For young people who want to give up vaping, simple interventions — like hotlines, informational text messages and nicotine replacement — are helpful tools for quitting, a new study finds.

The research, published Wednesday (Dec. 11) in the American Journal of Preventive Medicine, explored these interventions to help 18- to 25-year-olds quit vaping, and it reported strikingly positive results.

Researchers at The Ohio State University (OSU) assigned the 508 young adults, who were all keen to give up vaping, to four treatment groups. These volunteers received various combinations of coaching over the phone, nicotine replacement therapy (NRT) and mobile health support via text messages and online informational content.

After three months, over 40% of the participants in each group had gone at least a week without vaping. Those who got two interventions — namely, phone calls and NRT — or all three interventions fared the best, with a 48% quit rate.

"Unfortunately or fortunately, we were very effective in producing cessation," said study co-author Liz Klein, chair of OSU's Division of Health Behavior and Health Promotion — fortunately, because it's normally difficult to help people to stop vaping, and unfortunately, because the uniformly high rates left questions about which was the most effective intervention tested.

"We have to really do more work to understand the various pieces," Klein told Live Science.

Related: Is vaping healthier than smoking?

The best ways to help people, especially teens and young adults, stop vaping remains uncertain. "A lot of folks assume that quitting vaping is going to be identical to quitting smoking, and we just don't have evidence that they're exchangeable," Klein said.

But the issue is gaining attention. In 2018, the U.S. Surgeon General declared e-cigarette use by teens and young adults to be an epidemic. Atop many unknowns about the potential long-term harms of vaping, Klein said nicotine addiction may change young people's brain development, potentially altering their ability to concentrate and their responses to other drugs of abuse.

For the new study, people who vaped but did not smoke cigarettes were recruited via social media. They all received coaching via telephone calls — commonly known as a quitline, which is an established support tool for people seeking to stop smoking. "Ethically, we didn't feel comfortable" including a control group who received no help, for comparison, Klein noted.

One group was given only these calls. A second group received NRT, too, and were sent nicotine patches and either gum or lozenges. The third group received quitline calls and support via text messages, which shared online videos and other informational content. A fourth and final group received calls, NRT and mobile support.

The quit rates were 41% for quitline calls only, 43% for calls plus mobile support, 48% for calls and NRT, and 48% for all three interventions.

The study therefore supports NRT as a vape-quitting aid, but it poses questions about mobile support. Although a previous trial found that text messages boosted quit rates, here, they seemed to add negligible benefits. "We need to drill down and understand a little bit more" why that might be, Klein said.

But the surprisingly high cessation seen across all of the groups suggests quitlines could help young adults kick vaping.

"This study is only the third randomized trial of a vaping cessation program for young people to be published," said Amanda Graham, chief health officer at the Truth Initiative, a charity dedicated to preventing nicotine addiction in young people, who was not involved in the study. It's exciting to see this neglected field growing, she added.

However, suggestive as the results are, Graham said that because the study lacked a control group without quitline support, it can't yet be concluded exactly how effective the phone coaching was. She would also like to see longer follow-up than the week of abstinence at the three-month mark used in this study.

Klein and her colleagues are now deciding which interventions to test in larger, longer trials, which will also look at people who both vape and smoke.

There was considerable demand to join this study, Klein said, and both she and Graham noted that, in recent large surveys, a majority of young people who vape say they want to stop. This contrasts with previous generations of young people who smoked cigarettes and often viewed quitting as something to do later in life.

"With traditional cigarette smoking, young people weren't beating down the door to say, 'I need services and I'm not getting them,'" Klein said. "I do think we're detecting a higher rate of interest and engagement."

This article is for informational purposes only and is not meant to offer medical advice.

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun? Send us your questions about how the human body works to community@livescience.com with the subject line "Health Desk Q," and you may see your question answered on the website!

To save a man who needed a double-lung transplant but had a very complicated case, doctors relied on three key tools: antibiotics, an artificial lung and DD-size breast implants.

"I never imagined we'd be using DD breast implants to help bridge a patient to lung transplantation, but our team is known for taking on the most difficult cases and thinking outside the box to save lives," Dr. Ankit Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern Medicine, said in a statement.

The transplant patient, a 34-year-old Missouri man named David "Davey" Bauer, had started smoking cigarettes at age 21. He smoked about a pack a day until switching to e-cigarettes, or vape pens, in 2014. In April of this year, he began experiencing shortness of breath and was diagnosed with the flu. He also developed a bacterial infection of the lungs that was resistant to antibiotic treatment.

Bauer was admitted to a St. Louis hospital and was placed on an ECMO (extracorporeal membrane oxygenation) machine, which does the work of the heart and lungs, but his condition worsened. That's when Northwestern received a call about Bauer needing a double-lung transplant.

Related: Creating 'universal' transplant organs: New study moves us one step closer.

"Davey's lungs were so heavily infected that they started to liquify," Dr. Rade Tomic, a pulmonologist and medical director of the Northwestern Medicine Canning Thoracic Institute Lung Transplant Program, said in the statement. "If you looked at his X-ray, there was nothing left — the lungs were completely filled with pus."

The Northwestern team determined that, for Bauer to survive the transplant, his infection would need to clear first. To make that happen, they'd need to remove his extensively infected lungs.

To deliver oxygen to the man's organs while his lungs were removed, the team jerry-rigged pieces of an ECMO machine to create channels that would keep oxygenated blood flowing to Bauer's heart and out to the rest of his body.

"I spent the whole night thinking about how I'm going to create these channels and do all these things," Bharat told CNN. But even with these artificial channels in place, the medical team still needed a way to physically support Bauer's heart, given that the lungs, which normally surround it in the chest cavity, would be removed. In the end, they decided breast implants were the best tools for the job.

"One of our plastic surgeons was very gracious to give us a rapid-fire course on the different types, shapes and sizes of breast implants, so we picked out a couple options and some of them were easier than others to mold inside Davey's chest, with the DD option being the best fit," Bharat said in the Northwestern statement. 

Bauer's infected lungs were removed on May 26, his name came up for new lungs on May 27, and the procedure was completed on May 28. 

"I honestly barely remember walking into the ER [in St. Louis]," Bauer told People in an exclusive report published Nov. 7. "Then I woke up out here in Chicago with new lungs." 

Bauer was discharged to rehabilitation therapy in late September after recovering in the intensive care unit for several months.

"I plan to get a t-shirt made that says 'DD Davey' on it and change all my gaming profiles," Bauer said in the Northwestern statement. "But in all seriousness, I'm so proud to be the first Northwestern Medicine patient to undergo this innovative procedure, and I hope this medical first paves the way for more critically ill patients to receive lung transplants in the near future."

Bauer's GoFundMe page details more of his story.

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun? Send us your questions about how the human body works to community@livescience.com with the subject line "Health Desk Q," and you may see your question answered on the website!

Nicotine e-cigarettes are among the best tools to help people quit smoking.

That's according to an analysis of more than 300 clinical trials that collectively included more than 150,000 adult smokers worldwide. The data suggest that nicotine-containing e-cigarettes, or vapes — handheld devices that deliver nicotine via an aerosol with flavoring — and two pills called varenicline and cytisine were associated with the greatest chance of quitting smoking for at least six months. 

These stop-smoking aids' success rates were closely followed by those of dual nicotine replacement therapy (NRT), an approach that involves using two aids at the same time, such as a nicotine patch alongside taking gum or lozenges. However, the evidence for dual NRT was less certain than that for vapes and the medications. 

The authors of the new review, published Tuesday (Sep. 12) in the Cochrane Database of Systematic Reviews, hope the findings will provide more clarity on the relative effectiveness of these stop-smoking aids. 

"Our findings provide clear evidence of the effectiveness of nicotine e-cigarettes and combination nicotine replacement therapies to help people quit smoking," Jamie Hartmann-Boyce, senior study author and assistant professor at the University of Massachusetts Amherst, said in a statement. 

Related: Is vaping healthier than smoking?

"The evidence also is clear on the benefits of medicines, cytisine and varenicline, but these may be harder for some people to access at the moment," he said.

Varenicline, although currently available in the U.S., is not accessible in many countries worldwide due to recent shortages. Meanwhile, cytisine is not widely available because it's been licensed in only some countries in eastern and central Europe and western Asia, and in Canada. That said, the drug is in late-stage clinical trials in the U.S. and thus moving toward approval.

"We're in a kind of weird position with this review where we're saying these are the top three most successful, but actually only one of them is widely available at the minute and that's e-cigarettes," Nicola Lindson, lead study author and a senior researcher and lecturer at the University of Oxford, told Live Science.

The review revealed that, on average, 14 in 100 people who are trying to quit smoking are likely to succeed for at least six months using e-cigarettes, varenicline or cytisine. That's compared to 12 in 100 who use dual NRT, 9 in 100 who use one form of NRT, and 6 in 100 who don't use any stop-smoking aids. 

In the paper, the authors highlighted the need for further data to determine the long-term consequences of using these aids, beyond the six-to-12-month timeframe that most of the trials they analyzed considered. Lindson added that, in the future, more trials could directly compare the effectiveness of these different treatments, for example, by pitting cytisine against e-cigarettes in addition to a placebo, or could potentially test the use of multiple treatments together.

The rising popularity of e-cigarettes has raised concerns about their potential environmental impact and their use by young people who have never smoked. Given that vapes are a relatively new stop-smoking aid — developed in 2003, compared to NRT, which has been approved in the U.S. since the 1980s — scientists are still researching their potential health effects. 

According to Lindson, though, the message for people trying to stop smoking is clear.

"What we would always recommend is that people should be encouraged to use e-cigarettes to stop smoking if they've already smoked," she told Live Science. "But it's best not to use them if you have never smoked, because they're not going to be completely risk-free — they're just, we believe, a lot safer than smoking." 

This article is for informational purposes only and is not meant to offer medical advice.

Electronic nicotine delivery systems (ENDs), also known as electronic cigarettes, e-cigarettes or vape pens, were introduced in the early 2000s as an alternative to tobacco products. Instead of generating smoke, these pocket-sized devices deliver nicotine with an aerosol that looks like water vapor. But are vape pens "'healthier"' than cigarettes?

It depends. Experts told Live Science that they agree that "vaping" poses a small fraction of the risks of smoking. However, they stress that vape pens are not entirely safe, and we still do not know enough about the long-term effects of e-cigarette use. 

It took decades of research to prove the harms of cigarettes — after being introduced to the U.S. in the early 19th century, cigarettes were first linked to lung cancer and other diseases in the 1940s and 1950s. Vape pens have been on the market for less than 20 years, and complicating the situation, some vape liquids and types of ENDs may be more harmful than others. 

So how harmful are e-cigarettes? Here is everything we know so far about the potential health effects of vaping.

Smoking vs. vaping: Which is more toxic?

Cigarettes contain tobacco leaves and other additives, such as flavorings and preservatives, that, when burned, generate up to 7,000 different chemicals, including hydrogen cyanide, arsenic, lead and carbon monoxide, according to the American Cancer Society (ACS). 

Dozens of these harmful chemicals are carcinogens, or cancer-causing substances, most of which come from the tobacco leaves themselves, rather than the additives, according to the ACS. Smoking cigarettes can increase the risk of several different types of cancer, as well as cause lung and heart disease. By contrast, nicotine, the addictive chemical in tobacco leaves, does not cause cancer, according to the WHO; that said nicotine can have other harmful effects on the body, in addition to being highly addictive.

Vape pens come in many shapes and sizes, but they all work based on the same principle: A battery-powered core heats and then rapidly cools a vape liquid, also called e-liquid or vape juice, creating a smoke-free aerosol that a user inhales, or "vapes." Vape juice can contain nicotine that's either synthetic or derived from tobacco, but it doesn't contain tobacco leaves or other chemicals found in the plant.

Given both the lack of smoke and the lack of tobacco in e-cigarettes, people who completely switch from smoking to vaping tend to have lower exposure to toxic substances than do individuals who use cigarettes, Dr. Alayna Tackett, an assistant professor in the Division of Medical Oncology and the Center for Tobacco Research at the Ohio State University Wexner Medical Center, told Live Science by email. 

However, vape pen liquids can contain other substances that may form carcinogenic compounds when heated, she said.

How toxic is vape liquid?

Most e-liquids consist primarily of nicotine, flavorings and solvents, which generate vapor and keep ingredients in suspension. However, the exact composition of a specific e-liquid will largely depend on the brand's manufacturing process, according to a 2021 review published in the journal Pharmacology & Therapeutics. This makes it difficult to assess exactly how toxic e-liquids are. 

The two most common solvents used in e-liquids are propylene glycol and glycerol, which the Food and Drug Administration (FDA) generally recognizes as safe for human consumption. However, they may not be safe to inhale, the 2021 review states. Propylene glycol and glycerol are both airway irritants, meaning they may cause inflammation and other adverse reactions in the respiratory system, the review authors wrote. 

Similarly, while flavorings used in e-liquids are generally safe to eat, no studies show they are safe to inhale as aerosols, and some may be dangerous to inhale, according to the review. For example, the buttery-flavored compound diacetyl was linked to a severe respiratory disease called bronchiolitis obliterans — a condition nicknamed "popcorn lung" because workers at a microwave popcorn factory developed the disease after inhaling diacetyl.

Both solvents and flavoring agents may generate toxic byproducts, such as formaldehyde, a substance classified as a probable human carcinogen, the review authors wrote. Inhaling formaldehyde in high doses can be harmful, and a 2017 study in the journal PLOS One found that concentrations of formaldehyde from heated vape liquid solvents may exceed acceptable limits established by the U.S. Environmental Protection Agency. In theory, this may put ENDS users at a higher risk of cancer, but this cancer risk has not been clearly demonstrated in research. 

As noted previously, most e-liquids also have varying levels of nicotine. Because tobacco smoke has a relatively low nicotine concentration and is harsh on the lungs, it is difficult to overdose on the addictive chemical when smoking cigarettes. Vape pens, however, can contain high concentrations of nicotine, and users can often dial up the amount of nicotine delivered in a single puff. 

As a result, vaping may increase the risk of nicotine overdose, the review authors noted. Nicotine overdose, or nicotine poisoning, is a condition whose symptoms include muscle twitching, fainting, vomiting, heart palpitations, seizures and difficulty breathing. If it triggers severe enough symptoms, nicotine poisoning can sometimes be deadly, according to Mount Sinai.

A 2014 study by the CDC revealed a significant uptick in nicotine vape pen-related calls to poison control centers — the number of calls increased from one per month in September 2010 to 215 per month in February 2014, while the number of calls involving cigarettes remained steady over that time.

Can vape liquid get contaminated?

Vape pens themselves can also contaminate e-liquids. Repetitive heating of the device's core can cause nickel, copper, iron and other metals to slip into the aerosol; breathing in such metals could lead to an increased risk of cancer, kidney damage, heart disease and neurological disorders, according to the Pharmacology & Therapeutics review.

The risk of metal contamination may be higher for closed pod ENDs, which have replaceable e-liquid cartridges, than in disposable vape pens designed to be used for a while and then tossed. And the metal contamination from a pod type e-cigarette may change across its lifetime, according to a 2023 study in the journal Toxics. Researchers found that the longer the device was used, the higher were the concentrations of hazardous metals in its vapor.

In addition, black-market vaping products containing THC (the psychoactive ingredient in marijuana) have sometimes been contaminated with vitamin E acetate, a synthetic form of vitamin E. Likely introduced by manufacturers as a way to dilute the THC content of vape juice, vitamin E acetate was linked to a major outbreak of vaping-related illness that hit the U.S. in 2019.

What diseases have been linked to e-cigarettes?

People who smoke cigarettes would be better off switching to e-cigarettes if they are still using nicotine and haven't had success with other substitutes, like nicotine gum. However, for those who have never smoked, it remains unclear what the health implications might be from vaping. 

The evidence is limited and we do not have studies showing the long term impact of vaping, Hazel Cheeseman, deputy chief executive of Action on Smoking and Health, a charity set up by the Royal College of Physicians in the U.K. to promote smoking abstinence, told Live Science by email. 

That said, preliminary research suggests that vaping may raise the risk of certain health conditions.

Lung injury and lung disease

E-cigarettes may lead to irreversible lung damage and lung disease, according to the American Lung Association. 

For example, vaping can sometimes cause E-cigarette- or Vaping Product-Associated Lung Injury (EVALI), according to a 2020 review published by The American Journal of Medicine. Symptoms of EVALI include shortness of breath, cough, chest pain, nausea, abdominal pain, fever and chills. Up to one-third of patients admitted to an intensive care unit with the condition require mechanical ventilation, the review authors noted. The cause of EVALI is not fully understood, though it appears that vitamin E acetate plays a central role. However, other compounds found in both nicotine- and THC-containing vape liquids may also contribute to the condition, according to Yale Medicine.

In addition, e-cigarette use has been linked to lung diseases, including pneumonia, respiratory bronchiolitis-associated interstitial lung disease (an inflammatory disease previously seen mainly in heavy tobacco smokers), and hypersensitivity pneumonitis (a type of allergic reaction in the lungs), according to a 2022 review published in the journal Annual Review of Physiology.

Vape pen use may also weaken the lungs' immune defenses and increase the risk of infections with pathogens, including the influenza virus and Streptococcus pneumoniae bacteria, according to a 2022 review published in the journal Cureus.

Lastly, studies suggest that e-cigarettes may aggravate symptoms of asthma in adolescents with the condition, according to a 2023 review published in the journal Current Opinion in Allergy and Clinical Immunology. However, more research is needed to understand this effect.

Eye disorders

Exposure to e-cigarette vapor may also lead to eye disorders, according to a 2021 review published in the journal International Ophthalmology. Studies suggest that e-liquid substances such as aldehydes and flavorings may damage the eyes' tear film and lead to inflammation, worsening of the sight and reduced blood flow to the eye, according to the article. However, more research is needed to understand what exactly is causing these effects. 

Scientists are getting closer to understanding the link between e-cigarette use and eye disorders. For example, a 2021 mice study published in the Journal of Molecular Medicine found that full-body exposure to vape vapor may prompt the immune system to release more cytokines - chemical messengers that induce inflammation - which then accumulate in the superficial parts of the eye responsible for light absorption, as well as nourishment and protection of the deeper eye tissues. Animals exposed to e-cigarettes had a particularly high level of cytokines interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α), compounds that may damage the delicate barrier that regulates the transport of nutrients between the eye and the bloodstream, the study authors wrote.

Tooth decay

Very little research has been done on the impact of vaping on oral health. However, preliminary evidence suggests that people who vape are more at risk of developing cavities than those who do not vape or smoke, Dr. Sam Jethwa, the vice president of The British Academy of Cosmetic Dentistry, told Live Science by email. 

When people inhale during vaping, the sugar in some vaping liquid sticks to the teeth, causing damage to the tooth enamel. Vape liquid may also change the microbiome of the mouth, making it more hospitable to decay-causing bacteria, Jethwa told Live Science. Vaping also appears to encourage tooth decay in areas where it usually does not occur, such as the bottom edges of front teeth rather than the deep grooves of the back teeth, he said. 

Vaping can also decrease saliva production and cause dry mouth, which is a known driver of cavities. "Saliva provides a natural lubrication for the mouth and helps to neutralize the acid that can decay tooth enamel," Jethwa said.

DNA damage and cancer

We have not seen any evidence to date that vaping contributes to cancer, Dr. Irem Patel, consultant integrated respiratory physician and honorary senior lecturer at King's College London In England, told Live Science by email. However, it can take decades of follow-up and complex study designs for such increased risk to show up in the data. 

