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Argumentative Essay on Vaping

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Published: Mar 14, 2024

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Vaping and Its Negative Aspects Essay

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Introduction

Works cited, attention-arousing and orienting material.

Vaping has become a curse of the recent decade. Vapes are better than nicotine-containing cigarettes. Vapes do not harm the health of a smoker. Vapes are about vaping, not smoking. As one popular vape-producing company puts it, “live long and vape strong”. It seems that vapes create a new reality in which smoking could be safe. Well, what if I say that, in the US, in one week 12 people died because of vaping and 805 people were diagnosed with the breathing illness related to vaping (Pesce par. 1). If these statistics are not enough to give up vaping, the goal of the current speaker is to persuade that vapes are not as warm and fuzzy as companies want us to believe.

Credibility

Vaping is regarded as an escape for smokers who try to give up their addiction since the latter could substitute the former. Still, there are numerous sources that vaping is a decent and safe habit. The argument against vaping is backed by the results of the researches, the viewpoints of medical experts, and the experience of vapers. The importance of this topic is undeniable since even underaged people become addicted to vapes.

Thesis Statement

Vaping has numerous devastating effects and did not worth doing.

Preview of main points

There are two major reasons to give up a habitude of vape. Firstly, vaping is addictive and undermines the ability to self-control. Secondly, usage of a vape, even if it is nicotine-free, poses a health hazard and leads to diseases of the respiratory system.

Vaping is addictive

It is a well-known fact that there are numerous kinds of vaping liquids. They have various chemical compositions, tastes, and smells. Some of them might contain nicotine, while others are free of it. The problem is that vaping causes addiction in any case.

One of the reasons for this is that vapes are regarded as tools to socialize and make new acquaintances (Levin par. 21).

In essence, new friends and a higher circle of socialization is positive outcome of vaping.

However, the issue lies in the fact that young people that are shy to make friends, for instance, during classes, start vaping to fit in with the team.

Vice versa, if an individual intends to give up vaping, he or she might postpone this idea because of the fear to distance herself from the friends who use vapes.
In the interview with the 21-years old man, Levin illustrates how strong the addiction might be (par. 16). Josh Evans avows that he inhales the vapors even though sometimes it makes him feel physically bad and fail to fight against vaping (Levin par.16).
The final point worth being mentioned is that addiction to vaping leads to more serious addictions in the long-term perspective.

In two years, the number of young adults using vaping cartridges with the flavor of cannabis or nicotine increased more than twice (Pesce para.2).

According to the President of the Campaign for Tobacco-Free Kids, Matthew Myers, people that become addicted to vapes or e-cigarettes at a young age, grow into heavily smoking adults (Lemons 17).

(Transition: The fact that vapes triggers addiction would not be that important if it were not for the health hazard.)

Vaping is dangerous for health

Blaha informs that all lung fluid samples of people ill with “e-cigarette, or vaping, product use associated lung injury (EVALI)” show the presence of vitamin E acetate (par 6.).

From this, it could be inferred that vaping liquids contain chemicals that cause diseases of the respiratory system. Thus, even nicotine-free vapes could have a devastating effect on health.

Another point of concern about vaping is that hitherto remains a lot of doubts about how certain chemicals in liquids affect health (Blaha par. 9). Nevertheless, some studies confirm that vaping leads not only to asthma but also to cardiovascular disease (Blaha par.9).

Therefore, it could be argued that vaping remains an insufficiently studied phenomenon. The absence of a clear understanding of the consequences of vaping, as well as PR campaigns of brands that produce vapes and liquids, give a reason to think that vaping does not affect health. At the same time, the growing number of young people with breathing diseases makes them think that vaping is not as good as it might seem at the first sight.

(Transition: As you can notice, vaping has a significant number of disadvantages that should motivate people either not to try it or give up the habit.)

Summary statement

Vaping is not only addictive but also challenges the well-being of a vaper. In the scientific community, there is no common opinion on the effect of the chemicals that are included in the composition of vaping liquids. Notwithstanding this fact, the example of people diagnosed with EVALI proves that vaping represents a threat and that life would be better without this addiction.

Concluding remarks

Still, it is important to remember that our health and quality of life depend on our own choices. Vapes were not created by nature and human beings survived for centuries without smoking and vaping. I will leave you with the question: if the necessity to vape was not put in our bodies and minds by nature, do we need it?

Blaha, Michael Joseph. “5 Vaping Facts You Need to Know.” Health Conditions and Diseases , 2020. Web.

Lemons, Jane Fullerton. E-Cigarette Dilemma . CQ Press, 2019. Web.

Levin, Dan. “Vaping on Campus: No Parents, No Principals, a Big Problem.” The New York Times , 2019. Web.

Pesce, Nicole Lyn. “These Charts Show the Shocking Number of High School and College Students Who Vape.” Market Watch , 2019. Web.

Vaping Products Abuse and Health Harms
The Vaping Ages 13 and Up
Nicotine Addiction Research and Assessment
Cultural Competence: Jamaican Heritage
Public Service Announcement Commercial on Drugs
Health Disparities Among Minorities in the US
Consumer Health and Social Media Network in Saudi Arabia
The African Americans' Reluctance to Get Vaccinated
Chicago (A-D)
Chicago (N-B)

IvyPanda. (2022, September 6). Vaping and Its Negative Aspects. https://ivypanda.com/essays/vaping-and-its-negative-aspects/

"Vaping and Its Negative Aspects." IvyPanda , 6 Sept. 2022, ivypanda.com/essays/vaping-and-its-negative-aspects/.

IvyPanda . (2022) 'Vaping and Its Negative Aspects'. 6 September.

IvyPanda . 2022. "Vaping and Its Negative Aspects." September 6, 2022. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

1. IvyPanda . "Vaping and Its Negative Aspects." September 6, 2022. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

Bibliography

IvyPanda . "Vaping and Its Negative Aspects." September 6, 2022. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

The youth vaping epidemic: Addressing the rise of e-cigarettes in schools

Subscribe to the brown center on education policy newsletter, nandeeni patel and np nandeeni patel intern, the brown center on education policy - the brookings institution diana quintero diana quintero former senior research analyst, brown center on education policy - the brookings institution, ph.d. student - vanderbilt university @quintero05diana.

November 22, 2019

Last December, the U.S. surgeon general raised an alarm regarding the rise in e-cigarette use among the nation’s youth, saying it has increased “at a rate of epidemic proportions.” According to the 2019 National Youth Tobacco Survey , over 5 million youth are currently using e-cigarettes, primarily the JUUL brand, with nearly 1 million youth using the product daily. This substantial increase in teenage vaping is seriously impacting middle and high schools across America.

Teen vaping has gained a significant amount of media attention since President Trump expressed concern about vaping’s public health effects in a September meeting with the FDA. While Trump had suggested a ban on flavored e-cigarettes, it seems that he has backed away from that idea due to political fallout among voters .

Vaping is on the rise in schools

Of the youth population, 27.5% regularly use e-cigarettes, approximately 22 percentage points higher than high schoolers who smoke normal cigarettes. These numbers are alarming because vaping has various types of negative impacts on health. First , e-cigarettes have been linked to severe lung and heart diseases. Second , e-cigarettes with high levels of nicotine can put youth at risk for developing a nicotine addiction which subsequently hinders brain development. Third, e-cigarettes expose youth users to harmful substances, like heavy metals, and are a gateway to smoking cigarettes.

E-cigarettes are causing public health and disciplinary concerns in schools nationwide. Teenagers are being hospitalized for vaping-related diseases, with at least one confirmed death . Teachers and school administrators are trying, yet failing, to prevent students from vaping in classrooms and on school campuses. Administrators are struggling to combat vaping with both punitive and restorative disciplinary measures , and students continue to vape even when facing penalties as serious as suspension. With the number of youth e-cigarette users increasing in the last decade and roughly doubling since 2017 , there may be a need for new policies that could standardize an approach to combating teenage vaping and help curb the impact on students.

President Trump proposed two routes to tackle vaping: a ban on flavored e-cigarettes , and raising the minimum age of purchase on e-cigarettes from 18 to 21. According to recent reporting , Trump has delayed a flavor ban. In response to Trump’s inaction, the House Energy and Commerce Committee passed a bill on Tuesday that would ban flavored tobacco products, raise the minimum age of purchase to 21, and restrict online sales of tobacco products. Despite the bill in the House, Trump is meeting with vaping industry executives and public health advocates. It is unclear how vaping regulations will unfold, but it is worthwhile to examine potential plans and their implications on students.

