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Sharp Health News

What you need to know about e-cigarettes

Nov. 16, 2017

What you need to know about e-cigarettes

You’ve seen them in the store, on TV and in the hands of men and women of all types: electronic cigarettes, or e-cigarettes.

These hand-held, nicotine delivery devices heat a liquid that results in the aerosolization of water, propylene glycol, glycerin, nicotine and flavorings — producing a smoke that users and nonusers inhale. The use of e-cigarettes is usually called “vaping” and the liquid is termed “e-liquid.”

The e-cigarette was invented in China by a pharmacist in 2003; most e-cigarettes in the U.S. are made in China. There are approximately 500 brands of e-cigarettes with global sales in excess of $7 billion and they are considered a gateway to cigarette use in youth and teens. Approximately 13 percent of U.S. adults and young adults have used an e-cigarette.

Health hazards of e-cigarettes
E-cigarettes were introduced into the U.S. market as a less toxic form of tobacco use, which may help users quit smoking tobacco, a known health hazard. Since then, studies have been published revealing the toxic effects of e-cigarette usage. States and the federal government are recognizing the health dangers of e-cigarettes and are beginning to regulate them like other tobacco products. The U.S. Food and Drug Administration (FDA), which regulates e-cigarettes and tobacco products, announced plans in November 2018 to restrict access to flavored e-cigarette products and further limit marketing to teens by manufacturers. New York recently joined a growing list of states, including California, that banned vaping in indoor public spaces.

Firsthand exposure
Glycol, a component used in e-cigarettes, is a known upper airway irritant used in the theater industry and emergency training exercises. Reports of eye dryness, throat irritation and dry cough have been noted with e-cigarette use.

Nicotine in high doses results in nausea and vomiting, and reports of ingestion of the e-cigarette liquid are becoming more common. A study published in May 2017 showed that two known carcinogens — o-toluidine and 2-naphthylamine — were found at two to three times higher concentration in the urine of e-cigarette users than in nonusers.

Traditional cigarettes are a known risk factor for bladder and lung cancer; however, long-term data is insufficient to prove an association with e-cigarettes at this time. Preliminary research indicates that vaping is associated with a temporary but powerful increase in arterial stiffness, which raises the risk of a future heart event.

A more common hazard associated with vaping is the explosion of the battery used to heat the liquids, which can result in third-degree burns to hands, arms and legs. The lithium ion battery is similar to the type found in many hoverboards that were recalled due to fire risk.

Secondhand exposure
A 2018 study by the Centers for Disease Control and Prevention (CDC) found a dramatic increase in use of e-cigarettes by teens, with 78 percent more teens reporting daily use than in 2017. Health risks from secondhand smoke include delayed lung development, tooth decay and a higher risk of attention deficit hyperactivity disorder (ADHD).

Thirdhand exposure
Just as traditional cigarettes leave a smoke and nicotine residue on floors, walls and other surfaces, research shows that e-cigarette vapor leaves traces of nicotine behind, exposing small children to carcinogens.

The best advice is to never start smoking. Inhaled toxins are delivered through many different routes and forms, and contribute to the epidemic of lung disease — estimated to peak by 2020 and be the leading cause of death and disability for the coming years.

If you are using tobacco, it is important to set a quit date, talk to your doctor about medication aides and establish behavior modifications to increase your chances of success.

Dr. Asha Devereaux, MPH, is a pulmonary medicine doctor affiliated with Sharp Coronado Hospital.

Learn more about smoking cessation classes available through Sharp.

For the news media: To talk with Dr. Asha Devereaux about e-cigarettes for an upcoming story, contact Erica Carlson, senior public relations specialist, at

This story was updated in November 2018 to include new information from the FDA.

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