Cameron Landis started vaping when she was 17 simply because she was curious. Her boyfriend at the time was doing it, and cigarettes made her sick, so she figured she’d give it a try.
Four years later, Landis, now 21, is still vaping. She’s not alone in favoring what seems to have become a fixture in youth culture — which experts agree is dangerous and full of unknowns. Just this past December, U.S. Surgeon General Jerome Adams declared e-cigarettes among young people an epidemic in the United States. Other critics say e-cigarettes are enticing young people to start and develop a nicotine habit that could mean picking up regular cigarettes later.
New technology to help smokers quit
As millions of Americans have sought ways to quit smoking, both medicine and technology have attempted to rise to the task in the form of patches, pills, lozenges and gum. The philosophy is to reduce the need for smoking by administering nicotine through alternative methods, which over time should reduce the nicotine habit itself.
According to the Centers for Disease Control, cigarette smoking is the leading cause of preventable disease in the United States, accounting for almost half a million deaths every year.
However, cigarette smoking has seen a steady decline across the country over the last decade. In 2005, 20.9 percent of American adults smoked cigarettes — in 2016 (the most recent year for which the CDC has data), that percentage was down to 15.5 percent of adults.
For many public health advocates, this is a positive change — the more people who quit smoking, the fewer preventable deaths there will be every year. Over the last few years, however, an additional alternative method of cigarette replacement has conquered all others, at least in popular culture: vaporizers and e-cigarettes.
What are vapes and e-cigs?
“Vapes” and “e-cigs” are devices that in some ways are meant to recreate the experience of smoking but without many of the toxins, tars and carcinogens that are built into a traditional tobacco cigarette.
Vapes and e-cigs function in very similar ways: They contain rechargeable lithium batteries, pods that typically are filled with a liquid mix of nicotine, water, glycol, glycerin, propylene and flavorings — known as e-liquid, e-juice, vape juice or just juice — and an atomizer with a heating coil used to heat the liquid when the user inhales.
When users vape, the “smoke” they exhale is not traditional cigarette smoke, but rather the vapors from the heated e-juice that the user has inhaled, sometimes called clouds. A single pod — good for about 200 puffs — delivers about the same amount of nicotine as a pack of cigarettes.
How helpful are e-cigarettes and vapes at helping smokers quit? Well, they seem to be helping people live longer. A British Medical Journal study published in 2017 found that “replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths” from traditional cigarette smoking.
An unintended consequence
Many critics of e-cigarettes and the multibillion-dollar industry around vaping aren’t critical of the potential help it can provide to traditional adult tobacco users, but rather how vape pens have become extremely popular among teens and young adults.
Juul, the most popular vape brand in America, markets itself as a healthier alternative to smoking adults. Critics say that their sleek products with fruity flavors are meant to entice young people to start and develop a nicotine habit, which would cause them to either continue vaping or switch to traditional tobacco. A study published last year in the journal PLOS ONE suggested that teens who use e-cigarettes are between two and seven times more likely to one day smoke traditional cigarettes compared to teens who never try e-cigs.
Because vaping is still a relatively new concept, researchers say there’s a lot we still don’t know about how it could affect the body. For one, nicotine can be dangerous for developing brains, blunting emotional control and decision-making and impulse-regulation skills. Teens and their still-maturing brains are also more vulnerable to addiction.
One of the most recent studies found that vaping could be linked to breathing problems. The study, done at the University of Rochester Medical Center, reported that aerosols and flavorings in e-cigarettes can cause inflammation in lung tissue.
“People need to understand that e-cigarettes are potentially dangerous to your health,” Dr. Michael Joseph Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, wrote in the Johns Hopkins Medicine Healthy Heart blog.
You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe.”
Although the sales of vape and e-cigarette products are restricted to those 18 and older, age hasn’t proven to be a big obstacle to young people — just like with regular cigarettes or alcohol.
Growing in Popularity
Landis, of Williamsburg, says she saw 13-year-olds vaping when she worked at a summer camp several years ago. And Larissa Jakub, a middle-school teacher in Northern Virginia, says she’s encountered students vaping during school days, particularly in the bathroom. E-cigarettes have showed up in Hampton classrooms, practically under the noses of teachers.
Young people seemingly have become so enamored of Juuls that they’re popping up in class assignments.
“My college kids keep including characters with Juuls in their group-written plays at the end of the semester,” says Bethany Marx, an associate professor of theatre at SUNY College of Oneonta. “This fall, Cinderella lost her Juul instead of her shoe at a frat party.”
There are even national vape “Cloud Competitions,” where users compete to blow the biggest cloud, the longest cloud and very advanced trick clouds. These are not your grandfather’s tobacco pipe smoke rings: Trick cloud videos online have amassed millions of views. While the vape juice that competitors use to blow their clouds doesn’t contain nicotine, these events are sponsored by independent and major vape retailers, all selling their devices and nicotine-containing products to attendees.
Can youth vaping be stopped?
The popularity of e-cigarettes among teenagers led Dr. Scott Gottlieb, commissioner of the Food and Drug Administration, to recently issue potential enforcement actions which specifically called out Juul and its “youth appeal,” as well as a strategy for how to stop youth use of e-cigarettes. Legislators have also called on the FDA for review.
According to the FDA’s Youth Tobacco survey, 3.6 million high school and middle school students are now using e-cigarettes — an increase of 78 percent in just a year. More than a quarter of high school students report using e-cigarettes regularly on at least 20 days of the month. More than two-thirds are using flavored e-cigarettes.
The future of smoking seems to not involve real smoke at all. The FDA has titled e-cigarettes and vaporizers “Electronic Nicotine Delivery Systems” or ENDS, which is a straightforward way of describing exactly what they do and the problems they cause. As well as the health problems associated with nicotine addiction, there are also the potential hazards that the devices themselves pose to users. The batteries of the vape pens can explode.
“We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in his rare public health advisory in December. “We must take action now to protect the health of our nation’s young people.”