By Sarah Miller, RN and Jessica Becker
Updated September 2013
Electronic cigarettes, or e-cigarettes, are being marketed as the “safe” new alternative to conventional cigarettes. They can be used indoors, allowing smokers to get their fix wherever and whenever they want. But are e-cigarettes safe? What does the FDA think about them? Are e-cigarettes going to reverse the decline in smoking—giving new life to an old habit—or can they help people quit smoking? Here is what you need to know before picking up an e-cigarette.
What are e-cigarettes?
E-cigarettes are battery-operated devices shaped like cigarettes that provide an alternative way to receive nicotine, the addictive chemical found in tobacco. They work by heating a liquid cartridge containing nicotine, flavors, and other chemicals into an inhalable vapor. Because e-cigarettes heat a liquid instead of tobacco, what is released is considered smokeless.1 However, studies show that exposure to the chemical used to create the vapor (propylene glycol mist) may cause respiratory inflammation and eye irritation.2
Are e-cigarettes safer than conventional cigarettes?
The key difference between conventional and e-cigarettes is that e-cigarettes don’t contain tobacco. But, it isn’t just the tobacco in cigarettes that causes cancer. Conventional cigarettes contain a laundry list of chemicals that are proven toxic, and e-cigarettes have some of these same chemicals.
Nicotine is one of the chemicals found in both conventional and e-cigarettes. It is addictive and has been shown to reduce bone health.3
An analysis of e-cigarettes by the FDA in 2009 found that they “contained detectable levels of known carcinogens and toxic chemicals to which users could be exposed”.4 For example, in e-cigarette cartridges marketed as “tobacco-free,” the FDA detected diethylene glycol (a toxic compound found in antifreeze), tobacco-specific nitrosamines which are carcinogenic to humans, and other toxic tobacco-specific impurities.5 The body’s reaction to many of the toxic chemicals in conventional cigarette smoke causes chronic inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease.5 Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will lessen the risks for these diseases.
You may have also heard that free radicals produced by the smoke from cigarettes can damage veins and arteries and lead to heart disease. It is possible that the vapor from e-cigarettes may contain fewer free radicals because it is not smoke. This does not mean, however, that smoking e-cigarettes is safe for your heart.
There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke. Cancer takes years to develop, and e-cigarettes were only very recently introduced to the United States. It is almost impossible to determine if a product increases a person’s risk of cancer or not until the product has been around for at least 15-20 years. Despite positive reviews from e-cigarette users who enjoy being able to smoke them where regular cigarettes are prohibited, very little is known about their safety and long-term health effects.
Can e-cigarettes be used to cut down or quit smoking regular cigarettes?
If a company makes a claim that its product can be used to treat a disease or addiction, like nicotine addiction, it must present studies to the FDA showing that its product is safe and effective for that use. On the basis of those studies, the FDA approves or doesn’t approve the product. So far, there are no good studies looking at whether e-cigarettes can be used to cut down or quit smoking long-term. The few short-term studies that have been done were with a small number of smokers who were not randomly selected.6
The FDA has not approved e-cigarettes for use in cessation, or quitting smoking.7
In September 2010, the FDA sent a warning letter to five distributors of e-cigarettes who were marketing their product this way: E-CigaretteDirect LLC, Ruyan America INC., Gamucci America (Smokey Bayou INC.), E-Cig Technology INC. and Johnson’s Creek Enterprises LLC. After this warning letter, four of the companies changed their position to say that their e-cigarettes are not intended to be used as a way to quit smoking. E-Cig Technology INC. hasn’t made any changes to their website in response to the warning letter.
While some people say that e-cigarettes are helping them smoke fewer regular cigarettes, those are just personal anecdotes, which is very different from science or evidence. It is likely that e-cigarettes will lead to more people smoking since the laws prohibiting smoking in many places do not apply to them.
Teenagers and e-cigarettes
The percentage of teenagers who have tried e-cigarettes has more than doubled in just a year, from 4.7% in 2011 to 10% in 2012. Over 1.78 million U.S. students in middle school and high school tried e-cigarettes in 2012, according to the National Youth Tobacco Survey. Furthermore, 1 in 5 middle schoolers who said they had tried e-cigarettes also said they had never smoked conventional cigarettes. 8 This is worrisome for two reasons: 1) the younger people are when they begin smoking, the more likely it is they will develop the habit: nearly 9 out of 10 smokers start before they are 18;9 2) e-cigarettes will introduce many more young people to smoking who might otherwise never have tried it, and once they are addicted to nicotine, some may decide to get their “fix” from regular cigarettes. Whether e-cigarettes end up being a “gateway” to regular cigarettes or not, young people who use them risk becoming addicted to nicotine and exposing their lungs to harmful chemicals.
