While electronic cigarettes have gained popularity in recent years as a healthier alternative to traditional combustible cigarettes, the long-term health effects are still unknown and may be detrimental, according to health experts.

The United States’ most popular brand of e-cigarette, the Juul, was created to help adult smokers quit, though it has become most popular among teenagers and young adults. Its single-use cartridges contain nicotine salt as well as various flavors. In a 2018 study by Truth Initiative, a tobacco control organization, 10 to 11 percent of 15-21 year olds reported that they currently use a Juul. Health experts such as the American Academy of Pediatrics are calling for better regulation of e-cigarette use, in light of the lack of knowledge on long-term health effects and the way companies market to younger people. 

According to Benton County Health Department Health Policy Specialist John Ruyak, a current issue with e-cigarettes is that they are largely unregulated. 

“This is an industry that is not well regulated, so we don’t have a consistent way to test the products. There is no consistent way to know what is in the products and if they are labeled correctly,” Ruyak said.

According to Ruyak, switching from combustible cigarettes to e-cigarettes can lead to a reduction in short-term health problems. However, there are potential health risks associated with e-cigarette use by itself. Long-term health impacts are not known due to the short amount of time that these products have existed.

Marc Braverman, an extension specialist and professor in the School of Social and Behavioral Health Sciences, is co-chair of OSU’s Tobacco Policy Task Force. As an Extension Specialist, Braverman delivers health-based programs to the community.  

The Tobacco Policy Task Force aims to prevent e-cigarette usage as well as help users quit. Braverman said that because e-cigarettes are not regulated in the same way as combustible cigarettes, users may not know exactly how much nicotine they are consuming.

“The user won’t necessarily know what the nicotine level is, because there is a great deal of mislabeling, or no labeling at all,” Braverman said via email.

A Juul pod can have the same amount of nicotine as a pack of cigarettes. According to Ruyak, studies have suggested that nicotine, aswell as being addictive, can interfere with the brain while it is still developing under the age of 25. This may lead to a decreased ability to learn and recall information. Many users are unaware of the risks since e-cigarettes are seen as a safe alternative to combustible cigarettes. 

“I think the companies themselves have done a really good job of distancing their products from combustible, regular cigarettes,” Ruyak said. 

However, studies have shown that e-cigarette users who develop an addiction to nicotine are eventually more likely to try combustible cigarettes if they find themselves without access to an e-cigarette.

According to Braverman, nicotine is toxic at very high levels, leading to some cases of life-threatening nicotine poisoning, especially for young children who ingested the sweet flavors directly.   

“[Vaping] may well be safer than cigarette smoking, but that is not saying much since cigarette smoking is so extremely hazardous,” Braverman said via email. “Also, e-cigarettes in

their many forms are so new that we really don’t know how severe the health threat is and what the health impacts on long-term users will be several years down the road.”

 Another potential health concern is the presence of toxic chemicals such as formaldehyde, lead, and nickel in the vapor of e-cigarettes. Though these chemicals may not be in the vape juice, it appears that they are created during the vaporization process. When the metal coil heats up, it can transfer the metals to the vapor.

Ruyak says that e-cigarettes appeal to young people primarily because of marketing as well as flavors such as mango or vanilla.

“All the ways that we said weren’t okay for cigarette companies to be advertising their products [to youth], those are now being used by vape companies to market their products,” Ruyak said.

Teenagers and young adults may be drawn to e-cigarettes through advertisements and social media. However, in a survey it was determined that the number one reason most minors began using these products was because of the flavor. Traditional cigarettes with flavor were banned in 2009 because of this reason.

The flavor itself may lead to negative health effects. According to Ruyak, certain flavor chemicals present in e-cigarettes such as diacetyl are safe to consume but can cause lung disease when breathed in. Some chemicals that are used to create cinnamon flavoring have been shown to be highly toxic to human cells. 

According to Ruyak, a number of vape products use the same type of color palette and design on their packaging as products such as apple juice, candy, and cookies to draw in young users.

“We recognize in public health that flavor, cartoons, and certain words used to describe products are ways that you attract younger people,” Ruyak said.

According to Ruyak, it will take years of studies to conclusively say if vaping is harmful or not harmful to human health. 

“We’re not going to know the long term health effects in the next five or ten years, it will be much longer,” Ruyak said.

Marion Ceraso, an associate professor of practice in the School of Biological and Population Health Sciences and the Extension Family and Community Health Program, is co-chair of the OSU Tobacco Policy Task Force. According to Ceraso, members of Task Force, notably Student Health Services and the Office of Human Resources, aim to provide up-to-date information about e-cigarettes to students and employees.

“Many e-cigarette users say they wish they had never started once they realize they are addicted,” Ceraso said via email. 

Ceraso believes that in the future, the Food and Drug Administration could strengthen e-cigarette regulations in a number of ways. This might include banning the use of flavors, requiring stricter age-verification on internet sales, and implementing a federal excise tax on e-cigarettes.

A bill introduced by Gov. Kate Brown last year would create Oregon’s first e-cigarette tax. In this proposal, the current 65 percent tax on many tobacco products would extend to e-cigarettes.