Examining a potential ban of flavored e-cigarettes

Major vaping companies, like JUUL Labs, have pushed against the flavor ban, which may have influenced Trump’s sudden decision to pull back from the policy. JUUL, which controls three-fourths of the e-cigarette market and has a forecasted 2019 revenue of $3.4 billion , is being investigated by the Food and Drug Administration (FDA) for allegedly illegally advertising its products as less harmful than regular cigarettes. Consequently , JUUL altered its leadership and marketing practices by suspending all advertising in the U.S. and replacing its CEO.

Banning the sale of flavored e-cigarettes would have hefty implications on vaping companies since they employ thousands of small shop owners and hardware designers. Banning the legal sale of flavored vaping products would also create a robust black market for e-cigarettes. A black market for vapes could be lethal for youth who find themselves smoking from cartridges cut with cheaper substances.

Trump faced pressures from the vaping lobby, which flocked to the nation’s capital claiming, among other things, that flavored e-cigarettes help smokers quit regular cigarettes. It is unproven , however, if there are health benefits to a regular smoker who instead becomes a long-term vaper. Research further suggests that while e-cigarette use was associated with high rates of smoking cessation, more than 80% of smokers who entered a randomized trial to stop smoking with the help of e-cigarettes continued to smoke e-cigarettes a year later. This is especially concerning given that smoking e-cigarettes has a negative impact on health.

Should the age limit be increased?

Whether by congressional action or Trump’s executive authority, the age minimum to purchase e-cigarettes can be changed from 18 to 21. Some vaping advocates believe that youth vape because of the nicotine in e-cigarettes. While the nicotine content in e-cigarettes can get students addicted to vaping, our analysis of the 2018 National Youth Tobacco Survey indicates that the most students report vaping for the flavor (about 35%) and because their family and friends use e-cigarettes (about 30%). Increasing the age of purchase to 21 would not address either of those incentives to vape.

Changing the age limit to 21 might fail to prevent many minors from getting their hands on e-cigarettes; in fact, 19% of youth report first trying an e-cigarette before the age of 13. Starting at the age of 13, rates of youth vaping in each age group increase. In 2018, 22% of 16-year-olds and 24% of 17-year-olds reported smoking an e-cigarette. This is an increase from 2017, when 11% of 16-year-olds and 14% of 17-year-olds reported smoking an e-cigarette. This shows that students are gaining access to and using e-cigarette products at an age well below the current age limit of 18. Further, over 70% of youth e-cigarette users report buying e-cigarettes from people rather than a shop, and 27% of frequent users reported living with someone who smoked. Youth vapers are typically not going to shops to buy vapes, they are buying vapes from their peers. Thus, minors who vape may still have access, although slightly restricted, to flavored e-cigarettes from friends and family who are over the age of 21.

We cannot know what will happen to e-cigarettes if the minimum age increases, but we can look to the experience of increasing the minimum age on alcohol for some suggestive evidence. According to the 2017 Youth Risk Behavior Survey, 30% of youth drank some amount of alcohol while 14% of youth engaged in binge drinking. Though raising the age limit for purchasing alcohol helped reduce youth alcohol consumption , youth consumption of alcohol persists.

State and local action

Federal action to stop the teenage vaping epidemic will likely fall short on some, if not most, metrics. Consequently, the onus will fall on state governments, boards of education, and local school districts to combat the issue of teen vaping. Several localities have already taken vaping into their own hands. For example, four states have banned vaping on school grounds, seven states have enacted or will enact a ban on flavored vaping products, and 18 states have raised the legal smoking age from 18 to 21 in the past three years. While the numbers show that vaping has increased drastically even with these state-level bans placed in populous states like New York and Texas, the effect of these state policies is largely unknown.

Beyond traditional tactics like monitoring bathrooms and hallways to confiscate vaping devices, states could also take a new approach to fighting the e-cigarette epidemic, like offering grants to schools to invest in on-site counseling. South Portland High School has been addressing teen vaping by offering mental health services and guiding students away from the social influences that encourage vaping. This school—and others, like Arrowhead High School in Milwaukee—have also been getting students involved in their anti-vaping campaign via peer-to-peer education.

The teenage vaping crisis calls for innovative solutions. In collaboration with federal and state action, local actors can look at the FDA’s Youth Tobacco Prevention Plan for insight on ways to initiate community-supported approaches that restrict access to vaping products, curb teenage-focused marketing tactics, and educate teenagers about the harmful, long-term effects of vaping.

How bad is vaping and should it be banned?

Professor at the National Drug Research Institute (Melbourne), Curtin University

PhD Candidate (Psychiatry) & Research Assistant, University of Newcastle

Disclosure statement

Nicole Lee works as a consultant in the health sector and a psychologist in private practice. She has previously received funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.

Brigid Clancy is an Associate at 360Edge, a drug and alcohol consultancy company.

University of Newcastle and Curtin University provide funding as members of The Conversation AU.

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Vaping regularly makes headlines, with some campaigning to make e-cigarettes more available to help smokers quit, while others are keen to see vaping products banned, citing dangers, especially for teens.

So just how dangerous is it? We have undertaken an evidence check of vaping research . This included more than 100 sources on tobacco harm reduction, vaping prevalence and health effects, and what other countries are doing in response. Here’s what we found.

How does vaping compare to smoking?

Smoking is harmful. It’s the leading preventable cause of death in Australia. It causes 13% of all deaths , including from lung, mouth, throat and bladder cancer, emphysema, heart attack and stroke, to name just a few. People who smoke regularly and don’t quit lose about ten years of life compared with non-smokers.

Nicotine, a mild stimulant, is the active ingredient in both cigarettes and nicotine vaping products. It’s addictive but isn’t the cause of cancer or the other diseases related to smoking.

Ideally, people wouldn’t be addicted to nicotine, but having a safe supply without the deadly chemicals, for instance by using nicotine patches or gum, is safer than smoking. Making these other sources available is known as “harm reduction”.

Vaping is not risk-free, but several detailed reviews of the evidence plus a consensus of experts have all estimated it’s at least 95% safer to vape nicotine than to smoke tobacco. The risk of cancer from vaping, for example, has been estimated at less than 1%.

These reviews looked at the known dangerous chemicals in cigarettes, and found there were very few and in very small quantities in nicotine vapes. So the argument that we won’t see major health effects for a few more decades is causing more alarm than is necessary.

Is ‘everyone’ vaping these days?

Some are concerned about the use of vaping products by teens, but currently available statistics show very few teens vape regularly. Depending on the study, between 9.6% and 32% of 14-17-year-olds have tried vaping at some point in their lives.

But less than 2% of 14-17-year-olds say they have used vapes in the past year. This number doubled between 2016 and 2019, but is still much lower than the rates of teen smoking (3.2%) and teen alcohol use (32%).

It’s the same pattern we see with drugs other than alcohol: a proportion of people try them but only a very small proportion of those go on to use regularly or for a long time. Nearly 60% of people who try vaping only use once or twice .

Smoking rates in Australia have declined from 24% in 1991 to 11% in 2019 because we have introduced a number of very successful measures such as restricting sales and where people can smoke, putting up prices, introducing plain packaging, and improving education and access to treatment programs.

But it’s getting harder to encourage the remaining smokers to quit with the methods that have worked in the past. Those still smoking tend to be older , more socially disadvantaged , or have mental health problems.

Read more: My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'

Should we ban vapes?

So we have a bit of a dilemma. Vaping is much safer than smoking, so it would be helpful for adults to have access to it as an alternative to cigarettes. That means we need to make them more available and accessible.

But ideally we don’t want teens who don’t already smoke to start regular vaping. This has led some to call for a “ crackdown ” on vaping.

But we know from a long history of drug prohibition - like alcohol prohibition in the 1920s - that banning or restricting vaping could actually do more harm than good.

Banning drugs doesn’t stop people using them - more than 43% of Australians have tried an illicit drug at least once. And it has very little impact on the availability of drugs.

But prohibition does have a number of unintended consequences, including driving drugs underground and creating a black market or increasing harms as people switch to other drugs, which are often more dangerous.

The black market makes drugs more dangerous because there is no way to control quality. And it makes it easier, not harder, for teens to access them, because there are no restrictions on who can sell or buy them.

Read more: Learning about the health risks of vaping can encourage young vapers to rethink their habit

Are our current laws working?

In 2021, Australia made it illegal to possess and use nicotine vaping products without a prescription. We are the only country in the world to take this path.

The problem is even after more than a year of this law, only 8.6% of people vaping nicotine have a prescription, meaning more than 90% buy them illegally.

Anecdotal reports even suggest an increase in popularity of vaping among teens since these laws were introduced. At best, they are not helping.

