Key E-Cigarette Information
What are they called?
The formal name is Electronic Nicotine Delivery Systems, or ENDS. The most common name is E-cigarettes, or E-cigs for short. Street names include E-hookah, Vape sticks, and Vape pens.
How do they work?
E-cigarettes are a relatively new product that delivers nicotine through a liquid (also called E-juice) consisting of glycerin and/or propylene glycol, as well as flavorings such as fruit, bubble gum, candy, gummy bear, and other flavors very attractive to youth. The basic components of an E-cigarette are a cartridge containing a nicotine solution, a heating element that aerosolizes the solution, and a power source for the heating element, which is usually a rechargeable lithium battery.
E-cigarettes emit fewer and less dense toxicants than combustible tobacco products. However, some deliver higher levels of nicotine and formaldehyde than conventional cigarettes. E-cigarette aerosol is not harmless “water vapor” and is not as safe as clean air.
What is in them?
While E-cigarettes do not contain tobacco, most contain nicotine and other harmful chemicals found in conventional cigarettes. The process of heating the nicotine solution to produce the aerosol also produces aldehyde, acetaldehyde, and acrolein, which are known carcinogens. The glycerin/propylene glycol and 8,000+ flavorings in E-cigs are found in many food products and are generally considered safe for human consumption. However, safety for these substances was established for eating them, not for aerosolizing and inhaling them into the lungs.
How harmful are they?
Besides containing known carcinogens and ingredients whose safety for inhalation has not been established, most E-cigarettes contain nicotine. E-cigarettes contain nicotine levels equivalent to and higher than conventional cigarettes. They can be purchased in several concentrations of nicotine, ranging from 0% to 36%. There is no known safe level of nicotine exposure to the developing fetus, and exposure during childhood is not recommended. Nicotine delivered by E-cigarettes during pregnancy could result in multiple adverse health consequences for normal child growth and development, including sudden infant death syndrome, altered brain corpus callosum, obesity, deficits in auditory processing causing delayed speech, deficits in attention and cognition, and various detrimental effects on appetitive behaviors. Research clearly shows that nicotine exposure during adolescence can quickly escalate into nicotine addiction. The younger the exposure to nicotine, the stronger the influence on the developing brain. Preteen exposure is associated with stronger nicotine addiction, impulse control problems and disruptive behaviors, and early engagement with other substances such as alcohol, marijuana, and other drug use. What typically begins as youthful experimentation can easily lead to a lifetime of nicotine addiction—and possibly drug abuse.
 Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. Journal of Physiology 2015;593(16):3397–3412. See online http://onlinelibrary.wiley.com/doi/10.1113/JP270492/epdf
Because they are so new, few studies have examined the short- and long-term health effects of E-cigarettes. What we do know is E-cigarettes contain nicotine, a highly addictive substance.
Because many E-liquids are custom-mixed by individuals at home, in homemade chemistry sets, and without safety regulations, the potential exists for additional health risks to E-cigarette users. Even commercial E-liquids are produced with unknown manufacturing procedures, packaging materials, and purity standards. Should children be smoking an E-liquid produced in a basement or garage?
E-cigarettes are a source of extremely high doses of ultrafine particles in the human respiratory system. These particles have been linked to cardiovascular disease in smokers, and early evidence suggests that the same biologic mechanism may apply to E-cigarette vapor.
Of greater concern are the 8,000+ added unique flavorings that are considered safe for use in food but have not been widely tested for their potential sensitizing, toxic, or irritating characteristics.
|Image selected from http://tobacco.stanford.edu/tobacco_main/subtheme_ecigs.php?token=fm_ecigs_mt037.php on 8/15/2016|
Nicotine and Child Health
- Nicotine is much more harmful to the immature teen brain compared to the developed adult brain.
- Even a little nicotine can lead to ADHD and compulsive disruptive disorders, which can contribute to classroom behavior problems.
- E-cigarettes can deliver nicotine in doses larger than regular cigarettes.
- Children and youth become addicted to nicotine faster than adults.
- Nicotine is a social and biological “gateway” for use of harder drugs.
- Nicotine is extremely harmful to the developing fetus. Pregnant teens need to know this!
- Drinking nicotine in E-juice is harmful and possibly fatal for babies and toddlers. It should be locked up!
