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The truth about vaping
We finally have enough data to get a grip on the potential health consequences of this increasingly popular addiction, says Graham Lawton, published December 9, 2023
AS THE old joke goes, when I read about the dangers of smoking, I gave up reading. If you are a vaper, you might feel like you want to stop reading now. Don’t: you need to know this.
I am a vaper. Like many others, I used to smoke and switched to vaping for health reasons. I plan to quit completely, but I haven’t managed it yet. I am sure vaping is better for me than smoking, but I am also sure it is worse than not vaping. I cough in the morning and feel massively addicted to the nicotine. I don’t even really know what I am inhaling. I worry that it will be hard to quit, that I am causing long-term damage to my body and that by vaping, I am susceptible to slipping back down the slope to cigarettes. I also have the same worries for the teenagers I see coming out of school and immediately enveloping themselves in sweet-smelling clouds.
As vaping has increased throughout the Western world, these fears have been repeated often. Part of last month’s King’s Speech in the UK focused on new legislation aiming to create a smoke-free generation in part by cracking down on youth vaping. Worldwide, there have been calls for tougher regulation and more investigation into vaping’s health effects as increasing numbers of children admit to taking up the habit.
But there hasn’t been a huge amount to say on whether fears over health effects are well-founded – until recently. Now, vaping has finally been around for long enough for answers to start emerging from the fog.
Modern e-cigarettes first went on sale in China in 2004. They entered the UK, US and other Western markets soon afterwards and have grown in popularity ever since. England now has about 4.5 million regular or occasional vapers – 7.5 per cent of the population. The US has a similar percentage. Vaping among teens and young adults has rocketed, peaking at 27.5 per cent in high school students in 2019 in the US, according to the US Food and Drug Administration National Youth Tobacco Survey. In the UK, the proportion of children aged between 11 and 17 experimenting with vaping grew by 50 per cent in the past year. This is all despite it being an offence to sell e-cigarettes to people under 18 in the UK and under 21 in the US.
Harmful ingredients
Vapes vary in design, but they all have the same basic features: a tank for the “e-liquid”, a heating element to vaporise the liquid and a mouthpiece to inhale the resulting aerosol. Despite the name, vapes don’t produce vapour, but rather a suspension of particles and droplets in a gas. For that reason, many health bodies prefer to call them electronic nicotine delivery systems, or ENDS. E-liquids typically contain nicotine and flavourings, as well as a solvent to dissolve them and convey them into the lungs. The most common solvents are propylene glycol and glycerin.
The short-term health impacts of vaping – and some potential long-term consequences – are now quite well-known. What has become clear is that they aren’t all sweetness and light. Let’s start with the e-liquid. All three of its standard ingredients can do immediate harm. Nicotine is addictive and overstimulates the sympathetic nervous system, causing the heart to beat harder and faster and blood pressure to rise, according to the American Heart Association (AHA), which published a scientific statement on ENDS in July. As yet, there is no evidence of this leading directly to heart attacks or other cardiovascular problems, but chronic overstimulation of the heart is known to be a risk factor for cardiac failure.
The solvents, meanwhile, can irritate and inflame the airways. Propylene glycol and glycerin are both generally recognised as safe by the FDA, by which it means they are non-toxic. However, manufacturers of the chemicals recommend that inhalation be avoided. Short-term exposure can lead to coughing, a sore throat and decreased lung function. Perhaps that is where my morning cough has come from. In studies on the effects of theatrical smoke, long-term exposure to propylene glycol is associated with wheeziness and chest tightening.
Some flavourings found in vapes also ring alarm bells for the AHA. The buttery compounds diacetyl and acetylpropionyl are known industrial hazards. Some of the other common flavours – menthol, coffee, strawberry, chocolate, cinnamon, sweet tobacco, caramel and vanilla – contain compounds that produce inflammatory responses in cultured cells. Sweeteners including sucrose and glucose, meanwhile, are converted by heat into compounds called reactive aldehydes, which are believed to be a leading cause of heart and lung disease in smokers.
Vapes also chuck out some unintentional byproducts, including heavy metals released from the heating element. Some elements contain a nickel-chromium alloy: rats exposed to nicotine-free aerosols produced using these elements developed wheezing and laboured breathing, while stainless steel elements didn’t have the same effect. Studies of people exposed to nickel and chromium compounds through their occupation show an association with increased risk of lung cancer, and nickel is one of the few carcinogens to be found in higher amounts in some vapes than in tobacco smoke. There is also evidence that the older an element or disposable vape, the more heavy metal pollution it spews out. The 101st-to-150th puffs on a disposable produce about 60 times as much as the first 50.
Vape aerosol also delivers some of the nasties found in tobacco smoke: carbon monoxide, tobacco-specific nitrosamines and volatile organic compounds (VOCs), such as formaldehyde and acrolein. But where data exists, it consistently shows much lower levels of exposure from vaping than from smoking, according to a 2022 review by Public Health England (PHE). I blew some vape aerosol into my indoor air quality monitor and was pleasantly reassured by the fact that it failed to trigger the VOC alarm, which occurs when they reach a harmful concentration.
When it comes to identifying the relationship between vaping in general and cancer, there are some red flags. Some animal and cell culture studies suggest that vaping may produce the kinds of DNA damage, inflammation and other biological alarm bells that are known to precede a tumour. One study exposed mice to 54 weeks of vaping aerosol and found that they developed lung and bladder cancer much more often than their non-vaping counterparts.
However, whether these effects in animal models correspond with a risk of disease in humans isn’t yet clear (see “Does vaping wreck your lungs?”, below). “The precise long-term effects of vaping nicotine will not be fully known for decades,” says Wayne Hall at the University of Queensland in Brisbane. In a recent statement, the AHA points out that it took decades to establish the link between smoking and lung cancer, but vaping has only been widely practised for 10 years.
Nonetheless, the review by PHE answers some other important questions. It found little evidence of toxic substances in the bodies of vapers, with significantly lower levels than in smokers, and often the same or only slightly higher levels than in people who don’t smoke or vape. It also looked at biomarkers associated with cancer, respiratory and cardiovascular conditions and found the same pattern. Nor was there evidence of a risk from second-hand vape.
PHE did flag up the buttery flavourings and cinnamaldehyde (which gives a cinnamon flavour) as potentially concerning, but absolved the solvents. Overall, the review concluded, even though vaping isn’t risk-free, it “poses a small fraction of the risks of smoking” in the short and medium term. This is in keeping with its earlier review, from 2015, in which it concluded that e-cigarettes are around 95 per cent less harmful than smoking.
That chimes with my experience. I have smoked. I have vaped. I have mixed and matched, and I have abstained altogether. Quitting both is obviously preferable, and I will get there one day, but smoking feels at least 20 times worse for my health. And it stinks.
Indeed, I have much to thank my vape for. I have successfully used it to wean myself off smoking, as have many others. According to PHE, data from smoking cessation services in England shows that vaping is now a key weapon in the smoke-free arsenal. People who go cold turkey have a roughly 50 per cent success rate over a four-week period from their date of quitting. Switching to a vape increases that to just over 60 per cent. Vaping plus a prescription drug (nicotine replacement therapy, or the now-unavailable bupropion or varenicline, which were withdrawn from the market after reports of contamination with toxins) was even more successful.
There is no evidence of health risks from second-hand vape
[click thru for this discussion and about how vaping is largely effective at decreasing smoking in the groups using it]
[Useful information on safely vaping is included at the end of this article.]
Abycats' Thoughts 