The past two years have given us plenty to stress about, with issues of job stability, health, and more perpetually on our minds. We’ve all had to manage our mental health and deal with the daily stress. So before we explore the impact that smoking can have on health, it’s important to remember that stress can also be incredibly harmful. If you’re struggling to figure out how to quit smoking without sacrificing your wellbeing, you’re not alone. National Non-Smoking Week is January 16-22, 2022, so we’re exploring the topic in greater depth. 

How Many People Smoke Cigarettes and Vapes?

The 2019 Canadian Tobacco and Nicotine Survey (CTNS) reported that of Canadians 15 years and older, roughly 3.7 million (12%) smoked cigarettes and 5 million (16%) had ever smoked an e-cigarette or vape [1]. 

Among daily cigarette smokers, 42% made at least one attempt to quit smoking. One of the most popular methods of smoking cessation, alongside quitting without preparation and reducing the number of cigarettes smoked, was switching to e-cigarettes [1].

E-cigarettes have been widely advertised as being a “safe” alternative to smoking, helping people to quit smoking cigarettes. But are they truly safe? Let’s dive into the differences between cigarettes and e-cigarettes, how they affect our mental and physical well-being and tools to support you in reducing how much you smoke, should that be your goal.

What’s the Difference Between Cigarettes and E-Cigarettes?

Although most of us are familiar with cigarettes, the same can’t be said for e-cigarettes. 

E-cigarettes go by many names: “e-cigs,” “vape pens,” “vapes,” “mods,” “e-hookahs,” “tank systems,” and “electronic nicotine delivery systems (ENDS).” E-cigs were introduced as a safe alternative to cigarettes, aimed at helping smokers reduce and ultimately quit smoking. However, this widely held belief that e-cigarettes are “safe” is not entirely accurate.

What’s in a Cigarette?

Let’s begin with cigarettes. Alongside cigars and pipe tobacco, cigarettes are made from dried tobacco leaves. Other substances, like menthol, are added to improve the smoking experience and add flavour. When you burn tobacco, combined with other additives, you produce and breath in smoke involving a mixture of chemicals. 

Tobacco smoke includes thousands of chemicals (7,000 to be exact), many of which unfortunately are carcinogenic, or are cancer-causing substances. At least 70 chemicals in tobacco smoke have been identified as carcinogens, including [2]:

  • Nicotine (a highly addictive substance that acts as a stimulant and speeds up communication between the brain and body. Nicotine is the main reason cigarettes and tobacco-based products are so challenging to quit. More on this below.)
  • Formaldehyde (an industrial disinfectant also used for preserving bodies in the morgue.)
  • Lead (a heavy metal known for its extremely damaging effects. For adults, it can cause pain, nausea, extreme mood shifts, and more. In children, lead poisoning slows development, damages the brain and nervous system, and can cause learning and behaviour problems as well as impaired self-control and social aggression.)
  • Hydrogen Cyanide (a chemical agent used in war, as well as in fumigation, mining, and in creating pesticides, plastics, and other synthetic fibres. It disrupts the function of oxygen, harming the lungs, brain, heart, and blood vessels. Exposure can be fatal.) 
  • Arsenic (a substance often used as an alloying agent, which means it helps mix metals, often to strengthen steel. Arsenic is a carcinogen and exposure can be fatal.)
  • Carbon Monoxide (an odourless, colourless gas that can cause flu-like symptoms, and ultimately can be fatal.)
  • Benzene (a volatile organic compound used as a starting material to make other chemicals used to create plastics, rubbers, detergents, pesticides, and more.)

How Do E-Cigarettes Work?

E-cigarettes or vapes are electronic devices that heat a liquid, usually including nicotine, flavourings, and chemical additives. As the user inhales, the liquid heats and releases an aerosol into the lungs.

Vapes can be used to smoke marijuana, and cannabis-based vape pens often also include nicotine and chemicals found in traditional e-cigarettes.

