Electronic cigarettes, or vapes, are battery-powered devices that contain liquid that is heated and then inhaled like a regular cigarette, says Sanjivan Kohli, MD, a pulmonologist at Providence Mission Hospital in Southern California. The liquid itself contains tobacco-derived nicotine, flavorings, propylene glycol, vegetable glycerin, and other ingredients. When heated, the liquid forms an aerosol which is inhaled. Many smokers believe that switching to an e-cigarette or another type of electronic nicotine delivery system (ENDS) such as a vape pen is a healthier alternative because they inhale water vapor instead of tobacco smoke, but that idea is wrong, says Dr. Kohli.
“In fact, the ingredients in e-cigarette aerosols have not been evaluated by the FDA. Therefore, they cannot be recommended as safe,” says Dr. Kohli.
What’s in e-cigarettes?
The vaping liquid inside e-cigarettes includes nicotine, propylene glycol (a colorless, odorless liquid with a sweet taste) and other flavorings and chemicals, Dr. Kohli says. “Electronic cigarettes come in many shapes and sizes and can resemble traditional cigarettes, pipes, pens, and cigars.”
The flavors of many electronic cigarettes are designed to appeal to young people. According to a recent study by the Centers for Disease Control and Prevention (CDC), e-cigarette flavors can range from fruity flavors to candy or dessert flavors, chocolate and mint. With such “fun” flavors, vaping may seem trivial, but the content of e-cigarettes is far from trivial, according to the study. In addition to nicotine, e-cigarettes often contain ultrafine particles (which can be inhaled deep into the lungs), the chemical diacetyl (which has been linked to lung disease), heavy metals like nickel, tin and lead and carcinogens.
What is JUUL?
JUUL is a very popular brand of e-cigarettes among young people, says David Krol, MD, medical director of the Connecticut Children’s Care Network in Hartford, Connecticut. Shaped like a thumb drive, the battery-powered device contains about as much nicotine as a pack of 20 cigarettes, he says. Although the age requirement to buy JUUL is 18+ (and in some places 21+), young people report getting the product from brick-and-mortar stores, friends and family, or online.
In June 2022, the FDA issued marketing denial orders (MDOs) to JUUL Labs Inc. for all of its products in the United States, says Dr. Krol. These orders required the company to cease sales and distribution of its JUUL e-cigarette device and several of its vaping products, saying the brand has played a disproportionate role in increasing youth vaping.
However, on July 5, the FDA temporarily suspended his order while further research into the product’s safety was conducted. JUUL products can still be purchased during this review process, as can other e-cigarette brands not affected by the order.