Battery-powered e-cigarettes heat a liquid that typically contains nicotine derived from alcohol, flavorings, and other chemicals, turning it into a vapor that users inhale (vape). The most popular brand of e-cigarette, Juul, sells four types of Juul pods, which look like a USB flash drive and charge in a USB computer outlet in two flavors: Virginia Tobacco and Menthol, in nicotine concentrations of 5.0 percent and 3.0 percent. Because e-cigarettes have been around for less than 20 years, scientists are still learning about their health effects. But there’s already enough evidence to justify efforts by the U.S. Food and Drug Administration (FDA) to prevent e-cigarette use among young people.
The Vaping Debate: To Ban Sales or Not?
On June 23, 2022, the FDA denied Juul Labs Inc. the ability to market Juul products in the United States. A day later, however, the U.S. Court of Appeals for the District of Columbia Circuit entered a temporary administrative stay of the marketing denial order for Juul Labs, which allowed Juul Labs to continue selling its products. On July 5, 2022, the FDA stayed the marketing order, allowing Juul to continue selling its products, pending further FDA review. While the jury is deliberating on the public health safety of e-cigarettes, one thing is for sure: e-cigarettes lack the dangerous smoke, tar, and carbon monoxide of traditional smokes. “E-cigarettes aren’t as bad for you as regular cigarettes, but they’re not harmless,” says Holly Middlekauff, MD, a cardiologist at the David Geffen School of Medicine at the University of California in Los Angeles. Still, e-cigarettes use a concentrated nicotine, known as nicotine salts, in liquid, which is sometimes called e-liquid. The nicotine e-cigarettes contain is highly addictive; it’s what hooks users. “When people use podlike e-cigarettes like Juul, their nicotine levels go up similarly to those of a tobacco cigarette smoker. That’s why it’s likely to cause addiction,” Dr. Middlekauff says. In and of itself, nicotine can also pose health risks. Nicotine exposure during adolescence can harm a teen’s developing brain, leading to a nicotine addiction, permanent loss of impulse control, and mood disorder, according to the U.S. Surgeon General.
Inside Story: How Vaping Can Impact Heart Health
Research from short-term nicotine studies in nonsmokers and young people help shed light on what could happen to your heart if you use e-cigarettes long-term. Here’s what happens to your ticker when you vape as a nonsmoker — someone who has never smoked regular cigarettes. Bump in heart rate and blood pressure When you vape, the nicotine jolt will increase your adrenaline levels, which will make your heart beat faster and boost your blood pressure, which, in turn, will increase your heart’s need for oxygen. “You may feel heart palpitations,” Middlekauff says. Overall, e-cigarettes may increase heart rhythm abnormalities, which are linked to heart disease risk. A study published in March 2017 in JAMA Cardiology found that habitual e-cigarette users had abnormal heart rate patterns similar to tobacco cigarette smokers. The abnormal heart rate pattern is associated with increased heart attack risk and sudden death in people with and without known heart disease. If e-cigarettes are anything like tobacco cigarettes, however, your heart rate will return to normal once you quit vaping, but more research needs to be done. Rise in oxidative stress People who used an electronic cigarette for 15 minutes had significant increases in oxidative stress markers in their immune cells, according to research Middlekauff and a colleague published in Vascular Health and Risk Management in 2019. “Oxidative stress increases your risk of many diseases, including heart disease, premature aging, and cancer,” Middlekauff. Oxidative stress in blood vessels — a situation in which harmful free radical oxygen molecules outnumber detoxifying antioxidants — can lay the groundwork for atherosclerosis, the buildup of dangerous, artery-clogging plaque, according to a review in the September 2017 Current Atherosclerosis Reports. It’s unclear yet whether the nicotine in e-cigarettes is causing the oxidative stress, says Middlekauff. “We don’t have that piece of the puzzle yet,” she says.
