‘Ice’ flavoured e-cigarettes may be a gateway to nicotine dependence

E-cigarettes are often touted as a good alternative for people trying to wean themselves from tobacco.

But a new study from researchers at the University of Southern California reveals a certain kind of e-cigarettes may do the complete opposite.  

The researchers found the use of ‘ice’ flavoured e-cigarettes is positively associated with smoking conventional cigarettes among young adults.  

‘Ice’ e-cigarettes are marketed with both sweet and cooling properties, in combination with fruit or desserts (such as ‘blueberry ice’ and ‘melon ice’). 

The researchers also noted that the use of ice e-cigarettes is linked with nicotine vaping frequency and dependence.  

While e-cigarettes contain fewer toxic chemicals than traditional cigarettes, they usually contain nicotine, an addictive chemical.

It’s already known that nicotine constricts blood vessels and over time this leads to a loss of elasticity, which can increase the risk of developing heart disease.  

E-cigarettes are particularly risky for the developing brains of teenagers and can also damage babies in the womb, according to the World Health Organisation. 

Whether using e-cigarettes – known as vaping – is safe has been a topic of debate for years as their use has increased rapidly, particularly among young people (stock image)

Despite this, the NHS says: ‘Many thousands of people in the UK have already stopped smoking with the help of an e-cigarette, and there is growing evidence that they can be effective.

It’s thought switching to e-cigarettes provide a safer alternative to traditional cigarettes while still providing a nicotine hit. 

The NHS says the liquid and vapour in e-cigarettes contain some potentially harmful chemicals also found in cigarette smoke but at much lower levels. 

Public Health England and the Royal College of Physicians estimate e-cigarettes are at least 95 per cent less harmful than traditional cigarettes. 

This new study hints at the possibility that there’s something about ice e-cigarettes in particular that makes them a possible gateway to both smoking traditional cigarettes and more frequent vaping – but the experts aren’t sure what.

Public Health England and the Royal College of Physicians estimate e-cigarettes are at least 95 per cent less harmful than traditional cigarettes (stock image)

Public Health England and the Royal College of Physicians estimate e-cigarettes are at least 95 per cent less harmful than traditional cigarettes (stock image)

WHAT ARE E-CIGARETTES?  

E-cigarettes, also known as vapes, are devices that allow you to inhale nicotine in a vapour rather than smoke.

E-cigarettes don’t contain tobacco and don’t produce tar or carbon monoxide, two of the most damaging constituents in cigarette smoke. 

E-cigarettes work by heating a solution (e-liquid) that typically contains nicotine, propylene glycol and/or vegetable glycerine, and flavourings. 

Using an e-cigarette is known as vaping. 

Source: NHS 

‘Young adult use of ice flavoured e-cigarettes may be common and positively associated with combustible tobacco use, nicotine vaping frequency and dependence and use of disposable e-cigarette devices,’ the authors say.

‘Because ice flavours represent a hybrid that may contain both cooling and fruity flavouring constituents, it is unclear how these flavours fit into current and future regulatory policies that place differential restrictions across different flavour categories. 

‘Further studies of the specific cooling agents and chemical constituents in ice flavoured products and health effects of ice flavoured e-cigarette use are warranted.’

As ice e-cigarettes have only recently entered the US market, the researchers wanted to gauge their appeal and see if they’re linked to other behaviours around vaping and/or smoking among young adults.          

For their study, they drew on 344 online survey responses submitted between May and August 2020.

The survey was part of the Happiness & Health Study – a prospective study of health behaviours which originally recruited 3396 ninth grade students in Los Angeles in 2013.

The survey aimed to find out if respondents vaped and if so, which flavour they had used most often in the preceding 30 days – menthol/mint, fruit/sweet or ice.

Respondents, whose average age was 21, were also asked if they smoked regular cigarettes, what symptoms of vaping dependency they had and how often and what type of vaping device they used. 

Overall, 168 (49 per cent) reported most often using ice flavours, 60 (17 per cent) menthol/mint and 116 (34 per cent) fruit/sweet.

VAPING ‘DOESN’T WORK AS A QUITTING AID’ AND ACTUALLY LEADS TO TOBACCO

Vaping doesn’t work as an aid for quitting tobacco and actually has the opposite effect, suggests new research.

Researchers said there was ‘no evidence that e-cigarettes were helpful in the quit attempt’ in a large-scale study in the US.

Scientists from the University of California in San Diego carried out an analysis of data on 45,971 Americans included in the government-commissioned Population Assessment of Tobacco and Health (PATH) Study.

Participants in the study were interviewed in 2013 and 2014 and are interviewed every year. 

A quarter of smokers who tried to quit in the first years of their enrolment used e-cigarettes to help with their attempt. And at their follow-up interview one year later, 9.6 per cent had managed to stay away from tobacco over the previous 12 months.

However, even though some had stopped smoking, researchers say the number who quit was hardly different at all from smokers who didn’t use e-cigs.

