The long-term health effects of vaping are unknown because research on the vaping caused illnesses has only begun to be studied.
But here is what we do know. When someone vapes, they are not just inhaling harmless water vapor as many believe. Besides nicotine, e-cigarettes can contain harmful and potentially harmful ingredients, including:
• Ultrafine particles that can be inhaled deep into the lungs.
• Flavor additives such as diacetyl, a chemical linked to serious lung disease.
• Volatile organic compounds.
• Heavy metals, such as nickel, tin and lead
• For THC-containing vaping products, vitamin E acetate has been identified as being a highly probable vaping cartridge additive that is causing lung injury and death. On Nov. 8, 2019, the Center for Disease control announced that they identified vitamin E acetate in the lung fluids of 29 people sickened in the outbreak of dangerous vaping-related lung injuries. Inhaling vitamin E has been described as “inhaling grease” that coats the lungs cells. In October, the CDC expected a correlation between THC-containing vaping liquids, but the Nov. 8 findings show a direct correlation with vitamin E acetate at the primary site of injury within the lungs.
Many of the THC-containing products used by those sickened, or who died, were obtained on the illicit market. Vitamin E acetate has been used in recent months as a cutting agent or additive on the cannabis black market to stretch the amount of THC in vape cartridges. Vitamin E acetate is a popular additive because it is colorless and odorless, has similar viscosity to THC oil and is much cheaper.
Vitamin E acetate is also used as a thickening ingredient in e-liquids which may not contain THC. The CDC is maintaining its recommendation that consumers consider refraining from using all vaping and e-cigarette products, including those containing nicotine. That is because a small proportion of patients stricken with EVALI continue to report exclusive use of nicotine-containing products.
On Oct. 29, 2019, the Center for Disease (CDC) reported 1,888 cases of e-cigarette vaping product use associated lung injury (EVALI) and 37 deaths. One week later, Nov. 5, the CDC reported 2,051 cases of EVALI  and 39 deaths with more suspected EVALI deaths under investigation. Each week more and more ENDS related illnesses and deaths are being reported.
Nov. 5, 2019, CDC EVALI patient data found:
•14 percent of the EVALI patients are under 18 years old;
• 40 percent of patients are 18 to 24 years old;
25 percent of patients are 25 to 34 ye• ars old; and
• 21 percent of patients are 35 years or older.
• About 86 percent of EVALI patients reported using THC-containing products; 34 percent reported exclusive use of THC-containing products.
• About 64 percent reported using nicotine-containing products; 11 percent reported exclusive use of nicotine-containing products.
People who vape should be aware that this illness is occurring and be on the lookout for symptoms that include:  shortness of breath or trouble breathing, chest pain, cough, fatigue & possible fever. People who think they may have been sickened by any vaping product should contact their doctor, local public health agency or poison control at 1-800-222-1222.
Some localities have taken e-cigarette regulations into their own hands. San Francisco, where Juul has its headquarters, voted in June 2019 to ban the sale of e-cigarettes that have not been approved by the FDA — which, for now, is all of them. Many countries have banned the import and sale of ENDS products. In the U.S., states are beginning to ban the sale of flavored ENDS and restricting their usage in public areas. In July 2019, the state of Colorado put e-cigarette use in the same category as tobacco cigarettes under the Colorado Clean Indoor Air Act. Retailers are also recognizing the health risks and liability in selling ENDS products. In June 2019, Walmart raised the age consumers can buy tobacco and ENDS products from 18 to 21 while also stopping its sale of fruit and dessert flavored nicotine products.


What’s past is prologue
Today, once again, health officials are alarmed by the marked increase in ENDS use among youth and young adults and are concerned that these products may undo the years of tobacco control efforts that have successfully reduced cigarette smoking among both youth and adults in recent years.
On Nov. 23, 1998, attorney generals from 46 states, the District of Columbia, and the U.S. territories signed a contractual agreement the Master Settlement Agreement (MSA) with the major cigarette companies to settle state lawsuits. The companies agreed to make annual payments in perpetuity, totaling approximately $125 billion over the first 25 years, and to accept certain restrictions on tobacco product advertising, marketing and promotion. Specifically, the MSA prohibited cigarette companies from targeting youth in the advertising, promotion or marketing of their products.
Many of the same “big tobacco” companies that contractually agreed to the 1998 Master Settlement Agreement are now owners of e-cigarette companies. The most popular e-cigarette brand is Juul which has three-quarters of the U.S. e-cigarette market. In December 2018 Philip Morris USA purchased 35 percent of Juul. The brand Vuse, which came in second in the e-cigarette industry with 10 percent of the market share at the end of 2018, is owned by R.J. Reynolds Vapor Company, a subsidiary of Reynolds American Inc., which was acquired by British American Tobacco in 2017.
These same big tobacco companies are once again touting their products as a healthier alternative to cigarettes. And once again, these companies are peddling addictive products that contain nicotine and other chemicals that cause lung disease. Public health groups like the American Cancer Society, American Heart Association, American Lung Association and the Campaign for Tobacco Free Kids are once again fighting for greater regulation and taxation.
The advertising and marketing of e-cigarette products has created scrutiny from public health professionals and legislators who have noted many similarities to the advertising claims and promotional tactics used for decades by the tobacco industry to sell conventional tobacco products. Several of the e-cigarette marketing themes have been rehashed from past cigarette advertising including messages focused on freedom, rebellion and glamor. E-cigarette products are marketed with a variety of unsubstantiated health and cessation messages, with some websites featuring videos of endorsements by physicians. Unlike conventional cigarettes, for which advertising has been prohibited from radio and television since 1971, e-cigarette products are advertised on both radio and television, with many ads featuring celebrities. E-cigarettes also are promoted through sports and music festival sponsorships, in contrast to conventional cigarettes and smokeless tobacco products, which have been prohibited from such sponsorships since the Master Settlement Agreement (MSA). E-cigarettes also appear as product placements in television shows and movies.
A greater concern is the usage of social media by e-cigarette corporations to target youth. As was true in the tobacco industry, the e-cigarette industry organizes users through advocacy groups. The extensive marketing and advocacy through various channels broadens exposure to e-cigarette marketing messages and products; such activity may encourage nonsmokers, particularly youth and young adults, to perceive e-cigarette use as socially normative.