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A 22-year-old man received a double lung transplant earlier this month after being on life support for 70 days.

Jackson Allard, a North Dakota resident, went to the emergency room for a stomach ache in October, but was instead admitted to the hospital because his oxygen levels had dipped too low. The news was first reported by Valley News Live based on a GoFundMe page set up by Allard's family friend.

Doctors in North Dakota diagnosed Allard with parainfluenza, a virus that can cause respiratory infections, which spiraled into pneumonia, then acute respiratory distress syndrome - a life-threatening injury caused by fluid build-up in the lungs.

"When they did X-rays, you couldn't even see his heart. It was all white. So that means the whole lung was full of fluid," said Doreen Hurlburt, Allard's grandmother.

Hurlburt said Allard had used e-cigarettes since he was 16 or 17, but recently started vaping more heavily.

"He had no idea how bad it was for him," she said. "The day before he was intubated, he said, 'I had no idea I could get this sick.'"

Scientists still don't fully understand the association between vaping and lung disease, so it's unclear what role vaping may have played in Allard's case. Some studies suggest that using e-cigarettes could make people more susceptible to respiratory tract infections.

Dr. Brian Keller, medical director of the Massachusetts General Hospital Lung Transplantation Program, said studies involving animals and human cells have shown that e-cigarette use can damage blood vessels and cells that line the lungs. But scientists are still trying to narrow in on which compounds in e-cigarettes are the worst for human health.

"There's actually several that can cause damage," Keller said. "This includes the nicotine itself, but also the burning of a carrier fluid like propylene glycol or glycerol, as well as the flavoring that a lot of people add to their vaping device."

Hurlburt said her grandson's doctors suspected that his use of e-cigarettes prevented him from recovering from his initial viral infection.

"As he was not getting better, they're like, 'Well, he vaped and vaping hurts your lungs,'" she said.

Allard's mother, Jaime Foertsch, said her son was placed on a life-support device called extracorporeal membrane oxygenation, or ECMO, then airlifted to M Health Fairview in Minnesota at the end of October.

Foertsch said Allard was the longest patient that M Health Fairview had ever kept on an ECMO machine, which adds oxygen to the blood and sends it back to the body. A hospital representative declined to comment on Monday, citing the Health Insurance Portability and Accountability Act (HIPAA), which safeguards patient privacy.

To be considered for a transplant, Allard needed to come off sedation and be able to walk. But at the end of last year he was struggling to survive: Doctors had to replace parts of his ECMO device twice due to blood clots forming, which could have been fatal. Then on Dec. 12, he went into cardiac arrest and had to be resuscitated.

"In several family meetings the [Surgical Intensive Care Unit] team said there was a 1% chance of survival," Foertsch said in an email. "We never gave up and kept advocating for Jackson."

By the end of the month, Allard had improved and was able to stand and take a few steps, his family said.

"All of a sudden, it just turned around," Hurlburt said. "It was just like day and night."

On New Year's Eve, Foertsch got the call that doctors had allocated a pair of new lungs to her son. Allard received a transplant the next day. By Jan. 5, he no longer required life support.

Allard is still on a ventilator in the ICU, his mother said, but he's able to get in and out of bed with some help and walk about 5 feet with a walker.

"The nurses are calling him a legend and a miracle," Foertsch said. "He is getting stronger every day and hopes he will be moved to rehab soon."

Hurbult said her grandson still needs to re-learn how to talk, but he's able to communicate.

"He thanked the nurses for all the help," she said. "He just said, 'Thanks for working so hard to save me.' He's a sweet kid."

Lung transplants are relatively rare, and even rarer for people under age 50. Out of 2,569 lung transplants performed in the U.S. in 2021, just 440 were in recipients ages 18 to 49. Most vaping-related lung injuries don't require a transplant, but patients typically need some type of respiratory support like supplemental oxygen or mechanical ventilation.

"I've only been able to come across a couple of reports of patients requiring lung transplant after vaping," Keller said.

A 17-year-old boy in Michigan who received a transplant in 2019 is believed to be the first case. Last year, a 34-year-old man in Missouri also received a double lung transplant after developing a life-threatening lung infection that was resistant to antibiotics. The man had a history of smoking cigarettes and also vaped for nine years.

Around 54% of those who receive a lung transplant survive for at least five years after surgery.

Hurbult said Allard will need to spend around six months in Minneapolis so doctors can monitor his progress and make sure he's tolerating the transplant. But his family anticipates a full recovery.

"He's going to get his life back," Hurbult said. "We're going to get our Jackson back."

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22-year-old man who vaped required double lung transplant: 'He had no idea how bad it was'

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Jackson Allard spent 70 days on life support after a parainfluenza infection. His family thinks vaping may have exacerbated his illness.

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A ban on disposable vapes could discourage the use of e-cigarettes among people who are trying to quit smoking, research has found.

The government is considering a ban over concerns that children are using the products and becoming addicted. However, a study by academics at University College London and funded by Cancer Research UK has found it would also affect 2.6 million adults across Great Britain, 1.2 million of whom smoke and a further 744,000 who have previously.