A first-of-its-kind study published in 2023 in the journal Nicotine & Tobacco Research compared the extent of DNA damage in the cells that line the inside of the mouth between vape pen users who never smoked cigarettes, cigarette smokers who did not vape, and non-users. Researchers found that people who vape and those who smoke cigarettes may show similar levels of DNA damage, and such DNA changes can be a precursor to cancer. Sweet, mint and menthol flavored e-liquids appeared to inflict the most damage, the study found. Still, more research is needed to understand this correlation.

Vaping may increase the risk of getting COVID-19, at least in teens and young adults, a new study suggests.

The researchers analyzed information from more than 4,300 U.S. teens and young adults, ages 13 to 24, who completed an online survey in early May, according to the study, published Tuesday (Aug. 11) in the Journal of Adolescent Health. Participants answered questions about their cigarette and e-cigarette use, as well as whether they had experienced symptoms of COVID-19, undergone testing or were diagnosed with the disease from a positive test.

Among those tested for COVID-19, e-cigarette users were five times more likely to be diagnosed with COVID-19, and those who used both e-cigarettes and traditional cigarettes ("dual users") were seven times more likely to be diagnosed with COVID-19, compared with those who did not use e-cigarettes or traditional cigarettes.

In addition, dual users were nearly five times more likely to report experiencing symptoms of COVID-19 at the time of the survey, regardless of whether they were tested, compared with non-users.

"Young people may believe their age protects them from contracting the virus or that they will not experience symptoms of COVID-19," study lead author Shivani Mathur Gaiha, a postdoctoral scholar at Stanford University School of Medicine, said in a statement. But this study shows that people who vape, or use cigarettes and e-cigarettes face increased risks."It's not just a small increase in risk; it's a big one,” Gaiha said.

The researchers don't know what causes the link, but they have a number of hypotheses. Both smoking and vaping are known to damage the lungs and affect the immune system, which may increase the risk of developing a COVID-19 infection after exposure to the virus, according to NBC.

In addition, behaviors such as repeatedly touching your face and mouth to use an e-cigarette, or sharing vaping products, could also increase the risk of infection. Although about half of the participants said they were sheltering in place, "that doesn't mean they're not in the backyard with a friend sharing their vaping product," study senior author Bonnie Halpern-Felsher, a professor of pediatrics at  Stanford University School of Medicine, told CNN.

However, the study only found an association between vaping and COVID-19 infection, and cannot prove that vaping led to the illness. But the study did take into account a number of factors that could infuence participants' risk of infection, such as their self-reported compliance with shelter-in-place orders and the rate of COVID-19 diagnoses in their state, as well as their age, sex, race/ethnicity, body mass index and socioeconomic status.

The researchers hope their results not only provide a warning to teens and young adults about the risks of vaping, but also encourage the U.S. Food and Drug Administration (FDA) to further tighten regulations on e-cigarettes and how they are sold to young people.

Recently, lawmakers sent a letter to FDA commissioner Dr. Stephen Hahn urging the FDA to temporarily clear the market of all e-cigarettes for the duration of the COVID-19 pandemic, CNN reported. The letter cites the current study as evidence that vaping is a risk factor for COVID-19.

Originally published on Live Science.  

Yesterday (Jan. 2), the Food and Drug Administration (FDA) announced a new policy to crack down on companies that sell mint- and fruit-flavored electronic cigarettes, popular products among children and teens. 

The policy aims to quell the widespread use of e-cigarettes among U.S. minors, because this use places millions of young people at risk of nicotine addiction, abnormal brain development and the use of conventional cigarettes later in life, according to a statement from the agency. For now, the crackdown will not affect the sale of tobacco- or menthol-flavored products, as research suggests that young users are far more attracted to fruit and mint flavors. 

"Our action today seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustible tobacco while ensuring [that] these products don't provide an on-ramp to nicotine addiction for our youth," Alex Azar, the secretary of the Department of Health and Human Services, said in the FDA statement.

Related: Does Vaping Have Any Benefits?

The FDA announcement follows an outbreak of vaping-related illness connected to contaminated e-cigarette products. But even if minors get their hands on untainted e-cigarette products, the devices still pose significant risks to their health, the FDA warned. The agency has called vaping among minors an "epidemic," as more than 5 million middle and high school students use e-cigarettes nationwide, according to the 2019 National Youth Tobacco Survey. Of these, 1.6 million minors report using e-cigarettes at least 20 days out of every month while about 1 million say they use e-cigarettes daily. 

"We will not stand idly by as this crisis among America's youth grows and evolves, and we will continue monitoring the situation and take further actions as necessary," Azar said. 

The new FDA policy does not ban the sale of flavored e-cigarettes. Instead, the agency will now prioritize the removal of "illegally marketed" fruit- and mint-flavored products from the market. To be deemed "legal," products that fall under the Tobacco Control Act, including e-cigarettes and other "electronic nicotine delivery systems," must undergo an FDA review. 

This science-based evaluation determines whether the product poses unacceptable risks to public health and weighs whether e-cigarettes make it more likely that people who do not use tobacco products will start using them. Although the act dictates that all e-cigarettes must undergo this review, the agency has delayed enforcing the policy for several years. To date, no existing e-cigarette products have undergone the approval process, and therefore, no product is considered "legally marketed" by the FDA. 

The agency could subject any e-cigarette product to enforcement of the act at any time. The new policy simply states that mint- and fruit-flavored e-cigarettes will be the first to face scrutiny.

Related: E-Cigarettes: What Vaping Does to Your Body

The FDA also plans to target products for which the "manufacturer has failed to take … adequate measures to prevent minors' access" through the use of age-verification technology and other sales restrictions. The agency will focus on cartridge-based e-cigarettes, as minors commonly use these products, according to the 2019 Monitoring the Future survey. 

Starting May 12, 2020, the FDA will take action against all manufacturers who continue to sell e-cigarettes without first submitting the required premarket application. This action will affect all kinds of e-cigarettes, flavored or otherwise. 

"While we expect that responsible members of industry will comply with premarket requirements, we're ready to take action against any unauthorized e-cigarette products as outlined in our priorities," FDA Commissioner Stephen Hahn said in the FDA statement. "We'll also closely monitor the use rates of all e-cigarette products and take additional steps to address youth use as necessary." 

• 4 Myths About E-Cigarettes 
• Vaping: How E-cigs Work (Infographic) 
• Images: New Cigarette Labels Unveiled by the FDA 

Originally published on Live Science. 

Some disease outbreaks have plagued humanity since antiquity, while others are relatively new — such as an outbreak of Legionnaires' disease that was linked to hot tubs, for instance. Here's a look at some of the most notable outbreaks — consisting of both old and new threats — that made headlines in 2019.

Measles 

In 2019, the U.S. experienced its worst measles outbreak in more than 25 years.

From Jan. 1 to Dec. 5, there were 1,276 confirmed cases of measles reported in 31 states, according to the Centers for Disease Control and Prevention (CDC). That's the highest number of cases in any year since 1992. For comparison, last year there were 375 U.S. cases of measles, and in 2010 there were just 63 cases.

The majority of this year's cases, 75%, were linked to measles outbreaks in New York within Orthodox Jewish communities, according to the CDC. Most people who caught the disease were not vaccinated against measles.

These outbreaks were so severe and lasted for so long that they threatened to take away the country's "measles elimination" status, which the U.S. has held since 2000.

Measles elimination means there is no "indigenous" transmission of the disease. In other words, all of the measles outbreaks that have happened since 2000 have had their source in foreign countries and have lasted less than a year. But if a chain of measles transmission continues for more than a year, then the disease is no longer considered eliminated. 

Fortunately, health officials were able to stop the spread of measles before the one-year mark, and the U.S. narrowly avoided having its measles elimination status taken away.

Measles can spread quickly in communities that have low vaccination rates. "This past year's outbreak was an alarming reminder about the dangers of vaccine hesitancy and misinformation," Alex Azar, secretary of the U.S. Department of Health and Human Services, said in a statement.

Hot tubs 

Hot tubs can spread diseases even if you don't get in them. That's what happened in a North Carolina outbreak of Legionnaires' disease linked to hot tubs.

The outbreak sickened nearly 140 people who attended a North Carolina state fair in September, according to the North Carolina Department of Health and Human Services. Four people died in connection with the outbreak. 

Preliminary findings from the investigation showed that people who were diagnosed with Legionnaires' disease were much more likely to report walking by hot tubs — which were on display at an event center at the fair — compared with people who did not get sick, the statement said.

Legionnaires' disease is a serious lung infection, or pneumonia, caused by Legionella bacteria, according to the CDC. This bacterium lives in watery environments, such as cooling towers and air conditioning systems, as well as in hot tubs. People become infected when they inhale airborne water droplets (within vapor or mist) containing the bacteria. The disease does not spread from person to person.

In light of the outbreak, the CDC issued an advisory to physicians and public health practitioners in November, alerting them that hot tub displays at temporary events (like a state fair) may pose a risk for Legionnaires' disease. "Event planners and hot tub vendors should know about the risk that hot tubs pose when not maintained adequately, even if the hot tub is for display only," the advisory said.

E-cigarettes 

What started out as a seemingly small cluster of lung illnesses tied to vaping soon exploded into a nationwide outbreak that would ultimately sicken more than 2,000 Americans in 2019.

One of the first indications of the outbreak came in July, when doctors in Wisconsin reported seeing eight teenage patients with serious lung damage after vaping. This led Wiconsin health officials to issue an alert to doctors in their state and beyond asking them to be on the lookout for more cases. 

Soon, dozens more cases of so-called EVALI (which stands for "e-cigarette, or vaping, product use associated lung injury") popped up around the country. Officials scrambled to find out what could be causing the outbreak, which seemed to primarily affect young, previously healthy people — a population that doesn't typically develop such severe lung disease.

Clues soon began to emerge. It appeared that most patients reported using vaping products containing THC (the active ingredient in marijuana) before falling ill. In late September, health officials said they suspected that THC-containing vaping products were playing a big role in the outbreak.

Then, officials found a substance called vitamin E acetate — an oil sometimes added to THC-containing vaping products — in lung samples taken from EVALI patients. Officials declared that this substance was a "very strong culprit of concern" in the outbreak. Still, there may be more than one cause of the outbreak, officials said.

As of Dec. 17, more than 2,500 people have been hospitalized with EVALI from all 50 states, according to the CDC. Fifty-four people have died in connection with the outbreak. 

In recent months, emergency room visits for cases of EVALI have been on the decline, the CDC said. But the agency continues to recommend that people avoid using THC-containing vaping products, particularly from informal sources like friends and online sellers.

Foodborne illness 

Americans may have experienced déjà vu this November when, shortly before Thanksgiving, the CDC warned the public not to eat romaine lettuce tied to an outbreak of E. coli. The agency had issued a similar warning in November 2018.

The 2019 outbreak involved romaine lettuce harvested from Salinas, California. Americans were told to throw away their romaine lettuce if it said "Salinas" on the label. The outbreak also led the U.S. Department of Agriculture to recall more than 75,000 lbs. of salad products containing romaine lettuce.

So far, the E. coli outbreak has sickened 138 people in 25 states, according to the CDC. Of these, 72 people have been hospitalized and 13 have developed a serious kidney condition called hemolytic uremic syndrome. No deaths have been linked with the outbreak so far. The CDC is continuing to investigate the source of this illness.

Eastern Equine Encephalitis 

This was a particularly bad year for infections with a rare but deadly illness known as eastern equine encephalitis (EEE). 

The viral illness, which is spread by mosquitoes, can cause brain inflammation. About 30% of patients who develop this brain inflammation die from the disease, and those who survive often have brain damage, according to the CDC.

Typically, there are only about seven cases of EEE in the United States each year. But in 2019, that number rose to an alarming 38 — the highest number of cases reported in more than half a century, according to STAT news. Fifteen people died from the disease.

Massachusetts, which reported 12 cases, took the brunt of the outbreak. It's unclear why 2019 was such a bad year for the disease. But it's known that the virus's activity can wax and wane, leading to large numbers of cases in some years, but few in others. 

Originally published on Live Science. 

This year saw an alarming rise in the percentage of U.S. teens who vape marijuana, according to new findings from a government-backed survey.

The trend is all the more concerning in light of the recent outbreak of vaping-related lung illnesses, which have sickened more than 2,400 people across the U.S., with the majority of cases occurring in teens and young adults, according to the Centers for Disease Control and Prevention (CDC).

The survey, called Monitoring the Future, is conducted every year to track drug use among U.S. teens and is funded by the National Institute on Drug Abuse. This year, researchers gathered data from more than 42,000 U.S. students in the eighth, 10th and 12th grades.

Results show that the percentage of 12th graders who reported vaping marijuana in the  preceding month soared from 7.5% in 2018 to 14% in 2019. This 6.5% increase is one of the largest single-year jumps seen in the survey’s 45-year history for any substance used in the previous month, the authors said. For comparison, between 2017 and 2018, the percentage of 12th graders who reported vaping marijuana in the previous month increased just 2.5%.

Among eighth graders, the percentage who reported vaping marijuana in the preceding month increased from 2.6% in 2018 to 3.9% in 2019; and among 10th graders, this percentage increased from 7.0% in 2018 to 12.6% in 2019.

The percentage of adolescents who reported vaping marijuana over the preceding 12 months in 2019 was 20% among 12th graders, 19% among 10th graders and 7% among eighth graders.

"As the number of adolescents who vape marijuana increases, so too does the scope and effect of any associated health consequences, which may include lung injury when using black market formulations," the authors, from the University of Michigan, wrote in their paper, published today (Dec. 18) in the journal JAMA.

Indeed, officials believe that vaping products containing THC, the active ingredient in marijuana, are playing a large role in the current outbreak of vaping-related lung illnesses. Around 80% of patients hospitalized with vaping-related lung illnesses reported vaping THC products. A substance known as vitamin E acetate, which is found in THC-containing vape products, has also been linked to the outbreak, according to the CDC.

"The rapid rise of marijuana vaping indicates the need for new prevention and intervention efforts aimed specifically at adolescents," the authors said.

A separate survey, also released today, similarly called attention to the rise of teen marijuana vaping. This second survey, called The National Youth Tobacco Survey, involved data from more than 38,000 U.S. students in grades 6 through 12. 

Among the entire student population, the percentage who reported ever using mairjuana in an electronic cigarette device (vaping marijuana) increased from about 11% in 2017 to nearly 15% in 2018.

The rise in marijuana vaping may be due to several factors, including the increase in sales of a newer generation of e-cigarettes known as "pod mods" that use disposable or refillable "pod" cartridges (which can include THC cartridges), according to the authors of the second paper, also published today in JAMA. Makers of this style of e-cigarette have been criticized for marketing to young people.

Other factors behind the rise in teen marijuana vaping may include increased access to marijuana through informal sources, such as friends and family members, as well as a reduced perception that marijuana can be harmful, the authors said.

More studies are needed to assess the immediate and long-term health effects of vaping marijuana, they concluded.

•  9 Weird Ways You Can Test Positive for Drugs 
•  8 Tips for Parents of Teens with Depression 
•  25 Odd Facts About Marijuana 

Originally published on Live Science. 

Officials have more evidence that a chemical called vitamin E acetate is playing a role in the recent vaping outbreak, which has sickened thousands of Americans.

On Tuesday (Nov. 26), researchers at the Minnesota Department of Health released the results of a study in which they analyzed 20 vaping products seized from black-market manufacturers during the outbreak of lung illnesses this year, and 10 products seized in 2018 — before the outbreak started. They found vitamin E acetate present in all samples tested from 2019, but not in any samples from 2018.

The findings suggest "vitamin E acetate might have been introduced recently as a diluent or filler" in vaping products, the authors wrote in their paper, published in Morbidity and Mortality Weekly Report, a journal from the Centers for Disease Control and Prevention (CDC).

Vitamin E acetate is an oil derived from vitamin E that black-market manufacturers sometimes add to vaping products containing THC (the active ingredient in marijuana) as a way to "cut" or dilute the THC. Earlier this month, health officials called vitamin E acetate a "very strong culprit of concern" in the vaping outbreak, after they found it in lung samples taken from patients with vaping-related lung illnesses, also known as EVALI, Live Science previously reported. 

In addition to the seized products, researchers in the new study also analyzed vaping products obtained from 12 patients with EVALI in Minnesota. Of the 46 samples analyzed, more than half (52%) contained vitamin E acetate. 

What's more, among the 12 patients who submitted the samples, 11 used products that were found to contain vitamin E acetate.

The chemical was specifically found in THC-containing products; it was not found in products that contained only nicotine.

The findings "support a potential role for vitamin E acetate in the EVALI outbreak," the authors said.

Still, the researchers stress that their study found an association and can't prove that vitamin E acetate actually causes lung injury. In addition, there may be more than one chemical or ingredient involved in the outbreak, they said.

The authors also note that their study was small, and larger studies are needed to confirm whether vitamin E acetate is indeed a newly introduced substance.

"Until the relationship between vitamin E acetate and lung health is better characterized, vitamin E acetate should not be added to e-cigarette, or vaping, products," the authors concluded. The CDC currently recommends that people do not use THC-containing e-cigarette products, particularly from informal sources such as friends, family or online dealers.

As of Nov. 20, more than 2,200 Americans have developed lung illnesses in connection with the outbreak, according to the CDC.

•  4 Myths About E-Cigarettes 
•  Gasp! 11 Surprising Facts About the Respiratory System 
•  9 Weird Ways You Can Test Positive for Drugs 

Originally published on Live Science. 

In a major blow to the vaping industry, the American Medical Association has called for a ban on e-cigarettes and vaping products that the FDA doesn't deem tobacco cessation devices.

As a tobacco researcher and former smoker, I don't care much about the health of the vaping and e-cigarette industry. But I do care about the health of smokers, and I wonder whether policy makers may now be reacting too strongly to e-cigarettes.

Although e-cigarettes in the U.S. are not regulated or approved by the FDA as smoking cessation devices, they may have helped thousands quit cigarettes.

I also wonder to what degree fear and hysteria, rather than evidence, might be informing this crucial public health topic. Smoking is the nation's number one cause of preventable death, claiming close to half a million lives a year.

Info overlooked, left out?

As of Nov. 20, 42 people have died, and more than 2,000 have been sickened from vaping-related illnesses. The New York Times reported last month on the youngest person to die from vaping, a 17-year old boy from the Bronx.

If your reaction to this story is to call for comprehensive vaping bans, you are not alone. The outbreak of vaping-related pulmonary illnesses has generated substantial news coverage, with stories of vaping-related deaths emerging frequently, and likely contributing to several states implementing vaping bans.

Reporting and public discourse often leave important data out of conversations, however.

For example, the National Academies of Sciences' report, published in January 2018, reviewed all of the evidence to date on e-cigarettes, and found that, except for nicotine, toxicant exposure from e-cigarettes is lower than from combustible cigarettes.

Although "less harmful" does not mean "harmless," harm minimization is likely the most productive approach for persistent smokers. That is, although nicotine itself poses risks to some vulnerable groups, there is little evidence that nicotine alone causes cardiovascular disease, cancer and pulmonary diseases when decoupled from smoke.

The National Academies' conclusion about e-cigarettes being less harmful than cigarettes presumes that vaping products are being used as intended. This is not always the case. In fact, recent findings indicate that most lung injury cases have involved vaping THC products, and/or products obtained from informal and poorly regulated markets, with as few as 10% of cases involving nicotine alone.

Although some evidence suggests that laws legalizing medical and recreational cannabis are associated with youth THC vaping, the potential relationship between vaping injuries and marijuana legalization is sparsely acknowledged.

An issue unique to the U.S.?

