Alternatives to Smoking: What Users Ought to Know About Vaping and Nicotine Pouches

Smoking kills! Since most people now know about this fact, they have been looking for alternatives that are safe. Here I will discuss two of them: vaping and nicotine pouches.

VAPING

Vaping devices are electronic nicotine delivery systems that heat liquid into an inhalable aerosol. They have surged in popularity. Despite marketing claims to the contrary, substantial evidence reveals significant health risks.

Addiction

Nicotine, the primary active ingredient in most vape liquids, is one of the most addictive substances known. Research indicates that 17.8% of e-cigarette users report feeling “very addicted,” while 42.3% consider e-cigarettes equally or more addictive than combustible cigarettes. The addictive potential is amplified by several factors: modern vape devices use nicotine salts that deliver nicotine more rapidly and in higher concentrations than traditional cigarettes, and the high nicotine concentrations in many devices (often not listed on packaging) accelerate dependence. The more a person vapes, the more their brain and body adapt to nicotine, making cessation increasingly difficult. When nicotine enters the system, it triggers dopamine release, creating a “feel-good” sensation that reinforces continued use. However, nicotine’s effects wear off rapidly, triggering cravings and establishing a cycle of dependence. Nearly all vapes circulating contain nicotine, even when not listed on packaging, making prevaping users unknowingly vulnerable to addiction.

Toxicity

Vaping exposes users to a complex toxic chemical cocktail. The e-liquids contain propylene glycol and vegetable glycerin. These are ingredients meant to be eaten, not inhaled which become toxic when heated. When vaporized, these components transform into dangerous chemicals including acetaldehyde, acrolein, and formaldehyde, all of which can cause lung disease and cardiovascular disease. The two primary e-cigarette ingredients in the US are toxic to cells, with toxicity increasing alongside the number of additives in the e-liquid. Acrolein, a herbicide primarily used to kill weeds present in e-cigarettes, can cause acute lung injury, COPD, asthma, and potentially lung cancer. Vitamin E acetate, a thickening agent sometimes added to THC-containing vape products, was identified by the CDC as a “chemical of concern” in vaping-associated lung injuries. Flavoring agents pose additional risks. Diacetyl, a flavoring chemical linked to “popcorn lung” (bronchiolitis obliterans), is present in many flavored vapes and causes irreversible lung damage. Secondhand emissions contain nicotine, ultrafine particles, volatile organic compounds like benzene usually found in car exhaust, and heavy metals including nickel, tin, and lead. The FDA has not found any e-cigarette to be safe and effective for smoking cessation.

Cardiovascular disease

Vaping is associated with significant cardiovascular risks. Research has linked nicotine-containing e-cigarettes to acute changes in blood flow, including increased blood pressure and heart rate. These physiological effects can lead to atherosclerosis and increase the risk of heart attacks and strokes. Other e-cigarette ingredients, particularly flavoring agents, independently carry risks associated with heart and lung diseases in animal studies. A recent analysis found a significant association between former or current e-cigarette users and the development of several respiratory diseases within two years of use, suggesting cardiovascular and respiratory systems are simultaneously compromised.

Brain damage

The human brain does not fully develop until approximately age 25, making young users uniquely vulnerable. Regular nicotine vape use causes changes to brain development that negatively affect learning, concentration, mood, and memory. Nicotine rewires the brain, changing the parts responsible for decision-making, impulse control, and mood regulation. These changes can interfere with mood and make users more likely to become addicted to nicotine and other drugs. Nicotine exposure during adolescence also increases feelings of stress and worsens depression and anxiety. Vaping hasn’t been around long enough to see irreversible diseases yet, but biologically, damage is happening and inflammation is occurring—creating conditions that will lead to diseases later.

References

• American Lung Association. (n.d.). Health Risks of E-Cigarettes and Vaping. https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung
• American Lung Association. (2025). The Truth About What Vaping Is Doing to Your Body. https://www.lung.org/blog/illnesses-vaping-causes
• Panagis Galiatsatos, M.D., MHS. Johns Hopkins School of Medicine.
• European Journal of Public Health. (2022). Understanding addiction in e-cigarette users – the EVAPE project. Oxford Academic. https://academic.oup.com/eurpub/article/32/Supplement_3/ckac130.078/6765989
• National Institutes of Health. (2024). The Risks of Vaping. NIH News in Health. https://newsinhealth.nih.gov/2020/05/risks-vaping
• American Heart Association. (2023). As E-Cigarette Use Grows, More Research Needed on Long-Term Effects of Vaping. https://www.stroke.org/en/news/2023/07/17/as-e-cigarette-use-grows-more-research-needed-on-long-term-effects-of-vaping
• NSW Health. (n.d.). Vaping – Nicotine Addiction | Young People Factsheet. https://www.health.nsw.gov.au/tobacco/Factsheets/vaping-nicotine-addiction-young-people-factsheet.pdf
• Centers for Disease Control and Prevention. (2025). Health Effects of Vaping. https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html
• National Institutes of Health. (2025). NIH-Funded Studies Show Damaging Effects of Vaping, Smoking on Blood Vessels. https://www.nih.gov/news-events/news-releases/nih-funded-studies-show-damaging-effects-vaping-smoking-blood-vessels
• Johns Hopkins Medicine. (2025). 5 Vaping Facts You Need to Know. https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping

NICOTINE POUCHES

Nicotine pouches are small, smokeless, tobacco-free pouches containing nicotine. They have existed for a long time but have recently rapidly gained popularity, particularly among young people. They are often claimed to be safer alternatives to cigarettes. Is this claim true?

