Let’s start with some good news: Fewer teenagers are smoking than ever before. According to a January 2019 report from the National Institute on Drug Abuse, the number of teens who smoke cigarettes daily has dropped 88 percent since the mid-1990s. But, as we all know from the cloudy corners on the outskirts of high schools, more teens are flirting with the dangers of vaping instead. Today, a whopping 21 percent of high schoolers use e-cigarettes, up from just 1.5 percent in 2011, according to the Centers for Disease Control and Prevention. For middle-school kids, vaping rates rose from 0.6 percent in 2011 to 4.9 percent last year, a 49 percent increase over 2017.
At least they’ve done away with those foul-smelling cancer sticks, right? At first, experts thought so. In fact, vaping was promoted for years as a less-harmful step towards quitting smoking. The usually sweet-smelling vapors were thought to be a lot better than tobacco and chemicals set on fire.
We were wrong.
“Our understanding of e-cigarettes is still accumulating, but at this point, we are pretty confident that e-cigarettes are at least two-thirds to three-fourths as bad as cigarettes,” says Stanton Glantz, Ph.D., professor of medicine at the University of California, San Francisco’s Center for Tobacco Control Research and Education. “And remember, cigarettes are pretty horrible. Vaping is like, instead of jumping out of the 40th story of a building, you’re jumping out of the 30th story.”
Other experts think Glantz is being conservative. Thanks to new chemical cocktails, the increased nicotine delivery, and the power of that drug on the brain (all the worse in concentrated form), Juuls and other e-cigarettes may in fact be worse than your average cancer stick.
Here’s a look at what the experts now know — and why those headlines of hospitalized teens from nicotine toxicity and vaping-related lung troubles may be just the beginning.
The Clear and Present Dangers of Vaping
This summer saw the various nefarious effects of vaping play out in the news over and over. In July alone, eight teenagers in Wisconsin were hospitalized for serious lung damage caused by vaping, some of whom had to be put on ventilators in the intensive care unit. During the first week of August, four Minnesota teens were hospitalized for a week or longer because of vaping-related lung troubles, prompting the state’s health department to issue a warning against e-cigarettes.
Also, this summer, an 18-year-old Florida college student’s lung collapsed — something virtually unheard of in someone so young — after he’d been using a Juul vaping device daily for a couple of years. And just this month, the Food and Drug Administration announced it has received 127 reports of seizures and other serious neurological symptoms linked to vaping since 2009.
“With the data we should have about three or four years from now, I think we’ll find that e-cigarettes are equally as bad or worse in terms of overall health risks.”
Seizures? Lungs collapsing? Nicotine toxicity? These are not things one would hear about when cigarette smoking was the norm. Vaporized nicotine is a different danger. When it comes to lung health, look to the great array of chemicals that Juul and e-cigarettes require to make them work properly. In other words, that vapor is in no way just sweet-smelling water — it’s a huge assortment of chemicals going straight to your lungs.
Then, there are the brain issues, the epidemic of “nic sick” teens who experience nausea, headaches, lightheadedness, and even vomiting. This is due to this especially concentrated form of nicotine that you don’t get in regular cigarettes. The FDA is playing catchup now on regulating e-cigarettes in their many forms. Meanwhile, researchers are pointing to increasingly worrisome evidence of the kinds of harms Juul and its brethren can make. It’s a race that, many worry, will end with more teens and adults in the hospital before all is said and done.
“Nic Sick,” Nicotine Salt, and the Dangers of Vaping
The dangers of combustible cigarettes are well-documented. Cigarettes consist of roughly 7,000 chemicals, according to the National Cancer Institute, 69 of which are proven carcinogens. Along with nicotine, cigarette chemicals include hydrogen cyanide, lead, arsenic, ammonia, benzene, and carbon monoxide, and most are found in tar, the nasty residue left behind from burning tobacco.