The research, published in the journal Public Health, was based on a survey of 69,973 adults. It found that between January 2021 and August 2023 the percentage of the population using disposable e-cigarettes grew from 0.1% to 4.9%.

The researchers said that although preventing the uptake of vaping by children and those who have never smoked was a "public health priority", the ban may inadvertently discourage the use of e-cigarettes among people who are trying to quit smoking. The study said: "Vaping is substantially less harmful than smoking, so it is essential that a ban on disposables does not discourage people who smoke from switching to vaping."

Dr Sarah Jackson of UCL's Institute of Epidemiology and Health Care, and the lead author of the study, said: "Our study suggests a ban on disposable e-cigarettes would affect an estimated 2.6 million people in England, Wales and Scotland.

"While banning disposables might seem like a straightforward solution to reduce youth vaping, it could have substantial unintended consequences for people who smoke.

"In the event of a ban, it would be important to encourage current and ex-smokers who use disposables to switch to other types of e-cigarettes rather than going back to just smoking tobacco."

Prof Jamie Brown, the senior author of the study, said: "There is a need for action to reduce disposable vaping among young people who have never smoked. However, trade-offs need to be carefully considered. A ban may discourage use of e-cigarettes among people trying to quit smoking and may induce relapse among those who have already used disposables to quit.

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"Cigarettes are far more harmful to our health and are not currently banned, and a ban on disposable e-cigarettes may signal to large numbers of people that these products are worse for our health or that their harm is comparable to that caused by smoking tobacco."

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Disposable vapes ban 'could lead to relapse in people trying to quit smoking'

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Study suggests proposal to prevent uptake by children in UK may discourage use of e-cigarettes instead of tobacco among adults

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Sumner County School officials are hoping they can help their students kick the vaping habit by installing special sensors in the places they visit most to sneak secret puffs, school bathrooms.

The district's efforts come as Tennessee ranked the highest of all 50 states and Washington D.C. for vape usage, according to a study published by Forbes Advisor. In the U.S, about 2.8 million school-aged kids vape, according to data from the annual National Youth Tobacco Survey.

"At the end of the day, if we can eliminate eight hours of the activity, we've got a shot at eliminating it completely," Sumner County Schools Director Scott Langford said in a school board meeting this week.

"If you are having to go two or three times during the day to hit a vape for either nicotine or THC, that's a problem for any kid, but it's definitely a problem for a kid under 18, and the quicker we can get them help, the better off they'll be," he said.

More: What states vape the most? Tennessee leads the way and so does the South

About 1.97 million high school students and 800,000 middle school students currently use tobacco products, the U.S. Food and Drug Administration and Centers for Disease Control and Prevention reported in November 2023.

And among those who reported using e-cigarettes - more than 2.1 million kids - more than one in four used them daily in 2023, choosing offerings from popular brands like Elf Bar, Esco Bars, Vuse, JUUL and Mr. Fog, according to national survey findings on youth use of e-cigarette products.

Results from the annual survey also show that while tobacco use decreased among high school students by 3.9%, it increased among middle school students by 2.1%.

This figure, 3.9%, translates to about 580,000 fewer high school students using e-cigarettes - the primary reason for the decline, according to the survey.

Sumner County Schools crack down on vaping

Sumner County School Board members voted unanimously Tuesday to approve the purchase of vape sensors, and they plan to install them in middle and high school bathrooms across the district.

No information was provided about how much the sensors cost or how many the district plans to install in each school. Emails requesting specific information about the sensors, including these details, were unreturned as of press time for this story.

"Kids that are dealing drugs, we're expelling. If you're dealing drugs on a Sumner County school campus, you're expelled. We're not going to let someone bring down other kids, and I support that. I don't like to be hardline on things, but I don't see any choice in that," Langford said.

"If we hit it with enough of a consequence and kids know that the sensors are there, it discourages the activity during the school day... also, if it triggers, it gives us a much faster opportunity to intervene to get help to a child that's got a problem."

Several offenses, including the unlawful possession of any drug on school grounds or at a school-sponsored event, are noted as Zero Tolerance Offenses in the Sumner County Schools handbook and may result in a student being expelled from regular attendance at school for at least one calendar year.

Policy changes are being discussed for students who trip the vape sensors.

"We would expect (the sensors) to be operational, fully, by next semester... that way we can put all of that in student handbooks and have all the procedures and everything down pat before we get started," Katie Brown, assistant director of schools for student services, said in Tuesday's board meeting.

How do the sensors work?

The sensors detect changes in the atmosphere like smoke and sound, officials said last week. Brown noted that they would pick up, "a loud noise, like if there's vandalism or screaming, a fight or something like that, or smoke or any kind of vapor.

"Sometimes, in our trial, we did notice that some cleaning products were sending that off... but it's really just a change in the atmosphere around the sensor," she said.

After a sensor has been triggered, a notification will be sent to school administrators, who can then view a real-time video feed from a camera in the hallway.

"They can see who's entering and leaving the bathroom in real time," Brown said.

Sensors inside the bathroom facilities won't record conversations, district officials confirmed in the meeting.
Katie Nixon can be reached at knixon@gannett.com.

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Sumner Schools to install vape sensors in middle, high school bathrooms. Are kids vaping?

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Sumner County Schools officials crack down on vaping.