Addiction

Nicotine pouches are highly addictive by design. Nicotine is a well-established addictive drug that activates reward pathways in the brain, leading to dependence. Research demonstrates that nicotine salts used in pouches deliver higher concentrations more rapidly than traditional nicotine products, accelerating addiction. Among young people who try nicotine pouches, 73% continue using them, indicating strong addictive potential. The average user consumes half a can daily (8-12 pouches), with 10 pouches at 6mg equivalent to 1–1½ packs of cigarettes or 1½ e-cigarette pods daily. Alarmingly, the number of youths using nicotine pouches has doubled in the US since 2021, reaching now ~400,000 users. This rapid uptake among youth suggests that the product’s smokeless, odorless features make nicotine use more accessible and socially acceptable, facilitating addiction before users fully understand the consequences.

Toxicity

Nicotine pouches contain unregulated and potentially toxic levels of nicotine. While nicotine itself is not unregulated, many products in the US lack FDA authorization and are on the market illegally without proper safety testing. A 2022 study found that 26 of 44 nicotine pouch products contained cancer-causing chemicals, including ammonia, formaldehyde, chromium, and nickel. These contaminants likely result from inadequate manufacturing processes and quality control. The absence of standardized regulation means nicotine concentrations can vary significantly between products and even within batches, making dosing unpredictable. Furthermore, non-tobacco nicotine products may seem healthier than smoking, but they come with their own laundry list of health effects, and public health experts recommend avoiding nicotine altogether.

Cardiovascular disease

The cardiovascular risks associated with nicotine pouches are well-documented. Nicotine increases blood pressure, heart rate, and blood flow to the heart while constricting arteries. These physiological effects can lead to atherosclerosis and heart attacks. The American Heart Association explicitly warns that nicotine can damage the heart and other vital organs. However, some industry-sponsored research claims that nicotine administered through pouches has only transient effects on blood pressure and heart rate in healthy users, with no demonstrated long-term cardiovascular damage. This discrepancy highlights the importance of independent research versus industry-funded studies. Nevertheless, the mechanistic evidence—nicotine’s vasoconstrictive and hemodynamic effects—strongly suggests increased cardiovascular risk, particularly with chronic use or in individuals with pre-existing conditions.

Brain dmage

Nicotine damages brain development. The human brain does not fully develop until approximately age 25, making adolescents and young adults uniquely vulnerable to nicotine’s neurotoxic effects. Nicotine exposure during adolescence alters the development of the prefrontal cortex, the brain region responsible for attention, learning, memory, and impulse control. These changes can be permanent, leading to lasting cognitive deficits and difficulties with concentration and memory. Additionally, adolescent nicotine exposure increases the risk of psychiatric disorders, including anxiety and depression, and priming the brain for addiction to other substances. Nicotine pouches are particularly dangerous for youth precisely because of these developmental vulnerabilities. Given that 400,000 US youths now use nicotine pouches, the public health implications are substantial.

References

• American Lung Association. (2024). ZYN 101: What to Know About Big Tobacco’s Latest Addiction. https://www.lung.org/blog/zyn-nicotine-addiction
• American Heart Association. (2025). Triple Threat: The Hidden Dangers of E-Cigarettes, Oral Nicotine Pouches, and Vaping. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/triple-threat-e-cigarettes-oral-nicotine-pouches
• Cleveland Clinic. (2024). Are Nicotine Pouches Safe? Health.ClevelandClinic.org. https://health.clevelandclinic.org/are-nicotine-pouches-safe
• Dentalcare.com. (2025). Nicotine Impact on Adolescent Brain Development. CE693. https://www.dentalcare.com/en-us/ce-courses/ce693/nicotine-impact-on-adolescent-brain-development
• Verywell Health. (2024). Is Zyn Bad for Your Heart? https://www.verywellhealth.com/is-zyn-bad-for-your-heart-8735079
• Yale Medicine. (2024). What Parents Should Know About Nicotine Pouches. https://www.yalemedicine.org/news/nicotine-pouches
• initiative to Undo. (2024). The Effects of Nicotine on the Adolescent Brain. https://www.undo.org/addicting-kids/the-effects-of-nicotine-on-the-adolescent-brain
• Tobacco Free Coalition. (2025). Not Your Grandparent’s Tobacco: The New Nicotine Products. https://www.tobaccofreeco.org/the-new-nicotine-products-2/

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Having lost several friends to lung cancer, I am convinced that the best alternative to smoking is quitting.