Chances are, you probably know someone who vapes. In the past few years, e-cigarettes have become very well known and an extremely controversial topic because they became popular among teenagers and young adults. 

Since it is relatively new, there used to be a very small amount of scientific research on the effects of vaping on health. Nobody could say for sure that vaping would be bad for you, so there was not much stopping people from doing it. In fact, many people believed it was perfectly fine to vape.

This led to widespread use throughout the nation. In recent years, the e-cigarette business has taken off. Vape shops, delis, and supermarkets have made Juuls very accessible across the country. Buying one became as easy as walking into a store or pressing a button online.

Despite its successes, things are not looking good for vaping at the moment. As of now, numerous events and legislations are taking place all at once to destroy the reputation of Juul and e-cigarettes in general. 

State and federal bans on flavored e-cigarettes have been put into action, the FDA began conducting investigations on Juul and other e-cigarette companies, and thousands of people have been sent to hospitals with vaping-related respiratory illnesses. In turn, the public’s view on vaping has worsened. There is now more scientific evidence and personal stories about the negative effects of vaping on people’s lives, including teenagers.

However, despite everything going on against e-cigarettes, there is no clear end to vaping in sight. There are still people who advocate for vaping and are against the e-cigarette bans. There are also still ways for young adults to get them, including e-cigarette brands that copy Juul.

Teen Vaping

People who smoke were supposed to be the only ones who were vaping, but it has become a very big thing to teenagers as well. 

Many teens thought vaping was a cool thing to do, and nobody really thought about the negative effects of it because it’s still a new thing. Once teenagers started ending up in the hospital because they couldn’t breathe, adults started paying attention to youth and how they were being affected because of it. Vaping was ultimately a good thing because it was originally supposed to help smokers who are trying to quit, but the most popular brand, Juul, had led the wrong people to their products, and now because of it we have a dilemma on our hands that must be fixed before it’s too late. Now vaping has become another problem that this generation has to deal with. 

The majority of people who vape are teens and young adults. In fact, about 85% of 18-29 year olds have tried vaping, according to a statistic from Statista. 

Percentage of adults in the U.S. who had tried vaping or using electronic cigarettes as of 2018, by age.

According to the graph, 18-29 year olds are the highest percentage of people that vape. 30-44 year olds are the second highest group, and electronic cigarette use decreases as the age group increases. This is most likely because vaping is somewhat new, so younger people are more attracted to it than older people.

While this percentage can be shocking, a lot of people under 18 also get their hands on electronic cigarettes. 

“Basically I started vaping because all my friends have been doing it, and I thought that it was normal so I started vaping to fit in,” said an anonymous 16 year old who attends Forest Hills High School and will be referred to as R.A. 

Many young adults and teens believe that vaping is better than smoking cigarettes. Not many people know the risks of vaping because it is still new; most teens view vaping as a gateway to help them feel good. 

“Without it I feel very angry, but with it I feel relaxed,“ says R.A. 

According to the people and students interviewed, nicotine in the vape juice gives a feeling that they describe as “relaxing” or “good”. Nicotine isn’t the major problem when it comes to smoking. The bigger problem is the smoke they’re inhaling into their lungs and the chemicals that are being put into their bodies. In order to get the nicotine they want, they don’t have to cloud their lungs with smoke. They could use other ways in order to get the drug like nicotine patches or even chewing tobacco. Other examples of smoke-free alternatives to cigarettes is nicotine chewing gum, nicotine inhaler, nicotine nasal spray, snuff, etc. These are all other methods that are better than smoking multiple cigarettes a day or even smoking them at all.

A problem that is being faced related to vaping are knockoff brands that teens are starting to smoke which could be worse than the more popular brands because they could contain other chemicals or mix the wrong chemicals, and it could be more harmful. For example, a stig, which is also another vape device doesn’t look like a Juul, but is also equivalent to a pack of cigarettes just like the Juul pod. They are disposable so that when it dies and you’re done with it, you just throw it out. There are many other disposable vape products, and there are many other rechargeable vape devices.

