In recent months, the national uptick in teen vaping has become less of a viral trend and more of a burgeoning public health emergency. Although e-cigarettes are nothing new, they are coming under increased scrutiny as otherwise healthy, young smokers experience a sudden rise in lung problems — and, now, even deaths. With investigations ongoing, it remains unclear exactly what vaping does to your lungs, but here's what we know so far.
On Sept. 11, Kansas health officials reported that a woman died from lung disease soon after starting to smoke e-cigarettes, marking the sixth potentially vaping-related death in the United States. Less than a week prior, officials in Indiana, California, and Minnesota made announcements linking deaths in their respective states to vaping. Before that were two similar deaths in Oregon and Illinois, according to the Centers for Disease Control and Prevention (CDC), not to mention hundreds of hospitalizations in recent months that have led public health officials to question and warn against e-cigarettes. Muntu Davis, Los Angeles county’s public health officer, compared recent events to the dangers of cigarettes that were unknown decades ago: "We question whether we're on that same path in terms of vaping," he said, according to The Los Angeles Times.
As of Sept. 6, the CDC has cited about 450 cases across 33 states of common symptoms — including chest pain, shortness of breath, and vomiting — among people with histories of vaping. While lung scan results appear similar to pneumonia, tests show there are no infections, according to The New York Times. There is yet no specific substance or product that links all the cases, but the CDC plans to continue identifying a cause through interviews and investigation. It launched an official investigation on Aug. 1, 2019, according to the press release.
“We are committed to finding out what is making people sick,” CDC Director Robert Redfield said in another press release. “All available information is being carefully analyzed, and these initial findings are helping us narrow the focus of our investigation and get us closer to the answers needed to save lives.”
Vaping, which refers to using an electronic device that heats nicotine, marijuana, or other chemicals into a vapor to be inhaled, has long been at the center of health debates regarding youth. In Feb. 2019, the National Institute of Health revealed an almost 10% increase in the number of teenagers who have tried vaping from 2017 to 2018. As for nicotine specifically, the 2018 National Youth Tobacco Survey found that e-cigarettes fueled "alarming increases" in teenage use of tobacco overall.
Diana Zuckerman, president of think tank the National Center for Health Research, tells Elite Daily in an interview that despite the current lack of conclusive evidence, recent episodes have been a serious warning sign about the unknown dangers of vaping. One reason it's so difficult to identify causes, she says, is because patients report such a wide variety of vaping histories. "People who have been harmed are being asked what they were vaping and we don’t know if they’re describing it accurately, either intentionally or unintentionally," she notes. Patients have generally in their late teens and twenties, but otherwise healthy — with similar symptoms including vomiting, fever, and fatigue, per The New York Times.
The sudden rise in health concerns may be attributable to greater awareness or more states beginning to report cases, Zuckerman said. Or, while e-cigarette companies say they have been safely selling their products for years, it may simply be that it's taken time to notice the health effects of a relatively new technology. "It's not like people are vaping and ending up at the hospital the next minute," she said. "Certainly, I wouldn't think that people are vaping more than usual in the past week."
One potential cause may be the oil solvent ingredients in e-cigarettes, which are mixed with nicotine or marijuana to become vapor. Inhaling these oils may cause lung problems, according to The New York Times. The FDA reported that a significant number of recent samples tested for the investigation identified two specific ingredients. One is the tetrahydrocannabinol (THC) in marijuana vaping products, and the second is vitamin E acetate, one of those oil solvents. Although there is no conclusive link, the FDA urged against using THC oils in a consumer update on Sept. 6.
A report in The New England Journal of Medicine on Sept. 6, however, found that about 20% of studied patients had not ingested THC at all and had only vaped nicotine products. Further, as many vaping products do not list all their ingredients, it is hard to know what contains Vitamin E acetate. Vitamin E acetates are commonly used as dietary supplements, and although there is no proven link, it is "a good example of something that seemed absolutely safe and innocuous" but may turn out not to be when inhaled as vapor instead of swallowed, Zuckerman says.
She added that although many people suspected dangerously altered home brews as a potential cause, standard market e-cigarettes may be responsible as well. In the meantime, the FDA and CDC have emphasized that smokers should not modify or buy products off the street. On Sept. 11, the Trump administration announced it plans to ban sales of most flavored e-cigarettes, two days after the FDA concluded e-cigarette company Juul illegally marketed its products as a less harmful alternative to cigarettes, per The New York Times. In a statement to Elite Daily on Sept. 11, a representative of Juul said that the company was "reviewing the letters [from the FDA] and will fully cooperate." In August 2019, it declared a company priority to combat youth vaping and announced further measures to restrict youth access to vapor products. Zuckerman said the epidemic is "an enormous wakeup call" for people who thought of vaping as a safer alternative to cigarettes, and that parents should be more wary about their children vaping.
"Years ago, we knew that we didn't know how safe or unsafe [e-cigarettes] were, because it takes research to find that out," Zuckerman said. "We didn't know all the risks of cigarette smoking for decades. So, just because a product is new and hasn't killed anybody yet doesn't mean it's safe."
All this goes to say, once again, that while experts do not fully understand potentially adverse health effects, it is better safe than sorry. For now, the best option is to avoid e-cigarettes altogether — or, at the very least, to know what ingredients are in vaping products and where they're coming from.