Vaping: Crisis or Alarmism
Vaping, until the onset of the global pandemic, was the newest crisis destroying the United States. For the past two years a surge in youth vaping has been increasingly drawing more attention and raising questions about safety. More recently, stories of vaping-related injuries and deaths in teens as young as 15 years old plagued media throughout the fourth quarter of 2019. E-cigarette, or Vaping, Associated Lung Injury also known as EVALI is the term coined by the CDC to describe this new disease. As of February of 2020 there are a reported total of 2,807 hospitalizations from EVALI as well as 68 deaths. In response to the growing issue of youth vaping and triggered by news of EVALI, cities and states have issued bans on vaping. Recently, the FDA has banned all flavored vape cartridges besides tobacco and menthol flavors nationwide in an effort to curb the “teen vaping epidemic.” Recently, media has portrayed vaping as a harmful new product, but research reveals that vaping is a much safer alternative to smoking. If this is true, then why don’t more Americans know this? Why has there been so much regulation against vaping? And what about the kids getting into vaping? This article will go into depth about vaping in general as well as the negative effects regulation and media alarmism have on the consumers they claim to be trying to protect.
First, it is important to talk about the amount of damage caused by cigarettes and tobacco use in America. In America, every year more than 480,000 people die from illness related to tobacco use. To give some perspective, this is more than annual deaths from vehicle accidents, alcohol, drug use, and firearms combined. According to the American Cancer Society half of all Americans who continue smoking will die because of the habit and their life expectancy is on average 11.5 years shorter than non-smoker’s. There is clearly a need for an alternative to help smokers transition away from smoking. This is where vaping comes in.
A relatively new invention, modern e-cigarettes began appearing in the US in 2007 and experienced a slow growth in popularity until around 2013 when there was a major increase in e-cigarette use. As popularity has increased so has the selection of products and availability. Vape stores are commonly found all across the country and vape cartridges can be found in most gas stations.
Vapes are relatively simple devices, while many differ in size, voltage, and design, they all function similarly. All vapes consist of a battery, atomizer, and some form of tank that holds vape juice or e-liquid. The atomizer (sits on top of the battery)consists of a heating element to vaporize the e-liquid and a heat-resistant wick that absorbs the liquid before it is vaporized. When the user activates the heating element of the atomizer by pressing a button or inhaling (depending on design), the liquid in stored in the wick is vaporized. The vapor is then inhaled through the mouthpiece at the tip of the e-cigarette. The vaporized liquid, despite the name, is an aerosol because it is made up of aerosolized particles rather than water vapor; however, it is commonly referred to as vapor. Vapor is made from vegetable glycerin, propylene glycol, flavoring, and sometimes nicotine. The three most common types of vapes you should be aware of are disposable vapes, cartridge vapes, refillable tank vapes. Disposable vapes can not be recharged or refilled after being used. Cartridge vapes are rechargeable, when the user runs out of vape juice they buy a new cartridge (atomizer and tank) to replace it, cartridges come with different flavors of juice. A third type of vape is one with a refillable tank, these vapes are rechargeable and the user fills the tank with vape juice bought separately to refill it. While there are many nuances to different types of vapes, features, and juice that are used, that is in the most simple sense how all vapes work.
There is still much to learn about the long term health effects of vaping, however, current research has conclusively proven vaping to be a much safer alternative to cigarette smoking. Public Health England estimates nicotine vapes to be at least 95% less harmful than traditional cigarettes. What is concerning is the number of adults not aware of this fact. Only 30% of US adults understand e-cigarettes to be less harmful than traditional cigarettes and among current smokers only 31% understand this fact(2018). E-cigarettes, which have been shown to significantly decrease the number of cigarettes smoked daily, have the potential to save many lives, yet a large majority of Americans believe e-cigarettes to be as harmful or more harmful than cigarettes. Even more concerning is the fact that the number of people who believe e-cigarettes to be as harmful or more harmful than cigarettes has likely increased since the original study as a result of the massive growth in media attention towards the EVALI crisis.
Vaping is less harmful than cigarettes. This is because much of the harmful chemicals produced by cigarettes are a result of combustion. Toxic chemicals like tar and carbon monoxide are produced by the combustion of tobacco and lead to cardio-respiratory disease. Vaping is significantly less harmful because vapor is not produced through combustion and contains none of the harmful chemicals found in tobacco. The only chemical that cigarettes and vapes have in common is nicotine, the drug responsible for making cigarettes addictive and hard to quit. There is some evidence that nicotine exposure can negatively affect fetal and youth brain development, as well as maternal and fetal health during pregnancy, however other than that, nicotine alone is relatively harmless and is found naturally occurring in peppers, eggplant, tomatoes, and potatoes. Nicotine’s addictive effects are the reason for its infamy, while other chemicals within cigarettes are responsible for the real damage to smokers’ health. Vaping is not harmless though, at a high enough volume, like all things, vaping can be harmful to one’s health. When used incorrectly, metals from the heating element in the atomizer of some vapes can seep into the e-liquid making it harmful to users. Some vape juices have also been found to contain certain carcinogens but more research is needed to determine if vaping leads to cancer or any other disease.
