Almost 50 deaths have been the result of a nationwide outbreak of lung disease which comes as a direct consequence of the use of electronic cigarettes.
Vapes – pocket-sized devices that produce nicotine-containing vapor – are aggressively marketed by e-cigarette companies, especially toward teenagers and young adults.
There has been a rapid increase in vapes’ usage nationally and globally over the last few years.
Marketed also as a healthier alternative to regular smoking, their image has been tarnished following a spike in reports of vaping-related lung damage earlier this year. The Centers for Disease Control and Prevention had received reports of 2,290 vaping-related cases of lung disease from all states but Alaska; Washington, D.C.; and one U.S. territory by November 20th.
“You shouldn’t be putting anything into your lungs in general. Even vaping water vapor can irritate cells in your lung and cause problems related to that,” said Matthew Olonoff, who works with the Nicotine Dependent & Treatment Lab of Northwestern University’s Feinberg School of Medicine.
Olonoff said that while usage rates of cigarettes kept declining, those of e-cigarettes were skyrocketing.
“It is still unclear what specifically, but something about these devices has really attracted audiences,” he said.
They have been especially successful with younger audiences.
He presumed it might be a combination of various factors, including the look of the device, the nicotine formulation in the liquid, the ease of concealment and the flavoring. “It’s also a technological device and younger adults are more tech-savvy: they are able to relate and understand the idea of technology more,” Olonoff added.
Recent studies show vaping at its highest level yet. In 2018, 39.9% of college students reported having vaped, up 19.9% from when e-cigarette usage started being recorded in 2015 in a dataset published by the University of Michigan.
About a third of college students reported having vaped nicotine devices and almost a quarter reported having vaped marijuana devices.
The CDC has identified the chemical vitamin E acetate as a likely contributor to the outbreak of lung disease.
It states that this chemical is used mainly as a thickener for THC-containing products, especially those from informal and black-market sources.
Melissa Megala, a freshman at Northwestern University, is a student using THC pods.
“If you’re going to vape against your parents’ will, you might as well go and smoke weed,” she explained her decision not to go with the more conventional – and legal – nicotine vapes.
Megala believes that the upcoming legalization of cannabis in Illinois with the start of the new year will lessen the risks for vapers.
“It’s black market stuff. It’s made in some guy’s living room and they can put whatever they like into it. Once it’s legalized, you’ll be able to get it from more reliable sources,” she said.
Olonoff pointed out that this lacking regulation is also a concern with nicotine vapes, saying that “you can go and buy an e-liquid and have no idea what’s really in it.”
While artificial flavoring has been outlawed for cigarettes, it is commonplace in vaping devices. Combined with aggressive marketing and social factors, Olonoff thinks this may be one of the reasons that vaping is especially prevalent in younger populations, such as high schoolers and young adults at colleges. “A lot of the flavoring, like the cotton candy flavors, can be geared more towards younger audiences,” he said.
The manufacturers’ marketing also relies heavily on portraying electronic devices as safer and cleaner alternatives.
Megala agreed with this idea.
“When I see someone smoke a cig, I’m like: ew. You know, it smells bad, tastes bad, all that. Vaping is also healthier and it doesn’t burn as much in my throat,” she said.
Olonoff hopes that the recent outbreak of lung injury cases will help change the perception of e-cigarettes being safe.
“Any irritant that enters your lungs is likely to cause health problems,” he said.
“I hope that the publicity shows that, like with other tobacco products, this does have consequences and bad things can happen when you use these devices.”
At Northwestern, most students said vaping was almost entirely absent from their lives and they knew few people who did it.
“I haven’t seen anybody vape on our campus,” said Ryan Kim, a Northwestern freshman originally from New York City.
Students at other top colleges have made similar observations.
Luca Pistor, a freshman at Stanford University in California, noticed the absence of a vaping culture at his university as well.
“I have literally not heard anything about vaping since leaving high school,” he said.
High-scoring students with low-income families are less likely to attend selective private colleges than low-scoring, high-income students, according to a report by the Education Trust.
With socioeconomic factors being a potential risk factor for tobacco usage, it appears to match that Northwestern and other elite private universities would have fewer vapers.
The relative absence of vaping at Northwestern University may in part also be linked to the fact that in Illinois raised the minimum age for the purchase of e-cigarettes to 21 in April.
In September, Illinois’ governor Jay Pritzker went one step further, becoming one of a growing number of lawmakers endorsing an outright ban on the sale of flavored e-cigarettes, which would include the popular brand Juul.
In August of 2018, Juul controlled over 72% of the US market for e-cigarettes, according to Wells Fargo Securities analyst Bonnie Herzog.
A law banning flavoring for vapes was passed in Michigan on September 4th, and the retailer Walmart pulled all flavored e-cigarettes out of their assortment toward the end of the same month.
“With this outbreak of deaths, it’s a moment to take a step back and have a look at how good or bad these devices really are,” Olonoff said. “Some people think it’s the cool alternative to smoking, and that’s a dangerous thought to have. Because at the end of the day, we don’t want to have anyone smoking or vaping. Smoking-related diseases are one of the top preventable causes of death.”