Questions About Smoking, Tobacco, and Health

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What about electronic cigarettes? Aren’t they safe?

Electronic cigarettes or e-cigarettes are designed to look like cigarettes, right down to the glowing tip. When the smoker puffs on it, the system delivers a mist of liquid, flavorings, and nicotine that looks something like smoke. The smoker inhales it like cigarette smoke, and the nicotine is absorbed into the lungs. The e-cigarette is usually sold as a way for a smoker to get nicotine in places where smoking is not allowed. Some people think they can be used to help people give up tobacco.

The makers of e-cigarettes say that the ingredients are “safe,” but this only means the ingredients have been found to be safe to eat. Inhaling a substance is not the same as swallowing it. There are questions about how safe it is to inhale some substances in the e-cigarette vapor into the lungs. And e-cigarettes are not labeled with their ingredients, so the user doesn’t know what’s in them. The amounts of nicotine and other substances a person gets from each cartridge are also unclear.

A study done by the FDA found cancer-causing substances in half the e-cigarette samples tested. Other impurities were also found, including one sample with diethylene glycol, a toxic ingredient found in antifreeze.

Studies have shown that e-cigarettes can cause short-term lung changes that are much like those caused by regular cigarettes. But long-term health effects are still unclear. This is an active area of research, but the safety of these products is currently unknown.

We do know that electronic cigarettes are designed to deliver nicotine, and nicotine is addictive. This strongly suggests that e-cigarette use will lead to dependence, unless the user weans him or herself from them. A CDC survey published in 2013 showed that e-cigarette use in middle school and high school students doubled between 2011 and 2012, with 10% of high school students and 3% of middle school kids using them and risking addiction to nicotine. Among high school students, 80% smoked regular cigarettes and used e-cigarettes at the same time.

Because the American Cancer Society doesn’t yet know whether e-cigarettes are safe and effective, we cannot recommend them to help people quit smoking. There are proven methods available to help people quit, including pure forms of inhalable nicotine as well as nasal sprays, gums, and patches.

Until electronic cigarettes are scientifically proven to be safe and effective, ACS will support the regulation of e-cigarettes and laws that treat them like all other tobacco products.

The e-cigarette boom is now spawning sales of electronic cigars, e-hookahs (see the section “What about more exotic forms of smoking tobacco, such as clove cigarettes, bidis, and hookahs?”), and other special devices designed to reproduce different types of smoking using vaporized liquids. Even less is known about their ingredients and safety than about e-cigarettes. Like e-cigarettes, these new products need to be researched and regulated.


Last Medical Review: 02/13/2014
Last Revised: 02/13/2014