Electronic cigarettes, or e-cigarettes, are a popular new tobacco product that have still largely unknown public and individual health effects. In fact, you may be surprised to learn that e-cigarettes are entirely unregulated by the U.S. Food and Drug Administration (FDA).
E-cigarettes and Lung Health
Because of this, there are no safety checks or requirements for what can go into an e-cigarette.
The American Lung Association is concerned about the potential health consequences of e-cigarettes. Federal oversight and regulation of e-cigarettes is desperately needed to protect children and the public. This need becomes more urgent as e-cigarette use dramatically increases, especially among youth.
What Are E-cigarettes?
E-cigarettes, including e-pens, e-pipes, e-hookah and e-cigars, are known collectively as electronic nicotine delivery systems (ENDS). According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol (vapor) containing nicotine or other substances.
Unlike traditional cigarettes, e-cigarettes generally are battery-operated and use a heating element to heat e-liquid from a refillable cartridge, releasing a chemical-filled aerosol.
What Is in E-cigarettes?
The main component of e-cigarettes is the e-liquid contained in cartridges. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals.
The truth about traditional cigarettes vs e-cigarettes.
Because there is no government oversight of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining what’s in them. So there is no way for anyone—healthcare professionals or consumers—to know what chemicals are contained in e-liquids, or how e-cigarette use might affect health, whether in the short term or in the long run.
Early studies show that e-cigarettes contain nicotine and also may have other harmful chemicals, including carcinogens.
Nicotine is an addictive substance, and almost all e-cigarettes contain nicotine. Even some products that claim to be nicotine-free still may contain the drug. For instance, initial FDA lab tests conducted in 2009 found that cartridges labeled as nicotine-free had traceable levels of nicotine. A 2014 study found little consistency in the amount of nicotine delivered by e-cigarettes of the same brand and strength.1 Similarly, another 2014 study found that the amount of nicotine in e-liquid refills often is substantially different from the amount listed on the package.2 Experienced users learn how to use e-cigarettes in a way that increases their exposure to nicotine. Newer e-cigarette devices, especially “tank” styles with higher voltage, also deliver a greater concentration of nicotine. This matters because the more nicotine used, the greater the potential for addiction.
Nicotine is not safe. The U.S. Surgeon General has found exposure to nicotine during pregnancy harms the developing fetus, and causes lasting consequences for developing brain and lung function in newborns. Nicotine exposure also affects maternal and fetal health during pregnancy, and can result in low birth weights, preterm delivery and stillbirth.
Nicotine also negatively impacts adolescent brain development. Human brain development continues far longer than was previously realized, and nicotine use during adolescence and young adulthood has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention.3
Without FDA regulation and review, we simply don't know what is in e-cigarettes. However, in initial lab tests conducted in 2009, the FDA found detectable levels of toxic cancer-causing chemicals—including an ingredient used in antifreeze—in two leading brands of e-cigarettes and 18 various cartridges. A review of studies found that levels of toxins in e-cigarette aerosol varied considerably within and between brands. A 2014 study found that aerosol from e-cigarettes with a higher voltage level contains more formaldehyde, another carcinogen with the potential to cause cancer. The findings are alarming, and the American Lung Association urgently calls for FDA oversight of these products.