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Yes, We Should Be Concerned About the Health Effects of Vaping

Electronic cigarettes have fewer toxins than regular cigarettes, but what’s that hit doing to your health?

minute read

by Carie Behounek | June 9, 2025
Man hits a vape to illustrate use of e-cigarettes for addiction series

Here’s some news worth celebrating: Fewer Americans than ever are smoking cigarettes.

Now here’s the buzzkill: Vaping is a big reason why teens and young adults are disproportionately addicted to nicotine.

Nicotine is highly addictive. Marketed to young people and people trying to quit regular cigarettes, electronic cigarettes offer users the ability to inhale flavored nicotine. These e-cigarettes, or “vapes,” are generally viewed as less harmful than their combustible counterparts. But they are not without harm, said Gina Kruse, MD, MPH, associate professor in the Division of General Internal Medicine at the University of Colorado School of Medicine.

This is the fourth article in a CU Anschutz Newsroom series exploring addiction, a serious public health issue our doctors and researchers are working hard to address.
See other articles in the series.

“Tobacco use is still the leading cause of preventable death in the U.S.,” Kruse said. “And ‘vaping’ is problematic for two reasons. First, the marketplace continues to evolve making regulation of the products people consume challenging. Second, we don’t yet know the long-term impacts of using e-cigarettes.”

Kruse serves as director of the Colorado Nicotine, E-Cigarettes, and Tobacco Research Alliance (CoNECTR) at CU Anschutz. In the following Q&A, she shares what we know about vaping – and perhaps more significantly – what we do not know about using e-cigarettes to consume nicotine.

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Is vaping really safer than smoking cigarettes?

Yes – an e-cigarette has fewer of the toxins and chemicals that make conventional cigarettes so harmful. But there are caveats. Researchers have been trying to look at the toxins and substances they contain, including the amount of nicotine – the chemical in tobacco that makes it highly addictive. But the marketplace is evolving quickly, and there’s no infrastructure in place that can test all vaping products to see what’s actually in them.

What are the health effects of vaping?

Short-term health effects include negative impacts on heart rate and blood pressure. Some data show impacts on respiratory symptoms and lung function. We have also seen a negative impact on mental health, anxiety and ability to concentrate. Research is needed to isolate the long-term effects of vaping. E-cigarette users tend to fall into two categories: People who switched to vaping after quitting conventional cigarettes and young people who started vaping as teens or young adults.

There are stories in the news about a teenager who vaped in secret for years and developed “popcorn lung.” What do parents need to know?

“Popcorn lung” is a condition called bronchiolitis obliterans. It’s rare, serious and not reversible. Without treatment, it can be fatal. It relates to damage to tiny airways in the lungs and causes coughing, wheezing and fatigue. In the early 2000s, the term “popcorn lung” was coined when workers at a popcorn factory developed lung problems from inhaling a flavoring chemical called diacetyl. Early studies of e-cigarette liquids found diacetyl. It's banned from use in e-cigarettes in the E.U. and U.K. but not in the U.S.

Among youth, e-cigarettes are the most used tobacco product. In 2024, 5.9% of middle and high school students reported vaping in the past 30 days. Disposable vape products are the most commonly sold device type, and they are not subject to the flavor ban that applies to pod-type e-cigarettes. It’s important for parents to talk to their kids about the health risks of vaping, including respiratory problems. Be aware of signs of use and signs of nicotine withdrawal such as irritability, anxiety and decreased appetite.

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How prevalent is vaping?

The highest prevalence of e-cigarette use is actually in young adults aged 21-24 years, which right now is about 15.5% reporting having used in the past 30 days. Overall among adults, past 30-day e-cigarette use is up from prior years, increasing from 4.5% in 2019 to 6.5% in 2023. It is great news that fewer people are smoking conventional cigarettes; however, the rise in vaping has exceeded the drop in conventional cigarettes.

Are e-cigarettes addictive?

Yes. Nicotine is the addictive substance in tobacco-based vaping solutions. It interacts with receptors in your brain to produce dopamine, which produces that rewarding effect. Like other addictive substances, as you continue to consume nicotine, it makes your brain grow more receptors so you need to consume more to feel the same. And when you're not smoking or consuming nicotine, you get withdrawal symptoms, which include things like cravings, restlessness, decreased appetite, irritability and trouble sleeping.

"Tobacco is still the leading preventable cause of death. The best thing you can do for your health is to quit all tobacco products." – Gina Kruse, MD 

How do e-cigarettes compare to regular cigarettes?

There have been studies that compare nicotine consumption in a pack of cigarettes and the nicotine solutions in e-cigarettes. Most of the studies looked at reusable e-cigarettes that had cartridges containing 40 milligrams of nicotine at 5% strength, making the cartridge of a pod-type e-cigarette about equal to 20 cigarettes, or a pack.

In 2020, the U.S. Food and Drug Administration restricted the sale of cartridge-type reusable e-cigarettes using flavors other than tobacco and menthol. But they exempted disposable e-cigarettes. A recent study said in 2022 alone, 48 new disposable e-cigarettes hit the market with 6% or more nicotine strength and much larger cartridges. So these disposable brands are bigger, cheaper and filled with fruity flavors, making them highly attractive to young people. In terms of FDA-approved e-cigarette devices, there is a short list that has been approved. But the marketplace is currently flooded with these newer disposable devices and products that have not been authorized for sale. It’s an enforcement challenge.

Related: CU Cancer Center Leaders Applaud Denver’s Ban on Flavored Tobacco Sales

Are there differences in the health impacts of vaping tobacco versus vaping cannabis?

We don’t know. Studies have shown that more than half of people who consume e-cigarettes also consume cannabis, whether vaping or smoking. It’s an active area of research because if we’re only looking at vaping tobacco, we’re missing part of the picture.

What are signs of vaping-related nicotine addiction?

Penn State developed an electronic cigarette dependence index that helps to assess nicotine dependence levels. It includes questions such as “how many times per day do you use your e-cigarette? How soon after you wake up do you first use it? Do you awaken at night to use your e-cigarette? Do you ever have strong cravings to use an e-cigarette? Is it hard to keep from using an e-cigarette in places you’re not supposed to?”

Can using an e-cigarette help me quit smoking conventional cigarettes?

Several studies have found evidence that e-cigarettes are effective at helping people to quit conventional cigarettes. In the U.S., our cessation guidelines involve medications such as varenicline and bupropion, as well as nicotine-replacement therapies and behavioral support. In the U.K., e-cigarettes are also listed as a way to help people quit traditional cigarettes. A takeaway from this is that all the science points to e-cigarettes as being a less-harmful product, and quitting traditional cigarettes is the most important thing you can do for your health. From a research standpoint, there are questions around what switching means in terms of reducing your risk for conditions attributable to tobacco, including how much that risk is reduced by switching to vaping.

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Why haven’t researchers learned more about this?

In terms of health effects, it’s a challenge to understand the true health impacts of switching to vaping. Differentiating between the health effects people got from years of smoking from risks of e-cigarette use is really hard. We may learn best by studying the long-term health effects of the youth and young adults who have only vaped and never smoked combustible cigarettes. Hopefully, we can get information sooner rather than later so people can make informed choices.

What would you say to anyone using e-cigarettes?

The potential for addiction to these substances is real. They are less harmful than conventional cigarettes but the long-term health effects are not yet known. Nicotine withdrawal makes you feel bad, and freeing yourself from nicotine dependence could improve your quality of life.

Also, it’s worth restating: Tobacco is still the leading preventable cause of death. The best thing you can do for your health is to quit all tobacco products.  

Featured Experts
Staff Mention

Gina Kruse, MD, MPH