Electronic cigarettes or e-cigarettes first came on the market in 2003 as an alternative to tobacco cigarettes and an aid to quitting smoking. More than 10 million people participate in vaping every day, either in an attempt to reduce their use of tobacco cigarettes or recreationally. Despite these high numbers, there has been no definitive agreement on the ability of these devices to help people quit. Likewise, researchers have yet to identify the full extent of the short- and long-term risks of vaping.

How do E-cigarettes Work, and What is in Them?

An e-cigarette is a device that allows the user to inhale nicotine in a vapor rather than as smoke. The battery-powered devices heat a liquid that usually contains propylene glycol, glycerol, nicotine, and flavorings. Most contain a wide variety of additional chemicals. Some vaping devices do not contain nicotine.

The liquid is contained in disposable or refillable cartridges or a reservoir and is vaporized by the heat, producing ultrafine particles. Some devices allow the user to increase the temperature of the heating element to deliver more or less nicotine. There are more than 7000 unique flavorings available to e-cigarette users, which helps explain their popularity.

Girl using e-cigarette John Keeble / Getty Images


Smoking Habits

Extensive marketing has gone into promoting e-cigarettes as aids to quit smoking and their use continues to increase and is most common among smokers. However, there is insufficient data to recommend them as an effective cessation method. Studies show that e-cigarettes are no more or less effective in helping people stop smoking than nicotine replacement therapy. There has been a reduction in the use of tobacco cigarettes in e-cigarette users, but many e-cigarette users are continuing to smoke tobacco cigarettes as well.

Man vaping tolgart / Getty Images


Are E-cigarettes Safe?

The exact composition of the vapor from e-cigarettes varies greatly across all the products, which makes investigating the health effects of e-cigarettes very challenging. Some of the additives are present in many products we use in our daily lives and are tested for their safety in this context. However, inhaling requires a new body of research. Propylene glycol and glycerin are common additives in food products and cosmetics, but the former is also in antifreeze and paint solvent. When the liquids are heated, they produce additional toxic chemicals, including formaldehyde, acetaldehyde, and heavy metals such as nickel, tin, and lead. The ultrafine particles produced on heating the e-liquids carry these potentially toxic chemicals deep into the lungs.

Research recognizes that e-cigarettes contain levels of toxic chemicals that are below those in tobacco cigarettes, but they may not be below harmful levels. The nicotine content also raises concerns over safety. Overall, compared to tobacco smoke, there are fewer toxic chemicals and lower concentrations of these chemicals in e-cigarette vapor. However, there is no substantial evidence that e-cigarettes are safe in long term use.

E-cigarette liquids Justin Sullivan / Getty Images


Short Term Effects

E-cigarettes appear to pose fewer adverse effects in the short term than tobacco cigarettes, but this doesn't mean they are risk-free. Propylene glycol from the vapor can have a drying effect on the mouth and throat. Other side effects include coughing, wheezing, headache, mouth irritation, eye irritation, abdominal pain, nausea, and vomiting.

Young man with sore throat bymuratdeniz / Getty Images


Long Term Effects

The long-term effects of e-cigarettes are unknown. Nicotine increases heart rate and blood pressure and reduces the amount of oxygen reaching the heart, increasing the risk of heart attacks. In the lungs, inhaled nicotine can increase inflammation and cause chronic lung disease. There are concerns over dental health with prolonged e-cigarette use; nicotine can damage the tissues of the gum, causing periodontal disease.

Vaping smoke Dan Kitwood / Getty Images


Vaping Disease

Multiple cases of severe lung disease reported in the US, UK, and Japan are believed to be connected to vaping, and could be categorized as vaping disease or vaping associated pulmonary injury (VAPI). In many instances, the e-cigarettes used contained tetrahydrocannabinol (THC). This is the active ingredient in cannabis that produces the “high” and is added to some e-cigarette liquids. The worst affected were young people, previously fit and healthy and under the age of 20 years, who experienced a cough, sore throat, difficulty breathing, chest pain, and fever within a week after starting e-cigarettes. Many also developed nausea, vomiting, abdominal pain, and diarrhea. The majority of people recovered over the following weeks. In a small number of young people, these symptoms progressed to breathing failure and, in some cases, death.

Intensive care bed vm / Getty Images


The Cause of Vaping Disease

It is still too early to fully understand the underlying cause of vaping-related illness. Experts believe it may be related to the vaping of cannabis oils. Vitamin E acetate has been used in conjunction with tetrahydrocannabinol in the liquids, and some researchers suspect this combination is dangerous. There is also a possible link to e-cigarettes from informal sources and online dealers; many people who develop VAPI appear to have purchased from these sources.

Vaping merchandise Matt Cardy / Getty Images


E-cigarettes and Young People

Unlike tobacco cigarettes, e-cigarettes are not age-restricted. Studies have shown that e-cigarette use is dramatically increasing amongst young people who have never smoked compared to adult non-smokers who use e-cigarettes. The advertising of fruity and sweet flavors and the lower costs are particularly likely to entice younger demographics. The lack of a ban on usage in public places may increase the social approval for e-cigarettes and thereby increase the number of young people exposed to nicotine. Experts are also concerned that vaping could lead to smoking cigarettes. Furthermore, research shows that nicotine can damage the developing brain and impair learning, attention, mood, and impulse control in people up to 25 years old.

Young People Vaping zoranm / Getty Images


Pregnancy and Secondhand Smoke

Nicotine in any amount is unsafe in pregnancy. It can pass through the placenta to the unborn baby and damage the developing brain. Pregnant women should avoid using e-cigarettes and inhaling secondhand vapors. There is limited research on the effects of the other toxic chemicals in e-cigarettes on the health of pregnant women and their unborn babies. Mothers should take care to avoid exposing children and infants to secondhand smoke and vapor.

Vaping devices HAZEMMKAMAL / Getty Images


Faulty Devices and Accidents

The manufacture of e-cigarettes is poorly regulated; faulty devices and charging units have caused explosions and fires, mostly occurring while charging the device, and particularly those bought from illicit sources. The liquids in e-cigarettes are highly dangerous if swallowed, and the products should be kept away from children. Spills can cause skin irritation, due to the concentration of chemicals.

E-cigarette explosion Rain Ungert / Getty Images


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