Vapes were hailed as miracle devices to help adults stop smoking. But now vaping has invaded the high street and, more worryingly, our children’s schools. They often come in brightly coloured packaging, in innocent-sounding flavours, such as watermelon and candy floss, so it’s perhaps no surprise that vaping has proved so enticing to teens and even younger children.
Schools are struggling to cope, as children can barely make it through lessons before they have to duck out for a vape. But it’s not simply the addictive nature of nicotine-infused e-cigarettes that’s the problem: now, we’re beginning to see the shocking health impact on developing bodies, with children as young as nine showing up in hospital with devastating lung damage.
The latest figures from NHS England reveal that in the past year there were 15 cases of under-nines being hospitalised with injuries ranging from bleeding lungs to lung collapse.
Commenting on the hospitalisations, Professor Andrew Bush, a consultant paediatric chest physician at the Royal Brompton Hospital, in London, described vapes as being more dangerous for teenagers than cigarettes. “If a teenager starts smoking cigarettes, probably the worst that’s going to happen to them is they’re going to be sick and throw up behind the bike shed,” he says. “The acute use of e-cigarettes can put them in hospital.”
While public figures have repeatedly spoken out about the easy accessibility of disposable vapes – earlier this month, the children’s commissioner for England called for them to be banned, while in February, Chris Whitty condemned the marketing of them to children – they remain extremely prevalent. While the organisers of Glastonbury made a halfhearted attempt to ban them from the festival, pop star Lana Del Rey openly defied the directive by vaping during her set.
(In New Zealand, disposable or single-use vape products will be prohibited from sale from November, while reusable vapes will not be sold from March next year).
And this is all before you even consider the risk of inhaling vapes spiked with other substances. Last week, a 51-year-old man was arrested on suspicion of attempting to poison a woman by offering her a puff on a spiked vape at the Isle of Wight festival.
According to John Dunne, director-general of the UK Vaping Industry Association, more needs to be done to enforce existing regulations that prohibit the sale of vapes to under-18s. Dunne told the Telegraph that the problem can be tackled by cutting the supply of vapes to children, and a more effective approach to dealing with illicit products entering the market.
“There is significant evidence that regulations for dealing with underage vaping and illicit product trading are not being enforced throughout the UK,” he says. “Recent research using freedom of information requests has revealed that across 12 major UK cities, between 2021 and early 2023, fines for underage or illicit sales were given out to retailers on just seven occasions. Furthermore, the total amount of fines given out across these same cities and over the same time period was £2188 [NZ$4551]. This is less than the current maximum fine that can be issued to just one offender, at £2500.”
Vapes are becoming steadily more common with younger age groups. According to the latest statistics from the Action on Smoking and Health (ASH) group, nearly 21 per cent of UK children aged 11-17 have tried vaping, up from 14 per cent in 2020.
Dr Gareth Nye, a lecturer in physiology and researcher at Chester Medical School, says that one of the dangers that vapes pose to anyone, from children to adults, is that the chemicals within them can initiate a powerful autoimmune reaction within the lungs, causing damage over time.
“Whenever we put something into our body that the immune system doesn’t recognise, it aims to remove it from the body for our own protection,” he says. “In the process of removing foreign bodies, our immune system damages healthy cells, which over time leads to a loss of that tissue. This occurs with all vaping products, as with conventional cigarettes.”
Experts also say that the range of sweet flavours – from strawberry to banana, bubblegum, vanilla and even doughnut – ease of use and nicotine content mean that children and teenagers use them excessively. They are also far cheaper than cigarettes, with some disposable vapes costing as little as £4.99, and online stores offering deals such as five for £20.
“If you think about the way some teens are using them, they’re just hitting them all day long, sometimes waking up in the night and vaping,” says Sally Huey, assistant professor at Georgetown University, Washington DC. “It can end up being equivalent to smoking a pack of cigarettes’ worth of nicotine a day.”
Vaping has only really started to become popular in the past decade in the UK, due to the low prices. Those aged 18-24 are the biggest consumers, according to ASH. But since 2019, medical experts have become increasingly worried in the wake of widespread reports from the US of children becoming “nic-sick” through vaping-induced nicotine overdoses.
While vapes were once considered safe by the general public, there is far more in them than just water vapour. In fact, the combination of water, flavourings and nicotine tends to make up about 10-18 per cent of the e-juice within vapes, with the rest being propylene glycol and other chemicals. In addition, when the e-liquid is heated during the process of powering the vape, other toxic chemicals can be formed.
