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Vaping: It's All Smoke and Mirrors

JUUL packaging surrounded by smoke.

A new generation is at risk for irreversible lung damage and disease as a result of e-cigarettes. These have been around now for nearly a decade and are showing no signs of disappearing. Just as troubling is that many people view these electronic nicotine delivery systems (also referred to as ENDS) as harmless.

Yet, despite the fact more research is needed, there is enough evidence implying the immediate health risks in using them brings. The negative health consequences from long-term tobacco use and smoking either cigarettes or cigars took decades to prove.

It's now known that anyone who smokes or has smoked places themselves at higher risk for lung and heart disease. However, can the same be said about e-cigarettes made popular by today's youth and even among adults for a variety of reasons?

Drawn to the fruity flavor cartridges, or trying to wean from traditional tobacco products, or even to curtail hunger, many people believe e-cigarettes or "vaping" is safer than smoking cigarettes and simply not addictive.

What Are E-cigarettes?

They are called many things—hookahs, Juuls, pens, mods, "vapes," e-cigs. Whatever you call them, all have the same purpose no matter what the shape or size of the device.

Juul is probably the most popular brand of e-cigarette currently marketed. It's shaped like a USB flash drive and is battery-powered. The device heats a nicotine-containing liquid pod to produce an aerosol inhaled by the user and any bystander within its radius (in the form of secondhand "smoke"). All Juul e-cigarettes have a high level of nicotine and in fact, according to the manufacturer, a single Juul pod contains as much nicotine as a pack of 20 regular cigarettes.

The appeal of "Juuling" is the flavorings added to the pods. But this flavoring is accompanied by other chemicals comprising the aerosol itself. A study in the American Heart Association journal suggests that e-cigarette flavorings may damage blood vessels and the heart. Harmful substances, trace metals, and other toxins have been found in e-cigarettes. All of which can lead to various cancers.

Some e-cigarettes are made to look like regular tobacco products or may resemble pens, USB sticks, and other everyday items. Given their elusive casing, it makes them easy to conceal or identify, allowing teens to use them at home and in schools as well as a vehicle for marijuana and other drugs.

Equally disturbing are two reported deaths and thousands who have been injured or burned because of "vape pen" explosions. Clearly the dangers extend beyond what is being done to the lungs and heart.

The Great Debate

Smoking is the leading cause of death and disease in the United States and according to the FDA, teen electronic cigarette use has skyrocketed by nearly 80 percent in the past year. Nearly half a million Americans are dying from its effects each year. Yet it's also preventable.

For those wishing to argue that "vaping" is safer than smoking and an effective way to quit, the Center for Disease Control (CDC), the surgeon general's office, public health groups, and others point to the evidence disputing such a claim.

While some adult users may have successfully quit smoking and attribute it to "vaping," the fact remains that e-cigarettes contain nicotine, a highly addictive, dangerous substance. Furthermore, some argue that "vaping" can be a gateway to regular cigarettes.

The aerosol, or "vapor," produced by e-cigarettes is not a harmless, flavorful water vapor. These liquid pods also contain some of the same toxic chemicals found in smoke from traditional cigarettes, which is, in a word, poison. When tested, aldehydes, traces of metal, and other carcinogens responsible for playing a role in lung and oral cancers were present.  

The truth is, whether or not one believes e-cigarettes have less than or the equivalent amount of nicotine of traditional tobacco products, it's difficult to downplay the effects toxins can have on your lungs, skin, gums, and circulatory system. Why take the chance?

Effects of "Vaping"

E-cigarettes invite harmful and unknown chemicals into the body and bloodstream. These cancer-causing agents reach deep into the lungs, irritating the bronchi and cause an increase in blood pressure, heart rate, as well as compromise adequate flow of blood to the heart and restrict of the arteries.

