By Carol A. Cates, MSN, MBA, RN
Chief Nursing Officer
Odessa Regional Medical Center
The first time I gave a shot in nursing school, I cried. I cried because the patient said the shot hurt. Not because I did anything wrong, but because the medication I gave hurts when it is given as a shot. My instructor at the time gave me some very wise words that I will never forget. She said, “Very few things we do in healthcare are a choice between good and bad. They are a choice between bad and worse.” We start IV’s and give shots, which hurt and are therefore bad, to avoid severe pain, or treat infections which are worse.
Surgery, which is painful and, in many ways, traumatic to the system, is bad too, but it is done to prevent worse pain and suffering. My instructor was a little wrong about one thing, though. We do have good choices in healthcare. That good is prevention. Because if we prevent illness and injury, we don’t have to deal with the bad and worse parts of healthcare.
That to me is a bit like the debate about smoking versus using eCigarettes (also called vaping). There is not a good choice between the two, it’s a bad and worse thing. The good choice is not doing either of them.
We know smoking is bad. Decades of research have shown smoking plays a significant role in increasing risk for cancer, heart disease and strokes, lung disease, and pregnancy complications.
Vaping is bad too. But, because vaping has only been around for about 15 years, we just don’t have the studies that show us if vaping is the bad or worse when compared to smoking. We do know that the nicotine in eCigarettes is highly addictive, is toxic to growing fetuses, can affect the brain development of teens and young adults, and contributes to cardiovascular disease. We are also learning the aerosols that are inhaled when using an eCigarette can contain tiny particles of contaminants, flavorings that have been linked to lung disease (diacetyl), heavy metals including lead, and some cancer-causing chemicals. What we don’t know is the long-term effect of eCigarettes when it comes to the non-nicotine stuff that is inhaled in eCigarette aerosols.
There is also less regulation on eCigarette products than on conventional tobacco products, so they have been linked to many false advertising claims like nicotine-free products that are found to contain nicotine on testing. They have advertising and flavors that are targeted at kids and young adults. Some eCigarette aerosols can contain illegal drugs.
When it comes to the chemicals and tiny particles, right now, it is believed that smoking is worse than vaping. But that still doesn’t mean vaping is good. Currently, the only recommendation for eCigarettes is to use them as a tool to stop smoking, although they have not been approved by the Food and Drug Administration (FDA) for that use. They should not be used as an addition to smoking or as an introduction to nicotine, but those options account for most of the use of eCigarettes.
There have also been outbreaks of lung injuries related to eCigarettes, collectively known as EVALI (eCigarette or vaping associated lung injury). Most of these cases happened in August and September of 2019. Most of those cases were related to tetrahydrocannabinol (THC) use in eCigarettes. There is also a very strong link to EVALI and vitamin E acetate as a contaminant as well. EVALI has caused nearly 3000 hospitalizations and cost 68 lives. In the case of EVALI, eCigarettes are definitely very bad.
Unfortunately, eCigarette use is growing at a frightening rate. The Centers for Disease Control and Prevention (CDC) is now estimating that more than 1 in 10 young adults (ages 18-24) regularly use eCigarettes. That is bad enough, but even more scary is the number of middle and high school students that are using eCigarettes. The CDC estimates 2.55 million kids under 18 regularly use eCigarettes. In 2022 a whopping 22.7 million eCigarette products were sold each month.
eCigarettes are not a healthy option to smoking. Smoking right now seems to be worse, but vaping is still bad. The good option is the same as for most things in healthcare, prevention. Don’t start and quit if you have started. The CDC has some great resources for stopping smoking and vaping on its website. The American Cancer Society has other resources on its website. You can also speak to your primary health care provider about options for helping you quit smoking or vaping.