Reports on vaping also tend to leave out that vaping illnesses are a uniquely American problem. In the U.K., where e-cigarettes are regulated as cessation devices, comparable lung illnesses are not occurring. In fact, clinical trials conducted outside the U.S. have found e-cigarettes to be as effective as, or more effective than, nicotine replacement therapy at promoting cessation.

In the U.S., where e-cigarettes are regulated as tobacco products rather than cessation devices, comparable trials are lacking.

However, recent findings from one nationally representative survey indicated that smokers who used e-cigarettes daily were significantly more likely to stop smoking for at least two years compared to non-e-cigarette users — 11% versus 6%.

These results were consistent with another national study of about 5,000 adults. In that study, 337 (6.90%) quit smoking cigarettes and 778 (16.69%) substantially reduced their smoking rate, with about 14% of quitters and 15% of reducers reporting e-cigarette use.

One caveat is that officials and scholars cannot determine whether using e-cigarettes specifically facilitated quitting smoking, as some may have quit over time anyway even without e-cigarettes.

Undermining gains?

One significant risk of vaping alarmism is undermining the gains the nation has made in reducing cigarette smoking, including youth smoking. National data among middle and high school students show that cigarette smoking has continued to decline even as vaping explodes.

Some studies have suggested that e-cigarettes serve as a gateway to cigarettes for some teens. However, the most recent study of the gateway question found that among 12,000 U.S. youth, those who vaped were more likely to try cigarettes, but not more likely to become regular smokers. In simpler terms, the relationship between vaping and smoking is likely explained by shared risk factors — that is, the same characteristics that predict teen vaping also predict teen smoking.

The group most often neglected in our conversations about vaping is current cigarette smokers. Although smoking prevalence today is at an all-time low of 13.7%, smoking is increasingly concentrated among the most vulnerable — those with mental illness, substance use disorders or living in poverty.

It is exceedingly difficult to promote cessation among these "hardened" smokers. That's why health professionals and policy makers should be open to allowing, or even encouraging, these smokers to manage their nicotine addiction by transitioning from combusted to non-combusted sources of nicotine.

Just as opioid maintenance therapy is the standard of care for individuals with opioid use disorder, long-term nicotine maintenance should be an option for those addicted to nicotine. I have been "nicotine-maintained" for about five years, primarily with nicotine replacement therapy, but at one point with a "cig-a-like" vaping product. Five years is longer than the recommended 8-12 weeks of nicotine replacement therapy, but the prolonged therapy has allowed me to function effectively as a nonsmoker.

Today's often economically disadvantaged smokers likely cannot afford five years of nicotine replacement therapy. Although Medicaid recipients smoke at higher rates than those with private health insurance, most states have limited coverage for tobacco cessation treatment. Until nicotine replacement therapy is more affordable, we ought to consider the implications of decisions that dramatically limit smokers' access to alternative, less harmful sources of nicotine, such as comprehensive vaping bans.

In fact, one effect of Massachusetts' statewide vaping ban is a rise in cigarettes sales as former smokers reliant on e-cigarettes return to the most toxic, dependence-producing tobacco product available.

To be clear: The scientific evidence to date does not suggest that we should all be advocates for vaping. However, I believe we should have more reasoned conversations about vaping that are grounded in science, and acknowledge that while 39 deaths is 39 too many, there are half a million smoking-associated deaths each year in the U.S. Advocating for these smokers having easy and affordable access to less harmful sources of nicotine is imperative to improving U.S. public health.

[You're smart and curious about the world. So are The Conversation's authors and editors. You can read us daily by subscribing to our newsletter.]

This article was originally published at The Conversation. The publication contributed the article to Live Science's Expert Voices: Op-Ed & Insights.

A teen in Canada may be the first person to develop "popcorn lung" due to vaping, according to a new report.

Although the teen is one of thousands of people to be sickened in a recent outbreak of vaping-related lung illness, his case is unique because of the type of lung injury he developed, the authors said.

The 17-year-old went to the emergency room after he developed a "severe, intractable cough," along with difficulty breathing and a fever, according to the report, published today (Nov. 21) in the Canadian Medical Association Journal (CMAJ).

The teen was previously healthy but reported that he had vaped every day for the last five months. He vaped a variety of flavored electronic cigarettes, which he purchased online, and often added THC to his vaping fluid, according to the report authors, from the Western University Schulich School of Medicine & Dentistry in London, Ontario, and the University Health Network in Toronto.

Related: 27 Oddest Medical Case Reports

The teen's condition soon worsened, and he was admitted to the intensive care unit. His lungs were so damaged that he had to be placed on an extracorporeal membrane oxygenation (ECMO) machine, which pumps blood through an artificial lung outside the body.

Doctors conducted multiple tests for infections, but those exams all came back negative. However, imaging tests showed that the teen had bronchiolitis, which means that the smallest airways in the lungs, called bronchioles, are inflamed and obstructed.

That's when doctors suspected that the teen could have "popcorn lung," medically known as bronchiolitis obliterans, a rare condition in which the bronchioles become damaged and inflamed, often as the result of inhaling chemicals, according to the National Institutes of Health.

The condition gets its name from a cluster of cases that occurred more than a decade ago among workers at a microwave popcorn factory. The workers developed bronchiolitis obliterans after breathing in the chemical diacetyl, an artificial flavoring used in microwave popcorn.

Diacetyl has been found in e-cigarettes before; indeed, in 2016, the American Lung Association even warned about the risks of diacetyl in flavored e-cigarettes. But popcorn lung hasn't actually been connected with a case of vaping-related lung injury, until now.

The new case "may represent the first direct evidence" of bronchiolitis obliterans from e-cigarettes, Dr. Matthew Stanbrook, deputy editor at CMAJ, wrote in an accompanying editorial.

It's important to note that although doctors suspected popcorn lung in the teen based on imaging tests, the physicians were not able to confirm the diagnosis with a lung biopsy, as the procedure was deemed too risky for the patient.

Even so, the teen showed a different pattern of lung injury than is seen in other cases of vaping-related lung injury, also known as EVALI, the authors said. Specifically, EVALI typically involves damage to the alveoli, the small air sacs in the lungs, versus the bronchioles in the current case, the doctors said.

The teen's condition was so dire that he was referred to a lung transplant center and narrowly avoided needing a double lung transplant, the authors said. (Earlier this month, doctors in Detroit performed the first double lung transplant for a case of EVALI, in a Michigan teen.)

Still, the Candian teen ended up spending nearly 50 days in the hospital and continues to recover at home. It appears that he now has chronic damage to his airways and his exercise ability is limited, the authors said. The teen isn't using e-cigarettes, marijuana or tobacco products anymore.

Overall, the cases of EVALI described in the medical literature show "a variety of pathophysiological presentations and severity of disease," the authors wrote. In other words, the features that show up on lab tests and scans aren't the same for every patient. This variation may be due to a number of factors, including exposure to different chemicals within e-cigarettes and differences in the dose and temperature of the inhaled agents, the authors said.

So far, the vaping outbreak has sickened more than 2,100 people in the U.S. and there have been seven confirmed or probable cases in Canada, the report said. 

Researchers at the U.S. Centers for Disease Control and Prevention have identified an additive called vitamin E acetate as a "strong culprit of concern" in the vaping outbreak in the U.S. However, other causes cannot be ruled out, and there may be more than one cause, Live Science previously reported.

•  Gasp! 11 Surprising Facts About the Respiratory System 
•  9 Weird Ways You Can Test Positive for Drugs 
•  4 Myths About E-Cigarettes 

Originally published on Live Science. 

Doctors just performed what appears to be the first double-lung transplant for a patient suffering from vaping-related injury.

The 17-year-old patient had been sustained on an ECMO machine, which helps support heart and lung function, for more than a month before undergoing surgery, his medical team reported during a news conference today (Nov. 12). "He wouldn't have survived even minutes without it," said Dr. Hassan Nemeh, a thoracic surgeon at the Henry Ford Hospital in Detroit who helped conduct the operation. 

The lung transplant itself took place on Oct. 15 and took about six hours to perform. Now, the teenager can breathe without support and is undergoing physical therapy to regain his strength, his doctors said. The teenage patient's condition was so poor that quickly he got bumped to the top of the national waiting list for lung transplants, Nemeh said. (A standardized scoring system determines who needs transplants most urgently, not the doctors themselves, he added.)   

"The lung itself was so firm and scarred — this is an evil that I haven't faced before," Nemeh said. CT scans of the teenager's lungs revealed extensive inflammation and scarring of the tissue. The areas of the organ that contain air typically appear black on a CT scan; but in the patient, hardly any black showed up at all on his scan. Spots of dead tissue speckled both lungs, signalling to the medical team that the damage was "irreversible," said Victor Coba, a specialist in critical care medicine at Henry Ford who also treated the patient. 

Related: The 9 Most Interesting Transplants

The patient, who was only 16 when first admitted to hospital, will take months to fully recover and will have to adhere to particular instructions to maintain his health in the long term, his doctors said. 

The patient did not participate in the news conference but asked his medical team to "share photographs and an update to warn others" about the dangers of vaping-related lung injury. His family contributed a written statement to the conference, stating that the teenager went "from the typical life of a perfectly healthy 16-year-old athlete," sailing, playing video games, and hanging out with friends, "to waking up intubated and with two new lungs." They expressed their hope that others would be compelled to stop vaping after hearing the patient's story.  

Although the first to receive a lung transplant, the teenage patient represents just one of more than 2,050 cases of e-cigarette or vaping-associated lung injury reported since March, according to the Centers for Disease Control and Prevention (CDC). The illness, also known as EVALI, has affected people in every U.S. state except Alaska and claimed 39 lives so far. 

Most affected patients report having used products that contain THC, the main high-inducing compound in cannabis. Studies suggest that vape fluids that contain this psychoactive chemical may "play a major role in the outbreak," according to the CDC. At this time, the Henry Ford medical team did not specify what kind of vaping products the teenage patient used. 

Last Friday, the CDC announced that its investigators had linked a potentially dangerous chemical to the outbreak of vaping-related illness. The "very strong culprit of concern" — a compound called vitamin E acetate — can be added to vaping fluids as a thickening agent and sticks to the lungs like "honey" when inhaled, the AP reported. The compound also resembles THC oil, according to the CDC, so it's often used to cut, or dilute, vaping liquids that contain THC.    

The CDC recommends that people avoid buying vaping products "off the street" or modifying vaping liquids or devices as bought from a manufacturer. The organization recommends that those who vape monitor themselves for unusual symptoms, though to be completely safe people should avoid the use of vaping products altogether, particularly those containing THC. 

"Our teenage patient would have faced certain death if not for the lung transplant," Nemeh said. "It's a senseless disease — totally preventable." 

• 9 Weird Ways You Can Test Positive for Drugs 
• 27 Oddest Medical Cases  
• Healing Herb? Marijuana Could Treat These 5 Conditions 

Originally published on Live Science.

Experts finally have a strong contender for the cause of the vaping outbreak that has led to over 2,000 cases of lung illnesses and 39 deaths across the country, according to new findings. The potential culprit? A substance called vitamin E acetate.

In an analysis conducted by the Environmental Health Laboratory of the Center for Disease Control and Prevention (CDC), vitamin E acetate was found in all the samples of lung fluid taken from 29 patients across 10 states hospitalized with EVALI, the new name given to the lung illnesses caused by vaping. (EVALI stands for e-cigarette, or vaping, product use-associated lung injury.)

Vitamin E acetate is an oil derived from vitamin E that's added to vaping products containing THC (the active ingredient in marijuana) as a cutting agent. Previously, the U.S. Food and Drug Administration (FDA) and investigations by New York state had suggested this oil might be a cause for concern after it was found in a number of products taken from patients with EVALI.

Related: 4 Myths About E-Cigarettes

But this is the first time the oil has been detected directly in the lungs of patients in what's called bronchoalveolar lavage (BAL) samples, which are extracted from the lining of the lung using a tube pushed in through the nose. "These findings provide direct evidence of vitamin E acetate at the primary site of injury" in the lungs, Dr. Anne Schuchat, the principal deputy director of the CDC, said during a news conference today (Nov. 8). 

Vitamin E acetate is a "very strong culprit of concern," Schuchat said. The CDC's analysis of these samples didn't reveal any other potential contaminant or ingredient that could be linked to the illnesses, but these findings don't rule out other compounds or ingredients that may be causing the illnesses, she said. 

This oil is sometimes added to THC-containing products in high concentrations for "illicit" or "profit" purposes, such as to dilute the material, make it look nice or make it so that manufacturers of illegal products won't have to use as much THC or active ingredients, Schuchat added. 

That being said, there is still a small group of EVALI patients who report having used only nicotine-containing e-cigarettes or vaping products rather than THC-containing products. Vitamin E acetate "could potentially be used in a variety of substances," Schuchat said. But "in those that were tested so far, it's primarily been [in] THC-containing e-liquids."

THC or hints of it were detected in 82% of the BAC samples. Finding THC in 82% of samples is "very noteworthy," but on the flip side, not finding it in 18% of samples is "very explainable," said Dr. Jim Pirkle of the CDC's Environmental Health Laboratory during the news conference. "THC is not something we would expect to be hanging around in the lung fluids," whereas vitamin E acetate is "enormously sticky… like honey," he added. So when it goes into the lung "it does hang around."

Vitamin E acetate can be found in skin products or in foods and doesn't cause harm when swallowed or applied as such, Schuchat said. But studies have not been conducted to see what happens when the oil is inhaled. "When vitamin E acetate is inhaled, it may interfere with normal lung function," she said. 

It's not clear how vitamin E acetate might actually harm the lungs. But it's likely that the oil coats the lungs and makes it so they can't exchange oxygen. As the lungs attempt to get rid of the oil, they become inflamed, which hampers the breathing process even more, according to a previous Live Science report. 

However, one previous study found no evidence of the lungs being coated by oil in tissue samples taken from 17 EVALI patients across the U.S. Rather, the authors concluded in their study, published in The New England Journal of Medicine, that the injuries are similar to "chemical pneumonitis," or inflammation in the lungs caused by breathing in chemical fumes.

Schuchat notes that more studies are needed to determine if other compounds or vaping ingredients, in addition to vitamin E acetate, could be contributing to the lung injuries.  "There may be more than one cause of the outbreak," she said.

The CDC's study was published today in the Morbidity and Mortality Weekly Report (MMWR). Another MMWR report published today, found through a survey conducted in Illinois, that patients who had EVALI were about nine times more likely to have gotten their products from informal sources such as a friend, a family member or the black market.

The findings reinforce the agency's recommendation that people should not use vaping products containing THC, particularly those obtained from informal sources. "Until the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette, or vaping, products," the authors concluded.

• 10 Scientific Quit-Smoking Tips
• 7 Ways Marijuana May Affect the Brain
• 9 Weird Ways You Can Test Positive for Drugs

Originally published on Live Science.

Nearly three dozen people have died from vaping-related lung illnesses as the nationwide outbreak that continues to grow.

Today (Oct. 17), the Centers for Disease Control and Prevention (CDC) announced that the outbreak's death toll has climbed to 33, up from 26 deaths reported last week. The outbreak victims range in age from 17 to 75, with an average age of 44, the agency said.

What's more, the total number of cases in the outbreak increased to 1,479, up from about 1,300 reported last week.

The majority of those affected by the outbreak are young people, with about 80% of cases occurring in people under age 35.

Officials believe a "chemical exposure" is likely behind these illnesses, Live Science previously reported. But it's still unclear what chemicals or contaminants are to blame. Recently, the CDC said that THC-containing products may play an important role in these illnesses, with more than three-quarters of patients nationwide reporting use of vaping products containing THC, the active ingredient in marijuana.

The CDC is currently performing lab tests of lung biopsies and tissue specimens from patients, as well as conducting "aerosol emission testing" of e-cigarette products used by patients in an effort to uncover the chemicals contributing to the outbreak, the agency said.

Also today, e-cigarette company Juul announced that it has suspended sales of its fruit-flavored vaping products from its website, according to CNBC. (Last year, the company stopped selling the flavored products in retail stores.) The move follows last month's announcement that the Trump administration plans to ban flavored e-cigarettes from the market.

•  4 Myths About E-Cigarettes 
•  Gasp! 11 Surprising Facts About the Respiratory System 
•  8 Tips for Parents of Teens with Depression 

Originally published on Live Science. 

The mysterious vaping outbreak in the U.S. has led to nearly 1,300 lung injuries and 26 deaths as of last week, including deaths among young, seemingly healthy people. But what makes these illnesses so serious, and even deadly?

So far, state and federal investigators haven't found what's causing the illnesses, and there could be more than one cause. Whether the culprit is chemicals or oils, the substances place a heavy burden on the lungs, making it difficult for them to efficiently pump oxygen through the body.

For most patients, that means shortness of breath, cough, chest pain and sometimes even nausea, vomiting, fever and weight loss. But for others, the condition, now being called "e-cigarette or vaping product use associated lung injury," or EVALI, can develop to become life-threatening.

Related: 4 Myths About E-Cigarettes

There are two possibilities for what's causing the severe lung damage, said Dr. Michael Siegel, a professor in the Department of Community Health Sciences at the Boston University School of Public Health. The first is lung damage caused by inhaling viscous oils, which are sometimes added as thickening agents to black-market vaping products, especially to THC-vaping cartridges, he said. 

One such oil is called vitamin E acetate, and it was found in many — but not all — of the product samples from patients, which were recently tested by federal officials. Of the 225 THC-containing products tested, 47% contained vitamin E acetate, the U.S. Food and Drug Administration reported in a news conference on Oct. 11. 

The oil essentially coats the lungs, which aren't "designed to handle oil," Siegel said. The air sacs in the lungs get covered in oil and can't exchange oxygen. As the lungs try to get rid of the oil, they become severely inflamed, and it becomes even more difficult to exchange oxygen. "The lungs cannot work properly, and the patient may experience respiratory failure requiring mechanical ventilation," he said. That's likely what is causing the illnesses, he said.

Related: 11 Surprising Facts About the Respiratory System

The second possibility is that it's not the oil that's causing the problem but a chemical contaminant in vaping liquid that's toxic to the lungs, Siegel said. "It causes direct damage to the lungs and also triggers a severe inflammatory response."

Recently, a group of researchers studied samples of lung tissue taken from 17 patients across the U.S. who had fallen ill with the mysterious vaping-related illness. They didn't find any evidence that oils that coated the lungs were causing the problem, and the authors "feel comfortable saying" that a buildup of oil in the lungs is not what's causing the injury, said the first author of that study, Dr. Yasmeen Butt, a surgical pathologist at the Mayo Clinic.

Rather, under the microscope, the lung tissues showed signs of injury similar to "chemical pneumonitis," or inflammation caused by breathing in chemical fumes, which is most likely the cause, the authors wrote in their study, published Oct. 2 in the New England Journal of Medicine (NEJM). Similarly, pneumonitis has been linked to the practice of "dabbing," or inhalation of butane hash oil, a concentrated form of marijuana that contains high levels of THC, according to a report published in the journal Respiratory Medicine Case Reports last January.

In the NEJM study, the cells lining the walls of patients' lungs were often so damaged that they fell off, Butt told Live Science. In severe cases, this led to acute respiratory distress syndrome — a serious lung infection in which the air sacs that are losing cells become permeable to materials flowing through the body and start building up with materials such as dead cells, blood-clotting proteins and fluids.

Those materials block off the air space in the sacs and the lungs can't perform oxygen exchange very well. Acute respiratory distress syndrome has a very high mortality rate because you can't really "fix it," Butt said. "You just have to do the best you can with oxygenating them and hope that they're able to pull through."

