Tobacco Research / 30.06.2025
Understanding the Vaping Landscape: What Research Still Needs to Uncover
Editor's note: Tobacco in any form is harmful to your health. Please discuss your use of tobacco products, including vaping, with your health care provider.
[caption id="attachment_69305" align="aligncenter" width="500"] Photo by Sabrina Rohwer:[/caption]
The popularity of vaping products has surged in recent years, with flavored disposable vapes especially dominating shelves and online marketplaces. While these products are often marketed as smoother, more palatable alternatives to traditional cigarettes, the long-term health effects remain unclear. As researchers work to better understand the impact of vaping on respiratory and cardiovascular health, there’s growing pressure to also examine the behavioral and chemical patterns surrounding use.
Photo by Sabrina Rohwer:[/caption]
The popularity of vaping products has surged in recent years, with flavored disposable vapes especially dominating shelves and online marketplaces. While these products are often marketed as smoother, more palatable alternatives to traditional cigarettes, the long-term health effects remain unclear. As researchers work to better understand the impact of vaping on respiratory and cardiovascular health, there’s growing pressure to also examine the behavioral and chemical patterns surrounding use.
Dr. Dai[/caption]
Dr. Hongying Daisy Dai, PhD
Professor and Associate Dean of Research
The College of Public Health
University of Nebraska Medical Center.
MedicalResearch.com: What is the background for this study?
Response: Tobacco use landscape has been changing in the United States with fewer combustible cigarette smokers and more e-cigarette and other emerging tobacco users. Nicotine concentration level is a key product characteristic of modern e-cigarette products and high-nicotine vaping devices have recently become available. This study seeks to examine whether biomarkers of exposure to tobacco-related toxicants have changed since 2013 among adult nicotine e-cigarette users, non-nicotine e-cigarette users, and cigarette smokers.
Response: Cigarette smoking is one of the well-established causes of periodontitis, but the effect of using electronic cigarettes (e-cig), especially its long-term impact on periodontal health, is not yet clearly understood. Considering the increased popularity of e-cig use, especially among teenagers and young adults, and the known effect of high nicotine concentration in e-cigarette products, we conducted this clinical research to see if there were differences in periodontal health between e-cig users, traditional smokers, and nonsmokers. The study consisted of two visits, 6 months apart, where measures of oral and periodontal health were obtained.
Our data showed significantly greater clinical attachment loss in the e-cigarette users and cigarette smokers than in the non-smokers at both study visits. In only e-cigarette users, we observed an over 0.2 mm average increase in the clinical attachment loss after 6 months. 
Dr. Al Rifai[/caption]
Mahmoud Al Rifai, MD, MPH
Cardiovascular Disease Fellow
Baylor College of Medicine Houston, TX
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Dr. Virani[/caption]
Salim S. Virani, MD, PhD, FACC, FAHA, FASPC
Professor, Section of Cardiovascular Research
Director, Cardiology Fellowship Training Program
Baylor College of Medicine
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Co-Director, VA Advanced Fellowship in Health Services Research & Development at the Michael E. DeBakey VA Medical Center
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation Houston, TX
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: E-cigarettes have gained popularity since their introduction in the U.S. market nearly 20 years ago and their use has increased especially among younger adults. On the other hand, public health efforts aimed at curbing tobacco use over the past few decades have resulted in a decrease in cigarette use. However, state-specific laws and regional cultural differences with regards to perception of these products may result in variability in tobacco use patterns. We therefore evaluate temporal changes in e-cigarette and cigarette use in each U.S. state between the years 2016 to 2018.
Response: The background for this study involves the associations of household rules and parental awareness with youth tobacco use using data from the Population Assessment Tobacco and Health Study. Health concerns regarding non-cigarette tobacco products, specifically e-cigarettes, have been on the rise. We wanted to explore whether parents are up to date with the trends of popular tobacco products today and what role they may play in youth tobacco cessation and prevention.
The main findings of the study revealed that parents less often suspected their children’s tobacco use if their children reported using only e-cigarettes, and other non-cigarette tobacco products, when compared with cigarettes. Additionally, we found that youth who agreed with their parents that their home has strict rules for tobacco use were less likely to initiate of tobacco use compared to youth who had different understanding of the rules from their parents or youth from households with more permissive household rules. 
Dr. Hollingsworth[/caption]
Alex Hollingsworth PhD
Assistant Professor
O'Neill School of Public and Environmental Affairs
Indiana University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: I've been working with Coady Wing and Ashley Bradford on a few different studies of the effects of recreational marijuana laws on drug and alcohol use.
Soon after EVALI became a major issue, the prevailing theory from the CDC and others was that EVALI was caused by the use of vitamin E acetate in illegal THC vaping products.
Our group read about this and we thought about some of the things that often happen in black markets for illegal drugs. For instance, during the alcohol prohibition era, bootleg alcohol producers often made and sold alcohol products that were not that safe to drink. In more recent years, there are cases where black market sellers of illegal drugs like heroin try to increase profit margins by adding other substances, which can be harmful.
We thought that maybe something like that could be happening in EVALI. Perhaps people in states where recreational marijuana is legal tended to purchase marijuana products from the legal market and the legal market was not selling any marijuana vaping products that included vitamin E acetate.
Dr. Hongying (Daisy) Dai[/caption]
Hongying (Daisy) Dai, PhD
Associate Professor
Department of Biostatistics | College of Public Health
University of Nebraska Medical Center
Omaha, NE
MedicalResearch.com: What is the background for this study?
Response: E-cigarette use increased dramatically from 11.7% to 27.5% for high school students and from 3.3% to 10.5% for middle school students during the periods of 2017 - 2019. In September 2018, the Food and Drug Administration (FDA) warned that youth e-cigarette use is reaching an epidemic proportion.
Exposure to secondhand aerosol (SHA) from e-cigarettes is not harmless as e-cigarettes aerosol contains nicotine and potentially harmful substances, including carbonyl compounds, TSNAs, heavy metals, and glycols. This study analyzed the 2015-2018 National Youth Tobacco Survey (NYTS) and the main findings are:
Dr. Villanti[/caption]
Andrea Villanti, PhD, MPH
Associate Professor
Department of Psychiatry
Vermont Center on Behavior and Health
University of Vermont
MedicalResearch.com: What is the background for this study?
Response: Our earlier work documented a significant association between first use of a flavored tobacco product and current tobacco use (
Dr. Miech[/caption]
Richard Miech Ph.D
Professor
Principal Investigator, Monitoring the Future
Institute for Social Research
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Every year Monitoring the Future conducts a survey to examine trends in adolescent substance use. We draw a random sample of schools from a list of all schools in the United States and conduct our survey in ~400 schools. Our survey is representative of U.S. 8th, 10th, and 12th grade students. In other words, our results are what you would find if you surveyed every single 8th, 10th, and 12th graders in the United States, within the bounds of a small sampling error of a few percentage points.
An increase in vaping is the big news for 2018. In 10th and 12th grade the increase in nicotine vaping was the largest we've ever seen for any substance in the past 43 years. As a result of this increase in nicotine vaping, overall use of nicotine increased as well, which suggests that vaping is drawing youth into nicotine use. We also saw a significant increase in marijuana vaping.