The sharp rise in young e-cigarette users highlights the need to stop distributors from advertising e-cigarettes as a safe alternative to smoking tobacco.
How are e-cigarettes regulated?
Originally, the FDA tried to block the sale of e-cigarettes on grounds that they were an untested drug-delivery device (nicotine is a drug), but in 2010 a federal appeals court ruled that the FDA could only regulate e-cigarettes as tobacco products.10 The FDA was given the authority to regulate the manufacturing, labeling, distribution and marketing of all tobacco products in 2009 when President Obama signed into law the Family Smoking Prevention and Tobacco Control Act.
Even with this new Act, the FDA’s ability to regulate e-cigarettes is limited. However, individual states have the authority to implement more strict laws, or even ban e-cigarettes completely. For example, in May 2013, the California state senate proposed a law making all e-cigarettes subject to the same regulations and restrictions as traditional cigarettes and tobacco products.11
E-cigarettes have not been around long enough to determine if they are harmful to users in the long run. Studies by the FDA show that e-cigarettes contain some of the same toxic chemicals as regular cigarettes even though they don’t have tobacco.Unfortunately, many people, including teenagers, are under the impression that e-cigarettes have been proven safe. Unless you want to be a guinea pig, hold off on e-cigarettes until more safety information is available. And if you want to quit smoking or reduce the number of cigarettes you are smoking, check out these Quit Smoking Resources compiled by the Centers for Disease Control (CDC).
- Richard J. O’Connor Non-cigarette tobacco products: What have we learned and where are we headed? Tob Control. Author manuscript; available in PMC 2013 July 19. Published in final edited form as: Tob Control. 2012 March; 21(2): 181–190. doi: 10.1136/tobaccocontrol-2011-050281. ▲
- G Wieslander,D Norback, andT Lindgren. “Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory effects”. Occup Environ Med. 2001 October; 58(10): 649–655. < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740047/>. ▲
- Tanaka, H.,Tanabe, N., Kawato, T., Nakai, K., Kariya, T., Matsumoto, S., & … Maeno, M. (2013). Nicotine Affects Bone Resorption and Suppresses the Expression of Cathepsin K, MMP-9 and Vacuolar-Type H+-ATPase d2 and Actin Organization in Osteoclasts. Plos ONE, 8(3), 1-12. doi:10.1371/journal.pone.0059402. ▲
- Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA. FDA News & Events. FDA, 22 July 2009. Web. 09 Aug. 2013. <http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm>. ▲
- Stoller, JK & Juvelekian, G; Chronic Obstructive Pulmonary Disease; 2010 Cleveland Clinic Center for Continuing Education. Retrieved from www.clevelandclinic.meded.com/diseasemanagement/chronic-obstructive-pulmonary-disease on Sept. 2, 2010. ▲
- Odum, L. E., O’Dell, K. A., & Schepers, J. S. (2012). Electronic Cigarettes: Do They Have a Role in Smoking Cessation?. Journal Of Pharmacy Practice, 25(6), 611-614. doi:10.1177/0897190012451909. ▲
- Electronic Cigarettes FDA News & Events. FDA, 25 July 2013. Accessed 14 Aug. 2013. <http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm>. ▲
- Centers for Disease Control and Prevention. E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012. Accessed September 25, 2013. Available at: http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html ▲
- Centers for Disease Control and Prevention. Fact sheets: Youth and tobacco use. Accessed September 25, 2013. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/ ▲
- “Regulation of E-Cigarettes and Other Tobacco Products.” FDA News & Events. FDA, April 25, 2011. Accessed: Aug. 20, 2013. <http://www.fda.gov/newsevents/publichealthfocus/ucm252360.htm>. ▲
- Corbett, E.M. (2013) Electronic cigarettes: restriction of use and advertising. LEGISLATIVE COUNSEL’S DIGEST. February 22, 2013. Accessed: August 20, 2013. http://leginfo.ca.gov/pub/13-14/bill/sen/sb_0601-0650/sb_648_bill_20130222_introduced.html. ▲