That's also why providing people with oxygen through respirators or mouth tubes in the hospital doesn't always save them. "It doesn't matter how much oxygen you push into [the lung] … it has to get through all of that material," Butt said. So there's not much else to do other than wait for the body to get rid of that material itself, she said. 

Most of the fatalities have been among older people — a population that could be considered high-risk for complications along with pregnant women and people who have a history of heart or lung disease. The oldest person to have died of EVALI was 75 years of age, and the youngest a 17-year-old from the Bronx. 

From a population of 342 patients on which the Centers for Disease Control and Prevention (CDC) has information, more than half the patients who were over age 50 required a tube to be placed through their mouths into their lungs to make it easier to breathe or to be hooked up to a respirator that mechanically breathes for them, according to a new CDC report released Oct. 11 in the journal Morbidity and Mortality Weekly Report (MMWR).

It's unclear how much of this damage is reversible or permanent. "We don't know yet whether these acute cases of respiratory failure will lead to irreversible damage or whether the patients will eventually return to normal lung function," Siegel said. 

• 10 Scientific Quit-Smoking Tips
• 7 Ways Marijuana May Affect the Brain
• 9 Weird Ways You Can Test Positive for Drugs

Originally published on Live Science.

More than two dozen people have died in connection with an outbreak of vaping-related lung illnesses across the U.S.

Today (Oct. 10), the Centers for Disease Control and Prevention (CDC) announced that the outbreak's death toll has climbed to 26, up from 18 deaths reported last week. The recent deaths include that of a 17-year-old in New York, who is now the youngest victim of the outbreak.

The size of the outbreak also increased to nearly 1,300 cases in 49 states, up from 1,080 cases in 48 states reported last week, the CDC said. (Alaska is now the only state not reporting any vaping-related lung illnesses, according to CDC data.)

The majority of those affected by the outbreak are young people, with about 80% of cases occurring in people under age 35.

Officials believe a "chemical exposure" is likely behind these illnesses, Live Science previously reported. But it's still unclear what chemicals or contaminants are to blame. Recently, the CDC said that THC-containing products may play an important role in these illnesses, with more than three-quarters of patients nationwide reporting use of vaping products containing THC, the active ingredient in marijuana.

Symptoms of the vaping-related lung illnesses include shortness of breath, cough and chest pain, and in some cases, nausea, vomiting, fever and weight loss after vaping.

While the investigation into the outbreak is ongoing, the CDC recommends that people refrain from using e-cigarettes or vaping products, particularly those containing THC.

•  4 Myths About E-Cigarettes 
•  8 Tips for Parents of Teens with Depression 
•  Mixing the Pot? 7 Ways Marijuana Interacts with Medicines 

Originally published on Live Science. 

A New York teenager who died from a vaping-related lung illness appears to be the youngest victim in an outbreak that has sickened more than 1,000 people, according to news reports.

The 17-year-old, who lived in the Bronx, was hospitalized twice last month with a vaping-related lung illness, according to the New York Times. He died on Oct. 4.

So far, the outbreak, which began in July, has sickened 1,080 people in 48 states, according to the latest information from the Centers for Disease Control and Prevention (CDC). 

As of Oct. 1, 18 deaths were linked with the outbreak, with the youngest death occurring in a 27-year-old, according to the CDC. Since then, at least five more deaths have occurred, but other than the Bronx teenager, they have all been among adults, the New York Times reported.

In addition, the Utah Department of Health recently announced the death of a resident "under the age of 30" from a vaping-related lung illness.

Officials believe a "chemical exposure" is likely behind these illnesses, Live Science previously reported. But it's still unclear what chemicals or contaminants are to blame. Recently, the CDC said that THC-containing products may play an important role in these illnesses, with more than three-quarters of patients nationwide reporting use of vaping products containing THC, the active ingredient in marijuana.

And a report published last week concluded that these illnesses are most likely due to toxic chemical fumes produced from vaping, with these fumes directly damaging the smokers' lungs.

Symptoms of the vaping-related lung illnesses include shortness of breath, cough and chest pain, and in some cases, nausea, vomiting, fever and weight loss after vaping.

The CDC is scheduled to release an update on the outbreak tomorrow (Oct. 10).

•  4 Myths About E-Cigarettes 
•  8 Tips for Parents of Teens with Depression 
•  Gasp! 11 Surprising Facts About the Respiratory System 

Originally published on Live Science. 

The number of vaping-related illnesses has reached a staggering 1,080 cases, with 18 confirmed deaths, according to the latest report from the Centers for Disease Control and Prevention (CDC).

What's more, it doesn't look like the outbreak has "peaked" or is in any way slowing down, Dr. Anne Schuchat, the principal deputy director of the CDC, said during a press conference today (Oct. 3). "We are worried that there's plenty of risky products still out there."

The 275 cases since last week includes both new patients who have recently become ill and those who were previously ill and are just now reporting it. "Given the continued occurrence of life-threatening new cases, CDC recommends that people refrain from using e-cigarette or vaping products, particularly those containing THC," the active ingredient in marijuana, she said.

Related: 4 Myths About E-Cigarettes

Though the U.S. Food and Drug Administration has collected over 440 samples of vaping products and constituents across 18 different states, the agency has not found a common thread among all the products that could be causing the illnesses.

Of the 578 patients that CDC has information from, 78% reported using THC-containing products. 

A report published last week, which focused on patients in Illinois and Wisconsin, also found that a majority of patients were using THC-containing products and specifically "prefilled" cartridges (which are filled before the user buys them). In addition, many of those patients had obtained those products illegally off the streets. However, that report is focused on a very specific geographic region and so it can't be concluded that these illnesses are caused solely by products bought illegally, Schuchat said. 

Previously, investigators had also found vitamin E acetate in many, but not all, of the products , especially those obtained from patients in New York, suggesting that the oils could have accumulated in people's lungs and caused the illnesses. 

However, a new report published yesterday (Oct. 2) in The New England Journal of Medicine didn't find any evidence that was the case after the researchers examined lung biopsies of 17 patients across the U.S. Instead, they concluded that the illnesses were likely the result of inhaling toxic chemical fumes. 

All of that being said, it's still unclear what's causing hundreds of people to report to the hospital with shortness of breath, cough, chest pain and sometimes even nausea, vomiting, fever and weight loss after vaping. What is clear is that "these are really serious injuries in the lung," Schuchat said. "We don't know how well people will recover from them, whether lung damage may be permanent." 

• 9 Weird Ways You Can Test Positive for Drugs
• 7 Ways Marijuana May Affect the Brain
• Kick the Habit: 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

As the mysterious outbreak of vaping-related illnesses in the U.S. continues to grow, a new study sheds more light on what could be making people sick.

The study, published today (Oct. 2) in The New England Journal of Medicine, concluded that these illnesses are most likely due to toxic chemical fumes produced from vaping, with these fumes directly damaging the smokers' lungs.

This conclusion is based on an analysis of lung biopsies from 17 patients across the U.S.

Some doctors had suspected that the accumulation of fats or oils (known medically as lipids) in patients' lungs had caused these vaping-related illnesses, but the new study found no evidence for this.

"While we can't discount the potential role of lipids, we have not seen anything to suggest this is a problem caused by lipid accumulation in the lungs," study senior author Dr. Brandon Larsen, a surgical pathologist at the Mayo Clinic in Scottsdale, Arizona, said in a statement. "Instead, it seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents."

Related: 4 Myths About E-Cigarettes

So far, the outbreak has sickened more than 800 people in 46 states, according to the latest data from the Centers for Disease Control and Prevention (CDC). Among these cases, 12 patients have died. 

For the new study, the researchers analyzed patients' lung biopsies under a microscope.

In all cases, the samples showed signs of acute lung injury, including pneumonitis, a type of inflammation of lung tissue that isn't caused by an infection.

According to the authors, their results suggest that patients' vaping-related lung injuries are a form of "chemical pneumonitis," or inflammation of the lungs caused by breathing in chemical fumes.

But it's still unclear what chemicals or contaminants could be causing the illnesses. Last week, the CDC said that THC-containing products may play an important role in these illnesses, with more than three-quarters of patients nationwide reporting use of vaping products containing THC, the active ingredient in marijuana. In the new study, 71% of the patients reported vaping with marijuana or cannabis oil.

Previously, it was reported that a substance known as vitamin E acetate, an oil derived from vitamin E, had been found in some product samples taken from patients. In addition, a recent analysis commissioned by NBC News found another substance, a pesticide called myclobutanil, in 10 THC vaping cartridges obtained from unlicensed dealers. This pesticide can convert into the chemical hydrogen cyanide when burned, NBC News reported.

"This is a public health crisis, and a lot of people are working frantically around the clock to find out what the culprit or culprits could be — and what chemicals may be responsible," Larsen said. "Based on what we have seen in our study, we suspect that most cases involve chemical contaminants, toxic byproducts or other noxious agents within vape liquids."

While the investigation of the outbreak is ongoing, the CDC recommends that people consider refraining from using e-cigarette products, particularly those that contain THC.

•  Gasp! 11 Surprising Facts About the Respiratory System 
•  9 Weird Ways You Can Test Positive for Drugs 
•  Mixing the Pot? 7 Ways Marijuana Interacts with Medicines 

Originally published on Live Science. 

After weeks of searching for the cause of a mysterious outbreak of vaping-related lung illnesses across the U.S., health officials now say that THC-containing products may play an important role in these illnesses.

Today (Sept. 27), officials from the Centers for Disease Control and Prevention (CDC) released a new report on the outbreak showing that more than three-quarters of patients nationwide reported using vaping products containing THC, the active ingredient in marijuana. 

A second report, which focused on patients in Illinois and Wisconsin, similarly found that the vast majority of the individuals reported using THC-containing vaping products. In particular, they reported using vaping cartridges that were "prefilled" with THC, which means the cartridges were already filled and packaged before the user obtained them.

What's more, most of the patients reported obtaining the vaping products from informal sources, such as off the street or from friends or a dealer.

Still, officials stressed that they don't know for sure what's causing the outbreak, saying they can't rule out non-THC-containing products as possible risks.

"The outbreak [data] is currently pointing to a greater concern around THC-containing products," Dr. Anne Schuchat, principal deputy director of the CDC, said in a news conference today (Sept. 27). But "we do not know whether the only risky substance for lung injury is the THC-containing products."

Related: 4 Myths About E-Cigarettes

So far, the outbreak, which was first identified in July, has sickened more than 800 people in 46 states, according to the CDC. Of these, 12 people have died from vaping-related illnesses.

Many of those sickened are teens or young adults; about 62% of the cases involve 18- to 34-year-olds, and 16% of the individuals are under 18. 

Patients reported symptoms such as shortness of breath, cough and chest pain, and some reported nausea, vomiting, fever and weight loss. Most of the illnesses have been serious, with the vast majority requiring admission to the hospital and many requiring treatment in the intensive care unit.

For one of the new reports, published today in the CDC journal Morbidity and Mortality Weekly Report (MMWR), researchers analyzed information from 514 patients across the U.S. They found that 77% of patients reported using vaping products containing THC or both THC and nicotine in the month before their symptoms started. Only a small portion of patients, 16%, reported using exclusively nicotine-containing e-cigarettes.

For the second report, also published today in MMWR, state health officials in Illinois and Wisconsin conducted detailed interviews with 86 patients in the two states. In those interviews, 87% of patients reported using vaping products containing THC, and of these, nearly all (96%) were in the form of packaged, prefilled vaping cartridges.

Overall, patients reported using 87 different brands of e-cigarette products. Although no single brand was reported by all patients, two-thirds (66%) of patients reported using a brand called Dank Vapes, a black-market "brand" of vaping products. Dank Vapes doesn't appear to be a single company, but rather a branded packing used by sellers of unregulated vaping products, according to Inverse.

Officials also stressed that they don't know the exact substance causing these illnesses. Previous reports said that a substance known as vitamin E acetate, an oil derived from vitamin E, had been found in some product samples taken from patients. In addition, an analysis commissioned by NBC News found another substance, a pesticide called myclobutanil, in 10 THC vaping cartridges obtained from unlicensed dealers. This pesticide can convert into the chemical hydrogen cyanide when burned, NBC News reported.

While the investigation of the outbreak is ongoing, the CDC recommends that people consider refraining from using e-cigarette products, particularly those that contain THC.

•  9 Weird Ways You Can Test Positive for Drugs 
•  8 Tips for Parents of Teens with Depression 
•  Gasp! 11 Surprising Facts About the Respiratory System 

Originally published on Live Science. 

The mysterious outbreak of vaping-related lung illnesses has now hit nearly every U.S. state, according to health officials.

Today (Sept. 26), the Centers for Disease Control and Prevention (CDC) announced that the number of confirmed or probable cases in the outbreak has reached 805 in 46 U.S. states. That's up from 530 cases in 38 states reported last week. (A confirmed or probable case is one that meets the CDC's current case definition, or the specific criteria officials use to classify a vaping-related illness.) 

The only states not reporting vaping-related lung illnesses are Alaska, Alabama, New Hampshire and Rhode Island, according to CDC data. One territory, the U.S. Virgin Islands, has also reported at least one case.

What's more, 12 people have reportedly died from these illnesses, up from seven deaths last week.

Many of the patients are teens or young adults — about two-thirds of the cases involve 18- to 34-year-olds, and 16% are under 18. All patients with the lung illness reported using e-cigarettes, and many reported using the devices to vape marijuana before they got sick, although some reported using only nicotine.

Patients reported symptoms such as shortness of breath, cough and chest pain, and some reported nausea, vomiting, fever and weight loss. 

The cause of the illnesses is still a mystery; no single vaping device, product or substance has been tied to all of the cases. However, earlier this month, officials said they believe  a "chemical exposure" is likely behind these illnesses, Live Science previously reported.

Recently, The Washington Post reported that issues with black-market vaping products may be making people sick. For example, some black-market manufacturers are adding more thickening agents to dilute THC oil, to give it the appearance of a thick oil while using less actual oil from THC (an active ingredient in marijuana).

The CDC recommends that people consider not using e-cigarettes while the investigation is ongoing. And regardless of this investigation, e-cigarettes should not be used by youth, young adults, pregnant women or adults who currently don't use tobacco products, the CDC said. What's more, people should not buy e-cigarette products off the street and should not modify the products or add substances that aren't intended for vaping by the manufacturer, the agency said.

•  4 Myths About E-Cigarettes 
•  8 Tips for Parents of Teens with Depression 
•  10 Scientific Quit-Smoking Tips 

 Originally published on Live Science. 

People across the country continue to fall ill with mysterious lung diseases tied to vaping, and federal officials have revealed that they've opened a criminal investigation to search for the cause. 

The number of confirmed or probable cases has reached 530 across 38 states and one territory, according to the latest update from the Centers for Disease Control and Prevention (CDC). That's up from 380 patients reported last week. A confirmed or probable case is one that meets the CDC's current case definition, or the specific criteria officials use to classify a vaping-related illness. 

Seven people have reportedly died from these illnesses, which have struck men at a higher rate; about 75% of the patients are male. No one cause or set of causes has been linked to all of the cases, the CDC reported. 

The investigation continues at both the state and federal level. Today, the Food and Drug Administration (FDA) announced that its Office of Criminal Investigations (OCI) has been working in parallel to investigate the supply chain and identify what is making people sick.

Related: 4 Myths About E-Cigarettes

"In cases like this, we typically turn to [the] OCI," said Mitch Zeller, the director of the Center for Tobacco Products at the FDA. "They have special investigative skills, and there are leads to track down." However, the OCI is not pursuing any prosecution for personal use of any of these substances, he said. 

Previously, the FDA found that many of the products used by the patients contained a contaminant commonly found in THC vaping products called vitamin E acetate. "We are seeing vitamin E acetate in some samples, but our laboratory analysis continues to show a mix of results," he said. "There's no one compound ingredient constituent including vitamin E acetate that is showing up in all of the samples." 

Many of the patients reported using numerous vaping products and substances, including a mix of nicotine and THC.

The FDA has collected over 150 vaping product samples for analysis. The agency is searching for a variety of constituents — THC and other cannabinoids, opioids, cutting agents, pesticides, poisons, toxins and additives — to see if any have a link with the illnesses.

"Identifying any compounds present in the samples is the one piece of the puzzle and will not necessarily answer questions about causality," he said. "We are leaving no stone unturned."

The CDC has been recommending that people who are concerned about these health risks steer clear of e-cigarettes or vaping products, and no one should be buying them off the street or modifying them in any way. Regardless of the investigation, youths, young adults, pregnant women and adults who don't currently use tobacco products should not use them, Dr. Anne Schuchat, the principal deputy director of the CDC, said during the briefing. 

But if you're an adult who's using nicotine-containing e-cigarettes, you should not revert back to smoking cigarettes;  rather you should contact a health care provider who can discuss possible treatments, she said. What's more, "if you recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak, we recommend you see a health care provider as soon as possible." Those symptoms include cough, shortness of breath and chest pain. Some patients also reported having nausea, vomiting, diarrea, fatigue, fever or abdominal pain.

"People are dying," she said. "We ask you to take these recommendations seriously."

• 9 Weird Ways You Can Test Positive for Drugs
• 7 Ways Marijuana May Affect the Brain
• Kick the Habit: 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

Electronic cigarettes flavored with mint and menthol may contain high levels of a potentially cancer-causing chemical that's banned from food in the U.S., according to a new study.

The finding comes just days after President Donald Trump's administration proposed banning flavored e-cigarettes following a string of mysterious vaping-related illnesses across the country.

Pulegone is an oil extracted from mint plants such as peppermint and spearmint that was previously added to candies and chewing gum to give flavor. Last year, the Food and Drug Administration (FDA) banned synthetically made pulegone as a food additive because of carcinogenic effects found in animal studies.

Related: 4 Myths About E-Cigarettes

However, there is a "discrepancy in regulation of the chemicals in food versus e-cigarettes," said study co-author Sven Jordt, an associate professor in anesthesiology, pharmacology and pathobiology at Duke University's School of Medicine. For e-cigarettes, the FDA's "level of regulation is fairly minimal."

Indeed, several Centers for Disease Control and Prevention (CDC) studies previously found high levels of pulegone in mint- and menthol-flavored e-cigarettes and smokeless tobacco. "The fact that it's allowed in e-cigarettes is very concerning," Jordt told Live Science. 

For the new study, the researchers analyzed how much risk came with inhaling or ingesting pulegone. They calculated what's called the "margin of exposure" — a measure used by the FDA to calculate the cancer risk posed by food additives —  for people who smoked various levels of flavored e-cigarettes and used smokeless tobacco.

To do that, the researchers used data obtained from the FDA about what levels of pulegone exposure were low enough to avoid causing tumors in animal studies. (Similar studies in humans don't exist.) The researchers also examined data obtained from the CDC on the amount of pulegone people were exposed to on average when using various products.

The FDA deems a product safe for consumption if its margin of exposure (which is expressed as a ratio) is 10,000 or above. In other words, they say a food additive is safe when its concentration in food is 10,000 times lower than what would cause cancer in animals such as rats. 

The researchers calculated the margin of exposure for five different brands of menthol- and mint-flavored e-cigarettes and one brand of smokeless tobacco. They then compared the levels to that of menthol cigarettes. 

In the results, the margin of exposure for people smoking or consuming smokeless tobacco that contains pulegone ranged from 325 (in the heavy users) to 6,012 (in the light users) — much higher than the safety margin. What's more, people who smoked flavored e-cigarettes or consumed smokeless tobacco were exposed to much higher levels of pulegone than those who smoked menthol cigarettes, which have largely reduced levels of pulogene compared to what they contained in the 1970s, Jordt said.

