What Are Electronic Cigarettes?

Electronic cigarettes, also known as e-cigs, e-hookahs, mods, vape pens, vapes, tank systems, and electronic nicotine delivery systems (ENDS), are devices that allow users to inhale an aerosol, often containing nicotine, and other chemicals. These devices come in various shapes and sizes, with most having a battery, a heating element, and an area to hold a liquid.

Note: The use of an electronic cigarette is often termed as “vaping.”

Different Types of Electronic Cigarettes

Electronic cigarettes come in various forms, mimicking everyday items to make them more user-friendly. Some resemble regular cigarettes, cigars, or pipes, while others look like pens, USB sticks, and other common items. Larger devices, known as tank systems or mods, do not mimic other tobacco products.

How Do Electronic Cigarettes Work?

Electronic cigarettes operate by heating a liquid (usually containing nicotine) to create an aerosol, which the users then inhale into their lungs. This aerosol can also affect bystanders who breathe in the exhaled aerosol.

Composition of E-cigarette Aerosol

The aerosol from electronic cigarettes can contain harmful and potentially harmful substances, including:

• Nicotine
• Ultrafine particles that can be inhaled deep into the lungs
• Flavorings such as diacetyl, a chemical linked to serious lung disease
• Volatile organic compounds
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead

The Potential Benefits of Electronic Cigarettes

Despite the potential risks, electronic cigarettes have been touted as a beneficial tool for adult smokers if used as a complete substitute for regular cigarettes and other smoked tobacco products.

Can E-cigarettes Help in Smoking Cessation?

The potential of electronic cigarettes as a tool to help adults quit smoking is still a topic of ongoing research. Although some studies have found evidence of their effectiveness, other research has been inconclusive. Until an FDA review, the safest and most evidence-based cessation strategy should include a combination of counseling, nicotine replacement therapy, and/or cessation drugs like varenicline.

The Risks of Electronic Cigarettes

Despite the potential benefits, electronic cigarettes are not without their risks. They are deemed unsafe for youth, young adults, pregnant adults, and adults who do not currently use tobacco products.

Nicotine and Health Risks

Nicotine, a common ingredient in most electronic cigarettes, is highly addictive and poses several health risks. It is toxic to developing fetuses and can harm adolescent and young adult brain development, which continues into the early to mid-20s. Moreover, nicotine is a health danger for pregnant adults and their developing babies.

Health Risks of E-cigarette Aerosol

Besides nicotine, e-cigarette aerosol can contain substances that harm the body. This includes cancer-causing chemicals and tiny particles that reach deep into the lungs. However, it is worth noting that e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.

Unintended Injuries from E-cigarettes

Electronic cigarettes can cause unintended injuries. Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions occurred when the e-cigarette batteries were being charged.

In addition, acute nicotine exposure can be toxic. There have been instances where children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.

E-cigarettes: Less Harmful than Regular Cigarettes?

The debate on whether electronic cigarettes are less harmful than regular cigarettes is complex. While e-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.

The Controversy Surrounding E-cigarettes

The claim from Public Health England that e-cigarettes are definitively 95% safer than traditional cigarettes has been a subject of controversy. Critics argue that the analysis conducted in 2013, which led to this claim, did not take into account the recent research on the health effects of vaping. The claim also fails to acknowledge the potential for negative net public health impact among a population of users that have otherwise never used tobacco products.

The Popularity of E-cigarettes

Electronic cigarettes have gained significant popularity over the years. They are the most commonly used tobacco product among youth. In 2022, 2.55 million U.S. middle and high school students used e-cigarettes in the past 30 days. In 2021, 4.5% of U.S. adults currently used e-cigarettes.

The Need for Regulation

The recent outbreak of vaping-related lung injuries has underscored the need for regulation in the e-cigarette market. This outbreak dramatically demonstrates the dangers of an unregulated market in inhaled substances, with no premarket review for consumer safety.

The Issue of Variability in E-cigarettes

There is enormous variability within the product category of electronic cigarettes. The products include different ingredients, different hardware, and deliver highly variable amounts of nicotine and potentially toxic chemicals. This variation makes it difficult to issue overall public health recommendations about the category and demonstrates the huge and long-standing need for pre-market review of these products.

Are E-cigarettes Safer?

The growing evidence of potential health risks and lung injuries related to e-cigarette use has led researchers to question whether electronic cigarettes are safer than combustible cigarettes. Recent studies suggest that e-cigarettes may present their own unique health risks, including to the respiratory and cardiovascular systems.