It may seem counterintuitive, but the way to reduce the black market is to make quality-controlled vapes and liquids more widely available, but restricted to adults. If people could access vaping products legally they wouldn’t buy them on the black market and the black market would decline.

We also know from many studies on drug education in schools that when kids get accurate, non-sensationalised information about drugs they tend to make healthier decisions. Sensationalised information can have the opposite effect and increase interest in drugs . So better education in schools and for parents and teachers is also needed, so they know how to talk to kids about vaping and what to do if they know someone is vaping.

What have other countries done?

Other countries allow vapes to be legally sold without a prescription, but impose strict quality controls and do not allow the sale of products to people under a minimum age. This is similar to our regulation of cigarettes and alcohol.

The United Kingdom has minimum standards on manufacturing, as well as restrictions on purchase age and where people can vape.

Aotearoa New Zealand introduced a unique plan to reduce smoking rates by imposing a lifetime ban on buying cigarettes. Anyone born after January 1 2009 will never be able to buy cigarettes, so the minimum age you can legally smoke keeps increasing. At the same time, NZ increased access to vaping products under strict regulations on manufacture, purchase and use.

As of late last year, all US states require sellers to have a retail licence, and sales to people under 21 are banned. There are also restrictions on where people can vape.

A recent study modelled the impact of increasing access to nicotine vaping products in Australia. It found it’s likely there would be significant public health benefits by relaxing the current restrictive policies and increasing access to nicotine vaping products for adults.

The question is not whether we should discourage teens from using vaping products or whether we should allow wider accessibility to vaping products for adults as an alternative to smoking. The answer to both those questions is yes.

The key question is how do we do both effectively without one policy jeopardising the outcomes of the other?

If we took a pragmatic harm-reduction approach, as other countries have done, we could use our very successful model of regulation of tobacco products as a template to achieve both outcomes.

Read more: It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking

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The Risks of Vaping

A Look at Safety

Illustration of a teenager saying no to friends offering him an electronic cigarette

You’ve probably heard a lot about vaping lately. You might also know about the recent outbreak of lung injuries and deaths linked to vaping in the U.S. But those aren’t the only risks that come with vaping. Here’s what you need to know.

Vaping devices, also known as e-cigarettes, vape pens, and e-hookahs among other terms, come in many shapes and sizes. Some look like traditional cigarettes, cigars, or pipes. Others are shaped like every-day objects, such as pens or USB memory sticks.

While they may look different, most vaping devices work in a similar way. Puffing activates a battery-powered heating device. This heats the liquid in a cartridge, turning it into vapors that are inhaled.

Vaping exposes the lungs to a variety of chemicals. These may include the main active chemicals in tobacco (nicotine) or marijuana (THC), flavorants, and other ingredients that are added to vaping liquids. Plus, other chemicals can be produced during the vaporizing process.

“If the liquid has nicotine in it, then the user is inhaling nicotine along with the other ingredients in the liquid,” explains Dr. Thomas Eissenberg, an expert on tobacco research at Virginia Commonwealth University.

While vaping devices work similarly, some are more powerful than others. They create more vapor and deliver more chemicals.

So how safe is vaping? Studies suggest nicotine vaping may be less harmful than traditional cigarettes when people who regularly smoke switch to them as a complete replacement. But nicotine vaping could still damage your health.

“Your lungs aren’t meant to deal with the constant challenge of non-air that people are putting into them—sometimes as many as 200 puffs a day—day after day, week after week, year after year,” Eissenberg says.

“You’re inhaling propylene glycol, vegetable glycerin, flavorants that were meant to be eaten but not inhaled, and nicotine,” he explains. “And all of those are heated up in this little reactor, which is an e-cigarette. When they get heated up, those components can turn into other potentially dangerous chemicals.”

One harmful chemical may be a thickening agent called Vitamin E acetate, which is sometimes used as an additive in THC-containing vape products. The CDC identified it as a “chemical of concern” among people with vaping-associated lung injuries. They recommend avoiding any vaping product containing Vitamin E acetate or THC, particularly those from informal sources like friends, family, or in-person or online dealers.

Vaping is now more popular among teens than smoking traditional cigarettes. One in four high school seniors say they vaped nicotine in the past month. And studies have found that teens who vape nicotine may be more likely to go on to smoke traditional cigarettes.

Marijuana vaping has also increased dramatically among teens. About 20% of high school seniors vaped marijuana in the past year. The rates have more than doubled in the past two years.

New laws are aimed at curbing vaping among teens. People must now be 21 to buy any tobacco product, including vaping products. And companies can no longer produce and sell flavors that appeal to children like fruit and mint.

If you’ve already started vaping or smoking cigarettes, it’s never too late to quit. See the Wise Choices box for tips on stopping.

The Dangers of Vaping

As our nation turns away from smoking tobacco and toward legalization of marijuana, vaporization of both plants has increased in popularity. There are medical and cultural implications of this new trend which are just recently being reported and investigated. The purpose of this article is to review the scientific and sociological literature as it pertains to the vaporization of both marijuana and tobacco products and the potential medical and cultural implications of this new phenomenon.

The invention of vaping is attributed to Herbert Gilbert, a cigarette smoker and scrap metal dealer from Pennsylvania. Gilbert’s device was battery-powered to vaporize a liquid for inhalation, very similar to modern electronic cigarettes. He admitted to the Smithsonian magazine that he believed it to be a breakthrough alternative to cigarette smoking to save people from tobacco’s harmful effects as it did not contain nicotine. After multiple permutations, the device was never mass-produced but its patent has been cited by many companies since then. He actually proposed an alternative use for the device for people that were dieting and believed that they could vaporize the tastes of their favorite foods to quench food cravings. He initially proposed a handful of flavorings including cinnamon, rum, orange, and mint. 1 – 2 A year after the patent was submitted in 1963, the Surgeon General Luther Terry released his report “Smoking and Health” on the potential health consequences of cigarette smoking. This was the first report implicating cigarettes in a causal relationship with lung cancer and heart disease as well as laryngeal cancer and chronic bronchitis. 3

Since that time, “vaping” as it is called has diverged into two very separate activities with some common elements. The practice of vaporizing tobacco products and nicotine-containing liquids continued to be developed and has manifested in the modern day in the form of both commercial and custom-made dedicated devices. Separately, in the early 1990s vaping emerged as a new method to use marijuana both recreationally and medicinally. 4 These behaviors have significant overlap in the devices used for inhalation, the cultural changes associated with their acceptance, and the potential health effects. In this article, we will examine the cultural and medical implications of vaping as well as some obstacles to good scientific study.

Al though vaping tobacco was initially conceived as a healthier way to smoke, it took on a life and an industry of its own. In 2019, vaping tobacco is a new gateway to nicotine abuse that frequently skips the initial phase of addiction to cigarettes. It has been perceived as safer, better tasting, more efficient, and more discrete. Vaping tobacco provides new users with an overall better initial experience when compared to the first time smoking cigarettes. 4 – 5 Eighty years ago, cigarette smoking was culturally accepted and even considered “cool.” In the present day, vaping tobacco has its own culture that is often separate from cigarette smoking. Substantial marketing investment by tobacco companies in response to a decrease in combustible cigarette consumption in the last few years has led to an overall normalization of vaping tobacco and a change in perception that it is safe. Combustible cigarette smoking has become culturally stigmatized, with many cities outlawing tobacco smoking in bars and restaurants and sometimes even on the street. Vaping is a method by which people can consume tobacco products without being part of a fringe and marginalized group. 4 – 6

Marijuana has always had its own culture. Induction into this culture previously required a supplier of the illegal drug that would also provide education about how to smoke it, either through pipes or rolled into cigarette form. There are many generations of marijuana smokers who are now considering the long-term health effects of smoking. Much like with vaping tobacco products, chronic marijuana smokers are vaporizing marijuana as a potentially healthier alternative. This is especially true of the “Baby Boomer” generation. 7 The legalization of marijuana has drastically changed the landscape of the use of this drug, both in terms of the potency of available products and the methods by which it can be ingested or inhaled. In states where marijuana has become legal, vaporizing marijuana oils is more convenient and more popular. 6 , 7

A final cultural consideration of vaporization of tobacco is the misunderstanding that vaporizing tobacco is somehow a viable way to quit smoking cigarettes. No clinical trials have been able to show that vaping helps reduce cigarette smoking, but there are some trials that show that dual-use is common and that many people who start vaping with the intention to quit smoking end up smoking cigarettes and vaping tobacco. They are acquiring the risk profiles of both activities without benefit. 8 It is common to see patients in this group feel somehow encouraged that through vaping they have been able to reduce their intake of combustible cigarettes, with no consideration to the unknown possible dangers of vaporizing. 9

Problems with Studies

Good clinical evidence is lacking regarding the potential harm of vaping or the potential benefits. There are some problems with studying something like vaping. For one thing, any research has to make a distinction between vaporizing marijuana and vaporizing tobacco and this is not always possible. Additionally, the methods by which people vaporize tobacco and marijuana differ. As far as tobacco devices go, there are many brands with many different compositions and construction designs. Regarding the vaporization of marijuana, there are no standardized devices and there are no standard formulations.

