Vaping Pop Quiz

Twenty questions in 20 minutes – can you get 80-100%?

Based on the World Council for Health Substack Article below, I challenge vape users, in particular, to get 80 to 100% on this open-book pop quiz! Answers at the end of the article.

The Filtered Truth: Vaping, "Liquid Poison," and the Smoke-Filled Battle for Our Lungs

Open-Book Quiz: “The Filtered Truth: Vaping, ‘Liquid Poison,’ and the Smoke-Filled Battle for Our Lungs”

Time: 20 minutes
Instructions: Answer the 20 questions below. Some questions may have more than one correct answer. Select all that apply.

Section 1: Chemical Composition and Toxicity (Questions 1–6)

1. Which of the following chemicals are found in conventional cigarette smoke?

   • A. Tar

   • B. Carbon monoxide

   • C. Formaldehyde

   • D. Polynuclear aromatic hydrocarbons (PAHs)

2. Which toxic compounds can be generated in e-cigarette aerosols when the e-liquid is overheated?

   • A. Acetaldehyde

   • B. Nicotine

   • C. Formaldehyde

   • D. Diacetyl

3. Nanoparticles of which metals have been detected in e-cigarette aerosols?

   • A. Nickel

   • B. Chromium

   • C. Lead

   • D. Zinc

4. Which flavouring chemicals in e-cigarettes are linked to respiratory disease?

   • A. Diacetyl

   • B. Acetoin

   • C. 2,3-pentanedione

   • D. Propylene glycol

5. Compared to conventional cigarettes, e-cigarette aerosol:

   • A. Contains fewer toxic compounds overall

   • B. Contains metallic nanoparticles

   • C. Is just water vapour

   • D. Can produce ultra-fine particulate matter that reaches deep into the lungs

6. Which microbial contaminants have been found in e-liquids?

   • A. Endotoxin

   • B. β-glucans

   • C. E. coli

   • D. Staphylococcus aureus

Section 2: Biological Effects (Questions 7–13)

7. Vaping has been shown to suppress which of the following in the immune system?

   • A. Alveolar macrophages

   • B. Cytokine response

   • C. T-cell receptor diversity

   • D. Antibody production

8. Both smoking and vaping can cause:

   • A. Endothelial dysfunction

   • B. Arterial stiffness

   • C. Reduced oxidative stress

   • D. Increased risk of heart attacks

     

9. Vaping alters the lung microbiome by:

   • A. Promoting pro-inflammatory bacteria

   • B. Increasing microbial diversity

   • C. Reducing susceptibility to infections

   • D. Creating a warm, moist chemical-laden environment

10. Evidence on the carcinogenic potential of e-cigarettes includes:

• A. DNA damage in human lung and bladder cells in vitro

• B. Proven 20-year cancer epidemiology data in humans

• C. Presence of carbonyls and heavy metals

• D. Complete safety for non-smokers

11. The term “safer” is used cautiously for e-cigarettes because:

• A. It only applies to adult smokers switching completely from combustible tobacco

• B. No study declares e-cigarettes completely safe

• C. It implies non-smokers can safely start vaping

• D. The long-term risks are unknown

12. Which immune cell type is specifically mentioned as being suppressed by vaping?

• A. Alveolar macrophages

• B. Neutrophils

• C. Lymphocytes

• D. Eosinophils

13. Industry-funded studies on vaping tend to:

• A. Focus on relative safety and short-term biomarkers

• B. Examine absolute risks and long-term pathophysiology

• C. Downplay health risks

• D. Exclude nicotine measurements

Section 3: Epidemiology and Usage Patterns (Questions 14–17)

14. Approximate daily adult smoking rates in the European Union:

• A. 19.7%

• B. 2%

• C. 27%

• D. 28%

15. Among young people (15–24) in Europe, vaping is:

• A. Increasing rapidly

• B. Lower than adult smoking rates in all countries

• C. A gateway for new nicotine users

• D. Declining steadily

16. Russia’s proposed e-cigarette ban is primarily due to:

• A. Surge in youth vaping

• B. Unregulated market

• C. High adult smoking prevalence

• D. International trade pressure

17. China’s situation regarding e-cigarettes:

• A. World’s largest producer of e-cigarettes

• B. High domestic youth use

• C. Has completely banned e-cigarettes

• D. Home to over 300 million smokers

Section 4: Public Health, Policy, and Research (Questions 18–20)

