The Health Risks of Vaping

10/21/2019 UPDATE: Recent illnesses have been associated with use of e-cigarettes (vaping). Since the specific causes of these lung injury cases are not yet known, the Centers for Disease Control and Prevention (CDC) recommends refraining from all vaping products.

There is a lack of understanding surrounding the health risks of vaping. Researchers are still actively seeking to understand exactly how harmful vaping is—but more than enough evidence now shows that it introduces major health risks. Recent studies have found that harmful substances found in many vaping products could increase your chances of serious health concerns like heart attacks, chronic obstructive pulmonary disease (COPD), and addiction, especially among teens.

The use of electronic cigarettes has gained a lot of steam over the past several years, most notably among teens and young adults. Commonly referred to as “vaping,” these products use an aerosolized vapor infused with flavors or nicotine that are then inhaled by the user.

They look and feel a lot like cigarettes, but e-cigarettes don’t burn tobacco, a primary driver of why smoking is so dangerous. Because of this, these devices are often promoted as a safer alternative to smoking. But while electronic cigarettes do appear to be less harmful than combustible cigarettes, they aren’t exactly risk-free.

Harmful Substances

Unlike cigarettes that work by burning tobacco and producing a smoke, e-cigarettes heat up liquid to create a vapor. A lot of different companies make e-cigarette products, and the kinds of ingredients found in some liquid cartridges can differ from one brand to the next. Some of the most common harmful substances found in vaping products include flavoring chemicals, toxic metals, and nicotine.

Flavoring Chemicals

Flavor compounds and other ingredients in e-cig fluid have historically been a bit of a free-for-all, and are only becoming gradually regulated over time as the U.S. Food and Drug Administration (FDA) enacts new requirements. Nicotine warnings and ingredient lists submitted to the FDA are required as of 2018-2019 for most e-cig fluid sold in the U.S., but true safety regulation—where excessively harmful products are kept off the market— will not fully be in force until 2022.

Even then, the criteria for product acceptance can be as loose as it “does not raise different questions of public health” compared to an existing tobacco product. That’s hardly a strong recommendation of safety.

A wide range of chemical compounds are used as flavorants. Some flavor additives, such as diacetyl (found in butter-flavored popcorn) may be safe in small quantities in food but potentially risky to inhale over long periods. Diacetyl has been shown to cause a serious lung disease called “popcorn lung” when inhaled over long periods of time, raising serious concerns among health professionals about its presence in some vaping products.

Diacetyl, however, is just one of many different chemicals added to e-cig fluids. With limited research available on e-cigs and their ingredients, it’s unclear whether other additives pose similar risks.

Toxic Metals

The high-temperature vaporization process that produces the vaping aerosol can also generate undesirable chemical compounds. Most e-cig fluid is simply evaporated or aerosolized into a cloud of fine droplets on the hot coils, but some is chemically altered or contaminated with trace heavy metals shed from the coil, including non-negligible amounts of toxic metals like lead.

A study published in the February 2018 issue of Environmental Health Perspectives, analyzed different samples of e-cigarette aerosol and found roughly half of their samples had levels of lead higher than safety standards put in place by the Environmental Protection Agency

Toxic metals like lead are hard for our bodies to process. Because of this, repeated exposure can result in the metal building up in the body and causing damage to the brain, kidneys, and other vital organs. 

It's still not known how much of these toxic metals actually gets taken in by the body while vaping or whether the amounts found in e-cigarettes can affect health long term. It’s a tough question to study, in part because electronic cigarettes aren’t standardized. How they’re made, including what metals are used for the coils, how hot those coils get, and how quickly they cool, can impact the concentration of metals in the aerosol.

User behaviors matter, too, as deeper, more frequent puffs could increase the likelihood of metals leaking into the aerosol or absorption of metal into the body.

Nicotine

Many electronic cigarettes contain nicotine, the addictive chemical found in cigarettes and other tobacco products. But nicotine isn’t just addictive. It affects nearly every aspect of the human body, including the brain, blood vessels, and immune system. How much you’re exposed to while vaping will depend a lot on the product itself and how often or deeply you inhale.

Despite nicotine being commonplace in many vaping fluids, users often don’t know if it’s present in the product they’re using.

Liquid cartridges made by JUUL, an e-cigarette brand popular among teens, have about as much nicotine as a pack of cigarettes.

Yet nearly two-thirds of JUUL users aged 15 to 24 years old surveyed didn’t know the brand’s cartridges contained nicotine.

Addiction

The nicotine found in e-cigs can lead to addiction by affecting the reward centers of the brain and prompting feel-good chemicals to be released in the body. The more nicotine you use, the more you need to get the same pleasurable effect (a process known as tolerance).

After a while, the brain stops being able to function properly without nicotine (called dependence). When that happens, cutting off the flow of nicotine (ex. quitting “cold turkey”) can prompt withdrawal symptoms like agitation or intense nicotine cravings, until your body learns to adjust back to life without it. Addiction happens when using nicotine no longer feels optional. It becomes a compulsion that’s extremely difficult to control.

For those already addicted to nicotine through cigarettes and other tobacco products, this is largely trading one addiction for another. But smokers aren’t the only ones picking up vaping.

