods.
The Potential Danger of Heating Aldehydes
It has been found when these ingredients are heated, they create the formation of formaldehyde and other cancer-causing chemicals. They also cause irritation and inflammation of the lungs.
It was found that some of the by-products in e-liquid had a 50-80% likelihood of not breaking down upon going through the vaporization process. This is to say that a large quantity of these chemicals is reaching the airways rather than burning away in the vapor.
In a small study, it was found that the concentration of aldehydes on the breath was 10 1/2 times higher than before vaping. In the case of formaldehyde, they found that the majority of its high concentration was actually being retained in the users’ respiratory tract. Some studies showed it was comparable to a traditional cigarette.
The effects of these chemicals and others are still being studied, but currently, there is evidence of respiratory issues including lung infections, bronchiectasis, pleural effusion, and more. This does not include potential cancer-causing elements or other reactions your body may have to e-cigarettes.
Can e-cigarettes be used to quit smoking?
Let us address the idea that e-cigarettes can be used to quit traditional cigarettes as a nicotine replacement aid. For reference, the FDA has not approved e-cigarettes as an official nicotine replacement therapy. They have acknowledged that a percentage of smokers do use them as such.
In 2012 and 2014, a study was performed using a nationally representative sample of 2,028 U.S. smokers. This study showed that long-term users had a higher quit attempt rate than short term users (72.6% vs. 53.8%) and a higher cessation rate (42.4% vs 14.2%). Cessation rate was defined as abstinent for 3 months or longer.
They concluded that long-term use of e-cigarettes was associated with a higher rate of quitting. They also stated that among those making an attempt to quit, e-cigarettes surpassed the FDA-approved therapy.
Another study was performed by Scott Weaver and his colleagues at Georgia State University in 2015-2016. They concluded that smokers who used e-cigarettes quit smoking at half the rate of smokers who did not use e-cigarettes. They also found that smokers using e-cigarettes were less likely to quit than non-users. Of the 1,284 adult smokers that were part of the study, only 858 completed their follow up survey.
It should be mentioned that many people who use e-cigarettes also still smoke traditional cigarettes. Additionally, e-cigarettes do still contain nicotine, therefore it is possible to become addicted to them or move from e-cigarettes to traditional cigarettes even if you had never smoked a traditional cigarette prior.
While more studies have been performed, the results are just as inconclusive. Therefore, it will take further studies and research before it can be said if e-cigarettes decisively can help one quit smoking traditional cigarettes.
The focus of the recently proposed ban on flavored e-cigarettes, vaping liquid, flavored cigars, and menthol cigarettes is primarily aimed at greatly decreasing the teen use of these nicotine or tobacco products. The number of teens gravitating toward these products is alarming, as are the potential health risks involved. By banning the flavoring which is primarily the attractant to teens, the hope is the number of teens who quit or do not start at all will greatly increase. The FDA is not expecting this to take full effect for about 2 years. As a pre-emptive move, however, several states have, or are in the process of, implementing their own ban on the products.
While more studies need to be done regarding the safety of vape juice and e-cigarettes, the possibility of them causing long-term damage to your health is not worth the risk, in our opinion. While they can be fun recreationally and could replace regular cigarettes, studies have not shown that they are any healthier than traditional cigarettes. Plus, do you really want to give huge companies who have no regard for your health even more money? Just some food for thought.