When vaping was first introduced it was marketed mainly as a safer alternative to smoking and as a potential smoking cessation method. But increasingly people who have never smoked are vaping, and now the concern is that vaping is more of a pathway into smoking than one out of it.
According to the CDC, about 30% of all adults who vape have never used other tobacco products, but among young adults aged 18-24 the figure is 61.4%. Most vaping products contain nicotine, which is highly addictive, especially to the adolescent brain. Most users establish their habit in adolescence. The industry is now specifically targeting young users with flavored products and influencer campaigns.
Vaping is offered as a safer option to combustible tobacco, and it probably is safer than smoking, but that does not mean that it is safe. There are fewer carcinogens in vaping than in tobacco smoke, but there are some. There hasn’t been enough long term research yet to know the overall risk, so we cannot say definitively, but there is evidence of increased lung cancer risk and cancer markers in even young people who vape. Further, combing vaping and smoking has an increased cancer risk to smoking alone.
Smoking, however, has other health risks other than cancer, specifically cardiopulmonary risks. How do these compare? A 2020 narrative review concluded: “Overall, vaping has been found to cause similar effects as smoking on lung function and cardiovascular function.”
However, this is an area that requires more research, and there is a recent study to fill this gap. The study looks at 75 healthy young adults 18-30 – 25 people smoked but never vaped, 25 people vape but never smoked, and 25 who never smoked or vaped. The groups were otherwise similar in terms of lifestyle risk factors and overall health.
The subjects “underwent an incremental cycle exercise test with standard metabolic, cardiorespiratory, blood lactate and sensory measurements. Brachial artery flow-mediated dilatation (FMD) was assessed using Doppler ultrasound. Blood samples were collected to assess vascular inflammatory markers.”
And they found:
“At peak exercise, both E-cigarette users and C-cigarette smokers had lower exercise capacity, oxygen uptake, and ventilation compared to controls…; all p<0.05). Furthermore, E-cigarette users and C-cigarette smokers demonstrated decreased exercise ventilatory efficiency, with higher ventilation, blood lactate, dyspnoea ratings, and leg discomfort during submaximal exercise compared to controls. E-cigarette users and C-cigarette smokers showed lower FMD compared to never-smokers (p<0.05), which was inversely associated with vascular cell adhesion molecule-1 and thrombospondin-2.”
Basically, both smokers and vapers had about a 15% decreased exercise tolerance compared to non-users. They had decreased lung capacity and oxygen uptake, and increase blood lactate during exercise. Increased lactate is a sign that the muscles are not getting enough oxygen during exercise.
The vape that is inhaled is not just water vaper. Vapes heat a liquid into an aerosol that typically contains nicotine, propylene glycol, vegetable glycerin, and artificial flavorings. When heated, these chemicals break down into heavy metals, carcinogens, and volatile organic compounds. This causes inflammation, and even low levels of chronic inflammation can have negative effects.
The research to date, including this latest study, supports the conclusion that vaping is not safe. It has similar cardiopulmonary effects to smoking and less but still significant carcinogenic effects. Vape that contains nicotine is highly addictive, especially to adolescents. In fact, vaping fluid can has significant nicotine – one vape pen can have as much nicotine as 20 cigarettes.
The FDA now approves 45 vaping products. In May of this year they approved fruit-flavored products that are specifically attractive to young users. Such products are targeted at created new young users who will become addicted long term.
We had made a lot or progress reducing smoking and the diseases that tobacco products cause. But now we are at risk of losing all those gains due to the rise of vaping, which is hooking new users and leading to multiple product use, including nicotine pouches.
Going forward we need more comprehensive regulation before a new generation of users are hooked on these unhealthy products. The Lung Association has: “urged FDA to reconsider its decision to authorize kid-friendly e-cigarette flavors and not authorize any flavored tobacco products moving forward, including mint or menthol.” I agree with this. Kid-friendly products should be banned, and should all advertising aimed at youth, including influencer campaigns.
