Vapes are now marketed almost like candies, with colorful packaging and enticing flavors such as mango, vanilla, and strawberry—all sold at convenience stores near you.
For the past six years, the only flavored vapes that were legally sold in the United States were the more familiar tobacco and menthol varieties. However, the recent Food and Drug Administration (FDA) authorization of two flavored vape products could change that. Although the agency has put guardrails in place to prevent children from accessing them and reduce illegal sales, the decision has still raised concerns.
The issue with flavored vapes is not only that flavors may increase their appeal and addictive potential, but also that the flavoring chemicals themselves may pose health risks.
The Health Risks of Flavors
Flavors are chemicals, and each has a distinct chemical structure that can lead to different health effects.
Irfan Rahman, a professor of environmental medicine at the University of Rochester, said that among the hundreds of vape flavors studied, there are two primary ways flavorings can become toxic:
- Some flavor additives are inherently toxic when inhaled.
- When heated and vaporized, flavoring chemicals often break down into toxic aldehydes.
Toxic aldehydes that have been detected in vaping vapors include formaldehyde, acrolein, and acetaldehyde. These compounds can inflame and damage the lining of the lungs, causing coughing, wheezing, chest pain, and, over time, irreversible lung damage.
Fruit flavors are particularly likely to release aldehydes, Rahman said.
Some flavoring chemicals are toxic to the lungs even without breaking down into aldehydes. These include flavors such as diacetyl, acetoin, and 2,3-pentanedione, which are often added to create buttery flavors such as popcorn and caramel.
Other flavorings that have been shown to cause inflammation, DNA damage, and stress to the lung cells include cinnamon, vanilla, strawberry, and even menthol.
Although these chemicals may be considered safe when eaten and are often added to ultra-processed foods such as store-bought margarine and popcorn, they cannot be safely breathed in, Rahman said.
Unlike the liver, which breaks down toxins into less harmful components, the lungs can only remove toxins by using mucus to sweep them up and then pass them into the digestive system for disposal. When more toxins enter the lungs than they can clear, it can lead to permanent damage.
A study of workers in popcorn factories exposed to diacetyl found an increased incidence of a type of serious obstructive lung disease later nicknamed “popcorn lung.”
Even unflavored vapes carry risks, including exposure to heavy metals that sometimes leach into e-liquids.
The main ingredients in e-cigarettes are propylene glycol and glycerin. Although the FDA classifies these ingredients as “generally recognized as safe” for eating, heating can cause them to break down and release toxic aldehydes.
Nicotine and Addiction
Flavors make vapes more appealing, especially to adolescents.
One study led by researchers from the University of Southern California showed that children who used flavors other than menthol or tobacco were more likely to continue vaping and take more puffs.
However, the biggest concern with vapes is the highly addictive chemical inside them—nicotine, which accounts for up to 2 percent of vape ingredients.
“Early adolescence is a particularly vulnerable period for the negative effects of nicotine,” Frances Leslie, a neuropharmacologist and professor emeritus at the University of California–Irvine, told The Epoch Times in an email.
During this period, the brain is particularly malleable, and exposure to stressors or addictive substances can easily take root.
Adolescents can become dependent on nicotine at lower levels of exposure than adults, making addiction that begins during this stage more difficult to reverse, according to a study published in Neuroscience & Biobehavioral Reviews.
Disruptions to the brain’s reward pathways can affect not only substance use, but also motivation, self-control, and attention.
Children exposed to nicotine have been shown to have greater impulsivity, inattention, and depression, Leslie said.
Broad Risks of Vaping
Although vaping is generally considered less harmful than smoking, it still poses significant health risks.
“Vaping has immediate effects like hyper reactivity and triggering asthma,” Adam Leventhal, director of the University of Southern California Institute for Addiction Science, told The Epoch Times.
Studies are still limited regarding the exact long-term effects.
“Chemicals in vapes have biological activity in a lot of different organ systems,” Leventhal said. “We just don’t know what type of damage that may cause.”
The strongest evidence to date involves the lungs and the mouth.
Vaping has been linked to lung conditions such as e-cigarette or vaping product use-associated lung injury, chronic obstructive pulmonary disease, and popcorn lung. Toxicants such as heavy metals and aldehydes can also increase risks of lung damage and cancer.
Vaping can also increase dental and oral health risks, Rahman said. People who vape have higher rates of gingival and periodontal disease and a greater risk of dental caries.
Evidence is also accumulating on heart-related risks, including hypertension, and reproductive issues such as erectile dysfunction.
Although health influencers have promoted nicotine as a wellness product for the brain, the evidence has been mixed. One small study involving 18 adults saw a short-term boost in memory.
However, long-term studies have not shown that nicotine users have better brain health. Leslie noted that the effects of nicotine in adults and children can be drastically different, with adolescent use linked to poorer memory.
Some people do use vaping as a temporary aid to quit smoking.
“It certainly is less hazardous for the time being [than smoking],” Leventhal said.
Research has shown that people get exposed to fewer toxins when they vape than when they smoke.
FDA Safeguards and Ongoing Concerns
The FDA has put several safeguards in place to discourage use among minors and to encourage people to give up smoking.
The vape device must be Bluetooth-connected to the user’s phone to be used. Users must also verify that they are at least 21, and the device conducts random biometric check-ins to ensure that the registered user is the one using it.
Nonetheless, some experts remain concerned.
Leslie said that allowing fruit-flavored vapes may increase their appeal to adolescents.
“Although these are intended to assist adult smokers in cessation, these may also be used illicitly by teens,” Leslie said.