Studies to prove a benefit of vaporizing tobacco over smoking cigarettes have been confounded by the lack of a direct correlation between the number of puffs of an electronic cigarette and the number of conventional cigarettes smoked. With different brands of electronic cigarettes having different chemical ingredients and different concentrations of nicotine, the issue is even more complicated. 9 , 10 Many of the studies performed on electronic cigarettes used a Nicorette inhaler as a control for comparison. It is important to note that the Nicorette inhaler does not heat its component chemical liquid, where vaporization does heat the internal components and the liquids. 11

The studies on the safety or dangers of vaporizing marijuana are limited in number because the marijuana itself is difficult to acquire. There were a small number of the plants released in the early 90s for clinical research. 12 Most of those studies utilized the same device, manufactured under the name “Volcano”. This device is expensive and is drastically different from any of the modern handheld devices for vaporizing marijuana and tobacco. It does not serve as a good facsimile for comparison to modern day vaporization technology. Many of the clinical research studies available focus on aspects of vaping such as the amount of nicotine or marijuana delivered but there’s not a great deal of evidence on the analysis of other toxins released both from vaporizing tobacco leaf products and marijuana. With all of these limitations, most of the available studies are non-clinical or have very small numbers of study subjects. A strong and thorough assessment of the potential dangers of vaporizing tobacco and marijuana products has not been forthcoming. 12 , 13

Medical Dangers of Vaping

All of the medical dangers of vaping are unknown. Only a small number of people who admit to vaping marijuana are doing so for medical reasons, and there are almost no studies. A large number of people believe that vaping tobacco is a healthy way to quit, and this belief has been fostered by the tobacco industry. 6 , 14 There is no strong clinical signal in the direction of using electronic cigarettes as an effective method of quitting smoking. It is difficult to hold an informed discussion with patients about the potential risks and benefits of vaping. Potential risks come from multiple places: device specific concerns, the makeup of the liquid products being vaporized, and the potential for toxicity of both nicotine and marijuana when inhaled in concentrated forms.

Chemical Composition of the Liquid Products

The pharmacologically active components of vaping products are not regulated, and the methods by which they are extracted and suspended in solution vary greatly. The user believes they are inhaling a pure form of THC (the active component of marijuana) or nicotine but there is often little regard for what else is being inhaled concomitantly. The risk profiles of these inhaled chemical mixtures change significantly depending upon the method by which they are vaporized or heated. 15 – 17

The conventional solvents for the dissolution of nicotine or THC have been propylene glycol and glycerol, and these are the best studied. Initially thought to be benign, there is now some research demonstrating that propylene glycol when vaporized causes significant respiratory irritation and even increases the incidence of asthma. The breakdown products from heating propylene glycol and glycerol to target temperatures include formaldehyde and hemiacetals such as acetaldehyde. Formaldehyde is a Group 1 carcinogen that contributes a 5–15 times higher lifetime risk of cancer. It is present in traditional smoked tobacco in much lower quantities. Hemiacetals such as acrolein and acetone have been implicated in nasal irritation, cardiovascular effects, and lung mucosal damage and these byproducts are produced in higher quantities with higher voltage devices. Basically, as the temperature of the coil increases, the carcinogenic risk of vaping approaches that of traditionally smoked cigarettes. 9 , 10 , 16 – 18

The flavorings added to the nicotine and THC extracts represent a separate but no less worrisome health risk. We tend to think of food additives as safe, and we sometimes learn empirically about the hazards they pose when people are exposed to them in ways other than direct ingestion. Diacetyl is a food additive that is also used in flavoring electronic cigarettes that approximates the flavor of butter. In the early 2000s, diacetyl was implicated as a cause of bronchiolitis obliterans organizing pneumonia (BOOP) in factory workers exposed to it in large quantities. Although it is considered safe to eat, exposure to this chemical is regulated and limited by OSHA due to its proven health effects. 8 , 19 The flavoring additives of electronic cigarettes on the mass market are typically passed through the FDA under a provision that these chemicals, almost exclusively synthetic, are “generally accepted as safe” for human consumption. The caveat with this provision is that consumption refers to oral ingestion. It is unknown what potential health effects result when something perfectly safe to eat and digest is vaporized at 500 degrees and inhaled. Some research is demonstrating that the flavorings incorporated into electronic cigarettes have cytotoxic effects. 8 Furthermore, sweeter flavorings tend to contain stronger oxidizers. One study used a murine model of lung epithelial cells and demonstrated a higher release of inflammatory cytokines IL-6 and IL-8 as well as fibroblastic changes in the subjects exposed to sweeter electronic cigarette flavorings, with the mice appearing to lose redox balance. 20

Problems with Manufacturing of E-Cigarettes

There is no real regulation of either nicotine-containing electronic cigarette products or marijuana extracts for vaping. Every part of the manufacturing process allows for error and contamination, with too many unknowns about the potential dangers of vaporizing each individual component. With marijuana still being illegal in many states and on the federal level, this is even more of a problem with THC containing products available on the black market. Recent research has shown that Vitamin E is a new solvent into which these THC extracts are dissolved, probably due to its relative ease of acquisition. All of the health effects of inhaling vaporized vitamin E are unknown. 21 There is recent evidence that vaporized vitamin E oil may be a cause of Electronic cigarette and Vaping Associated Lung Injury (EVALI). The simplest and highest-yield method of extracting THC oil from marijuana buds utilizes a rudimentary setup that exploits certain properties of compressed butane gas, called “supercritical fluid extraction”. The traditional backyard equipment setup is a PVC pipe and a butane lighter refill canister which, under the right conditions, can explode with multiple case reports of severe burns. Most of those who self-report home extraction of THC oil learned how to do so from materials available on the internet, and by watching videos on Youtube. 22 , 23

Toxicity of Nicotine and THC

It bears noting that when vaping is successful and delivers concentrated nicotine or THC to the user, the amount of drug delivered is much higher than would typically be inhaled by burning and smoking the raw tobacco or marijuana plant. Sociological questionnaires on vaping habits reveal a trend toward dabbing THC contributing to addictive behavior not reported by those users who smoke marijuana in a non-concentrated form. The same pattern of addiction, tolerance, and withdrawal that has been observed in drugs like heroin, traditionally considered “hard drugs”, is now being reported in those vaping THC. 5 , 6 , 15 , 24 There have been some cases of nicotine poisoning from using electronic cigarettes, with an increased risk of toxicity associated with customized devices and higher nicotine concentrations in the liquids. Finally, many of those who attempted to quit cigarettes by transitioning to vaping are reporting that quitting vaping is actually significantly harder than quitting smoking traditional cigarettes, with some respondents even turning back to cigarettes as a way to help wean off their vaporizer device. 25 – 27

Device-Specific Concerns

The basic design of the device, in the case of vaping both tobacco and marijuana, is largely unchanged from the original patent by Gilbert. There is a reservoir that holds an oil or liquid, a mouthpiece, and a heating element. Theoretically, vaporizing the liquid does not combust it and saves the person vaping from exposure to byproducts generated by high heat. However, there is no regulation of these devices and no agreed upon standard temperature. There appears to be a wide variance in the quality of the components of these devices depending on the price of purchase. 2 , 10 , 11 , 16 , 28

There are multiple different metals used for the heating element, including: Nichrome (nickel-chrome), tungsten, stainless steel, and Kanthal (Ferritic iron chromium aluminum alloy) among others. Powered by a battery, the element wire is heated to a temperature range around 375–525 degrees. The long term effects of sustained exposure to the oxide products of these metals are unknown. 2 , 16 , 28

There are manufactured electronic cigarettes under various brand names ( Figure 1 ), but there is also a subculture of people who vape either tobacco and marijuana (or both) through devices that they custom build, referred to as “mods”. There are many websites and physical stores catering to this hobby, and there are many different accessories and components available to change different aspects of device performance. A user can find stronger batteries, a wide array of device designs, and an even broader selection of metals for the heating element in different lengths and diameters. The practice of “direct dripping” involves users directly dripping the vaping liquid onto a heated coil with the express intention of increasing the quantity of vapor as well as increasing the concentration of the active ingredients being vaped. 6 , 16 , 20 , 29 This practice increases toxin exposure and often goes along with modified devices that increase temperature by increasing voltage. Increasing the voltage of the device with stronger batteries and driving higher temperatures on the heating coils has been shown to approach equivalency with cigarettes in terms of exposure to carcinogens. It is unknown what other potential health effects are caused by modifying these properties of the device. 10

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Vaping Brands Chart- E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019.

