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How Vaping-Related Deaths Put Cloud Over E-Cigarettes

An e-cigarette contains a battery-powered element that heats a liquid spiked with either nicotine, the addictive stimulant present in tobacco, or THC, the psychoactive ingredient in marijuana, producing a vapor the user inhales. It’s a way to ingest those substances without the smoke and tar that comes from a burning cigarette or joint. In some cases, a vaping device, such as the popular Juul, is small enough that an underage vaper, say, can palm it, discreetly take a hit when a teacher or parent isn’t looking, and breathe the resulting aerosol into a sleeve or collar. Vaping liquid comes in flavors such as mango and candy corn.

2. How popular is vaping?

The market for vaping products was estimated at about $11.5 billion worldwide in 2018 and is growing rapidly. In a survey, a quarter of U.S. high school seniors said they’d indulged in the previous 30 days.

3. What’s caused the outbreak of illnesses?

U.S. health authorities are struggling to figure that out. By Oct. 10, 26 deaths and 1,299 early lung injuries had been tied to vaping in the U.S. Illustrating the difficulty of zeroing in on the culprit, in one analysis, 86 patients reported using 234 unique products with 87 different brand names. There also is a burgeoning black market for e-liquid cartridges, making it hard to track down what might be in them. Much of the focus was on devices containing THC, as well as potential additives or cutting agents.

An early study concluded that injuries in 17 patients were most likely caused by exposure to toxic chemicals. The health effects of regularly inhaling the base components of vaping fluid — propylene glycol and glycerin — aren’t fully understood. While these common food additives are deemed safe to eat, heavy vapers receive large doses over long periods of time, delivered in ultrafine particles to the deepest parts of the lungs. In 2015, a U.S. government researcher warned that two ingredients in some e-cigarette flavorings, diacetyl and pentanedione, had been found to be potentially harmful. Diacetyl was linked to a 1990s case in which eight workers at a microwave popcorn factory in Missouri developed lung damage after breathing in the chemical, used to give the popcorn a buttery flavor.

5. Are vaping-related injuries something new?

Not entirely. Bloomberg News identified at least 15 lung injuries prior to this year’s outbreak, spanning the globe from Guam to Japan to England to the U.S. As vaping exploded in popularity, scientists and regulators missed hints that it might not be as benign as proponents hoped. Focused on whether vaping reduces exposure to cancer-causing compounds in cigarettes, they largely sidestepped questions about whether e-cigarettes posed entirely new risks.

6. How have U.S. authorities responded to the outbreak?

A number of states and cities have moved to limit access to vaping products. The Food and Drug Administration plans to force the removal from the market of all vaping liquids that taste like anything other than tobacco. Sales could resume only with the agency’s approval. (Michael R. Bloomberg, the founder and majority owner of Bloomberg News parent Bloomberg LP, has campaigned and given money in support of a ban on flavored e-cigarettes and tobacco.)

7. What about outside the U.S.?

E-cigarette sales are already banned entirely in 28 countries, including Brazil, India, Turkey and Uganda. In the U.K., public health officials stood by their position that while vaping entailed risks, it was safer than smoking. Under European Union regulations in effect in the U.K., the nicotine in vaping liquid is limited to about a third the strength of that in Juul refills. Youth vaping rates are much lower in the U.K.

8. How’s the industry been affected?

The crisis derailed merger talks between tobacco giants Philip Morris International Inc. and Altria Group Inc., which owns a 35% stake in Juul Labs, the dominant e-cigarette maker in the U.S. Juul, whose chief executive officer was replaced, announced a suspension of advertising in the U.S. after the FDA warned that it had promoted its products as less risky than cigarettes without gaining agency approval. The company faces a lawsuit consolidating more than 50 claims that it improperly marketed its goods, particularly to teens.

To contact the reporters on this story: Robert Langreth in New York at;Lauren Etter in Austin at

To contact the editors responsible for this story: Timothy Annett at, Lisa Beyer

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