A problem is that since teenagers and adults like the feeling of the nicotine, they will continue vaping/smoking to feel those same effects. They crave the feeling of nicotine in their bodies and become addicted to it at an early age. The more you smoke, the more likely you are to get addicted to the nicotine so then you not only crave it, but your body needs it. 

The companies who make the products don’t care about people’s health, all they care about is making money off them. If people start getting addicted at a younger age, then they’ll be customers for life and that would be good for the companies that just want to make money off you. Not only are teenagers influencing other teens, but companies are even leading young adults towards their brand. Like the Juul slogan which was presenting itself to the wrong audience.

Eight people were interviewed about their vaping habits. Six youth and one adult who vapes and one public health expert. The public health expert, Dr. Maggie Ornstein, provided the information on harm reduction in this article. The interviews with the teenagers were very repetitive, especially in their reasons for starting. As an example, several people gave fitting in as their reason for starting to vape. 

A sophomore at the NYC iSchool, who wishes to remain anonymous, started vaping just after 8th grade because they wanted to be apart of the new trend, but they did not know it would change a part of their life. “I felt like it helped me fit in and I never thought of it as being harmful. It felt good,” they said. 

Another common theme from the interviews had to do with the negative effects of vaping. For example, they would get tired faster and not be able to run as much. They never believed vaping was harmful for them, but then they noticed the sudden changes they were having, for example, their lungs would hurt after running, and they would lose their breath much faster. It would result in them not being able to play many running games such as tag because they wouldn’t be able to run for a long period of time without having to stop to catch their breath.

An anonymous teenager, who is a freshman at William Cullen Bryant highschool in Queens, has recently started vaping because of who he had started to hang out with. He went from being a shy, independent kid to hanging out with troublemakers: “My other friends got boring so I started hanging out with these people to actually have some fun and I ended up catching on their habits.” This shows the influence of peer pressure that friend groups have on teens when starting to vape.

Besides teenagers, there are adults who quit cigarettes and start vaping because it is “better” for their health. When asked if vaping helped her quit cigarettes, Juliet Ornstein, a woman who recently started vaping to quit traditional cigarettes, responded, “It did. I would still smoke cigarettes once in a blue moon though.” She started smoking cigarettes in her junior year of high school because she says, “it was cool and all my friends were doing it.” Even though she started smoking then, it has and still does affect her life now. She smoked for many years and now she was finally able to quit cigarettes and is using the less harmful option, which is vaping.

Some people who have tried to quit cigarettes before vaping was a thing, were mostly unsuccessful because they would suffer from withdrawal and smoke again to feel better. Now that vaping came to be, they were able to start smoking something ‘better’ and finally stop with the cigarettes. “It was an excellent choice for me because I stopped smoking cigarettes and I feel better. I tried the nicotine patches, but they did not work so I went back to smoking,” Ornstein says. 

Harm Reduction

“Cigarette smoking remains the single most important avoidable cause of death in the developed world. The CDC reports that smoking is responsible for 438,000 deaths in the U.S. annually, a figure which has changed little over the last 15 years.” This quote is important because it explains how deaths related to cigarette smoking can be reduced. Harm reduction is one approach to help people stop smoking traditional cigarettes, which is important because it’s the smoke that causes respiratory illnesses and lung cancer which can result in death. Harm reduction isn’t about getting people to stop using nicotine, it’s goal is to stop the inhalation of smoke into their lungs to reduce the chances of getting sick and dying because of it.

According to the Centers for Disease Control and Prevention (CDC), there have been 33 deaths related to vaping. While this shows the dangers of vaping, compared to the number of deaths related to cigarette smoking, vaping is clearly less harmful than smoking cigarettes.