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New American Heart Association scientific statement outlines current science on health effects of e-cigarette use, calls for more research on long-term impact
Statement Highlights:

The number of people who use electronic nicotine delivery systems, typically referred to as e-cigarettes, has grown exponentially, especially among youth and young adults. E-cigarette use more than doubled from 2017 to 2019 among middle and high school students.

Ingredients of e-cigarettes, including nicotine, flavoring agents, sweeteners and propylene glycol and vegetable glycerol, may each independently pose dangerous health risks.

More clinical studies on the long-term impact of e-cigarettes on the heart, blood vessels and lungs are needed, and experts emphasize additional molecular and laboratory research is needed in the interim to help determine biological implications of e-cigarette use.

Embargoed until 4 a.m. CT / 5 a.m. ET Monday, July 17, 20 23
DALLAS, July 17, 2023 - Research increasingly reveals health risks of e-cigarette use, and more studies are needed about the long-term impact e-cigarettes may have on the heart and lungs, according to a new scientific statement from the American Heart Association published today in the Association's flagship journal Circulation.

The new scientific statement, "Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products," details the latest usage data and trends, identifies current health impacts, highlights existing basic and clinical scientific evidence surrounding e-cigarettes and recommends research priorities to further understand the short- and long-term health effects of e-cigarette use.

Vaping products, also known as e-cigarettes, are battery-operated systems that heat a liquid solution, or e-liquid, to create an aerosol that is inhaled into the lungs. Most e-liquid formulations deliver nicotine, which has been established as having negative health effects as well as strong addictive properties. The products may also contain other substances, most commonly tetrahydrocannabinol (THC), the psychoactive element of cannabis, as well as methamphetamine, methadone or vitamins. The liquids also include humectants (hygroscopic carriers such as propylene glycol and vegetable glycerol) that act as solvents and create a water aerosol or vapor, flavoring agents, cooling agents such as menthol and sweeteners, in addition to metals from the heating coil and other chemicals.

"E-cigarettes deliver numerous substances into the body that are potentially harmful, including chemicals and other compounds that are likely not known to or understood by the user. There is research indicating that nicotine-containing e-cigarettes are associated with acute changes in several hemodynamic measures, including increases in blood pressure and heart rate," said the volunteer chair of the scientific statement writing committee Jason J. Rose, M.D., M.B.A., an associate professor of medicine and the associate dean of innovation and physician science development at the University of Maryland School of Medicine in Baltimore. "There has also been research indicating that even when nicotine is not present, ingredients in e-cigarettes, particularly flavoring agents, independently carry risks associated with heart and lung diseases in animals. Negative effects of e-cigarettes have been shown through in vitro studies and in studies of individuals exposed to chemicals in commercially available products."

The writing committee points to the significance of the clinical diagnosis of "E-cigarette, or Vaping, product use Associated Lung Injury" (EVALI). EVALI was first recognized as a condition by the U.S. Centers for Disease Control and Prevention in 2019, when approximately 2,800 hospitalizations occurred among e-cigarette users in less than a year. This is cited in the statement as one example that emphasizes the lack of knowledge surrounding the risks of e-cigarettes and their ingredients. In the case of the EVALI hospitalizations, vitamin E acetate has been implicated as the ingredient likely causing illness. This substance is used as a thickening agent in some e-cigarette liquids.

Studies gauging the specific impact e-cigarettes have on heart attacks and strokes are limited. Much research on e-cigarette use has been conducted in people who have also used or were currently using traditional cigarettes. Additionally, large survey studies have focused on younger adults who have a low occurrence of heart attacks and strokes. The writing committee says longer-term studies of e-cigarettes users of all ages are needed, including among people who already have cardiovascular disease.

One recent analysis of the adult Population Assessment of Tobacco and Health (PATH) study found a statistically significant association between former or current e-cigarette use at the time participants enrolled in the study and the development of incident respiratory disease (chronic obstructive pulmonary disease/COPD, chronic bronchitis, emphysema or asthma) within the next two years. The PATH Study, an ongoing study that started in 2013, is one of the first large tobacco research efforts undertaken by the National Institutes of Health and the U.S. Food and Drug Administration.

Additional studies cited in the statement indicate a rapid increase since 2010 in the number of people who had ever used e-cigarettes or were currently using the devices, and most of those users were current or former traditional cigarette smokers. In addition, by 2016, data from the Behavioral Risk Factor Surveillance System indicated about 1.2 million adults in the U.S. who had never smoked combustible cigarettes before were currently using e-cigarettes.

The writing committee noted that e-cigarettes are reported to be the most commonly used tobacco product among youth, particularly high school and middle school students. The statement cites data showing that almost 3 out of 4 young people using e-cigarettes exclusively report using flavored e-cigarette products. This high rate of use by youth makes it critical to assess the short- and long-term health effects of these products, according to the statement.

"Young people often become attracted to the flavors available in these products and can develop nicotine dependence from e-cigarette use. There is significant concern about young people assuming e-cigarettes are not harmful because they are widely available and marketed to an age group that includes many people who have never used any tobacco products," Rose said. "The long-term risks of using e-cigarettes are unknown, but if the risks of chronic use are like combustible cigarettes, or even if the risks are reduced but still present, we may not observe them for decades. What is equally concerning is that studies show that some youth who use e-cigarettes go on to use other tobacco products, and there is also a correlation between e-cigarette use and substance use disorders."

