Nurses Can Change The Conversation About E-Cigarettes


Although e-cigarettes are often marketed as a “safe alternative,” non-smokers should understand that smoking still poses risks of lung damage, explains an expert with CTCA.

Nurses have the power to spread the word about e-cigarette risks, according to Tiffany Klein, RN, BSN, Cancer Treatment Centers of America Atlanta.

Klein, who has experience in oncology and currently works on a pulmonology team, recently spoke to Oncology Nursing News® about her experience with electronic smoking and vaping, and how the rise of these activities can affect patients and nurses across various specialties.

Oncology Nursing News®: Could you provide an overview of what your experience has been working with the pulmonary team at CDC, Atlanta?

Klein: I started out here at CTCA in Urgent Care-working with acute oncology needs. I moved over to the ICU here for a couple years, which got me in touch with our thoracic surgeon and pulmonologist and I transitioned over to working with him here in the last eight months or so. We focus primarily on lung screening program(s): we focus on diagnostic procedures for biopsies to diagnose lung cancers, and then we deal with lung diseases as well.

What are some of the safety concerns or risks that your team has noticed in regard to electronic smoking?

One of the biggest things that my [team] and I talk about a lot is [how] there's an increased occurrence of lung damage associated with these items. Especially [with] inhaled carcinogens. A lot of people—especially teens—are purchasing these items online or overseas because it is easily accessible. And there has been an increase in these items coming from China with substances that we don't know about, or that actually promote a disease we call lipoid pneumonia.

What many people don't realize is they're not really getting even any THC in the oils that they're that they're obtaining; they're actually inhaling butane, which increases their CO2 levels and makes them feel as though they're getting a high from it. In reality, they are just in a toxic state for a little while. [These] conditions promote hypersensitivity pneumonia. When we inhale substances that our body doesn't like, the lining of the lung and flames [become irritated] and decreases your capacity to breathe and this leads to infection and acute respiratory distress syndrome (ARDS). We see a lot of those patients in the ICU.

Furthermore, [regarding] the oils, 70% of our THC market is untested. So the bottom line is that people just really don't even know what they're inhaling.

Has your team noticed in increase in electronic smoking popularity?

There was a study out October 2021 JAMA Pediatrics journal [that] showed teen vaping marijuana doubled from 2013 to 2020.1 And I think that's directly related to the fact that it's so easy to access online, it's so easy to obtain, easy to hide, easy to use without the smell.

How might policy or cultural attitudes help prevent a number of youth from continuing to put themselves at risk?

We need to change our marketing strategies [and] implement some type of policy change so that what the commercials that these kids are seeing on TV aren't focused as the “safe alternative to smoking cigarettes.” [We need] true education on what you are inhaling, and what you're getting, so that they can make as much of an informed choice as they can when choosing to pick that habit up. We really need to focus on middle school and high school aged children to help them either stop using or try to prevent them from using and we need stricter regulations on what's allowed to be in these oils, adequate documentation on the package of exactly what's in [the oils], and [listing] the risk of each item that's in it and what the risk of inhalation are. [We should also] increase marketing to the general population to just a real education of what they're what they're getting, what they're taking in, and the risk associated, instead of promoting it as a “safe alternative.”

In your opinion, is there anything that nurses can do to have an impact?

Especially with those with the pulmonology focus, I think we need to get out in the schools; have presentations, education sessions, offer smoking cessation classes—we do that for adults, but we don't really get into the schools and do that. I feel like schools and parents would be open to that.

We still don't even know the long-term effects of a child picking up nicotine at such a young age; 10, 11, 12—the effects it has on their brain down the road, their learning capacity. We don't really know right now, what it will do to them 15 or 20 years down the road. [People] need to be educated with the truth and figure out a way for it to stop being promoted as the “cool” thing to do.

Oncology nurses, or nurses in general, are right at the bedside caring for these people and seeing the reality of what it is like. For example, I had a patient who was having a surgery where tissue oxygenation was very important, or the outcome would fail in a bad way. The physician himself is really big on no smoking and no nicotine because it decreases the oxygenation of tissues, and it does not promote healing in any way. [This patient] was so attached to her JUUL, I found it stuffed in her shirt. She was sneaking and hiding it in the hospital.

So, I think nurses have the access to these types of things, and the experience to get the word out to everybody that this is just not something that is as safe as everyone really thinks it is.


  1. Lim CCW, Sun T, Leung J, et al. Prevalence of Adolescent Cannabis Vaping: A Systematic Review and Meta-analysis of US and Canadian Studies. JAMA Pediatr. 2022;176(1):42–51. doi:10.1001/jamapediatrics.2021.4102

Editors Note: This article was updated on February 7th, 2022 with additional edits to the original piece.

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