4 Facts You Need to Know About E-Cigarettes

As of Dec. 20, 2019, the new legal age limit is 21 years old for purchasing cigarettes, cigars, or any other tobacco products in the U.S.

Modern e-cigarettes or electronic cigarettes (also called vaping devices, JUULs, and vape pens) were developed in China in 2003 and introduced in the United States in 2007 as a "healthier" alternative to smoking traditional cigarettes, with the purported aim of helping smokers quit. As there are upwards of 480,000 deaths per year attributed to smoking combustible cigarettes, there was much excitement over the possible life-saving impact of e-cigarettes when they were first introduced.

These tobacco-free, battery-powered devices usually contain nicotine, flavorings, and other chemicals. Rather than inhaling smoke, e-cigarette users inhale an aerosol vapor of the ingredients.

There is evidence that vaping has less detrimental health effects than traditional cigarettes. But being less deadly than cigarettes doesn't mean that e-cigarettes are without significant health concerns, many of which have not yet been fully investigated.

E-cigarettes are considered somewhat safer to use than cigarettes but are not the panacea that many had hoped they would be. The relative benefits and efficacy of using e-cigarettes to quit are complicated and controversial, to say the least. Below, we investigate the latest research on e-cigarettes, including whether or not vaping is a good way to quit smoking.

Man smoking electronic cigarette
Martina Paraninfi / Moment / Getty Images

Electronic Cigarettes Are Now Regulated 

Originally, vaping products were not regulated by the government, so quality control was of great concern, and e-cigarettes could be sold to children. This changed in August 2016 when, due to increasing concern over safety and exploding teen use of e-cigarettes, the Department of Food and Drug Administration (FDA) began regulating these products.

While traditional smoking has decreased in teens (and adults), the use of vaping has skyrocketed. Most experts cite unethical marketing to youth populations by manufacturers for this massive increase, which some estimate as around 20% of high schoolers. Kid-friendly flavorings and hip, discrete device designs have come under heavy scrutiny by federal and state authorities.

Regulating these products is a huge endeavor as there are now over 450 brands of e-cigarettes are on the market. Though many of the hazardous components of combustible cigarettes are not in e-cigarettes, that does not mean that these products are safe. Much still needs to be learned about these smoking alternative devices, including their long term effects.

Additionally, while some smokers have quit smoking by transitioning to vaping, many more have taken up vaping recreationally, and there is growing concern among policy experts, health department officials, doctors, and parents over the explosion in youth and young adult vaping.

According to the American Lung Association, 20% of teens vape and many fear that e-cigarettes will act as a gateway to traditional smoking.

Combustible Cigarettes vs. E-Cigarettes

We do know that vaping is less toxic than combustible cigarettes. Traditional cigarette smoke contains upwards of 7,000 toxins, including 250 poisonous and 70 cancer-causing chemical compounds. No level of secondhand cigarette smoke is considered safe to breathe.

E-cigarette emissions, on the other hand, contain far fewer toxins, in part because the vapor is not a byproduct of burning organic matter, but of heating the nicotine-containing liquid, which causes it to vaporize.

While e-cigarettes are advertised as less hazardous than traditional cigarettes, much is still unknown and they're definitely not harmless.

The Impact of Regulation

In the United States, tobacco products that are regulated must adhere to strict rules imposed by the FDA. 

These include: 

  • Manufacturers must register existing products and report product ingredients.
  • New products must be reviewed and approved by the FDA before going on the market.
  • Claims that products offer a reduced health risk must be backed up by science that the FDA confirms and also agrees that the product offers a benefit to society as a whole.
  • Tobacco products cannot be sold or given as samples to minors.

Originally, regulated tobacco products included cigarettes, cigarette tobacco, smokeless tobacco, and roll-your-own tobacco. In 2016, the FDA extended its umbrella of control over more tobacco products, including e-cigarettes, cigars, pipe tobacco, nicotine gels, hookah tobacco, and dissolvables.

These products are all now subject to the rules noted above, including listing health warnings on products, not selling them in vending machines at locations that are accessible to children, and adhering to minimum age and I.D. restrictions for sales.

Since becoming regulated, e-cigarettes now must include the exact amount of nicotine it claims to have and are now produced following quality control guidelines. Pharmaceutical grade nicotine is also mandated to be used in all U.S. nicotine replacement therapy (NRT) products, but this is not the case with e-cigarettes.

Finally, the quality of electronic cigarette devices can vary widely, which can affect vapor composition and toxicity.

E-Cigarettes Contain Deadly Toxins

E-cigarettes contain a number of toxins in varying amounts, including formaldehyde, acetaldehyde, acrolein, O-methyl benzaldehyde, acetone, volatile organic compounds, phenolic compounds, and polycyclic aromatic hydrocarbons. 