Given the established, high health risks of smoking combustible cigarettes, e-cigarette products have been evaluated as smoking cessation tools. The writing committee examined the limited research in this area and concluded that any benefits e-cigarettes may offer to help people stop smoking or stop using tobacco products needs to be clearly balanced alongside the products' known and unknown potential health risks, including the known risk of long-term dependence on these products.

"E-cigarette companies have suggested that their products are a way to quit smoking traditional cigarettes. There is no strong evidence to support this beyond any short-term benefit. The lack of long-term scientific safety data on e-cigarette use, along with the potential for the addiction to e-cigarette products seen among youth, are among the reasons the American Heart Association does not recommend e-cigarette use for cessation efforts," said Rose Marie Robertson, M.D., FAHA, the Association's deputy chief science and medical officer and co-director of the Association's Tobacco Center of Regulatory Science. "It's also important to note that e-cigarette products are not approved by the U.S. Food and Drug Administration (FDA) for tobacco cessation. The Association recommends a combination of multiple-episode cessation counselling accompanied by personalized nicotine replacement therapy with FDA-approved doses and formulations, as well as medications to help control cravings, to help people who smoke combustible cigarettes with cessation. And all of this needs to be undertaken with the understanding that quitting often takes many tries, and any failures should be seen as just episodes to learn from on the road to finally beating a powerful addiction for good."

The scientific statement writing committee emphasizes a critical need for additional knowledge and research, specifically:

Future research should focus on gaining knowledge about serious and potentially long-term effects of e-cigarettes on the heart, blood vessels and lungs.

Studies are needed that include patients with pre-existing cardiopulmonary disease, such as coronary artery disease or chronic obstructive pulmonary disease, to evaluate and compare outcomes among e-cigarette users in comparison to traditional smokers, and those who use e-cigarettes along with traditional cigarettes (referred to as dual users) and nonsmokers.

More in-depth research is needed about the common chemical ingredients in e-cigarettes and the effects they independently have on pulmonary and cardiac health.

Clinical studies are needed to study the risks and potential benefits of e-cigarettes as alternatives to traditional combustible cigarettes.

Since the long-term health impact of e-cigarettes may take decades to emerge, more molecular and laboratory studies are needed in the interim to help determine the biological implications of e-cigarette use.

"Because e-cigarettes and other vaping systems have only been in the U.S. for about 15 years, we do not yet have enough information on their long-term health effects, so we must rely on shorter term studies, molecular experiments and research in animals to try to assess the true risk of using e-cigarettes," Jason Rose added. "It is necessary for us to expand this type of research since the adoption of e-cigarettes has grown exponentially, especially in young people, many of whom may have never used combustible cigarettes."

The scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association's Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; the Council on Epidemiology and Prevention; the Council on Cardiovascular Radiology and Intervention; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; the Stroke Council; and the Council on Arteriosclerosis, Thrombosis and Vascular Biology. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations.

Statement writing group members and their disclosures are listed in the manuscript.
Additional Resources: About the American Heart Association
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association's overall financial information are available here.
### For Media Inquiries: 214-706-1173
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

Cathy Lewis: 214-706-1324; cathy.lewis@heart.org

Arielle Beer: 202-785-7902; arielle.beer@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

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Current evidence identifies health risks of e-cigarette use; long-term research needed

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Statement Highlights: The number of people who use electronic nicotine delivery systems, typically referred to as e-cigarettes, has grown exponentially, especially among youth and young adults. E-cigarette use more than doubled from 2017 to 2019 among ...

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The vaping-smoking debate
Smoking and health
Rise of vaping
Vaping and respiratory health
Vaping vs smoking: A health comparison
Public health implications
Making healthier choices
References
Further reading

​​​​​​​The vaping-smoking debate

For decades, smoking has been a major public health concern, with medical experts across the globe warning against the serious health impacts of smoking and highlighting the threat it poses to public health.

In recent years, vaping has emerged as an increasingly popular alternative to smoking. While it is often seen as a less dangerous habit, it is highly addictive and its long-term impact is yet to be fully understood, due to the newness of vaping. Recent research has linked vaping with increased risk of lung disease, and cardiovascular disease.

There is also rising concern over the impact of vaping on children. Data indicates that vaping is more popular among children than smoking ever was. From 2022 to 2023 the proportion of children experimenting with vaping grew by 50%.

​​​​​​​Image Credit: ducu59us /Shutterstock.com

Smoking and health

According to the World Health Organization (WHO), tobacco kills 8 million people each year, including 1.3 million non-smokers who die from exposure to second-hand smoke. Of smokers who do not quit, one in three will die from their habit.

Smoking is the leading cause of preventable death across the globe and the number one cause of cancer. Roughly 90% of lung cancer cases in men and 70-80% of cases in women are attributed to cigarette smoking.

The Centers for Disease Control and Prevention (CDC) highlight that smoking is known to cause not only cancer, but also heart disease, stroke, diabetes, lung diseases, and chronic obstructive pulmonary disease (COPD). It is also associated with an increased risk of eye diseases, tuberculosis, and immune system illnesses.

