Vaping was supposed to be a healthier alternative to cigarettes.
Along the way, it became an edgy trend among teens and young people, a talisman for Gen Z-ers to share with recovering smokers, marijuana enthusiasts and anyone else looking for a different way of lighting up.
However, a rash of deaths and serious complications related to vaping and e-cigarette use have brought lingering health concerns about the habit into focus. As of September 13, at least six people in the United States are reported to have died following e-cigarette use and it seems every day brings a new story of someone landing in the hospital with serious health issues related to the habit.
While these tragic events have prompted legitimate conversations about the future of vaping — the Trump Administration has vowed to remove flavored vaping products from the market — they have also revealed an unsettling truth: There is a lot we don't know about vaping, and despite a growing awareness in the medical community, it may be a while before its effects are fully understood.
Here are some myths and truths surround in the vaping trend, as well as some mysteries that doctors, regulators and health professionals are trying to crack.
MYTH: Nicotine causes cancer
Nicotine itself is not a carcinogen. It is the other chemicals found in cigarettes and tobacco products — lead and formaldehyde, to name a few — that cause cancer. Because vape products don't have these additives, many people, including e-cigarette brands themselves, argue vaping products are safe.
However, nicotine is not completely harmless. "It's not all that toxic to the cardiovascular system, but it can raise the blood pressure," says Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. "It can raise heart rates, and it's associated with some but not all of the cardiovascular risks of smoking."
The US Centers for Disease Control and Prevention notes that most e-cigarettes contain nicotine, a highly addictive substance that can harm adolescent brain development.
MYTH: Because vape products don't burn tobacco, they're safe
It's clear from doctor input and CDC information that nicotine itself cannot be considered safe, nor is the method of vaping harmless. It simply is when compared to smoking, by and large. "There is a perception that [vaping] is safe," Blaha says. "But the line really should be, it's 'safer' [than smoking], but not safe."
How is it dangerous? For one, Blaha says, there's all kinds of things entering your body when you vape, and a lot of them aren't regulated or well understood. "When you use e-cigarettes you're getting nicotine, you're getting the solvents, the flavors, you get trace heavy metal exposure from the heating coil, and you get other tobacco metabolites," Blaha says. Because remember, nicotine comes from tobacco. So, e-cigarettes are considered a tobacco product.
There are secondary factors to consider, like the potential for harder drug use and the mental effects of addiction and dependence.
"Addiction and the use of nicotine is closely associated with other health disorders like depression," Blaha says. "Is it causal? It's not clear. There's a two-way street when it comes to substances like this. People who are depressed may be more likely to use these substances, and these substances may lead to more feelings of depression. Regardless, stress, anxiety, depression are absolutely linked with addiction."
MYTH: Nicotine is the only chemical people vape
To clarify: Vaping is the act of inhaling an aerosol from a vaporizer, and e-cigarettes are a type of vaporizer. Some people use them interchangeably, but there's more to vaping than nicotine. Vaping is a very popular method of marijuana use. According to Blaha, people sometimes also vape herbs.
One reason this variance can be especially dangerous is because the types and amounts of chemicals in vaping products aren't typically standardized. For the most part, a cigarette is a cigarette. But vape products are something different. Not only that, but the types of vape pens and methods of use vary so much, it's hard to nail down a typical vaping habit.
"The complexity of this is how varied user's experiences are. People use everything from occasionally to daily, to a couple of puffs to a lot of puffs, they might use more than one device," Blaha says. "There's so many moving parts, unlike a traditional cigarette. The e-cigarette user experience is customizable. The devices, flavors, nicotine levels are different."
TRUTH: Vaping can lead to smoking
To vapers, this sounds like a "slippery slope" scare tactic designed to vilify the habit. However, Blaha says there is solid evidence that links the two, and the "gateway effect" between vaping and smoking is "absolutely" valid.
TRUTH: Vaping is a young person problem
While not everyone who vapes is a young person, vaping is a strong cultural commodity among teens and Gen-Z adults.
A lot of this has to do with the way vaping is perceived. Adi Jaffe, a mental health expert specializing in addiction, explains: "Marketing is an incredibly powerful tool and in the context of vaping, what the marketing efforts around vaping did, and did very well, is making people think smoking is the 'old thing,' Vaping is the new tech version. We've fixed all the problems; it's not smoking. It's smoking 2.0."
The devices themselves, and the way they are used, capitalize on this feeling of "newness."
"They're made to look like so many of the other devices that we carry around with us," Jaffe says. "For young people especially, they integrate into how they already interact with the world. It looks like a thumb drive, it looks like something they already have and know how to use."
MYTH: Vaping habits look like smoking habits
While there is research to suggest vaping is a viable smoking cessation tool, the reality is millions of Americans — many of them young people — vape for the sake of vaping, not as a smoking alternative. What's more, the habits and social challenges of vaping are vastly different than smoking. That can be a major problem.
"One of the biggest problems with these things is just how easy it is to use," Jaffe says. "You can use it anywhere, even in places where you're not supposed to. It's so easy to just reach for, unlike for instance, a cigarette. One of the reasons we're having success with quitting smoking is that it's hard to smoke these days. A lot of places don't allow it; there's a stigma, there's a process. Vape pens don't have any of those barriers."
E-cigarette users sometimes report near-constant vaping. A teen told the New Yorker in April that he slept with his vape pen under his pillow. An 18-year-old who had to be put on life support for a lung infection from vaping said she used her e-cigarette device every 10 to 15 minutes. Jaffe says he's seen the same — a patient of his would hold a vape pen in his hand constantly, inhaling from it every minute or so.
These varying patterns are another reason the dangers of vaping are so hard to pin down. Someone who vapes 100 a day is probably going to have a different experience than someone who does it 10 times a day.
MYTH: Everyone knows about vaping
While vaping may be common on campuses and among groups of teens and smokers, in general there isn't a lot of awareness about the trend. "It's not something that has a lot of official literature around it," says Blaha "There's no guidelines on it, say, from the American College of Cardiology."
Blaha gives regularly gives talks and lectures about vaping and e-cigarette issues, and he says two years ago almost no one knew anything about the trend. There's been a rise in awareness now, he says, but a typical clinician or medical professional may not be armed with intimated knowledge about the phenomena.
"All clinicians from obstetrics doctors to pulmonary doctors, everyone needs to learn about this. The problem is, we want to learn about things that have high quality information and evidence, and there just isn't a lot out there," he says.
That may be slow to change.
"We find out about things so slowly in research. It takes a decade to 15 years before research evidence is so strong, and I think vaping is exactly one of those examples," Jaffe says. "We're not going to find out more about vaping until more of these recent events continue to put the issue in the public interest."
The bottom line is, the medical community is scrambling to catch up with the fast-growing vaping phenomena. And until regulations and solid medical research provide more of a framing for the trend, the real dangers of vaping and e-cigarette use will remain undefined, filtered through desperate calls for change and the occasional headline-making tragedy