Ghinai I, Pray IW, Navon L, et al. MMWR Morb Mortal Wkly Rep 2019;68:865–869.

Shifting Perspectives on Vaping

The smoking of tobacco in pipes and cigarettes used to be much more common, and it took a long time to realize the true dangers of combustible cigarette smoking. The terminology used can be confusing ( Figure 2 ). The available body of medical literature regarding the potential harms of vaping consists of data from animal models, observational studies with small numbers of subjects, and single case reports and series. One observational study utilized pulmonary function tests to show that vaping decreases FeNO and increases respiratory impedance. 30 There have been multiple case reports of vaping-associated lipoid pneumonia. As previously mentioned, there have been reports of both THC and nicotine toxicity. There are many reports of mechanical injury and burns from malfunctioning devices. The perception that vaping is safe is starting to change.

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Vaping Terminology

An additional common theme has been that many of the electronic cigarette and vaping associate lung injury (EVALI) cases are related to black-market THC products marketed under a variety of brand names. In one study, approximately 96% of THC for vaping was typically sold in pre-filled cartridges or “carts”. A clear majority, over 60%, were sold under the label ‘Dank Vapes.’ This does not represent an actual brand, but rather a type of empty packaging readily available online and in vaping shops which can then be filled with whatever homemade product a dealer has at their disposal. It is not widely known by consumers that Dank Vapes is not a brand, and this may contribute to a sense of false trust. 31 , 32

The cultural phenomenon of vaping both marijuana and nicotine were billed as a healthy alternative to smoking and at times even seen as an option to aid in cessation. With the current body of evidence and the outbreak of EVALI in 2019, it is incumbent upon all healthcare practitioners to advise patients that vaping should not be considered safer than smoking and that there are very real and new dangers associated with vaping that still require further study. Providers must learn more about the dangers of vaping and identify adverse health effects from this practice in patients. An evidence-based approach to smoking cessation based on established data and practice patterns is needed.

Peter Laucks, DO, MSMEd, (left ), is in the Department of Internal Medicine, Pulmonary and Critical Care Fellowship at Truman Medical Centers, Kansas City, Missouri. Gary A. Salzman, MD, (right), MSMA member since 2007, is Professor of Medicine; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

Contact: ude.ckmu@gnamzlas

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None reported.

Persuasive Essay on Vaping and E-cigarettes Should Be Banned

📌Category:	,
📌Words:	862
📌Pages:	4
📌Published:	14 March 2022

Nicotine is a highly addictive substance which is as hard to give up as heroin. 2.06 million teens are using nicotine on a daily basis across America. Nicotine is commonly used in vaping and e-cigarettes, and the dosage is either lower or the same as in cigarettes and tobacco products.Some believe vapes lead to drug addictions, while others say they do nothing wrong and have no effect. Vaping and E-cigarettes should be banned. Vaping is unbenefictial to a person’s health and rather targets their packaging towards young children and gives them a higher risk of developing a nicotine addiction.

The number of kids who vape is increasing, addicting new generations to nicotine and cigarettes, and introducing them to smoking. The percentage of kids who vape has gone up throughout the years, For example, "As of 2020, 19.6% of high school students used e-cigarettes, the most-used tobacco product among the age group, followed by cigars (5%)" (ProCon 1). 19.6% of high school students rely on nicotine. The nicotine in the vapes is the same as the one in cigarettes that can lead to them turning to cigarettes. Many of the students can get their friends addicted to nicotine as well, increasing the number of students who use e-cigarettes. The site also mentions that "One JUULpod contains as much nicotine as a pack of cigarettes, both of which last for about 200 puffs" (ProCon 1). Vaping can be just as bad and addictive as cigarettes. It may take longer to use the whole vape rather than a pack of cigarettes, but it's still the same amount of nicotine consumed. It is not a healthier option if it's not as different as cigarettes. Matthew Myers, who campaigns against tobacco, stated, "Like cigarette companies, e-cigarette makers claim they don’t market to kids. But they’re using the same themes and tactics tobacco companies have long used to market regular cigarettes to kids (Exploring Issues 1). E-cigarettes and vape companies tend to rely on the same marketing used to get kids into cigarettes. They use the same techniques as tobacco companies that try to get kids to buy their products. They use a confident and good looking person to say vaping is cool and desirable. Vaping attracts many new people into smoking and opens many opportunities for health issues.

Nicotine can lead to many problems regarding health. Nicotine is a very addictive substance and can damage a person's body. One way it can affect a person is "Nicotine used by young people may increase the risk of addiction to other drugs and impair prefrontal brain development, which can lead to ADD and disrupt impulse control"(ProCon 1). Nicotine can cause cravings and cause impulsive behavior if a person becomes addicted. Nicotine can lead to more drugs and can cause brain damage to a person. Brain damage can lead to disorders like ADD. Not only does it lead to brain disorders, but also long-term diseases and strokes. The article states, "People who use e-cigarettes have a 71% increased risk of stroke and a 40% higher risk of heart disease, as compared to nonusers" (ProCon 1). People who use e-cigarettes or vapes have a higher chance of having a stroke or heart disease, which could kill them. The chemicals in the products can expose a person to life-long struggles because of a stroke. Heart disease is a long-term disease that can result from vaping and is the leading cause of death in America. A main contributor to these injuries and illnesses is the chemicals inside the vape. An example of what the chemicals can do is "Some ingredients in the liquids used in e-cigarettes change composition when they are heated, leading to inhalation of harmful compounds such as formaldehyde, which is carcinogenic" (ProCon 1). The liquids can change when heated, changing the compounds in the liquid. The liquid compounds could become dangerous and turn into chemicals like formaldehyde, which can lead to irritations all over the body and sometimes even cancer. Some health conditions and problems can cause problems for the rest of a person's life, but some argue it helps people with smoking.

E-cigarettes help people stop smoking. Studies have been done many times on this topic. One study states, "A July 2019 study found that cigarette smokers who picked up vaping were 67% more likely to quit smoking" (ProCon 1). That may be true, but people can still face health issues and still ingest an equal amount of nicotine found in a pack of cigarettes. Vapes can be safer than cigarettes because of the fact that they use vapor, not smoke. The website says, "However, most scientists agree that ESDs are much less harmful to health than tobacco cigarettes" (Exploring Issues). Vapes can be much safer than tobacco with items inside, but they can also expose a person to the same health problems as tobacco. Vaping can even heat up and change the liquid compound inside of it, creating formaldehyde, which can lead to cancer and irritations. The heat in the vapes can burn holes in the lungs as well, just like cigarettes.

Vaping can cause many problems regarding health and contributes to attracting more children to turn to vaping. Vapes can be marketed the same as cigarettes and can be just as harmful. Vaping can lead to a gateway of health issues like strokes, heart attacks, ADD, nausea, and more. The liquid in the vapes can create dangerous compounds when heated up and can burn holes into the lungs. It may be different than smoking and a healthier option, but the risks are still present.

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Breland, Alison, et al. “Electronic Cigarettes: What Are They and What Do They Do?” Annals of the New York Academy of Sciences, vol. 1394, no. 1, 2016, pp.530.,doi:10.1111/nyas.12977.
“E-Cigarettes: The Health Risks of Vaping.” NBCNews.com, NBCUniversal News Group, www.nbcnews.com/better/health/better-cigarettes-vaping-comes-its-own-set-health-risks-ncna819716.
“Is Vaping Bad for You? Learn the Truth about the Side Effects Here.” Best Vape Deals - Cheap Vape Mods, Tanks & EJuice | Vaping Cheap, 10 Oct. 2018, vapingcheap.com/vaping-side-effects/.
Palazzolo, and Dominic L. “Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. A Literature Review.” Frontiers, Frontiers, 1 Nov. 2013, www.frontiersin.org/articles/10.3389/fpubh.2013.00056/full.
“The Different Types of Vapes You Need to Know.” Vaping360, vaping360.com/vaping-101/different-types-of-vapes/.
“10 Shocking Dangers of Vaping | Health Risks Of Vaping And E-Cigarettes.” The Authentic Gay, 30 Jan. 2019, www.theauthenticgay.com/10-vaping-health-risks/

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A Vapid Solution: Why banning disposable e-cigarettes would be a failure of law-enforcement

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The New Great Inflation: How Western Central Banks Got It Wrong...and What They Should Do About It

Economic Affairs (43.3)

Obituary: David Boaz (1953-2024)

A ban on disposable vaping products would take away a safer choice from millions of adult smokers.
It is already illegal to sell vaping products to under-18s.
The scale of youth vaping is often overstated. Twice as many 11–15-year-olds drink alcohol regularly than vape regularly.
Environmental concerns are negligible since only tiny amounts of rare resources are used and vapes are easily recyclable.
The sensible response to concerns about youth vaping and the environment is to enforce existing restrictions and to encourage responsible recycling, not take away the freedom of adults to choose.