One of the biggest reasons vaping has come under such heavy scrutiny is the spike in EVALI cases. US media sites from all sides of the aisle have rushed to cover the mysterious illness and death “caused” by vaping. Stories like that of Simah Herman, an 18-year-old who became an anti-vaping advocate after being put under a medically induced coma after her lungs filled with fluid, have been used to scare consumers under the guise of misinformation. Herman’s Instagram post of her in a hospital bed wearing a ventilator and holding a sign that read “ I WANT TO START A NO VAPING CAMPAIGN” went viral, and her story instantly became the motivation of anti-vaping crusaders throughout government and media. Herman’s story is not unique, stories of other young people who faced serious illness or death because of “vaping” have been used to castigate vaping as dangerous to consumers, but is it all true?
Testing conducted by several laboratories including the CDC’s, has reinforced new information that indicates that EVALI cases are almost always unrelated to nicotine vaping. Federal investigators now believe that EVALI is caused by the use of illegal THC vaping products obtained on the black market. Researchers believe that EVALI may be similar to lipoid pneumonia, a disease caused by fatty particles in the lungs. Evidence suggests that Vitamin E acetate, a chemical likely used as a thickening agent in the THC cartridges used by EVALI patients, is the likely cause for EVALI. Vitamin E acetate, typically a safe nutritional supplement, is now believed to be dangerous when inhaled. Research has discovered Vitamin E acetate present in the lungs of almost all EVALI cases and absent in healthy lungs. Vitamin E acetate has also been found present in all black market THC cartridges tested by the CDC.
These findings show the irresponsibility of media, politicians, and medical officials who all acted against nicotine vapes. This kind of fear-mongering is more than just a reactionary mistake. Statements and actions like these keep smokers from switching to e-cigarettes, something that could potentially save their lives.
“This is all because of vaping. Vaping is advertised as “a healthier alternative to smoking” which is false. whether it’s nicotine or weed vaping can be fatal”
-Simah Herman
From this quote that was taken from the caption of Herman’s viral post, we can see how easily the use of illegal THC cartridges is casually lumped in with legal nicotine cartridges. The ABC article that popularized Herman’s story barely mentions Herman’s use of THC vaping products while mainly focusing on her use of nicotine vape cartridges. This kind of action is misleading at best and propaganda at worst. While this kind of rhetoric about vaping is wrong, it can seem like a harmless mistake. It is easy to overlook this kind of lie minimizing its effects: “if nicotine vaping still poses health risks then is it really that harmful if it is treated as the cause of EVALI?” To that I answer with a profound yes. This kind of sentiment is exactly how politicians, public health officials, and the media will continue to justify misleading the public and lying about vaping.
To gain a better understanding of vaping among high schoolers, the heart of the crisis, I interviewed 5 high school students from across the United States about vaping in their schools. I found that all of them told similar stories, indicating that it is fair to assume that what is happening in these high schools applies to the whole country. In case you didn’t already know the most popular device used by high schoolers nationwide is JUUL (a small cartridge nicotine vape notably known for containing high nicotine concentrations and having a USB stick-like design) but different areas also seemed to have other popular vape types. Suorin Air, Suroin Drop, Smok Novo, and Puff Bars were all mentioned as popular vapes in high schools. All of the mentioned vapes, except for the disposable Puff Bar, use some kind of cartridge system. Some are designed to be refilled and others are not, nevertheless students refill cartridges anyway. All of the mentioned vapes are also known for being small and easy to conceal which is a likely explanation for their popularity among teens.
To give a perspective at the number of students vaping “there is a 50/50 chance that when you walk into a bathroom you smell some type of vape.” Vaping occurs regularly at home and school, “usually kids will go into the bathroom stalls, some kids who don’t care will [use vapes] in class but cover the [vapor]”. It seems that “most kids get stuff from friends who get it from their older brother”, this kind of supply chain is not something new and resembles the way that many teens have obtained alcohol, despite being underage, for years. I was also told that “if you ask every kid in the school … about a fifth of them could get you stuff [e-juice and or cartridges or vapes]”, so you can begin to understand the scale of vaping in high schools, and maybe even begin to understand the alarm behind new regulations imposed on vaping. The scale of vaping in high schools and the ease with which students obtain vapes is cause for concern.