While the amounts of these chemicals are much less in e-cigarettes than in traditional cigarettes, there is a risk of exposure to some of the same chemicals that are hazardous in cigarette smoke.

Carcinogens

E-cigarette liquid and vapor has been shown to contain tobacco-specific nitrosamines (TSNAs), a group of four chemical compounds that are thought to be some of the most potent carcinogens in tobacco products and tobacco smoke. TSNAs are present in green tobacco and processed tobacco, including liquid nicotine.

TSNAs are associated with lung cancer, oral and esophageal cancer, liver cancer, and pancreatic cancer. There is growing evidence that TSNAs may contribute to cervical cancer.

Heavy Metals

E-cigarette emissions contain many toxic metals including chromium, a metal not present in cigarette smoke, zinc, cadmium, and lead. The concentrations are often much lower than in traditional cigarette smoke but are not zero. Nickel is present in levels four times higher than in regular cigarette smoke.

It is likely that the metals may come from the cartridges and that standardizing the quality of their construction may reduce these toxins.

E-Juice Is Poisonous

The "active" ingredient in e-cigarettes and the reason most people use them is nicotine, and nicotine is a highly addictive poison. It has been used in insecticides for years and is the addictive ingredient in both cigarettes and e-cigarettes.

According to a CDC study that reviewed calls to poison centers across the United States involving e-cigarette liquid containing nicotine, the incidence of accidental poisoning has skyrocketed in the last few years as e-cigarettes have gained in popularity.

There was just one call per month pertaining to liquid nicotine in September 2010 and 215 calls per month by February 2014. Approximately half of the calls involved children under the age of 5 being exposed to e-cigarette liquid and 42% from people over the age of 20.

When it first hit the market, e-liquid was available in several sweet candy flavors, which were especially appealing to kids. Poisoning occurs when nicotine-laced e-liquid is inhaled, ingested, or absorbed through the skin or eyes.

In an effort to reduce these poisonings and curb the epidemic use of e-cigarettes among youth, the FDA required e-cigarette companies to cease manufacturing and selling flavored vaping products (other than menthol and tobacco) by the end of January 2020. 

In December 2014, what may be the first death of a child due to liquid nicotine occurred in upstate New York state when a one-year-old who ingested liquid nicotine died soon after. Local police didn't confirm that the liquid nicotine was associated with e-cigarettes, but it is likely.

Earlier in 2014, a puppy in Britain got hold of an e-liquid cartridge and was dead within hours of chewing through it and ingesting a small amount of the liquid.

Concern Over Harm to Lungs

There is also a growing alarm over the still unexplained vaping-related deaths and lung complications (that may cause life long lung damage to those impacted) that came to light in 2019. This public health crisis is still being investigated but has heightened worry over the increasing popularity of vaping, particularly in youth populations.

E-Cigs Are a Smoking Alternative, Not a Quit Aid

Despite being marketed as a smoking cessation aid, e-cigarettes are a smoking alternative, not a quit aid. It turns out that instead of quitting smoking, most e-cigarette users actually keep smoking combustible cigarettes in addition to vaping. Additionally, the FDA has not found any e-cigarettes to be effective for smoking cessation.

However, some people do use the e-cigarette in an attempt to quit nicotine altogether, and some are achieving success with it. On the flip side, most e-cigarette users either transfer their addiction from tobacco to the device or eventually go back to smoking traditional cigarettes full time because they're still actively addicted to nicotine.

A Word From Verywell

If you're thinking of using e-cigarettes to quit smoking, be sure to first consider the serious risks vaping can pose and do some research on the quit aids available on the market today. Have a discussion about all of your options with your doctor, who can offer advice on the best smoking cessation methods for you.

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Article Sources
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  1. Lichtenberg K. E-Cigarettes: Current evidence and policy. Mo Med. 2017 Sep-Oct;114(5):335-338.

  2. Bold KW, Krishnan-Sarin S. E-cigarettes: Tobacco policy and regulation. Curr Addict Rep. 2019;6(2):75-85. doi:10.1007/s40429-019-00243-5

  3. U.S. Food and Drug Administration. The Facts on the FDA's New Tobacco Rule. Current as of June 16, 2016.

  4. American Lung Association. What's in an E-Cigarette? Updated December 11, 2019.

  5. University of Southern California. Secondhand E-Cigarette Smoke: Healthier Than Regular Cigarette Smoke, But Still Contains Some Toxic Elements. August 2014.

  6. Centers for Disease Control and Prevention. New CDC study finds dramatic increase in e-cigarette-related calls to poison centers. Published April 3, 2014.

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