E-cigarettes: Guidelines for safety and tobacco cessation

Over the last decade, we saw the increased use of electronic cigarettes or electronic nicotine devices (ENDs), commonly referred to as “vapes.” While they come in a variety of sizes and styles, they all work by producing an aerosol that is inhaled into the lungs. The aerosol is produced by warming up a liquid that contains nicotine, flavorings, and other chemicals. In 2019, the Centers for Disease Control and Prevention (CDC) reported 4.5% of adults in the US used e-cigarettes. Due to the lack of long-term studies on health and safety, there are many unknowns about ENDs. New guidance is emerging on how to navigate the confusion around this relatively new form of nicotine delivery.

The most common question about e-cigarettes—are they safe and can they help smokers quit traditional tobacco? The aerosol in vapes and nicotine contain heavy metals and cancer-causing substances. However, that is still a lot less than the 7,000 chemicals present in cigarette smoke. Compared to combustible tobacco products, e-cigarettes are considered less harmful and may be a safer alternative for those who smoke traditional cigarettes. In 2019, of the adult e-cigarette users, 36.9% were dual users who also smoked cigarettes, and 39.5% formerly smoked cigarettes. The other concerning trend was that among this group of adult e-cigarette users, 23.6 % had never smoked cigarettes. In that group of adults who had never smoked cigarettes, 56% were 18-24 years old.

Youth Vaping

According to the American Lung Association, while the use of cigarettes declined by over 70% in both middle and high school students between 2002-2019, e-cigarettes have become the most used nicotine product for youth. In 2021, 11.8% of high school students and 2.8% of middle school students reported using an e-cigarette in the last 30 days. Nicotine is a highly addictive substance and it’s unsafe for a developing brain. Youth who begin to use nicotine are more likely to get hooked, become regular tobacco users, and have an increased risk for addiction to other substances.

Looking to Quit

For those who want to quit tobacco products, are e-cigarettes a useful tobacco cessation tool? According to the 2021 U.S. Preventative Services Task Force recent guidelines, there is not enough evidence to recommend e-cigarettes for adults, including pregnant persons, trying to quit smoking. They continue to recommend a combination of behavioral interventions and FDA-approved pharmacotherapy for tobacco cessation.

Best Practices for Tobacco Cessation

• There are three types of FDA-approved tobacco cessation methods:
  • Nicotine replacement therapy (NRT), which includes the patch, gum, lozenge and nasal spray
  • Bupropion hydrochloride sustained release (Wellbutrin)
  • Varenicline (Chantix)
• Behavioral support: Using both approved pharmacotherapy and tobacco cessation support increases a person’s chances to quit tobacco and sustain this after 6 months.
• Behavioral support can be delivered by trained counselors and coaches to individuals or a group either in-person, telephonically, or through messaging.

Tobacco Cessation with Virgin Pulse

At Virgin Pulse, tobacco cessation takes place in a non-judgmental conversation that considers the whole person. Individuals will be empowered to set goals and small steps toward a tobacco-free life. Tobacco coaches listen and guide members as they create their unique Quit Plan that encompasses pharmacotherapy, stress management, adopting a healthy lifestyle, and relapse prevention.

Note: VP Live Services is only for US clients.

Virgin Pulse also offers tobacco cessation coaching and support via Workplace Options, a partner in our Global Partner Ecosystem. Workplace Options offers emotional, practical, and physical wellbeing support to employees and their families around the world. As part of this support, Workplace Options also hosts onsite or virtual seminars to educate and encourage behavior change related to tobacco use. The seminar content is adapted to appropriate cultural norms and practices for the country where the course is to be delivered, as well as delivered in the needed local language. Interested to learn more, contact your Client Success Team for more information.

Note: Workplace Options is available for US and international clients.

About the Author

Basi Perkins, MPH, CHES, CTTS

Basi is a Certified Tobacco Treatment Specialist and Certified Health Education Specialist. She has a Master’s in Public Health from Florida International University in Miami, FL. For almost a decade she has worked in clinical settings and public health programs focused on tobacco cessation and health promotion. As a health coach, she sees herself as someone who supports by listening and affirming everyone’s innate ability to make positive changes that contribute to their sense of health and wellbeing.

About Virgin Pulse Live Services

VP Live Services support your members with the right help, at the right time to get the outcomes they are looking for. Our Live Services team is made up of hundreds of accredited Guides and Health Coaches providing unlimited access to live experts across the care continuum and containing costs for clients. Wherever your workforce is on the onsite-to-remote spectrum, we've got you covered with the full suite of telephonic, app chat, and in-person human-centered support.

Health Coaching features a whole-person approach that blends lifestyle optimization with specialization in an industry-leading 22 conditions, providing total population health management that helps the healthy stay healthy, improves clinical outcomes, and reduces costs associated with chronic conditions. Members access coaching resources directly through their app and once paired with a coach, they identify their goals for a thriving life and work together to progress toward their vision and achieve their targeted outcomes.