Vaping has been marketed as a less harmful alternative for adults who are trying to quit smoking. But it comes with its own health risks – and children who are among the heaviest users of vaping products may be unaware of how difficult it is to stop, reversing decades of progress against nicotine dependency and increasing the likelihood of cigarette use later.

“They are incredibly addictive,” said Dr. Stephen Kantrow, a pulmonologist and program director of the pulmonary critical care fellowship at LSU Health New Orleans. “Nicotine was on its way out, and then the vapes are delivering it right back in a way that parents can’t detect.”

A ban expected to remove flavored vape products from Louisiana’s shelves would impact a large number of Louisiana’s teens. One in ten middle schoolers in Louisiana vape. In high school, that rises to one in four. In just four years, vaping among high schoolers has doubled.

That ban is currently being challenged by retailers in court.

Nicotine addiction

Vaping has different risks than combustible cigarettes, which deliver carcinogens and combustion products to the lungs through the burning of tobacco leaves. One of the most notable is nicotine addiction, which raises the risk of high blood pressure and a narrowing of the arteries, according to the American Heart Association.

Among kids who vape, 58% use flavored vapes, which typically contain higher levels of nicotine, according to the Louisiana Youth Tobacco Survey.

Once a person is addicted to nicotine, the likelihood they will turn to cigarettes is high.

Lack of regulation

Businesses have pivoted quickly as new regulations tried to limit e-cigarettes among kids. When the Trump administration banned flavored products in vaping devices, a loophole allowed flavors in disposable products.

“The FDA has a very difficult time regulating because the companies are so creative, they can just rename products,” said Kantrow. “It’s a whack-a-mole game.”

But the lack of regulation also means the health effects are poorly understood. In animal models, exposure to heated flavored chemicals has shown effects on the body’s immune response to infections. 

“What’s the chronic effect … if you take a flavor and heat it up? We don’t know,” said Kantrow. “There’s no health science behind it. There’s just businesses putting flavors together in a heated cartridge.”

It took roughly two decades for the health impacts of cigarettes to materialize. Advocates worry about the long-term damage of a product kids get hooked on at a young age.

“We don’t know the mid- to long-term health consequences of e-cigarettes, because they’ve been sold for just a little more than a decade,” said Ashley Lyerly, senior director of advocacy for the American Lung Association. “The lasting health consequences of these products are concerning.”

Lung injuries

In 2019 and 2020, there was an epidemic of lung injuries among e-cigarette users. A condition known as EVALI, which stands for e-cigarette or vaping use-associated lung injury, was identified and eventually linked to off-market devices that contained vitamin E or THC, the psychoactive element in marijuana. While it is no longer considered an epidemic, severe lung injuries still occur among people who vape, said Kantrow. There is not a consolidated way to report those injuries, so doctors have little understanding of how common it is or who is most likely to experience it. 

“You don’t know who’s going to develop very severe lung complications from flavored vapes containing nicotine,” said Kantrow.

Benefits

Among people who already smoke, there is evidence that swapping conventional cigarettes for vaping reduces a person’s exposure to many harmful chemicals, according to a report from The National Academies of Sciences, Engineering and Medicine.

But vaping doesn’t help anyone quit their nicotine addiction. And vaping increases the chances that kids will later pick up a cigarette.

Nationally, vaping is decreasing, from 14.1% to 10% among high schoolers, according to a study released by the Centers for Disease Control and Prevention on Thursday. But in Louisiana, the latest numbers show the rate is near 25%.