"Levels by far exceeded [the] amount FDA was considering safe," Jordt said. "Users may eventually develop cancer based on the risk we found." That would, of course, not happen immediately, but over the course of many years. Now, Jordt and his team are exposing human lung cells in a lab dish to pulegone to see if the compound damages the cells. "We are also approaching the CDC and FDA about this data," he said. 

The findings were published today (Sept. 16) in the journal JAMA Internal Medicine.

• 10 Scientific Quit-Smoking Tips
• 9 Disgusting Things That the FDA Allows in Your Food
• 8 Tips for Parents of Teens with Depression

Originally published on Live Science.

Flavored electronic cigarettes may soon be banned in the United States, according to news reports.

Today (Sept. 11), the Trump Administration announced that it plans to finalize a policy that would remove non-tobacco-flavored e-cigarettes, such as mint and menthol flavors, from the U.S. market.

"The Trump Administration is making it clear that we intend to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities," Health and Human Services Secretary Alex Azar said in a statement.

When the new plan goes into effect in the coming weeks, it would result in the removal of flavored e-cigarettes within 30 days, according to Bloomberg News. After that, companies that want to market flavors of e-cigarettes besides tobacco would need to apply to the Food and Drug Administration for approval of their product. The manufacturers of these flavored vaping products would need to prove that the risks of the products, such as their potential for use by teens, are outweighed by its benefits, Bloomberg reported.

The announcement comes admit an outbreak of mysterious vaping-related lung illnesses that has sickened hundreds of people across the country. The cause of the outbreak, which has mostly affected teens and young adults, is still unclear.

•  4 Myths About E-Cigarettes | Live Science 
•  9 Disgusting Things That the FDA Allows in Your Food 
•  8 Tips for Parents of Teens with Depression 

Originally published on Live Science. 

The rise in cases of otherwise healthy young adults who have been hospitalized or even died from vaping-associated lung injury is alarming.

Many people don't know what is contained in these vaping devices, what the reported health effects actually mean, and, most importantly, why all of this developed so quickly, considering that e-cigarettes have only been popular for fewer than 10 years.

Vaping describes the process of inhaling aerosols generated by devices such as e-cigarettes.

When e-cigarettes first came to the U.S. in 2006, many smoking cessation experts were optimistic. They viewed the delivery of nicotine through e-cigarettes to be a useful alternative to traditional cigarettes. That is because e-cigarettes did not have all of the other harmful combustion products inhaled through cigarette smoke. Since there is no doubt that smoking traditional cigarettes is harmful to your health — and the number one cause of preventable death in the U.S. — e-cigarettes were marketed as a "safer" alternative.

As an inhalation toxicologist, I study how inhaled chemicals, particles and other agents affect human health. Since e-cigarettes were introduced, I have been concerned about how the scientific community could possibly know the full spectrum of their dangers. After all, it took decades for epidemiologists to discover that regularly inhaling the smoke from burning plant material, tobacco, caused lung cancer. Why would the scientific community be so quick to assume e-cigarettes would not have hidden dangers that might take years to manifest too?

Do e-cigarettes even work as a cessation tool?

Many smokers have reported that switching from cigarettes to e-cigarettes has helped their physical well-being, including reduced coughing.

But a few randomized clinical trials examining the use of e-cigarettes as a cessation tool have shown mixed results. While some trials demonstrate a significant increase in cessation success (from 9.9% to 18%), people using e-cigarettes were much more likely to remain dependent on nicotine as compared to those randomized for more traditional nicotine replacement products, such as nicotine patch, gum and nasal spray. Or, they were more likely to relapse to using cigarettes.

In short, whether, how, and to what extent e-cigarettes have potential as a cessation tool is not yet settled, especially considering that more than 80% of smokers randomized to use e-cigarettes continued to smoke after the cessation trial.

Safer than a spitting cobra

Cessation claims aside, the messaging of e-cigarettes as a "safer" alternative may have led many of the 3.6 million teenagers in the U.S. who use e-cigarettes today to believe these devices are "safe." "Safer" does not equal "safe," and the messaging of "safer" was based on comparisons to cigarettes.

Public Health England, the equivalent of the FDA in the U.K., stated in 2015 that "while vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger."

This statement did not consider the fact that health effects of inhaling flavoring chemicals contained in popular e-cigarettes are completely unknown, or that heating liquids in these devices causes thermal decomposition of those e-cigarette chemicals that "pose limited danger" into known toxicants. It also did not consider that e-cigarettes are a fast evolving consumer product with ever-changing devices and chemicals, creating mixtures and exposures of unknown health consequences.

This mistake was further advanced by assessing the adverse health effects caused by using e-cigarettes as a comparison to what occurs when someone smokes cigarettes for several years. It is well established that smoking cigarettes causes diseases such as chronic obstructive pulmonary disease, chronic bronchitis, emphysema and cancer. Many of these diseases do not manifest clinically until many years after the first cigarette has been smoked.

No controlled studies were ever conducted assessing whether using e-cigarettes causes any adverse health effects in people who never smoke. To this day, scientists do not know the potential long-term health consequences of using e-cigarettes for decades.

E-cigarettes cause very different health effects than cigarettes

I think that scientists and policymakers should completely stop comparing vaping outcomes to smoking outcomes. The now 450-plus confirmed cases of vaping-associated lung injuries prove this point. The clinical manifestations in these patients are not something a doctor would ever see in somebody who has been smoking cigarettes for a few months.

Similarly, these clinical outcomes have not been reported in marijuana users, even though THC, the psychoactive ingredient in marijuana, has now been associated with a large percentage of these cases.

Furthermore, the onset of these significant health problems is much faster than one would anticipate from smoking-related diseases. Since doctors are seeing severe diseases after relatively short exposures, does that make vaping more harmful than cigarettes?

Considering that the compounds inhaled through cigarette smoke are very different from those inhaled through the vast number of different flavored e-cigarettes and vaping devices, wouldn't that be like comparing apples and oranges? Nobody would consider it reasonable to compare health effects caused by smoking cigarettes to those induced by smoking crack.

A lot of attention is now being placed on identifying the potential "culprit" for the observed health effects in the more than 450 cases of vaping-induced lung injury. Additives contained in THC liquids have emerged as a potential cause.

However, not all cases identified by the CDC have a documented history of vaping THC, and some have only reported a history of using nicotine products. Furthermore, case reports of vaping-associated lung injury with symptoms similar to those reported by the Centers for Disease Control and Prevention but no history of THC use have been documented before, suggesting that vaping-associated lung injury has been detected before this recent rise in reported cases.

In addition, other vaping-associated clinical outcomes have been reported as well, indicating that vaping-induced adverse health effects can vary. Hence, it is premature to draw any conclusions regarding which compounds — and there are likely several — inhaled by vaping nicotine or THC containing products are causing specific types of lung injury.

While it is too early to say whether or to what extent e-cigarettes can be used to support smoking cessation, one conclusion can already be drawn: Vaping is not without health effects.

This article was originally published on The Conversation. Read the original article.

UPDATE: On Sept. 12, the Centers for Disease Control and Prevention (CDC) announced that there are currently 380 confirmed and probable cases of lung disease tied to vaping in 36 states. This revised case count is lower than what the agency announced last week because the new number includes only confirmed and probable cases that meet the CDC's current case definition, or the specific criteria officials use to classify a vaping-related illness. The previous case count included "possible" cases that did not necessarily meet this definition. Live Science published this article (below) on Sept. 6.

The number of Americans sickened by mysterious, vaping-related lung illnesses continues to soar as health officials unravel clues to what could be causing these illnesses.

Today (Sept. 6), the Centers for Disease Control and Prevention (CDC) announced that it is aware of 450 possible cases of severe lung illnesses tied to vaping that are under investigation in 33 states. (That's more than double the number of cases under investigation as of last week.)

Among these cases, three deaths have been confirmed in connection with these illnesses — one each in Illinois, Oregon and Indiana — and a fourth death is under investigation.

Overall, many of the patients are teens or young adults who were previously healthy. All patients reported using e-cigarettes, and many reported using the devices to vape marijuana before they got sick.

Related: 4 Myths About E-Cigarettes

So far, the cause of the illnesses is unknown; no single vaping device, product or substance has been tied to all of the cases, said Dr. Dana Meaney-Delman, the manager of the CDC's investigation into the lung illnesses.

Officials believe "chemical exposure" is likely behind these illnesses, but much more information is needed to determine which substances are involved, Meaney-Delman said at a news conference today. "[We're] working hard to understand why people are getting sick."

Yesterday, it was reported that a substance known as "vitamin E acetate" — an oil derived from vitamin E — had been found in 10 out of 18 marijuana product samples taken from patients for testing by the Food and Drug Administration (FDA). The agency is now analyzing more than 120 samples from around the country for a broad range of chemicals, said Dr. Ned Sharpless, acting FDA commissioner.

But simply identifying a compound in samples doesn't mean that it caused the illnesses, officials stressed. "Identifying any compounds present in the samples will be one piece of the puzzle but won't necessarily answer questions about causality," Sharpless said in a statement.

Today's announcement coincided with the release of several new reports on vaping-related illnesses. The reports include a detailed description of some of the cases, as well as a "case definition," or the specific criteria officials use to classify  a vaping-related illness. This will help "define the clinical picture of what we are dealing with" and help doctors identify patients more quickly, Meaney-Delman said.

One report, published today in The New England Journal of Medicine, describes a cluster of 53 patients from Wisconsin and Illinois who developed serious respiratory symptoms after vaping. Most of these patients were young — the median age was 19 — male and generally healthy prior to their illness. Patients reported symptoms such as shortness of breath, cough and chest pain, and some reported nausea, vomiting, fever and weight loss. All of the patients had vaped within the prior three months, and 84% reported vaping marijuana products.

Interestingly, the report seems to suggest that these vaping-related lung illnesses are indeed a new phenomenon, and not something that simply went undetected in the past. The rate of monthly emergency room visits for severe lung illness in young adults was twice as high in June through August 2019 than in the same months in 2018, the study found.

Another report, published Sept. 6 in the CDC journal Morbidity and Mortality Weekly Report, describes five young patients in North Carolina who had similar symptoms after vaping. All of the patients were diagnosed with lipoid pneumonia, a rare condition in which fats or oils enter the lungs and lead to pneumonia, or inflammation of the lungs. Doctors couldn't determine whether the lipids came from outside the body — from an inhaled substance — or from inside the body, due to altered fat metabolism, the CDC said.

The CDC recommends that people consider not using e-cigarettes while the investigation is ongoing. And regardless of this investigation, e-cigarettes should not be used by youth, young adults, pregnant women or adults who currently don't use tobacco products, the CDC said. What's more, people should not buy e-cigarette products off the street and should not modify the products or add substances that aren't intended for vaping by the manufacturer, the agency said.

•  9 Weird Ways You Can Test Positive for Drugs 
•  8 Tips for Parents of Teens with Depression 
•  Gasp! 11 Surprising Facts About the Respiratory System 

 Originally published on Live Science. 

For weeks, officials have searched for what could be causing a string of vaping-related respiratory illnesses across the country. Now, they may have found a clue: Many of the products used by the patients contained a common contaminant — an oil derived from vitamin E, according to news reports. 

The news of the contaminant comes from the U.S. Food and Drug Administration (FDA), which shared the information with state officials in a telephone briefing this week, The Washington Post reported. But it's not clear if this contaminant is indeed causing the illnesses, and the investigation is far from over, officials said.

The FDA analyzed 12 nicotine samples and 18 THC (the active ingredient in marijuana) samples taken from patients across the country. The vitamin E-derived oil, known as "vitamin E acetate," was found in 10 out of the 18 cannabis products.

Related: 4 Myths About E-Cigarettes 

But tests didn't find anything unusual among the various nicotine products used by patients who fell ill, according to the officials. 

State officials in New York found that nearly all of their cannabis samples taken from patients in the region also had this vitamin E-derived oil, according to a statement from the New York State Department. 

Vitamin E acetate is sold as a nutritional supplement and isn't harmful when ingested or applied as a skin treatment, according to the Post. But when it's inhaled, it can coat the lungs and cause symptoms such as cough, shortness of breath and chest pain.

There are now over 215 possible cases of people hospitalized after having reported using vaping products — some who bought the products legally and others off the street. Two deaths have been reported in connection with vaping-related illnesses — one in Illinois and another in Oregon.

• 9 Weird Ways You Can Test Positive for Drugs
• 7 Ways Marijuana May Affect the Brain
• Kick the Habit: 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

A second person has died from a lung illness related to vaping, according to a statement from the Oregon Health Authority (OHA).

Over 200 patients across the country — mostly young adults and teenagers — have been hospitalized with vaping-related respiratory illnesses in the last couple of months. The cause of the illnesses, and whether or not they're related to a specific brand or chemical in the electronic cigarettes that are being smoked, are questions that are still being investigated. Only one other death has been reported in connection with these illnesses, in a patient in Illinois.

Now, authorities have identified a second patient, an individual in Oregon, who died back in July from such an illness. The patient had reportedly used an e-cigarette or vaping device that contained cannabis, which they had purchased from a cannabis dispensary, according to the statement. 

Health officials recently identified a common contaminant in some of the cannabis products used by patients across the country — an oil derived from vitamin E, according to The Washington Post. But it remains unclear whether this is the cause or one of the causes of the illnesses. 

Related: 4 Myths About E-Cigarettes

The Oregon patient, whose age and gender weren't revealed, reportedly had symptoms that were similar to other reported cases of vaping-related illnesses. Public health authorities are asking clinicians to be alert for signs of severe respiratory illness in patients who recently used such products — which may include shortness of breath, cough, chest pain, vomiting, diarrhea, fatigue, fever or weight loss.

Recently, the Centers for Disease Control and Prevention issued a statement that advised against using electronic cigarettes while it investigates the issue. Even aside from the ongoing investigation, youth, pregnant women or adults who don't currently use tobacco products shouldn't be using e-cigarettes anyway, they wrote.

• 9 Weird Ways You Can Test Positive for Drugs
• 7 Ways Marijuana May Affect the Brain
• Kick the Habit: 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

It's probably not a good idea to use e-cigarettes right now, according to public health officials.

In light of a spike in mysterious lung illnesses linked to vaping, the Centers for Disease Control and Prevention (CDC) is advising anyone who's concerned about these health risks to "consider refraining from using e-cigarette products" while the agency investigates the issue, officials said in a statement. So far, officials have identified 215 possible cases of lung disease tied to vaping in 25 states, but the cause is still unknown, the statement said.

Officials in Wisconsin issued a sterner warning against e-cigarettes, urging residents to "stop using any vape and/or e-cigarette devices immediately," according to a recent statement from the City of Milwaukee Health Department. So far, 16 people in the city have been hospitalized with severe lung disease tied to vaping, the statement said.

Even aside from the ongoing investigation of vaping and lung disease, e-cigarettes should not be used by youth, young adults, pregnant women or adults who currently don't use tobacco products, the CDC said. What's more, people should not buy e-cigarette products off the street and should not modify the products or add substances that aren't intended for vaping by the manufacturer.

People who do decide to use e-cigarettes should monitor themselves for symptoms such as cough, shortness of breath and chest pain, and promptly seek medical attention if they become concerned about their health, the CDC said.

Government officials are investigating which brands and types of e-cigarette products may be involved in these cases. Many patients reported vaping THC products before they got sick. However, it's still unclear if all of the cases have a common cause or if they are different diseases with similar symptoms, the agency said.

•  4 Myths About E-Cigarettes 
•  8 Tips for Parents of Teens with Depression 
•  9 Weird Ways You Can Test Positive for Drugs 

 Originally published on Live Science. 

The number of potential cases of severe lung illnesses linked to vaping has increased to 193,  the Centers for Disease Control and Prevention (CDC) announced today (Aug. 23). One adult patient in Illinois has died. 

The CDC is investigating the string of vaping-related illnesses, now reported in 22 states. The investigation is ongoing, and it's still unclear if the cases were linked or what kinds of products the patients had used, according to the CDC.

"Even though cases appear similar, it isn't clear if these cases have a common cause or if they are different cases with similar presentations," Ileana Arias, the acting deputy director for noninfectious diseases at the CDC, said at the news briefing.

Related: 4 Myths About E-Cigarettes

However, all of the patients reported having used electronic cigarettes or vaping products in the past couple of months, she said. In many cases, the patients also reported having used products containing THC, the active ingredient in marijuana.

Several states are conducting their own investigations into the string of illnesses and reporting back to the CDC, while the Food and Drug Administration (FDA) is helping to test and identify products and devices that the patients may have used. The FDA has received product samples from a number of states and is starting to analyze them for specific constituents. 

"We don't have any specific information to share at this time," said Mitch Zeller, the director of the Center for Tobacco Products at the FDA.

"It's possible that the reported cases could have been occurring before this investigation was even initiated," said Brian King, the deputy director for research translation in the Office on Smoking and Health at the CDC. It could just be that "we weren't necessarily capturing them."

"We do know that e-cigarette aerosol is not harmless," he said. These products contain many chemicals, both listed and unlisted, that can be problematic for the lungs, such as ultrafine particulates, heavy metals like lead, volatile organic compounds and cancer-causing chemicals, King said. Even e-cigarette flavorings, such as those that make it taste "buttery," have compounds previously linked to severe respiratory illness, he said.

That being said, the CDC has not identified specific products or ingredients linked to any of these cases. 

In Illinois, 22 patients, between the ages of 17 and 38, were hospitalized from severe lung illness associated with vaping. The Illinois patient who died was an adult, said Dr. Jennifer Layden, the chief medical officer and state epidemiologist for the Illinois Department of Public Health.

Again, it's not clear what products these patients used. The only "consistent information is that all patients have vaped in recent months," she said.

The FDA encourages the public to submit detailed reports of any unexpected tobacco- or e-cigarette-related health or product issues.

• 7 Ways Marijuana May Affect the Brain
• 9 Weird Ways You Can Test Positive for Drugs
• 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

UPDATE: On Aug. 21, the Centers for Disease Control and Prevention announced that there are now 149 possible cases of severe lung illness associated with vaping reported in 15 states. 

Vaping has sent nearly 100 people, mostly teens and young adults, to the hospital with lung illnesses in the last couple of weeks. 

The Centers for Disease Control and Prevention (CDC) is investigating 94 possible cases of "severe lung illness associated with vaping," which have been reported in 14 states as of Aug 17, according to a statement from the agency. It's unclear what's causing the illnesses or even if there is a link between patients' symptoms and the kinds of products they used.

But the patients have reported vaping various substances, including nicotine and marijuana. Some of the patients said they bought their e-cigarette products on the street, according to a previous Live Science report. What could be harming them?

Related: 4 Myths About E-Cigarettes

Based on the limited information, the "most likely" explanation is that a toxic chemical in the electronic cigarettes is causing a "severe reactive, inflammatory" response in the patients' lungs, said Dr. Michael Siegel, a professor of community health sciences at Boston University's School of Public Health. 

If that's the case, this chemically induced lung injury could lead to several severe lung conditions. One condition, known as  acute respiratory distress syndrome (ARDS), has been associated with the inhalation of toxic fumes. Another condition is chemical pneumonitis, or inflammation of the lungs that is caused by inhaling irritants, Siegel told Live Science. 

But "it is very unlikely that this is being caused purely by nicotine-containing e-liquids," he added. Rather, the reaction is probably caused by a "contaminant that is present in certain formulations of cannabis products" sold for vaping, possibly on the streets, he said. 

For example, pneumonitis has been linked to the practice of "dabbing," or inhalation of butane hash oil, a concentrated form of marijuana that contains high levels of the drug's active compound, THC. Heating butane hash oil to high temperatures may result in the formation of chemicals that are toxic to the lungs, according to a report published in the journal Respiratory Medicine Case Reports last January. 

