What is it?
What are e-cigarettes?
From the CDC:
E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.
E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—flavorings, and other chemicals that help to make the aerosol.
Users inhale this aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales into the air.
E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
Some e-cigarettes are made to look like regular cigarettes, cigars, or pipes. Some resemble pens, USB sticks, and other everyday items. Larger devices such as tank systems, or “mods,” do not resemble other tobacco products.
Using an e-cigarette is sometimes called “vaping.”
E-cigarettes can be used to deliver marijuana and other drugs.
What is in e-cigarette aerosol?
The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:
- The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:
- Ultrafine particles that can be inhaled deep into the lungs
- Flavoring such as diacetyl, a chemical linked to a serious lung disease
- Volatile organic compounds
- Cancer-causing chemicals
- Heavy metals such as nickel, tin, and lead
It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.
What are the health effects of using e-cigarettes?
E-cigarettes are still fairly new, and scientists are still learning about their long-term health effects. Here is what we know now:
- Most e-cigarettes contain nicotine, which has known health effects.
- Nicotine is highly addictive.
- Nicotine is toxic to developing fetuses.
- Nicotine can harm adolescent brain development, which continues into the early to mid-20s.
- Nicotine is a health danger for pregnant women and their developing babies.
Besides nicotine, e-cigarette aerosol can contain substances that harm the body.
This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.
E-cigarettes can cause unintended injuries.
Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the e-cigarette batteries were being charged.
The Food and Drug Administration (FDA) collects data to help address this issue. You can report an e-cigarette explosion, or any other unexpected health or safety issue with an e-cigarette, here.
In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.
What are the risks of e-cigarettes for youth, young adults and pregnant women?
Most e-cigarettes contain nicotine, which is addictive and toxic to developing fetuses. Nicotine exposure can also harm adolescent brain development, which continues into the early to mid-20s.
E-cigarette aerosol can contain chemicals that are harmful to the lungs. And youth e-cigarette use is associated with the use of other tobacco products, including cigarettes.
For more information about the risks of e-cigarettes for young people, visit Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults.
Are e-cigarettes less harmful than regular cigarettes?
Yes—but that doesn’t mean e-cigarettes are safe.
E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes.
However, 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.
Can e-cigarettes help adults quit smoking cigarettes?
E-cigarettes are not currently approved by the FDA as a quit smoking aid. The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, including pregnant women.
However, e-cigarettes may help non-pregnant adult smokers if used as a complete substitute for all cigarettes and other smoked tobacco products.
To date, the few studies on the issue are mixed. A Cochrane Review found evidence from two randomized controlled trials that e-cigarettes with nicotine can help smokers stop smoking in the long term compared with placebo (non-nicotine) e-cigarettes.
However, there are some limitations to the existing research, including the small number of trials, small sample sizes, and wide margins of error around the estimates.
A recent CDC study found that many adults are using e-cigarettes in an attempt to quit smoking. However, most adult e-cigarette users do not stop smoking cigarettes and are instead continuing to use both products (known as “dual use”).
Dual use is not an effective way to safeguard your health, whether you’re using e-cigarettes, smokeless tobacco, or other tobacco products in addition to regular cigarettes. Because smoking even a few cigarettes a day can be dangerous, quitting smoking completely is very important to protect your health.
Who is using e-cigarettes?
E-cigarettes are now the most commonly used tobacco product among youth.
In the United States, youth are more likely than adults to use e-cigarettes.
In 2016, more than 2 million U.S. middle and high school students used e-cigarettes in the past 30 days, including 4.3% of middle school students and 11.3% of high school students.
In 2016, 3.2% of U.S. adults were current e-cigarette users.
In 2015, among adult e-cigarette users overall, 58.8% also were current regular cigarette smokers, 29.8% were former regular cigarette smokers, and 11.4% had never been regular cigarette smokers.
Among current e-cigarette users aged 45 years and older in 2015, most were either current or former regular cigarette smokers, and 1.3% had never been cigarette smokers. In contrast, among current e-cigarette users aged 18–24 years, 40.0% had never been regular cigarette smokers.
Guide for quitting smoking: Provides free resources, including a mobile app and quit guide.
Information for parents, caregivers, and influencers of youth and young adults about e-cigarettes: Features comprehensive information about the impact of e-cigarette use among young people, and includes resources such as a tip sheet for parents to talk to their teens about e-cigarettes.
Surgeon General’s Report on E-cigarette Use Among Youth and Young Adults: Released in 2016, this is the first report issued by a federal agency to comprehensively review the public health issue of e-cigarette use among youth and young adults.
The report’s scientific findings are based on the best available evidence regarding a variety of topics, including trends in e-cigarette use; health effects of e-cigarettes, nicotine, and secondhand e-cigarette aerosol; e-cigarette marketing and advertising; and evidence-based strategies to reduce e-cigarette use among young people.
State laws and policies regarding e-cigarettes: This CDC fact sheet reports on laws pertaining to sales, use, and taxation of e-cigarettes in the 50 states and the District of Columbia.
1. US Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the Surgeon General [PDF–8.47 MB]. Atlanta, GA: US Department of Health and Human Services, CDC; 2016.
2. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the U.S., Korea, and Poland. Int J Drug Policy. 2015;26(6):583–588.
3. Patnode CP, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Evidence Synthesis No. 134. AHRQ Publication No. 14-05200-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
4. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Can electronic cigarettes help people stop smoking, and are they safe to use for this purpose? Published 13 September 2016.
5. Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA. Quit Methods Used by US Adult Cigarette Smokers, 2014–2016. Prev Chronic Dis 2017; 14:160600.
6. Bjartveit K, Tverdal A. Health Consequences of Smoking 1-4 Cigarettes Per Day. Tobacco Control 2005;14(5):315–20.
7. QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:1177.
8. Jamal A, Gentzke A, Hu SS, et al. Tobacco Use Among Middle and High School Students — United States, 2011–2016. MMWR Morb Mortal Wkly Rep 2017;66:597–603.
9. Quickstats: Percentage of adults who ever used an e-cigarette and percentage who currently use e-cigarettes, by age: National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017
JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.
JUUL has taken the world by storm. JUUL is currently the most popular electronic cigarette (e-cigarette) with a market share of 49.6% (http://tobaccocontrol.bmj.com/content/early/2018/04/13/tobaccocontrol-2018-054259)
All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.
News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.
Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.
Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC’s Infographic.
Why is nicotine unsafe for kids, teens, and young adults?
Most e-cigarettes contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products.
Nicotine can harm the developing adolescent brain.1 The brain keeps developing until about age 25.
Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.
Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.
Using nicotine in adolescence may also increase the risk for future addiction to other drugs.
What are the other risks of e-cigarettes for kids, teens and young adults?
Scientists are still learning about the long-term health effects of e-cigarettes.
Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.
Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.
Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.
Can using e-cigarettes lead to future cigarette smoking among kids, teens, and young adults?
Many young people who use e-cigarettes also smoke cigarettes. There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.
Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.
But e-cigarette use among young people is unsafe, even if they do not progress to future cigarette smoking.
What can I do about it?
Parents and Family Members
- Set a good example by being tobacco-free. If you use tobacco, it’s never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.
- Talk to your child or teen about why e-cigarettes are harmful to them. It’s never too late. Get the Talk With Your Teen About E-cigarettes tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful to them.
- Set up an appointment with your child’s health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.
- Speak with your child’s teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.
- Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.
Pediatricians and Family Physicians
- Inform patients and families of some of the facts about e-cigarettes; ENDS emissions are not harmless water vapor, ENDS are not recommended for smoking cessation, etc.
- If you see pregnant woman as patients, inform then ENDS are not a safer alternative to combustible cigarettes for use during pregnancy and for the best pregnancy outcomes, patients should completely quit using any nicotine-product.
- Ask the right questions: “Do you smoke?” is a less effective way to get patients talking. Also ask patients, “Do you vape or use electronic cigarettes?”
- Help patients navigate the cessation options that are covered by insurance, low-cost or even free for them to use.
- For more information: https://www.aap.org/en-us/Documents/5AsENDSfactsheet.pdf
School Administrators and Educators
- Set a good example by being tobacco-free. Don’t use tobacco in front of your students or on school grounds. If you use tobacco, it’s never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.
- Pass a 100% Comprehensive Tobacco-Free School Policy. Prohibit using all types of tobacco products on all school premises, at all times, especially during school-sponsored events, such as outdoor athletic events. Download our 100% Tobacco-Free Schools Model Policy: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/tobacco-use-prevention-and-cessation/media/tfs-model-policy
- Update tobacco curriculum to include updated information on the dangers and risks of using electronic nicotine products, including JUUL. One strong curriculum is the CATCH My Breath curriculum, found here: https://catchinfo.org/enroll/
E-cigarette manufacturers market their products in different ways. They market through price discounts, social media, at the point of sale, etc. E-cigarette companies try to market their products to kids by putting the products at eye level and by disguising the product with kid-friendly flavors and colorful, attractive advertising.
