Expert Health Articles


Rick D. Watson, M.D.Rick D. Watson, M.D.

Blanchard Valley Medical Associates
Pulmonary and Critical Care Specialist

Electronic cigarettes (e-cigarettes) are a type of electronic nicotine delivery system that is battery operated and heats a liquid, usually propylene glycol or glycerine, along with flavoring agents and nicotine to create an aerosol for inhalation known as vaping. These products were invented in 2003 in China and now constitute over $2 billion in retail sales. This product was initially intended as a device to help adults quit smoking but is now being used as a recreational nicotine delivery device by adults and youth. 

There are several health concerns regarding electronic cigarettes from the point of view of the individual user, as well as public health concerns. The components of the aerosol generated by the electronic cigarette include carcinogens, irritants such as acrolein, formaldehyde and nicotine byproducts. The chemicals generated by the variety of flavors used for electronic cigarettes are unknown. The electronic cigarette devices vary widely in the production of these chemicals, as well as the concentrations of nicotine, and can be altered by the user. In general, the amount of toxins produced by electronic cigarettes is less than conventional cigarettes; however, safe levels have not been established. Nicotine-containing refill liquids are colorful and appealing to children, and poisoning related to ingestion has increased markedly and can be fatal. 

From a personal standpoint, concern about the use of electronic cigarettes is largely due to the unknown nature of the chemicals being inhaled and their long-term side effects (It took decades of use of conventional cigarettes until they were recognized as being the cause of lung cancer). Adult use of electronic cigarettes is largely related to an attempt to stop using conventional cigarettes; however, the data supporting this shows these devices do not improve cessation rates beyond what could be achieved by conventional smoking cessation tactics in most individuals. Unfortunately, some e-cigarette users continue to use conventional cigarettes and obtain none of the benefits of quitting. 

Concern regarding youth use of electronic cigarettes is twofold; the first being the adverse effects of nicotine on the developing brain, which is well established, and the second being that the youth e-cigarette user will progress to tobacco products in the future. A recent study of ninth grade students from Los Angeles has shown that those students who were using electronic cigarettes when they entered the ninth grade were much more likely to use conventional combustible tobacco products over the next year compared to those who were not using at entry into ninth grade. Access to electronic cigarettes by youth is not difficult due to the presence of local shops selling these products and their large presence on the internet. 

From a public health perspective, the use of e-cigarettes would be justified in traditional cigarette smokers who are trying to quit as this device appears to be a less toxic product. However, no good studies have proven its efficacy. Concerns over the safety also include the potential for abuse with the use of inhaled liquids containing marijuana or other drugs. Also, the exhaled vapor from the use of electronic cigarettes also contains many chemicals and some metals that have unknown safety for those exposed to secondhand vapors. The use of these products should not be permitted indoors based on recommendations from The American Heart Association, The American Thoracic Society and The World Health Organization. Lastly, the re-normalization of smoking behavior as cool, sexy or sophisticated, as is portrayed in the advertising of electronic cigarettes, can undermine public health efforts at smoking cessation and lead to a new generation of nicotine users.