But other experts say that noncannabis e-cigarettes, those that contain nicotine instead of THC, could also cause such reactions. A group of researchers recently found that nicotine releases potentially harmful enzymes — molecules that have a role in breaking down proteins in the body — into the lungs. Those researchers published their results on Aug. 7 in the American Journal of Respiratory and Critical Care Medicine.

These enzymes are known to cause lung damage, said Robert Tarran, the senior author of that study and a professor at the University of North Carolina School of Medicine. At least in part, "I think that … the teenagers are taking in very high amounts of nicotine that is then affecting the immune cells in the lung," he said.

Previous research into e-cigarettes has found multiple chemicals in the vapor that can damage cells and trigger inflammation in the lungs and in the bloodstream, said Dr. Laura Crotty Alexander, an associate professor of medicine at the University of California, San Diego. "It could be a particular chemical in the e-cigarette vapor or multiple different chemicals leading to acute lung injury," Crotty said.

An acute lung injury means that the cells of the lungs have been damaged and the immune system has responded to try and stop the damage and heal the lungs. Because of inflammation and cell damage, gas exchange in the body is "impaired" such that patients are short of breath, deprived of oxygen and often coughing, Alexander said. This could be caused by store-bought or street-bought e-cigarettes, she said.

A study published today (Aug. 20) found that right after vaping a non-nicotine-containing e-cigarette, participants had much less oxygen flowing through their blood. "We could only conjecture at this point" about whether this finding could help explain the mysterious vaping-related illness, said, Felix Wehrli, senior author of the study and a professor of radiologic science and biophysics at the University of Pennsylvania Perelman School of Medicine.

One possibility is that these patients' lungs could not take up oxygen properly, he said. If that was the case, the lungs might have resorted to taking up more oxygen from the blood. This phenomenon would also explain why Wehrli and colleagues saw a reduction of oxygen flowing through blood vessels after vaping in their study, he said.

In part because e-cigarettes are often thought of as being safer than regular cigarettes, since they don't contain tobacco, there has been a surge in e-cigarette use in recent years, especially among teens.

Most e-cigarette liquids contain three major components: propylene glycol, glycerol and nicotine, Alexander said. But when you heat these components into a vapor, you create completely different chemicals, some of which are toxic, such as formaldehyde and acrolein. "But because there's new e-cigarettes and e-liquids coming on market at least every month, it's impossible to keep up with all the different chemicals that are being sold and breathed in," she said. 

What's more, the Food and Drug Administration isn't actively regulating these devices, she said. The administration doesn't require companies to label products with all the ingredients, and the ones that are labeled are often wrong, she said. As for the e-cigarettes sold on the street, what's in them is even more unclear, she said. So her advice to teenagers is "if somebody hands you one of these devices at a party, do not use it," she said. "Because you have no idea what's in it."

In any case, according to the CDC statement, there isn't conclusive evidence that an infectious disease is causing the illnesses. The investigation is ongoing, and the agency said it will share more information as it becomes available.

• 7 Ways Marijuana May Affect the Brain
• 9 Weird Ways You Can Test Positive for Drugs
• 10 Scientific Quit-Smoking Tips

Originally published on Live Science.

Vaping may create dangerous toxins that temporarily reduce blood flow and damage blood vessels, according to a new study. What's more, these effects were seen when people used e-cigarettes that did not contain nicotine.

While the dangers of smoking cigarettes are very well established, the health effects of smoking electronic cigarettes aren’t clear. Recently, the Centers for Disease Control and Prevention announced an investigation into a string of mysterious vaping-related illnesses that have landed nearly 100 people in the hospital. 

But knowing that the effects of vaping may spread further than the lungs, the researchers wanted to investigate the effects of e-cigarettes on the body's blood vessels and blood circulation. 

To do this, they recruited 31 healthy adults who did not smoke; researchers tied a tight cuff around one thigh of each participant. They kept this cuff on for a couple minutes, restricting blood flow through a major vein and artery in the leg, known as the femoral artery and vein.

Related: 4 Myths About E-Cigarettes

Then, the researchers took the cuff off and used magnetic resonance imaging (MRI) to measure participants' blood flow. Typically, when blood is restricted in this way, there will be a demand for increased blood flow when the cuff is removed, because the tissue is starved of oxygen and nutrients, said senior author Felix Wehrli, a professor of radiologic science and biophysics at the University of Pennsylvania Perelman School of Medicine. 

Indeed, the researchers saw that when they removed the cuff,  participants' blood flowed much faster, reaching a peak velocity before dropping back down to normal levels after a minute or so. Next, the participants took 16 puffs of an e-cigarette that did not contain nicotine and once again had a cuff tied to their legs and their blood vessels imaged.

Post-vaping, the participants' blood vessels did not dilate, or widen, as much as before to let blood through. In fact, after a participant smoked, the vessels dilated, on average, 34% less than they did before vaping. What's more, blood acceleration was 25.8%  slower, peak blood flow — the maximum blood flow through the vessels— was reduced by 17.5%, and oxygen levels in the vessels dropped by 20%.

The findings suggest that vaping, even just once, leads to temporary changes that impair blood vessel function, the authors said.

"This normal [blood circulation] response is blunted by e-cigarette exposure," and the reason is likely because of the ingredients found in e-cigarettes, Wehrli told Live Science. E-cigarettes come in a wide variety of brands and flavorings and so they may have a giant list of ingredients. But the basic ingredients, propylene glycol and glycerol, are pretty much the same, he added. 

When propylene glycol and glycerol are heated to high temperatures, they form other substances that are known to be toxic, he said. In a previous paper, the same team showed that smoking e-cigarettes actually caused a "toxic immune response" in the endothelium, or blood vessel lining. 

However, these studies looked only at the very short-term effects of vaping, and participants' blood vessels returned to normal within an hour or so, Wehrli said. So the "effect we see is transient," he said. 

Extrapolating a bit, "one could argue" that if someone keeps on vaping all day, every day over years, the body doesn't have time to revert to baseline — and vaping might lead to disease, Wehrli  said. But future studies that follow people for many years will be needed to prove this, he added.

"This well-done paper adds to the evidence that e-cigarettes have immediate deleterious effects on blood vessels," said Stanton Glantz, a professor of medicine at the University of California, San Francisco's Center for Tobacco Control Research and Education, who was not a part of the study. "These changes are both bad in the short run but are also indicators of long-term risk for cardiovascular disease."

Dr. Michael Siegel, a professor of community health sciences at Boston University's School of Public Health, who was also not a part of the study, agrees that this study confirms that e-cigarettes, even without nicotine, cause dysfunction in the blood vessels. 

But because this effect is short-lived and completely reversible, "it should not be assumed from this research that vaping is a cause of heart disease or permanent blood vessel damage," he said. "Further research will be needed to determine whether vaping poses a risk of irreversible blood vessel injury."

The study was published today (Aug. 20) in the journal Radiology.

• 9 Weird Ways You Can Test Positive for Drugs
• Mixing the Pot? 7 Ways Marijuana Interacts with Medicines
• 7 Ways Marijuana May Affect the Brain

Originally published on Live Science.

UPDATE: On Aug. 17, the Centers for Disease Control and Prevention announced that it is now investigating a cluster of lung illnesses tied to vaping. There are currently 94 possible cases in 14 states. Live Science published this article (below) on Aug. 14.

Adolescents and young adults in the Midwest are landing in hospitals after developing severe breathing problems from vaping, and no one knows why. 

A total of 22 people in Minnesota, Wisconsin and Illinois have been hospitalized after vaping, according to NBC News. That includes the eight cases reported in Wisconsin at the end of July, according to a previous Live Science report. 

The patients reported cough, shortness of breath and fatigue, and sometimes vomiting and diarrhea, according to a statement from the Illinois Department of Public Health. The teens' symptoms progressively worsened before they arrived at the hospital.

One patient in Wisconsin had to be put in a medically induced coma after his lungs began filling with fluid. He has since been discharged and is currently recovering, according to NBC News.

Related: 4 Myths About E-Cigarettes

It's unclear what these cases have in common, other than vaping. But state health departments, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are working to identify the e-cigarettes that the teens had used and what chemicals the patients might have inhaled, according to the statement.

The FDA doesn't require e-cigarette makers to list the ingredients of their products. What's more, some of the teens may have purchased vaping products off the street rather than in shops, according to NBC News. 

"The short- and long-term effects of vaping are still being researched, but these recent hospitalizations have shown that there is the potential for immediate health consequences," Dr. Ngozi Ezike, director of the Illinois Department of Public Health, said in the statement. 

Editor's Note: This article was updated to clarify that these cases were mostly among adolescents and young adults.

• 10 Scientific Quit-Smoking Tips
• 7 Ways Marijuana May Affect the Brain
• 9 Weird Ways You Can Test Positive for Drugs

Originally published on Live Science.

A young man in the United Kingdom developed serious burns after his vape pen exploded in his pocket, according to news reports.

The man, 24-year-old Will Hawksworth, was driving home from the store when the batteries in his vape pen (also known as an e-cigarette) apparently exploded and set his jacket on fire, according to Fox News.

"By the time I stopped [the car], I was pretty much engulfed in flames," Hawksworth said.

Hawksworth's car went up in flames while he and his girlfriend waited nearby for help. When Hawksworth reached the hospital, he was diagnosed with second- and third-degree burns on his chest and abdomen. 

E-cigarette explosions appear to be rare, but they are very dangerous, according to the U.S. Food and Drug Administration (FDA). The exact cause of these explosions isn't clear, but some evidence suggests that issues with the devices' batteries may play a role. 

To help prevent these explosions, the FDA recommends that users avoid charging their e-cigarette overnight or leaving the device unattended while charging; avoid using cellphone or tablet chargers with the devices; replace vape pen batteries if they get damaged or wet; and protect the device from extreme hot or cold temperatures, such as by not leaving it in direct sunlight or in a cold or hot car for long periods.

Now, months after the explosion, Hawksworth says the skin on his chest tends to become irritated and turn bright red when exposed to heat. But "it could have ended so much worse. I feel lucky to be alive," he said.

Hawksworth started vaping when he was 19, but he doesn't plan to continue. "'ll never go near a vape pen ever again. They are lethal," he said.

In June, doctors reported the case of a teenage boy who was seriously injured when an e-cigarette exploded in his mouth, breaking his jaw.

•  27 Oddest Medical Case Reports 
•  9 Odd Ways Your Tech Devices May Injure You 
•  12 Amazing Images in Medicine 

Originally published on Live Science.

Eight teenagers in Wisconsin have been hospitalized with serious lung damage after vaping, according to health officials.

All of the teenagers were hospitalized during the month of July, according to Children's Hospital of Wisconsin, the facility where the teens were treated. These patients experienced a number of respiratory symptoms — including shortness of breath, chest pain, cough and fatigue — in the days and weeks leading up to their hospitalization. Some of the teens needed medical assistance to breathe. The teens also experienced nausea, diarrhea and weight loss.

All of the patients reported vaping in the weeks and months before their hospitalization, according to Children's Hospital of Wisconsin. Doctors haven't identified the exact cause of the teens' illnesses.

"It was alarming to have, over a short period of time, eight previously healthy teens come in very sick, unable to breathe, with weight loss, looking as if they had some sort of chronic lung disease when they didn't," Dr. Louella Amos, a pediatric pulmonologist at Children’s Hospital of Wisconsin, told the Milwaukee Journal Sentinel.

Some of the teens reported buying vaping products, including nicotine and THC, on the black market, the Journal Sentinel reported.

In general, the health effects of vaping are not fully understood, the hospital said.

"The popularity of vaping is obviously skyrocketing among our kids and its dangers are still relatively unknown," Dr. Michael Gutzeit, chief medical officer of Children's Hospital of Wisconsin, said in a statement. "We don't have a lot of information about the long-term effects or even the short-term effects."

The Wisconsin Department of Health Services is investigating the illnesses and recently sent out an alert to doctors asking them to be on the lookout for more cases. Officials are interviewing patients about the types of vaping products they used.

Most of the sick teens have responded to steriod treatment and have been released from the hospital, but one patient is still hospitalized, according to CBS News.

In addition to the eight confirmed cases, six more possible cases of teens with lung damage tied to vaping are being investigated, the Journal Sentinel reported.

• 8 Tips for Parents of Teens with Depression
• 10 Facts Every Parent Should Know About Their Teen's Brain
• 4 Myths About E-Cigarettes

Originally published on Live Science.

The health hazards of e-cigarettes are still being studied, but one danger seems clear: Sometimes, they explode.

That was the case for a teenage boy who was seriously injured when an e-cigarette exploded in his mouth, breaking his jaw, according to a new report of the case.

The 17-year-old arrived at the emergency room 2 hours after the explosion, according to the report, published today (June 19) in the The New England Journal of Medicine. The patient had extensive wounds to his mouth, several missing teeth and a broken lower jaw, said Dr. Katie Russell, a pediatric trauma surgeon at the University of Utah and Primary Children's Hospital in Salt Lake City, who treated the patient. [27 Oddest Medical Case Reports]

Doctors needed to remove several teeth from the boy's mouth because their sockets had been destroyed, Russell told Live Science. The boy also needed a dental plate put under his lower gums to stabilize his jawbone.

But his mouth still wouldn't close properly, and so doctors wired his jaw shut for six weeks to give it time to heal, Russell said.

Russell and her colleagues wanted to publish this case because they were surprised by the extent of injury that occurred from an e-cigarette, she said.

"When I met this patient, I had no idea that a vape pen could do this. It takes a lot of force to break your jaw," Russell said.

It's now been more than a year since the boy's incident, and during that time, more reports of e-cigarette explosions have come to light. In February, a 24-year-old man in Texas died after a vape pen exploded in his face and tore a major artery in his neck, according to CNN.

E-cigarette explosions appear to be rare, but they are very dangerous, according to the Food and Drug Administration (FDA). The exact cause of these explosions isn't clear. In the boy's case, the device was in good condition and hadn't shown any problems prior to the explosion, Russell said.

Some evidence suggests that issues with the devices' batteries may lead to explosions, the FDA says. To help prevent these explosions, the FDA recommends that users avoid charging their e-cigarette overnight or leaving the device unattended while charging; avoid using cellphone or tablet chargers with the devices; replace vape pen batteries if they get damaged or wet; and protect the device from extreme hot or cold temperatures, such as by not leaving it in direct sunlight or in a cold or hot car for long periods.

The teen boy still has missing teeth, as he has not been able to get replacements due to insurance reasons, Russell said. But he hopes to get new teeth this summer.

Russell hopes the case helps educate health care providers and the public about the risks of these devices. "It seems like this technology really hit the market with force, and we may have been undereducated about the risks associated with these devices."

As for the boy's e-cigarette habit — he's not using them anymore. "He totally quit all cigarettes after this incident," Russell said.

• 9 Odd Ways Your Tech Devices May Injure You
• 10 Facts Every Parent Should Know about Their Teen's Brain
• 12 Amazing Images in Medicine

Originally published on Live Science.

The U.S. Food and Drug Administration (FDA) is investigating a possible link between e-cigarette use and seizures, the agency announced today (April 3).

The FDA said that, between 2010 and 2019, there were 35 reported cases of people who had seizures shortly after they used e-cigarettes. Most of these reports involved teenagers or young adults.

In some cases, the seizures happened after the user took a few puffs; in other cases, the seizures happened up to one day after use. Patients varied in their experience with e-cigarettes, from first-time users to seasoned users.

The agency stressed that it's not yet clear if the e-cigarettes caused the seizures. There could be other factors that contributed to the patients' seizures, such as the use of other drugs. Indeed, a few of the patients reported use of other substances in addition to e-cigarettes, such as marijuana or amphetamines. Some patients may also have had underlying medication conditions that triggered the seizures.

However, it's known that seizures can be a symptom of nicotine poisoning, which happens when people are exposed to high levels of the compound, such as through accidental swallowing of nicotine-containing e-liquids. The FDA notes that some e-cigarettes have designs that allow users to obtain high levels of nicotine quickly.

"We believe these 35 cases warrant scientific investigation into whether there is in fact a connection" between e-cigarettes and seizures, the FDA said in a statement.

The agency is calling on doctors and the general public to report cases of seizures tied to e-cigarette use to better understand the link.

"Additional reports or information about these incidents may help us determine if there’s a connection and help identify common risk factors and if any e-cigarette product attributes, such as nicotine content or formulation, may contribute to seizures," the statement said.

• 4 Myths About E-Cigarettes
• 10 Facts Every Parent Should Know about Their Teen's Brain
• 9 Weird Ways You Can Test Positive for Drugs

Originally published on Live Science.

Electronic cigarettes are often thought of as "healthier" than conventional cigarettes, but the jury's still out on their potential health risks. Now, a new study has found a link between e-cigarette use and an increased risk of stroke and heart attacks.

The study analyzed information from about 400,000 Americans who took part in a national health survey in 2016. Of these, about 66,800 reported that they regularly used e-cigarettes.

Compared with non-e-cigarette users, regular users had about a 70 percent higher risk of stroke, a 60 percent higher risk of heart attack or angina (chest pain) and a 40 percent higher risk of coronary heart disease.

About 79 percent of e-cigarette users also reported using conventional cigarettes, compared with just 37 percent of non-e-cigarette users. [4 Myths About E-Cigarettes]

But the findings linking e-cigarettes with an increased risk of stroke, heart attack and coronary heart disease held even after the researchers took into account whether people were also conventional cigarette smokers, said study lead author Dr. Paul Ndunda, an assistant professor at the University of Kansas School of Medicine.

What's more, when the researchers analyzed a subset of participants who reported smoking fewer than 100 conventional cigarettes in their lives (meaning they were not regular users of cigarettes), they found that e-cigarette users were still 29 percent more likely to report having a stroke, 25 percent more likely to report having a heart attack and 18 percent more likely to report having coronary heart disease, Ndunda told Live Science.

The findings will be presented next week at American Stroke Association's International Stroke Conference 2019 in Honolulu, but has not been published in a peer-reviewed journal.

The new finding is "quite concerning," said Dr. Larry Goldstein, co-director of the Kentucky Neuroscience Institute at the University of Kentucky, who was not involved with the study. "This is the first real data that we're seeing associating e-cigarette use with hard cardiovascular events" like heart attacks and strokes, Goldstein said in a video interview with the American Stroke Association, which is a division of the American Heart Association (AHA). However, Goldstein noted that the study had limitations. For example, the researchers weren't able to take into account some factors that are known to increase people's risk of stroke and heart disease, such as high blood pressure, alcohol use and an unhealthy diet.

In addition, because the study only examined people's responses at one point in time, it is not able to tease out cause and effect — that is, it cannot prove that e-cigarette use was the cause of people's cardiovascular problems, or whether people who use e-cigarettes have other characteristics that increased their risk.

Still, Goldstein said that these early findings need to be taken seriously, especially given the relatively large percentage of young people who use e-cigarettes. In 2016, about 11 percent of U.S. high school students reported using e-cigarettes in the last 30 days.

Unlike conventional cigarettes, which heat and burn tobacco, e-cigarettes heat up and vaporize a liquid, which usually contains nicotine and other flavorings.

The AHA cautions against the use of e-cigarettes, saying that they may pose health risks that scientists do not yet fully understand. And since e-cigarettes usually contain nicotine, they may get people addicted to the substance, according to the AHA.

Some previous studies have also suggested that the flavorings in e-cigarettes themselves may be harmful. A study published last year in the journal Arteriosclerosis, Thrombosis and Vascular Biology found that e-cigarette chemical flavorings had harmful effects on blood vessel cells in a lab dish.