Rise of vaping

The use of e-cigarettes, known as vaping, is different from the traditional smoking of tobacco. It involves a device that heats nicotine along with flavorings and other chemicals to produce an aerosol that is inhaled by the user.

Vaping is largely perceived as a safer alternative to smoking. While vaping does not expose users to tar or carbon monoxide, two of the most dangerous elements in tobacco smoke, vaping is far from safe and has its own health risks.

Vaping's increase in popularity, particularly among young people, is a major cause for concern due to the real health risks associated with vaping. An astounding 2.55 million US middle school and high school students reported using e-cigarettes in 2022. While many experts agree that compared with smoking, vaping is less dangerous to health, it is not a safe alternative and should not be promoted as such.

Vaping and respiratory health

In 2019, reports of severe and sudden lung problems related to vaping emerged in the news. The condition that was termed e-cigarette or vaping use-associated lung injury (EVALI) resulted in the hospitalization of 2,800 patients, as of February 2020, 68 of which died. Sadly, most cases reported were among teens and young adults.

Since the outbreak of EVALI, researchers have begun to understand the mechanisms of the disease. So far, we know that the pathophysiologic mechanisms that underlie the disease most likely involve cytotoxicity and neutrophilic inflammation that is a result of inhaling the chemicals used in vapes.

E-cigarette use has also been linked with pre-symptomatic cardiovascular dysfunction. The vapor inhaled from e-cigarettes contains harmful substances including diacetyl, which is linked to lung disease; acrolein, which causes lung injury and COPD; and aldehydes, which are known to cause lung disease and heart disease. E-cigarette vapor also includes cancer-causing chemicals, heavy metals, and volatile organic compounds (VOCs), which are known to pose risks to health.

Finally, e-cigarettes also pose a second-hand smoke risk, like regular tobacco cigarettes. The devices do not just emit harmless water vapor, as some argue. The vapor emitted by e-cigarettes contains a cocktail of toxins that are known to cause cancer, nicotine, and ultrafine particles.

Smokefree 'Health Harms' - Impact of smoking vs vaping demonstration

Vaping vs smoking: A health comparison

Vaping is relatively new, and therefore, we do not have data on its long-term health effects. The health risks of smoking, on the other hand, are very well understood. Therefore, it is not possible to make a thorough comparison between vaping and smoking at this point.

What we do know is that vaping is not a risk-free alternative to smoking and it has been associated with an increased risk of a number of diseases including lung illnesses, stroke, cancer, pneumonia, and even mental health issues such as depression and anxiety.

Public health implications

There is an urgent need to address the growing popularity of vaping among young people and children. E-cigarette companies have been accused of deliberately targeting young adults and adolescents via tactics such as leveraging social media, sponsorship of festivals and music events, and introduction of flavors that appeal to youth.

If strategies are not implemented to protect young people from vaping then the next generation may face a plethora of negative health impacts, the likes of which are not completely clear. What we do know is that vaping is detrimental to health, and children should be protected from picking up this habit. Equally, it should not be seen as a healthy alternative to smoking.

Making healthier choices

While experts generally agree that the health risks of vaping are less severe than those of smoking, vaping should still be discouraged by health organizations, and children should be protected from being introduced to it. There is an argument for using vaping as a method to assist those with a smoking habit in quitting tobacco products, however, the risks of vaping should be made clear to users.

Many strategies that have been used to target smoking may be applicable to vaping, such as adding appropriate warnings to vaping products and removing products from visible displays in shops.

Overall, there should be an effort not only to stop tobacco smoking but also to stop vaping.

References

Dai, X. et al. (2022) 'Health effects associated with smoking: A burden of proof study', Nature Medicine, 28(10), pp. 2045-2055. doi:10.1038/s41591-022-01978-x.

Groner, J. (2022) 'Health effects of electronic cigarettes', Current Problems in Pediatric and Adolescent Health Care, 52(6), p. 101202. doi:10.1016/j.cppeds.2022.101202.

More than 2.5 Million Youth Reported E-Cigarette Use in 2022 [online]. CDC. Available at: https://www.cdc.gov/media/releases/2022/p1007-e-cigarette-use.html (Accessed October 2023)

Outbreak of Lung Injury Associated with the use of E-Cigarette, or Vaping, Products [online]. CDC. Available at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (Accessed October 2023)

Park, J.-A., Crotty Alexander, L.E. and Christiani, D.C. (2022) 'Vaping and lung inflammation and injury', Annual Review of Physiology, 84(1), pp. 611-629. doi:10.1146/annurev-physiol-061121-040014.

Walser, T. et al. (2008) 'Smoking and lung cancer: The role of inflammation', Proceedings of the American Thoracic Society, 5(8), pp. 811-815. doi:10.1513/pats.200809-100th.

Further Reading

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Vaping vs. Smoking: Is One Really Safer Than the Other?

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Vaping has emerged as an increasingly popular alternative to smoking.

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E-cigarettes can take a toll on your skin! 6 side effects of vaping

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Vaping is not a safer alternative to traditional smoking! Here are 6 side effects of vaping on skin and how to protect your skin against them.

