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How Safe Are E-Cigarettes?

On Wednesday, the FDA chided the five biggest e-cig manufacturers, giving them 60 days to come up with a plan to curb teen use. But how bad are nicotine vape pens in the first place?

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Bad news for teenage JUUL connoisseurs — on Wednesday, the U.S. Food and Drug Administration (FDA) announced that the popular e-cigarette brand was one of five manufacturers that must “put forward plans to immediately and substantially reverse” the access and appeal of their products to underage users. JUUL, Vuse, Blu, MarkTen XL and Logic make up 97 percent of e-cigarette sales total, and the vast majority of illegal sales to minors, who, over the last several years, have made vaping their preferred tobacco intake method. These five companies have 60 days to submit their plans “describing how they will address the widespread youth access and use” to the FDA, or risk being hit with new marketing restrictions or seeing their products pulled from stores entirely. Juul told the New York Times they will “work proactively” with the FDA, and they’ve previously announced that a new app-connected version of the stick — designed to help users cut down — will be released next year. But the government agency seems intent on a crackdown.

As the FDA noted in their announcement about the new Youth Tobacco Prevention measures, the agency “remains committed” to their “comprehensive approach” to addressing nicotine addiction, including promoting “the potential of e-cigarettes to help adult smokers move away from combustible cigarettes.” Apparently no one quite anticipated that dessert- and fruit-flavored e-cigs would be so appealing to boundary-testing teenagers who’ve matured beyond collecting LipSmackers and huffing fruit-scented markers. The result has been a whole new generation of nicotine addicts — but hey, at e-cigarettes aren’t physically harmful like smoking, right? It’s just water vapor!

Not quite. While the electric vaporizer was invented in 1927 and the first “smokeless non-tobacco cigarette” was patented back in the 1960s, e-cigarettes didn’t become available in the United States until 2007. With only a decade of e-cig use to study, there is still a lot left to learn about its health effects — but to be clear, there’s a lot more to it than just water vapor.

“I would not discourage a tobacco smoker from switching to e-cigarettes, but we need more research on vaping risks and how the two compare,” said Dr. Holly Middlekauff, professor of medicine at UCLA, in 2017. “I would definitely discourage a non-smoker from starting to use e-cigarettes.”

A 2015 study found that propylene glycol and glycerol, the two solvents used in e-cigarette juice, may be FDA-approved in food at certain temperatures, but when heated to the level necessary to produce vapor, they produce carcinogenic compounds like formaldehyde.

A February 2018 study from Johns Hopkins Bloomberg School of Public Health discovered manganese, chromium and nickel in e-cig vapor, cancer-causing metals that have been linked to lung, liver, immune, cardiovascular and brain damage when regularly inhaled. (These metals are also present in traditional cigarettes, just in different concentrations.) Researchers say the coil that heats and aerosolizes the vapor is what’s producing the metals, which contaminate both the vapor and the e-cigarette juice tanks.

Perhaps more concerning, however, was the presence of lead, which couldn’t be attributed to the coil. As one researcher ominously put it, “There’s no reason for lead to be in there,” and said further testing needs to be done to narrow down its origin.

One study co-author by Middlekauff at UCLA found that habitual e-cigarette smokers were more likely than non-smokers to show signs of oxidative stress and higher levels of adrenaline, both risk factors for heart disease.

“We do not know if a tobacco cigarette smoker is better off switching to e-cigarettes. Most studies show that carcinogens are present at much lower levels in e-cigarettes compared to tobacco cigarettes,” said Middlekauff. “So it is conceivable that the risk for heart disease is similar for e-cigarettes and tobacco cigarettes, but that the risk for cancer is much greater with tobacco cigarettes.”

So hey, at least there’s some good news. While e-cigarettes don’t make nicotine any less addictive, or reduce the harm of cancer-causing metals, or do particularly great things for the heart, at the very least, e-cig smokers have less tar in their lungs than regular smokers.

As Middlekauff put it, “When it comes to smoking versus vaping, we need to consider the distinction between what’s ‘safe’ and what’s ‘safer.’”

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