• Kick the Habit: 10 Scientific Quit-Smoking Tips
• 8 Tips for Parents of Teens with Depression
• 9 New Ways to Keep Your Heart Healthy

Originally published on Live Science.

Scientists have proved that inhaling vaporized marijuana will get you, like, way higher than smoking the exact same amount of weed.

The new research, led by scientists at the Johns Hopkins Behavioral Pharmacology Research Unit in Baltimore, tested the effects of smoked versus vaped marijuana on 17 participants who had smoked marijuana before, though not in the 30 days before the study's start (participants had smoked once in the last year, on average). Over the course of six 8.5-hour sessions, these participants got very, very high for science.

The study was funded by the Substance Abuse and Mental Health Services Administration, though one of the study's authors reported that he has previously received fees from, or consulted for, companies with ties to cannabis. [25 Odd Facts About Marijuana]

During each session, participants either smoked or vaped a dose of marijuana containing 0 milligrams, 10mg or 25mg of tetrahydrocannabinol (THC) — the primary psychoactive component in cannabis. While each participant ended up both smoking and vaping all three possible doses over their six sessions, they were blind to how much THC they were consuming each time. The participants were kept in the dark in order to prevent bias while filling out a subsequent drug-impairment questionnaire — which, as every pot enthusiast knows, is the most fun thing you can do while super-high.

In addition to self-reporting how stoned they felt via questionnaire, participants were also subjected to a battery of physical and cognitive tests throughout the duration of each high. The stoners had their heart rates and blood pressures measured 10 times over 8 hours, and were asked to complete computerized tasks that involved replicating shapes on a screen, solving simple addition equations and responding to two different stimuli simultaneously with a mouse and a computer keyboard. Again: The apex of weed-enabled fun.

The results of these tests showed that, first of all, inhaling a 25mg dose of THC will get you really, really high, regardless of whether it was smoked or vaped. (After taking this dosage, two participants vomited, and another experienced hallucinations.) Likewise, for both smokers and vapers the majority of drug effects — including high heart rate, dry mouth, red eyes, paranoia and the munchies — peaked within the first hour after getting high, and sometimes did not return to baseline levels for more than 8 hours. (Often, these effects persisted for hours after the participants' blood THC concentration returned to normal.)

Overall, the effects of vaping proved much more potent at every dosage.

"Vaporized cannabis produced significantly greater subjective drug effects, cognitive and psychomotor impairment, and higher blood THC concentrations than the same doses of smoked cannabis," the researchers wrote in their study, published today (Nov. 30) in the journal JAMA Network Open.

At both the high and low doses, vaped weed resulted in significantly higher concentrations of THC in participants' blood than smoked weed. And the vapers made roughly twice as many mistakes on the cognitive tests and felt greater negative drug effects, including dry mouth, itchy eyes and paranoia, than the smokers did.

Simply put: Vaporized weed got people higher. And, according to the researchers, their doses weren't even that strong compared to what's commercially available.

"Notably, the highest dose of cannabis administered in this study (25mg of THC: 0.19 g; 13.4 percent THC) is substantially smaller and has a lower THC concentration than what is typically contained in pre-rolled cannabis cigarettes available for purchase in cannabis dispensaries, which commonly contain roughly 1.0 g of cannabis with THC concentrations often exceeding 18 percent," the study authors wrote.

With recreational weed now legal in nine American states and all throughout Canada, it's important to remember that even moderate amounts of THC can have significant impairing effects on casual consumers, and that not all methods of consuming cannabis are created equal.

• 7 Ways Marijuana May Affect the Brain
• Mixing the Pot? 7 Ways Marijuana Interacts with Medicines
• Why Do People Vape? Reasons Have Changed

Originally published on Live Science.

Dr. Nina Shapiro is used to getting questions. After all, she's both a surgeon and a professor at UCLA.

And at a time when people are having a hard time distinguishing between facts and misinformation, Shapiro thought it would be the perfect opportunity to put all of those questions into a new book, called "Hype" (St. Martin's Press, 2018), in which she separates medical myth from reality. [25 Medical Myths That Just Won't Go Away]

Shapiro warns against putting too much stock in health headlines and asks you take a hard look at the information you find online. She also reminds you to wear your darn bike helmet. Want to know why? She'll happily tell you. After all, she's used to answering questions.

With that in mind, Live Science took the opportunity to ask Shapiro some of our most pressing questions. (This Q&A has been edited lightly for length and clarity.)

Live Science: I want to start with one of the most hyped topics in health: the effects of food and diet. Let's use eggs as an example. One study says eggs are great; the next says they'll kill you. What does this tell us about oft-quoted food studies?

Dr. Nina Shapiro: Food studies will tend to give you extremes, sometimes even, "Here's what will cure or prevent cancer." But we don't have a cure for cancer. We have ways we can help prevent it, but "cancer-busting foods" is a term that really bothers me because people can get wrapped up in it and think, "Oh, here's the answer." You can't just eat this kind of food to avoid cancer or cure your cancer. A lot of these headlines have a grain of truth in them, but the message gets exaggerated. Most people are not scientists, so what I recommend is just to do some simple research behind what you hear.

Certain words will always make me raise an eyebrow. "Groundbreaking," "breakthrough," "game-changing" — all these really strong terms are often misleading, because trust me, I work in this field — very few things are actually groundbreaking.

And when you read a headline that says, "This cures cancer," go beyond that headline. Was it an animal or a human study? Was it done in a petri dish? If it was a human study, was it three people or 3,000 people? Was it over a week, a month or a decade? What is its relevance to you?

LS: Is there a single most dangerous medical misconception floating around today?

Shapiro: There are many. One is the dangerous, dangerous misconception that vaccines cause autism, and that's still being thrown around in the health sphere. Along with that is the misconception that vaccines are not necessary. These false notions get thrown around, and people can quickly lose sight of reality. The vaccinations our children receive have allowed us to all but obliterate horrible, horrible diseases.

Another dangerous idea is that certain foods can treat or prevent cancer, and that certain nonregulated therapies can cure or prevent cancer. There are unnecessary deaths that result because of those false notions.

LS: You mentioned "Jane" in your book, a nurse you knew who did "alternative treatment" for her cancer, including raw food, teas, meditation and exercise. She died after just a few months because she accepted no medical treatment. The story is heartbreaking, but what's the real lesson here?

Shapiro: Part of the point of that story is that complementary alternative medicine is wonderful when it's used as just that — a complement to your therapy. This nurse, had she included all of what she did — eating healthy, exercise, meditation — along with her regimen of surgery, chemotherapy, radiation or whatever was necessary, she would have sailed through, and would probably be alive today. She had a very [treatable] cancer. There's really no reason not to use any of that therapy. It's very safe, for the most part. But when it's used as a stand-alone, that's when it becomes potentially deadly. You have to keep the "C" in "CAM," complementary alternative medicine. There's no such thing as alternative medicine. There's medicine that works, and medicine that doesn't. There's no evidence that diet, meditation or whatever works alone when it comes to [treating] cancer.

LS: Related to that, should people be wary of naturopathic medicine or homeopathy?

Shapiro: People think homeopathy means "natural." The idea of homeopathy is taking a small, infinitesimal amount of something and adding it as a tincture to somebody's care and that somehow becomes the treatment.

"Naturopathic" sounds so nice because it has "natural" as a root word, and it's alternative and it's not invasive and doesn't involve standard, FDA-approved medications. The practitioners are usually not physicians. They call themselves "naturopathic doctors," but they're not medical doctors. This can get infuriating, because many places that bill themselves as an "oasis of healing" … prey upon people at their most vulnerable — when they're facing a cancer diagnosis — and [these places] rope people into thinking that their treatment is a viable option as opposed to [chemotherapy], radiation therapy or surgery.

LS: Society has largely vilified smoking. But vaping is newish, and now many states are legalizing marijuana. What's the risk/reward there?

Shapiro: The only benefit in vaping is in helping people quit cigarette smoking. The problem is that it's becoming the gateway to cigarette smoking for children and teenagers. It's more common now to walk into a high school bathroom and see kids "Juuling," using the Juul [device] that looks like a flash drive, rather than smoking now.

A potential benefit of legalizing marijuana, or at least making it a prescription item, is that it can be an adjuvant treatment for patients with chronic pain, cancer pain, intractable nausea or intractable headaches when patients don't respond to other therapies. It could be something used in addition to or in place of, for example, strong opioids, that can alleviate some of this opioid epidemic, which is just a horror that we're facing right now. There are legitimate reasons to prescribe it, so there is a small role for it.

LS: Is there good, basic, simple health advice you can give people that will improve their health and their health expectations down the line?

Shapiro: We can control [laughs] honestly, some very, very boring basics, to be real. Put on your seat belt every time you're in the car. Kids and adults should wear bike helmets every time they're on a bike. Wear sunscreen today, [and] you lessen your chance of skin cancer tomorrow. These things don't make headlines, but these small things, statistically, save more lives and alleviate more long-term health problems than drinking organic milk or whatever the new headline of the day is. Those simple things are live-saving and life-prolonging.

One of my inspirations for this book was simply seeing so many people who were focused on health and wellness and prolonging and improving [their] quality of life just make these stupid mistakes. They don't think of the simple things. My best advice is, do those simple things, and please, whenever you see a health headline that sounds incredible, you need to dig a little bit deeper. Don't believe the hype, I guess.

"Hype" will be available beginning May 1 via Amazon and local bookstores.

Originally published on Live Science.

With names like "Banana Pudding," "Blueberry Cinnamon-Streusel Muffin" and "Butter Crunch," the flavoring ingredients in electronic cigarettes sound not only harmless but immensely appealing. But some of the liquids used in e-cigarettes may in fact have highly toxic effects on human cells tested in a lab, a new study reveals.  

Researchers in North Carolina found that some of the ingredients used in so-called "e-liquids" are more toxic than nicotine alone and many of them are more toxic to human cells than the main ingredients in these liquids, which are propylene glycol and vegetable glycerin, according to the findings, published today (March 27) in the journal PLOS Biology. 

E-cigarettes work by heating a liquid solution composed of propylene glycol, vegetable glycerin, flavorings and typically nicotine, until the liquid vaporizes. [E-Cigarettes: What Vaping Does to Your Body]

But little is known about the potential toxicity and chemical composition of most substances found in e-liquids, the researchers said.

In the new study, the researchers tested 148 e-liquids. They found that the e-liquids contained a total of 143 chemicals, which indicates that the ingredients in e-cigarettes are extremely diverse, said senior study author Robert Tarran, an associate professor of cell biology and physiology at the University of North Carolina School of Medicine.

With more than 7,700 commercially available e-liquid flavors — and the U.S. Food and Drug Administration just beginning to regulate the ingredients in e-cigarettes — a quicker method is needed to screen e-liquids to evaluate their safety and chemical makeup, according to the study.

So, the researchers did just that: In the new study, they developed a way to measure the toxicity of a large number of e-liquids at once. In addition, the scientists looked at how quickly e-liquids can affect the growth of human tissue culture cells — which aren't lung cells, but are good for testing purposes — and whether these e-liquids can kill cells, Tarran told Live Science.

After the researchers had identified some patterns of toxicity, they then used cells taken from people's lungs to confirm these observations, Tarran said.

Toxicity of e-liquids

The study revealed that the more chemicals an e-liquid contained, the more toxic it tended to be. The findings also showed that e-liquids containing either vanillin or cinnamaldehyde, two common flavor compounds widely used in e-cigarettes, were linked with higher toxicity values.  

Although the new study looked at human cells in the lab and didn't actually study the health effects of vaping in people, Tarran said he feels that the cells they used have been shown to be highly predictive of lung diseases, such as cystic fibrosis and chronic obstructive pulmonary disease (COPD). This makes him feel confident of their actual predictive value in people, but much more work needs to be done to learn more about the toxicity of e-liquids and the health effects of vaping, he added.

In three previous studies of human cells, Tarran said that he and his research team have found that vaping can lead to changes in the lungs, although the long-term consequences of using e-cigarettes are not yet known. These earlier studies have shown that vaping can suppress the immune system, change secretions in the airways and cause changes to proteins that help detoxify the lungs, suggesting that vaping is, in fact, a toxic burden to the lungs, he said.

Similar screenings of e-liquids could be performed in animals rather than in test tubes, Tarran said. However, animal research would be more time-consuming and expensive, and is not feasible for the more than 7,000 e-liquids being sold, he noted.

There is still a great deal that is not known about the ingredients in e-liquids. But this study suggests that the e-liquids that are highly toxic can be identified and prioritized for further research, Tarran said.

The public should push for additional research on the safety of e-cigarettes and better standards for the ingredients in these products, Tarran said. Most e-liquids do not reveal their chemical contents on the e-cigarette packaging, other than their nicotine concentration and  their ratio of propylene glycol to vegetable glycerin, he said.

To find out more about e-liquids, the researchers have created a searchable database at eliquidinfo.org.

Originally published on Live Science.

A new tobacco device by Philip Morris, known as IQOS, shouldn't go to market with the claim that it reduces disease risk compared with traditional cigarettes, a panel for the U.S. Food and Drug Administration (FDA) concluded today (Jan. 25), according to news reports.

But how exactly do these products work, and why did the FDA make this call?

The IQOS is a type of "heat-not-burn" tobacco product. These products could be thought of as "in the middle between [traditional] cigarettes and vaping products," said William Shadel, associate director of the Population Health Program at Rand Corp., a nonprofit research organization.

The devices use disposable tobacco "sticks" that are heated to give off an aerosol, but do not burn. Specifically, these tobacco sticks contain processed tobacco along with a few other components, including water, glycerin and cellulose fibers, according to Philip Morris. The sticks are placed into a holder, which heats the tobacco through an electronically controlled "heating blade," the company said.

The tobacco is heated up to a temperature of 662 degrees Fahrenheit (350 degrees Celsius), which is enough to create an aerosol, but not enough to burn it. (Tobacco in traditional cigarettes burns at a temperature of about 1,110 degrees Fahrenheit [600 degrees C], according to Philip Morris.) The product also comes with a charger to recharge the electronic holder. [10 Tips to Help You Quit Smoking]

Heat-not-burn products are different from electronic cigarettes (e-cigarettes), because the latter heat up and vaporize a liquid, which usually contains nicotine, Shadel said, while the former heats actual tobacco.

Philip Morris claims that, because IQOS doesn't burn the tobacco, the product releases much lower levels of the harmful chemicals typically found in tobacco smoke. The company wants to sell the product with the claim that using the products reduces the risk of tobacco-related disease, compared with using traditional cigarettes.

But the FDA panel voted to reject this claim, saying that the company hadn't provided enough evidence to show that its product lowers disease risk compared with cigarettes, according to Reuters. The panel did, however, endorse the claim that the product releases lower levels of toxic chemicals compared with traditional cigarettes.

Shadel said that this conclusion "seems about right based on the evidence available so far."

In theory, heat-and-burn products could be safer because they don't lead to the combustion of tobacco, Shadel said. But "there’s just not enough evidence that users will incur less risk" from using the products, Shadel told Live Science.

Shadel noted that most of the studies on IQOS have been conducted by Philip Morris, and much more research is needed by independent researchers who are not associated with the company to determine the safety of the product.

In addition, it's "unclear whether or not enough smokers would actually switch to these products" to have a public health benefit, Shadel said.

The panel's conclusion is just a recommendation, and in the coming months the FDA will make a final decision on whether Philip Morris can sell IQOS in the United States, and what claims the company will be able to make about the device, according to Reuters. The product is already available in 29 countries, according to Philip Morris.

Original article on Live Science.

Teen use of many drugs is on the decline, but U.S. officials remain concerned about teen marijuana use — which actually increased in the past year — and vaping, which is common, according to a new survey.

The government-backed annual survey, called Monitoring the Future, gathered data from more than 43,000 U.S. students in the eighth, 10th and 12th grades.

This year's findings included a slight increase in the rate of teen marijuana use: for all three grades combined, nearly 24 percent of the students surveyed reported using marijuana in the past year, up from 22.6 percent in 2016. But rates of teen marijuana use in 2017 are about the same as they were in 2015 — meaning that overall, rates have remained stable in recent years.

Part of the reason for this year's increase in teen marijuana use may be that today's teens perceive the drug as less risky than they did a generation ago, the researchers said. In 2017, just 29 percent of high school seniors said there was a "great risk" of harm in using marijuana regularly, down from 78 percent in 1991.

"Historically, marijuana use has gone up as adolescents see less risk of harm in using it," Richard Miech, principal investigator of the survey and a professor at the University of Michigan, said in a statement. "We’ve found that the risk adolescents see in marijuana use has been steadily going down for years to the point that it is now at the lowest level we’ve seen in four decades." [7 Ways Marijuana May Affect the Brain]

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said marijuana use among teens is concerning, in part because of its effect on education. Teens "are in school and they are supposed to be learning," Volkow said in a news conference today (Dec. 14). But regular marijuana use has been linked with poorer educational outcomes, such as a reduced chance of graduating, according to NIDA.

The survey also found that use of electronic vaporizers, or "vaping," is popular among teens. Nearly 1 in 3 high school seniors (28 percent) said they used some kind of vaping device in the past year. And when asked what they were vaping, 52 percent said "just flavorings," 33 percent said "nicotine" and 11 percent said "marijuana" or "hash oil," the survey found. (However, some research suggests that many teens may not actually know what is in their vaping device, according to NIDA.)

For the first time, the survey also asked the teens in the study about vaping specific substances in the past month. It found that, among high school seniors, about 17 percent of the participants reported vaping of any kind in the past month, 11 percent reported vaping nicotine, 10 percent reported vaping just flavoring and 5 percent reported vaping marijuana.

"We are especially concerned because the survey shows that some of the teens using these devices are first-time nicotine users," Volkow said. "Recent research suggests that some of them could move on to regular cigarette smoking, so it is critical that we intervene with evidence-based efforts to prevent youth from using these products."

But there is good news from the survey, the researchers said. Use of illegal drugs other than marijuana and inhalants (which include sniffing glue, gases or sprays) was at its lowest level in the history of the survey, which dates back to 1975. And despite high rates of opioid use among adults, rates of opioid use among teens continue to decline.

"The reductions [in opioid use] have been quite dramatic," Volkow said. For example, in 2017, just 2 percent of high school seniors reported misusing the opioid pain reliever Vicodin in the past year, down from 10.5 percent in 2003. And rates of heroin use among teens remain low, with just 0.4 percent of high school seniors, 0.2 percent of 10th graders and 0.3 percent of eighth graders reporting use of the drug in the past year.

The survey also found:

• Rates of teen use of hookahs are declining. In 2017, 10 percent of high school seniors reported using a hookah in the past year, down from 13 percent last year and 23 percent in 2010.
• Rates of teen use of traditional cigarettes continue to decline. For all three grades combined, all measures of cigarette use (including lifetime use, past month use and daily use) are at historic lows since they were first measured in 1991. For example, just 10 percent of 12th graders reported using cigarettes in the past month, meaning that rates of cigarette use are now lower than rates of marijuana use. (About 23 percent of 12th graders said they used marijuana in the past month.)
• Rates of teen use of alcohol have been declining for many years, but in 2017, rates of alcohol use were about the same as the year before. This could herald an end to the long-term declines in teen use of alcohol, the researchers said.

Despite declines in teen use of many drugs, the researchers said that people should not be complacent about tackling teen drug use, as every new generation is vulnerable. "They don’t know about why they shouldn’t use drugs any more than they know how to read, unless we teach them again," said Lloyd Johnston, a professor at the University of Michigan and previous director of the survey, during the press conference.

Original article on Live Science.

