July 20, 2020
Vaping is often touted as a healthier alternative to smoking cigarettes. But is vaping really better for you? We’re taking an in-depth look at vaping, its history, how it compares to smoking, and what effects it may have on your health.
What Is Vaping? What’s the Difference Between Smoking and Vaping?
To truly understand vaping, let's first take a look at the devices that are used to vape. Vaping devices, also known as vape pens or e-cigarettes, are electronic devices that heat a liquid, which produces an aerosol, like steam or fog. The liquid is made up of a bunch of different chemicals that can include nicotine, propylene glycol, and flavorings. That aerosol created from the heated liquid is what users inhale into their lungs – just like cigarette smoke from smoking. The liquids come in a variety of containers, sometimes known as vape pods.
One of the biggest differences between smoking and vaping is how the nicotine gets into the body. Vaping, for example, heats liquid. Smoking, on the other hand, burns solid tobacco. Another big difference between vaping and smoking are flavor options. Vaping liquids come in literally thousands of different artificial flavors such as mango, vanilla, espresso, gummy bear, cotton candy, and other dessert-like and fruity options. While those flavors might sound sweet to your stomach, don't be fooled—they're not lung-friendly.
In fact, as of February 6, 2020, all flavored, pre-packaged vape pods—excluding menthol and tobacco flavors—are banned nationwide due to new legislation designed to reduce the number of teen vapers.1
When Did Vaping Become Popular in the U.S.?
Believe it or not, vaping didn't immediately take off after the first device was developed. In fact, although vaping devices were patented as early as 1965, the first commercially successful device wasn’t invented until 2003 (38 years later!), and that device didn’t even enter American markets until 2007. Since the e-cigarette’s introduction, however, the number of e-cigarette users and other available vaping devices has continued to increase.
In fact, as of 2018, 3.2 percent of all adults in the United States vape.2 That statistic probably doesn't mean much to you, so let’s rephrase. That means that over 8 million US adults vape. Among teens and pre-teens, this usage rate is even higher, with 10.5 percent of middle school students and 27.5 percent of high school students vaping at least once in the past 30 days.3
As of December 20, 2019, the legal age to purchase nicotine-containing e-liquids is 21 years old, which is an increase from the original age of 18. However, teenagers and young adults (we’re looking at you 20-year-olds) are often able to purchase nicotine-free e-liquid or illegally order nicotine-containing e-liquid online at just 18 years of age, as many sellers do not require age verification. While some e-liquids claim to be nicotine-free, one study revealed that most still do contain a small percent. They also include potentially harmful substances such as diacetyl, which can cause popcorn lung (more on that later.)
How Did Vaping Become so Widespread?
Feel like you're living in a fog? It seems like you can’t go anywhere nowadays without seeing someone vape—and there’s a reason for that.
Many people believe that e-cigarettes are safer to smoke than traditional cigarettes, which are known to contain dangerous chemicals such as tar, lead, and arsenic. But what some vapers may not realize is that most e-cigarette liquids still contain nicotine, an addictive substance found in traditional cigarettes that causes a variety of health problems, including high blood pressure. For this reason, many people don't understand the true health impacts that can result from vaping. One study, for instance, showed that two-thirds of users aged 15 to 24 who use JUUL brand e-cigarettes are not aware that they always contain nicotine.4
Vaping may also be popular in younger crowds because there are tons of flavors to try. One survey revealed that over 80 percent of e-cigarette users ages 12 to 17 use vape pens because “they come in flavors that [they] like.”5 Another survey showed that over 90 percent of 18- to 24-year-olds vape with flavored liquids, with fruit flavors being the most popular flavor choice.6 However, with dessert, mint, and fruit flavors now banned, vapers might switch to other flavor choices, or use disposable products instead.
What Are the Health Effects of Vaping? What Is Vape Lung or Popcorn Lung?
While research is still ongoing as to vaping’s health effects, most health experts agree that it’s harmful. Nicotine and other potentially dangerous substances are found in 99% of all e-cigarette liquids—even those that claim they are nicotine free. Some of these substances are in the aerosol created by vaping devices, such as heavy metals like cadmium, lead, nickel, tin and copper, while others, like propylene glycol, are in the liquid itself. That’s not so yummy-sounding.