18. Recommended regulatory measures for public health authorities include:

• A. Banning flavoured products

• B. Limiting nicotine concentration

• C. Encouraging all adults to switch to e-cigarettes

• D. Mandating rigorous product testing for contaminants

19. Recommended strategies for adult smokers who cannot quit include:

• A. Nicotine replacement therapy (NRT)

• B. Varenicline

• C. Behavioural counselling

• D. Starting e-cigarettes without medical guidance

20. Long-term studies are crucial because:

• A. Vaping has only a decade of data

• B. Cancer risk may take 20–30 years to appear

• C. They can replace short-term biomarker studies entirely

• D. We are currently subjects in a population-level experiment

Answer Key: “The Filtered Truth” Quiz

Section 1: Chemical Composition and Toxicity

1. A, B, D – Tar, carbon monoxide, and PAHs are toxic compounds in cigarette smoke (U.S. Department of Health and Human Services, 2010).

2. A, C, D – Overheating e-liquids produces acetaldehyde, formaldehyde, and flavoring chemicals like diacetyl (Goniewicz et al., 2014; Allen et al., 2016).

3. A, B, C – Nickel, chromium, and lead nanoparticles come from the heating coil, solder, and device components (Olmedo et al., 2018).

4. A, B, C – Diacetyl, acetoin, and 2,3-pentanedione are linked to respiratory disease (Allen et al., 2016).

5. A, B, D – E-cigarette aerosol has fewer toxic compounds than cigarettes, contains metallic nanoparticles, and ultrafine particles deposit deeply (Zhang et al., 2013).

6. A, B – Endotoxin and β-glucans have been found in e-liquids (Lee et al., 2019).

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Section 2: Biological Effects

7. A, B – E-cigarettes suppress alveolar macrophages and cytokine response, impairing innate immunity (Clapp et al., 2017).

8. A, B, D – Both smoking and vaping cause endothelial dysfunction, arterial stiffness, and increased risk of heart attacks/strokes (Carnevale et al., 2016; Fetterman et al., 2020).

9. A, D – Vaping shifts microbial populations toward pro-inflammatory bacteria in a warm, moist chemical-laden environment (Wills et al., 2021).

10. A, C – DNA damage in vitro and presence of carbonyls/heavy metals indicate carcinogenic potential; long-term human data are limited (Lee et al., 2018).

11. A, B, D – “Safer” applies only to adult smokers switching completely; no study declares e-cigarettes fully safe; long-term risks are unknown.

12. A – Alveolar macrophages are specifically mentioned as suppressed (Clapp et al., 2017).

13. A, C – Industry-funded studies focus on relative safety and short-term biomarkers and often downplay risks.

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Section 3: Epidemiology and Usage Patterns

14. A – Daily adult smokers in the EU: 19.7% (Eurostat, 2019).

15. A, C – Vaping among 15–24-year-olds is increasing rapidly and acts as a gateway (Bello, 2024).

16. A, B – Russia’s proposed ban is due to unregulated markets and rising youth vaping (“liquid poison” panic) (Swentr, 2025).

17. A, B, D – China is the world’s largest producer, faces growing youth use, and has over 300 million smokers (WHO, n.d.).

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Section 4: Public Health, Policy, and Research

18. A, B, D – Recommendations include banning flavors, limiting nicotine, and rigorous testing (World Council for Health, 2025).

19. A, B, C – Safe strategies for adult smokers: FDA-approved NRT, varenicline, and behavioral counseling; e-cigarettes only as last-resort harm reduction.

20. A, B, D – Long-term studies are needed because vaping data are short-term, cancer risk may take decades, and current users are effectively part of an uncontrolled experiment.