When it comes to the ingredients in vape pens, many are surprised to hear nicotine included in the count. A recent study performed by the Center for Disease Control (CDC) found that 99% of e-cigarettes contain nicotine. However, some e-cig companies don’t disclose the fact that their vape has nicotine. Additionally, some e-cigarettes marketed as containing 0% nicotine have tested positive for nicotine [3].

Ingredients for e-cigarette cartridges often contain [3]:

  • Nicotine
  • Heavy metals including lead, tin, and nickel
  • Flavourings like diacetyl, which has been linked with serious lung disease
  • Carcinogens
  • Volatile organic compounds like benzene
  • Ultrafine particles that are inhaled into the lungs and can cause significant damage

JUUL E-Cigarettes

JUUL is one of the most popular e-cigarette manufacturers in North America. According to JUUL manufacturers, a single JUUL pod (about 200 puffs) contains as much nicotine as 20 regular cigarettes. Additionally, JUUL uses nicotine salts, making it easier to comfortably inhale extremely high levels of nicotine. The CDC reports that ⅔ of JUUL users between 15-24 years old are unaware that JUUL vapes always contain nicotine [3].

The Impact of Cigarettes and E-Cigarettes on Health

The CDC reports that for every one person who dies from smoking, at least 30 people suffer from smoking-related illnesses [4]. The effects of smoking cigarettes are well researched and involve many serious side effects.

Cigarettes, E-Cigarettes, and Physical Health

For instance, research has long confirmed that smoking cigarettes causes [4]:

  • Cancer
  • Lung disease
  • Stroke
  • Heart disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic bronchitis
  • Emphysema
  • Diabetes

Additionally, smoking cigarettes is known to increase the risk of [4]:

  • Certain eye diseases
  • Tuberculosis
  • Rheumatoid arthritis
  • Immune system dysfunction

Second-hand smoke also causes health issues including lung cancer, heart disease and stroke, which results in over 800 fatalities each year across Canada [5].

Cigarettes, E-Cigarettes, and Mental Health

Cigarettes and e-cigs not only impact our physical well-being but our mental health as well.

Smoking is associated with:

  • Cognitive decline
  • Dementia
  • Decreases in brain volume
  • Strokes
  • Cancer
  • Increased risk of depression (a survey involving over 2,000 students found that students who smoked experienced two to three times the rates of clinical depression as their non-smoking counterparts [6].)
  • Issues with impulse control
  • Future susceptibility to substance abuse and addiction
  • Increased difficulty focusing
  • Impaired learning and memory formation
  • Mood shifts

Additionally, another study found that smoking leads to deficits in the reward center processing sections of our brains, decreasing the amount of pleasure we receive from activities we once found enjoyable [7].

When considering the impact that smoking vapes or traditional cigarettes have on our brains, it’s important to explore nicotine.

Nicotine and the Brain

Nicotine is an incredibly addictive chemical compound that acts as a stimulant and is found in tobacco leaves. 

Nicotine is particularly harmful through the age of 25 when our brains reach maturation. When nicotine is used as the brain is still developing, it can interfere with learning, impulse control, mood, and controlled attention. 

Additionally, nicotine affects the way in which adolescents and young adults process and store memories. Usually, each time a new skill is learned or a memory is created, synapses in the brain build stronger connections. Nicotine interrupts and dominates this process, creating very strong connections that increase the risk of future substance addictions [8].

Why it’s Hard to Stop Smoking

Perhaps the most significant danger of nicotine is how addictive it is. Many people who try to quit smoking find themselves unable to do so, mainly because of nicotine.

Nicotine withdrawal symptoms often include [9]:

  • Intense cravings
  • Difficulty sleeping
  • Increased hunger and weight gain
  • Trouble focusing
  • Feeling anxious, depressed, or angry
  • Feeling grouchy and easily irritable
  • Feeling restless and jumpy

Why is Nicotine so Addictive?

Aside from the withdrawal symptoms that prompt users to reach for another cigarette, nicotine actually changes how our brains work. 

