Every otolaryngologist should know about vaping. Vaping-related harm may include catastrophic lung injury; fatal accidental ingestion in children; explosion of combustible devices, accelerated nicotine addiction; and interaction with COVID-19 risk. Vaping amplifies disparities in use and addiction, mediated through social determinants of health. This panel reveals the evidence around vaping most relevant to practicing otolaryngologists trying to grasp this complex public health concern. We explain vaping epidemiology, sociological undercurrents and disparities, pathophysiology of vaping-related disease, and what to do about it. We describe how JUUL’s meteoric rise to dominance in the e-cigarette space –growth rivaling that of Facebook– was catalyzed by social media, positioning as new technology, and stealthy design, and alluring flavors. We probe the science of vaping from surgical wound healing to effects of inhaling formaldehyde, propylene glycol, heavy metals, and other vapors risks magnified in unregulated cannabinoids. The experiences of individuals who survived vaping-related injury, from respiratory exacerbation to ventilator dependence is testimony to the crisis. The session offers insights on vaping-related disease, persistent misconceptions, and social determinants of health. E-cigarettes, a potential “off ramp” for adult smokers have evolved into a heavily trafficked “on ramp” for the next generation. We close with counseling pearls, advice for patients grappling with misinformation, and opportunities for our specialty to lead.