Since e-cigarettes were introduced to the United States in 2007, vaping has been touted as a safer alternative to smoking cigarettes, even by anti-smoking advocates. The inventor of the first commercially successful e-cigarette claims he was motivated by his father’s death from lung cancer.
That doesn’t mean that vaping is harm-free. There are too many factors and not enough research.
The Dangers of Vaping:
Vaping is a smokeless alternative to smoking. It often uses nicotine but instead of burning tobacco, it heats a liquid containing nicotine, chemicals, and flavorings. One pod of e-liquid is equivalent to a pack of cigarettes. For some users, that might last for days or a week, but others go through several in a day.
When one smokes, one inhales and exhales the smoke from burning tobacco, paper, and many chemicals. When one vapes, one inhales an aerosol, commonly referred to as a vapor, produced by heating a nicotine-infused liquid in an electronic device that is usually designated as an electronic or e-cigarette or a vaporizer.
There are many brands and a few types of e-cigarettes on the market, including some the size and shape of a cigarette, as well as vape pens and more bulky vape mods. One of the most popular is made by JUUL and resembles a USB flash drive.
At its most basic, an e-cigarette consists of a:
Another e-cigarette device, the IQOS by Philip Morris International, heats actual tobacco, not an e-liquid. IQOS has been sold in dozens of markets worldwide and was scheduled to be released in the United States beginning in September 2019.
Two other cigarette alternatives include hookahs for tobacco and bongs for marijuana. Although they filter their vapor through water, they still burn their product and produce smoke. Hookahs include the same health deficits as smoking, such as nicotine, tar, and other toxins.
Sometimes vaping is promoted as a means to encourage cigarette smokers to switch to e-cigarettes and eventually quit using all products entirely.
Adult smokers who take up vaping intending to quit smoking succeed, at least sometimes. Vaping allows them to control how much nicotine they inhale and lets them taper off. According to one Reddit thread, some vapers who have tried a traditional cigarette after vaping (usually because they ran out of vaping pods or cartridges) couldn’t finish it because they found it too unpleasant.
If vaping transitions smokers to quitting nicotine altogether, that’s a good thing. If vaping is less harmful than smoking, if people continue to vape, it may still be a better alternative.
Better doesn’t mean good. Other than in a harm reduction sense, no one argues that vaping tobacco is good for you. In an absolute sense, just like any form of smoking or use of nicotine, vaping is bad for you. According to pulmonary medicine specialist MeiLan K. Han, “the lungs were not designed to breathe anything other than clean air. Anything other than that is a potential health risk.”
Aside from chemicals, most commercially available e-liquids contain nicotine, one of the most addictive substances on Earth, which may be especially dangerous for young people with developing brains. Vaping may have other health risks.
Vaping seems to have many of the bad health effects of smoking. Traditional tobacco smoking produces carcinogenic tar and dangerous gases such as carbon monoxide that cause negative effects such as
E-cigarettes may produce the same drawbacks. Although they only heat nicotine-infused liquid, e-cigarettes produce aerosol that may still contain chemicals from the liquid or even metals and chemicals from the e-cigarette device. Even the tobacco for IQOS may be chemically treated, producing similar toxins and health concerns as cigarettes and e-cigarettes.
Some researchers say that even without producing tar, e-cigarettes may create similar health risks as smoking, including COPD (chronic obstructive pulmonary disease) and lung cancer. Higher levels of carcinogens, materials that cause cancer, have been found in the urine of teens who vape.
Others say that those risks are greatly reduced, but that other potential dangers remain. The risks include insulin resistance and type 2 diabetes, elevated heart rate and blood pressure, and a greater risk of addiction to other substances, particularly among young people.
According to news sources, e-cigarette liquids containing vitamin E acetate may cause pneumonia-like symptoms by coating the lungs with oil. Vitamin E is used almost exclusively as a thickening agent in black market vaping products that include tetrahydrocannabinol (THC, the active hallucinogen in marijuana) or cannabidiol (CBD, a non-hallucinogenic cannabis derivative). People use Vitamin E to dilute THC oil to use it in multiple batches.
