The facts about vaping - Respect your brain

Key health messages

Vapes can contain over 200 chemicals known to harm human health. In the short term vaping has been shown to cause damage to the lungs and throat, and lead to nicotine overdose. Because vapes haven’t been around for very long, the long term effects of vaping simply aren’t well known.

Nicotine is incredibly addictive. Exposing young brains to nicotine early can rewire your brain to be more addicted to substances into adulthood.

There are no guidelines for what is on vape labels. That means you can’t be certain what’s in them. Most vapes contain nicotine, even if they don’t say so.

Last updated: 09 August 2023
Download

What are vapes?

Vapes are also known as electronic cigarettes, e-cigarettes, vape pens, pod, JUUL, or stigs. There are many different types but all have the same basic parts, like you can see in the picture: a battery, a coil and a cartridge. When the battery is switched on, the coil heats up the e-liquid, which produces an aerosol that is inhaled.

Many disposable vapes are one piece, with no removable parts, and the e-liquid is stored inside a small pod inside the vape. Others are refillable and parts can be changed.1

What’s in a vape?

Vapes can contain over 200 chemicals.2  Chemicals from vapes come from three main sources including:

  • the e-liquid ingredients;
  • the chemical reactions created when the e-liquid is heated, and;
  • contaminant chemicals that appear in the e-liquid over time (such as heavy metals from the device leaking into the liquid).2

All of these chemicals are inhaled when you use e-cigarettes.3 Research studies that have tested the e-liquid and the aerosol from the same vape have found that all of the chemicals in the e-liquid are found in the aerosol, plus the extra chemicals from chemical reactions and contaminants.3 More details about these chemicals are shown in Table 1.

Can vaping harm my health?

Vapes have not been around for a very long time, so we don’t yet know what the long-term effects may be. But we already know that vapes harm key parts of the body.

Vaping can impact the brain

Nicotine is highly addictive. Using nicotine-containing vapes means you can develop nicotine dependence. This is when you need nicotine all the time to feel normal, otherwise you experience withdrawal symptoms like irritability, low mood, and even tremors. Young people’s brains are very ‘neuroplastic’ meaning that the structure can change to adapt to environmental factors. Exposure to nicotine can rewire your brain to be more addicted to nicotine and other substances into adulthood. Vapes can deliver nicotine at higher doses and in some cases, more rapidly than regular cigarettes. Small vapes can contain as much nicotine as 50 cigarettes (often much more!). Nicotine at such high doses is toxic, and can even lead to seizures.4 Nicotine overdose is sometimes called being ‘nic-sick’ and symptoms include nausea, vomiting, upset stomach, sweating, dizziness and headache. Vaping can also lead to worse mental health, both in the short and long term. Vaping has been found to be associated with increased symptoms of depression within 12 months of starting.5 In the long term, nicotine vaping can increase the likelihood of developing depression, anxiety and substance use disorders because of the way nicotine changes the brain’s reward pathway.6 There is strong evidence that vaping can increase the chance of smoking cigarettes,7 as well as other substances, such as marijuana.6

Vaping can impact the lungs and airways

When you inhale the aerosol from a vape, your mouth, throat and lungs are exposed to over 200 chemicals contained in the vape. These particles can damage your airways, including irritating the mouth, throat and oesophagus leading to a sore, dry throat and cough. For some people, vaping can bring their asthma back and make it worse. The ultrafine particles contained in the aerosol can deposit on the lungs and cause lung disease like pneumonia which requires hospitalisation to treat. In the US in 2019, 68 people died due to e-cigarette or vaping associated lung injury (also called EVALI), whereby a chemical component in the e-liquid called Vitamin E acetate caused significant damage to the lungs, leading to death.8 Several cases of EVALI have been recorded in Australia, including deaths.9 These health effects can occur regardless of whether the vape contains nicotine or not. Using vapes also puts people at risk of burns from the device and poisoning from nicotine e-liquid.10

Is vaping legal?

It is illegal to:

  • sell vapes (and all other tobacco products) to anyone under 18 years old
  • to sell nicotine vapes to anyone, unless they are prescribed by a doctor for smoking cessation purposes, and obtained with a prescription from a pharmacy.

Common vaping myths

MythFact
Vaping is just breathing in water vapourThe substance produced by vapes is an aerosol which contains tiny particles. This includes over 200 chemicals, including some that are known to cause cancer.
Vapes without nicotine aren’t harmfulMost of the health effects from vaping come from the chemicals in the e-liquid, whether nicotine is there is not. In fact, most of the chemicals are from the flavourings.
My vape doesn’t say it has nicotine in it, so it’s safeThe labels on most vapes cannot be trusted. When they have been tested, almost all vapes labelled as non-nicotine had high levels of nicotine in them.
Vaping relieves stressVaping can actually worsen stress, by producing withdrawal symptoms, making it seem like vaping makes you feel better. The only way to end this cycle is to stop vaping and use other relaxation methods instead.

