While the use of electronic cigarettes by teenagers and young adults continues to sharply increase, we are learning that the e-cigarette devices may not be safe.

For those who are not familiar with this fad, e-cigarettes are battery-powered devices made to resemble cigarettes that heat various substances into a vapor that is inhaled. The liquid substance that gets aerosolized is typically flavored and can have additives like nicotine, but has also been found to contain other potentially harmful chemicals.

First introduced in the United States around 2007, use of e-cigarettes has skyrocketed. Though largely unregulated, e-cigarettes have been heavily marketed to youth through alluring packaging and enticing flavorings. In the last two years alone, use has tripled among high-school-age youth and, for the first time, e-cigarette use by teenagers has now surpassed their use of traditional cigarettes. Use in individuals ages 18 – 29 tripled in just the last year.

These trends are concerning because there is still a lot unknown about the health effects of e-cigarette usage. While experts largely agree that the health risks from e-cigarettes are less than the negative impacts from traditional tobacco products, this does not mean they are completely safe. Although some preparations claim to be nicotine free, most contain nicotine, which is highly addictive, in various concentrations. Nicotine can have adverse effects on the cardiovascular and central nervous systems, as well as negatively impact pregnancy and even brain development in youth. Since e-cigarette products are unregulated, ingredient labeling can be inaccurate and tests have shown that products supposedly nicotine free still sometimes contain nicotine, while others have widely varying amounts of nicotine regardless of the concentration indicated on the packaging.

A recent report on e-cigarettes by the California Department of Public Health highlighted other hazardous chemicals and contaminants that can be found in e-cigarette liquids. Use of e-cigarettes and the aerosols emitted can affect the respiratory system – State Health Officer Dr. Ron Chapman’s report identifies at least 10 chemicals in the emitted aerosol known to cause cancer and birth defects or other reproductive harm. Although the mere presence of toxins does not automatically indicate immediate health impacts and not a lot of research has been conducted to determine long-term health outcomes, there is sufficient reason to be concerned.

There is also some evidence that e-cigarette use in youth can be a gateway to tobacco smoking. A recent analysis by the National Youth Tobacco Survey found that teenagers who used e-cigarettes were nearly twice as likely to try regular cigarettes and were more likely to become habitual smokers in the future. With e-cigarettes being a relatively new fad, we don’t know yet if these negative outcomes will fully materialize, but any activity that could potentially reverse the success we have had in lowering rates of tobacco smoking should be viewed as a public health risk. Proponents counter this by arguing that use of e-cigarettes has actually helped many individuals quit or decrease their tobacco habits. To date; however, the Food and Drug Administration has not recognized e-cigarettes as a legitimate smoking cessation therapy, and the majority of research studies have not supported this claim.

Longer-term experience and additional research with e-cigarettes are necessary, but there is reason to question their safety at this point as there is still much unknown about their potential health effects. This absolutely warrants caution and the need for regulation, particularly as it relates to our precious youth. At the very least, we should minimize second-hand exposure to the emissions of e-cigarettes until more is known and restrict access for minors; thus, many localities are treating e-cigarettes as another form of tobacco-related product.

Dr. Takashi Wada is director and health officer for Santa Barbara County’s Public Health Department.


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