Vaping seems to be the new fad amongst the United States population especially teenagers and young adults. The Global market has made an estimated twelve to fourteen billion dollars in sales of vape products in the years 2018 and 2019 with the United States having one of the largest vape markets in the world (Bonner et al, 2021). As vaping is becoming more popular so is the research on vapes and the effects they can have on the human body. In the study “Severe Lung Injury Associated with Use of e-Cigarette, or Vaping, Products—California, 2019” researcher Amy Heinzerling and her team examined patients that were admitted to the hospital and fit the criteria for e-cigarette or vaping product use-associated lung injury (EVALI). They found that seventy-one out of 160 patients with EVALI were admitted into intensive care units and forty-six out of the 160 patients required mechanical ventilation all due to vaping. They also found that one hundred of the 106 patients showed bilateral findings of infiltrates or opacities on their chest imaging (Heinzerling et al, 2020). Due to vaping these patients needed medical attention. Vaping contains various chemicals that should not be inhaled that can put a strain on the human body. The researchers further tried to investigate what chemicals were contained in the patients’ vape products and what it was doing to their bodies.
So, what is a vape and how is it used? In scientific terms, an E-cigarette (vape) contains “a lithium battery a heating element, and a reservoir for the “e-liquid”” (Dinardo and Rome, 2019, 790). Nicotine, cannabis, glycol or glycerin, and flavorings are typically found in the e-liquid. When the user inhales, the heater is turned on due to the negative pressure that closes a switch. Some of the liquid is then turned into aerosol and is inhaled (Dinardo and Rome, 2019). In simpler terms, a vape is a device that heats liquid juice. When the user sucks on the top of the device, it heats the liquid to turn it into a vapor that is then inhaled. These vapes contain an immense amount of chemicals that are inhaled by the user. Some of these chemicals include “formaldehyde, acetaldehyde, benzaldehyde, acetone and acrolein” (Bonner et al, 2021, 8). Many of these chemicals cause respiratory irritation and can lead to cancer. “The International Agency for Research on Cancer (IARC) concluded the transformation product propylene oxide has sufficient evidence in experimental animals for carcinogenicity” (Bonner et al, 2021, 6). Not only do these vapes contain chemicals but it also contains metals such as nickel, arsenic, lead, and chromium. These metals when inhaled can cause cancer, neurotoxicity, renal damage, and cardiovascular disease (Bonner et al, 2021). Many people who are using these vapes do not think of the harmful repercussions that these devices can cause. Although these vapes might not lead to an immediate response the long-term effects are brutal.
What does this study entail and what did they find? In the study “Severe Lung Injury Associated with Use of e-Cigarette or Vaping, Products—California, 2019”, the researchers evaluated 160 patients that were reported to the California Department of Public Health from August 7 to November 8, 2019. All these patients fit the criteria of EVALI which means that they showed infiltrates or opacities in their chest images had no applicable cause for illness and had vaped in the past 90 days. The researchers were examining these patients to find out if vapes were the cause of their respiratory problems or need for hospitalization. The researchers also performed laboratory tests on the vape products used by the patients to “help direct the public health response to the outbreak and guide clinicians caring for patients with EVALI” (Heinzerling et al, 2020, 862).
Researchers collected data on the patients concerning age, sex, and clinical care information regarding if they needed to be put into an intensive care unit or required a mechanical ventilator. They then surveyed eighty-six of the 160 patients or their family members with a questionnaire asking what types of vape products they use, how many, what flavors, what brands, how often they vaped, and the active ingredients in the vapes they used. The researchers then calculated p values for the categorical data and t-tests for the continuous variables. They determined that p values less than .05 were to be considered statistically significant. Researchers collected the patients’ vaping devices voluntarily. These devices were screened for “THC, CBD, cannabinoids, nicotine, vitamin E and vitamin E acetate, pesticides, synthetic cannabinoids, opioids, and other nontargeted compounds” (Heinzerling et al, 2020, 862). They also used total reflection x-ray fluorescence to screen for metals contained in these products.
