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Working to End the Vaping Injury Crisis Among Teens
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Statistics & Research on Vaping-Related Lung Damage

Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), state and local health departments, and public health partners are investigating hundreds of reports of lung illness among people who use vaping products, also known as e-cigarettes. Investigators do not yet know the specific cause of the lung injuries, including the specific product or substance that links the cases. Below, we have compiled the latest statistics and research involving vaping-related lung illness.

Rampant E-cigarette Use Among Teens

Teen Vaping Statistics

Since e-cigarettes entered the U.S. market in 2007, they have become the most commonly used tobacco product among American youth. The Surgeon General reported that more than 3.6 million American youth used e-cigarettes in 2018.

E-cigarette use among middle school and high school students increased by 900 percent from 2011 to 2015. That equates to one in five high school students and one in 20 middle school students. Among high schoolers, e-cigarette use increased by 78 percent from 2017 to 2018.

Nicotine's Effect on the Developing Brain

E-cigarettes largely contain nicotine, a highly addictive chemical. During adolescence, nicotine can harm the developing brain and negatively impact a person's learning skills, memory, and attention. It can also increase the risk for future addiction to other substances.

Vaping Facts

E-cigarettes take many forms. Each are typically composed of four components: a battery, atomizer with a heating coil, nicotine in liquid form, flavorings and chemicals, and absorbent material. E-cigarettes are also called e-cigs, vapes, vape pens, mods, pods, and e-hookahs. Vaping is the inhalation of the aerosol that these products produce.
As of 2019, JUUL was the most widely used brand of e-cigarettes with more than half the e-cigarette retail market share. Altria Group, Inc., the maker of Marlboro and one of the world's largest producers and marketers of tobacco and cigarettes, is a top investor of JUUL. Philip Morris is the American tobacco division of Altria Group. Other popular brands are blu (owned by tobacco giant Imperial Brands) and MarkTen (owned by Altria Group, which recently discontinued MarkTen e-cigarette products).
Most e-cigarettes contain nicotine, the same highly addictive chemical in tobacco and traditional cigarettes. They often contain other chemicals (such as glycerol, propylene glycol and benzoic acid), oils, extracts, and sometimes flavorings.
According to JUUL, manufacturer of the most commonly used e-cigarette products: "... our engineering team aims to ensure all parts are compliant to international safety and quality standards like Restriction of Hazardous Substances (RoHS) and Electromagnetic Compatibility (EMC) and undergo extensive testing and inspection at JUUL Labs. Furthermore, independent lab tests JUUL e-liquid and vapor. JUUL Labs tracks emerging FDA regulations closely, and we support responsible product quality standards." However, in September 2019, the FDA sent a letter to JUUL advising that its product safety claims amounted to illegal marketing. The FDA was particularly concerned about JUUL's messaging to young people. The letter explains in part that, "Referring to [electronic nicotine delivery system] products as '99% safer' than cigarettes, 'much safer' than cigarettes, 'totally safe,' and 'a safer alternative than smoking cigarettes' is particularly concerning because these statements were made directly to children in school." In an interview with CBS, the CEO of JUUL could not speak to the health or safety of the aerosol inhaled by their e-cigarettes, and he noted that the long-term effects of vaping are not known.

Research

2018 National Youth Tobacco Survey Data : A Startling Rise in Youth E-cigarette Use.” February 6, 2019.
“From 2017 to 2018, current e-cigarette use—defined by use on at least one day in the past 30 days—by high school students increased 78 percent, from 11.7 to 20.8 percent, accounting for a troubling 3.05 million American high school students using e-cigarettes in 2018.” The study also found that flavored tobacco products were especially appealing to teens and one of the main reasons why teens use the products in the first place. When first tobacco use was of a flavored product there was an increased likelihood of becoming current tobacco users.

CDC Report, “Outbreak of Lung Disease Associated with E-Cigarette Use, or Vaping. September 19, 2019.
More than 500 possible cases of lung illness reported from e-cigarette, or vaping use. Additionally, seven deaths have been reported. The CDC states that many of he cases involve patients who used e-cigarettes containing THC, and some have been e-cigarette products which just contained nicotine. Symptoms included cough, shortness of breath, chest pain, nausea, vomiting and fever with complaints developing in some cases over a few days or a few weeks. The CDC cautioned against buying any vaping products with THC, or off the street and not to add or modify the products as delivered by manufacturer.

Is Vaping Safer Than Smoking Cigarettes? National Center for Health Research. September 10, 2019.
“E-cigarettes, JUULs, and other similar products have not been around long enough to determine the harm they cause in the long run. Unfortunately, many people, including teenagers, are under the impression that e-cigarettes are safe or that they are effective in helping people quit smoking regular cigarettes. Studies by the FDA show that e-cigarettes contain some of the same toxic chemicals as regular cigarettes, even though they don’t have tobacco.”

FDA Cautions People to Avoid Vaping Products with THC Oil, Vitamin E Acetate. NEJM Journal Watch, September 10, 2009.
The FDA has found significant amounts of vitamin E acetate in most of the tetrahydrocannabinol (THC) vaping products tested from people who’ve become ill with severe respiratory illness. The agency says that “it is prudent to avoid inhaling this substance. “However, not all of the people who’ve become sick have used these products, so the FDA cautions that it can’t yet say that the vitamin E acetate is causing illness. The agency notes that people can’t be certain whether a vaping product contains vitamin E acetate, and it reminds users not to buy vaping products from the street. Consumers should also avoid using THC oil or adding material to store-purchased vaping products.

The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications. July 2019.
Cigarette smoking by Americans declined steadily from the mid-1960s to around 2005, when this progress began to slow. From 2013 to 2017, however, cigarette smoking rates fell sharply, during a period in which the use of electronic cigarettes or e-cigarettes increased sharply. This study examines the connection
between these two developments and the implications.

Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults.
The use of e-cigarettes is unsafe for kids, teens, and young adults.
Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.

FDA Warning Letter to JUUL. September 9, 2019.
The FDA letter stated that JUUL has engaged in deceptive labeling, advertising, or other activities by claiming that “… JUUL products are free of a substance, have a reduced level of or exposure to a substance, and/or that JUUL products present a lower risk of tobacco-related disease or are less harmful than one or more other commercially marketed tobacco products.” These marketing efforts would be likely to cause consumers to believe that JUUL products presented a lower risk of tobacco-related disease and as such needed to be discontinued. The FDA specifically referenced misleading statements made to children.