Introduction

The benefits of vaping, underage vaping, environmental concerns, the risks of banning disposable e-cigarettes.

Higher smoking rates due to lower uptake of vaping by current smokers. Disposable vapes are simpler and more convenient to use than refillable devices. They are pre-filled with e-liquid and are precharged. They are draw-activated and automatically switch off when they are not in use. Smokers who use them for the first time do not have to learn anything about wattage, nicotine fluid strength or battery power. Although they are more expensive in the long run, they require a smaller financial outlay initially (around £5 compared to around £40 for a refillable). All of this makes them a more viable proposition than refillable e-cigarettes for smokers who are thinking of trying vaping for the first time, particularly those who are elderly or on low incomes.
Higher smoking rates due to ex-smokers returning to smoking. As noted above, over a million adult vapers currently use disposable vapes, presumably because they find them preferable to refillable e-cigarettes. Without the option to vape their favoured products, many must be expected to return to smoking.
An increase in underage smoking . Fears of a ‘gateway effect’ have so far proved unfounded but by banning e-cigarettes that are currently used by under-18s, the government could inadvertently engineer a ‘gateway’ from vaping to smoking.
Growth of the black market. E-cigarettes are already being sold illegally to children. The e-cigarettes being sold are often themselves illegal. An analysis of vapes confiscated in a school in Kidderminster in May 2023 found that most of the products were illegal and unregulated, with many of them containing high levels of lead, nickel and chromium. 17 As Action on Smoking and Health says: ‘Children already find it easy to get hold of illegal vapes, as those selling them have no qualms selling to children, making them all illegal won’t help. The sale of illegal disposable vapes, already large and growing, will be turbo-charged if they are banned.’ 18 This is supported by evidence from Australia where e-cigarettes containing nicotine have always been banned and there is a major problem with children buying unregulated e-cigarettes on the black market. 19

About the authors

‘Crackdown on illegal sales of vapes’, Gov.uk, 9 April 2023 ( https://tinyurl.com/mrthkfk3 )
‘Sunak voices concern over vape advertising “targeted at kids”’, Evening Standard, 25 May 2023 ( https://tinyurl.com/3f3z9sv9 )
‘What are the health risks of smoking?’, NHS.uk, 16 September 2022 ( https://tinyurl.com/3fzpzy4f )
‘E-cigarettes: an evidence update’, Gov.uk, 19 August 2015 ( https://tinyurl.com/3ccbppes )
‘Nicotine without smoke: Tobacco harm reduction’, Royal College of Physicians , 28 April 2016 ( https://tinyurl.com/43ecspwt )
‘Comparing the cancer potencies of emissions from vapourised nicotine products including e-cigarettes with those of tobacco smoke’, BMJ , 4 August 2017 (https://tinyurl.com/3entmhvk)
‘Nicotine vaping in England: 2022 evidence update main findings’, Gov.uk, September 2022 (https://tinyurl.com/v8y7ed6c)
‘Electronic cigarettes for smoking cessation’, Cochrane Library, 17 November 2022 ( https://tinyurl.com/2ewkfnhh )
‘Smoking, Drinking and Drug Use among Young People in England, 2021’, NHS.uk , September 2022 ( https://tinyurl.com/2j8bd6mp )
‘Use of e-cigarettes among young people in Great Britain’, Ash , June 2023 ( https://tinyurl.com/mr24c5sp )
‘Smoking, Drinking and Drug Use among Young People in England, 2021: Data tables’, NHS.uk, 2 September 2022 ( https://tinyurl.com/4kvyrz53 )
‘Global EV outlook 2022’, International Energy Agency , May 2022 ( https://tinyurl.com/3avhnmkw )
‘Recycling vapes’, Recycle Your Electricals ( https://tinyurl.com/mr3w3d2s )
‘Policy options to tackle the issue of disposable (single-use) vapes’, Ash, August 2023 (https://tinyurl.com/2p9f5a5h)
‘ASH response to “Councils call for ban of disposable vapes”’, Ash , 15 July 2023 ( https://tinyurl.com/99wepmxt )
‘Vaping: High lead and nickel found in illegal vapes’, BBC , 23 May 2023 ( https://tinyurl.com/3k48w65n )
‘ASH response to “Councils call for ban of disposable vapes”’, Ash , 15 July 2023 ( https://tinyurl.com/99wepmxt )
‘New research finds Aussie teens find illegal vapes easy to access’, Cancer Council , September 2022 (https://tinyurl.com/3sdp2rdk)

1 thought on “A Vapid Solution: Why banning disposable e-cigarettes would be a failure of law-enforcement”

Disposable products are garbage, literally. They are future landfill. We need to move away from all disposable products. Reusable vape products create less garbage, less pollution, they’re less likely to be obtained and used by teens, and they save the user a significant amount of money over the long term. There is no good reason to opposed the banning of disposable vapes.

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Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations

Published: 15 August 2021
Volume 181 , pages 453–462, ( 2022 )

Cite this article

Timothy D. Becker ORCID: orcid.org/0000-0002-8400-1312 1 &
Timothy R. Rice ORCID: orcid.org/0000-0002-2044-1538 1

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Worldwide, youth electronic cigarette use (vaping) has risen significantly over the past decade. This public health concern has spurred many high-quality studies characterizing country-specific prevalence, risk factors, physical and behavioral health complications, and optimal methods of assessment and counseling for youth vaping. Clinicians remain underexposed to this recent work, limiting translation of evidence into higher quality patient care. This review aims to provide pediatricians and other clinicians working with youth a clinically focused survey of key research findings and considerations based on recent evidence. This narrative review surveys emerging trends in EC use across different countries, reasons for youth vaping, characteristics of vaping materials that promote youth use, associations with combustible cigarette use, relation with cannabis and other illicit substances, physical and behavioral health risks associated with vaping, and methods of assessment, counseling, and intervention for problematic vaping in youth. Since vaping remains a relatively new phenomenon, long-term health consequences remain unknown.

Conclusion : Youth vaping is an increasingly well-studied phenomenon with both physical and behavioral health risks. Pediatricians and other youth-focused clinicians can apply the lessons of recent research in work with youth and their families.

New Decade: “New” Devices for “Old” Drugs

Global youth vaping and respiratory health: epidemiology, interventions, and policies

Recommendations for Prevention and Treatment of E-Cigarette Use Among Youth in the Clinical Setting

Avoid common mistakes on your manuscript.

Screening, prevention, and treatment of substance use are core functions of adolescent healthcare [ 1 ]. Worldwide, youth electronic cigarette (EC) use, or vaping, has increased substantially over the past decade [ 2 ]. ECs are now often the first psychoactive substance used by youth in some settings [ 3 ], generating a surge in new research on health consequences of this trend. Adolescent use rates vary across Europe [ 4 ], and other countries [ 5 ] and clinician beliefs and practices regarding ECs vary considerably across settings [ 6 , 7 , 8 ].

To consolidate recent data concerning global epidemiology, physical and behavioral health risks, and clinical considerations, we review key facts and considerations for pediatricians based on recent studies, systematic reviews, and guidelines and recommendations. Adolescent vaping practices are ever-evolving, including during the COVID-19 pandemic [ 9 ]. To provide best practices in their care, pediatricians must be familiar with the most recent evidence on this global public health concern.

What is vaping and what distinguishes it from conventional cigarette use?