The researchers found that “seventy-one of the examined patients were admitted into intensive care, forty-six required mechanical ventilation, and four hospital deaths occurred” (Heinzerling et al, 2020, 861). Eighty-four percent of patients reported cough and eighty-two percent reported shortness of breath. Researchers also found that “twenty percent had lactic acid greater than 2 mmol/L, and forty-seven percent had procalcitonin greater than 0.5 ng/mL” (Heinzerling et al, 2020, 864). Through the questionnaire the researchers found that forty-seven percent used e-cigarettes, eighty-three percent reported using cannabis vapes, and “eighty-three patients reported using 130 (range, 1-5 per individual) unique vaping products in the ninety days prior to EVALI symptom onset” (Heinzerling et al, 2020, 863). Concerning the findings involving the testing of the vape product itself, researchers found low levels of pesticides, and metals such as arsenic, cadmium, chromium, and Propylene glycol. These chemicals and metals should not be inhaled and as discussed earlier can be carcinogens or lead to other health-related issues.
Are there potential flaws in this study? Some flaws represented in this study is the study only consisted of 160 patients, which is not very many to base an entire health study on considering the number of people that vape and use e-cigarettes. This could just be the case for those patients and not the general population. In the future, there could be more patients and people involved in the study as well as gathering data from other hospitals across California or other states in the United States. There were also interviews done over the phone by the local health department with patients or their family members. These interviews could cause major bias since they are done over the phone most people could feel pressured to have to answer and not answer truthfully. Another reason this method of obtaining information could be biased is the patients or their family members were answering to the local health department which is known to promote health and look down upon people who use vape products. The data also could be inaccurate since some patients’ family members will not know all the information or answers to the questions being asked. The study also only interviewed eighty-six out of the 160 patients and did not give a reason as to why they did not interview all the patients. The authors did make it known throughout the discussion and conclusion sections that more evidence is needed to make sure that readers are aware of the possibility of error with the study’s findings. The article stated multiple times throughout that more research should be done to improve the validity of this study and to make it known that it is always subject to error. Ultimately, I think this study is valid and can be one to take into consideration with others that are similar. Since this study was an observational study the repetition of this study could be hard. Studies can be done similarly but the study itself cannot be replicated exactly.
Vaping is now considered such a common thing. “The number of high school students in the U.S. using ENDS products increased from approximately 660,000 to 2 million in just one year (2013–2014)” (Bonner et al, 2021, 3). However, many people are not aware of the negative consequences it can have. Research is just now becoming more widely published on the negative effects of vaping on the body. “Publications containing the term “e-cigarette” have increased the greatest, peaking at 1193 publications in 2020. The term “vaping” produced 1108 publications in 2020” (Bonner et al, 2021, 2). With the increase in publications containing the term vaping research hope to make the effects of vaping more known. These vapes contain numerous amounts of harmful chemicals and toxins that should not be inhaled. Many people when vaping are not thinking of all the chemicals that are released into their body numerous times a day with each use of their vape. This article informs readers of how healthy individuals who vape are becoming hospitalized with EVALI and developing serious lung injuries along with other severe health implications. The seriousness of the effects on vapers’ lungs is still unknown, but we know that they are not irrelevant. The popularity of e-cigarettes is alarming and becoming part of the millennial culture, most readers are more than likely affected by vaping and this article could help get a friend or family member to stop or get the reader to quit themselves.
References
Bonner E, et al. 2021. The chemistry and toxicology of vaping. Pharmacology and Therapeutics. 225:1-24.https://www.sciencedirect.com/science/article/abs/pii/S0163725821000395.
Dinardo P, Rome E. 2019. Vaping: The new wave of nicotine addiction. Cleveland Clinic Journal of Medicine. 86(12):789-798. https://www.ccjm.org/content/86/12/789.
Heinzerling A, et al. 2020. Severe lung injury associated with use of e-cigarette, or vaping, products—California, 2019.Jama Internal Medicine. 180(6):861-869. https://jamanetwor.
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