Table 1. Chemicals contained in vapes and their health impacts

Chemical groupChemical detailsOther uses and health impacts

e-liquid ingredients

These are chemicals that have been added to the e-liquids on purpose

 Propylene glycol Used in antifreeze.
Ethylene glycolLarge amounts are toxic and can damage your nervous system, also used in antifreeze.
GlycerineOften used in food but when you breathe it in it can damage the airways.11
TolueneA chemical used in paint thinner, permanent markers, glue and cement
PhenolComes from coal tar and used to make detergents, bug spray and paint stripper – can harm the eyes, skin, airways and nervous system, causing seizures. Breathing in for a long time can harm the liver and kidneys.
XylenesUsed to make plastic bottles, paint thinner, it slows down the nervous system and can cause headaches, dizziness, nausea, vomiting and slow down your reaction time.
Ethyl acetateUsed in nail polish remover, and can harm the eyes, nose and throat and slow down the nervous system.
MethanolThe purest form of alcohol, can lead to death when small amounts are swallowed and can cause blindness.
PyridineUsed in bug spray, is toxic and flammable. When burnt it makes carbon monoxide – a poisonous gas that’s in car exhaust. When you breathe it in, it hurts the throat, slows down the nervous system and can cause dizziness, headache, nausea and can make you pass out.
Acetylpyrazine,
2,3,5 -trimethylpyrazine		These chemicals are used to make the flavours. They are not made to be inhaled so can damage your throat and lungs.
Benzene, ethylbenzene, styrene12Are used to make petrol and are known to cause cancer (carcinogenic). Benzene is the biggest air-borne cause of cancer in countries like Australia and America and one of the main ingredients in cigarettes that causes cancer.11
NicotineNicotine is a drug that can make you feel relaxed and stimulated. It hits your brain within seconds of breathing it in, making your heart race. “Nicotine dependence” is when you need nicotine all the time to feel normal and it can develop quickly. Over time, the number of receptors in the brain that use nicotine increases, meaning you need more nicotine to satisfy them. When you don’t have nicotine, you get withdrawal symptoms like grouchiness, stress, anxiety, cravings, poor sleep and the shakes. Nicotine is in most vapes, even if the label doesn’t say so.

Chemical reactions

These are new chemicals that are created via chemical reactions when the coil heats the e-liquid.

Aldehydes (predominantly acetaldehyde and formaldehyde)Acetaldehyde can cause cancer. It harms the skin, eyes, nose, mouth and throat and can cause nausea, vomiting and headaches.13 Formaldehyde is also cancer-causing and highly toxic.
Acrolein (propenal)

Acrolein is very harmful to the skin, eyes and nasal passages.

Free radicals and reactive oxygen species and furansFree radicals are very ‘reactive’ and harmful to human tissue.

Contaminant chemicals

These are chemicals that ‘leak’ into the e-liquid and aerosol from the materials the e-cigarette device is made of, including metals
and plastic.

Metals, with the following having been reported in aerosols: aluminium, antimony, arsenic, boron, cadmium, chromium, copper, iron, lanthanum, lead,
nickel, potassium, silver, tin, titanium, zinc		Heavy metals are known to be very toxic to humans. Chromium and arsenic cause cancer. Breathing in a lot of heavy metals can poison you, causing long-term health effects and death.

References

  1. Centers for Disease Control (CDC). Electronic cigarettes. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm. Published 2022. Accessed 2022, 18 July.
  2. National Health and Medical Research Council. Inhalation toxicity of non-nicotine e-cigarette constituents: risk assessments, scoping review and evidence map. In. Vol February 2022. Canberra: Australian Government; 2022.
  3. Ko TJ, Kim SA. Effect of Heating on Physicochemical Property of Aerosols during Vaping. Int J Environ Res Public Health. 2022;19(3).
  4. Bendel GS, Hiller HM, Ralston A. Nicotine Toxicity Secondary to Aftermarket Modifications to a Vaping Device. Military Medicine. 2022;187(7-8):e1007-e1010.
  5. Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73-78.
  6. Banks E, Yazidjoglou A, Brown S, et al. Electronic cigarettes and health outcomes: systematic review of global evidence. Report for the Australian Department of Health. In. Canberra: National Centre for Epidemiology and Population Health; April 2022.
  7. Yoong SL, Hall A, Turon H, et al. Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis. PLOS ONE. 2021;16(9):e0256044.
  8. Centers for Disease Control and Prevention (CDC). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. CDC. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Published 2020. Accessed 16 Mar, 2021.
  9. Atkin M. Autopsy finds man most likely died as a result of vaping. The Australian Broadcasting Corporation. https://www.abc.net.au/news/2022-02-21/autopsy-finds-man-most-likely-died-as-a-result-of-vaping/100800004. Published 2022. Accessed 2022, July 19.
  10. Australian Associated Press. Toddler died after consuming liquid nicotine while mother's head was turned, coroner says. The Guardian Australia. Mon 8 July 2019.
  11. National Academies of Sciences E, and Medicine Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems,. Toxicology of E-Cigarette Constituents. In: Eaton D, Kwan L, Stratton K, eds. Public Health Consequences of E-Cigarettes. Washington (DC): National Academies Press (US); 2018.
  12. Pankow JF, Kim K, McWhirter KJ, et al. Benzene formation in electronic cigarettes. PLoS One. 2017;12(3):e0173055.
  13. Kosmider L, Cox S, Zaciera M, et al. Daily exposure to formaldehyde and acetaldehyde and potential health risk associated with use of high and low nicotine e-liquid concentrations. Scientific Reports. 2020;10(1):6546.


Current as at: Wednesday 9 August 2023
Contact page owner: Centre for Population Health