Contemporary ECs were introduced in 2003 by a Chinese inventor and spread to Europe and North America in 2006, initially promoted as a smoking cessation aid in adults [ 10 ]. However, ECs have become particularly popular among nicotine-naïve youth, with use reaching epidemic proportions in some areas [ 11 , 12 ]. EC use became particularly popular among North American adolescents, with rates often exceeding rates of combustible cigarette (CC) use [ 13 ]. In Canada, lifetime EC use rates reached 37%, and current use rates reached 14.6% among adolescents in 2018 [ 13 ]. In the USA, current use rates reached a peak of 27.5% among high school students in 2019, before decreasing to 19.6% in 2020 (data collected from January through March, prior to the onset of COVID-19 restrictions in the USA) [ 14 ]. Among currently using US adolescents, 38.9% reported using at least 20 days per month, and 83% reported use of flavored ECs [ 14 ]. EC use has also been popular among UK adolescents, with lifetime use rates of 32.7% and current use rate of 8.9% in 2018, which in contrast to the USA were slightly lower than the CC use rate among UK youth [ 13 ]. Limited comparable data exist to make reliable cross-national comparisons of use rates between European countries, although rates generally appear lower than in North America [ 4 ]. In a 2016–2017 study among adolescents in seven Western European cities, 35.5% endorsed lifetime EC use (ranging from 23% in Germany to nearly 50% in Italy and Belgium), with 6.6% reporting EC current use (i.e., monthly or more frequently), compared to 17.2% current CC use [ 4 ]. Among university students across several Central and Eastern European countries in 2017–2018, while 43.7% reported lifetime use of EC, only 2.9% were current EC users, well below rates of current CC use (12.3%) [ 15 ]. South Korean adolescents’ current use rates (3% and 1% among young men and women, respectively) are also comparatively lower and have remained stable from 2016 to 2018 [ 16 ]. Restrictiveness of policies around mass marketing and sale to minors has been identified as a factor contributing to differences in EC uptake across locales [ 5 , 17 ].

ECs are battery-powered devices that contain a liquid that becomes aerosolized when heated, providing nicotine to users with less irritation than CCs [ 18 ]. ECs are also known as E-cigs and vape pens and are a type of electronic nicotine delivery systems (ENDS). E-liquids may contain a combination of propylene glycol or glycerin bases, flavoring compounds, nicotine, and/or other psychoactive substances such as cannabis derivates. EC design has evolved from single-use devices that resembled CCs, to rechargeable and refillable “vape pens,” to increasingly personalizable modular products (“pod mods”) [ 19 ]. Pod mod devices, initially marketed by JUUL Labs, Inc. and now sold by numerous vaping brands, have become particularly popular among youth. These devices were designed and marketed for their ability to deliver nicotine faster than competing ENDS [ 13 ] and can deliver particularly high levels of nicotine [ 18 , 20 ]. While nicotine concentration in traditional CCs is approximately 1.5–2% (1.5–2 mg/ml) ([ 21 ], as cited in [ 18 ]), the concentration of nicotine in some pod-based devices is as high as 5%, and daily use of one-quarter of a pod meets the addictive threshold of nicotine [ 18 ]. The increased use of high-dose nicotine products has raised alarm among health experts that a new generation may become addicted to nicotine [ 12 ].

Why do youth vape?

Youth uptake of ECs has occurred in the context of youth-targeted marketing, social media promotion of ECs, and peer influences. A study of US high school seniors identified three main motivations to vape: taste and entertainment (63%), experimentation (29%), and to replace CCs (7%) [ 22 ]. In comparison, a German study found that the vast majority of German youth (aged 14–19) cited curiosity (73.1%) as their reason for EC use, followed by quitting tobacco use (14.9%) and as a complement to tobacco use (7.5%) [ 23 ]. In a systematic review of six studies among young adults in varied settings (i.e., USA, Romania, France, New Zealand, and Saudi Arabia), curiosity and EC use by friends were the primary reasons for EC initiation among non-smokers [ 24 ]. Among former and current CC users, ECs were used due to perceptions of harm reduction, to aid smoking cessation, to use in smoking-restricted areas, for lower cost compared to CCs, or for flavoring [ 24 ]. Studies in Europe and Taiwan have identified male gender, older age, and parental and peer smoking as risk factors for EC use and dual use of ECs and CCs [ 4 , 25 , 26 ].

Some countries have been slow to regulate EC marketing [ 27 ], leaving youth vulnerable to advertisers. Advertising has consistently been associated with youths’ intention to use ECs [ 28 ]. A systematic review found that in addition to traditional marketing, often utilizing youth-directed strategies, social media platforms have been widely used for public discussion of ECs in a manner that produces largely positive or neutral EC portrayals [ 29 ].

Although policy environments seem to account for some cross-country variation in EC use [ 5 , 17 ], legal restrictions alone do not fully explain variation across countries. For example, Germany has one of the least restrictive nicotine product environments according to the Tobacco Control Scale [ 30 ]. Yet, Germany has lower youth EC use rates than Finland and Ireland, two of the most restrictive European countries [ 30 ]. These findings demonstrate the need to further study other factors accounting for cross-country variation [ 4 ].

Youth EC use is also influenced by the attitudes and behaviors of others around them toward CC use. In Europe, EC use rates have correlated with city-level CC use rates [ 4 ]. Peer influence is important [ 31 ]. Parent CC use is a risk factor for youth EC use, and parents’ attitudes around EC use influence adolescent use [ 32 ]. Certain family systems may have difficulty setting appropriate limits on adolescent access to and use of ECs: In one study, adolescents with divorced parents were 51% more likely to use ECs than those with married parents [ 33 ].

Candy or drugs? What youth vape and how they get it

Although ECs are most associated with nicotine, they are a vehicle for substance use that may or may not contain nicotine. In a 2017 nationally representative survey among US adolescents, 25% of current EC users reported vaping only flavoring, while the rest reported vaping nicotine (45%), marijuana (13%), or both (17%) [ 34 ]. Among European adolescents who had ever used ECs, 43% reported vaping non-nicotine liquids, 37% nicotine, and 19.6% reported not knowing what they vaped [ 4 ].

Many youth may misperceive or do not know what they are vaping. US adolescents commonly misunderstand that nicotine is a tobacco derivative, and those who report vaping only flavoring have been found to have particularly limited knowledge about nicotine use [ 35 ]. In one study, 40% of youth reporting use of nicotine-free products had urinary evidence of nicotine [ 36 ].

Flavors both attract youth to EC use and perpetuate ongoing use. US adolescents reported more interest in trying ECs offered by a friend if flavored like fruit, candy, or menthol than tobacco [ 37 ]. US and UK adolescents have expressed the belief that fruity flavored ECs are less harmful than tobacco-flavored ECs [ 37 , 38 ]. Adolescents whose first EC is flavored progress to current and more frequent use faster than peers whose initial exposure was unflavored [ 39 ], and use of ECs with nontraditional flavors (e.g., candy, fruit) by adolescents was associated with vaping continuation and puffs per use 6 months later compared to traditional flavors (e.g., menthol, tobacco, and flavorless) [ 40 ].

Although many locales restrict the sale of ECs to adolescents [ 27 ], underage youth find ways of obtaining devices. Most US adolescents who vape own their own device, although they also frequently share devices with peers [ 41 ]. One study found that most US youth obtained ECs through online or brick-and-mortar store purchases, while informal purchases, having others purchase for them, or receipt as gifts were less common [ 41 ]. In another study, e-liquids were most often obtained by US adolescents through social sources [ 42 ]. In a recent study undertaken during the COVID-19 pandemic following heightened regulations in the US surrounding EC marketing, a majority of US youth reported reduction in EC use due to difficulties obtaining EC products. However, youth who continued using ECs shifted toward buying products online, including by receiving deliveries without undergoing age verification [ 43 ].

Does vaping lead to, or help prevent, combustible cigarette use?

Many studies have investigated the concern that youth EC use may increase risk for initiation of CCs, threatening to undo decades of progress in reducing population level young adult tobacco use [ 44 ]. ECs are being used by youth with a lower risk profile than recent youth CC users: one analysis of nationally representative US data found that only 11–23% of EC-only users would have been predicted by risk factors to be CC users [ 45 ].

Additionally, ECs may be an independent risk factor for CC use, suggesting a “gateway effect,” although this remains subject to debate. A meta-analysis of 9 longitudinal studies ( n = 17,389) of CC-naïve youth found that EC use was significantly associated with subsequent CC use, even when controlling for known demographic and behavioral risk factors for CC use [ 46 ]. A subsequent meta-analysis of 11 studies, though finding the same effect, raised concern that existing evidence remains limited by attrition, publication bias, and inadequate adjustment for confounders [ 47 ]. However, studies extensively controlling for smoking risk factors still find ECs independently associated with later CC use [ 48 ]. A small longitudinal study found that nicotine doses in ECs were associated with frequency and intensity of subsequent EC and CC use [ 49 ]. Among youth who had already experimented with CCs, use of ECs positively associated with progression to current established smoking, suggesting that in youth already starting to use CCs, ECs may contribute to rather than reduce the risk of progression to regular CC use [ 50 ].

How does vaping relate to use of marijuana and other substances?

