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The Risks of E-Cigarettes: Unveiling the Unhealthy Side of Vaping

By Know Your Vape · · Updated

Contents

E-cigarettes are not harmless. The CDC states plainly that no tobacco products, including e-cigarettes, are safe, and that youth, young adults, pregnant people and adults who don't already use tobacco should not use them.

The evidence also shows that vaping generally exposes users to fewer harmful chemicals than smoking. This article covers the known risks, what is still uncertain, and where the evidence stands on vaping compared with cigarettes.

What are E-cigarettes?

E-cigarettes, often called vapes, are battery-powered devices that heat a liquid into an aerosol the user inhales.

The liquid usually contains propylene glycol, vegetable glycerin, flavorings and, in most products, nicotine. A coil heats the liquid when the user presses a button or draws on the device.

Flavors are a big part of the appeal, including to young people. That is one reason U.S. law restricts sales: it is illegal for any retailer to sell e-cigarettes to anyone under 21.

Potential Health Risks of E-cigarettes

The main risks are nicotine dependence, exposure to toxic substances in the aerosol, short-term effects on the heart and airways, injuries from batteries, and poisoning from e-liquid. Long-term effects are still being studied.

Lung Damage

E-cigarette aerosol can contain tiny particles that reach deep into the lungs, heavy metals such as nickel, tin and lead, and flavorings such as diacetyl, which is linked to a serious lung disease, according to the CDC.

In 2019 and 2020, an outbreak of e-cigarette or vaping use-associated lung injury (EVALI) put 2,807 people in the hospital and caused 68 confirmed deaths. The CDC linked most EVALI cases to THC-containing products, especially from informal sources, and found vitamin E acetate strongly linked to the outbreak.

Whether long-term vaping causes chronic lung disease is not yet known. The National Academies' 2018 review found no available evidence either way on whether e-cigarettes cause respiratory diseases in humans.

Nicotine Addiction

Most e-liquids contain nicotine, which is highly addictive. The National Academies found substantial evidence that e-cigarette use causes symptoms of dependence.

Nicotine intake from e-cigarettes varies a lot with the device, the liquid and how it is used. Experienced users can take in as much nicotine as they would from cigarettes.

Cardiovascular Risks

Nicotine raises heart rate shortly after use, and there is moderate evidence that it raises diastolic blood pressure in the short term.

Whether vaping leads to heart attacks, stroke or atherosclerosis over the long term is not known. The 2018 review found no available evidence on those clinical outcomes, so claims either way go beyond the data.

Respiratory Problems

There is moderate evidence of more cough and wheeze in adolescents who vape, and an association between vaping and asthma flare-ups.

People with asthma or other lung conditions should talk with a doctor about any inhaled product.

Chemical Exposure

Most e-cigarette products contain and emit potentially toxic substances besides nicotine. Some, such as formaldehyde and acrolein, can damage DNA.

Whether the levels people inhale are high enough to cause cancer has not been determined. Exposure varies widely with the device, the liquid and the power setting.

Accidental exposure to e-liquid is a real danger. The CDC reports that over 80% of U.S. poison control calls about e-cigarettes involve children under 5, so store liquids locked away from children.

Batteries are another hazard. Defective or misused batteries have caused fires and explosions with serious injuries, most often while charging.

The Dangers of Vaping for Youth

Appeal to Younger Demographics

Flavors, small devices and social media marketing have made vaping popular with teenagers. Federal law sets the minimum sales age at 21 for all tobacco products, including e-cigarettes, under the Tobacco 21 law signed in December 2019.

Nicotine Effects on Developing Brains

The brain keeps developing until about age 25. The CDC warns that nicotine can harm the parts of the brain that control attention, learning, mood and impulse control.

Gateway to Traditional Smoking

The National Academies found substantial evidence that e-cigarette use increases the risk of ever smoking cigarettes among youth and young adults.

Parents, educators and policymakers all have a part in keeping vapes away from young people. Retailers must check ID for anyone buying tobacco products.

Lack of Regulation and Safety Standards

E-cigarettes are regulated in the U.S. The FDA oversees their manufacture, labeling, advertising and sale.

A product that the FDA authorizes has gone through a scientific review and met the law's public health standard. Authorization does not mean a product is safe or FDA-approved. Read more about FDA approval and what it does and doesn't mean.

Many products on the market have not been authorized, and unauthorized or illicit products may not match their labels. Buy from licensed retailers and never add other substances to a device.

Research and Studies on E-cigarettes

Overview of Scientific Findings

The most complete U.S. review is the National Academies' 2018 report. It found conclusive evidence that e-cigarettes emit numerous potentially toxic substances, and substantial evidence that the aerosol contains metals.

The same report found conclusive evidence that adults who completely switch from cigarettes to e-cigarettes cut their exposure to many toxicants and carcinogens found in cigarette smoke.

For adults who smoke, a Cochrane review found high-certainty evidence that nicotine e-cigarettes help more people quit than nicotine replacement therapy. The CDC adds that any benefit depends on completely replacing cigarettes; using both is not an effective way to protect health.

None of this applies to people who don't smoke. For them, starting to vape adds risk with no health benefit.

Long-term Effects

E-cigarettes have not been widely used for long enough to know their long-term effects. The CDC says scientists are still learning about both short-term and long-term harms.

The 2018 review found no available evidence on whether vaping is linked to cancer in humans. That is a gap in the research, not proof of safety.

Secondhand Vaping

Vaping indoors raises airborne nicotine and particulate levels compared with background levels, according to the National Academies.

Secondhand exposure to nicotine and particulates is lower from e-cigarettes than from cigarettes, but it is not zero. Avoid vaping around children and pregnant people.

Conclusion

Vaping carries real risks: nicotine addiction, toxic chemicals, short-term heart and airway effects, battery injuries and e-liquid poisoning. Its long-term effects are still unknown.

For adults who smoke, completely switching to e-cigarettes lowers exposure to many toxic chemicals, and nicotine e-cigarettes can help some people quit. For anyone who doesn't smoke, especially young people and pregnant people, the safest choice is not to start.

For more information on the risks of vaping, please visit Know Your Vape, a trusted resource dedicated to providing accurate and up-to-date information on the health concerns associated with vaping.

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