Abstract
Once considered a harmless alternative to smoking tobacco, e-cigarettes are now a public health threat. Occupational health nurses should recommend workers avoid using e-cigarettes and vaping unless suggested by their doctor for smoking cessation purposes.
Electronic cigarettes (e-cigarettes), battery-operated devices or “vapes,” use liquid products vaporized by a heating element to produce an aerosol solution. E-cigarettes may hold nicotine, marijuana, ultrafine micro-particles, diacetyl, carcinogenic chemicals, heavy metals, and volatile organic compounds (Centers for Disease Control and Prevention [CDC], 2020a). Once considered a harmless smoking alternative, e-cigarettes are now a public health threat.
In August 2019, outbreak investigations started for e-cigarette, or vaping, product use–associated lung injury (EVALI). Through January 14, 2020, 2,668 EVALI patients were hospitalized and 60 deaths reported, most of whom were young non-Hispanic White males. Weekly emergency department visit rates declined from 116 per million in September to 35 per million during the week of January 5, 2020 (CDC, 2020b). More than 80% of hospitalized patients with EVALI reported using marijuana-containing products when vaping. Vitamin E acetate, sometimes in THC-containing products, was strongly linked to the outbreak, but other chemicals in THC and non-THC products may contribute (CDC, 2020b).
After vaping, symptoms may include nonproductive cough, shortness of breath, fever, chills, tachycardia, tachypnea, hypoxemia, and chest pain; some patients reported first having abdominal pain, nausea, vomiting, or diarrhea. Vital signs and pulse oximetry are needed, plus other diagnostics as indicated and to differentiate from influenza or community-acquired pneumonia. The CDC (2019) provides an algorithm for symptom management at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Algorithm-EVALI-Dec-2019-p.pdf. A thorough health history is essential because these symptoms can be attributed to other illnesses. It is important to use a non-judgmental interview technique to learn type of delivery device used along with products, additives, where product obtained, and duration of use. Evidence suggests products with THC gotten from friends, online dealers, or other informal sources increase risk for EVALI.
Occupational health nurses are important in illness prevention and should recommend that all workers avoid vaping. This education will not only benefit the worker but could help the worker’s family who may be harmed by the exhaled vapor, be burned or injured from exploding delivery devices, or suffer acute nicotine toxicity from ingestion, inhalation, or absorption through dermal or eye contact (CDC, 2020a). Occupational health nurses can encourage workers to talk with younger family members about vaping dangers as this population, particularly males, is at greatest risk for lung injury. Strongly recommend that teens, young adults, and pregnant workers never vape (CDC, 2020b). E-cigarettes with kid-friendly sweet flavors are marketed to younger populations, yet most hold nicotine, even when marketed as having none and can affect brain development, learning, memory, and risk of drug addiction. To stop the youth vaping crisis, the United States banned selling fruit- or mint-flavored products to minors (U.S. Food & Drug Administration [FDA], 2020). Warn workers against buying e-cigarette products off the street and adding other substances to vaping products. Evidence suggests e-cigarettes may help non-pregnant adult smokers when used as a complete substitute for smoking tobacco (CDC, 2020a). Encourage workers using e-cigarettes or electronic nicotine delivery systems (ENDS) as a smoking cessation aide to avoid smoking tobacco and talk with their provider about FDA-approved cessation medications or evidence-based treatments like counseling. Workers using e-cigarettes may need behavioral-based interventions for smoking cessation or even experience chemical addiction withdrawal depending on the type of product used. The Office on Smoking and Health provides web-based clinical tools and patient resources under Healthcare Provider Resources including quit lines and other cessation support resources (CDC, 2020b).
