What are the effects of vaping on teenagers

Medical professionals on e-cigarettes"The youth are made addicted"

Stefan Heinlein: It's a positive development: The number of smokers in Germany has been falling continuously for years. Butts are increasingly uncool, especially among young people. Price increases and smoking bans in pubs and public facilities also mean empty ashtrays - a problem for the tobacco industry. The rich profits of the past are shrinking. Many corporations have therefore switched and are marketing e-cigarettes in a targeted manner. They are touted as a lifestyle product - less harmful than tobacco cigarettes, aromatic, odor-friendly and modern. But now scientists from Boston Harvard University have presented a study together with the University of Mainz that warns against the consumption of e-cigarettes. Co-author is Professor Thomas Münzel from the Mainz University Hospital. Good morning, Professor!

Thomas Münzel: Good Morning.

Heinlein: Vaping kills - is that the result of your study in one sentence?

Coin: You can't say that because you have to differentiate now. Our study, which has been running for a total of two years, of the current deaths that have now been reported in the USA. I think the causes of the deaths in the USA have now been clarified. This is the so-called vitamin E acetate, which is added to e-cigarettes in the USA, but which is not available in this form in Europe. That means what we did, that we examined the traditional e-cigarettes, consisting of glycerine, propylene glycol, with and without nicotine, what goes over the counter here practically every day.

E-cigarettes are just as damaging to vascular functions as tobacco smoke

Heinlein: According to your research, what are the harmful consequences of consuming e-cigarettes? Perhaps you can explain it in such a way that we laypeople can understand it too.

Coin: In principle it is like this: We had done two examinations. The first is that we let smokers inhale e-cigarettes and measure vascular function, which is an important prognostic marker in cardiology. We saw that 30 minutes of e-cigarettes lead to a significant deterioration in vascular functions - incidentally to an extent that can also be seen after smoking normal cigarettes. What we also saw: The tension in the vessels increases, and this is also a kind of stress activation of the vessels.

Then we went and examined in an animal model what the mechanisms are for the deterioration in vascular functions, and we saw that three organs are primarily affected: the vessels, the brain and the lungs. And again, importantly: I think that most of us are already familiar with this, many free radicals are formed here, which we now know to accelerate the disease process in the organs. I get more chronic bronchitis, I get more atherosclerosis, vascular calcification, myocardial infarction. And it was also important to prove that e-cigarettes also have side effects in the brain that could possibly lead to an overall decline in memory performance.

(dpa / Marcus Brandt) The e-cigarette between entry drug and exit aid
Sales of e-cigarettes have risen sharply worldwide. Compared to conventional glow sticks, they are considered to be significantly healthier. But are they really useful as a drug addict for nicotine addicts? Or are they not just introducing young people to the consumption of nicotine through their supposed harmlessness?

E-cigarettes as a gateway drug

Heinlein: In a nutshell, is it an illusion when many smokers think that e-cigarettes are a health-friendly alternative to tobacco cigarettes and that is all half as bad?

Coin: I think the important thing is again: why was the e-cigarette introduced? It was an idea to get the people, the smokers, off the cigarettes. That does not work. We know that after a year, for example, 80 percent of people who have switched to e-cigarettes are still attached to those e-cigarettes. This is primarily a consequence of the high nicotine levels in these e-cigarettes.

The second is: If you take a traditional method like nicotine patches or nicotine chewing gum, only six percent are still on this phase-out product after a year. This so-called great, healthy alternative doesn't work. We see rather the opposite. You said that great in your introduction. I'm not assuming that the cigarette industry is interested in people stop smoking, but that they want to sell more. That said, they have now focused on the youth market. It's really great to put this Juel cigarette, such a USB stick in your mouth, with various flavors that come with it. And what we have seen is that the young people who smoke e-cigarettes with the high nicotine content smoke tobacco cigarettes three times more than tobacco cigarettes. What our plan was to have an exit drug from the cigarettes is now more and more of a gateway drug and the youth market is what they focused on and that I find the absolute disaster.