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Vaping is the act of using e-cigarettes, which were first introduced in the United States around 2006.

E-cigarettes are battery-powered devices that heat a liquid into an aerosol vapor for inhalation. The liquid used in e-cigarettes is also known as e-liquid or vape juice. The main components are generally flavoring, nicotine, and water, along with vegetable glycerin and propylene glycol, which distribute the flavor and nicotine in the liquid and create the vapor. Popular flavorings include mint, mango, and tobacco.

E-cigarettes are also known as "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," "vaporizers," "e-pipes," and "electronic nicotine delivery systems (ENDS)." Some e-cigarettes are made to resemble regular cigarettes, cigars, or pipes, while others look like pens or USB flash drives.

The JUUL brand of e-cigarettes, a vaporizer shaped like a USB drive, launched in 2015 and captured nearly 75% of the market in 2018, becoming so popular that vaping is often referred to as "juuling." Juul's market popularity has since declined to 42% in 2020.

The US Food and Drug Administration (FDA) has regulated e-cigarettes as a tobacco product since 2016. On Sep. 11, 2019, the Trump administration announced plans to have the FDA end sales of non-tobacco e-cigarette flavors such as mint or menthol in response to concerns over teen vaping. E-cigarette manufacturers were required to request FDA permission to keep flavored products on the market. The FDA had until Sep. 9, 2021 to make a decision.

On Sep. 9, 2021, Acting FDA Commissioner Janet Woodcock and Director of the FDA's Center for Tobacco Products Mitch Zeller announced that the FDA had made decisions on 93% of the 6.5 million submitted applications for "deemed" new tobacco products ("'deemed' new" means the FDA newly has authority to review the products but the products may already be on the market), including denying 946,000 vaping products "because their applications lacked sufficient evidence that they have a benefit to adult smokers to overcome the public health threat posed by the well-documented, alarming levels of youth use." The FDA had taken no action on JUUL products as of Sep. 9.

On Oct. 12, 2021, the FDA authorized the Vuse e-cigarette and cartridges, marketed by R.J. Reynolds one of the world's largest cigarette manufacturers. The move is the first time the FDA authorized any vaping product. According to a statement from the FDA, the organization "determined that the potential benefit to smokers who switch completely or significantly reduce their cigarette use, would outweigh the risk to youth."

On June 23, 2022, the FDA ordered Juul to stop selling "all of their products currently marketed in the United States." The order included removing products currently on the market, including Juul devices (vape pens) and pods (cartridges). The following day, June 24, 2022, a federal appeals court temporarily put the ban on hold while the court reviewed Juul's appeal. On Sep. 6, 2022, Juul settled a lawsuit brought by almost 36 states and Puerto Rico. The states and Puerto Rico accused Juul of marketing to minors. Juul admitted no wrongdoing in settling the lawsuit, but the company will have to pay $438.5 million, stop marketing to youth, stop funding education in schools, and stop misrepresenting the amount of nicotine in the products.

Nearly 11 million American adults used e-cigarettes in 2018, more than half of whom were under age 35. One in five high school students used e-cigarettes to vape nicotine in 2018. E-cigarettes were the fourth most popular tobacco products with 4% of retail sales, behind traditional cigarettes (83%), chewing/smokeless tobacco (8%), and cigars (5%) as of Feb. 2019. The global e-cigarette and vape market was worth $15.04 billion in 2020.

According to the most recent CDC data (2018), 9.7% of current cigarette smokers were also current vapers, though 49.4% of current smokers had vaped at some point. Of former smokers who had quit within the last year, 25.2% were current vapers and 57.3% had tried vaping. Of former smokers who quit one to four years ago, 17.3% were current vapers and and 48.6% had tried vaping. Of former smokers who quit five or more years ago, 1.7% were current vapers and 9% had tried vaping. And of people who have never smoked, 1.5% were current vapers and 6.5% had tried vaping.

18-29 year olds were more likely to say they vaped (17%) than smoked cigarettes, while every older age group was more likely to smoke than vape.

Is Vaping with E-Cigarettes Safe?

Pro 1

E-cigarettes help adults quit smoking and lowers youth smoking rates.

A July 2019 study found that cigarettes smokers who picked up vaping were 67% more likely to quit smoking. A New England Journal of Medicine study found that e-cigarettes are twice as effective at getting people to quit smoking as traditional nicotine replacements such as the patch and gum. E-cigarettes caused a 50% increase in the rate of people using a product designed to help people quit smoking.

Peter Hajek, Professor of Clinical Psychology at Queen Mary University London, said, "smokers who switch to vaping remove almost all the risks smoking poses to their health."

Vaping has likely contributed to record low levels of youth cigarette smoking, which hit a record-low of just 4.6% of high school students in 2020, down from 19.8% in 2006 (the year e-cigarettes were introduced in the United States).

Further, a report from Public Health England found no evidence that vaping is an entry into smoking for young people.
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Pro 2

Vaping is a safer way to ingest tobacco.

A UK government report stated that the "best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes."

Matthew Carpenter, Co-Director of the Tobacco Research Program at the Hollings Cancer Center, said, "Combustible cigarettes are the most harmful form of nicotine delivery."

