It's a simple question: is vaping bad for you? The answer: simultaneously simple and pretty complicated.
Vaping, aka smoking e-cigarettes, is a trend that's skyrocketed in popularity over the last few years, especially among teenagers, for whom e-cigarettes are actually illegal. It's left parents dumbfounded, wondering when and how smoking, albeit in an altered, tech-savvy form, became a thing again. And the answer to that is fundamentally the same as the first time around.
"It's just cool," said Stanton Glantz, PhD, medical professor and director of the UCSF Centre For Tobacco Research Control and Education, who has published several studies on the effects of e-cigarettes. "It looks like a flash drive. It's very high-tech and fun." It also doesn't look like a cigarette, which means it doesn't have the same negative, "cigarettes are bad" stigma, something that's been hammered into the brains of the past few generations of kids. And e-cigarettes, particularly Juul products [1], have been marketed to perfection through social media campaigns that, according to a a current class action lawsuit against the company, targeted teenagers specifically [2].
Though the company has claimed that it had never intended to market Juul to minors, the damage is done. Juul's Instagram and Facebook accounts are closed now [3], but the hashtag #juul still has over 500,000 posts to date. "It's like they've set a forest fire," Dr. Glantz told POPSUGAR. "It's like the fire's burning, and they don't need to be out there pushing it any further." And their marketing practices were so effective that many people — us included — are still confused as to whether vaping really is bad for you, and what it is in the first place.
What Is Vaping?
Vaping is the same thing as smoking an e-cigarette. (According to Dr. Glantz, you can also vape cannabis, but we'll be focusing on the tobacco product for this article.) The name gives you a clue as to how it works. Regular cigarettes burn tobacco, creating a smoke that the user inhales. E-cigarettes, on the other hand, don't burn anything. The technology consists of a "tiny toaster coil," as Dr. Glantz described it, wrapped around a wick, similar to a candle wick. That apparatus is soaked in a liquid, "usually propylene glycol, vegetable glycerin, flavourants, and nicotine," Dr. Glantz said. Heating the coil around the saturated wick (which is triggered when you inhale) creates a vapor of ultrafine particles, including nicotine, which you breathe into your lungs. (Another point of confusion: though e-cigarettes don't contain tobacco, they're still considered and referred to as "tobacco products.")
To simplify it, when you're smoking, you're inhaling smoke. When you're vaping, you're inhaling a vapor. "Both cigarettes and e-cigarettes generate these aerosols of ultrafine particles in order to give you a hard nicotine hit," Dr. Glantz explained, but the distinction between burning and vaporizing is a crucial one.
Is Vaping Worse Than Smoking?
The hope for e-cigarettes was that, by breathing in vapor instead of smoke, you wouldn't be exposed to the same toxic, cancer-causing substances that are generated by burning tobacco. And to some degree, Dr. Glantz told POPSUGAR, that's true. Over a range of studies measuring toxic chemicals in cigarette smoke, he explained, "the levels are much lower in an e-cigarette than a cigarette," he explained. "So that's the good news."
The bad news? The vapor and the particles you inhale from e-cigarettes are dangerous in and of themselves, Dr. Glantz said, causing damage to your arteries, lungs, and heart. "In terms of heart disease risk and lung disease risk, based on what we know so far, e-cigarettes are almost as bad as cigarettes."
Research, predominately focussed on teenagers, supports that. A 2017 study showed that high schoolers who vape are more likely to experience symptoms of chronic bronchitis [5], which include shortness of breath and coughing up mucus. Research done in South Korea in 2016 found a correlation between vaping and symptoms of asthma [6]. Dr. Glantz's own research has shown that smoking e-cigarettes presents a heightened risk of heart attack [7] that's similar to that of cigarettes, even for young people.
Studies on the long-term effects of vaping, including any association with cancer risk, will by definition take more time. But the cardiovascular risks are being seen even now, Dr. Glantz told POPSUGAR. In fact, he said, vascular consequences from vaping "occur within a few puffs."
The overall consensus is that e-cigarettes aren't as bad as cigarettes, but that doesn't make them good for you. Objectively, "not as bad as cigarettes" is a pretty low bar [8].
Is Vaping Addictive?
One more difference between smoking and vaping, with Juul in particular: the nicotine content. The nicotine aerosol that you breathe in from cigarettes, Dr. Glantz explained, "is pretty alkaline, so it's hard to inhale." It triggers a gag reflex which makes you cough and choke when you're not used to it. Juul products, on the other hand, contain an altered form of nicotine that's more neutral and less alkaline, making it easier to inhale. Juul also, famously, flavours their products to make them sweet and further mask the bitterness of the chemicals.
Put together, those two changes made it possible "to deliver a much higher dose of nicotine per puff than in a conventional cigarette," Dr. Glantz told POPSUGAR. "And that means you could get addicted a lot faster."
And the tasty flavours, easy-on-the-throat inhales, and savvy marketing campaigns all came together to put teenagers at particular risk [10]; people who wouldn't, under other circumstances, start using a smoking product. "E-cigarettes are really expanding the tobacco epidemic by bringing a lot of low-risk kids into it, who'd never be likely to start nicotine with a cigarette," Dr. Glantz said.
Starting to vape as a teenager not only runs the risk of creating an addiction, but also multiplies the likelihood that a cigarette habit will follow. A February 2019 study published in JAMA Network Open confirmed this, showing that kids who used e-cigarettes were four times more likely to try a regular cigarette [11] than those who'd never vaped.
Also promoted as a strategy to quit smoking [12], Dr. Glantz told POPSUGAR, "there are, no doubt, people out there who have used e-cigarettes to get off cigarettes." But he pointed out that "if you look at the overall evidence, and there's about 60 or so studies of this now, on average, smokers who use e-cigarettes are less likely to quit smoking than smokers who don't use e-cigarettes."
There is a lot more to be learned about vaping, but if we're looking to answer the basic question of whether it's bad for you, the answer is certainly yes. Worse than cigarettes? Maybe not. Still posing a health risk, associated with more heart attacks, cardio problems, and addiction? Yes. Vaping is promoted as fun and cool for young people and as a way to quit smoking for others. But the overall effect, Dr. Glantz said, "is to increase risks and make the tobacco epidemic worse."