Vaping: What You Need to Know

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
September 13, 2019
Risks of Vaping

Vaping gained traction over the last 15 years because it seemed like a healthier – possibly even lifesaving -- alternative to smoking combustible cigarettes. And since electronic nicotine delivery systems such as vapes, vape pens, hookah pens, e-cigs, tank systems and mods don’t need ashtrays to collect butts, smokers find them convenient. 

Over time, the electronic tobacco industry began flavoring products and marketing to non-smoking teenagers who want the cool appearance of a smoker without the health risks. This helped raise the number of Americans vaping to more than nine million, according to the U.S. Census Bureau. 

Which brings us to the question: Is vaping safe? Like most public health issues there’s no simple answer. As of now, research suggests that vaping is safer than smoking, but it’s not safe

“Smoking has been around a lot longer than vaping, so there’s solid data on its effects,” says Bernard Kaminetsky, MD, medical director, MDVIP. “We’re still learning about vaping.” Here’s what we do know.

How Do Vape Pens Work?

Vaping devices generally work in the same manner. Each device has a cartridge (or reservoir) that holds liquid (e-liquid, vape juice, e-juice) that’s comprised of chemicals, flavorings and nicotine – unless it’s a non-nicotine device. Puffing on the device’s mouthpiece activates the battery which triggers the heating element (or atomizer) to convert the liquid into an aerosol or vaper – hence the term “vaping.”  

Chemicals Commonly Found in E-cigarettes

It’s hard to pin down a specific list of ingredients in e-liquid because there are many brands with different versions and generations of products. And vaporizing these ingredients often creates additional chemicals. Here’s what commonly found in a typical e-cigarette:

  • Ultrafine and microscopic particles are found in many household products and are an environmental concern. When you inhale large toxic particles, you’ll begin coughing to expel it. However, when you inhale toxic ultrafine or microscopic particles, they can bypass the nose and throat, permeate deep into the lungs and migrate into the circulatory system. Many of the ultrafine and microscopic particles in e-cigs are found in air pollution and combustible cigarettes. Exposure can exacerbate breathing problems, like asthma, and constrict arteries, raising the risk for high blood pressure, heart attack or stroke.
  • Nicotine is a common ingredient, but non-nicotine products are also available. The amount of nicotine in products varies. And product labels aren’t a reliable indicator of nicotine content because studies have found mislabeling to be a common practice, according to the Truth Initiative. The effects of nicotine on cardiovascular health are well understood. Nicotine can cause inflammation and arterial plaque buildup; raise blood pressure and heart rate; narrow blood vessels and damage arterial tissue. But it also raises the risk for respiratory, gastrointestinal and reproductive issues and suppresses the immune system. And it’s addictive.
  • Flavorings use chemicals to achieve their appeal. In 2009 the Family Smoking Prevention and Tobacco Control Act included a ban on cigarettes flavorings except menthol. But this ban doesn’t apply to vape juice. Flavors such as cherry, custard, lemon tart and sugar cookie usually use diacetyl as an ingredient. Diacetyl is an organic compound found in fermented products like alcohol, tobacco, cultured milk and some fruits. It has a strong buttery flavor and enhances sweetness, so it’s commonly added to microwave popcorn, flavored syrup and many dessert items. But inhaling it can lead to bronchiolitis obliterans (or popcorn lung), an irreversible and incurable lung condition in which the bronchioles (smallest airways in the lungs) become scarred and inefficient. 
  • Humectants are used in products to help maintain moisture. Lotions are probably the best example of products with humectants. But consumable humectants, specifically propylene glycol and vegetable glycerin, also are used in nicotine delivery systems to maintain moisture. However, these ingredients also tend to absorb water, causing dry mouth and possibly a sore throat. 
  • Volatile organic compounds (VOCs) are gasses emitted from solvents, paints, varnishes and cleaning products, but they’re also found in vape juice. At certain levels, VOCs can irritate the eyes, nose and throat; cause headaches and nausea; and damage kidneys, liver and nervous system, according to the American Cancer Society. There’s also a concern that VOCs contribute to indoor air pollution.  
  • Heavy metals leak from some e-cigarette heating coils and can be toxic at certain doses. Many electronic nicotine devices generate aerosols with potentially unsafe levels of lead, chromium, manganese and/or nickel. Regularly inhaling these metals has ties to lung, liver, immune system, cardiovascular and brain damage, and cancers, according to a study published in Environmental Health Perspectives. 
  • Formaldehyde is a naturally occurring, carcinogenic chemical agent. Portland State University researchers found e-cigarette aerosols had up to 15 times more gaseous formaldehyde than combustible cigarettes as well as formaldehyde compounds that bonded to particulates, depositing deeper into the lungs than gaseous formaldehyde.     

Is Vaping Addictive?

Addiction is a real risk, especially for those vapes that contain nicotine. If you traded combustible cigarettes for electronic cigarettes, addiction is probably a moot point. But if you’re only a vaper, you might be surprised that quitting can be difficult and may require a vaping cessation program. 

“The bottom line is that if you smoke, you need to quit. Don’t switch to e-cigs, but quit,” Kaminetsky says. “When you’re ready to quit, talk to your primary care physician. They can prescribe medications to help you quit, help you find a cessation program that fits your needs and provide you with community resources for support.”

If you don’t have a doctor, consider partnering with an MDVIP-affiliated physician. MDVIP doctors have the time to work with you to help you quit smoking. Find a physician near you and begin your partnership in health » 

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Third-Hand Smoke Can Be a Health Risk for You and Your Loved Ones / Janet Tiberian, MA, MPH, CHES / May 14, 2017
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Tobacco Use on the Rise as Marijuana is Legalized / Janet Tiberian, MA, MPH, CHES / June 8, 2018

About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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