E-cigarettes are safer for indoor use. Researchers found that the level of nicotine on surfaces in the homes of e-cigarette users was nearly 200 times lower than in the homes of traditional cigarette smokers. Nicotine left behind on surfaces can turn into carcinogens; the amount of nicotine found where vapers live was similar to the trace amounts in the homes of nonsmokers.

Traditional cigarettes are known to cause health problems such as lung cancer, heart disease, and stroke. Worldwide, smoking is the top cause of preventable death, responsible for over seven million deaths each year.

The National Academies of Science, Engineering, and Medicine found conclusive evidence that switching to e-cigarettes reduces exposure to toxicants and carcinogens. Burning a traditional cigarette releases noxious gases such as carbon monoxide. Cigarette smoke contains tar, which accounts for most of the carcinogens associated with smoking. E-cigarettes don't have those gases or tar.
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Pro 3

E-cigarettes reduce health care costs, create jobs, and help the economy.

Sally Satel, a psychiatrist specializing in addiction and resident scholar at the American Enterprise Institute, argued, "promoting electronic cigarettes to smokers should be a public health priority. Given that the direct medical costs of smoking are estimated to be more than $130 billion per year, along with $150 billion annually in productivity losses from premature deaths, getting more smokers to switch would result in significant cost savings - as well as almost half a million lives saved each year."

Grover Norquist and Paul Blair, both of Americans for Tax Reform, stated, "e-cigarettes and vapor products are the Uber of the product industry. They're a disruptive and innovative technology... Thousands of good-paying jobs are being created by an industry that is probably going to save hundreds of thousands of lives."

Tax policy economist J. Scott Moody calculated that the harm reduction from smokers switching to vaping could save $48 billion in annual Medicaid spending.

Juul created more than 1,200 jobs just in 2018. A letter signed by a coalition of anti-regulation groups warned that efforts to limit the e-cigarette industry would destroy tens of thousands of jobs for manufacturers of the devices and the stores that sell them.
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Con 1

Vaping among kids is skyrocketing: addicting a new generation to nicotine and introducing them to smoking.

An Oct. 25, 2021 study found marijuana vaping by teens doubled between 2013 and 2020, and the number of minors who stated they'd vaped marijuana in the past 30 days rose from 1.6% to 8.4% in the same time.

US Surgeon General Jerome Adams declared youth e-cigarette use an "epidemic," noting a 900% increase in vaping by middle and high school students between 2011 and 2015.

As of 2020, 19.6% of high school students used e-cigarettes, the most-used tobacco product among the age group, followed by cigars (5%). Teens who use e-cigarettes are four times more likely to try regular cigarettes than their peers who never used tobacco, and 21.8% of youth cigarette use may be attributable to initiation through vaping.

Nancy Brown, CEO of the American Heart Association, stated, "The tobacco industry is well aware that flavored tobacco products [such as e-cigarettes] appeal to youth and has taken advantage of this by marketing them in a wide range of fruit and candy flavors."
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Con 2

Vaping causes serious health risks, including depression, lung disease, and stroke.

Nicotine use by young people may increase the risk of addiction to other drugs and impair prefrontal brain development, which can lead to ADD and disrupt impulse control. Adult vapers are also more than twice as likely to be diagnosed as depressed than their non-vaping peers.

The CDC confirmed six vaping-related deaths and over 450 possible cases of lung illness associated with e-cigarettes as of Sep. 6, 2019. People who use e-cigarettes have a 71% increased risk of stroke and 40% higher risk of heart disease, as compared to nonusers. Studies have shown that e-cigarettes can cause arterial stiffness and cardiovascular harm, and may increase the odds of a heart attack by 42%.

Researchers who found increased risk of blood clots from e-cigarettes wrote, "these devices do emit considerable levels of toxicants, some of which are shared/overlap with tobacco smoking; and thus their harm should not be underestimated."

Scientists at Johns Hopkins Bloomberg School of Public Health found that e-cigarettes leak toxic metals, possibly from the heating coils, that are associated with health problems such as kidney disease, respiratory irritation, shortness of breath, and more.

Some ingredients in the liquids used in e-cigarettes change composition when they are heated, leading to inhalation of harmful compounds such as formaldehyde, which is carcinogenic.
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Con 3

E-cigarettes can catch fire and even explode.

E-cigarette explosions have led to the loss of body parts (such as an eye, tongue, or tooth), third degree burns, holes in the roof of the mouth, and death.

Researchers at George Mason University found that 2,035 people sought emergency room treatment for burn or explosion injuries from e-cigarettes between 2015 and 2017, and believe there were more injuries that went untreated. They also found more than 40 times the number of injuries reported by the FDA between 2009 and 2015.

Airlines prohibit e-cigarettes in checked baggage due to the possibility of their lithium batteries catching fire. In Jan. 2019, a passenger's e-cigarette overheated and caught fire in the airplane cabin. That same month, a Texas man died when debris from an e-cigarette explosion tore his carotid artery. In 2018, a man in Florida was killed by shrapnel from his e-cigarette exploding.

