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Second Opinion: The Great Vape Debate

E-cigarettes are becoming more popular, but are they any safer? And are they a way off or gateway to cigarettes?

This week e-cigarettes are back in the news with articles in Vox and the California Healthline documenting increased use of both traditional nicotine, as well as marijuana, e-cigarettes among teens.

There are a lot of unresolved questions about e-cigarettes and vaping. Are they an effective way to quit cigarette smoking? Are they safe, or safer? Or, are they a gateway to smoking and harmful in their own right?

And ultimately, is there a better alternative?


To recap, e-cigarettes (also known as vape pens, hookah pens, etc.) work by vaporizing liquid nicotine which is then inhaled by the user. They are frequently marketed as “safer” alternatives to traditional cigarettes and often flavored (mango, mint, cheesecake, etc.) to increase their appeal. E-cigarettes have rapidly become the most commonly used form of tobacco among adolescents with one brand, Juul, accounting for roughly 50% of the market and spawning the term “juuling” into the teen vernacular.

The industry has grown rapidly and with virtually no regulation resulting in confusion among smokers, teens and parents as to the health effects of vaping. Clinical evidence is still scant given how new these devices are and is often overshadowed by manufacturer marketing claims. Separating fact from fiction here are a few things we do know about e-cigarettes:

  1. Nicotine, whether delivered via vaping or traditional cigarettes remains incredibly addicting. In fact, British addiction researches recently ranked nicotine as one of the five most addictive substances on Earth, along with cocaine and heroin.
  2. While the risk of lung cancer is likely less with vaping there remain significant cardiovascular risks. A recent UCSF study reported a two-fold increase in heart attack risk with e-cigarettes.  Traditional cigarettes increased heart attack risk three-fold and the risk jumped five-fold when both were used.
  3. Despite manufacturer hopes and claims that e-cigarettes may help smokers kick the habit, recent research seems to indicate that most cigarette smokers end up smoking and vaping.
  4. The industry is virtually unregulated and help for consumers isn’t coming anytime soon. The Food & Drug Administration recently delayed the deadline for e-cigarette regulation until 2022.
  5. Enterprising teens and adults have figured out how to hack e-cigarette devices to deliver cannabis in addition to nicotine. Public health officials are concerned as vaporized pot delivers more THC which can increase side effects such as anxiety and paranoia.

Bottom line; if you don’t currently smoke, don’t start vaping or smoking. If you do smoke and want to quit, evidence-based solutions such as smoking cessation counseling and nicotine replacement therapy are more likely to help you succeed. Blue Shield of California members can utilize our complimentary, proven QuitNet web and mobile smoking cessation application and all Californians have access to the Smokers’ HelpLine at 1-800-NO-BUTTS.