"Cigarette advertising is only not banned in Germany"

Heinlein: Professor Münzel, indeed: The development of the e-cigarette is also a reaction of the corporations to the falling number of smokers worldwide.

Coin: Exactly.

Heinlein: Did the corporations then also try to fool us consumers with the e-cigarette, according to the motto: Vaping is modern and less harmful, but cool?

Coin: Yes, I think that is the problem in principle. The e-cigarette companies even go there and say stop smoking our normal cigarettes and move towards e-cigarettes. What surprises me personally is that these studies that we are doing now, where we are showing that e-cigarettes have significant side effects, is almost like putting a drug on the market without having tested it beforehand it has side effects for. The side effects that we have seen cannot be neglected. Of course, if you compare tobacco smoke to e-cigarette vapor, the toxins in the e-cigarette vapor are lower, but there are different uptake genetics. We know, for example, that what we have shown in our study, an important toxic intermediate, this acrolein, is ten times higher in cigarette smoke than in e-cigarette vapor. What we can measure in the urine, however, is that the concentration is only two and a half times higher in those who smoke cigarettes versus e-cigarettes. It's a different absorption genetics. I inhale the smoke and I exhale the smoke again while the cigarette vapor is better absorbed through the lungs. There are so many unanswered questions here, and what we don't know at all is what the long-term effects of these products are. That means something is thrown on the market with all its might. The nicotine concentrations are extremely high. The youth become addicted. And what is an absolute catastrophe in Germany: We are the only country, the only country in all of Europe, where cigarette advertising is still publicly allowed. That just goes to show how strong the cigarette lobby is, and that now, damn it, has to be banned. The person who prevented that was Mr. Kauder. Herr Kauder is no longer there. Cigarette advertising must be banned and e-cigarette advertising must also be banned.

(picture alliance / newscom / Howard Lipin) Study: US youth under control of the e-cigarette
E-cigarettes are a big hit in the United States: some students start using them as early as 7th grade. So far, the massive problems have been hushed up at many schools for reasons of image. Lung diseases and the first deaths, however, force action.

Heinlein: Now there are other studies that say that vaping is not or barely harmful to health. In your opinion, from a scientific point of view, is that contract work for the tobacco industry?

Coin: That is a very important point that you are making. It's an extremely controversial discussion. England, for example, they swear by the e-cigarette, and there has already been bad criticism of our work. Of course there are also studies, which I find particularly exciting: For example, if an e-cigarette sponsored a study, 95 percent of the results show that the e-cigarettes are harmless. If studies are done where the e-cigarettes were not sponsored, the opposite comes out. I think that it is again an important point to make investigations here where one is completely independent of the industry when it comes to funding. But the general opinion is that e-cigarettes are harmful. We have no long-term experience and it has to be said that 20 countries have now also banned e-cigarettes because there is a simple fear that these e-cigarettes may cause long-term health damage. But what I see as the main problem is what you mentioned: Great design, great flavors with it, and then we add high nicotine concentrations so that the children and adolescents become addicted. We get a whole new generation of nicotine-addicted students and they'll switch to tobacco products, and then it's all for free.

There are no reliable long-term studies

Heinlein: Again briefly on these studies, Professor Münzel. Are there a lot of fake news, pseudoscientific studies on the market when it comes to e-cigarettes?

Coin: I would not say that. But it is always the case when a study is sponsored by the e-cigarette industry, it depends on the question. I have just now read in "Lancer", a very important magazine in England, which published a short report in October and they also show that large controlled studies have shown that the abstinence rate after six months due to the e-cigarette is relatively low. The data suggest that smokers switch to e-cigarettes but then remain dependent on e-cigarettes in the long term. That concept, e-cigarette and opting out, that doesn't work, and what we need are independent studies, not sponsored by the e-cigarette industry, and long-term impact studies. That will answer the question of whether e-cigarettes are harmful. In my opinion, you have to do something like this beforehand, before you bring a product like this onto the market and distribute it a million times over among people. The rates of increase are in Germany and all of Europe, in Europe especially in France and England, and catastrophic in the USA. Things are being smoked here that we don't know what the long-term negative effects will be, and that's the real scandal for me.

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