As vaping grows more popular, so do concerns about associated health hazards. Doctors say young people are especially at risk.

Public health officials have been wary about the long-term effects of vaping for some time. But the common belief among smokers—many of them teenagers, some as young as 13—was that vaping was less harmful than cigarettes.

Cracks developed in that theory this summer when vaping was linked to a series of serious lung issues. And then people began dying.

Now the Food and Drug Administration and other public health officials are warning people—especially young people or pregnant women—not to vape as they investigate an outbreak that’s killed at least 39 people and sickened thousands more.

In Ohio, nearly 100 confirmed or suspected cases had been reported as of mid-November. However, one local pediatric specialist believes the scope of the problem is much larger. The vaping trend affects not just high school students, but has trickled down to the middle school level as well.

Get top reads, event recommendations, guides, parenting trends and more ideas for family fun. Subscribe to Columbus Parent’s weekly e-newsletter, The Bulletin.

Vaping is the common term for the use of electronic cigarettes—devices sometimes as small as USB drives that heat a syrupy liquid, turning it into vapor. The liquid typically contains flavoring, nicotine and other additives. But the surgeon general’s office says the products also may contain harmful or potentially harmful ingredients.

The Centers for Disease Control and Prevention had not officially determined a cause for the illnesses as of mid-November but announced that recent testing of fluid from the lungs of 29 patients all showed the presence of vitamin E acetate—an additive in vaping products. “This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries,” the CDC said.

As of Nov. 5, CDC reports show 39 people have died and more than 2,000 patients have been linked to what it calls EVALI (e-cigarette, or vaping, product use-associated lung injury). Half of the reported cases involved patients under 25—some as young as 13. The CDC says most EVALI cases are connected to products containing THC, the active ingredient in marijuana. “Those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak,” it says.

“National Epidemic”

The Ohio Department of Health began tracking EVALI cases in August. As of Nov. 12, there were 52 known cases, and another 41 were under investigation.

Dr. Don Hayes Jr., a pulmonary specialist at Nationwide Children’s Hospital, suspects the problem may be even bigger. “What’s making the headlines are the severe cases where patients have ended up in the ICU on ventilators. Those are pretty easy to diagnose,” he says. “Who knows how many we’re missing that may be confused with asthma or other related pulmonary disorders in children.”

The outbreak comes at a time when the popularity of vaping has spiked with young people. FDA data shows that tobacco use by high school students declined steadily since 2011 as the use of e-cigarettes rose sharply. While only 5.8 percent of high school students reported using tobacco in 2019 (down from 15.8 percent in 2011), 27.5 percent said they use e-cigarettes—more than a twofold increase from 11.7 percent in 2017. By far, those students favor vaping products with fruit, menthol, mint or candy flavorings.

“It’s a growing national epidemic, in my opinion, because these products have targeted children because of the different flavorings,” Hayes says. “You can just flat-out say that these companies have specifically targeted children because most adults don’t necessarily need bubblegum or strawberry flavored inhalants in their vaping device.”

The FDA said in September that it intends to ban non-tobacco-flavored vaping products.

Gateway to Smoking

While vaping was originally designed to help people quit smoking, authorities worry it’s now instead becoming a gateway to smoking for more young people. Hayes notes that vaping dramatically increases the amount of nicotine intake compared with cigarettes.

“Teenagers, many of them that are vaping, weren’t on cigarettes to begin with,” Hayes says. “They’re starting this out as their introduction to this habit, to this addiction.”

 “Vaping is not a safer option than cigarettes, as some manufacturers portray,” says Joe Mazzola, Franklin County health commissioner. “No tobacco or nicotine use is safe.”

Nicotine use by younger people is especially risky, health officials say. As of mid-October, state law sets 21 as the minimum age to buy tobacco or vaping products. “Youth have shown an increased vulnerability to nicotine addiction and evidence suggests that nicotine use during adolescence and young adulthood has long-term impacts on brain development,” says Amy Acton, director of the Ohio Department of Health.

Two Central Ohio school systems are addressing the issue by installing devices in school restrooms that can detect chemicals founds in e-cigarette vapors. Hilliard City School District installed vaping detectors in some of the bathrooms at its three high schools in September as part of a trial program.

Olentangy Local School District expected to install nearly $63,000 in vaping detectors in every bathroom in its four high schools in November. “It’s a problem that’s made its presence known in the last year,” says district spokeswoman Kristyn Wilson, saying concerns from students, a number of infractions and the spike in national trends all contributed to the decision.

But beyond law changes and enforcement tactics, health officials say the first line of defense starts at home: Parents need to talk about the dangers of vaping.

“Don’t ignore the problem. Ask your children. Ask what their friends are doing,” Hayes says. “Just be open and honest about the kinds of risks that are involved.”