The "vapor" inhaled also can cause inflammations in the mouth, eventually leading to gum disease. Additionally, "vaping" has been proven to destroy the mitochondria used in wound healing.  Over time, inhaling the particles present in the "vapor" can cause what has become the well-known "smoker's cough."

And it bears repeating that most e-cigarettes contain nicotine, which has known health effects beyond addiction. Nicotine exposure damages adolescent brain development (learning, attention, impulse control), which does not end until one's mid-20s. It also contributes to the hardening of the arterial walls, which in turn, may lead to a cardiac event.

Learn more about how e-cigarettes affect lung health.

Studies and Stats to Date

The FDA reported earlier this year that 1.3 million more high school students use e-cigarettes now than in 2017. Although the FDA began regulating e-cigarettes and other tobacco products in August 2016, there has been a significant spike in their use. E-cigarette use has increased 78 percent in one year for high schoolers and 48 percent in middle schoolers. Additionally, the CDC reports nearly 38 percent of all high schoolers and even 13 percent of middle schoolers have tried "vaping" at least once, and those statistics likely are underreported.

Recently, a study observed more than 6,000 teenagers between the ages of 12 and 15 to determine if e-cigarettes are increasing the odds for teen smoking. What was found was that e-cigarettes were the premiere choice for those who chose to smoke and once they began, they also moved on to traditional cigarettes.

  • E-cigarettes are the most commonly used tobacco product among youth, particularly in the United States.
  • It has been reported in 2018, more than 3.6 million U.S. middle and high school students used e-cigarettes in the past 30 days. In 2017, 2.8 percent of U.S. adults were current e-cigarette users.
  • A 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.
  • Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.
  • Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.

Get tools and tips for schools, teens and parents about e-cigarettes.

Smoking Cessation

At this time, we still don't know the full potential health effects of e-cigarettes. We do know e-cigarette use has become an epidemic among youth. That's why the Surgeon General's Report calls on parents, teachers, health providers, the government, and communities to educate young people about and discourage the use of e-cigarettes.

The best choice to protect your health in the short and long-term is to quit or never begin smoking.

Learn more about e-cigarettes at and get help to quit at or by calling the Lung HelpLine at 1-800-LUNGUSA.

This post originally appeared on the UPMC Pinnacle's Healthier You blog. It has been edited for

Troy Moritz, DO, FACOS, is board chair for the American Lung Association in the Mid-Atlantic region and director of Thoracic Surgery at PinnacleHealth Cardiovascular and Thoracic Surgery at UPMC Pinnacle.

Related Topic: Tobacco & Smoking

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Submitted by Anonymous at: September 27, 2019
I'm curious and a bit concerned... why did you not include a citation to the study you referenced? Did I miss it?
Submitted by Fredric Alan Maxwell at: August 28, 2019
This is the most anti-vaping article I've read and I question its veracity, especially on using vaping as a means of stopping smoking tobacco. I use it and stopped smoking. My lung have greatly improved. What's more, the main problem with e-cigarettes is the additives. I use an additive-free solution and load my own pods, at a cost of about 5 cents each. Most of all, I stopped smoking tobacco. Much research is needed but this sound more like a GMO-fear piece than a well-researched article. Then again, ever since the American Lung Association sent me a calendar with what they called "breathtaking views" I have trouble taking them seriously.
Submitted by Jazz at: August 20, 2019
Has anyone developed popcorn lung or other side effects they personally attribute to vaping/use of JUUL?
Submitted by LSmith2125 at: August 16, 2019
Why is this being ignored?
Submitted by Breezy at: August 15, 2019
If kids and adults are dying from vaping, why not just stop making vapes of all sorts and ban them. If they are dying from cigarettes too, then take them away and get rid of the tobacco. I am a vaper and I have to have my nicotine. It just like a coffee person with coffee. Your body is so used to it and craves it. It's hard to stop but if there is an end to all smoking, then we would have to go through withdrawal and it would take time to make your body to not need nicotine in anyway.
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