Dr. Michael Collaco, left, associate professor of pediatrics at Johns Hopkins University School of Medicine, speaks on Wednesday with Lauren Cummings, executive director of the Northern Shenandoah Valley Drug Abuse Coalition, after Collaco’s program at Winchester Medical Center. Collaco spoke on the latest research concerning the effects of vaping on children and adolescents.

WINCHESTER — Electronic cigarettes and vaporizers are perceived as less harmful than traditional cigarettes, but research is starting to show it can still pose risks, especially to children.

At Winchester Medical Center on Wednesday, Dr. Michael Collaco, an associate professor of pediatrics at Johns Hopkins University School of Medicine, gave a presentation for health professionals on the risks of children and adolescents smoking or coming into contact with vaping materials.

The major risks associated with inhaling smoke and tar from traditional smoking have long been documented, including diseases and medical conditions such as lung cancer, gum disease and stroke. Traditional cigarettes also smell bad, pose a risk of fires and leave behind ash. Because of the concern for the effects of second-hand smoke, smoking has been banned in many buildings and business campuses around the country.

As such, e-cigarette companies have sought to avoid similar problems by offering a way that users could replace cigarette smoking with a cleaner way of obtaining nicotine or even mimicking the act of smoking without inhaling nicotine. It’s a way to either transition away from cigarettes or avoid them altogether. But Collaco said e-cigarettes also come with risks, many of which are still being studied.

Since e-cigarettes were first introduced to the world in 2007, first marketed in Asia, they’re still a relatively new concept, said Collaco.

“The risk of cancer is still unknown,” he said.

Focusing Wednesday on the threats to children and adolescents, he said that young people are attracted to e-cigarettes because of the variety of vape juice flavors, like apple, strawberry or coffee, and the easy of vaping anywhere, anytime. Unlike cigarettes, e-cigs aren’t outlawed indoors in many places, and the cloud of vapor that smokers expel is much less of a disturbance to bystanders than cigarette smoke is. Not only are e-cigs perceived as being less harmful than cigarettes, Collaco said, they’re also seen as cool.

However, he said, cessation of cigarette smoking is not a driving factor in adolescent e-cigarette use, and some high school students are doing both.

E-cigarette use among high school students increased by 78% (from 11.7% to 20.8%) between 2017 and 2018, Collaco said. Currently nicotine use of any tobacco product by high schoolers is at 27.1%, he said.

Though major brands of e-cigarettes offer a range of nicotine content, from 0% to 2.4%, JUUL pods contain 5.9% nicotine. JUUL uses a nicotine salt formulation that the company claims is absorbed 2.7 times faster compared to other e-cigarettes, Collaco said.

Yet 63% of 15- to 24-year-olds don’t know that JUULs always contain nicotine, he said. In terms of nicotine content, one JUUL pod is the approximate equivalent to 1 to 2 packs of conventional cigarettes, Collaco said, and some young people do go through a pod a day.

Because nicotine is addictive, Collaco said that gives e-cigarettes a 3 ½ percent risk of becoming a gateway to traditional cigarettes.

But nicotine isn’t the only issue with using e-cigarettes. Even the ones without nicotine contain chemical ingredients that research is showing change the air quality in the lungs of mice, Collaco said.

Flavorings are advertised as being OK to inhale because they’re food grade, he said.

“But we don’t inhale food into our lungs,” he said. “It’s not supposed to be there.”

There are many risks of vaping, he said:

Those who vape have a higher risk of respiratory problems

Vaping can aggravate symptoms of asthma

The FDA has investigated 127 reports of seizures and other neurological problems associated with vaping

As of Tuesday, the Centers for Disease Control have reported six deaths nationwide from a lung illness associated with vaping

Cardiopulmonary health effects include increased heart rate after inhaling nicotine

E-cigarettes are associated with additive stress, inflammation and impaired innate immune responses in test tube and culture dish studies and in studies of living organisms

Vaping materials have also been reported to spontaneously explode and cause burns.

Second-hand and third-hand vapor are also a concern, Collaco said. People who breathe in the vapor expelled by someone who’s vaping are taking in the same chemicals, he said. Furthermore, chemicals left on furniture and other surfaces in the home can prove hazardous to young children, he said.

Studies on mice have shown higher odds of wheezing among those with asthma who use vaporizers or other e-cigarettes. Hyperactivity has also been seen in adult mice who were exposed to vaporizers while they were developing.

Attention deficit hyperactivity disorder risk has been shown to be greater in the offspring of mice who were vaping while pregnant, said Collaco.

E-cigarettes have been banned on commercial flights in the U.S. As of July 1, Virginia has raised the legal age for possession and purchase of vaping materials to 21.

However, that doesn’t stop adults from vaping around children or teens, which still means young people can be harmed by e-cig chemicals.

On Sept. 9, the Federal Drug Administration issued a requirement for JUUL to advertise that its vaping materials come with modified risk, because JUUL hasn’t proven that they don’t.

But in spite of concerns over the risks of e-cigarettes, the industry is just getting started.

Collaco said that IQOS — a non-e-cigarette product produced by Philip Morris International that started in 2014 in Italy and Japan — was approved by the FDA in April to be produced and distributed in the U.S.

Wednesday’s program was part of a weekly educational series that Valley Health has been offering its staff for at least 40 years, said its organizer, Dr. Gregory Kujala. The presentations, which take place at the medical center, are televised live to Valley Health’s other locations around the Northern Shenandoah Valley and in nearby West Virginia, where he said staff have the opportunity to ask questions of the presenter.

He was glad that the hospital was able to get Collaco there to speak on e-cigarettes at a time when so many news reports and studies are being published daily on the topic.

“We try to be topical and timely,” Kujala said.

The programs also allow doctors on staff to obtain continuing education credit hours on site, as needed. “We hold ourselves up to a higher standard,” Kujala said.

Lauren Cummings, executive director of the Northern Shenandoah Valley Substance Abuse Coalition, said because there’s little education so far around the dangers of vaping, it’s a growing issue for local health professionals.

Cummings, who attended Wednesday’s program, said she presented information on vaping at a recent health fair in Winchester and that information is being added to the coalition’s website,

“At this point, we’re gathering it as we speak,” she said. “I anticipate there being a lot more information coming out … over the next year.”

Cummings said she’s concerned about the prevalence of young people vaping, despite the relative lack of information on its long-term effects.

“I think it’s alarming what we’re seeing as far as the use,” she said. What stuck out for her in Collaco’s presentation was “the amount of marketing that’s going on for teens.”

Teens can find vaping ads online, on TV, in magazines and in retail stores, she said.

“And what is always concerning to me is that it’s not giving you the dangers of it,” said Cummings. “They are marketing it such that it is a safer alternative to cigarettes.”

She disagrees.

“It’s still tobacco use and it is in fact dangerous,” she said.

Contact Josette Keelor at