Switching to e-cigarettes won't solve all the health problems smokers face. For example, e-cigarettes are still addictive, and studies suggest that they may be bad for heart health. But compared with traditional tobacco cigarettes — which, in addition to nicotine, are full of tar and other toxins — e-cigarettes could be a less-risky option, a new study suggests.

Using mathematical models, researchers calculated how two possible scenarios of cigarette and e-cigarette use — one optimistic scenario and one pessimistic scenario — could impact public health if Americans who smoked cigarettes switched to e-cigarettes over the next 10 years.

The researchers noted that the study had several limitations. For example, the models are based on smoking uptake and quitting rates through 2012, but they do not account for the recent growth in e-cigarette use. In addition, the models included only cigarettes and e-cigarettes, and excluded other tobacco products, such as smokeless tobacco, according to the study. [4 Myths About E-Cigarettes]

The optimistic and pessimistic scenarios were based on a status-quo rate up to 2012 of smokers either quitting smoking altogether or switching to vaping. In the study's "optimistic" model, the researchers assumed that more people stopped smoking tobacco cigarettes (primarily switching to e-cigarettes) and that the current scientific understanding that e-cigs aren't quite as bad as cigarettes holds true. In that optimistic model, the researchers found that 6.6 million premature deaths could be avoided in the U.S., according to the study, which was published yesterday (Oct. 2) in the journal Tobacco Control.

Though one of the study authors has worked with both Pfizer and Johnson & Johnson, two manufacturers of smoking-cessation medications, this particular study was funded by the National Institutes of Health and did not receive any industry money, according to a statement.

In the study's "pessimistic" model, the researchers assumed that fewer people gave up smoking than are doing so under the current rate and that the health risks of e-cigarettes turned out to be worse than scientists' current understanding. In this case, only 1.6 million premature deaths were avoided.

The findings "support a policy strategy that encourages replacing cigarette smoking with vaping to yield substantial life-year gains" compared with cigarette smoking, lead researcher David Levy, an oncologist at Georgetown University Medical Center, said in a statement. In other words, switching from cigarettes to e-cigarettes could extend the lives of smokers, compared with if they were to continue smoking traditional tobacco cigarettes. [10 Tips to Help You Quit Smoking]

In addition to living longer than they would if they continued smoking tobacco cigarettes, those who switched to e-cigarettes might see other health benefits, "including reduced disease disability to smokers, reduced pain and suffering, and reduced exposure to secondhand smoke," Levy said.

"Even the gloomiest analysis [the pessimistic model] shows a significant gain in years of life if nicotine is obtained from vaping instead of much more deadly amounts of toxicants inhaled with cigarette smoke," Levy said.

Writing in an editorial that was published alongside the new study, Marita Hefler, a public health researcher at Menzies School of Health Research in Australia, said that "the health gains modelled [in the new study] show that even in a pessimistic scenario," rapidly phasing out regular cigarettes could result in significant public health gains.

Original article on Live Science.

The reasons people use e-cigarettes are shifting: Fewer people are using them to quit smoking, and more people are using them to boost their social image, a new study finds. 

The findings could have important implications for public health, as they could help guide initiatives seeking to discourage e-cigarette use, the researchers said.

Although scientists have previously looked at why people choose to use e-cigarettes, the researchers of the new study noted that the surveys used in past research typically limited the participants' responses. [4 Myths About E-Cigarettes]

For example, surveys may have included a series of yes-or-no questions, or multiple-choice questions, and didn't allow respondents to answer in their own words, the researchers wrote in the study, which was published today (March 1) in the journal PLOS ONE. 

"What if we could listen in to what people are naturally saying about e-cigarettes to their friends rather than [to] a surveyor?" lead study author John Ayers, a public health researcher at San Diego State University, said in a statement.

To do so, the researchers turned to Twitter.

In the 2012 to 2015 study, they analyzed more than 3 million public tweets about e-cigarettes. Tweets that were initially included in the study contained words or phrases such as "electronic cigarette," "electronic cig," e-cig," "vape" and others.

These tweets were then narrowed down to only include those referring to using e-cigs; for example, tweets such as "I have an electronic cig and it's helping me quit" were included, but tweets such as "I just saw someone vaping" were excluded.

Finally, the researchers categorized the tweets based on the person's reason for vaping. They ended up with a total of seven major reasons: low cost, flavor choices, safe to use, can use indoors, favorable odor, quitting regular cigarettes and social image.

The tweets from 2012 showed that people's most common reason for vaping was quitting smoking regular cigarettes, according to the study, with 43 percent of tweets citing this as a reason. Social image was the second most common reason, with 21 percent of tweets, and indoor use was third, with 17 percent.

By 2015, however, less than 30 percent of the tweets cited quitting smoking regular cigarettes as a reason for vaping. Rather, social image was the most common reason cited, accounting for 37 percent of the vaping-related tweets. Indoor use also decreased as a reason, dropping down to 12 percent of the tweets, the researchers found.

The researchers noted that their findings were supported by previous research and anecdotal evidence.

For example, the decrease in quitting smoking as a reason for e-cigarette use lined up with a decrease in Google searches for e-cigarettes as a way to quit smoking, according to the study. And the decrease in citing indoor use lined up with the time frame over which a number of cities and states banned e-cig use indoors, they wrote.

At the same time, e-cig marketing has increasingly focused on social image, the researchers wrote. This supports the finding that social image has increased as a reason cited for use, they said.

Originally published on Live Science.

Teens who "vape" in high school are at increased risk for using tobacco cigarettes in the future, a new study found.

The study discovered that teens who use electronic cigarettes, a practice also referred to as vaping, in the 12th grade were four times more likely to start smoking tobacco cigarettes within the next year, compared with teens who didn't vape in the 12th grade.

The findings "contribute to the growing body of evidence supporting vaping as a 'one-way bridge' to cigarette smoking among youth," the researchers wrote in their study, published online today (Feb. 7) in the journal Tobacco Control.

When using an electronic cigarette, teens inhale vapor that may contain nicotine, as well as flavors such as bubble gum or milk-chocolate cream, the researchers said.

E-cigarettes are often advertised as safer alternatives to tobacco cigarettes, because the electronic variety's vapor contains fewer chemicals known to be harmful to humans, compared with traditional cigarette smoke. However, researchers are still investigating the health effects of e-cigarettes, and some studies have suggested that e-cigarette use still poses health hazards, such as an increased risk for markers of heart disease.

Other studies have suggested that teens who use e-cigarettes are more likely to start smoking regular tobacco cigarettes, compared to teens who don't use e-cigarettes. But these earlier studies involved teens in a single city or state, so the results were not necessarily representative of the U.S. population, the researchers of the new study said. [4 Myths About E-Cigarettes]

The new research involved a nationally representative sample of about 350 teens who were randomly selected from a larger survey of 122 schools around the country. Subjects were first surveyed on their smoking and vaping habits in 12th grade, and then surveyed again one year later.

Among teens who said they vaped in the 12th grade but had never tried a tobacco cigarette, 31 percent went on to try tobacco cigarettes in the next year, the study found. In contrast, among teens who hadn't vaped or smoked tobacco cigarettes in the 12th grade, just 7 percent went on to try tobacco cigarettes in the next year, the survey revealed.

The use of e-cigarettes may desensitize teens to the risks of tobacco cigarettes, explaining the findings in the study, the researchers said. Although 80 percent of 12th graders from the study said they thought smoking cigarettes posed a "great risk" of harm, those who vaped in 12th grade were four times more likely to change their views (saying cigarettes posed less of a risk) one year later, compared with those who didn't vape in 12th grade.

"Youth who begin to vape primarily to experiment and because vaping tastes good (the most common reasons for vaping) may detect no immediate health consequences and [so] conclude that the dangers of smoking are exaggerated," the researchers wrote.

The results also suggest vaping leads former cigarette smokers to return to smoking. This was seen in the teens who had smoked in the past but hadn't smoked recently when they took the first survey, in the 12th grade. In that group, those who vaped in the 12th grade were twice as likely to say they smoked cigarettes again one year later, compared to those who didn't vape in the 12th grade.

Still, the researchers noted that the new study cannot prove that vaping caused teens to start smoking cigarettes. The study did take into account some factors that could be associated with increased risk of smoking, such as the respondents' gender and ethnicity, as well as their parents' educational attainment. But there are still other factors the current study failed to address that could influence people's risk of smoking, the researchers said. This includes the teens' affiliation with smokers in the community, the perception of their friends' attitudes toward smoking and their level of rebelliousness, the investigators said.

Original article on Live Science.

Smoking e-cigarettes may be bad for your heart, a small new study suggests.

The study found that certain markers for heart disease risk were higher in e-cigarette users than in nonusers. For example, e-cigarette users had higher levels of adrenaline in their hearts, compared with nonusers. They also had elevated levels of inflammation and oxidative stress (a process that can damage cells) in their bodies.

"This suggests that e-cigarettes have a more complicated effect than just the direct pharmacological effect of nicotine," said study co-author Dr. Holly Middlekauff, a cardiologist at the University of California, Los Angeles' David Geffen School of Medicine. That's because nicotine and other e-cigarette compounds "may set in motion a constellation of physiologic effects that persist, even when nicotine is out of the system," Middlekauff told Live Science. [4 Myths About E-Cigarettes]

E-cigarettes are an increasingly popular alternative to tobacco cigarettes. They produce no combustion and contain no tobacco, but deliver a heated mixture of nicotine and flavors to the mouth and lungs of the user. The medical community's reaction to e-cigarettes has been mixed, with significant controversy over whether e-cigarettes represent a "safer" alternative to tobacco cigarettes, the study said.

Because e-cigarettes do not burn tobacco, they do not produce the same toxic compounds as regular cigarettes do. Moreover, they produce very little tar or carbon monoxide, so many proponents of e-cigarettes claim that e-cigs are healthier than regular, "combustible" cigarettes, Aruni Bhatnagar, a professor of medicine at the University of Louisville, who was not involved in the study, wrote in an editorial commenting on the study.

However, the cardiovascular risks of e-cigarettes are largely unknown. That's significant, because e-cigarettes do contain some heart-related toxins present in tobacco smoke, including formaldehyde and acetone, Bhatnagar wrote. Nicotine can also affect heart function and health, he noted.

In the new study, a total of 16 e-cigarette users (defined as those who had been using e-cigarettes for at least one year) and 18 nonusers were studied. The participants were ages 21 to 45 and included both men and women. None of the participants smoked tobacco cigarettes at the time.

On the day of the study, the researchers took the participants to a quiet, temperature-controlled room, and measured the participants' heartbeats for 5 minutes while they rested and for another 5 minutes while they practiced controlled breathing. A separate blood test looked at markers of oxidative stress and inflammation, which told researchers how well the body was responding to harmful toxins.

The results indicated that the e-cigarette users showed increased levels of so-called sympathetic arousal, meaning increased adrenaline levels, in their hearts, compared with nonusers. The e-cigarette users also had higher levels of oxidative stress than nonusers did. Both increased adrenaline levels in the heart and oxidative stress are ways in which tobacco cigarettes can contribute to increased cardiovascular risk, the researchers said.

However, the researchers cautioned that the study had some limitations. First, it relied on self-reporting for behaviors such as e-cigarette use and tobacco cigarette use, which can be an unreliable method. (However, the researchers noted that they did test users' blood to confirm whether they had recently smoked tobacco cigarettes.) In addition, the researchers were unable to quantify just how many e-cigarettes the e-cig users had smoked, given the difficulty of measuring the liquid used by each per day.

Furthermore, more former smokers of tobacco cigarettes were in the e-cigarette-user group than in the nonuser group, though the researchers noted that they did not believe this explained the difference in their findings. Finally, the researchers cautioned that they cannot confirm a cause-effect relationship between e-cigarette use and cardiovascular risk based on this single, small study.

The researchers are also still unsure of how the effects of e-cigarettes on the heart compare to the effects of tobacco cigarettes on the heart, and future research is needed to determine this, Middlekauff said.

The takeaway? "If you don't already smoke tobacco cigarettes, don't start using e-cigarettes — they are not harmless," Middlekauff said.

The study and editorial are published today (Feb. 1) in the journal JAMA Cardiology.

Originally published on Live Science.

A 6-year-old girl in Oregon experienced severe nicotine poisoning after her parents accidentally gave her liquid nicotine meant for electronic cigarettes instead of a children's liquid pain reliever, according to a new report of the girl's case.

The child survived, but nicotine poisoning can be fatal, and the researchers warned that such cases could become more common as e-cigarettes rise in popularity.

"As electronic cigarette use proliferates, children are now increasingly at risk of toxicity from ingestions of much larger quantities of nicotine from highly concentrated refill liquid, as in our case study," Dr. Matthew Noble, an emergency medicine physician at Oregon Health and Science University, and a co-author of the report, said in a statement.

The girl had previously sprained her ankle, and was taking children's Motrin (which contains ibuprofen) for pain relief. But when the bottle was finished, the girl's mother used it to store some liquid nicotine that she had bought online to use in an e-cigarette.

The child's father didn't know the Motrin bottle contained nicotine, and he gave the child a 10-milliliter dose of the liquid for her pain, according to the report. The girl immediately felt a burning sensation in her mouth and throat, which led the father to take a small sip of the liquid. He realized it was liquid nicotine and immediately called poison control and an ambulance, the report said. [27 Oddest Medical Cases]

Before the paramedics arrived, the girl lost consciousness and began involuntarily jerking her limbs. She later regained consciousness, but did not respond to questions or commands, the report said.

The girl was taken to the emergency room, where she began vomiting and sweating, and her pulse dropped from 150 beats per minute to 60 beats per minute, the report said.

Doctors gave her an anti-nausea medication and a sedative, and placed a tube in her throat to keep her airway open. They also gave her a medical form of charcoal used to help treat drug overdoses, because it absorbs nicotine and other drugs.

About an hour after she arrived at the ER, the girl was admitted to the intensive care unit and placed on a ventilator overnight. The next day, she was taken off the breathing support and was able to respond to commands. Doctors gave her a physical exam, which showed normal results, and she was released from the hospital.

The researchers estimated that the child consumed about 700 milligrams of liquid nicotine. Some studies have estimated that ingesting as little as 500 mg of nicotine can kill an adult. An average regular cigarette delivers about 0.2 to 2.4 mg of nicotine. [10 Scientific Quit-Smoking Tips]

In addition, a blood test done about an hour after the girl arrived at the hospital showed she had a blood level of nicotine of 348 nanograms per milliliter. The level of nicotine in the blood after an adult smokes a regular cigarette is about 12 to 54 ng/ml, the report said.

The researchers also tested the liquid nicotine that the child ingested, and they estimated that the concentration of nicotine in the original product was more than double the concentration that was listed on the product label.

"This finding supports previous work demonstrating that electronic cigarette refill containers may have unreliable commercial labeling and widely variable actual nicotine concentration compared with that advertised," the researchers wrote in their report.

The report is published in the January issue of the journal Annals of Emergency Medicine.

Original article on Live Science.

Injuries from exploding e-cigarettes appear to be on the rise, according to a new analysis from a Seattle hospital.

Over a nine-month period from October 2015 to June 2016, health care workers at the University of Washington Medical Center treated 15 patients for injuries from exploding e-cigarettes.

For comparison, from 2009 to 2014, there were a total of 25 reports of injuries in the U.S. from these devices, the authors wrote in a letter published today (Oct. 5) in the New England Journal of Medicine. [E-Cigarettes: What Vaping Does to Your Body]

"We suspect that with the growing use of [e-cigarettes], many hospitals around the country will see an increase in injuries related to e-cigarette explosions," the authors, led by Dr. Elisha Brownson, a surgeon specializing in burn care, wrote in the letter.

Of the 15 Seattle patients, 12 experienced burns from flames, according to the report. These injuries require extensive wound care and a procedure called skin grafting — in which a piece of the patient's healthy skin from another part of the body is transplanted to the burned area — the authors wrote.

Chemical burns were also a common type of injury from an exploding e-cigarette: among the Seattle patients, five experienced such burns, which also require wound care. These burns are caused by the alkaline chemicals found in the device's battery, according to the report.

Four of the patients experienced "blast injuries," the authors wrote. These injuries caused tooth loss and "extensive" soft-tissue loss in the patients, and some patients needed surgery to remove damaged tissue and close up their wounds, according to the report.

Some of the patients with blast injuries also had "traumatic tattooing," which occurs when foreign particles get embedded below the surface of a person's skin, creating a tattooed appearance.

The authors noted that more than half of the injuries were to the thigh or groin, one-third of the injuries were to the hands and one-fifth of the injuries were to the face.

Patients injured by e-cigarettes often require medical treatments from a number of different specialists, including emergency medicine providers, plastic surgeons, burn care providers, vocational counselors and psychologists, according to the report.

In all of the cases that the authors described, the device's lithium-ion battery caused the explosion.

The authors noted that the Food and Drug Administration recently announced that it would begin to regulate all tobacco products, including e-cigarettes, but that it's unclear if the agency would also regulate the batteries.

Originally published on Live Science.

A new type of smoking called "cannavaping" — using e-cigarettes for vaping cannabis — may help people use marijuana for medical reasons, according to a small, early study.

Smoking conventional marijuana cigarettes may lead a person to inhale high amounts of the toxic contaminants that are released when marijuana is burned, the researchers said. In contrast, cannavaping might provide a way to avoid inhaling high levels of these contaminants, the researchers said. Among these contaminants are carcinogenic compounds called polycyclic aromatic hydrocarbons, the researchers said.

Vaping involves heating a liquid to its boiling point and then inhaling the vapors; conventional smoking involves burning a substance, such as marijuana, and then inhaling the smoke. [11 Odd Facts About Marijuana]

"Vaporization should lead to a lower toxic burden than combustion [burning]," lead study author Vincent Varlet, an analytical chemist at the University Centre of Legal Medicine in Lausanne, Switzerland, told Live Science. "Vaporization constitutes a safer approach of cannabis administration than cannabis smoking."

There are also devices available that can vaporize marijuana and are designed to sit on a tabletop, but e-cigarettes may be more user-friendly, the researchers said. Both e-cigarettes and tabletop vaporizing devices are likely to be less harmful than marijuana joints, the investigators said.

In the study, researchers looked at the plausibility and efficiency of cannabis vaping as an alternative to smoking the substance for medical reasons. The scientists extracted active compounds in marijuana called cannabinoids and made an oil that they concentrated in an e-liquid, which is a type of liquid used in e-cigarettes.

However, they found that the concentration of the oil they made in the study was not sufficient. About 100 puffs on an e-cigarette would have been needed to induce the same therapeutic effects as those provided by intravenous administration of THC, one of marijuana's most powerful compounds, the researchers said. More research on the preparation and optimization of such liquid is needed, they said.

However, cannavaping might still one day provide a safer alternative to smoking cannabis, because it does not require heating the cannabis to the high temperatures reached when it is burned, the researchers found. That process leads to the inhalation of high levels of contaminants, the scientists found.

"Cannavaping appears to be a gentle, efficient, user-friendly and safe alternative method for cannabis smoking for medical cannabis delivery," they wrote in the study, published today (May 25) in the journal Scientific Reports. [4 Myths About E-Cigarettes]

Cannavaping may also offer an alternative to ingesting marijuana by eating products such as brownies or candies. When marijuana is consumed in this way, it is metabolized before it enters a person's bloodstream and its therapeutic ingredients may therefore become less active, Varlet said. This diluting effect does not occur with cannavaping, which allows the inhaled therapeutic compounds to enter the bloodstream directly, he said.

The researchers noted that they tested only one type of e-cigarette in the new study, and other brands that are available may produce different levels of certain impurities.

Follow Agata Blaszczak-Boxe on Twitter. Follow Live Science @livescience, Facebook & Google+. Originally published on Live Science.