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What Is Vaping?

Vaping is the term for smoking an electronic cigarette. The device heats liquid, containing nicotine and other chemicals, into a vapor that can be inhaled.

Most electronic cigarettes contain nicotine, but the devices can also deliver other drugs such as the cannabis-derived compounds THC and CBD. They resemble cigarettes, flash drives, pens, and other objects.

Smoking is the leading cause of preventable disease and death in the United States, according to the Centers for Disease Control and Prevention. Vaping may offer tobacco smokers a less dangerous alternative and a path to quitting altogether—electronic cigarettes deliver nicotine, the addictive element of regular cigarettes, but without tobacco, a cancer-causing agent.

However, the devices are not currently approved by the FDA as an aid to quit smoking. An agency task force concluded that there was not enough evidence to officially recommend that smokers switch to e-cigarettes. But while the cumulative data has not risen to that threshold, a few randomized controlled trials have found evidence that electronic cigarettes with nicotine, as opposed to e-cigarettes without nicotine, helped smokers successfully quit. Other surveys indicate that many people who begin vaping use both regular and electronic cigarettes, rather than quitting altogether.

What remains clear is that nicotine is extremely addictive and that e-cigarettes deliver a lot of it: One pod of liquid contains the nicotine equivalent of an entire pack of cigarettes. The explosive popularity of vaping has left many individuals, especially young adults, newly addicted to nicotine.

Vaping Among Adolescents

Vaping has spread through teen social circles with remarkable speed. One reason is that e-cigarette companies, most notably Juul Labs, directed marketing efforts toward teens, many of whom had never picked up a cigarette.

Between 2018 and 2019, the percentage of high-schoolers who reported vaping in the past 30 days jumped from 20 percent to 28 percent. For middle schoolers, the percentage rose from 5 percent to 11 percent. Overall, more than 5 million students currently vape, according to the CDC.

The FDA is considering action to try to curb the epidemic. The agency has proposed restricting the sale of e-cigarettes with youth-friendly flavors, for example, and tightening the age-verification process for online sales.

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Is Vaping Safe?

The aerosol in e-cigarettes contains far fewer dangerous chemicals than the 7,000 found in regular cigarettes. But the vapor isn’t completely safe. In addition to nicotine, it contains flavoring that is often made from the chemical diacetyl, which has been linked to lung disease. The aerosol also includes particles of harmful organic compounds and metals like nickel, tin, and lead.

Vaping is not safe for pregnant women, because nicotine can harm both the expectant mother and the developing fetus. Vaping is also dangerous for adolescents, as nicotine can disrupt healthy brain development, which continues until around age 25.

Connections between neurons are still forming in the brain during adolescence. Nicotine may elevate the risk for mood disorders and render the brain vulnerable to changes in the regions that govern impulse control, attention, and learning.

What We Know About Vaping-Related Illness and Death

In the spring of 2019, mysterious cases of respiratory illness began to emerge in adolescents and adults who used e-cigarettes. This kind of illness was an enigma to the medical community, who came to refer to it as E-cigarette, or Vaping, Product Use Associated Lung Injury (EVALI.)

As of November 2019, the CDC reported 2,290 cases of EVALI. Forty-seven of those individuals had died.

EVALI appears to be associated with a history of vaping THC, the compound in marijuana that produces the feeling of being high. A likely culprit is the chemical vitamin E acetate, which is used as a thickening agent. Vitamin E acetate doesn’t pose a risk in its natural forms, such as in foods like vegetables, meats, and oils, but it may impair the lungs when inhaled.

It will take more time and research to fully understand this illness; other chemicals may contribute to the condition, or multiple substances may combine to produce it.

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