What are E-Cigarettes?

In many states, they can be found at shopping mall kiosks or sold in the corner convenience store. And they are all over the Internet. The e-cigarette is here—a multi-part electronic nicotine delivery device that plugs into a wall or computer to charge instead of being lit by a match.

Focus article photo

Most e-cigarettes are manufactured to look like conventional cigarettes, cigars, or pipes. Some resemble everyday items such as ink pens and USB memory sticks.

Manufacturers claim e-cigarettes are easy, convenient, enjoyable, odorless, and less expensive than smoking regular cigarettes. Food and Drug Administration (FDA) warns these manufacturers not to market these devices as 1) being able to help someone quit smoking or 2) being safer than cigarettes. But what do our researchers and physicians studying cancer prevention and tobacco cessation have to say about them?

"This is like buying vitamins from a street vendor," said Susanne E. Tanski, MD, MPH, FAAP, a Norris Cotton Cancer Center researcher and Dartmouth-Hitchcock pediatrician who studies and teaches about ways to prevent kids from using tobacco. "You really have no way of knowing what you are getting or where it comes from, yet people willingly inhale these unregulated chemicals into their lungs."

How does an e-cigarette work?

How do these devices work as a delivery system for nicotine? When using an e-cigarette, which users call "vaping," air is inhaled through a plastic and/or metal cylinder, much the way a cigarette is puffed. The inhalation creates a vacuum, engaging a battery that initiates a heating element to warm chemicals housed in a replaceable cartridge, delivering the chemicals in the cartridge to the user, and creating a vapor plume from the end of the e-cigarette. The cartridges contain varying concentrations of nicotine as well as inflammable stabilizer such as propylene glycol or vegetable glycerin. These cartridges come in a variety of flavors such as cherry, mint, cappuccino–a practice prohibited by FDA for regular cigarettes.

How safe are e-cigarettes?

At the 4th Annual C. Everett Koop Tobacco Treatment Conference this fall sponsored by Dartmouth-Hitchcock Medical Center, Fred Wolff, Program Manager of Education & Training at the Maine Health Center for Tobacco Independence, reported on what is currently known about the safety of e-cigarettes to a large group of physicians and providers who had gathered to learn about the latest advances in smoking cessation.

While under FDA's jurisdiction, FDA has not yet evaluated e-cigarettes for safety or effectiveness. They have however identified significant concerns in limited studies, including significant quality control issues and finding unlabeled substances and contaminants. For example, they found that cartridges labeled as containing "no nicotine" contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff. Contaminants in some tested cartridges included diet medications and erectile dysfunction drugs. The stabilizer used in many e-cigarette cartridges is also of concern, noted Wolff and Tanski. While propylene glycol is used in other consumer products such as deodorant and hand sanitizer, no testing has been done on the short- or long-term effects to humans of inhaling it repeatedly and deeply once it's been vaporized.

Indeed, there have been reports of e-cigarette users experiencing mild respiratory tract irritation. There have also been safety concerns about possible malfunctioning. Wolff related one instance in which an e-cigarette blew up in a man's mouth, knocking out his teeth, and resulting in serious burns. FDA has established an adverse event report line at 1-800-FDA-1088.

Are e-cigarettes a smoking cessation aid?

Preliminary reports indicate e-cigarettes may help some smokers reduce their consumption of regular cigarettes or quit smoked tobacco completely.

Many in the medical community are reluctant to recommend them, however, with too little known about risks associated with electronic cigarettes. At the Koop Conference, Wolf ran through the list of concerns over e-cigarettes:

  • The composition of chemicals in e-cigarettes, and their effects, are unknown
  • There is concern about manufacturing safety practices
  • The amount of nicotine being delivered is unknown
  • There is no clear evidence that e-cigarettes help smokers quit
  • E-cigarettes might increase users' dependence on tobacco products
  • E-cigarettes could possibly encourage someone who wouldn't smoke to start

Yet another concern regarding the use of e-cigarettes is how it looks to children. Vaping looks like smoking, which might serve to "normalize" smoking behavior and promote it to young people.

A risk to children and pets

Surprisingly, a troubling issue to both Wolf and Tanski was the storage of the e-cigarette's nicotine replacement cartridges and refill bottles. The cartridges are colored and flavored, and a single refill bottle of nicotine can contain as much as 100mg of nicotine. If ingested, 10 mg of nicotine is a toxic dose for a small child. "These cartridges and refill bottles must be kept safely away from children or pets. A single cartridge can have ten times the nicotine in a cigarette, and could be lethal if ingested," said Tanski.

What is the bottom line?

"I don't recommend this product as a nicotine replacement therapy or smoking cessation aid," said Tanski. "They are not safe or reliable." Instead, says Tanski, if a person wants to quit smoking, there are many known safe options. "If someone has an addiction to nicotine, there are many FDA approved alternatives such as nicotine replacement gum, patches, lozenges, inhalers and nasal sprays, that deliver nicotine without encouraging the practice of smoking."

Learn more about safely reducing tobacco use

Norris Cotton Cancer Center in Lebanon offers a smoking cessation clinic for anyone hoping to end their dependence on tobacco.

Plus there are local clinics offered at many other locations of Dartmouth-Hitchcock.

No matter where you live, free help is available to all smokers who want to quit at 1-800-QUIT-NOW or by visiting

December 03, 2012