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Pulmonary researchers at Penn Medicine are investigating the health complications of vaping in an effort to tamp down the growing number of hospitalizations for lung-related injuries in recent months. 

The national outbreak has focused attention on the potential dangers of vaping and has even prompted policy responses from schools and the federal government. Frank Leone, a leading pulmonologist at Penn Med, said vaping does not break addictive habits and is not a healthy alternative to cigarettes, based on his patient work and ongoing research on tobacco dependence. 

Leone, who is the director of Comprehensive Smoking Treatment Program, conducts research on vaping that involves clinical trials with patients, identifying targets for pharmacotherapy, and implementation work aiming to challenge assumptions made by doctors and patients about dependence.

“You’re not really transitioning away from the smoking behavior,” he said. “Smoke is the vehicle for nicotine. You’ve changed the vehicle, but you’re still delivering nicotine to the brain, and all the connections that led you to smoke in the first place are still alive and well.”

Based on his research with tobacco dependence, Leone said users cannot simply quit vaping after learning about health complications. 

"Nicotine won’t let that decision sit easy in your soul," he said.

Leone said the idea that electronic cigarette aerosol is healthier than smoke has always been an assumption based on the "mental shortcut" that since cigarettes are toxic, a "vapor" alternative will be safer. Instead of "vapor," Leone uses the word “aerosol” to clarify that vapes do not contain water vapor, but rather a complex mix of several dangerous chemicals.

Frank Leone is a leading pulmonologist at Penn Medicine.

“The lung doesn’t really care that you’re not exposing it to smoke anymore if what you’re exposing it to is also toxic, and there are lots of mechanisms of potential lung injury and toxicity that were never really considered when these products were first introduced," Leone said.

Leone said the rapid spread of vape-related health complications have followed a trajectory similar to any “infectious epidemic,” where the vague symptoms could easily have been mistaken for other issues like pneumonia prior to widespread recognition.

Other factors in the current outbreak could be vape usage rising in leaps and bounds among young people over the past few years, as well as evolution in the physical attributes of aerosol in vapes such as their chemical makeup, Leone said.

Some Penn students said e-cigarettes have followed their age group from high school to college, where Juuls remain a pervasive element of social life.

“I think vaping is pretty common among Penn students, and I feel like the younger they are the more likely they are to vape,” Engineering sophomore Rachel Pellegrino said. 

“I definitely think it’s safer than cigarettes, but I don’t think that makes it safe at all," Pellegrino said.

In September, Campus Health hosted half a dozen undergraduate student focus groups on vaping, with the goal of learning about student perception of Juuls and other vapes, according to the Campus Health website. The focus groups did not require volunteers to have personal experience with vaping. 

The focus groups aimed to "gather information about students' understanding and perception of vaping and vape products," according to the website. Campus Health did not respond to multiple requests for comment on an update about the focus groups.

Wharton junior Kristen McLaughlin said she sees more people Juuling on Penn's campus than any other type of vaping. According to a 2018 Forbes article, Juul was on track to generate an estimated $1 billion in sales, which was up more than 300% from the year before. 

Leone said while patients at Penn have been treated for vaping-related health complications, none have been students of the University.

Leone added that Penn students who are having unexplained respiratory symptoms — a cough that does not go away, shortness of breath running up steps, or unexplained wheezing — should visit Student Health Service to evaluate whether vaping is the cause.

“Nobody is going to force them to stop vaping if they don’t want to, but they should also have all the information available,” Leone said.