Young people face special health risks when vaping, according to a tobacco dependence expert.

Federal health officials have so far identified 450 possible cases of severe respiratory illnesses reported after use of e-cigarette products in 33 states, with 5 deaths.

Although more information is needed to determine the cause of the illnesses, there is speculation that least some are due to contamination of cannabis products with a vitamin E extract.

“The hope for e-cigarettes from a public health standpoint was that they would be a less harmful alternative for adult cigarette smokers. Unfortunately, these products have had limited appeal for adult smokers and major appeal for young people,” says Michael Steinberg, professor of medicine at Rutgers Robert Wood Johnson Medical School and director of the Tobacco Dependence Program at the Rutgers University Center for Tobacco Studies.

“The recent, severe health effects in young users largely stem from people manipulating, modifying, and tampering with an already unregulated device. In many cases, patients reported the use of THC-containing e-cigarette products, and additives to these products may be responsible,” Steinberg says.

Here, Steinberg discusses the health considerations surrounding the use of e-cigarettes:

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