Is Vaping Safer than Smoking Cigarettes?
Electronic cigarettes, or cigarettes
are being marketed as the “safe” new alternative to conventional cigarettes. By
February 2020, reports of 68 deaths and more than 2,800 vaping-related
hospitalizations due to lung illnesses have made it clear that vaping can be even
more dangerous than smoking.1,2
The CDC has reported that Vitamin E acetate is a potential cause for the outbreak,
but it might not be the only one.2 Many of the patients report vaping marijuana
products or marijuana and nicotine products, but others only vaped nicotine
products. Until these reports of hospitalized teens and adults are scrutinized in
greater depth, we won’t know what types of vaping are most dangerous and
under what circumstances.
E-cigarettes come in a variety of forms and include vape mods, Juuls, and vape
pens. There are brand name products (Juul is the most widely used) and “home-
made” versions. Some contain high levels of nicotine, while others contain
marijuana or just contain flavoring. The focus of this article is on e-cigarettes
because most of the research that exists has been done on them, but much of the
information below is relevant to these other products as well.
The big questions are: Are they safe? Will they reverse the decline in smoking—
giving new life to an old habit—or can they help people quit smoking? Here is
what you need to know.
What are E-cigarettes?
E-cigarettes are battery-operated devices that were initially shaped like cigarettes,
but now include vape mods, Juuls, and vape pens. Some look like flash drives or
highlighter pens, making it easy for teens to hide them in plain sight. The brand-
name products contain nicotine, an addictive drug that is naturally found in
tobacco and that stimulates, causes stress during withdrawal, and then feels
relaxing as continued exposure follows withdrawal. It is the nicotine in cigarettes
that makes smoking so addictive, and the same is true for most vaping and
juuling. These electronic products allow nicotine to be inhaled, and they work by
heating a liquid cartridge containing nicotine, flavors, and other chemicals into a
vapor. Because e-cigarettes heat a liquid instead of tobacco, what is released is
considered smokeless.3
Is Vaping Safer than Smoking Traditional Cigarettes?
The key difference between traditional cigarettes and e-cigarettes and related
products is that the latter don’t contain tobacco. But, it isn’t just the tobacco in
cigarettes that causes cancer and other serious diseases. Traditional cigarettes
contain a laundry list of chemicals that are proven harmful, and e-cigarettes have
some of these same chemicals.
While smoking can cause lung cancer, breast cancer, emphysema, heart disease,
and other serious diseases, those diseases usually develop after decades of
smoking. In contrast, in 2019 it became clear that vaping could cause seizures and
serious lung damage after just a year, possibly less, based on CDC reports of
patients hospitalized for lung damage caused by vaping.2,3 While there have been
warnings about the possible risk of e-cigarettes for a decade, it was not expected
that they could cause such severe damage in such a short period of time.
The COVID-19 pandemic has raised even more concerns about the safety of
vaping. Youths aged 13-24 years old who have used e-cigarettes are more likely to
be diagnosed with COVID-19, be tested for the virus, and to experience Covid-19
symptoms.4
Since 2009, FDA has pointed out that e-cigarettes contain “detectable levels of
known carcinogens and toxic chemicals to which users could be exposed.” For
example, in e-cigarette cartridges marketed as “tobacco-free,” the FDA detected a
toxic compound found in antifreeze, tobacco-specific compounds that have been
shown to cause cancer in humans, and other toxic tobacco-specific
impurities.5 Another study looked at 42 of these liquid cartridges and determined
that they contained formaldehyde, a chemical known to cause cancer in
humans.6 Formaldehyde was found in several of the cartridges at levels much
higher than the maximum EPA recommends for humans. In 2017, a study
published in the Public Library of Science Journal showed that significant levels of
benzene, a well-known carcinogen, were found in the vapor produced by several
popular brands of e-cigarettes.7
The body’s reaction to many of the chemicals in traditional cigarette smoke
causes long-lasting inflammation, which in turn leads to chronic diseases like
bronchitis, emphysema, and heart disease.8 Since e-cigarettes also contain many
of the same toxic chemicals, there is no reason to believe that they will
significantly reduce the risks for these diseases.
In fact, a preliminary study presented at the 2018 annual meeting of the American
Chemical Society found that vaping could damage DNA.9 The study examined the
saliva of 5 adults before and after a 15-minute vaping session. The saliva had an
increase in potentially dangerous chemicals, such as formaldehyde and acrolein.
Acrolein has been proven to be associated with DNA damage, for example, and
DNA damage can eventually cause cancer.10
A study of mice funded by the National Institutes of Health found that e-cigarette
smoke could cause mutations in DNA that could increase the risk of cancer. These
specific mutations have been shown to potentially contribute to the development
of lung and bladder cancer in mice exposed to electronic cigarette smoke. The
researchers claim that these chemicals could also induce mutations leading to
cancer in humans. It has not been reported how many of those harmed had used
juul devices. While many of those harmed had vaped marijuana, many also used
nicotine e-cigarettes,11 so the risks of “juuling” need to be carefully and
immediately studied.
