While vaping has been touted by manufacturers as a safer smoking alternative, the public health community is careful to point out the risks. Since the introduction of e-cigarettes to the U.S. in 2007, vaping has taken hold among young people, with approximately 6% of surveyed middle and high school students reporting using e-cigarettes in 2024.
Columbia pediatric pulmonologist Alexandra Kass, MD, and addiction psychiatrist Silvia Franco Corso, MD, see the many ways in which vaping affects the body and behavior-especially among their younger patients. They explain the impact of vaping on the lungs, heart, and brain, and share recommendations for talking with young people.
What Is Vaping and How Do E-Cigarettes Work?
Vaping was originally developed and marketed as a way to deliver nicotine without the hazards of smoking tobacco. The device-called a "vape" or an "e-cigarette" -consists of a container of liquid solution, a heat source, and a mouthpiece. A battery supplies the energy to vaporize the liquid, which becomes an aerosol (cloud of tiny droplets). It is this cloud that people who vape inhale.
The liquid solution in e-cigarettes varies in composition, depending on the manufacturer, the targeted demographic, and the drug to be delivered.
"E-liquid contains stabilizing agents (such as propylene glycol or vegetable glycerin), varying amounts of nicotine or THC, as well as flavoring additives and other chemicals," says Dr. Kass.
Why Vaping Is Especially Dangerous for Teens and Young Adults
The effects of vaping, although still not completely understood, can be seen in three organ systems of the body: the lungs, the heart and circulatory system, and the brain. Although each system's exposure to vaping is cause for concern, it is vaping's effect on the brain that puts young people at even greater risk than the rest of the population.
The brains of young people are not yet fully formed: Regions responsible for pleasure, decision-making, and risk-taking are continuing to mature, and synapses (chemical and electrical links between brain cells) are still developing. Vaping, it turns out, interferes with these processes in ways that are profound and long-lasting.
How Vaping Damages the Lungs and Causes Breathing Problems
As a pediatric pulmonologist, Dr. Kass is alarmed by what she has seen in her patients.
"Vaping can irritate and inflame the airways. I have seen children develop cough, bronchitis-like symptoms, and worsening asthma." She notes, too, that there have been cases of extreme reactions to vaping, where "previously healthy kids have been admitted to the ICU on respiratory support due to vaping."
The American Lung Association (ALA) singles out acrolein, an herbicide mainly used for killing weeds, as causing permanent lung damage. According to the ALA, acrolein can cause acute lung injury and lead to chronic obstructive pulmonary disease, asthma, and lung cancer.
Vaping's Impact on Heart Health and Blood Pressure
Vaping also affects the heart and circulatory system. Nicotine can cause an unsafe increase in blood pressure, heart rate, and flow of blood to the heart, according to the American Heart Association (AHA). Nicotine can also cause a narrowing of the arteries and a hardening of the arterial walls, which can lead to a heart attack.
While vaping has been marketed as a safer alternative to smoking cigarettes, its potency is often underappreciated. The amount of nicotine delivered by one JUUL pod equals the nicotine delivered by a pack of cigarettes, says the AHA. And without universal standards for different manufacturers and their products, it is difficult to know how much nicotine a particular vape delivers to its user.
How Nicotine in Vapes Affects the Brain and Addiction Risk
Nicotine, which is highly addictive, has profound and lasting effects on the brain.
"When someone develops an addiction, especially after starting drug use at a young age, the brain's reward system is fundamentally altered," says Dr. Franco Corso. "Drugs such as nicotine, alcohol, and cannabis increase dopamine release in brain regions that make up the reward system, like the nucleus accumbens, reinforcing drug-seeking behavior."
Exposure to these substances is especially fraught for young people. "In adolescents, the effect is amplified because the brain is still developing, particularly in areas responsible for impulse control, decision-making, and emotion regulation, such as the prefrontal cortex. Early drug exposure disrupts normal maturation of these neural pathways, leading to lasting changes in brain structure and function."
Part of the allure of vaping, says Dr. Franco Corso, is the convenience. "Many devices produce no unpleasant odor, so unlike the last 30 years, when someone had to go outside of a building to light a cigarette, now folks can vape almost anywhere-in their office, at a doctor's appointment, from their bed, etc.-without others noticing. This makes it easier to vape throughout the day."
Occasionally, Dr. Franco Corso is asked if vaping can serve as a "gateway" to experimentation with other substances.
"We don't yet have a definitive answer to this question," she says. "That said, we know that there are shared risk factors-like impulsivity, sensation-seeking, and a tendency toward risk-taking-that make some young people more likely to try vaping as well as other substances. In addition, certain mental health conditions, such as anxiety, depression, and ADHD, are linked to higher rates of substance use across the board."
How to Talk to Kids and Teens About the Risks of Vaping
Regarding how to communicate with young people about the risks, Dr. Franco Corso shares a few suggestions. "The best approach is to start the conversation early, before a child is exposed to vaping or peer pressure. Choose a relaxed, non-confrontational moment to bring up the topic, and begin by asking what your child knows or has heard about vaping."
She encourages open, nonjudgmental dialogue and active listening, which allows children to express their thoughts and concerns. "Listening carefully and without judgment helps build trust and keeps the lines of communication open. This communication could shed light on what is driving the vaping behavior. Is it sensation-seeking? Is it a coping strategy? Has it become an addiction?"
It is also helpful for parents to provide clear, age-appropriate information about the risks of vaping, such as the potential for nicotine addiction, the effects on brain development, and the possibility of progressing to other substances. In addition, says Dr. Franco Corso, "Parents can say that while vaping is marketed as a safer alternative to smoking cigarettes, that doesn't make it safe. Vaping carries real health risks, especially for young people."
Dr. Kass agrees, echoing the benefits of open awareness and interaction. "I encourage parents to pay attention to subtle signs, like fruity or sweet odors, unusual USB-like devices, or changes in stamina or sleep. Let your teen know these conversations are safe, and that they can come to you if they have questions or feel peer pressure. Keep it an ongoing dialogue rather than a one-time talk."
Alexandra Kass, MD, a pediatric pulmonologist, is an assistant professor of pediatrics at the Vagelos College of Physicians and Surgeons.
Silvia Franco Corso, MD, an addiction psychiatrist, is an assistant professor of psychiatry at the Vagelos College of Physicians and Surgeons.