So, what is in vapes that makes them so harmful?
Nicotine
While nicotine is perhaps only 0.3-2 per cent of a vape, it is the main chemical culprit that makes these products so dangerously addictive. A smoker typically absorbs between 1-2 milligrams of nicotine from a single cigarette.
Some of the most high-strength disposable vapes on the market, while still falling under UK regulations, contain 20mg/ml of nicotine. Finishing the vape – about 600-800 puffs – works out about the same as smoking up to two packs of 20 cigarettes.
“Anecdotal evidence suggests users of disposable vapes can use this amount over one evening, which means the levels of nicotine will be extremely high in a short space of time,” says Dr Nye.
Dunne points out that research has shown that vaping is considerably less harmful than smoking. “Whilst vaping is not risk-free, it is at least 95 per cent less harmful than smoking, according to evidence compiled by the Institute of Psychiatry, Psychology & Neuroscience at King’s College London on behalf of the Office for Health Improvement & Disparities,” he says.
One of the major problems with nicotine is that it can alter the development of the growing brain and initiate problems that then persist into adulthood.
“You see that attention, the ability to focus and impulsive traits are all different when people are exposed to nicotine during childhood,” says Huib Mansvelder, professor of neurophysiology at Vrije Universiteit, in Amsterdam.
Scientists are also concerned that young vapers may then transition to cigarette smoking. A 2021 study in the journal Addictive Behaviors found that 15- to 27-year-olds who vaped were seven times more likely to begin smoking in the next year than non-vapers.
Dr Nye also predicts that children who vape regularly will be more at risk of various chronic illnesses in decades to come. “Dentists are reporting increases in gum-tissue problems, as nicotine constricts blood vessels, including those in the oral cavity,” he says. “It can be assumed this is occurring in other areas of the body, suggesting that young people using these products are at an increased risk of heart attacks, strokes, cancers and other diseases at an earlier stage in their lives.”
Vegetable glycerin and propylene glycol
The biggest proportion of a vape, some 70-80 per cent of the cartridge, is a mix of these two chemicals. Propylene glycol is also used as a common food additive, as well as being a component in products ranging from antifreeze to the artificial smoke in fog machines at pop concerts.
While both vegetable glycerin and propylene glycol are considered safe for consumption in foods, eating and inhaling are very different processes, and experts say that the lungs are a far more fragile and sensitive environment compared with the stomach. Dr Nye points out that staff working with fog machines have gone on to develop long-term lung conditions.
“The lungs don’t have a protective barrier like the acidic environment of the stomach,” says Prof Mansvelder. “We can’t rely on the assumption that these substances will be just as harmless when inhaled as a vapour.”
Formaldehyde and benzene
The process of heating vegetable glycerin and propylene glycol, which occurs when the vape is activated, has been shown to lead to the formation of formaldehyde and even benzene – a chemical typically found in car-exhaust fumes – both of which are known carcinogens.
While the link between vaping and certain cancers is small and still relatively unclear in the absence of major population studies over the course of many decades, Dr Nye explains that the evidence shows that a risk is still very much present.
“Vapers are around 2 to 2.5 times more likely to develop oral cancers than non-users, with the risk likely to be seen as increasing in younger populations with a prolonged exposure,” says Nye. “This is still much less than smokers, but there is an increased risk.”
Metal particles and microplastics
Researchers have identified a range of traces of heavy metals in various vapes, including nickel, tin, lead and cadmium. The last is a toxic metal that is also found in cigarettes, and can cause lung problems.
“These metals are being produced from the battery and electrical components within the vape, in addition to microplastics,” says Dr Nye. “Both metals and microplastics have been seen in the body following vaping, and are incredibly difficult for the body to break down and remove.”
Because of this, Nye says that repeatedly inhaling vape fumes containing these compounds may possibly result in lung inflammation that persists for years.
“In essence, the lungs never fully heal in areas where there are microplastics or metal ion settlements,” he says. “This can in theory lead to the establishment of lung diseases such as chronic obstructive pulmonary disease and cancers.”
However, Dunne says that there are many factors to consider before making an assumption that a vape product has adversely affected any person’s health. “The individual may be using an unregulated and untested illegal product, or indeed using a vape device as the mechanism to inhale illicit substances,” he says. “They may also be allergic to one of the ingredients.”