Teenagers and young adults are taking up vaping in droves, putting them at risk of getting addicted to nicotine and potentially increasing the chances they’ll develop other substance use issues later on.

Injuries

Electronic cigarettes use lithium-ion batteries to heat coils and produce an aerosol. On rare occasions, those batteries can malfunction, causing the device to overheat, catch fire, or even explode. According to the U.S. Fire Administration, nearly 200 such incidents were reported between 2009 and 2016, 133 of which resulted in injuries—often while the e-cigarette was actively being used or being stored in a pocket. The largest number of incidents in this study period happened in 2016, and trends suggest they’ll likely increase from year to year as sales of vaping devices continue to grow.

Something to note here: The safety of vape pens can vary depending on the brand, and some users even make their own vape pens at home, which can be highly dangerous even for those skilled in building electronics.

Because there are so many different designs and manufacturing processes when it comes to electronic cigarettes, some vaping products are more likely to malfunction than others.

Poisonings

Flavors used in e-cigs, like chocolate or cotton candy, don’t just appeal to teens and adults. They can also spark the interest of young children.

If vaping devices or fluid cartridges aren’t kept away from their reach, young kids can mistakenly touch, drink or inhale the liquid, or get vape fluids in their eyes or on their skin, and can lead to serious illness or death. E-cigarettes account for as many as 42 percent of cigarette exposure calls to poison centers in the United States, roughly half of which involve a child under the age 6.

Serious or Chronic Health Issues

Not much is known about how electronic cigarettes affect long-term health. They’re still too new, and a lot more research is needed. Recent studies, however, have started to find connections between using electronic cigarettes and serious or chronic health issues, including COPD and heart attacks.

Breathing Problems

The vapor made by e-cigs might seem harmless (especially when compared to smoke from burning tobacco), but it actually contains tiny particles that can irritate or damage sensitive lung tissue. It’s no surprise then that people who use vaping devices are more likely to report troubles breathing or experiencing chest pain, compared to those who don’t vape or smoke.

E-cig users appear to have a greater chance of developing COPD, a condition that includes emphysema and chronic bronchitis that is closely linked to traditional smoking.

This risk persists even when you take into consideration dual use—that is, those using both combustible and electronic cigarettes. In cases where e-cig users are also smokers, research showed the chances of breathing issues are compounded. 

Cardiovascular Issues

Another concern flagged by recent research is the potential harm vaping might have on cardiovascular health. Some chemicals found in e-cigs, such as nicotine, can affect blood flow. Studies show that regular use of electronic cigarettes could increase your chances of heart attack, stroke, and even heart disease. In fact, research shows e-cig users are almost twice as likely to experience a heart attack compared to non-users, even when analysts controlled for other known risk factors, including smoking status.

Health Risks Among Teens

An estimated 3.6 million middle school and high school students reported vaping in 2018, up from 2.1 million the year before. If trends hold steady, that number will continue to rise.

Teens and young adults are particularly vulnerable to the effects of vaping products, especially those containing nicotine. The brain is still developing during adolescence, and that can make it easier for some not only to become addicted to the nicotine in e-cigarettes, but also to develop substance use issues later in life.

Nicotine can also affect young people in other ways, including putting them at risk for mood disorders, reduce impulse control, and negatively impacting the parts of the brain responsible for memory and learning.

Vaping is currently much more popular among teens than smoking, but that could change.

Research looking at electronic cigarette use in adolescence found that teens who vaped were more likely to go on to smoke in early adulthood.

The public health implications of this can’t be overstated. Even with huge declines in tobacco use rates in the United States and elsewhere, smoking still kills millions of people a year. As more young people develop addictions to nicotine in adolescence, progress made over the past 50 years to lower the prevalence of tobacco-related deaths and illness could see major setbacks.    

Vaping as an Alternative to Smoking

Vaping appears to be less harmful than smoking, but it’s not hard to be. Smoking is one of the leading causes of preventable death worldwide, killing millions of people every year. It’s linked to a jaw-dropping number of health issues, from cancer to erectile dysfunction.

It’s no surprise that some smokers are turning to e-cigarettes as a means to wean themselves off traditional tobacco products more gently than quitting cold turkey. But whether vaping can actually help people quit smoking is still up for debate.

Research studying the effectiveness of vaping as a means to quit cigarettes is mixed, and it’s not currently approved as a smoking cessation product by the Food and Drug Administration. What’s more, instead of smokers switching entirely from smoking to vaping, many end up doing both, compounding the risk they would have experienced otherwise.

Perhaps the biggest concern about promoting vaping as an alternative for smoking is in the context of nonsmokers. For those who don’t already smoke, taking up vaping could cause real harm, especially among teenagers whose still-developing brains and body systems are more vulnerable to the harmful effects of nicotine and other potentially harmful substances found in e-cigarettes.

A Word From Verywell

If you’re a non-pregnant adult who already smokes, e-cigarettes could help you reduce the harm to your health overall until you can quit for good. Otherwise, you might want to steer clear. A lot more research is needed on the long-term risks from vaping, but what we do know already shows there are some potentially serious concerns associated with using e-cigarettes, especially among teens and young adults.

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