Recently, studies have shown that possible health effects of vaping may include chronic cough, phlegm, bronchitis, and an increased chance of developing asthma.7 Vaping is also associated with lung damage, commonly referred to as “vape lung” or “popcorn lung,” which we’ll dive a little more into later. This damage affects your lungs' smallest airways and can make you cough, feel short of breath, or experience chest pain.
As if that’s not enough, these respiratory problems can also contribute to someone’s ability to contract viral and bacterial illnesses, including COVID-19. In a recent study, researchers found that those who smoked tobacco products were more likely to develop severe cases of COVID-19 and require intensive care than other patients.8 While there’s still much more research in the works given the novelty of COVID-19, it’s safe to say that smoking plays a pretty big role in respiratory health.
Other health problems can include potential poisoning from breathing in or absorbing e-cigarette liquid in the skin or eyes. Children are especially at risk for those problems – and more. According to the US Poison Control, there were more than 8,000 accidental liquid nicotine exposures between 2012 and 2017 in children aged 6 or younger.9
What Caused the Recent Lung Injury Outbreak?
The exact cause of the outbreak is still under investigation, but the majority of cases are linked to vitamin E acetate that’s often found in marijuana-containing vaping liquids. Vitamin E acetate isn’t harmful when it’s added to or found in foods that we eat, but when it’s inhaled, it can interfere with normal lung functioning. Nationally, the CDC reports that as of January 21, 2020, 2,711 people were hospitalized for vaping-related lung injuries, with 60 deaths reported across 27 states and the District of Columbia (D.C.).10 However, about 14 percent of those hospitalized didn’t use marijuana-based liquid in their devices, indicating that vaping nicotine products can still lead to lung complications even when Vitamin E acetate isn’t present.11
Do You Absorb More Nicotine from Vaping or Smoking?
This answer isn’t so straightforward. A lot of factors can play into nicotine absorption, including the nicotine content found in each product. Studies so far have been inconclusive, with some suggesting regular cigarette users absorb more nicotine than e-cigarette users, and others stating that new, more powerful e-cigarette devices allow users to absorb equal amounts of nicotine into their bloodstreams. However, cigarettes in general are more likely to provide consistent levels of high nicotine absorption when compared to vaping devices. But this still doesn’t mean that nicotine concentrations in vape pods are any better for you.
Can Vaping Help Some Quit Smoking?
Currently, e-cigarettes aren’t an FDA-approved way to quit smoking. While some people might find they can help you reduce or quit smoking, e-cigarettes are more likely to help keep you addicted to nicotine. One study showed that although more people were able to quit smoking by switching to vaping than using nicotine patches and gums, 80 percent of those people were still vaping one year later. A common method to quit is to swap out cigarettes for vaping a few times per day. This method is called dual use, but it’s not a safer alternative to smoking.
How Many Equivalent Cigarettes Are in One Container of E-liquid?
Again, there’s no clear answer here. The amount of cigarettes found in one container of e-liquid, commonly known as a vape pod, differs depending on the manufacturer. For example, one manufacturer of e-cigarettes, JUUL, states that the nicotine contained in one of their pods is comparable to the nicotine contained in a pack of traditional cigarettes, which contains 20 cigarettes. Other liquids may contain more or less nicotine depending on things like the size of the container, the wattage of the e-cigarette device (which can alter nicotine absorption), and how experienced the user is at vaping.
While vaping might be a popular trend, we’ve still got a long way to go in order to understand its long-term effects—so it’s always a good idea to quit.
1 NBC News: Federal flavor ban goes into effect Thursday. Accessed February 5, 2020.
2 Truth Initiative: E-Cigarette Fact Sheet. Accessed January 27, 2020.
4 CDC: Quick Facts on the Risks of E-cigarettes for Kids, Teens and Young Adults. Accessed January 27, 2020.
5 U.S. Department Of Health And Human Services: E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Accessed January 27, 2020.
8 National Institutes of Health: Two important controversial risk factors in SARS-CoV-2 infection: Obesity and smoking. Accessed June 16, 2020.
9 CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Accessed January 27, 2020.