Currently, smokers are told to either quit smoking or eventually die because of it. This is not useful when thinking of how smokers are feeling or in relation to the dangers of nicotine. They clearly know what happens to people when they smoke and they know many people die because of it. If they were offered a better way to get the drug they want in their body by endangering themselves less then they could eventually quit fully or just be safer in general. Harm reduction is an approach that is used to help drug users be safer when they want to insert a drug in their body. For example, there are places that people can go to, to get clean needles so people don’t share them. From a harm reduction perspective this is better than sharing needles which can lead to the spread of infectious diseases, such as HIV. There’s also the tobacco harm reduction model, which helps smokers that can’t or don’t want to quit smoking. According to the Tobacco harm reduction: an alternative cessation strategy for inveterate smokers, smokeless tobacco products are an effective substitute for cigarettes when they are used as a complete substitute for cigarettes.

For adults, vaping is a safer alternative than smoking cigarettes. For the young adults that have never smoked cigarettes, vaping is negative because it’ll get them addicted to nicotine, which is potentially bad for brain development. Vaping is both positive and negative, as discussed above, it’s beneficial for adults to help them quit smoking, but it’s negative for kids who could become addicted and suffer health consequences later in life. If we make sure that vaping is only used for adults to quit cigarettes than we could keep it around, but if teens keep being hospitalized then we are going to have to take more action.

Vaping is a part of the harm reduction methods. The problem with it though is it’s still allowing smoke into your lungs, and it’s hospitalizing many of the young generation when it was supposed to help the smokers that want to stop smoking cigarettes. Teens vape because it’s cool, but if adult smokers had a choice to just stop smoking then they would, but it’s not that simple for them. They could use nicotine patches because then they’re not inhaling the smoke, and they’re getting the drug that they crave into their bodies. 

Another harm reduction method is using smokeless tobacco products, such as, chewing tobacco or snuff. These aren’t the safest options because it could result in oral cancer, but the risks are lower when compared to the risks of smoking traditional cigarettes. Also there are people who just try and smoke less cigarettes each day to cut themselves down on it. This method has not proven to be effective with scientific research, so it’s not the best choice for people wanting to quit smoking. People should choose the better option, which could be any non-smoke cigarette alternative, but everything will be harmful so they should find the most harmless thing they could and use that method first.

If every smoker was introduced to this and tried it than many people would’ve quit smoking eventually, and we wouldn’t have had as many deaths because of smoking. Vaping is similar, but not quite. We’re not lighting the chemicals on fire, and there’s many more chemicals in a cigarette, but we still get the smoke into our lungs, which can result to popcorn lung. Popcorn lung is when the smallest airways in your lungs get damaged and you feel short of breath. According to the Environmental Health Perspectives, diacetyl is common in vape juice and that’s a very harsh chemical that causes that condition. Diacetyl was originally used to give a butter-like flavor in popcorn, but workers in the factories would start to get sick when inhaling the chemical. That’s why it’s called “popcorn lung”

Many teenagers have been hospitalized because of vaping. They suddenly weren’t able to breathe and their lungs would start to give out, resulting in a respiratory illness. “We already treated an 18-year-old like this and we know of two more cases in Milwaukee,” a nurse at a Wisconsin hospital said to a parent, whose child had been hauled in because of sudden breathing difficulties. The mother thought she would lose her son after they had to put him into a medically induced coma because his blood oxygen level was only at 10%. The nurse was already prepared and knew what was happening because she had dealt with a couple similar cases before. 

The Vaping Epidemic

Many people, especially parents, are concerned about the health effects of vaping on this generation’s youth after mass hospitalizations from vaping related respiratory illnesses.

The Centers for Disease Control and Prevention state that as of October 15, 2019, 1,479 lung injury cases associated with electronic cigarettes have been reported from 49 states, and 33 deaths have been confirmed in 24 states. 80% of patients are under 35 and 16% are under 18, meaning they are getting these illnesses at a young age. These numbers continue to increase as time goes on. 

All the patients have one thing in common: a history of vaping. Most of them report using products containing nicotine and THC, or tetrahydrocannabinol, the substance that creates marijuana’s psychological effects. However, the specific product or chemical causing the illnesses is currently unidentified.