Below are some examples of deceptive e-cigarette marketing:
You can view more images here: https://countertobacco.org/media-gallery/store-image-maps/
Youth Cessation Options (All Free of Charge)
- My Life, My Quit (Ohio Tobacco Quit Line). This program combines best practices for youth tobacco cessation adapted to include vaping and new ways to reach a coach using live text messages or online chat. The program includes educational materials designed for teens creating with youth input and through discussion with subject matter experts and community stakeholders. To enroll, text or call 1-855-891-9989 or visit mylifemyquit.com
- This is Quitting (Truth Initiative). This is Quitting is a free text message program created with input from teens, college students, and young adults who have attempted to, or successfully quit, e-cigarettes. The program is tailored by age group to give appropriate recommendations about quitting and also serves as a resource for parents looking to help their children who now vape. Youth and young adults can access the new e-cigarette quit program by texting "DITCHJUUL" to 88709. Parents and other adults looking to help young people quit should text "QUIT" to 202-899-7550. https://www.thetruth.com/articles/hot-topic/quit-vaping
- Ohio Tobacco Quitline. Provides cessation services to youth and young adults. 1-800-QUIT-NOW, 1-800-784-8669 (Available free of charge to adults over 18, as well - teacher, parents)
Resources for Pediatricians and Family Physicians
- JUULing: What Pediatricians and Families Need to Know (American Academy of Pediatrics). https://www.aap.org/en-us/Documents/AAP-JUUL-Factsheet.pdf
- E-Cigarette factsheet for physicians (American Academy of Pediatrics). https://www.aap.org/en-us/Documents/5AsENDSfactsheet.pdf
- Clinical Action Communication Regarding Unexplained Vaping-Associated Pulmonary Illness (Centers for Disease Control and Prevention). Please report any potential case to your local health department. https://emergency.cdc.gov/newsletters/coca/081619.htm
Youth Prevention Programs for Educators
- Know the Risks: A Youth Guide to E-Cigarettes (Centers for Disease Control and Prevention). This presentation is intended to inform youth about e-cigarettes. anyone can deliver this presentation using the resources available on the webpage. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/youth-guide-to-e-cigarettes-presentation.html
- CATCH My Breath Youth E-cigarette Prevention Program (Catch Global Foundation). Catch My BreatheTM is a youth e-cigarette, JUUL and vape prevention program specific to grades 5-12. https://catchinfo.org/modules/e-cigarettes/
- The Tobacco Prevention Toolkit (Stanford University). This is an educational resource that can be adapted to fit the individual needs of educators and students in all types of settings, including elementary, middle and high school; community-based organizations; and health-related agencies. http://med.stanford.edu/tobaccopreventiontoolkit/E-Cigs/ECigUnit6.html
- More information about Stanford Medicine's Prevention Toolkit is available at: https://office365stanford-my.sharepoint.com/:p:/g/personal/rceb3_stanford_edu/EaOQeNHvKp1GkTXekf16DZQBC-5bdf6BoUtsQyt2tLcu7Q
Resources for Parents
- JUUL and Youth. Rising E-Cigarette Popularity (Campaign for Tobacco-Free Kids). An informative document about JUUL products. https://youthengagementalliance.org/wp-content/uploads/2016/08/JUUL-Fact-Sheet-2-5-18.pdf
- Know the Risks E-Cigarettes & Young People (U.S. Surgeon General). A tip sheet for parents to talk with teens about e-cigarettes. https://e-cigarettes.surgeongeneral.gov/documents/SGR_ECig_ParentTipSheet_508.pdf
Resources for Students and Young Adults
- Know the Risks E-Cigarettes & Young People (U.S. Surgeon General). https://e-cigarettes.surgeongeneral.gov/documents/SGR_ECig_ParentTipSheet_508.pdf
- Concerns Explode Over New Health Risks of Vaping (Science News for Students). https://www.sciencenewsforstudents.org/article/concerns-explode-over-new-health-risks-vaping
- Electronic Cigarettes: What's the Bottom Line (Centers for Disease Control and Prevention) https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Electronic-Cigarettes-Infographic-508.pdf
Childhood Poisoning Prevention
According to the American Academy of Pediatrics, one teaspoon of liquid nicotine can be fatal in 26-pound child. Liquid nicotine bottles sold in the U.S. average six teaspoons. Poison control centers began receiving calls about e-cigarettes and liquid nicotine products in 2011, which coincides with the initial period where these products reached the U.S. market. Calls increased by 160% between 2013 (1,540) and 2014 (4,011). An average of 3,060 annual calls were recorded between 2015 and 2018. Data from American Association of Poison Control Centers. https://www.aapcc.org/track/ecigarettes-liquid-nicotine
- E-Cigarettes and Young Children: The Dangers of Liquid Nicotine Exposure (American Academy of Pediatrics). https://www.aappublications.org/news/2018/04/25/e-cigarettes-and-young-children-the-dangers-of-liquid-nicotine-exposure-pediatrics-4-25-18?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=AAPNews_TrendMD_0
- Studies Look at Dangers of E-Cigarettes; AAP Continues Push for Regulations (American Academy of Pediatrics). https://www.aappublications.org/news/2018/04/23/ecigarettes042318?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=AAPNews_TrendMD_0
- E-Cigarettes Rising Cause of Nicotine Poisoning in Children (Medscape). https://www.medscape.com/viewarticle/863046?src=trendmd_pilot
General Research and Information
- Surgeon General’s Advisory on E-Cigarette Use Among Youth (Surgeon General). U.S. Surgeon General Jerome Adams, MD, MPH, issued a rare public health advisory in response to the unprecedented spike in e-cigarette use among youth. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf
- Public Health Consequences of E-Cigarettes (The National Academies of Sciences, Engineering, and Medicine).
- Full Report: http://nationalacademies.org/ecighealtheffects
- Conclusions by level of evidence: https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf
S. Amanda Burkett, MA, RS
Director, Tobacco Program
Ohio Department of Health
Amy Gorenflo, TTS
Cessation Services Program Administrator
Tobacco Use Prevention and Cessation Program
Ohio Department of Health
Taylor Kachmarik, MS
Public Health Consultant
Bureau of Maternal, Child and Family Health
Tobacco Use Prevention and Cessation Program
Ohio Department of Health