E-Cigarettes 101

By R. Morgan Griffin, WebMD Feature
Reviewed by Arefa Cassoobhoy, MD, MPH

Electronic cigarettes: Are they safer than tobacco? Or are they a high-tech way to hook a new generation on a bad nicotine habit?

Nobody knows yet.

Research into the effects of e-cigarettes lags behind their popularity. But ready or not, the era of e-cigarettes is here. It’s a booming, billion-dollar industry -- on track to outsell tobacco products within a decade. The number of teens and tweens using these products doubled between 2011 and 2012.

The time to get informed about these products is now.

How E-Cigarettes Work

They look like the real thing. The end glows as you inhale. As you exhale, you puff out a cloud of what looks like smoke. It's vapor, similar to the fog you might see at rock shows, says M. Brad Drummond, MD. He's an assistant professor of medicine at Johns Hopkins University School of Medicine.

All e-cigarettes work basically the same way. Inside, there's a battery, a heating element, and a cartridge that holds nicotine and other liquids and flavorings. Features and costs vary. Some are disposable. Others have a rechargeable battery and refillable cartridges.

Using an e-cigarette is called "vaping."

Are They Safe?

The nicotine inside the cartridges is addictive. When you stop using it, you can get withdrawal symptoms including feeling irritable, depressed, restless and anxious. It can be dangerous for people with heart problems. It may also harm your arteries over time.

So far, evidence suggests that e-cigarettes may be safer than regular cigarettes. The biggest danger from tobacco is the smoke, and e-cigarettes don't burn. Tests show the levels of dangerous chemicals they give off are a fraction of what you'd get from a real cigarette. But what's in them can vary.

"E-cigarettes may be less harmful than cigarettes," Drummond says. "But we still don't know enough about their long-term risks or the effects of secondhand exposure."

Pro and Con

E-cigarettes have triggered a fierce debate among health experts who share the same goal -- reducing the disease and death caused by tobacco. But they disagree about whether e-cigarettes make the problem better or worse.

Opponents say that because nicotine is addictive, e-cigarettes could be a "gateway drug," leading nonsmokers and kids to use tobacco. They also worry that manufacturers -- with huge advertising budgets and celebrity endorsements -- could make smoking popular again. That would roll back decades of progress in getting people to quit or never start smoking.

Others look at possible benefits for smokers. "Obviously, it would be best if smokers could quit completely," says Michael Siegel, MD, MPH, a professor at Boston University's School of Public Health. "But if that's not possible, I think they'd be a lot better off with e-cigarettes. They're a safer alternative."

Siegel compares replacing tobacco with e-cigarettes to heroin users switching to the painkiller methadone. The replacement may have its own risks, but it's safer.

Some supporters believe that e-cigarettes could help people quit, just like nicotine gum. Initial research looks promising, but more long term, in-depth studies are needed.

What Parents Should Know

  • Nicotine can affect brain development in children and teens, Drummond says.
  • Some e-cigarettes have candy flavoring, which could make them appealing to kids.
  • They don't leave a smell like tobacco. So it's harder for parents to know if their kids are vaping.

What Adults and Smokers Need to Know

  • If you don't smoke, don't start vaping. There are no health benefits and some risks.
  • If you smoke and are trying to quit, you're better off with an FDA-approved method of quitting, Drummond says, like the nicotine patch or gum. There's good evidence that they help. E-cigarettes may turn out to be an effective way to quit, but we don't have the proof yet.
  • If you're not planning to quit, would it be healthier to switch from tobacco products to e-cigarettes? Maybe. Talk to your doctor about the risks and benefits.

While experts debate, some cities -- like Boston, Los Angeles, and New York -- have passed laws about how people can buy or use e-cigarettes in public.

Bigger, changes are likely.

The FDA has proposed new regulations that would extend the agency’s authority over many tobacco products, including e-cigarettes.

A minimum age requirement is among the proposed regulations.

Tobacco-Free Campus Information

Reasons to Include E-Cigarettes in Your Tobacco-Free (TF) Campus Policy

5 Important Lessons From the Biggest E-Cigarette Study

Traditional vs. Commercial Tobacco Use

Tobacco can make you sick if not used properly. Indian teens who smoke, chew or dip tobacco focus on the pleasure it gives them. They forget its harmful effects. Commercial tobacco is packed with poison, such as nicotine, and is very addictive. It tricks you into thinking it is harmless, but can cause serious health problems such as cancer.

Traditional tobacco is a gift from Mother Earth. It should be respected and used properly just like sweetgrass, sage, and cedar. Tobacco is a Medicine used by our people to pray with. It provides us with spiritual strength, guidance, discipline and protection. You should never abuse such a gift.

Indian teens can choose to be healthy and learn to use tobacco in a respectful and sacred way. This way you will help carry on the traditional ways of our Indian people. Make your elders and your ancestors proud.

Tobacco is sacred! Be Respectful!

Traditional Tobacco

  • When tobacco is offered to the earth and fire, it is held in the hand and not smoked.
  • Some sacred pipes are smoked but not all pipes contain tobacco. Some tribes don’t use tobacco at all and some will use a blend of tobacco and other herbs.
  • Traditional tobacco teaches you discipline.
  • You learn respect for the creator and all creation.
  • You have a better understanding for your Indian culture.
  • Traditional tobacco is free of chemicals and poisons.
  • You gain spiritual development towards being a good person.
  • You use it to pray with and is considered a Medicine for one’s health and well being.
  • It is used less than once a month. There is no risk of cancer when used this way

Commercial Tobacco

  • Very high risk of cancer if you use chew, snuff, or smoke cigarettes.
  • Gives you an unpleasant odor and bad breath.
  • Chewing leads to gum disease, tooth decay and cancer of the mouth and throat.
  • Commercial tobacco contains harmful chemicals such as arsenic (poison), acetone (nail polish remover), methanol (anti-freeze), nicotine (insecticide),ammonia (window cleaner), carbon monoxide (car exhaust), cyanide (rat poison), dimethyl benzyl (toilet bowl cleaner), formaldehyde (preserves dead tissue).
  • When used daily it is easy to forget its harmful effects.
  • It is highly addictive.
  • Cigarettes discolor your teeth, cause lung cancer and heart disease.
  • Smoking can permanently damage your eyes, throat, bones, joints and skin-even if you later quit

Information from A Toe & A Can Designs, LLC.
Click here to see the full brochure.

Cigar Smoking Vs. Cigarette Smoking


Published in the NY Times, regarding e-cigarette regulations: http://www.nytimes.com/roomfordebate/2014/05/04/how-should-electronic-cigarretes-be-regulated/rules-for-e-cigarettes-were-long-overdue

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