Since there is no solid evidence of infectious disease, doctors believe the suspected cause is chemical exposure from e-cigarettes. When doctors from the Mayo Clinic examined lung tissue samples from 17 patients, they noticed that the damage to the tissue looked like chemical burns. Two of the samples were from patients who had already died from the lung injuries. Dr. Brandon T. Larsen, a surgical pathologist, described the damage as “the kind of change you would expect to see in an unfortunate worker in an industrial accident where a big barrel of toxic chemicals spills, and that person is exposed to toxic fumes.”

Those affected also have severe, more noticeable symptoms. Four teens in Children’s Minnesota had symptoms of a bad respiratory infection similar to pneumonia. “They have progressed to have significant difficulty with their breathing and increasing lung distress,” said Dr. Emily Chapman, chief medical officer for Children’s Minnesota. “They’ve ended up needing our intensive care unit and in some cases assistance with their breathing.” 

Just recently, the youngest vaping fatality in the U.S. has been recorded when a 17 year old boy in the Bronx, about the age of a high school senior, tragically died because of vaping. New York State officials disclosed that he is the first teenager in the United States to die from a vaping-related illness.

In addition to so many people dying, a major concern is that many of them are still very young. Many of the people who have been affected are in their twenties and sometimes even younger. It’s no surprise that many parents feel strongly about vaping.

With these series of events, it is evident that vaping can be dangerous. According to Binghamton University,  one Juul pod in the United States is equivalent to a pack of cigarettes in terms of nicotine. However, since they are easily hidden and easily accessible, users can continuously take hits with barely any breaks, resulting in very high levels of nicotine to the body. 

Banning Flavored E-Cigarettes

These frightening symptoms and mass hospitalizations of the country’s youth throughout the country have drastically impacted the public’s views. The fact that young people are dying is what disturbs people the most. 

Subsequent to the incidents, the Trump administration announced a federal ban on the sale of most flavored e-cigarettes: “We can’t allow people to get sick. And we can’t have our kids be so affected,” said President Trump. He and Melania Trump feel strongly about the issue because they have a teenage child, Barron. 

In addition, former New York mayor, Michael Bloomberg, is also supporting bans on flavored e-cigarettes. He spent $160 million to create bans in at least 20 states and cities in the United States. In fact, bans are already popping up throughout the country. San Francisco recently became the first major city in the U.S. to ban the sale and distribution of e-cigarettes in June 2019, and bans have taken already effect in New York and Michigan.

To add on the ban of flavored e-cigarettes, according to a USA today article, many teenagers buy e-cigarettes from the convenience stores instead of an actual vape shop. Vape shops are more legitimate because they don’t sell knock off brands, and the purpose of them is to just buy vape devices unlike a deli where they just sell them to make more money; including the knock off brands. 

For the adults who vape, they might leave the vape shops open so that those people could still buy what they want. Most teens buy from the corner stores or delis, who are willing to sell illegally to kids, so if the ban gets put into place, many teenagers won’t have easy access in buying them anymore. This would be positive for both the younger generation that started vaping and the older generation who are trying to quit traditional cigarettes. It shouldn’t be so easy for kids who are underage to buy vaping products. 

However, it seems impossible to get corner store owners to stop selling vaping products to teenagers. In 2017, New York State passed a law outlawing “adult businesses operating within 500 feet of a church, school, park and in most commercial and residential neighborhoods…”.  This is an example of a policy, that if passed for stores selling vaping products, could help limit kids access to products that are illegal for them to buy.  

The idea is that by banning flavored e-cigarettes, teens and young adults will be less attracted to vaping; people will not start vaping because it tastes good. Mint and menthol flavored e-cigarettes will not be prohibited though, since those flavors mimic the taste of traditional cigarettes, and ex-smokers still need an effective alternative to stop them from going back to traditional cigarettes. 

