Smoking and Vaping and Screening—Oh My!
One of my earliest memories is sitting on my dad’s lap at the kitchen table while he smoked a cigarette. I was about three years old, but I knew cigarette smoking was bad for your health. I looked up and asked, “why do you smoke, Daddy?”
I don’t remember his answer, but he continued to smoke that cigarette. My dad quit cold turkey within about a year of that memory. He still occasionally talks about how hard withdrawal was. Once he quit, he couldn’t stand the smell of cigarette smoke despite having cravings he had to battle. There were many restaurants we stopped going to because the “non-smoking section” still was filled with smoke.
A lot of progress has been made to prevent smoking initiation and promote smoking cessation. It is estimated that approximately one-quarter of American adults smoked in the mid-90s. Now, only approximately 14 percent of American adults smoke.
In many ways, this drop in cigarette smoking is a major public health win. However, the tobacco industry has been clever, developing new products and making these products desirable to youth and other vulnerable communities. Such products include e-cigarettes, hookah, snuff, and snus. When these products are included to create a comprehensive tobacco use estimate, approximately 22-24 percent of Delaware adults use some form of tobacco. These products still carry many of the same health risks as cigarettes but are sometimes marketed as a healthier alternative.
Of all the tobacco products, the use of e-cigarettes has increased the most drastically in the past decade. The tobacco industry has marketed e-cigarettes as a healthier alternative and even as a possible cessation product.
Among Delaware adults, only 4 percent were current e-cigarette users and 15 percent were former e-cigarette users in 2016. In contrast, in 2022 6.1 percent of Delaware adults reported being current e-cigarette users and 23.2 percent of Delaware adults reported being former e-cigarette users.
E-cigarette use is even more common among high school students. In 2021, one-third of Delaware high school students reported using e-cigarettes at least once. Almost 18 percent of Delaware high school students reported using e-cigarettes within the past month, and 5.5 percent were frequent users.
National studies have shown that LGBTQ+ individuals have a high health burden from tobacco use. According to the Delaware Youth Risk Behavior Survey, 65.3 percent of Delaware high school students who reported having sex with the same sex or both sexes also have used e-cigarettes, compared 54.1 percent of Delaware high school students who reported having sex with only the opposite sex. Only 19 percent of high school students who reported no sexual activity had ever used e-cigarettes.
The most notorious health outcome linked to tobacco is lung cancer. The current screening recommendations for lung cancer require the calculation of pack-years. Pack-years are the combination of how many cigarettes smoked over the course of someone’s smoking history. To qualify for lung cancer screening, a person must be 50-80 years of age and have at least a 20 pack-year smoking history.
However, the calculation for pack-years only includes cigarettes; other tobacco products are excluded from the calculations. This restriction could be systematically excluding people from important screenings, with cancer detected only at a later stage.
Current research is ongoing to determine the exact risk between e-cigarettes and lung cancer, though many peered-reviewed articles point to a plausible link between vaping fluids and the disease processes resulting in cancer.
If recommendations do not expand the eligibility criteria, those choosing to use e-cigarettes are potentially putting themselves at risk for later-stage lung cancer detection.
Delaware’s Tobacco Prevention and Control Program (TPCP) continues to promote policies and legislation that combats tobacco use. Delaware has enjoyed smoke-free indoor air since 2002, and the Clean Indoor Air Act was amended in 2015 to include e-cigarettes. In addition, the Delaware Youth Access law prohibits the sale of tobacco products to anyone under the age of 21. TPCP also supports the Delaware QuitLine, a free cessation counseling service.
If you or someone you love is thinking about quitting, it’s important to support them in their journey. It’s never too late to quit and there are immediate benefits (beyond financial ones) to quitting tobacco:
• Within an hour, heart rate and blood pressure drop.
• Within 12 hours, carbon monoxide has left the body.
• Within a day, the risk of a heart attack decreases.
• Within nine months, lung function increases by 10 percent.
• Within five years, the risk of mouth, throat, esophageal, and bladder cancer is reduced by half.
• The risk of lung cancer is reduced by about half after 10 years.
I am so glad that my dad chose to quit. He’s going to be 80 in February and is in good health. I’m proud of so many things he’s done over the years, but quitting cigarettes may be the one of which I’m most proud. ▼
Stephanie Belinske is an epidemiologist and a public health doctoral student at Johns Hopkins University.