One of the studies’ authors, Dr John P. Pierce, said: ‘Among this representative sample of US smokers trying to quit, we found no evidence that e-cigarettes were helpful in the quit attempt.

‘This lack of effectiveness was also apparent in the sub-sample who used e-cigarettes on a daily basis for this quit attempt.’ 

The study was published in the journal PLOS One.

Compared with the vapers of menthol/mint flavoured e-cigarettes, those vaping ice flavoured e-cigarettes were more likely to report smoking regular cigarettes over the previous 30 days – 31.5 per cent versus 22 per cent.   

Ice flavour vapers were more likely to report symptoms of vaping dependence than fruit/sweet flavour vapers (67 per cent versus 43 per cent).

They were also more likely to have started vaping during high school (74 per cent versus 65 per cent), and to report more daily vaping episodes – 11 versus eight.

And they were also more likely than fruit/sweet or menthol/mint flavour vapers to report more vaping days over the past month – 17 versus 12 on average.

The study authors point out that their research relied on recall and didn’t measure nicotine intake, nor did it differentiate between e-cigarettes containing nicotine and those that didn’t.

‘While causality cannot be inferred from this cross sectional study, it is possible that exposure to e-cigarettes in ice flavours may somehow increase nicotine vaping frequency and dependence,’ they say.

One possibility is that the novel combination of flavours in ice e-cigarettes make users more inclined to take a puff, or they’re just a more appealing purchase in vape shops. 

‘Previous clinical laboratory studies show that fruit and menthol flavours each independently increase the appeal of e-cigarettes and suppress the aversive qualities of nicotine in young adults by creating perceptions of sweetness and coolness, respectively,’ the authors say. 

‘Ice flavours represent a hybrid that may contain both cooling and fruity flavouring constituents.

‘Further studies of the specific cooling agents and chemical constituents in ice flavoured products and the health effects of ice flavoured e-cigarette use are warranted.’       

The peer-reviewed study, which was also authored by experts at the University of Nebraska Medical Center, has been published in Tobacco Control. 

Earlier this year, a study warned that taking up vaping increases the likelihood that young people will end up smoking traditional cigarettes daily by threefold. 

The authors, from UC San Diego, said: ‘Trying e-cigarettes and multiple other tobacco products before age 18 years is strongly associated with later daily cigarette smoking.’  

A report ordered by the Department of Health in the UK found that vaping, which is touted as a healthier alternative to smoking, would be a harmful choice unless replacing cigarettes (stock image)

A report ordered by the Department of Health in the UK found that vaping, which is touted as a healthier alternative to smoking, would be a harmful choice unless replacing cigarettes (stock image)

Last year, a UK government-commissioned report found that e-cigarettes can worsen heart disease and lung disorders while the risks posed by inhaling flavouring ingredients are still ‘unknown’. 

The report warned users who do not already use tobacco products ‘risk negative effects on their health’ by vaping, although vaping is a better option for traditional smokers than sticking with the cigarettes.  

Health threats to bystanders were considered low but people can suffer an increased heart rate from high nicotine exposure, if stood close to someone vaping, the report added. 

Meanwhile, a major UK clinical trial published in 2019 revealed that, when combined with expert face-to-face support, people who used e-cigarettes to quit smoking were twice as likely to succeed as people who used other nicotine replacement products such as patches or gum. 

VAPING CHEMICALS ‘MIX TO FORM NEW TOXIC COMBINATIONS’

The chemicals produced by e-cigarettes combine inside people’s lungs to make entirely new combinations that are toxic to living cells, scientists have found.

Chemicals that produce flavours such as vanilla, berry and cinnamon can mix up with other solvents in the gadgets and become a danger to health.

‘We consistently observed that the new chemicals formed from the flavours and e-liquid solvents were more toxic than either of their parent compounds,’ said Professor Sven-Eric Jordt, a pharmacologist at Duke University in North Carolina.

He and colleagues at Yale University isolated chemicals used in e-cigarettes and put them onto human lung cells in a lab.

The cells were those that occur in the lining of the bronchi, which are the main airways that connect the windpipe to the insides of the lungs.

Chemicals they looked at included the flavourings vanillin, ethyl-vanillin, benzaldehyde, cinnamaldehyde, and the solvents propylene glycol and vegetable glycerine.

The team said that e-cigarette manufacturers often claim that their devices are safe because they contain chemicals considered to be stable.

But when they mix inside the devices, Professor Jordt and colleague found, they form unstable compounds which could then go on to damage healthy cells.

They appeared to irritate receptors in nerve endings linked to the heart and blood vessels, and also to actually be able to kill cells in the lungs.  

Damaging effects could be seen even when the vapour was breathed in in low quantities. 

The scientists said they were surprised by what they saw in the lab because they did not expect the chemicals to become more unstable and dangerous as they mixed. 

‘Activation of sensory irritant receptors can increase the heart rate and, in predisposed people, can lead to an irregular heartbeat and higher blood pressure,’ said Professor Jordt.

‘It can also increase secretions in the nasal passages and throughout the lungs and airways, leading to coughing and breathing difficulties.’ 

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