The effectiveness of e-cigarettes as an alternative to traditional smoking can be found from a randomized trial that was published in The New England Journal of Medicine. To help quit smoking, a group of ex-smokers was given an e-cigarette starter pack with a refillable e-cigarette and one bottle of nicotine e-liquid. They were recommended to buy more e-liquids of the brand and flavor of their choice once the first bottle ran out. Another group of ex-smokers received nicotine replacement products for 3 months. 

The trial found that e-cigarettes were more effective at stopping smoking than nicotine replacement therapy at stopping traditional cigarette use. However, the group that received e-cigarettes were more likely to continue using their product, and they reported more throat or mouth irritation than the nicotine replacement product group. In other words, while e-cigarettes can help stop traditional smoking, there are drawbacks, including an attachment to vaping.  

Some also believe that banning flavored e-cigarettes will not do anything except make teenagers switch to mint and menthol, making the ban an ineffective method of prevention. This could be a realistic prediction because people who have already begun vaping will probably want to keep doing it and chasing the feeling they get when they vape.

However, mint and menthol flavored e-cigarettes are still potentially dangerous to whoever is using it. DukeHealth found pulogene, a potential carcinogen that has been banned as a food additive by the U.S. Food and Drug Administration, in large amounts in mint and menthol flavored e-cigarettes and smokeless tobacco products. People who switch to mint and menthol can still be at risk of illnesses.

Vaping can also have more obvious effects on your body. R.A. states, “One reason that made me consider quitting was I get tired faster. Like when I run after a while I can’t breathe.” 

The FDA Begins Investigations 

Before the recent scrutiny on vaping, the Food and Drug Administration did not heavily regulate e-cigarettes. In 2013, the American Thoracic Society (ATS) urged the FDA to ban e-cigarettes, but no review was conducted. The same happened again in 2014, 2015, 2016, and 2018 until ATS sued the FDA in 2018 for failing to effectively regulate e-cigarettes. ATS won the case and the court ordered the FDA to accelerate their product review of e-cigarettes. 

Since then, the FDA sees vaping as a huge issue, even considering youth vaping rates at epidemic levels. The FDA has targeted Juul and criticized the company for illegally advertising their products as safer than traditional cigarettes. The FDA claims that Juul’s slogan, “Make the Switch” gave the impression that vaping is healthier than traditional smoking when they were not given federal approval to do so. Juul did not have concrete scientific evidence to show that their product is less harmful than cigarettes, making it illegal marketing. 

Juul also advertised in schools directly to the nation’s youth without scientific evidence that vaping is not detrimental to long term health. The FDA claims that through promotional activities and outreach programs, Juul advertised to underaged teenagers.

Caleb Mintz testifies that a Juul representative went to his school and said their products were “totally safe” and “the iPhone of vapes.” The representative would say afterwards “but we don’t want you as customers.” The representative showed them how it the product worked, and Mintz and his friends were given the impression that it was just a device with harmless substances in it. 

The FDA sent a warning letter to Juul, and Juul said they will fully cooperate with the government. To preserve their reputation, Juul decided they will get rid of their “Make the Switch” slogan and start specifying that they do not want minors to use their product. 

One of Juul’s top investors, Altria, is in just as much trouble. Altria is one of the world’s largest producers and distributors of tobacco and cigarettes. They invested $13 billion into Juul in December 2018. 

Ever since the FDA began their investigation, Altria has lost $31 billion in market value, and the price of Altria stocks have decreased by 18%. In addition, Philip Morris International, another major cigarette company, was talking about merging with Altria, but after the investigations by the FDA, merger talks have ended. The company indirectly took a very hard hit from the recent events regarding vaping. 

Juul Copycats

Regardless of the FDA investigations on Juul and state and federal bans, people will still have ways of getting flavored e-cigarettes. Following Juul’s heavy scrutiny by the government and the public, knockoff e-cigarette brands are in more demand, including Eonsmoke and Ziip.