The evidence is mixed. Nicotine can increase blood pressure, heart rate, and adrenaline levels, so it can contribute to heart attacks and disease. In particular, flavored e-cigarette liquids may contribute to cardiovascular disease. But two 2019 studies came to opposite conclusions: one found no increased significant risk of heart disease from vapers who didn’t smoke. The other found that vapers faced increased risks of strokes, angina, and heart attacks.
There is still little research into the effects of vaping nicotine compared to smoking tobacco. The best evidence so far suggests that while there may be damage from vaping—including bone loss, tooth loss or decay, dry mouth, and bad breath—it produces much less damage than smoking.
There is no doubt that e-liquids containing nicotine are as addictive as tobacco or that addiction is a harm as real as lung cancer. Addiction to nicotine is not as immediately deadly as heroin or fentanyl, but it does teens little good. Addiction leads to cravings, which if not satisfied, make it difficult to concentrate. Because the brain is developing until about the age of twenty-five, such distractions can affect later behavior and health, including possibly making one more susceptible to other addictions.
So, is vaping more dangerous than cigarettes? While there is much we do not know, what we do know is that vaping seems far less physically dangerous than smoking cigarettes, maybe 95% less dangerous, but we don’t know for sure because the U.S. Food and Drug Administration (FDA) hasn’t reached a determination.
Although the FDA has been able to regulate e-cigarettes as a tobacco product since 2007, it elected >not to do so until 2022. In the meantime, they allowed the products to be marketed and sold. So, instead of solid, unbiased scientific evidence, we have pro-vaping advocates, in and out of the industry, and anti-smoking absolutists who are cherry-picking data to suit their arguments while ignoring other data.
That may be changing. The suspected vaping-related illnesses of hundreds of people in the United States may force the FDA’s hand.
Some local governments aren’t waiting. Charging that the FDA had failed to exercise its public duties by not regulating e-cigarettes, in June 2018, the city of San Francisco—where JUUL is headquartered—banned flavored vaping liquids. San Francisco extended the ban to all e-cigarettes in July 2019.
Now, following reports of hundreds of reported cases of alleged vaping-related lung problems among mostly young people (with an average age of nineteen) since August 2019, state and federal officials are taking action. On Sept. 4, 2019, Michigan became the first state to ban flavored vape liquids and pods, and the FDA said it would do likewise a week later.
Some vaping deaths have been reported, too, though so far these seem mainly confined to older people, from middle-aged people to senior citizens. Some of the people who died also had long-term respiratory problems.
While the exact causes of the deaths are unclear, suspects include black market cannabis vaping devices or pods (although one of the dead users had a vaping device from a licensed dispensary), the vitamin E-rich oils used in some e-cigarette liquids (cannabis), cheap and unregulated vaping pens with malfunctioning heating elements, or some unknown contaminant.
The fear is that these illnesses and deaths aren’t random incidents but something intrinsic to the vaping process that makes every e-cigarette a ticking time-bomb. (There have been a few cases of exploding vaping devices, sometimes when components from two or more different types of e-cigarettes are incorrectly or inexpertly combined.)
Other areas, including Canada and the United Kingdom (UK), have not experienced a similar rash of illnesses or deaths, however The National Health Service says this is because, “In the UK, e-cigarettes are tightly regulated for safety and quality.” The service still recommends them for stopping smoking because vapers don’t ingest the most hazardous elements of cigarette smoke, such as tar or carbon monoxide, and only much lower levels of others.
The United Kingdom also has banned certain worrisome chemicals, including diacetyl, which in higher concentrations may cause a condition called popcorn lung. (Cigarettes have hundreds of times as much diacetyl as e-cigarettes in the United States, but no cases of popcorn lung have been attributed to either.)
Teen smoking has been declining dramatically and now sits at about 6%, but vaping has risen to levels far higher than teen smoking has been for years.
In preliminary data, the National Youth Tobacco Survey, 2011-2019, found that from 2011 to 2019, cigarette use among high school students dropped almost steadily from 15.8% to 5.8%, while e-cigarette use rose almost as steadily from 1.5% to 27.5%. According to Dennis Henigan of the Campaign for Tobacco-Free Kids, the data suggests that more than 800,000 e-cigarette users vape 20 days a month.
Now middle- and high-school-aged young people who had never smoked have started vaping. Some have gone on to smoke cigarettes as well.
