E-cigarettes, also known as vapes, are a popular alternative to smoking tobacco cigarettes.
A Gallup poll in 2021 found that 6% of U.S. adults vape.
It’s more prevalent among younger people: 17% of 18-29 year olds polled said they’d vaped in the past week.
While smoking works by burning tobacco and creating smoke, vaping works by heating liquid and creating inhalable droplet clouds.
In addition to nicotine, the same addictive drug found in cigarettes, the liquids used in vapes often contain chemical flavorings.
For many users, the appeal of e-cigarettes comes from these flavors.
Flavored “vape juice” has proven especially popular among young adults.
In recent years, much of the discussion of e-cigarettes’ risks has focused on the rise of youth vaping.
That’s because nicotine is especially harmful to teenagers’ developing brains and bodies.
But vaping holds significant health risks for adults, too.
In this article I’ll examine the facts around vaping, with a focus on vaping’s effects on the bodies of adults and teenagers.
I’ll discuss whether vaping is less harmful than smoking, and I will summarize the current state of US government regulations around vaping.
Finally, I’ll talk about whether you should quit vaping, and when to see a doctor about your vaping-related concerns.
E-cigarettes are called vapes, pens, and mods—and are also discussed using brand names like “Juul” and “Pax.”
Some are shaped like cigarettes, while others look more like pens or sticks.
More than 460 e-cigarette brands are sold in the US.
Most work by using a battery-powered heating element that converts liquid into droplet clouds, a process known as “aerosolization.”
In today’s market, most vape liquids contain flavorings and additives.
Some also contain substances from cannabis plants, including cannabinoid (CBD) oils and tetrahydrocannabinol (THC).
THC is the psychoactive substance in marijuana that makes users “high.”
Nearly all e-cigarette liquids contain nicotine, an addictive compound that is also found in cigarettes and other tobacco products.
One U.S. Centers for Disease Control and Prevention (CDC) study found that 99% of US e-cigarette products contain nicotine–even as some vape labels do not disclose this fact, or falsely boast of being nicotine-free.
Is vaping less harmful than smoking?
According to the CDC, e-cigarettes expose users to fewer harmful chemicals than traditional tobacco products.
For this reason, it recommends that people using vapes as an alternative to cigarettes should not go back to smoking tobacco.
The CDC’s recommendation is not an endorsement that vaping is safe, however.
Instead, it’s based on the exceptional danger of burned cigarettes, which kill half of all people who smoke them long-term.
In fact, the CDC advises that all people who do not currently smoke tobacco should not start vaping because of the health risks associated with nicotine and other substances found in vapes.
For some users, the risks associated with nicotine in particular may actually be more pronounced in vapes than in traditional tobacco products.
That’s because some vape pods contain as much nicotine as 20 cigarettes.
In recognition of these risks, no US government body has approved e-cigarettes as a tool for quitting smoking.
This is despite many people believing they can quit smoking cigarettes by switching to vapes.
Risks of Vaping
A vape cloud is not harmless water vapor.
It typically includes a significant amount of nicotine, the dangers of which have been well-studied after decades of research on tobacco smoking.
Nicotine is a highly addictive psychomotor stimulant drug.
It can harm people’s brains, nervous systems, and hearts.
But it’s not just the nicotine that’s risky.
The other ingredients in e-cigarettes vary widely—and, according to lab analyses, sometimes include chemicals such as formaldehyde, acrolein, and acetaldehyde, all of which can cause irreversible lung damage.
Researchers are working to track the long-term effects of thousands of available flavorings and additives.
Even if a vape additive is safe to eat, it might become harmful when it’s heated and inhaled into the lungs.
That is the case with a “buttery”-tasting food additive called diacetyl, which has been found in dozens of vape flavors.
Diacetyl can cause respiratory decline and “popcorn lung disease” when inhaled.
Another example is the food additive vitamin-E acetate, which became a common, and dangerous, ingredient in THC-laced vape pods.
By early 2020, the substance had been strongly linked to dozens of deaths in the US from a new lung disease called EVALI: E-cigarette or Vaping Use-Associated Lung Injury.
Heavy metals are another concern.
Over time, chemicals in vape juice can begin to eat away (corrode) a vape device’s metal components.
This can introduce metals such as chromium, nickel, lead, tin, and aluminum into the vape cloud, and ultimately into people’s lungs.
