Vaping is growing at an alarming rate among adolescents, putting their health at risk both now and in the future. Over 1,200 cases of severe acute lung injuries and at least 26 fatalities have brought the dangers of vaping to the forefront in recent months, but the risk of its potential long-term effects should also be considered. While these long-term effects have not yet been studied, there is plenty of evidence that indicates that vaping is not safe.
E-cigarettes, such as the popular Juul, vaporize nicotine (or THC) as well as flavorings and other chemicals. Even though this vapor doesn’t contain the tar that results from combustible tobacco and cannabis, inhaling vaporized drugs and the chemicals that accompany them exposes the deepest parts of the lungs to heavy metals, formaldehyde and other particles. This exposure increases lung tissue inflammation, as well as increases the risk of cancer and other lung diseases. In fact, new evidence shows a correlation between vaporized nicotine constituents in e-liquids and lung cancer in lab rodents.
Other concerns about vaping exist beyond consequent lung damage. Nicotine levels (and THC) in the inhaled vapor can far exceed the typical doses of these drugs delivered from combustible products depending on the strength of the cartridge and the voltage of the device. Higher doses amplify cognitive impairment, acute cardiovascular stress, and long-term damage to a number of organ systems. Each dose of nicotine increases heart rate and blood pressure, and it affects the pancreas, causing a slight increase in blood glucose. Exposing the developing adolescent brain to such high doses of nicotine or THC is also a major cause for concern.
Dependence on nicotine can develop quickly with routine use. Furthermore, tolerance to nicotine drug effects increases over a short period of routine use, meaning users need to increase their dose over time to feel the desired effect. As tolerance increases, users become more dependent on the drug — needing to use it more consistently to avoid or counteract unpleasant drug withdrawal effects.
Adolescents who vape are not only damaging their lungs — perhaps irreversibly in some cases — but are also becoming highly addicted to nicotine. Because nicotine is so difficult to quit once someone has become dependent, adolescents who begin to vape routinely are likely facing years of challenges trying to quit nicotine and stay quit.
The industry’s successful efforts marketing vape products to teens, coupled with the federal government’s inaction over the past decade, have played a role in this epidemic. In light of the current evidence, FDA approval of these products was a mistake. While several states such as New York, Rhode Island, and Oregon have banned flavored vape products, these laws don’t go far enough.
As public health advocates, we recommend a total ban on e-cigarettes and vaping products until more studies can be conducted. Permanent legislation that could help protect adolescents would include a ban of the sale of these products to anyone under 21 years old.
In the meantime, regulation at the local level is the only tool at our disposal to protect adolescents from the risks of vaping. A good example of this is the recent proposal from Mayor Jim Kenney and Health Commissioner Thomas Farley to restrict the sale of e-cigarettes to minors, reflecting increased concern over the spike in vaping-related illnesses and deaths.
Laura A. Siminoff is dean of Temple University’s College of Public Health. Bradley N. Collins is a professor and director of the college’s Health Behavior Research Clinic. Both served on Temple’s Presidential Smokefree Campus Task Force, which successfully made Temple a tobacco-free campus as of July 1, 2019.