Is nicotine bad for you? Yes. Nicotine itself is highly problematic. First and foremost, it’s crazy-addictive because it changes the brain. “Nicotine mimics the chemicals that brain cells use to communicate with each other and causes the brain to reconfigure itself,” Glantz says. “The nicotine molecule is shaped a lot like acetylcholine, which the nervous system uses to communicate, so it fakes out and overstimulates the nervous system.”
The brain responds to this, he explains, by growing additional nicotine receptors. And with more receptors, the body craves more nicotine. Without it, withdrawal sets in, causing jitters, anxiety, headaches, and irritability. “This rewiring of the brain is bad for adults, but it’s especially bad for young people because until around age 26, the brain is still developing,” Stantz says. “When you start messing up normal communication between nerves as the system is still being built, the adaptations are a lot more permanent.”
Looking strictly at the nicotine factor, e-cigarettes can be even worse than traditional cigs because they tend to deliver even more of the stimulant. With newer vaping devices, unlike first-generation e-cigarettes, nicotine levels can be controlled, either by adjusting the contraption itself or purchasing e-juices of varying concentrations. Regardless, they still tend to push out more nicotine than old-school smoke.
For this reason, Stantz calls out Juul devices as particularly dangerous. “Free-base nicotine, which you get in a cigarette and an older-generation e-cigarette, is very alkaline and hard to inhale, so it triggers a gag reflex, which limits the amount of nicotine per puff,” he says. “Juul transitioned to nicotine salt and added some acid to the e-liquid to make it less alkaline, as well as adding flavors. When you put all that together, it is much easier to inhale, so Juul devices deliver a much higher dose per puff.”
This may be why kids seem to be getting addicted to Juul much faster than they got hooked on traditional cigarettes and even older e-cigarettes.
The Other Dangers of Vaping: Heavy Metals and Formaldehyde
But there are many more issues with vaping than just the nicotine. While research shows e-cigarettes contain lower levels of carcinogens than regular cigarettes, their vapor, which many users assume is harmless, is downright dangerous. “It consists of ultrafine particles that are about 100 times smaller than a human hair,” says Glantz. “These particles include acrolein and formaldehyde, as well as diacetyl, cinnamaldehyde, and other flavorants that are fine to eat but not to inhale as fine particles.”
These chemicals’ tiny size, he explains, allows them to permeate the body more deeply, making them especially toxic. Earlier this year, Harvard researchers discovered that diacetyl and its chemical cousin 2,3-pentanedione — found in 90 percent of e-cigarettes tested — damage the cilia lining the lungs and airways, increasing the risks of asthma and chronic obstructive pulmonary disease (COPD).
“Vaping is like, instead of jumping out of the 40th story of a building, you’re jumping out of the 30th story.”
“E-cigarettes also include heavy metals like lead and silica,” Glantz says. “Their wicks often have silica, and when they wear out, you can get little particles of silica in the lungs, which is very harmful. Additionally, e-cigarettes disable the normal functioning of macrophages, cells within the lungs that gobble up bacteria and other infectious agents we breathe in. When you disable them, you are more prone to infections.”
Also, like smoking cigarettes, vaping threatens cardiovascular health. “Our blood vessels are constantly adjusting in size depending on how much blood flow is needed, a process called flow-mediated dilation,” Glantz says. “This is controlled by nitric oxide synthase, enzymes that e-cigarette aerosol completely disables, severely compromising the arteries’ ability to expand when they need to.” This issue has been linked to long-term heart disease, he adds, and it can cause platelets to clump together, leading to heart attacks.
Overall, the evidence clearly shows vaping is exceptionally risky for and even immediately harmful to teens. As for Glantz’s estimation that e-cigarettes are 66 percent to 75 percent as hazardous as combustible cigarettes? He doesn’t believe that statement will hold up much longer: “With the data, we should have about three or four years from now, I think we’ll find that e-cigarettes are equally as bad or worse in terms of overall health risks.”