The US Fire Administration (USFA) found 195 reports of e-cigarette explosions and fires including 133 acute injuries, of which 29% were severe. The USFA stated, "No other consumer product that is typically used so close to the human body contains the lithium-ion battery that is the root cause of the incidents."
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Discussion Questions
1. Is vaping safe? Explain your answer.

2. Should vaping restrictions or prohibitions be placed on teens? Why or why not?

3. While this article focuses on nicotine e-cigarettes, consider the safety of marijuana vaping.
Take Action
1. Consider Consumer Advocates for Smoke-free Alternatives Association's take on vaping as a cigarette alternative

2. Learn about e-cigarettes at Encyclopaedia Britannica.

3. Analyze the science of vaping at the American Heart Association.

4. Consider how you felt about the issue before reading this article. After reading the pros and cons on this topic, has your thinking changed? If so, how? List two to three ways. If your thoughts have not changed, list two to three ways your better understanding of the "other side of the issue" now helps you better argue your position.

5. Push for the position and policies you support by writing US national senators and representatives.
Sources

61.

Carma Hassan, "FDA Orders Juul Labs to Remove Products from US Market," cnn.com, June 23, 2022

62.

Associated Press, "Juul Can Keep Selling Its Vaping Products in the U.S. - for Now,' npr.org, June 24, 2022

63.

Christina Jewett, "Juul Settles Multistate Youth Vaping Inquiry for $438.5 Million," nytimes.com, Sep. 6, 2022

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Vaping Pros and Cons - 3 Arguments For and Against

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Proponents say vaping helps adults quit smoking. Opponents say vaping addicts a new generation to nicotine and introduces them to smoking.

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As part of a clampdown on under-18s using e-cigarettes, the UK government is planning to outlaw disposable vapes and a ban could come into force early next year

Single-use vapes are set to be banned in the UK

Peter Dazeley/Getty

A ban on disposable vapes is expected to come in across the UK as part of a broader clampdown on underage use of e-cigarettes. Rechargeable vaping systems will have to be sold in plainer packaging and there will also be shop display restrictions as well as higher fines for shops that break the law by selling to under-18s.

When will disposable vapes be banned?

The legislation will be debated before the next general election, which is likely to be this year, the health secretary Victoria Atkins told the BBC. The ban could then take effect in early 2025.

Why are disposable vapes being banned?

Vaping is thought to be much less harmful than cigarettes, and so smokers are generally advised to switch to vaping if that's the only way they can stop smoking. But people are advised not to take up vaping if they don't already smoke, as vapes still contain nicotine, which is addictive, and low levels of other potentially harmful chemicals.

As vaping has taken off among adults, so has illicit use by under-18s, especially of disposable vapes, which are initially cheaper than the alternative, of using a rechargeable vaping system. In the UK, 9 per cent of 11-to-15-year-olds are now using vapes. Manufacturers are accused of developing versions that appeal to children, with brightly coloured packaging and flavours, including varieties named after fruits or sweet brands. The new legislation would also restrict flavours and mandate plain packaging even for rechargeable vape systems.

What about the litter?

Single-use vapes have also come under fire because they are so often discarded as litter rather than being properly disposed of. They are difficult to recycle because they are part plastic, part copper and contain lithium batteries. In the UK, for instance, disposable vape litter has doubled in the past two years, according to surveys by the anti-littering charity Keep Britain Tidy.

Could there be downsides to a ban on disposables?

Single-use vapes are the easiest way for new starters to try out e-cigarettes, so this could mean some people stick with smoking who might otherwise have switched to vaping, says Clive Bates, former head of the UK anti-smoking charity, Action on Smoking and Health (ASH). "Disposable vapes are the easiest way to not smoke," he says. "They don't require any upfront expenditure."

There are also concerns that some people will turn to black-market disposable vapes instead, which may contain hazardous chemicals. A few years ago there was a rash of cases of lung injury in the US and Canada linked to illicit cannabis vapes containing an additive called vitamin E acetate, which is harmful to the lungs.

What are other countries doing?

A few other countries also have plans to ban single-use vapes, including Australia, France and Germany. In December, New Zealand introduced strict new laws on disposable vapes, including limiting their nicotine content. In Australia, people may legally access nicotine-containing vapes only with a doctor's prescription, but black market products are widely available in shops.

The UK plans to cut youth vaping will only work if the law is properly enforced, says Hazel Cheeseman of ASH. "If you don't have the right level of resources to make sure that we are able to enforce this law, then that will be a problem," she says.

Will the laws around smoking change?

England and Wales are also pressing ahead with plans to introduce an age-linked ban on buying tobacco cigarettes that would start with 14-year-olds and rise by one year every year. The effect would be that those now 14 or younger would never be able to legally buy cigarettes.

Those in favour of such a ban say it would make teenagers less likely to start smoking, but on the other hand, it could eventually lead to the bizarre outcome of adults of different ages facing different sales restrictions. "The intention is great but it leads to a slightly ridiculous situation, where an adult will go into a shop to buy a cigarette pack of cigarettes for another adult who's a year younger than him," says Jacob George at the University of Dundee, UK.

Topics:

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Why does the UK want to ban disposable vapes and when will it happen?

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A raft of new measures aimed at reducing underage vaping are set to come into law next year