Vaping in some schools is considered to be “kind of intertwined with being in high school” “kids who don’t [vape] don’t tell teachers, and kids who do [vape] will talk about [technical aspects of vapes, juice, and nicotine concentrations]”. It’s also worth noting that schools taking action seems to not have much of an affect, I was told that the penalties for being caught vaping differ on whether you are just using a vape or selling to others, they also seemed to vary school to school, with some resulting in a suspension for being caught with a vape and others getting moved to a remedial school. It is clear that in schools, e-cigarettes are not being used to help smokers get away from smoking, which is a good reason to draw attention towards preventing youth vaping. Many students are using vapes to get a nicotine buzz or nicotine high, the relaxing feeling that comes from the consumption of anything with nicotine. “Most kids start vaping because of curiosity about [vaping], they heard it’s not too bad so they try it, and they keep coming back for the buzz.” An interesting part of the interviews was hearing students’ attitude towards cigarettes. “[Cigarettes] are seen as a massive jump from vaping … most [students] stay away from cigarettes because they mess you up, … most [students] would probably not even try it.” This sentiment is confirmed by data showing current cigarette smoking among middle school and high school students has decreased by 10% since 2011.
It’s also important to note that along with nicotine vapes there is an increasing popularity in dab pens and weed vapes among high schoolers, which are vape-like devices designed to vaporize THC concentrate(the cannabinoid associated with the high from consuming marijuana). Much of the way that these kinds of devices or cartridges are obtained is through shady black market dealings which is likely why they are so dangerous to consume and why they are the cause of the sudden appearance of EVALI cases.
While there has been a decrease in cigarette smoking among high schoolers, there has been a massive increase in e-cigarette use, which is up 26% since 2011. E-cigarettes, while significantly less harmful than smoking are still not harmless, nicotine addictions developed from vaping can only serve to make minors more dependent on nicotine and susceptible to cigarette addiction.
It is important to look at the effect media, politicians, and health officials are having on the public’s perception of vaping. Media has proven to be dedicated to pushing a fear-filled narrative, rarely do they clarify the important fact that vaping is significantly less harmful than smoking, instead they generate online clicks and television viewers by concealing this information and scaring the public. They knowingly group causes for EVALI like illegal THC cartridges with legal nicotine cartridges to mislead for the sake of drawing more attention. Politicians and regulators are no better. Both President Trump’s rhetoric and the FDA’s actions to ban vaping flavors, while well-intentioned, will likely make the vaping situation in high schools worse or have no effect. Based on the assumption that flavors are the main reason young people vape and that flavors are used to target children (similar to how big tobacco was determined to be advertising to children), the FDA in January took action to ban all flavors other than menthol and tobacco for e-cigarettes that use cartridges. Given the fact that most young people don’t like cigarettes and like to vape with flavored cartridges, this seems like a reasonable regulation to prevent teens from vaping. But evidence from JUUL’s self-imposed regulation proves this wrong. In late 2018 JUUL, the company responsible for producing the most popular vape among teens, took action to remove all flavors except for tobacco, menthol, and mint. As a result sales dipped for a few weeks before rebounding to where they were before the change, even rising higher than they were pre-removal. This shows that flavor bans aren’t effective at turning away young people from vaping. Flavor bans can end up hurting smokers who are trying to get away from smoking more. Adults prefer fruity and dessert flavors to tobacco and menthol and reducing their options forces them to use vapors that taste like cigarettes, the thing they are trying to get away from. This can further lead them back to smoking cigarettes or turning to the black market for flavored vapes, which we know can be dangerous, and bans can have a similar effect on nicotine-addicted minors. Bans can even dissuade current smokers from ever using vaping to try to stop smoking. Health officials in the US have also failed to inform the public of the crucial fact that e-cigarettes are significantly less harmful than traditional cigarettes. Unlike governments like Canada’s, the UK’s, or New Zealand’s, which have all taken steps to make clear to the public that while not harmless e-cigarettes are a much less harmful option than smoking. Across the website for New Zealand’s Ministry of Health displays the message: “The healthiest option is not to vape or smoke. Don’t vape if you don’t smoke. Only vape to quit smoking.” Messages like this are informative and have the potential to save lives. If similar messages were displayed in the US we might be able to reduce the number of smokers. Unfortunately, it has taken a long time for the CDC to finally remove their recommendation that all people, including smokers, stay away from e-cigarettes. The CDC’s website now begrudgingly reflects the fact that vaping is a less harmful alternative to smoking. This may be too little too late as public perception of vaping is already bad and has probably worsened after the EVALI scare and as new vaping bans continue to be implemented across the United States.
Americans need to realize the potential benefits of vaping likely outweigh the risks. We don’t want teens to be addicted to vaping or nicotine, but the cost of keeping some high schoolers from trying vapes is not worth potentially saving the lives of 480,000 people across the United States who die every year from smoking. Smoking is America’s leading preventable cause of death, and vaping has the potential to help prevent those deaths. While vaping is not harmless it is significantly less harmful than smoking, and should be treated as such.
I also want to note that my research raised questions that didn’t fall within the immediate scope of my article but are worth mentioning. Specifically, I have found the sudden appearance of EVALI cases in late 2019 is somewhat suspicious. While still fairly new, nicotine vapes have been around for more than a decade and the sudden appearance of this disease raises questions about why it had never appeared before. The same goes for THC cartridges, which have been around for at least 6 years. It seems that something may have changed with the cartridge production process recently.
