In the United States, 4.5% of adults use e-cigarettes (also known as vaping), putting them at serious risk for health problems. Usage is highest among 18-24 year olds, with 11% of this population vaping.1
Among high school and middle school students, tobacco use is at an all-time low. Instead, e-cigarettes (also known as vapes, pod mods, or vape pens) are the most commonly used tobacco product, with more than one in four using them daily and one in three using them at least 20 days out of the past 30 days.2
Many people mistakenly believe that e-cigarettes are less harmful to their health because they do not burn tobacco, unlike traditional smoking. However, e-cigarettes pose serious health risks to the brain, arteries, and lungs.
What are e-cigarettes and why are they dangerous?
E-cigarettes refers to the act of inhaling and exhaling the aerosol produced by e-cigarettes and similar devices. First generation e-cigarettes, sometimes called “cigalike,” are designed to resemble traditional cigarettes. These devices are typically slim and small with a glowing tip that mimics the appearance of a lit cigarette. They are usually disposable or have replaceable cartridges that contain a nicotine liquid.
In contrast, newer versions of e-cigarettes, such as those that resemble USB flash drives, represent a change in both design and technology.3 These are often called “pod mods” and are more compact, discreet, and have a USB-like design that makes them easy to carry and use. Unlike first-generation cigarettes, pod mods usually come with pre-filled or refillable pods and may have features such as temperature control and variable voltage.
A prime example of this style is Juul, which has become synonymous with the flash drive design of e-cigarettes. These modern devices are especially popular with younger users due to their sleek, discreet design. All of these devices work by heating a liquid (commonly called e-liquid or vape juice) that contains nicotine, flavorings, and other chemicals to produce a vapor that is inhaled.
A study by researchers at Johns Hopkins University found that e-cigarettes contain about 2,000 chemicals, many of which are unidentified.Four Among the substances identified were caffeine, three industrial chemicals including tributylphosphine oxide, pesticides and two flavourings that can cause toxic effects and irritation to the respiratory system.Five
“People need to know that when they vape, they’re inhaling a very complex mixture of chemicals, and we have no idea what many of these compounds actually are,” lead author Kirsten Plasse, an assistant professor of environmental health engineering in the Whiting School of Engineering and the Bloomberg School of Public Health, said in a news release.
“I think the problem is that e-cigarettes are being promoted as healthier than smoking cigarettes. In my opinion, we’re not at that point yet.”6
Plus, the average vape pod contains as much nicotine as 20 cigarettes.7 But that e-liquid mixture is dissolved in an oily base, which poses an additional risk: “We think some of the evaporated oil gets deep into the lungs and causes an inflammatory response,” said Dr. Stephen Broderick, a lung cancer surgeon at Johns Hopkins University.8
E-cigarettes harm the brain
E-cigarettes pose risks to the entire body, but also to the brain, potentially affecting neurological health. A study in mice investigated the toxic effects of short-term e-cigarette exposure on brain function and inflammatory responses.9 The results showed that exposure to both cigarette smoke and e-cigarettes delayed the mice’s ability to find a food reward, suggesting potential damage to olfactory and memory function.
“The mice exposed to e-cigarettes showed no improvement in memory tasks the next day, suggesting that exposure to e-cigarettes may have caused abnormalities in memory function. Examination of the mice’s brains showed signs of inflammation, with both groups also showing high levels of the inflammatory marker TNF-α.”
The researchers concluded that e-cigarettes have similar toxicological properties to tobacco smoke and may adversely affect brain function. Early exposure to nicotine from e-cigarettes may cause long-term brain changes that affect attention processes, leading to Attention Deficit Hyperactivity Disorder (ADHD).Ten The Surgeon General’s advisory on youth e-cigarette use states:11
“E-cigarette aerosols are not harmless. Most e-cigarettes contain nicotine, an addictive drug found in regular cigarettes, cigars, and other tobacco products. Nicotine exposure during adolescence can have negative effects on the developing brain, which continues to develop until around age 25. Nicotine exposure during adolescence can affect learning, memory, and attention. Nicotine use during adolescence also increases the risk of later dependence on other drugs.”
E-cigarettes may cause heart disease
E-cigarettes pose risks to heart health, leading to increased blood pressure and hardening of the arteries.12 As atherosclerosis progresses, arteries do not expand as easily to accommodate blood flow, and the heart must work harder to pump blood. As a result, the heart muscle thickens (hypertrophy), and eventually heart failure can occur.
In the study, which used health data from the National Institutes of Health, researchers followed 175,667 people for 45 months, with an average age of 52. People who had used e-cigarettes at some point in their lives were 19% more likely to develop heart failure than people who had never used e-cigarettes.13 Overall, increased arterial stiffness is a significant risk factor for cardiovascular disease morbidity and mortality, and vaping can also increase your chances of having a heart attack.
