E-Cigarette Safety: The Jury Is Still Out


E-cigarette use among adults and adolescents has increased since 2010.

An acquaintance of mine recently celebrated his success in quitting cigarettes after multiple attempts.

“Good for you!” I said. “That is a very hard habit to break.”

But then he came clean.

He hadn’t really stopped smoking cigarettes but had switched over to electronic cigarettes, or “vaping.” Should those who vape view themselves as tobacco quitters? Are e-cigarettes safe or even safer than tobacco cigarettes?

E-cigarette use among adults and adolescents has increased since 2010. Many believe that e-cigarettes are a tool to quit or greatly reduce tobacco intake. Whatever the reasons, e-cigarette sales represent a $6 billion industry.

The main ingredients of e-cigarette liquids are nicotine, propylene glycol or glycerol, and choices of up to 5000 flavorings. The product can also contain other ingredients.

The issues surrounding e-cigarette use are as follows:

  • The nicotine content is not consistent. The range can be from 6 mg/mL to all the way up to or above 36 mg/mL. The labeling can be incorrect in identifying how much nicotine is contained in the liquid. Even cartridges labeled nicotine-free can contain nicotine.
  • No one knows for sure whether e-cigarettes are safe or even whether inhaling propylene glycol or glycerol is safe. There has been mention of studies suggesting that the vapors contain several carcinogens along with tiny particles of nickel, chromium, tin, or heavy metals that could damage the lungs. Some e-cigarettes have been found to give off formaldehyde and silicate particles.
  • E-cigarettes are not regulated.
  • Many of the flavors in e-cigarettes target youth. Data have provided evidence that e-cigarette use is prospectively associated with increased risk of combustible tobacco use initiation during early adolescence. While evidence has shown that adult e-cigarette use can aid in tobacco cessation, this has not been the case in youth.
  • Nicotine overdoses are increasing because of the lack of product consistency.

It will be interesting to see the evolution of e-cigarettes and regulation over the next few years.


Orellana-Barrios MA, Payne D, Mulkey Z, Nugent K. Electronic cigarettes—a narrative review for clinicians. Am J Med. 2015;128:674.

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