Some individuals who smoke combustible tobacco products, such as cigarettes, cigars, and pipes, have been turning to electronic cigarettes (e-cigarettes) as an alternative to combustibles and as a smoking cessation tool. E-cigarettes are also commonly referred to as electronic nicotine devices, alternate nicotine devices, hookahs, vape pens, or e-cigs. Use of e-cigarettes and inhalation of their contents is known as vaping (American Cancer Society, 2022).
The liquids used in e-cigarettes do not contain tobacco, but they do contain nicotine derived from tobacco, and thus the U.S. Food and Drug Administration (FDA) classifies them as a tobacco product. FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes that meet the definition of a tobacco product. E-cigarettes may also be used to aerosolize other substances for inhalation, including cannabinoid products.
Although evidence is lacking, e-cigarettes for inhalation of nicotine may be beneficial in reducing adverse health effects related to the use of combustible tobacco products. However, e-cigarettes are not FDA approved as a smoking cessation tool and the amount of nicotine and other substances a person inhales from each nicotine cartridge remains unclear.
E-cigarettes emit toxins and harmful ultrafine particles, both of which pose potential health risks similar to secondhand smoke. Many nicotine refill bottles or cartridges are not adequately packaged to prevent children from coming into contact with or accidentally ingesting toxic amounts of the vaping liquids. Studies also have shown that vaping may cause respiratory and cardiac changes (Gotts et al., 2019; Qasim et al., 2017).
Flavorings and scents have been added to e-cigarette liquids, leading to a dramatic increase in e-cigarette use among adolescents and young adults, sparking national concerns (U.S. Department of Health and Human Services, 2016). Also concerning is the increasing number of unexplained vaping-associated pulmonary illnesses and deaths, causing some states to ban vaping. In 2018, the U.S. Office of the Surgeon General declared e-cigarette use among underage smokers a national epidemic (Stone, 2019).
It is the position of ONS that:
Approved by the ONS Board of Directors, June 2015. Reviewed January 2016, September 2019, August 2022.
Health Care Policy and Consumer Advocacy
American Cancer Society. (2022). What do we know about e-cigarettes? https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarettes-vaping/what-do-we-know-about-e-cigarettes.html
Centers for Disease Control and Prevention. (2019). Statement from CDC Director Robert R. Redfield, M.D., and acting FDA Commissioner Ned Sharpless, M.D., on federal and state collaboration to investigate respiratory illnesses reported after use of e-cigarette products. https://www.cdc.gov/media/releases/2019/s0830-statement-e-cigarette.html
Gotts, J.E., Jordt, S.E., McConnell, R., & Tarran, R. (2019). What are the respiratory effects of e-cigarettes? BMJ, 366, l5275. https://doi.org/10.1136/bmj.l5275
Qasim, H., Karim, Z.A., Rivera, J.O., Khasawneh, F.T., & Alshbool, F.Z. (2017). Impact of electronic cigarettes on the cardiovascular system. Journal of the American Heart Association, 6, e006353. https://doi.org/10.1161/JAHA.117.006353
Stone, A., (2019). Surgeon general declares youth vaping a national epidemic. https://voice.ons.org/advocacy/surgeon-general-declares-youth-vaping-an-epidemic
U.S. Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the surgeon general. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf