What dangers lurk in e-cigarettes and vape pens?

  • March 9, 2021
  • Blog

Despite steadily declining smoking rates over the years, more and more Americans are trading in traditional tobacco products for electronic cigarettes. Because they are thought of as a safe alternative to regular cigarettes due to the reduction of harmful secondhand smoke, e-cigarettes and the retailers selling them have become abundant. Proponents of e-cigarettes advertise them as helpful in “kicking the habit” for traditional smokers, but those who swap smoke for vapor may be trading one danger for another.

There are many reasons people may choose to use e-cigarettes, and that use has increased exponentially since they hit the market. According to the Centers for Disease Control (CDC), approximately 13 percent of U.S. adults have tried e-cigarettes on at least one occasion, while nearly four percent consider themselves regular users. E-cigarettes are also wildly popular among teenagers. Rates of use have tripled in this demographic since 2014.

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How e-cigarettes work

How do these products work? The typical e-cigarette includes a number of components: a rechargeable lithium battery, a cartridge containing nicotine, flavoring additives, other chemicals such as glycol or glycerin, an atomizer containing a heating element or coil, an LED light which simulates the burn of a regular cigarette, and a sensor that activates the atomizer when the user takes a drag. The device works when the atomizer heats the liquid contained in the cartridge to a boiling point, thereby creating vapor which is inhaled by the user – thus, the term “vaping.” There are many, many versions of e-cigarettes but ultimately, they can all be sorted into one of two categories:

  • Rechargeable
    • Rechargeable e-cigarettes, or “vapes”, are exactly what they sound like: they can be recharged and used indefinitely. Users don’t need to replace the device, simply the liquid. Some devices allow users to refill the cartridges themselves, but others, such as the endlessly notorious Juul, sell prepackaged pods that can be inserted into the device and replaced when they’re empty.
  • Disposable
    • Again, disposable vapes are rather self-explanatory: they are sold pre-charged and filled with liquid, then disposed of when they’re empty. Rather than tossing the pod and keeping the rechargeable portion–like Juuls–or simply refilling the liquid inside, users discard the empty device and buy a replacement. Popular disposable vapes include Puff Bars and STIGs.

Wildly popular, but why? Wildly damaging, but how?

E-cigarettes broke into the market with a bang, advertising appeal after glowing appeal. They were sleeker, they were more discreet, they even came in flavors from mango to crème brulee. However, the icing on top of the cake was the claim that they were better for users than cigarettes and could assist smokers in quitting. Some of these appeals are admittedly rooted in truth: the designs–propelled by the company Juul, but soon adopted by others–look more similar to a hard drive than a vaping device. Box mods, which are a form of rechargeable vapes, and similar devices are bulky, but easily refilled and charged. Juuls and many disposables are slim, easily fitting between two fingers, and replacement devices and/or pods are inexpensive. They are much less conspicuous than cigarettes; though also small, cigarettes have a very distinctive smell that does not dissipate quickly. E-cigarette “hits” generally don’t yield as much smoke and in addition to the pleasant flavors resulting in a better, smoother taste, they also fade quickly and don’t leave users’ clothes or belongings smelling like smoke.

Even the claim that they are better than cigarettes has merit: the sheer number of pernicious chemicals in conventional cigarettes outnumbers those in the synthetic, electric alternatives. It is not a flawless solution, but a solution nonetheless, right? Well, maybe not. According to the CDC, almost 19.6% of high school students used e-cigarettes. This is a clear demonstration of who these new devices are really appealing to: the teenagers, who likely never would have started smoking otherwise. But again, why? Well, we’ve already established that. They’re sleeker, attractive to look at, appealing to a young eye appreciative of that feeling of newness that clings to an iPhone or a MacBook or really, anything innovative–e-cigarettes included. They’re more discreet, allowing underage users to more easily avoid detection. Crowding in bathroom stalls, trekking from the main school building to the football field, even exhaling furtively into a backpack at the back of the room: middle and high school students can take their vape with them everywhere. Tuck it in their backpack or jacket pocket, no lighter or perfume needed to cover up the smell.

Even the flavors appeal to teens. Mango, strawberry, banana, and other fruit flavored options are the most popular. However, other options such as mint, orange soda, creme brulee, and much more are also finding their way into locked bedrooms and giggling sophomore sleepovers. These exciting, tasty options encourage teens to believe that vaping “isn’t that bad.” It’s not as bad as smoking, which means it must be safe, which means they’ll be fine. But as many parents well know, just because a child may believe themselves ten feet tall and bullet-proof doesn’t mean they actually are. Teenagers do not have fully developed brains, meaning that nicotine inhibits the growth that isn’t set to end until mid- to late-twenties. The risks of this interference include the development of mood disorders, permanent reduction of impulse control, and the alteration of synapsis formation. This can affect attention and learning in students who haven’t even made it through high school yet. 

Further, the younger one is, the faster they learn. Nicotine addiction is, in essence, something learned and therefore, the onset is faster and more severe for underage users. This increases the severity of the aforementioned risks and it becomes a self-fulfilling cycle. However, it is not entirely the fault of the underage consumer: Juul is the most popular e-cigarette brand by far, and multiple aspects of their business model have resulted in disapproval from the public, even resulting in lawsuits. For one, their advertisements feature bright colors, excited people in their early twenties, and imagery that is more akin to an iPhone commercial than an advertisement for an obviously addictive chemical. These vibrant advertisements, coupled with the misconception that “safer” is the same as “safe” and Juul’s willing perpetuation of that clear untruth, pulled teens in on an ever-tightening string. Secondly, Juul pods have a significantly higher amount of nicotine than cigarettes, resulting in more nicotine per pod than is found in a pack of cigarettes. Pairing a teenager’s biological predisposition to addiction on an accelerated clock with these heightened levels of the addictive chemical quite nearly results in helplessness.

There can be no experimenting or else the teen will end up hooked. They must only say no. However, let’s not kid ourselves: that is hugely unrealistic. As emphasized before, teenagers’ brains are not fully developed. In fact, the parts that are still growing are specifically linked to impulse control and decision making. It is unfair to assume that a teen will never drink a sip or take a hit. It is unfair to avoid holding e-cigarette companies accountable for this sharp spike in underage nicotine consumption because they are partially at fault. This is not to say that the majority of the responsibility doesn’t fall on the user, because it does. It is not to say that this method of experimentation as a teen will not and should not yield consequences, nor that the manufacturers should cater to an audience that is legally prohibited from partaking in their product. It is also not to say that there is something inherently wrong about innovation: e-cigarettes are an innovation in their field, and yes, for adults who wish to transition to a healthier method of consumption, they may be an option. However, there is a point where the companies do contribute to this epidemic and it must be addressed.

The last, and most significant aspect of this contribution lies in education. E-cigarette companies must be upfront about what they are filling their products with and someone must hold them accountable for continuing that innovation. How can they make nicotine consumption as safe as it can be? It will never be safe because of the nature of the activity and the drug, but it can be better. The money that pours in from quick sales from an addicted consumer base is not worth the damage that e-cigarettes cause. However, the most disturbing piece of the flawed puzzle is the fact that e-cigarettes containing nicotine are considerably less dangerous than e-cigarettes containing tetrahydrocannabinol (THC), which is the psychoactive component of marijuana, and rechargeable vapes may quite literally turn out to be a bomb in the pocket of an unsuspecting user.

How e-cigarettes have become potentially fatal, more often catastrophic

The CDC has been investigated outbreaks of lung injury associated with e-cigarette, or vaping, product use (EVALI) for years and they found that it was strongly linked to Vitamin E acetate, which is found in many e-cigarettes containing THC. Vitamin E acetate, though harmless when ingested, is proven to interfere with normal lung function. As of January 14, 2020, the CDC discovered some disturbing statistics in regards to Vitamin E acetate’s undeniable link to EVALI:

  • out of 2022 hospitalized patients, it was discovered that the vast majority modified their e-cigarettes after purchase or obtained it from an informal party where it had already been modified
  • 82% of this 2022 used e-cigarettes to consume THC
  • 33% used e-cigarettes to consume THC exclusively
  • 57% used e-cigarettes to consume nicotine
  • 14% used e-cigarettes to consume nicotine exclusively

This does not rule out the role that other chemicals may have played in the onset of the illness, but it certainly cements Vitamin E acetate as a considerable threat. Luckily, it has been acted on as such: upon the removal of Vitamin E acetate from certain products and the education of the public about the chemical, and therefore THC cartridges’ threat, the rates of hospitalization as a result of EVALI have been falling. However, not all of the legislation regarding these issues has actually been effective, and there seems to be a pattern; on December 20, 2019, Donald Trump raised the legal smoking age from 18 to 21 in an attempt to halt underage nicotine consumption. However, the result may not have been what he expected.

For one, when has prohibition ever worked? No, it is not the same as an outright ban, but when products are restricted or eliminated from the public marketplace, they begin to grow in popularity on the black market. The resulting black market of e-cigarette products cannot be regulated in the same way, and since the consumers are young and susceptible, not to mention very likely addicted to the substance they’re pursuing, they do not have the necessary knowledge to protect themselves. The black market runs wild, the consumers fall ill, the problem remains and remains and remains. Fixing the issue mandates much, but the key is education and open communication between the public, the CDC, the FDA, and the companies they’re trusting with their lungs (and hearts and skin and bones and toes). Teenagers must understand how dangerous e-cigarettes are shaping up to be and adults must be able to make informed decisions about smoking. This and this alone will reduce e-cigarette usage among minors and create a safer environment for adults.

In addition to the negative health risks associated with inhaling the vapor produced by these products, there is also evidence that e-cigarettes may be susceptible to explosion due to battery failure. According to the U.S. Fire Administration, when the battery seal in these devices ruptures, pressure within the device builds up causing the container and/or battery to rupture. These explosions are more common in “mechanical mods”, which have powerful lithium-ion batteries–batteries that the FDA is wary about–that are capable of shattering bone and knocking out teeth upon combustion.

In some cases, the explosion can be violent. As one might expect, these explosions, which can occur during use, result in devastating and disfiguring blast injuries. Between 2009 and 2016, 195 explosions occurred, with 133 injuries in total and 38 injuries warranting hospitalization. In 2016, the University of Washington Medical Center received 15 patients in 9 months. 30% of these patients suffered from severe blast injuries; in Nevada, a 17 year-old boy was using a vape when it exploded and blew a hole in his jaw. He required multiple surgeries and endured six weeks of his jaw wired shut. There two stories about 14 year-old girls who were not e-cigarette users: the first was at Universal Studios, where she was burnt from an explosion in a nearby college student’s pocket and second was blinded in a mall. The threat is not just restricted to the user, but those around them. How easy would it be for an e-cigarette explosion to result in a house or apartment fire?

The $15.04 billion e-cigarette industry compounds the problem by continuing to bring these products to the market without appropriate warnings that would apprise unwitting consumers of the potential explosion hazard. It’s not as if the explosion hazard is inevitable; many of the explosions occurred from incorrect use on the consumer’s part, but the threat of, say, using a phone charger on a vape or allowing the vape to charge unattended is rarely emphasized by e-cigarette companies and even more rarely realized by the consumers. Alerting the public to the explosion hazard through conspicuous warnings exactly like the labels on the front of the box declaring nicotine an addictive substance is imperative to reducing the number of explosions.

Because e-cigarettes are relatively new to the consumer market, they remain largely unregulated. The same is true for the lithium batteries used to power these devices. Recently, however, the Food and Drug Administration (FDA) has recommended regulations which could give the agency more control over these products. Consumers need to be aware that these devices are controversial because of the way they are marketed and because they have an unreasonably safe design.

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The breakdown: How e-cigarette users can stay safe

Now, this is a lot of information thrust on you at once, and your questions may remain: if I’ve smoked cigarettes and am looking to quit, is vaping a good option?

  • No; it’s not. Vaping, though advertised as a step towards abstinence, often delivers more nicotine to your system than smoking cigarettes. It only perpetuates your addiction. There are multiple FDA approved options to help you quit that would be much more effective.

If I use rechargeable e-cigarettes, how can I prevent an explosion?

  • Only use the charger that came with the product. Don’t use phone or computer chargers on your vaping device.
  • Buy devices with explosion prevention aspects such as fire button locks and vent holes. If you have a device with these features, do not remove or disable them. 
  • Only use the recommended battery types for your device. Don’t mix different battery brands, use new and old batteries together, or use batteries with different charge levels.
  • Read the manufacturer’s instructions for e-cigarette care and maintenance. If there are none, call the manufacturer.
  • Charge your vape on a clean, flat surface and do not leave it unattended. Keep it away from things that can easily catch fire and in your line of sight at all times.
  • Protect your vape from extreme temperature conditions and don’t leave it in direct sunlight for extended periods of time.

How can I avoid EVALI while vaping?

  • Stick to nicotine e-cigarettes; do not vape THC. Vitamin E acetate, which is found in many THC e-cigarettes, has been strongly linked to EVALI.
  • Buy from formal sources. Do not buy from family members, friends, or online sellers. If you do, you’re running a high risk of buying product that has been tampered with.
  • Tune into your body: if you feel ill from your vape, even if you only use nicotine, take a break. See a doctor if it’s necessary; don’t be stubborn and insist that you’re alright.