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Lung Cancer, Smoking, and ENDS

Lung Cancer is the leading cause of all cancer deaths in the United States. Smoking is the greatest risk factor for lung cancer, causing more than 8 out of 10 lung cancer deaths. Exposure to second-hand smoke, chemical exposure, other lung diseases, and having a family history of lung cancer can also lead to increased risks.

Americans seemed to be getting the message that tobacco is addictive and harmful, contributing to death and serious health effects including, but not limited to:

  • Strokes and heart disease such as hypertension, heart attacks, increased cholesterol, and impaired blood circulation.

  • Lung disease such as COPD, asthma, and infections such as pneumonia and bronchitis.

  • Cancers of the lung, throat, mouth, esophagus, bladder, kidney, liver, stomach, pancreas, colon, rectum, cervix, and myeloid cancers.

  • Changes in hearing and vision.

In 2017, 47 million Americans used a form of tobacco with a decline in adult every-day smokers to 14% in 2017, “the lowest ever recorded.”1 An encouraging report by Johnston et al. (2019)  found that high school seniors who reported smoking daily decreased from 28.8% in 1976 to 3.6% in 2018.2 However, the growing appeal of vaping is a cause for concern. In fact, the same report by Johnston et al. (2019) cited that the increase in nicotine vaping use from 2017 to 2018 for 10th and 12th graders was the “largest ever recorded for any substance in the 44 years” since the Monitoring the Future surveys began.2 In 10th grade, vaping increased by 8.9% with a prevalence rate of 25% and in 12th grade, vaping increased by 10.9% to a prevalence rate of 30%. 2

Anti-smoking campaigns, the elimination of smoking in most public spaces, and evidence that smoking is harmful has reduced the number of individuals who smoke “traditional” tobacco products. Yet, a disturbing trend among the youth has emerged: using electronic nicotine delivery systems (ENDS) to inhale or vape. The youth represent nearly 1/3 of all e-cigarette users with 1 in 5 high-schoolers and 1 in 20 middle-schoolers admitting they have used an e-cigarette within the last 30 days. 3

The data is there against tobacco and nicotine. Data for the long-term effects of the use of e-cigarettes isn’t available. However, the short-term data suggests that the youth who use e-cigarettes are more likely than non-e-cigarette users to start smoking traditional tobacco products and can suffer serious lung injury.  Our youth has been misled into believing that some types of nicotine products, such as flavored vaping liquids and water-pipes, aren’t as harmful as ‘traditional’ cigarettes.

Why are ENDS appealing to our youth? They have seen friends and family members use ENDS, been marketed to, and believe that ENDS are more socially acceptable. Several manufacturers of ENDs have agreed to not promote their products on youth-targeted social media, but this hasn’t stopped peer-to-peer marketing. Youth are particularly drawn to the variety of flavors, the lower cost of ENDs, the ease in which ENDs can be hidden.

Most cartridges and vaping juice sold contain nicotine having higher concentrations than cigarettes. ENDS burn faster and leave the user wanting more sooner. Nicotine’s harmful effects on an adolescent’s brain can include lowered impulse control, mood disorders, and difficulty learning and concentrating. Adolescents are more susceptible to forming addictions including to nicotine. ENDs contain ingredients of which the effects when inhaled are not yet fully known. Some of the ingredients known include metals, formaldehyde and glycerin which will likely contribute to irreversible lung damage.

It’s imperative that we discourage the youth from using tobacco and any ENDS. As a community, we need to educate ourselves on this topic, promote tobacco and nicotine free environments, and talk openly to our youth. Pima County leaders recently rejected raising the minimum age to 21 for purchasing tobacco and e-cigarettes. This would’ve been a great step towards curbing the youth from having access, and perhaps, discouraged our youth from becoming smokers and vapers.

1  Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225–1232. DOI:

2 Office of Adolescent Health. (n.d.) Adolescents and Tobacco: Trends. U.S. Department of Health & Human Services. Retrieved from

3 (National Youth Tobacco Survey (NYTS), 2018)


Tagline: Bruce W. Porterfield, MD, PhD is a medical oncologist / hematologist at Arizona Blood and Cancer Specialists. He has been caring for patients in the Green Valley community for over eighteen years.


Bruce W. Porterfield, MD, PhD

Bruce W. Porterfield, MD, PhD

Medical Oncologist / Hematologist

For over eighteen years, Dr. Porterfield, who is a board-certified medical oncologist has cared for patients in Green Valley, Arizona. Dr. Porterfield is passionate about empowering his patients with knowledge about their disease and ways they can live life to the fullest. He volunteers his time giving educational presentations to his patients, staff and the community. He and his wife Sherri are frequent speakers on KGVY's "Staying Healthy" radio show. Dr. Porterfield has also written several articles for local publications on a variety of health-related topics.

Sherri Porterfield, RN, MSN

Sherri Porterfield, RN, MSN

Nurse Navigator

Sherri Porterfield, RN, MSN is a Nurse Navigator with Arizona Blood and Cancer Specialists. She has over 25 years of experience educating patients and the community. She volunteers her time, giving presentations to several different groups in the Green Valley and Tucson. Sherri is also developing Arizona Blood and Cancer Specialists' Survivorship program, and has written several articles for local publications.