- Nicotine overdose symptoms include rapid heart rate, nausea, elevated blood pressure, vomiting, diarrhea, dizziness, convulsion, and potentially seizure and death.
U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): USDHHS, CDC, Office on Smoking and Health. 2012.
U.S. Department of Health and Human Services. Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): USDHHS, CDC, Office on Smoking and Health 2014.
From 2011 to 2015, a disturbing trend has emerged:
E-cigarette use by our children is on the rise. In some states over 40% of middle school kids have tried an E-cigarette (over 50% in high school). Notice in Figures 1 & 2 that current E-cigarette use is rising, while regular smoking is falling. This data points to the fact that large numbers of American children will become addicted to nicotine and are at risk for becoming a regular tobacco user. That’s a death sentence.
SOURCE: Arrazola RA, et al. Tobacco use among middle and high school students—United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016 Apr 15;65 (14):361-7.
A mistaken belief held by many people about E-cigarettes pertains to “vapor” vs. “aerosol.”
Most people think E-cigarette smoke is harmless “vapor,” and some users will call themselves “vapers.” The tobacco industry prefers “vapor” because this implies harmless water.
Technically, the smoke emitted is an “aerosol,” not a “vapor.” There is no water in E-cigarette aerosol.
Aerosol: (aero = air; sol = solution) A liquid or solid suspended in a gas medium. An aerosol contains particles that are small enough (1–1000 millimicrons) to remain airborne for a considerable period of time.
Vapor: Visible particles of moisture floating in the air, such as fog, mist, or steam; any cloudy or imperceptible exhalation, such as smoke or noxious fumes.
Helpful Video Resources: Watch and share with your colleagues and friends.
- Are E-cigarettes Harmful? (Time: 1 minute 38 seconds)
- Surgeon General of the United States talks about health and E-cigarettes. (Time: 27 minutes)
- An excellent primer on E-cigarettes by Dr. Terry Pechacek from a public health perspective (Time: 40 minutes 48 seconds)
Glossary of E-cigarette Terms
Increase your vocabulary. There are many new words associated with E-cigarettes. The list continues to grow as the industry expands. Visit http://www.bestclearomizer.com/ultimate-vaping-glossary/ for an up-to-date glossary of terms. Please note the E-cigarette Glossary is an industry website. The negative health effects of E-cigarettes are minimized and downplayed.
This industry wants kids to think that aerosol is just harmless water. The site’s misleading definition for vapor is “the atomization of e-liquid which results in a fog juice vapor which is commonly accepted to be exhaled as water vapor (steam). This is the main visible factor in vaping that simulates smoke, but is a much safer alternative.” (Accessed May 2016).
Rules for Sales of E-Cigarettes and Other Electronic Nicotine Delivery Systems (ENDS)
Note: If you mix e-liquids or make or modify vaporizers, and you also sell these products, you will be regulated as both a retailer and a tobacco product manufacturer.
- Check photo ID of everyone under age 27 who attempts to purchase e-cigarettes or other ENDS.
- Only sell e-cigarettes and other ENDS to customers age 18 and older.
- Do NOT sell e-cigarettes or other ENDS in a vending machine unless in an adult-only facility.
- Do NOT give away free samples of e-cigarettes or other ENDS, including any of their components or parts.
Beginning June 11, 2018, these rules apply to all “covered tobacco products”:
- Do NOT sell or distribute e-cigarettes or other ENDS without a health warning statement on the package.
- Do NOT display advertisements for e-cigarettes or other ENDS without a health warning statement.
Rules for Sales of Nicotine Gels
- Check photo ID of everyone under age 27 who attempts to purchase nicotine gel.
- Only sell nicotine gel to customers age 18 and older.3
- Do NOT sell nicotine gel in a vending machine unless in an adult-only facility.3
- Do NOT give away free samples of nicotine gel.
Beginning June 11, 2018:
- Do NOT sell or distribute nicotine gel without a warning statement on the package.1
- Do NOT display advertisements for nicotine gel without a warning statement.1
 Taken from FDA Website (accessed August 16, 2016) http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/Retail/ucm205021.htm?gclid=CMmerqvaxc4CFY88gQodHssOWQ#ecig