Eonsmoke, which copycats Juul, is a cheaper brand that contains a higher level of nicotine than the Juul pods. Eonsmoke pods are also Juul compatible and come in many flavors, which makes them appealing to people who already vape. Ziip is also Juul compatible and comes in a wide range of nicotine salt strengths. 

Juul is currently taking legal action against them and other similar brands, claiming they mislead people and tarnish their brand. With these alternative vape products and the availability of mint and menthol flavors, vaping will not be going away anytime soon. 

Vape products can also be bought on the street after the bans. There’s nothing stopping people from selling e-cigarettes and pods, altered or unaltered, in secret. As a matter of fact, Dylan Nelson, a patient from Wisconsin who has been affected by the vaping epidemic, bought his vape cartridge on the street instead of a reputable shop, and he does not know if the cartridge was tampered with. 

Although vaping will most likely continue, that does not mean it won’t decrease. Banning the sale of e-cigarettes in shops will reduce the amount of vape shops, where most people can buy vape products, and make buying the product more difficult. The only problem is whether or not this is the right choice for ex-smokers. 

Opposing Views

Most people are against vaping and in favor of flavored e-cigarette bans. However, there are also people who are firmly against them as well. In Texas, many ex-smokers, who stopped smoking cigarettes because they vaped flavored e-cigarettes instead, protested outside of their state capitol against the recent bans. 

They held signs stating how long they have been smoking cigarettes and what e-cigarette flavor helped them quit. Many of them say vaping has saved their lives and are very passionate that e-cigarettes have more good than harm. Moreover, the American Vaping Association described the flavored e-cigarette bans as “draconian” because they will make ex-smokers start smoking traditional cigarettes again, which are more dangerous to one’s health than vaping. 

When asked for her opinion on banning flavored e-cigarettes once and for all, Juliet Ornstein had something similar to say about the issue, “I think it’s not that good because I think people should have a choice in what they want to smoke. I don’t want to go back to smoking cigarettes. ” 

In addition, when R.A. was asked his opinion on the issue, he said he would most likely resort to cigarettes if flavored e-cigarettes were to be banned. Ex-smokers and people who vape may be backed into a corner when the bans take full effect. Thus, although the bans were made in order to protect teenagers, there are still some drawbacks when thinking of the adults that will be affected.

Banning e-cigarettes would be a good thing when thinking of how teeenagers were and still are affected and hospitalized. However, adults who have been helped by vaping will be negatively affected. They most likely would go back to smoking cigarettes and things would just go back to how they were before when vaping wasn’t a thing and people were dying from smoking traditional cigarettes. We should not only be thinking about the young generation and the way we are affected, but we should also think about the people that could be or are being helped by this safer alternative.

Conclusion

The current situation for vaping is definitely a dilemma. Thousands of reported vaping-related illnesses have led to negative public views, state and federal bans, and government investigations to protect the nation’s youth. Removing flavored e-cigarettes, while good in intention, may have little effect on the amount of people who vape and even create drawbacks. 

Although Juul is being scrutinized the most, other brands are still out there like Eonsmoke and Ziip. Prohibiting flavored vape products can reduce accessibility to teens and young adults, but also for ex-smokers who have built a reliance on them and refuse to switch to mint and menthol. This can cause people to switch to traditional cigarettes, which are more detrimental to your health. Thus, suddenly cutting off e-cigarettes to everyone will lead to negative results. 

One possible solution that benefits both ex-smokers and young adults who vape, besides keeping mint and menthol flavors, is to make flavored e-cigarettes only accessible to people through a prescription for rehabilitation. The reason e-cigarettes are so common is because vaping products are available online or in shops, making them attainable by anyone. By making flavored e-cigarettes a prescription, people who need it to stay off cigarettes will have an alternative. Ex-smokers can get help while keeping accessibility limited. This way, people are less likely to begin vaping. 

By only letting those who need it get it, both young adults and ex-smokers are considered, but there is no clear path to this solution. In the near future, the sale of flavored e-cigarettes will be prohibited across the country.