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The Risks of Another Epidemic: Teenage Vaping

In a review published last December in the Cleveland Clinic Journal of Medicine, Dr. Rome and her co-author, Perry Dinardo, challenged the public perception that vaping is harmless, or “at least less harmful than cigarette smoking.”

While it’s likely to be true that vaping may be less hazardous than tobacco cigarettes, since the vaped aerosols that reach the lungs are devoid of the thousands of tobacco-derived toxic and carcinogenic substances inhaled by cigarette smokers, vaping still introduces a fair share of potentially harmful chemicals. In addition to nicotine, some of the chemicals, like the carcinogen formaldehyde, are created when the nicotine-rich liquid in some vaping devices is heated to high temperatures.

“E-cigarettes might have their own unique health effects we haven’t discovered yet,” said Theodore L. Wagener, director of the Center for Tobacco Research at Ohio State University. “Although compared to tobacco cigarettes, e-cigarettes without a doubt expose users to much lower levels of harmful chemicals, we still don’t know how the body handles them and what their long-term effects might be.”

Remember, it took many decades of smoking by tens of millions of people before the deadly hazards of tobacco cigarettes were recognized.

The surge in the use of electronic cigarettes was tied to a game-changing product, Juul, a cartridge device introduced in 2017 in a slew of enticing flavors. Flavors especially attractive to youngsters are now banned from use in closed-system devices like Juul, which now is sold only in tobacco and menthol flavors, but can still be used in the open-system products sold in vape shops. And now, taking advantage of a loophole in regulations, a disposable product called Puff Bar, which comes in more than 20 flavors, has replaced Juul as the vape of choice among young people.

Concerns about vaping grew after a 2019 outbreak of severe lung injuries, which were subsequently linked to vitamin E acetate, an additive found in some vaping devices that deliver THC, the psychoactive ingredient in marijuana. Juul pods are not designed to be refillable with substances like THC or other chemicals.

Producers of Juul introduced changes that enhanced the palatability and safety of vaping, but at the same time “made it easier for kids to start using nicotine,” Dr. Wagener said. Instead of freebase nicotine that is very harsh to inhale, Juul contains a nicotine salt, “a very palatable form of nicotine that makes inhaling high doses of nicotine easy,” he explained. And Juul doesn’t require the high temperatures that produce toxic substances like formaldehyde. A single pod contains the nicotine equivalent of a pack of conventional cigarettes.

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