Over the past few years, I’ve been getting more questions about vaping and whether it’s safe to engage in. Some individuals look towards vaping as an alternative to other forms of smoking (cigarettes, cannabis, etc.), while others turn towards vaping as a form of recreation or relaxation. I’d like to take this opportunity to explain what vaping is and what we know about the potential risks and health effects.
What is vaping?
Vaping is the act of inhaling and exhaling the aerosol which can be produced by an e-cigarette or similar device. This aerosol is known as “vapor.” While e-cigarettes do not expose the user to some of the more harmful components of cigarette smoke (tar, oxidant gases, carbon monoxide), the vapor still contains matter than can cause lung irritation or have toxic effects. E-cigarettes were first introduced into the US in 2006 and were initially promoted as a method to help people quit smoking1. Nowadays, there are multiple types of devices in addition to e-cigarettes, including vape pens and personal vaporizers that can be utilized for vaping. There has been a growing popularity for recreational use, not just smoking cessation, and teenagers and young adults are among those utilizing such products.
What is e-juice or e-liquid?
Vaping involves heating up the contents of a liquid, sometimes referred to as “e-juice” or “e-liquid,” which then turns to aerosol and is inhaled. The ingredients of the liquids can vary widely and may include some of the following:
Nicotine: The nicotine content can range from none (nicotine-free) to up to 36mg/mL2. There have been some studies that indicate the advertised amount of nicotine may be inaccurate, and some supposedly “nicotine-free” liquids have been found to contain some nicotine3. For reference, a typical cigarette may contain 15-25mg of nicotine4.
Propylene glycol/glycerol: These compounds are often used as preservatives for both food and tobacco products, but at high temperatures, there are concerns that propylene glycol and glycerol can decompose and formaldehyde and acetaldehyde may form, which are considered carcinogens (cancer-causing agents)5.
Flavoring: There can be multiple types of flavoring, including candy, fruit, soda and alcohol flavors. The flavoring may increase the attractiveness of e-cigarettes to teens and young adults.
Other substances: Some liquids have been found to contain metals such as tin, lead, nickel, and chromium. Sometimes tobacco-related compounds have also been detected2.
There has been mixed data on the health effects and safety of e-cigarettes and vaping. In 2015, Britain’s Department of Health reported that e-cigarettes are likely significantly less harmful than traditional tobacco cigarettes. However, just because vaping is potentially less harmful than regular cigarettes, it doesn’t mean the practice is safe overall. A 2016 study through the Harvard School of Public Health raised concerns about common ingredients they found in e-cigarette flavors6. A flavoring chemical called diacetyl, which has been linked to severe respiratory disease, was found in over 75 percent of liquids tested. Other potentially concerning chemicals were also identified in the study. The Food and Drug Administration (FDA) has expressed concerns that e-cigarettes or vaping may serve as a gateway product to conventional cigarettes, and also indicated that the products may contain toxic ingredients.
The overall safety of vaping is unclear, and there is concern about the lack of regulations when it comes to the products on the market. The FDA has recently created new regulations to help reduce access to minors given the growing concerns about e-cigarette products. From 2011 to 2014, e-cigarette use has increased from 1.5 to 13.4 percent in high school students and from 0.6 to 3.9 percent in middle school students 7,8. While vaping may not be as harmful as smoking, there is developing evidence that there are still potential dangers and adverse effects from vaping. The practice should not be considered benign and significant caution should be exercised when introducing such products to teenagers and young adults.
1. Hajek P, Etter JF, Benowitz N, et al. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014;109:1801
2. Bhatnagar A, Whitsel LP, Ribisl KM, et al. Electronic cigarettes: a policy statement from the American Heart Association. Circulation 2014;130:1418
3. Goniewicz ML, Kuma T, Gawrong M, et al. Nicotine levels in electronic cigarettes. Nicotine Tob Res 2013;15:158-66
4. “Nicotine (PIM).” Inchem.org. Retrieved 6-23-2017.
5. Hutzler C, Paschke M, Kruschiniski S, et al. Chemical Hazards present in liquids and vapors of electronic cigarettes. Arch Toxicol 2014;88:1295
6. Allen JG, Flanigan SS, LeBlanc M, et al. Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes. Environmental Health Perspectives 2016;124:6
7. Centers for Disease Control and Prevention (CDC). Notes from the field: electronic cigarette use among middle and high school students – United States, 2011-2012. MMWR Morb Mortal Wkly Rep 2013;62:729
8. Arrazola RA, Singh T, Corey CG, et al. Tobacco use among middle and high school students – United States, 20111-2014. MMWR Morb Wkly Rep 2015;64:381
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