Nicotine affects the neural pathways underlying pleasure and reward and may increase the brain’s long-term sensitivity to other psychoactive substances and drug-seeking behaviors throughout adulthood [ 51 , 52 ]. In the USA, the surge in EC popularity happened concurrently with a loosening of cannabis regulations, and studies have found that many youth use both ECs and cannabis [ 3 ]. A recent US study using cross-sectional data from 2000 to 2019 suggests that adolescents who use cannabis have declining rates of CC use and increasing rates of EC use [ 53 ]. In a meta-analysis, the odds of current or past cannabis use were significantly higher among youth who had used ECs, with particularly strong associations among adolescents [ 3 ], whose brains are viewed as more vulnerable to addiction than older youth [ 54 ]. Three longitudinal studies suggested a temporal relationship in which EC use predates cannabis use [ 55 , 56 , 57 ], suggesting that addressing EC use is an important means of preventing youth cannabis use and of mitigating the adverse neuropsychological effects of cannabis [ 58 , 59 ]. Additionally, another meta-analysis found EC use associated with a six-fold risk of alcohol use and binge drinking in adolescents, though most included studies were cross-sectional and did not sufficiently adjust for confounders [ 60 ].

What are the physical health risks of vaping?

Although EC aerosols appear less cytotoxic than compounds inhaled during CC use [ 61 ], they pose their own physical health risks, especially on the respiratory system [ 62 ]. ECs may potentially expose users to heavy metals from batteries and heating coils that may be carcinogenic or toxic to the heart and lungs, though the long-term effects of these exposures among vapers remain unclear [ 63 ]. E-liquid bases (e.g., propylene glycol) can be respiratory irritants [ 64 , 65 ] (see Table 1 ).

During the summer of 2019, North America underwent an outbreak of EC- or vaping-associated acute lung injury (EVALI). Dozens of deaths and thousands of cases of acute respiratory compromise due to nonspecific acute injury occurred [ 11 ]. EVALI was most closely associated with vaping cannabis derivates with vitamin E acetate, which was found present in a large majority of bronchoalveolar lavage samples in one case series of patients with EVALI [ 66 ]; however other pathogenic components have also likely contributed [ 67 ]. Radiographic findings in adolescents with EVALI include centrilobular ground-glass nodules and ground-glass opacities with subpleural sparing [ 68 ].

Additional vaping-related health risks have also been described. Vaping and ingesting e-liquids have been associated with seizures [ 69 ]. ECs adversely impact oral health, though possibly less severely than CC [ 70 ]. Like CCs, secondhand EC vapor exposure may also pose a health risk and contaminate indoor air quality, although also seemingly less so than secondhand CC smoke [ 71 ]. During the COVID-19 pandemic, adolescents may violate social distancing and risk viral exposure as mediated through neurobiologically determined [ 72 ] valuation of risks [ 51 ]: sharing of vaping devices and mask-free use increases the risk of transmission, increasing the risk of morbidity for the family upon return to home.

How does vaping relate to mental health?

Adults with mental illness suffer disproportionately from tobacco-related morbidity and mortality, and most begin smoking before age 21, making tobacco prevention in young people with mental illness an important priority [ 74 , 75 ]. Youth with mental illness may be attracted to ECs due to beliefs that ECs may help to modify their psychiatric symptoms, in attempts to offset side effects of psychotropic medications, or due to common underlying risk factors for mental illness and substance use (e.g., executive function deficits) [ 76 , 77 ]. In a recent systematic review of vaping and mental health comorbidities in youth, vaping has been consistently associated with depression, suicidality, attention-deficit/hyperactivity disorder (ADHD), and conduct disorder in adolescents [ 76 ]. Nicotine exposure adversely affects brain development in animal models and increases risk of further substance use [ 78 , 78 , 80 ] and broader mental illness [ 81 , 81 , 83 ], as well as problems with learning and memory [ 84 ]. Due to a lack of longitudinal studies examining mental health among EC users, it remains unclear to what extent vaping effects the long-term trajectory of psychopathology [ 76 ]. Among extant small longitudinal studies in youth, one study suggested a bidirectional relationship between EC use and depressive symptoms [ 85 ], while another found that ADHD symptoms predicted onset of EC use but not worsening of ADHD symptoms [ 86 ].

Assessment of vaping in youth

Clinicians can most effectively manage the potential risks of EC use on physical health, mental health, and substance use by routinely assessing patients for EC use. Screening tools for youth EC use have not yet been developed and validated, but questions about EC use can be easily integrated into existing assessment methods [ 87 ]. The absence of electronic medical record prompts for the assessment of EC use has been identified as an area requiring attention in adolescent primary care visits [ 88 ]. Table 2 offers items to consider for assessment based on available evidence [ 1 , 19 , 87 ].

Counseling youth and families about vaping

outh often have misconceptions about vaping, and parents may mistake the possible benefits of ECs among adult smokers [ 73 , 90 ] for harmlessness in youth. ECs have not been established as an effective intervention for nicotine cessation in youth [ 90 ]. Clinicians can provide information about the risks of vaping, while acknowledging that some long-term risks remain unclear. Possible points to discuss with families are listed in Table 3 .

Interventions for problematic vaping

Many youth want to quit vaping [ 89 ]. At the individual patient level, clinical interventions specific to vaping remain underdeveloped. To date, general principles and established treatments for CC use have been applied. This approach carries potential limitations: a qualitative study of Canadian youth and young adults identified several differences between vaping and CC use that may influence the cessation process [ 91 ]. In this study, unlike CC users, EC users reported their enjoyment of flavors as a reason for ongoing use. The convenience and discreetness of vaping (e.g., lack of distinct smell) contribute to ease of EC use throughout the day and in many locations, leading to a lack of awareness of how much they are vaping. Lastly, youth in this study also cited a lack of trusted information about health risks of vaping compared to CCs and greater perceived social acceptability of vaping compared to CC as factors complicating EC cessation.

Like all substance use disorders, clinicians can begin by engaging youth in strength-based motivational interviewing, weighing the risks of vaping against perceived benefits, and identifying specific goals for use reduction or cessation with youth who wish to quit [ 87 ]. Youth often cite health, cost, freedom from addiction, social considerations, and academic performance as reasons for wishing to quit vaping [ 89 , 91 ]. These goals may include eliminating use of favored flavors that although not addictive seem to reinforce use in youth. Social media information and misinformation about EC has caused confusion for some youth that may reduce motivation for cessation [ 91 ]; medical professionals can provide credible information about health risks to reinforce motivation for change. Since youth EC users may be less aware of how much they are using (e.g., how many pods per week) than CC users, helping the youth keep a log of use may provide a useful means of developing insight into their use [ 91 ]. Clinicians should encourage youth to allow family involvement (e.g., by restricting access to vaping devices, supporting adherence to behavioral goals, and positively reinforcing change) [ 87 ]. Parents who smoke should also be referred to smoking cessation resources. When available, individual or group cognitive behavioral therapy for nicotine use can help youth manage symptoms and prevent relapse with good efficacy on quit rates [ 92 ]. Mobile apps, such as the “quitSTART” app, can help teens track cessation goals and manage symptoms [ 93 ], and text messaging-based programs such as “This is Quitting” have shown effectiveness for facilitating abstinence in a recent randomized trial [ 94 , 95 ].

Nicotine replacement therapies and bupropion have been found safe and effective in adults, but evidence of effectiveness in adolescents is more limited, and effectiveness seems enhanced when combined with psychosocial interventions [ 92 ]. Despite limited evidence for pharmacotherapy, given the relative safety of the medications and the potential harms of nicotine dependence, combination long-acting patch and short-acting as needed gum or lozenges have been recommended for youth under 18 looking to quit vaping [ 87 ].

On the population level, school-based interventions, media campaigns, and policy proposals have been proposed to help mitigate EC use [ 96 , 97 ]. Peer-led network-informed intervention programs show promise [ 31 ]. Clinicians can advocate for policies that restrict where vaping products are sold (e.g., banning sales near schools), restrict sales to youth, restrict vaping indoors or in public places, ban advertising, require warning labels on packaging, and ban flavors that are attractive to youth [ 96 , 97 ].

Youth vaping is now a well-studied phenomenon with various physical and behavioral health risks, some of which differ from traditional smoking. Although vaping-specific treatments remain underdeveloped, pediatricians and other youth clinicians can apply the lessons of recent research to counsel youth and their families and prevent long-term complications of vaping-related nicotine addiction.

Abbreviations

Attention-deficit/hyperactivity disorder

Combustible cigarette

Electronic cigarette

Electronic nicotine delivery systems

Electronic cigarette or vaping-associated acute lung injury

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Becker, T.D., Rice, T.R. Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. Eur J Pediatr 181 , 453–462 (2022). https://doi.org/10.1007/s00431-021-04220-x

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DOI : https://doi.org/10.1007/s00431-021-04220-x

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