One reason is that makers of vaping products, of which JUUL is one of the largest and most successful, seem to be following the old tobacco company strategy of deliberately marketing nicotine products to teens. The companies market their products using colorful packaging, sleek designs, and teen-friendly flavors.
Vaping pods and cartridges don’t necessarily taste like cigarettes. There are tobacco flavors, but most sales are for fruity and minty flavors.
A test of flavored e-cigarette liquids found that they caused damage to blood vessels, especially menthol and cinnamon, even when they didn’t contain nicotine. (Although JUUL voluntarily pulled most of its flavored pods from U.S. brick-and-mortar stores on Nov. 13, 2018, ahead of a feared FDA ban, it didn’t do the same in Canada. It didn’t pull menthol off the market anywhere.)
Another reason for vaping’s popularity among the young is that vaping is easier to conceal than smoking. You may be able to get away with it and not be treated as a pariah because:
Anti-smoking campaigns haven’t eliminated smoking, but they have reduced it. Many who vape are offended by the idea that they might smoke. They consider smoking and vaping two entirely separate things. They may not realize that vaping liquids contain nicotine.
Some teens’ thinking is so compartmentalized that some JUUL users don’t even consider it vaping; it’s JUULing. Because vapers don’t consider it smoking, they resist adopting anti-smoking techniques.
The signs that a teen is vaping mostly require keen observational skills. The scent of the aerosol cloud quickly fades and the cloud disperses. Look for some of the often subtle side effects of vaping, such as:
According to Linda Richter of the Center on Addiction, there are no researched methods so far for quitting e-cigarettes. Instead, some say that people should consider techniques used to quit traditional cigarettes. Unfortunately, the techniques may not work with teens or teens may not be able to access them.
Nicotine gum, lozenges, patches, inhalers, and nasal sprays deliver a dose of nicotine without burning or heating, preventing many of the dangers associated with smoking or vaping. Some experts worry that the products will not work for teens because the dose of nicotine is too low.
In the United States, people under the age of eighteen cannot legally buy over-the-counter products with nicotine, but they may use doctor-prescribed products.
Bupropion and some other antidepressants help people quit smoking by interfering with the way nicotine causes addiction.
Another medication, varenicline (often known by the brand name Chantix) may improve your chances of quitting, but it has not been tested on nicotine users who are eighteen years old and younger.
Because drugs such as varenicline do not contain nicotine, they can be combined with nicotine replacement therapy. Varenicline users have experienced side effects such as seizures, suicidal thoughts, hallucinations, and disturbing dreams.
Nicotine addiction, like other addictions, may require counseling therapy. This therapy may occur in person or over the phone, and it may or may not include medication.
Cognitive behavioral therapy (CBT) has proven effective with other addictions. Like drugs that change the brain, CBT changes behavior and thoughts by teaching new coping skills. Unlike nicotine replacement therapy and medication, research has found that CBT is appropriate and effective for adolescents. It’s not just for addiction, but also for mental health disorders such as depression and anxiety that often co-occur with addiction.
Text coaching is a form of counseling conducted via smartphones, tablets, and other digital devices. The anti-smoking advocate organization the Truth Initiative has expanded its digital smoking cessation programs to include one specifically for e-cigs. It provides a service that sends tailored, age-appropriate text messages with advice and encouragement to stop smoking.
The best way to stop teens from vaping is to reason with them. You are afraid of how vaping will affect your children, but you cannot win them over with fear. You also cannot bully them. Try informing them instead.
If you parrot some talking points you recall from high school anti-smoking or anti-drug presentations, you’ll sound as laughable as someone from the propaganda film Reefer Madness. The science about addiction has changed, and vaping isn’t smoking. You will have to learn new facts and arguments.
Read the U.S. surgeon general’s site Know the Risks: E-cigarettes & Young People and Stanford University’s Tobacco Prevention Toolkit, but double-check them. The facts and news about vaping are being updated all the time.
Nicotine is addictive, as any smoker knows. E-cigarettes, with their attractive design, billows of vapor, and lack of smoking’s obnoxious smells, may be especially addictive to young minds. To overcome such an addiction requires a heroic effort.
Don’t panic, don’t distort the facts, and tell your teen the good and many persuasive reasons that vaping is bad for their health.