A study presented at the 2019 American College of Cardiology Annual Scientific Sessions found that adults who e-cigarette are at significantly higher risk of heart disease and mental health problems than non-smokers, even after taking into account known risk factors such as BMI and high blood pressure. Compared to non-smokers, e-cigarette users were:14
- 34% more likely to have a heart attack
- 25% more likely to develop coronary artery disease
- 55% more likely to suffer from depression or anxiety than non-smokers with the same risk factors
“This finding supports the current understanding of the role of serotonin in the treatment of bronchitis in children and young adults,” study author Dr. Mohinder Vindhyal, assistant professor at the University of Kansas School of Medicine at Wichita, said in a news release.15
“I would not want my patients or family members to vape because e-cigarette users have a 55% increased risk of heart attack compared to non-smokers. Upon further investigation, I found that whether e-cigarette users are daily or occasional users, they are more likely to suffer from heart attack and coronary artery disease.”
E-cigarettes lead to permanent lung damage
E-cigarette vapour contains ultrafine particles that can be inhaled deep into the lungs, and may also contain chemical flavourings such as diacetyl, which can damage the tiny tubes in the lungs and lead to serious lung disease.
This damage and inflammation can leave permanent scarring and lead to bronchiolitis obliterans, also known as popcorn lung, which can cause coughing, chest pain, and shortness of breath.16
Inhaling oil-containing e-liquid from e-cigarettes can also cause lipoid pneumonia, a specific type of pneumonia that occurs when fats and oils get into the lungs. “There’s no good treatment for lipoid pneumonia other than supportive care until the lungs heal on their own,” Broderick says.
“The most important thing you can do is identify what the trigger is – in this case e-cigarettes – and eliminate it.” E-cigarettes may even increase the risk of primary spontaneous pneumothorax, or lung collapse.17
There is also the possibility of E-Cigarette/Vaping Use Associated Lung Injury (EVALI), a serious lung illness in e-cigarette users that may be caused by vitamin E acetate and other compounds found in the products.18 In 2020, at least 2,807 cases of EVALI occurred in the United States, most of which required hospitalization and resulted in reported deaths.19
“Essentially, EVALI is a serious disease that primarily affects the lungs and causes a significant number of hospitalizations and deaths in relatively young, healthy people across the United States,” Megan Levli, M.D., assistant professor of pediatrics at the University of North Carolina School of Medicine, said in a news release.20
E-cigarettes harm the immune system
E-cigarette use is not considered a “safe” way to smoke, as it can put immune system function at risk.twenty one “E-cigarettes can block immune cells from battling threats,” the University of Birmingham warned in a news release.twenty two The effects were seen even with brief, low-level exposure, suggesting even occasional e-cigarette users may be at risk.
This effect is linked to neutrophils, white blood cells that the immune system uses as a first line of defense.twenty three These travel throughout the body, trapping and neutralizing bacteria and other pathogens that can cause illness.
Neutrophils exposed to e-cigarette vapour had higher concentrations of microfilament F-actin, resulting in reduced cell movement and function.twenty four Traditional smoking is also known to affect neutrophils.
UK introduces bill to create first smoke-free generation
On 20 March 2024, the UK government introduced the Tobacco and E-Cigarette Bill, which will significantly restrict the sale and use of tobacco and e-cigarette products, particularly among young people. The bill will make it illegal to sell tobacco products to anyone born on or after 1 January 2009. The measure is intended to effectively phase out smoking in future generations. According to the UK government:twenty five
“We will create the first smoke-free generation by ensuring that tobacco will not be legally sold to children who turn 15 this year or younger. Because there is no safe age to smoke, the sales age will be raised by one year each year to prevent future generations from starting.”
It also announced new powers to restrict e-cigarette flavours and packaging to make them less attractive to children. These powers will allow the government to change the way e-cigarettes are displayed in stores.
To crack down on sales to minors, the government will introduce faster and simpler instant fines of £100 for shops selling tobacco and e-cigarettes to minors in England and Wales. Local authorities will retain 100% of revenues to reinvest in the enforcement of this and other existing tobacco and e-cigarette laws. This is on top of the maximum fines of £2,500 that can already be imposed by the courts.
E-cigarette alternatives, such as nicotine pouches, will also be banned as more and more children turn to more addictive alternatives.”
If you’re a parent, having open discussions about the risks and realities of e-cigarettes is an effective way to educate your children and teens about the many health risks. If you’re thinking about quitting smoking, don’t choose e-cigarettes as a “safer” alternative. Remember, e-cigarettes typically contain nicotine and are designed to be used continuously, just like cigarettes.
Physical activity, such as walking, can help distract you from the urge to smoke and reduce the stress that triggers smoking. Relaxation techniques, such as yoga, meditation, and emotional freedom techniques, can also help manage stress and reduce the psychological urge to smoke.