Exposure to these metals could lead to lung inflammation, toxicity, and cancer. (Corrosion can also cause vapes to spontaneously explode—another health hazard).
Vaping effects on the body
The long-term effects of chemical additives and heavy metals in vaping are still being studied.
But the long-term effects of nicotine exposure on the body are already known.
Just like with cigarette smoking, the nicotine in vapes raises your blood pressure and heart rate, and spikes your adrenaline.
This can greatly increase the stress on your heart, increasing the likelihood of an abnormal heart rate (arrhythmia) and of having a heart attack.
Another of the most common effects of vaping on the body is nicotine withdrawal.
When we say that nicotine is “highly addictive,” we mean that it rearranges different parts of the brain to respond well to its presence—and malfunction in its absence.
These effects aren’t physically dangerous, but they are highly unpleasant.
Nicotine cravings can begin as little as 30 minutes after vaping; by the end of a day without vaping, you may start to feel waves of sadness, anxiety, or depression, as well as more obsessive cravings for your next vape fix.
Hunger, irritability, brain fog, and anger all begin to mount, and can last up to two weeks or a month.
In the US, the responsibility for regulating e-cigarettes is divided between the states and the federal government’s Food and Drug Administration (FDA).
The FDA first moved to regulate e-cigarettes as an offshoot of “tobacco products” in 2016.
Among other effects, this created new protocols for reporting and documenting the potential harm of various vaping ingredients.
In 2020, the FDA began to prohibit most sales of flavored e-cigarette cartridges and liquids (menthol and tobacco flavors are mostly still allowed).
By ordering thousands of flavored vape products off of shelves, the FDA hopes to reduce vaping’s appeal among young adults.
In June 2022, the FDA banned Juul products in the U.S. market.
Vaping and Teenagers
In 2020, 20% of high school students and 5% of middle school students reported using vape products.
This amounted to an estimated 3.6 million teenage vape users—a decline over previous years, but still a sky-high figure compared to a decade before.
What’s more, as many as 1 in 5 high-school-aged vape users report vaping every single day.
Even as new FDA flavor rules have come into effect, fruit and candy varieties have remained popular among young users, thanks to regulatory loopholes and enforcement gaps.
Vaping is especially dangerous for young adults because of the ways that nicotine affects adolescent brain development.
This process, which continues into the mid-20s, is crucial for building up intelligence and the ability to regulate emotion.
During adolescence, brains typically make new cellular connections at an elevated pace, as new skills are learned and new experiences are gained.
These connections form the basis of our adult capacities for reasoning and decision-making, among other functions.
Nicotine use among young adults interferes with the way these brain connections are formed.
It can therefore harm the parts of the brain responsible for attention, learning, mood, and impulse control.
Lower levels of self-discipline, as well as distorted behaviors around seeking “rewards” may explain why teenaged nicotine exposure may lead to higher levels of other substance abuse later in life.
Should You Quit Vaping?
Because of the above effects on adolescent brains, youths and young adults should never use e-cigarettes, and should try to quit immediately.
If you are pregnant, quit immediately.
Exposure to nicotine during pregnancy can result in a number of health problems in children, including sudden infant death syndrome (SIDS), cognitive delays, language development delays, attention deficits, and altered appetites.
If you’re an adult who uses vaping as an alternative to cigarette smoking, you should not quit vaping to return to traditional tobacco products.
Consider switching to FDA-approved smoking cessation tools such as nicotine patches and certain prescription drugs.
Currently, the CDC’s position toward all other adults is to warn them against starting to vape.
If you already vape, weigh all available information about the risks of doing so, and talk to your doctor about tools for managing nicotine withdrawal in the event you decide to quit.
When to See a Medical Provider
Contact your doctor if your health feels outside of the ordinary.
For instance, if you’re having difficulty breathing, are undergoing strong mood swings, or are experiencing unusual cardiac stress.
Whether or not these symptoms are ultimately linked to vaping addiction, they are things your doctor will want to know.
Talk to your doctor about vaping if you decide to quit.
As with all nicotine addictions, it is possible to quit vaping “cold turkey.”
But many people benefit from having a doctor-supervised plan to deal with the physical and psychological aspects of nicotine dependence.
Your healthcare provider can help you create a quit plan, discuss and prescribe medications, recommend nicotine replacement therapy options, and connect you with resources such as support groups and therapists who specialize in nicotine and substance abuse.
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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
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