E-Cigarettes: What You Need to Know

You may have seen electronic cigarettes (e-cigarettes) in stores, in advertisements, or being used. But e-cigarettes, while increasingly popular, are not harmless. Created as an alternative to tobacco cigarettes, e-cigarettes are sophisticated mechanical devices designed to deliver the same highly addictive nicotine that is in tobacco cigarettes, without the other harmful effects of tobacco smoke.

What’s Happening
In the past decade, e-cigarettes have become a more than $1 billion industry in the United States, with over 460 brands on the market. Many adults who use e-cigarettes are current or former smokers looking to stop nicotine cravings, quit smoking, or cut down on tobacco cigarettes. However, e-cigarettes may have a limited effect on helping people quit since at least 75 percent of adults who use e-cigarettes also use tobacco cigarettes.1

And although most states prohibit the sale of e-cigarettes to people under the age of 18, more and more teens are using them. In fact, recent surveys2 show dramatic increases each year in the number of teens who have tried an e-cigarette in their lifetime, as well as in the number who have used them in the past month. This is at a time when smoking tobacco cigarettes is at an all-time low among middle and high school students.

What’s Ahead
With e-cigarette use on the rise, the federal government is considering regulation of how e-cigarettes are made and sold. If this happens, e-cigarettes may be subject to rules on safety, advertising, and warning labels similar to those that govern the sale of tobacco cigarettes. For now, however, consumers should not assume that the products are guaranteed to be safe or that claims made in advertising are accurate.

As for the science on the risk of e-cigarettes and the possible benefits for current smokers, research is just beginning. But there is already a growing body of evidence showing that teens would be smart never to start using e-cigarettes.

What are electronic cigarettes?

Electronic cigarettes, also known as e-cigarettes, e-vaporizers, or electronic nicotine delivery systems, are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. They can resemble traditional tobacco cigarettes (cig-a-likes), cigars, or pipes, or even everyday items like pens or USB memory sticks. Other devices, such as those with fillable tanks, may look different. Regardless of their design and appearance, these devices generally operate in a similar manner and are made of similar components. More than 460 different e-cigarette brands are currently on the market.1 Some common nicknames for e-cigarettes are:

  • e-cigs
  • e-hookahs
  • hookah pens
  • vapes
  • vape pens
  • mods (customizable, more powerful vaporizers)

How do e-cigarettes work?

Most e-cigarettes consist of four different components, including:

  • a cartridge or reservoir, which holds a liquid solution (e-liquidor e-juice) containing varying amounts of nicotine, flavorings, and other chemicals
  • a heating element (atomizer)
  • a power source (usually a battery)
  • a mouthpiece that the person uses to inhale

In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapor (called vaping).

E-cigarette Use in Teens

E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States. Their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they’re safer than cigarettes have helped make them appealing to this age group. Further, a study of high school students found that one in four teens reported using e-cigarettes for dripping, a practice in which people produce and inhale vapors by placing e-liquid drops directly onto heated atomizer coils. Teens reported the following reasons for dripping: to create thicker vapor (63.5 percent), to improve flavors (38.7 percent), and to produce a stronger throat hit—a pleasurable feeling that the vapor creates when it causes the throat to contract (27.7 percent).2 More research is needed on the risks of this practice.

In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death. A study showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year.3 Another study supports these findings, showing that high school students who used e-cigarettes in the last month were about 7 times more likely to report that they smoked cigarettes when asked approximately 6 months later, as compared to students who said they didn’t use e-cigarettes. Notably, the reverse was not true—students who said they smoked cigarettes were no more likely to report use of e-cigarettes when asked approximately 6 months later. Like the previous study, these results suggest that teens using e-cigarettes are at a greater risk for smoking cigarettes in the future.4However, more research is still needed to understand if experimenting with e-cigarettes leads to regular use of smokable tobacco.

Under U.S. Food and Drug Administration (FDA) regulations designed to protect the health of young Americans, minors can no longer buy e-cigarettes in stores or online (see “Government Regulation of E-cigarettes”). The FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories

E-cigarettes: Where do we stand?

(CNN)E-cigarettes are increasingly being used as a nicotine alternative as smokers seek ways to kick their habit. They work by heating a pure liquid called e-juice — composed of flavorings, propylene glycol, glycerin and often nicotine — until it vaporizes. The resulting vapor is much less offensive to many, both smokers and non-smokers.

But their use has been surrounded by debate, focusing on the lack of evidence regarding the harms associated with their long-term use, as well as their potential to act as a gateway into smoking among teens.
The latest salvo: A study published Monday in the journal Pediatrics found five cancer-causing toxins in the urine of 16-year-olds who inhaled e-cigarette vapor, and a second study found, yet again, that e-cigarettes encourage teens to begin smoking traditional cigarettes.
Last week, a study of nearly 70,000 people found that daily e-cigarette use can double the risk for heart attack. If the user continues to smoke regular cigarettes each day along with e-cigarettes, the combined risk goes up five times.
“E-cigarettes are widely promoted as a smoking cessation aid, but for most people, they actually make it harder to quit smoking, so most people end up as so-called ‘dual users’ who keep smoking while using e-cigarettes,” said Stanton Glantz, lead author of the latter study, in a statement.
Science and public policy have bounced back and forth for over a decade, as different studies produce different — and sometimes contradictory — results. Let’s take a look at the debate over the years:

2003 headline: Invention of e-cigarettes

The inventor of the electronic cigarette, Hon Lik, smoking his invention in Beiijng on May 25, 2009.

Three pack-a-day smoker Hon Lik, a 52-year-old Beijing pharmacist, created the first successful electronic cigarette after his father, another heavy smoker, died of lung cancer. By 2007, e-cigarettes were marketed in Europe and the United States by manufacturer Ruyan as a way to safely stop smoking tobacco.
Hon was not the first person on record to have the idea for an electronic non-tobacco option. Herbert A. Gilbert filed for a patent in 1963, in an era when tobacco smoking was widely accepted and the health risks were less apparent.