E-Cigarettes and Vaping: Harmful or Harmless?

We’re writing this article in reaction to an increase in the number of news stories cropping up in the media recently about E-Cigarettes. They range from shocking, vehemently anti-e-cigarette articles, such as Pennsylvania teen develops lung problems after only three weeks of vaping (May 17^th, 2018),  to more measured efforts such as Concerns over health effects of vaping – and rising use among teens February 26^th, 2018), to op-eds that question the anti-e-cigarette point of view, such as 10 Research Studies to Silence the Vape Skeptics (May 31, 2018).

As you can see, some stories claim e-cigarettes and vaping are demonstrably dangerous, some claim the jury is out and more research is needed, while others claim vaping is a safe alternative to cigarette smoking. Our goal is to offer the available evidence and let you decide for yourself what’s true and what’s not, so you can make an informed decision with eyes wide open.

For the record, our default position as concerned citizens and parents is that inhaling addictive substances – like the nicotine found in almost all e-cigarettes – is not a good choice for teenagers. If they asked for our advice, we’d simply tell them “Don’t do it.”  One more thing: we’re well aware people use vape devices for marijuana. This article will only address the use of vaping and e-cigarettes as nicotine delivery vehicles.

That said, we’ll start our discussion of e-cigarettes and vaping at the beginning.

A Brief History of E-Cigarettes

In 1963, a regular guy named Herbert Gilbert submitted a patent application for a new invention: the electronic cigarette. Gilbert was a college graduate with a degree in business, and a veteran of the US Armed Forces. He fought in the Korean war, then returned home to work at his father’s scrap yard in Beaver Falls, Pennsylvania. Even back in the early 60s, when the health risks of cigarette smoking were neither widely known nor publicized, he knew there was a problem with cigarettes. He also knew it was a problem he could help fix.

In a 2013 interview, Gilbert describes how he came up with the idea:

“I’m a logical guy and logic told me to define the problem and then develop a solution. The problem…was that when you burn leaves and wood, it yields a result no one wants to take into their lungs. To put it simply, the problem [was] combustion. I had to find a way to replace burning tobacco with heated, moist, flavored air.”

He found a way, and applied for the patent, which was granted in 1965. His invention did not use water vapor, like modern e-cigarettes, but his design is basically the same as those found across the globe today. He shopped his device to chemical and tobacco companies, but nobody invested, and thus, his patent was never commercialized.

Developments in E-Cig Technology

The 1970s, 80s, and 90s saw an explosion of research into various non-combustion nicotine inhalant devices, but none received FDA approval for sale or use in the United States. Conspiracy theories about this non-approval by the FDA abound, but that’s a rabbit hole we won’t go down in this article. The real modern era of e-cigarettes began in China in 2003, when a pharmacist named Hon Lik invented a working smokeless device after his father, a heavy smoker, died of lung cancer. He worked for a company called Dragon Holdings, which developed and marketed the product as a safe alternative to smoking.

The first new-generation e-cigarettes arrived in the United States in 2006, and their popularity has steadily increased over the past twelve years. Forbes Magazine estimates the current value of the e-cigarette industry at just over four billion dollars. Market experts project the global value of the e-cig industry will reach forty-eight billion dollars by the year 2023, with U.S. market share accounting for roughly 20-25%, or around twelve billion dollars.

American Adolescents: The Statistics on Vaping

For the sake of simplicity, we’ll use the terms vape or vaping for the rest of this article, instead of e-cigarette, e-cigs, or non-combustible nicotine inhalant devices. Vaping is common among young adults (18-24) and adults (25-49), but we’ll focus on the upward trend witnessed in vaping in the adolescent age group (12-17) since 2011. Although a sharp increase in vaping prevalence over that time period was to be expected, since it’s a relatively new product, the data are alarming, nevertheless.

It’s important to look at the adolescent numbers, because contradictory headlines fill the online media regarding the relative safety and/or dangers of vaping. Also, as vaping and vape products are a recent phenomenon, any long-term studies about the health consequences of vaping are of primary importance to the current generation of teenagers and their parents. They need to know if vaping is harmful, harmless, or somewhere in between.

But first, we’ll present the most recent data on vaping, as presented in a whopping, 300-page report – E-Cigarette Use Among Youth and Young Adults – published by the Surgeon General of the United States, and a more recent survey conducted by the Centers for Disease Control (CDC), called Tobacco Use Among Middle and High School Students – United States, 2011-2015.

Middle School Vaping, 2011-2015

• In 2011, 0.6 % of middle schoolers reported having vaped in the last 30 days.
  • 4% of females
  • 7% of males
• In 2015, 5.3 % of middle schoolers reported having vaped in the last 30 days.
  • 8% of females
  • 9% of males
• Over a period of five years, that’s an increase of 783%.
  • 1,100% for females
  • 742% for males
• In 2011, 1.4% of middle schoolers reported ever having vaped.
  • (no gender data)
• In 2015, 13.5% of middle schoolers reported ever having vaped
  • (no gender data)
• Over a period of five years, that’s an increase of 864%.
  • In 2015, roughly 1,595,481 middle schoolers report ever having vaped.