Other Dangerous Chemicals in the E-Cigarette Mix
The inhaled aerosol in e-cigarettes contains other potentially harmful chemicals, such as:
AcroleinAcetaldehydeFormaldehyde
All of those can lead to premature atherosclerosis and abnormal heart rhythms, Middlekauff says. “The levels of these chemicals are much lower compared to tobacco cigarettes, but if a large population starts using electronic cigarettes, a significant number of people will develop health issues and we’ll have another public health problem.”
E-Cigarettes Aggravate Heart Disease
If you already have an irregular heartbeat or high blood pressure or diagnosed heart disease, the nicotine in e-cigarettes is especially risky business. “People with coronary artery blockages and people with congestive heart failure could be made worse by exposure to nicotine. They might develop chest pain or increased symptoms of heart failure,” says Elliott Antman, MD, a professor of cardiovascular medicine at Harvard Medical School in Boston. Someone with an arrhythmia — atrial fibrillation, for example — could have an episode provoked by nicotine, Dr. Antman says.
E-Cigarettes Beat Regular Cigarettes
As bad as the nicotine in e-cigarettes is for you, e-cigarette smoking is still preferable to regular cigarette smoking. “Smoking tobacco cigarettes is about the worst things anyone can do to themselves,” Middlekauff says. Tobacco smoke contains 60 to 70 carcinogens that e-cigarettes don’t. Although e-cigarettes aren’t marketed as a smoking cessation aid, like nicotine gum or patches, Middlekauff believes they have potential to help regular cigarette smokers kick the habit as a step-down approach. Regarding the current debate over whether or not Juul can sell its products in the United States, Middlekauff says, “it seems inconsistent to be able to buy a Marlboro but take away Juul, which could be an important smoking cessation tool.” Still, for your heart health, it’s wise not to start vaping — even if you think you’re young and invincible — especially if you don’t already smoke, she says.
How to Quit Vaping
Quitting vaping is just as hard as quitting smoking. “Nicotine is as addictive as heroin. Just talk to any smoker who’s tried to stop and they’ll tell you it’s the hardest thing that they’ve ever done,” Middlekauff says. To increase your chances of success, the American Heart Association offers a five-step process for quitting vaping and smoking. If you get the sense your teen or young adult child is vaping, even just occasionally, such as at parties, talk about the risks. This conversation guide from the American Lung Association can help get the ball rolling. Vaping is easy to hide because it doesn’t leave a telltale odor or visible secondhand emissions. In general, to figure out what’s up with your middle schooler, high schooler, or even college-age kid, create an environment where it’s easier for your child to talk about it. Rather than asking your teen directly (You’re Juuling, aren’t you?), ask nonjudgmental questions, maybe while you’re driving somewhere, such as: “I keep hearing about Juuling. Are your friends doing that?” “Is it popular at school? What do you think about it?” and “How safe do you think it is?” Be prepared to hear that Juuling isn’t a big deal. “Many teens know cigarettes are bad for you but think vaping is inconsequential,” says Steven Schroeder, MD, the director of the Smoking Cessation Leadership Center at the University of California in San Francisco. Many teens don’t realize, for example, that all Juul pods contain nicotine. A study published in the August 2022 issue of Tobacco Control found that one Juul pod could contain as much nicotine as an entire pack of cigarettes. Also, appeal to your teen’s natural sense of rebellion. “Kids don’t like to be tricked,” Middlekauff says. Talk to teens about how the vaping industry is manipulating them. You might say, for example: “‘The company is trying to make Juuling seem cool so you’ll get hooked and buy more Juul pods. They’re just trying to make a bunch of money.’ That turns teens off more than the negative health effects,” Middlekauff says. If you suspect your child is addicted to vaping, programs are available. This Is Quitting, for example, is a smoking-cessation program developed with the Mayo Clinic that offers a texting program to help young people quit e-cigarettes. Teens can enroll by texting DITCHVAPE to 88709. The program delivers tailored messages via text that give age-appropriate quitting advice.