Nicotine mimics the signals of several neurotransmitters, tricking the brain into believing there are higher levels of certain chemicals (like acetylcholine) than there actually are. The brain responds by decreasing its production of these neurochemicals. When you stop smoking, you experience a deficit in these chemicals, which your brain expects to come from another source. 

Additionally, nicotine stimulates the production of dopamine, a neurotransmitter that makes us feel good. When we experience this neurotransmitter deficit, we also experience decreased dopamine levels, which can make it harder to find pleasure in everyday life and to stop smoking.

Are E-Cigarettes Safer Than Regular Cigarettes?

Generally, e-cigarettes are safer than burned cigarettes and may provide smokers with a middle ground to help them quit smoking. That being said, e-cigarettes are by no means “safe.”

Although vapes have fewer and lower amounts of the 7,000 chemicals in burned cigarettes, the nicotine and other substances in e-cigarettes are not standardized and can vary widely. Additionally, vapes may actually serve as a jumping-off point for smoking, with a 2018 report from the National Academy of Medicine finding that vape use may increase the frequency and amount of smoking in the future [10].

A study published in the European Heart Journal and led by Professor Thomas Münzel found just one occasion of vaping increased heart rates and dysfunction in the inner lining of arteries (called the endothelium), and made arteries stiffen. The endothelium is essential for regulating inflammation and blood clotting, protecting tissues from toxic agents, and dilation and constriction of blood vessels. Endothelium dysfunction is associated with heart disease. Additionally, the study found that vapes increased the production of an enzyme called NOX-2, which contributed to the damage of blood vessels in the lung and brain [11].

Although we’re still exploring the long-term effects of vaping, e-cigs have been linked with [12]:

  • Many of the same addictive effects and withdrawal symptoms as traditional smoking
  • Coughing
  • Difficulty breathing
  • Chest pain
  • Nausea and vomiting
  • Diarrhea
  • Fatigue
  • Fever

Tips to Quit Smoking

It can be tough, but quitting smoking can make a big difference in how you feel on a daily basis.

If you’re beginning your journey to smoking cessation, there are a few things you can do to help along the way.

  1. Create new routines or habits that don’t remind you of or center around smoking.
  2. Try nicotine replacement therapies, like nicotine patches or lozenges.
  3. Get support. Whether from a trained health professional or a community who understands what you’re going through, support can be essential. There are also therapists that specialize in smoking cessation counselling. 
  4. Learn new methods to relax. When you feel the tempting call to smoke, you can employ breath work, progressive body relaxation, or other techniques to help you through.
  5. Start living a healthy lifestyle — this could include working out, changing your diet, picking up new hobbies, and more! Start nourishing your body and spirit in other ways that make you feel good.

The following resources might also be of help:

  • Contact your local public health unit or call Telehealth Ontario (toll-free) at 1-866-797-0000 for more info on quitting smoking
  • Visit the Smokers’ Helpline website, phone 1-866-366-3667 or text the word iQuit to the number 123456 to register for programs and text-message support.
  • Review the support services in your province at the Canadian government’s website here.

References:

  1. https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2019-summary.html
  2. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html#:~:text=Yes%E2%80%94but%20that%20doesn’t,in%20smoke%20from%20regular%20cigarettes.&text=However%2C%20e%2Dcigarette%20aerosol%20is%20not%20harmless.
  3. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
  4. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm#:~:text=Smoking%20causes%20cancer%2C%20heart%20disease,immune%20system%2C%20including%20rheumatoid%20arthritis.
  5. https://www.canada.ca/en/health-canada/services/smoking-tobacco/avoid-second-hand-smoke/second-hand-smoke/dangers-second-hand-smoke.html
  6. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227042
  7. https://nida.nih.gov/news-events/science-highlight/healing-altered-brains-smokers
  8. https://e-cigarettes.surgeongeneral.gov/knowtherisks.html
  9. https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/7-common-withdrawal-symptoms/index.html
  10. https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes
  11. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Cardiologists-establish-how-e-cigarettes-damage-the-brain-blood-vessels-and-lungs
  12. https://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/health-risks-of-e-cigarettes.html
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