Vaping & the EVALI Epidemic: What We Know and Next Steps

Published: December 12, 2019

For years, we’ve known about the dangers of tobacco use, but recently, a new smoking product has been in the spotlight. Electronic cigarettes, also known as e-cigarettes, vapes or (vape) pens, are linked to the most recent disease outbreak that has officials and civilians alike on edge. These vape pens are filled with a suspension fluid that contains chemicals like nicotine and tetrahydrocannabinol (also known as THC, the psychoactive compound found in marijuana) which is subsequently aerosolized upon heating and inhalation, according to Michael & Susan Dell Center for Healthy Living graduate assistant and outbreak researcher, Onyinye Omega-Njemnobi. As of December 3, 2019, the outbreak, nicknamed the EVALI outbreak (E-cigarette, or vaping, product use associated lung injury), has affected over 2,200 individuals in all 50 states, and has killed 48 people. While there are variations in the presentation of the lung injuries across individuals, all of the lung injuries are extremely serious and most have led to hospitalization. Patients who have presented themselves for medical examination after using e-cigarette or vaping products have reported symptoms like coughing, shortness of breath, nausea, fever, and weight loss, among others. Symptom onset ranges from a few days to a gradual onset of several weeks.

Recently, major breakthroughs in the investigation of the outbreak have come to light. Vitamin E acetate, commonly known as vitamin E oil, has been implicated as a potential chemical of concern in relation to the EVALI outbreak. Normally used as a hydrating or healing serum, the benefits of vitamin E oil have been studied when used dermally as a topical treatment, or ingested. Previous research suggests, however, that when vitamin E acetate is inhaled, it can impede normal lung functioning. Researchers believe that it is being used as a thickening agent for vape devices, especially in THC-containing vaporizer liquids or suspensions. While there is a lot of evidence that implicates vitamin E oil in this outbreak, CDC officials are quick to remind the public that we cannot rule out other chemical sources as potential causes. The best way to protect yourself against serious lung injury and disease is to avoid vaping nicotine or THC containing products.

You may be wondering, what’s the ‘buzz’ about vaping, anyway? What makes it more appealing than traditional tobacco products? E-cigarettes were first manufactured and marketed as a smoking cessation tool, though there is no evidence, nor statements by the Food and Drug Administration (FDA) supporting such theory. Conversely, evidence shows that close to 60% of vapers go on to become regular smokers or dual users (someone who uses both e-cigarettes and other tobacco products). According to CATCH My Breath researcher, Tara Vaughn, e-cigarette and vape manufacturers continue to exploit users and potential users, especially youth, by perpetuating the myth that e-cigarettes are safer than traditional nicotine delivery methods like cigarettes and snuff. Omega -Njemnobi emphasizes the dangerous levels of nicotine in most vape pods, stating that a single e-cigarette pod, like those made by JUUL contains on average equivalent amount of nicotine as a pack of cigarettes, sometimes more.

Since 2014, e-cigarettes and vaporizers have been ranked as the #1 most-used tobacco product among youth and young adults. E-cigarette manufacturer Juul makes a device that looks like a USB drive, making it discreet, and also making it easier for kids to get away with smoking behaviors, says Vaughn. Juul has also caught heat recently for offering flavored pods like mango and bubble gum, which critics claim explicitly target kids and teens. Since the beginning of the EVALI outbreak and due to public and governmental pressure, Juul has pulled most of their flavored pods, leaving only menthol and tobacco flavors available for sale. Other tobacco companies that manufacture pods have not followed suit. Center Faculty members, Dr. Steven Kelder and Dr. Melissa Harrell, testified to the Texas Senate Health and Human Services committee on December 3rd of this year to push Texas lawmakers to ban the sale of all flavored pods in Texas. According to Kelder, since 2016, rates of e-cigarette use in Texas for youth and teens have jumped over 300%, well surpassing the threshold for epidemic status. Experts say that this ban would dis-incentivize e-cigarette use amongst youth and young adults.

Again, it is important to emphasize that the safest thing to do to avoid the dangers of e-cigarette and vape use is to avoid vaping altogether. If you have children, the best method of dealing with the potentiality of vaping behavior is to focus on preventing experimentation or initiation of the behavior, as those who vape are 4x more likely to start smoking cigarettes and/or other tobacco products. It is important to have calm and logical discussions with teens and youth about  the dangers of e-cigarette and vaporizer use, ensuring an atmosphere for open dialogue. Allow your child or teen to ask questions, and research the answers that you cannot provide together. If you catch your child vaping, try to not make your child feel ostracized for their behavior. Perhaps, underlying issues like peer-pressure or depression could really be the catalyst for their choice to vape, and addressing those issues is equally crucial to maintain your child’s overall health.

To learn more about the EVALI outbreak as well as dangers of vaping and e-cigarette use visit CDC.gov and FDA.gov. Additionally, you can visit catchmybreath.org to learn about a free 5th to 12th grade E-Cigarette & JUUL Prevention Program.