Vaping Trends and Health Concerns: What to Know

Research: Vaping Study Reveals User Disparities

Vaping is pervasive among specific groups, particularly high school students and young adults. Meanwhile, researchers are still studying the long-term health impacts caused by the relatively new electronic cigarette industry.

Lung cancer from traditional cigarettes may not appear for decades due to the long latency period. This same delay is why we lack conclusive proof that heavy vaping could cause similar health problems. However, studying how Americans use e-cigarettes could provide quicker insights.

Investigating disparities in e-cigarette use

Several Sylvester Comprehensive Cancer Center and UHealth researchers set out to do just that, thanks to a push from Kyle Edwards, a second-year University of Miami Miller School of Medicine medical student. In the study, “Disparities in electronic cigarette use: A narrative review,” published in Critical Reviews in Oncogenesis, they reviewed 77 relevant articles.

In 2018, the U.S. Surgeon General declared e-cigarette use among 18-24-year-olds an epidemic, a sentiment echoed by a 2019 study that found high usage rates among high school and middle school students. The researchers aimed to identify whether certain groups were disproportionately affected by this epidemic.

“Whether it’s among peers or just walking around the streets in downtown Miami, there are a lot of young people using these products. They’re perceived as healthier than conventional cigarettes, but we don’t really know all that much about it,” says Edwards.

Following are some of the study findings: 

• Racial, ethnic, and gender minorities were more likely to use e-cigarettes. There are conflicting conclusions regarding disparities by socioeconomic status.
• They found a relationship between the use of e-cigarettes and anxiety, stress release, and social pressure.
• There’s more aggressive e-cigarette marketing and more vape shops in lower socioeconomic areas.

Addressing the hidden dangers of vaping

Part of the challenge in decreasing e-cigarette use is the devices are so inconspicuous. While most indoor spaces ban smoking, vaping is common in public restrooms and spaces like restaurants and bars.

Coral Olazagasti, M.D., a head and neck oncologist who was part of the study, says, “It’s easy to hide, and you don’t even have to ask for permission. That’s a scary thought that anyone can just pull it out anywhere, and no one even looks sideways,” she says. 

Similarly, Edwards has seen peers vaping for years and says, “I know that in high school, people would go to the bathroom to use these products, and there’s definitely peer pressure where it feels like you have to use this to fit in.” 

Understanding why people are vaping is crucial to addressing the issues, which is why the recent vaping disparities study is so important. For example, in a survey of California high school students, minorities were more likely to cope with stress and anxiety with vaping.

“If they’re using it because of anxiety or depression as a crutch or for recreational reasons, offering advice about other healthier avenues to channel those feelings might help,” says Dr. Olazagasti.

Misconceptions and dangers of vaping

The perception that e-cigarettes are a safer alternative because they are marketed as smoking cessation tools and contain no tobacco is misleading. Studies indicate that the dangers of smoking and vaping manifest after prolonged use, yet public perception often underestimates these risks.

For instance, a study showed that fewer than half of surveyed high school students believed e-cigarettes were harmful, and even fewer acknowledged their addictive potential. Nevertheless, evidence increasingly suggests that the chemicals in these products can cause cancer, lead to adverse health effects for both active and passive users, and harm the environment.

Nicotine addiction and public health implications

Nicotine addiction is a critical concern with vaping, which can start as a social activity but often leads to dependency. “It starts as a recreational party drug. People drink and then use nicotine to get another buzz, but then it becomes addictive,” says Edwards.

Also, unlike traditional cigarettes, which are typically used outside and burn quickly, e-cigarettes allow for longer, continuous exposure, potentially increasing health risks. A cigarette often requires going outside and burns down in about 2-5 minutes. E-cigarettes take less effort because users are vaping inside and take as long as 20 minutes to finish a cartridge. 

Health risks are not limited to your lungs

While physicians are concerned about lung cancer, the health risks of vaping extend well beyond the lungs. According to a July 2023 statement published by the American Heart Association, e-cigarette use is associated with cardiovascular issues such as increased heart rate and blood pressure, which can lead to chronic heart disease​​. Several studies cited in a paper published in the June 2022 issue of Toxicology Reports also connect E-cigarettes to an increased risk of seizures.

Additionally, vaping poses significant risks to oral health, including dry mouth, irritation of the gums, and increased risk of oral cancers. Other studies have shown that the chemicals in e-cigarette vapor can alter oral bacterial environments and cellular integrity, leading to these complications​.

Vaping can harm those around you

The risks associated with secondhand vapor are now well-recognized as a significant public health concern. According to a study published in the journal, Thorax, exposure to secondhand nicotine vape was associated with increased risks of bronchitis and shortness of breath in young adults, even after accounting for active smoking and vaping.

There has also been a marked increase in e-cigarette–associated calls to U.S. poison centers. The CDC reported that from April 1, 2022–March 31, 2023, a total of 7,043 e-cigarette exposure cases were reported, representing a 32% increase, from 476 in April 2022 to 630 in March 2023. More than 87 % of these cases were in children under 5.

E-cigarette waste harms the environment

The increase in e-liquid-related poison center calls underscores the dangers of improper disposal of e-cigarettes and related products, not just to humans but also to the environment.  

According to the FDA, these products contain hazardous substances that can leach into groundwater or cause soil contamination if not disposed of correctly. Users are urged to take their used vaping products to hazardous waste facilities to ensure these toxins do not end up in landfills​​. The agency offers other tips for handling nicotine waste on their website.

Rethinking screening and public health strategies

Despite these early warning signs of the dangers of vaping, health care providers typically still focus on cigarette smoking. Eligibility screening guidelines for lung cancer focus on heavy smoking habits, so many physicians aren’t even asking about e-cigarette use.

“Our minds have not yet been rewired to introduce the potential risks of e-cigarettes,” says Dr. Olazagasti.

Thankfully, some clinicians are learning that asking the question, “Do you smoke?” is no longer adequate. In fact, Dr. Olazagasti says since the study, she’s begun routinely asking patients about vaping.

Understanding how these products are used is key to developing public health interventions that can prevent people from starting to use them in the first place. 

Natasha Bright and Wendy Margolin contributed to this story. Both are regular contributors for UHealth’s news service.

Tags: cancer research, Dr. Coral Olazagasti, e-cigarettes, Sylvester Comprehensive Cancer Center, vaping