KANSAS CITY, Kan. -- You've no doubt seen the headlines surrounding e-cigarettes: the potential dangers, the restrictions, the stats on how many people -- especially teens -- use them.
Researchers are undoubtedly worried about that last one. Despite the fact that e-cigarettes are illegal for anyone under 18, one in every five teens admits to vaping.
But what's even more worrisome is most scientists aren't sure about the long-term effects of it.
"We haven't found anything yet that would suggest this is safe," Dr. Matthias Salathe said.
That's where Salathe comes in. The pulmonologist has been studying the effects of e-cigarette use on human lung cells.
His ground-breaking research at KU Hospital reveals just how high the risks are -- and how it could lead to a new generation where thousands have severe lung disease.
An enormous amount of nicotine
Salathe said e-cigs might be even more addicting than cigarettes, leading to concerns about overall health and addiction.
"This vapor containing nicotine is really interfering with the ability of these cells to transport mucus," he said. "That is reminiscent to tobacco smoke exposure and therefore reminiscent to a disease that we call chronic bronchitis that you start spitting up phlegm."
One Juul pod, for example, has about the same amount of nicotine as 20 cigarettes, according to Truth Initiative, an anti-tobacco organization.
"You expose your lungs to an enormous amount of nicotine," Salathe said.
Children's Hospital of Wisconsin reports it treated eight patients within four weeks this summer -- all with severe lung damage and all with a habit of vaping.
"Vaping in teenagers is something that's harming our kids, and we want that to be loud and clear," said Mike Gutzeit, chief medical officer of the hospital.
But what's inside the liquid pod of an e-cig is often a mystery.
What's in a name?
The vapor of e-cigarettes can be flavored -- cotton candy, blueberry, cappuccino -- and unsurprisingly, that's appealing to teens.
"When you inhale that flavor, it's not as terrible as inhaling your first cigarette smoke that most people would say is disgusting," Salathe said.
But although the flavor name sounds sweet, there's no telling what it's actually made of.
"There is no requirement to declare what's in the flavors," Salathe said. "There are some flavors that we actually know that are detrimental to your lungs."
Salathe said diacetyl has shown up in some liquid pods. It's known to cause "popcorn lung" or bronchiolitis obliterans, an irreversible lung disease.
And some people experiment with chemicals that aren't meant to be in the pods at all.
"Kids add things, or they mix flavors, and then that just adds a whole new level of mystery," said Olivia Boster, a recent high school graduate. "Teenagers aren't chemists. They're not scientists. They shouldn't be messing with chemicals to figure out how they're going to react."
'Like an epidemic'
Statistics from the Centers for Disease Control and Prevention say just over 20% of high school students use e-cigarettes.
"But that number underestimates the amount tremendously," Salathe said.
Realistically, that's just the number of teens who admit to vaping. Salathe said some high schools say it's more like 60-70% of students.
"It's much easier to find people who vape than people who don’t," Boster said.
The recent grad said even more students admitted to using the devices in her high school class. She was on a task force at her school aimed at stopping e-cigarette use.
"My graduating class, there was at least 63% had, like, tried it and more had used it on a regular basis. It became like an epidemic,” Boster said.
A check of several metro school districts' policies confirmed just like traditional cigarettes, e-cigarettes are prohibited on school grounds.
Salathe said he once believed today's teens would buck the trend of nicotine use.
"There are very few teenagers these days that start to smoke. It's sort of out of fashion," he said.
Boster said from a young age, commercials have drilled it into teens' brains that smoking isn't good.
"We have made incredible advances in trying to convince people not to smoke, and teenagers have really embraced that," Salathe said.
But the problem, he said, is that now we've just replaced smoking with vaping.
History repeats itself?
Instead of cigarette ads featuring glamorous actors posing for a Camel close-up, e-cigarettes have taken a 21st Century twist.
There are vape trick videos, party tricks of sorts for kids to mimic and show off, further ingraining the habit into the culture of a generation.
"It is the same principle that was exploited in the '30s, '40s and 50s -- except we should be should be smarter than that," Salathe said.
Or so you'd think.
And then there are the health claims, seeming to say, "Hey, at least it's not a cigarette."
Some teens even recently testified on Capitol Hill that a Juul representative told high school freshmen that vaping is "totally safe."
"If that becomes fashion ... then we just have generated a new wave of not cigarette, but e-cigarette use with potentially the same consequences," Salathe said.
He and many other health experts feel we're just going down the same path all over again.
"We could be seeing a very large portion of our young population growing up with lung diseases that we thought were on the verge of diminishing," he said.
Raising the age
But fortunately, there are some who are fighting to keep teens from going down that path -- including the largest e-cigarette company in the country.
Last week, Facebook and Instagram announced there will be no e-cigarette ads targeted toward users who are 18 years old or younger.
There are multiple areas in Kansas, Missouri and other states that have raised the age to buy tobacco products, including e-cigarettes, to 21. There's even been a push to raise the age on a federal level though nothing has passed yet.
FOX4 reached out to dozens of local lawmakers, from the state to federal level, regarding the use of e-cigarettes among young people. Read their responses, in their own words, here.
U.S. Rep Emmanuel Cleaver was the only federal lawmaker to respond, saying he supports a federal Tobacco 21 law. His office said he just signed on to be a co-sponsor of the Tobacco to 21 Act.
"These companies are trying to addict a whole new generation of kids, and it is as despicable as it is dangerous," Cleaver said. "We've seen this playbook before, and we`re going to do our best to make sure we stop this trend before it snowballs out of control."
Salathe and Boster agree that raising the age is a step in the right direction to keep e-cigs out of the hands of young people.
"Delaying the ability to have access to it may just do a tremendous job of changing the culture," Salathe said.
An unlikely ally
Perhaps the most surprising supporters of the Tobacco 21 campaign is JUUL, easily one of the most popular e-cigarette companies in the U.S.
"We’ve led our industry in support of raising the minimum-purchasing age for all tobacco products, including vapor products, to 21," Juul Labs CEO Kevin Burns wrote in an op-ed for the Washington Post.
The company has also stopped selling flavored pods in retails stores. You can still buy them online, but only with a 21-and-over restriction and limits on how much you can buy at one time.
Juul Labs touts great success in helping adult smokers quit traditional cigarettes. But it's not clear if vaping is actually healthier for people who make the switch.
So once again, that's where researchers like Salathe come in, continuing to study the long-term effects of e-cigarettes.