UNC researchers investigate the unknowns of e-cigarettes

August 8, 2014

In an Aug. 7 article in Endeavors, Susan Hardy asks the question of the hour: To vape or not to vape? Her article, which draws on the work of health behavior professor Kurt Ribisl, PhD, and health behavior postdoctoral fellow Jessica Pepper, PhD, is partially reprinted below and is available in its entirety here.

Cream of mushroom. Piña colada. A whole Thanksgiving dinner, from turkey to pie.

These are some of the flavors of e-cigarettes you can buy online or in stores. About half of U.S. smokers have tried e-cigarettes, according to research by UNC postdoc Jessica Pepper. But is that a bad thing? A good thing? Or both?

Jessica Pepper, PhD

“We have no long-term health data. We don’t know whether they help people quit smoking,” says Pepper, who so far has made her career studying e-cigarettes at the UNC Gillings School of Global Public Health.

In 2013, Pepper also found that pediatricians and nurse practitioners who treat adolescents aren’t well-informed about e-cigarettes. In fact, the number-one way health-care providers say they’ve learned about e-cigarettes is from their patients, Pepper says. “Clearly, we need to be doing some education. But we’re not entirely sure what to tell doctors to say.”

In the next few years, researchers at two UNC Tobacco Centers of Regulatory Science will help figure out just what to do about e-cigarettes. The Food and Drug Administration and the National Institutes of Health fund 14 of these centers around the United States to research tobacco-derived products. UNC is the only institution to have two separate centers—one to study the medical effects of tobacco products, and the other to figure out how to educate the public on the risks (and, perhaps, the benefits).

Fifty years after the U.S. government first warned the public that cigarettes cause lung cancer and bronchitis, almost one in five adults still say they smoke some days or every day, according to the Centers for Disease Control. Smoking is still the leading cause of preventable death both in the United States and around the world, Pepper says. Some researchers think e-cigarettes might be the thing that will turn the tide.

Since 2007, e-cigarettes have gone from almost nonexistent in the United States to being available in about one-third of convenience stores, according to a study by UNC PhD candidate Shyanika Rose. But most people order their e-cigarettes online. There are also brick-and-mortar stores, including at least two in Chapel Hill, devoted to selling the supplies. Vaping, as it’s called, is completely legal, and may be less harmful than smoking, researchers think.

“The most dangerous part about regular cigarettes is the combustion—the act of lighting something on fire,” Pepper explains. An e-cigarette doesn’t light anything on fire, so it doesn’t produce smoke. Instead of tobacco leaves, an e-cigarette is filled with tobacco-derived nicotine mixed with a flavoring and a type of alcohol (not the kind you drink) to keep it wet. You fill your battery-powered e-cig with this e-juice, which evaporates when the battery heats it up, producing a visible vapor instead of smoke. Vaping doesn’t produce a lingering, unpleasant odor like smoking does, although you might smell the flavoring if you’re standing near someone using an e-cigarette.

Dr. Kurt Ribisl

So far, each new study about the effects of e-cigarettes has told us something different, Pepper says. “You’ve got one study that says e-cigarettes have one-tenth to one five-hundredth of the amount of chemicals that are in cigarettes, but you’ve got a publication that came out a few weeks ago that says certain e-cigarettes, used in a certain kind of way, can produce as much formaldehyde as a regular cigarette.”

The discrepancies, she says, probably have to do with the strength of the e-cigarette’s battery. The newest models can heat e-juice to higher temperatures, which can produce more harmful chemicals.

“Pretty much everyone, even the most conservative public-health people, agree that smokers will be best off if they quit—but if they can’t quit, they’re better off going to e-cigarettes,” says Pepper’s mentor, health-behavior researcher Kurt Ribisl, who heads one of the two UNC tobacco centers.

In a 2013 study, researchers randomly assigned cigarette smokers to use either nicotine patches or e-cigarettes. At the end of the study, the rates of health problems in the two groups weren’t very different, Ribisl says. But that was just after six months. It will take years to determine the long-term effects of vaping.

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