High School Vaping, 2011-2015

• In 2011, 1.5% of high schoolers reported having vaped in the last 30 days.
  • 7% of females
  • 3% of males
• In 2015, 16% of high schoolers reported having vaped in the last 30 days.
  • 8% of females
  • 0% of males
• Over a period of five years, that’s an increase of 966%.
  • 1,728% for females
  • 726% for males
• In 2011, 4.7% of high schoolers reported ever having vaped.
  • (no gender data)
• In 2015, 37.7% of high schoolers reported ever having vaped
  • (no gender data)
• Over a period of five years, that’s an increase of 702%.
  • In 2015, an estimated 5,624,876 high schoolers reported ever having vaped

It’s easy to see why vaping is the topic of so much speculation. The dramatic increase in having vaped in the last 30 days and ever having vaped for middle schoolers and high schoolers is staggering. It’s no wonder parents are concerned. It’s hard to imagine any parent is happy about their teen vaping at all. And it’s no surprise the media seizes on these numbers to generate frightening, click-bait headlines about the prevalence of vaping and the potential health risks.

Which brings us to the next topic: is vaping harmful, helpful, or somewhere in between?

Health Effects of Vaping

The article we linked to in the first paragraph, “Pennsylvania teen develops lung problems after three weeks of vaping,” outlines a nightmare scenario for parents. A hospital admittend an 18-year-old female complaining of chest pains and difficulty breathing. Doctors diagnosed her with hypersensitivity pneumonitis, a.k.a. wet lung,  and admitted to pediatric ICU. She soon went into respiratory failure. Physicians put her on a respirator and inserted tubes into her lungs to drain fluid from her lungs. She remained on the respirator for five days.

Dr. Daniel Weiner, the doctor who treated the young woman, co-authored a study on her case, which was the first reported instance of acute respiratory distress syndrome caused by vaping in teenagers. Since this was a single case, not an experiment with a control group, it’s difficult to prove vaping caused the wet lung – but it serves as an object lesson on the dangers of vaping: in the absence of any other cause of her condition, Dr. Weiner concluded, “I think this case highlights for us that the lung can be very sensitive to inhaled irritants, and sometimes reactions to inhaled substances can be life-threatening.”

Positives and Negatives

So, aside from isolated incidents like that one, what do we know about the health effects of vaping? First, we’ll start with the positives. Believe it or not, there are positives:

• Vaping has the potential to help people quit smoking regular cigarettes
• Vaping is less dangerous than regular cigarettes (wet lung reports notwithstanding)
• Second-hand smoke from vaping exists – as second-hand vapor – but it’s not nearly as harmful for passive bystanders as regular cigarette smoke

Let’s put those benefits into context, and point out a flaw in the entire vaping is good argument, especially as it pertains to teenagers. First, vaping has the potential to help people quit smoking: this presumes smoking is something undesirable that needs to be stopped. Therefore, vaping is the lesser of two evils. That’s the fundamental flaw in the vaping is good argument. Parents of teens don’t want any evils for their kids – lesser or greater. Second, vaping is less dangerous than  cigarettes: exact same rebuttal. Smoking and nicotine addiction are unhealthy to begin with, and vaping is simply less unhealthy. Parents don’t want anything unhealthy for their kids, period. The fact vaping is less unhealthy means there was an unhealthy habit there to begin with.

Now, let’s talk about the health risks of vaping for adolescents.

Vaping Risks

• Nicotine. Vaping is most commonly used as a non-combustible delivery vehicle for nicotine. Nicotine is a chemical with the following long-term, negative health consequences:
  • Addiction. Once in the bloodstream, it reaches the brain and activates pleasure and reward centers within ten seconds. Its pleasurable side-effects last only a short time, and cravings begin almost immediately.
  • Pregnant women and fetuses. Nicotine is known to impair fetal nervous system and lung development. Exposure to nicotine can also result in low birth weight, pre–term delivery, and stillbirth.
  • Brain development. Nicotine negatively alters the development of the cerebral cortex and hippocampus in adolescents.
• Aerosol Components. Although e-cigarette vapor contains far fewer than the 7,000 harmful chemicals found in regular cigarettes, they do contain at least forty-two chemicals, some of which can be harmful to human health and cause long-term health problems, including cancer:
  • Acetaldehyde
  • Acetone
  • Acrolein
  • Benzene (found in car exhaust)
  • Cadmium
  • Chromium
  • Diacetyl (can cause an irreversible lung disease called popcorn lung)
  • Diethylene glycol
  • Formaldehyde
  • Isoprene
  • Lead
  • Nickel
  • Phenol
  • Propylene glycol
  • Propanol
  • Tin
• Flavorings. Currently, vaping products come in over 500 flavors. Researchers know little about the effects of these flavor additives. Vape manufacturers claim they’re safe, because they’re approved for use in food. However, no studies have been conducted on the effect of these additives when they enter the bloodstream through inhalation.

Parents: What You Can Do

Don’t believe the hype – but err on the side of caution.

Don’t believe the hype goes both ways: don’t believe the claims that vaping is harmless, because it’s not. Vape advocates live in a strange world where vaping is okay because it’s less unhealthy than regular cigarettes. That’s an absurd notion, particularly where the health of a growing adolescent is concerned: being less unhealthy does not make vaping healthy.

Vaping is not healthy.

At the same time, don’t buy every alarmist, scary sounding headline about the dangers of vaping until health scientists conduct more research on the side-effects. Click-bait headlines generally lead to articles that are short on facts, but long on hyperbole. It’s well established that nicotine is addictive and harmful to human health, and it may be true that the other chemicals in e-cigarette vapor cause cancer, popcorn lung, and other serious long-term health conditions. The final word as to whether they’re harmful in the amounts found in e-cigarette vapor is yet to be determined. Well-designed studies and experiments by qualified researchers are in process, and we’ll know soon if the sensationalist headlines are accurate or inaccurate.

For now, the known health risks should suffice: vaping is for nicotine; nicotine is addictive; nicotine is bad for your health; addiction is bad for your health; therefore, parents should educate their teenagers about the health risks of vaping, and advise them to steer clear.