One vape has 20 cigarettes worth of nicotine

More than 1.6 million U.S. middle and high school students reported vaping in 2023, and nearly 90 percent used flavored vapes. But America’s youth vaping epidemic may be no accident.

UC San Francisco Professor of Medicine Pamela Ling, M.D., MPH, is the Director of the UCSF Center for Tobacco Control Research and Education. The center studies tobacco, including industry marketing to understand how its tactics shape people’s health. Big tobacco owns many of the top vape manufacturers.

Ling explains why vapes are more addictive than ever before — and why regulating them is so tough.

Q: How potent are vapes?

A: Almost a decade ago, the average vape cartridge had the nicotine content of about a pack of cigarettes or 20 cigarettes. These days, popular vapes can easily have the nicotine content of three cartons or 600 cigarettes.

To make it possible to inhale such strong concentrations of nicotine, vape maker Juul Labs added acids to its vapes in 2015 to make “nicotine salts.” The salts reduce adverse reactions like throat burning and coughing. Today, the most popular disposable vapes use that technology, so vapes are stronger than ever.

Q: Is vaping safer than smoking cigarettes?

A: We don’t know for sure. I think we can feel pretty confident that vaping exposes you to fewer chemicals and toxins than smoking cigarettes.

Observational studies have found that for lung disease, the risk associated with vaping does seem to be reduced when compared to cigarettes. But for cardiovascular disease the risks were no different than smoking.

And we don’t have definitive data on whether vaping causes less lung cancer than cigarettes. We hope that it does, but it takes 10 to 20 years for someone to develop lung cancer, so it’s too soon to have this kind of data.

Q: Why are so many people worried about vaping in kids and young adults?

A: In the U.S., rates of vaping are higher among youth than older adults. We’re concerned about adolescents or kids vaping in part because we know vapes deliver nicotine exceptionally efficiently. The earlier you are exposed to nicotine, the more likely you are to become addicted — and that’s true of all substances because your brain is still developing up until 25 years old.

Q: Why are flavored vapes bad?

A: Vapes come in thousands of flavors, and some are really appealing, like bubble gum, crème brûlée, and chicken and waffles. Even if teens aren’t interested in nicotine, just curiosity about the flavors can be enough to entice them. Because vapes deliver nicotine efficiently, it doesn’t take long to get addicted.

Q: How has the FDA tried to reduce kids’ access to vapes?

A: Currently, the U.S. Supreme Court is grappling with the latest in a string of court cases brought by vape and e-cigarette makers to challenge the Food and Drug Administration’s (FDA) ability to regulate the products.

When the FDA started regulating tobacco in 2009, it had no authority over electronic cigarettes. It took until 2016 for the FDA to gain the authority to regulate the sale, advertising and distribution of e-cigarettes.

Technically, the FDA must approve all vapes before they can be marketed. But the FDA has only approved 34 vape products out of the hundreds publicly available.

The FDA sends warning letters to companies doing particularly bad things, like those selling vapes that looked like toys, video games and highlighter markers. But it’s challenging because there are so many kinds of vapes. Companies exploit loopholes in regulations, and regulations haven’t kept up.