An Epidemic Supplanted by a Pandemic: Vaping-related Illness and COVID-19

Yoo Mee Shin, MD; Daniel P. Hunt, MD; Joyce Akwe, MD, MPH


South Med J. 2022;115(1):8-12. 

In This Article

Historical Background

Electronic cigarettes, or e-cigarettes, also known as vaping devices, are electronic nicotine delivery systems designed to simulate smoking by delivering an aerosolized mixture. The mixture usually contains nicotine, flavor, and a delivery system commonly made of propylene glycol or glycerin.[1–3] The first smokeless nontobacco cigarette was invented by Herbert A. Gilbert in 1965.[4] The objective was to provide a safe and harmless means of smoking by replacing burning tobacco and paper with heated, moist, and flavored air. In addition, Gilbert wanted to create a method by which warm medications could be introduced into the lungs in case of a respiratory ailment through inhalation.

The first e-cigarette entered the Chinese market in 2003 and the US market in 2007.[5] Since the introduction of e-cigarettes to the US market, marketing has increased and the design and manufacturing process has continued to evolve. E-cigarettes were initially marketed as a healthier alternative to conventional tobacco cigarettes, especially as the list of health hazards caused by conventional tobacco cigarettes continued to grow.[6] Proponents of e-cigarettes claim that these products give users a satisfying smoking experience, without exposure to the toxic components of conventional cigarette smoke. They argue that switching to e-cigarettes will be of public health benefit.[7] By 2014, e-cigarettes had expanded to 466 brands and 7764 different flavors.[8] These products are widely available online and in retail outlets, especially in neighborhoods with a higher household income[9] and in states with weak laws for clean indoor air and with low taxes on cigarettes.[7]

Tobacco control efforts cut the youth cigarette smoking rate in half from 1997 to 2007 and estimated to have saved more than 8 million lives during the past 50 years.[10,11] E-cigarettes, varying in power and potency, typically contain a nicotine-based liquid that is vaporized. The introduction of e-cigarettes is known to have increased the use of nicotine-containing products among youths.[12] E-cigarettes become a gateway to smoking by exposing young people.[12] Since 2014, e-cigarettes have been the most commonly used tobacco product among youths.[12] In 2019, approximately 1 in 4 youths (23.0%) had used a tobacco product during the past 30 days. This is approximately 3 in 10 high school students (31.2%) and approximately 1 in 8 middle school students (12.5%).[13] In 2020, the current use of any tobacco product was reported by 16.2% (4.47 million) of all students, including 23.6% (3.65 million) of high school students and 6.7% (800,000) of middle school students. E-cigarettes were the most used tobacco product among high school (19.6%; 3.02 million) and middle school (4.7%; 550,000) students.[3] Awareness and use of e-cigarettes also increased considerably among US adults during 2010 through 2013. In 2013, more than one-third of current cigarette smokers reported that they had used e-cigarettes.[14]