Electronic cigarettes, also known as e-cigarettes, e-vaporizers, vapes, or electronic nicotine delivery systems, are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. Some common nicknames for e-cigarettes include e-cigs, vapes, vape pens, and mods (customizable, more powerful vaporizers). Using an e-cigarette is most commonly referred to as "vaping". E-cigarettes come in many shapes and sizes but commonly have a power source (battery), a heating element (atomizer), a mouthpiece, and a cartridge or reservoir to hold liquid. Vapes produce an aerosol by heating a liquid that usually contains nicotine, 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 were developed and marketed as alternatives to traditional combustible cigarettes. However, e-cigarettes are not an FDA-approved quit aid, and there is no conclusive scientific evidence on the effectiveness of e-cigarettes for long-term smoking cessation. They have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products. However, E-cigarettes still contain nicotine, the chemical that makes traditional cigarettes addictive. They are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.
Some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to them as a complete replacement. However, there are still important health effects to using e-cigarettes.
Known health effects of nicotine:
- Nicotine is addictive
- Nicotine is harmful to developing fetuses
- Nicotine can harm adolescent brain development, which continues into the early to mid-20s
Use exposes the lungs to a variety of chemicals:
- Including those added to e-liquids, and other chemicals produced during the heating/vaporizing process
- The aerosol created by e-cigarettes can contain ingredients that are harmful and potentially harmful to the public’s health, including: nicotine; ultrafine particles; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead
E-cigarettes can be used to deliver drugs other than nicotine. Some are designed for the purpose of delivering marijuana and marijuana concentrates, or oils such as CBD. These devices contain a battery, a heating element (bowl or atomizer), and a mouthpiece. They are designed to be discreet and often look like pens, cosmetics, or USB flash drives.
A recent study published in the Journal of Drug and Alcohol Dependence examined the potential for e-cigarette devices to be used for illicit drug delivery. A systematic literature search and review of online drug forums found evidence of current use of e-cigarettes to vape illicit drugs including:
- marijuana and synthetic cannabinoids,
- crack cocaine,
- synthetic cathinones ("bath salts"), and
E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States. In the United States, youth are more likely to use e-cigarettes than adults. According to the CDC, In 2016, more than 2 million U.S. middle and high school students used e-cigarettes in the past 30 days. Their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they're safer than cigarettes have helped make them appealing to teens.According to the National Institute on Drug Abuse, e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death.
Because nicotine affects the development of the brain's reward system, continued e-cigarette use can not only lead to nicotine addiction, but it also can make other drugs such as cocaine and methamphetamine more pleasurable to a teen's developing brain (U.S. Surgeon General's Report, 2016).The 2017 Idaho Healthy Youth Survey (IHYS) asked questions about e-cigarette and vaping risk perception and use. The IHYS found:
- 36.5% of youth surveyed think there is "no risk" or "slight risk" of harming themselves physically or in other ways when they use a vape pen or e-cigarette.
- 23.9% have used a vape pen or e-cigarette at least once, while 5.1% used 100 times or more.
- 13.9% of students used a vape pen or e-cigarette in the past 30 days, with 3.3% using on 20 or more of the past 30 days.
Be Aware of JUUL
JUUL is a popular 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 liquid to produce an aerosol that is inhaled. 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. Although JUUL is currently the top-selling e-cigarette in the U.S., other e-cigarettes are becoming available that look like USB flash drives. Because of their shape, school teachers might not notice students using JUUL in school, including in classrooms and bathrooms. Check out the Truth Initiative report - Behind the Explosive Growth of JUUL.
In 2016, the FDA established a rule for e-cigarettes and their liquid solutions. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products. This means:
- It is illegal to sell e-cigarettes, hookah tobacco, or cigars in person or online to anyone under age 18.
- Buyers have to show their photo ID to purchase e-cigarettes, hookah tobacco, or cigars, verifying that they are 18 years or older.
- These products cannot be sold in vending machines (unless in an adult-only facility).
- It is illegal to hand out free samples.
The FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories For more information about this ruling, visit the FDA's webpage, The Facts on the FDA's New Tobacco Rule.
The FDA Commissioner released a statement regarding new enforcement actions and a plan to prevent youth e-cigarette use, specifically calling out JUUL, in August, 2018 and an additional statement in November 2018 with plans to limit access to flavored tobacco products.
"Electronic Cigarette" means any device that can provide an inhaled dose of nicotine by delivering a vaporized solution [and] includes the components of an electronic cigarette including, but not limited to, liquid nicotine.
39-5705: Sale or Distribution of Tobacco Products and Electronic Cigarettes to a Minor
Requirement to check ID And verify age before selling an e-cigarette
It shall be unlawful to sell, distribute or offer tobacco products or electronic cigarettes to a minor.
39-5706: Vendor Assisted Sales
Vending machine sales and self-service displays are restricted to adult-only tobacco stores that are clearly marked as such.
It shall be unlawful to sell, distribute or offer tobacco products or electronic cigarettes by any means other than vendor assisted sales where the customer has no access to the product except through the assistance of the seller.
Preventing youth use of e-cigarettes and other vaping devices will require community-based efforts to monitor the activities of youth and decrease youth access to devices, e-liquids, and other illicit substances. Prevention strategies for the prevention of youth vaping include establishment and enforcement of laws restricting access, informing parents and educators of the health harms and what to look for, media campaigns targeting youth and adults, reducing youth exposure to e-cigarette advertising, and implementation of evidence-based prevention programs.
Students who participate in 1 or more days of supervised after-school activities are less likely to have ever used e-cigarettes. After-school activities provide:
- Supervision by positive adult role models
- Youth leadership opportunities
- Incorporation of skills building
- A piece of a comprehensive prevention plan
Addressing risk factors early and paying careful attention to children at higher risk can reduce that child’s likelihood of a future problem. This is a simplified list of some overall risk factors. Learn more at youth.gov
- Family history of substance use disorders
- Mental health or behavioral issues
- Impulse control problems
Protective factors may reduce the risk of youth engaging in substance use. Increasing protective factors in addition to reducing risk factors can be more effective in preventing substance use.
- Ability to make friends and get along with others
- Reliable support and discipline from caregivers
- Mastery of academic skills (math, reading, writing)
- School Engagement
These are simplified lists of some overall risk and protective factors. Learn more at youth.gov
Many teens believe e-cigarettes are safer than cigarettes or don't know there is nicotine in the e-liquid. Others simply think it is cool, or easy to get away with. Talking to them can generate open communication and expectations about e-cigarette use. The Surgeon General's Parent Tip Sheet provides information about e-cigarettes and tips for talking to your kids about them in English and Spanish.