« Back to Fall 2015

An E-Cigarette Primer for Teachers and Students of Project ALERT

by Pam Luna, Dr.PH, MST

What Is An Electronic Cigarette?

An electronic cigarette, or e-cigarette (“e-cig”), is an electronic nicotine delivery system (ENDS).  The device uses a coil to heat up an “e-liquid” (“e-juice” or “juice”) containing nicotine and other chemicals and turns it into an aerosol for inhalation into the lungs.  Some of the devices look like a cigarette and others are more customized and may be referred to as e-pens, e-hookahs, mods, or tanks.  When a person uses these devices it is referred to as “vaping,” because when the user inhales the aerosol and then breathes it out (exhales), it looks like a cloud of vapor.  E-cigs are battery-powered, and in some models the user can adjust the temperature of the heating element in the liquid to control features like taste, intensity, and vapor output.

Why Do Teens “Vape”?

Some teens choose to vape because they think using ENDS is a way to reduce or to stop smoking cigarettes.  Others may be influenced by ads, attractive packaging, and celebrity endorsements.  Perhaps they like to perform smoke-like tricks with the vapor or find the various flavors in the e-liquid—many of which are sweet—appealing.   Among the many reasons for why teens may continue to “vape” is because they are addicted to nicotine, perhaps through experiences smoking cigarettes, chewing tobacco, or use of e-cigarettes.

How Do Teens Use E-Cigs?

Inhaling an e-cigarette is similar to inhaling a regular cigarette. The difference is that when the user puts the device to their lips and inhales, a heating coil is activated which turns the vaporizing fluids into an aerosol, allowing the lungs to breathe in a variety of chemicals, including highly addictive nicotine, and exhale a mist or “vapor.”  Some models are disposable after normal use over a short period of time.  Others are reusable and must be regularly re-filled with liquid nicotine.  The financial investment can be a deterrent to adolescents when they consider the cost to purchase the device itself, replacement parts and batteries, and the vaporizing fluid (projected costs are about $850 per year for a regular user).  Additionally, retail outlets in many states will not sell e-cigs to minors.

Where Do Teens Use E-Cigs?

E-cigs are not illegal for those 18 and older, but many places do not allow them to be used in public places.  They often fall under the same local laws that restrict the use of tobacco in public places.  This is due to concerns about the health effects, not only for the person using these devices, but also for others who are nearby (second-hand exposure). Schools, movie theaters, sporting events, airplanes, theme parks and many other public places that teens frequent have banned their use. E-cigarette use most likely occurs in private residences and social events.

Why Is It Dangerous To Use E-Cigs?

Nicotine is highly-addictive, producing cravings similar in intensity to heroin and cocaine.  The amount of nicotine in e-liquid varies and is unregulated so a teen can get much higher doses of the substance than they realize.  Many youth that report using e-cigarettes had never used traditional cigarettes.  One worry is that teens are more likely to smoke cigarettes once they become addicted to e-cigs in order to continue receiving their nicotine fix.  Although not everyone who uses e-cigarettes will become addicted right away, it is likely to happen, especially with repeated use. This is of concern especially for teens and how it may impact brain development, which is not complete until around age 25.  Nicotine increases heart rate and blood pressure, causes lung irritation, and can aggravate asthma.

There are known carcinogens and other toxic chemicals in the heated liquid, including formaldehyde, arsenic, aluminum, and lead. Inhaling these chemicals deep into the lungs is very risky.  Since e-cigs are not regulated by the U.S. Food and Drug Administration (FDA), it is typically unknown exactly what is in the e-liquid consumed.  The chemicals can cause birth defects and reproductive harm over time.

Manufacturers and marketers are specifically targeting adolescents.  The liquid nicotine is combined with chemical flavorings such as bubble-gum, cherry, and chocolate, making e-cigs appealing to children and youth.  Design deficiencies in the devices are also a concern. Findings have revealed that the nicotine liquid containers can leak and are not required to be child-proof. Consumption of the liquid by children through the mouth, skin, and/or eyes can poison them--even a little exposure to the nicotine liquid can cause death in young children.

Important Questions Answered

I have heard e-cigarettes will help people to quit smoking cigarettes.

This has not been proven.  Trusted studies have shown that after a short time from switching to e-cigarettes, a person begins to use both traditional cigarettes and e-cigarettes, introducing even more nicotine into their system.

Isn’t vaping better for you than smoking cigarettes?

Neither is good for you. Both are addicting, present health risks, and cost a lot of money.  Further, once you begin to vape you have a much greater chance of using regular cigarettes and taking on all the risks associated with traditional smoking.

There are lots of ads and information about vaping. Who should I believe?

The cigarette and vaping industries are businesses.  So, they will try their best to sell their products.  Like anything that has to do with your health and well-being, refer to trusted sources first and educate yourself with current research studies.  Ask yourself, “does this person or organization have the experience and authority to make these claims? Do they benefit financially from the product that is being sold? Has sufficient research been done and have the findings appeared in professional publications?” Be discerning and don’t automatically accept what you read and hear—check the facts.

How come there are ads on TV and in magazines for e-cigarettes?

E-cigs are unregulated in the U.S.  The science on the health effects was limited when e-cigs began to be mass marketed and companies are currently allowed to advertise without restrictions.  As time goes on, more trusted information will become available. In the meantime, we already have enough information to conclude that the choice to use e-cigs carries significant health risks.

I heard that a lot of teens are using e-cigarettes?

There has been an increase in the number of teens who have tried e-cigarettes in the past few years. This is a concern because of the potential to become addicted to nicotine, along with other associated health risks.  However, most teens do not use this product and do not smoke cigarettes. In fact, a recent large scale survey of about 15,000 8th graders found that 86% had never used an e-cig in the past year.


See more information at:




Search the Centers for Disease Control and Prevention for the latest research:


California Department of Public Health. (2015). State Health Officer’s Report on E-Cigarettes: A Community Health Threat. Sacramento, Calif. Available at: 


Crowdis, R. & Luna, P. (2015). A creative way to address the increase in electronic cigarette use by teens. The ALERT Educator (Winter, 2015). Santa Monica, Calif.: RAND Corporation. Available at: 

Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future: 2014 Overview of Key Findings on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, University of Michigan. Available at: www.monitoringthefuture.org//pubs/monographs/mtf-overview2014.pdf

Luna, P. (2015). Integrating e-cigarette content into Project ALERT. The ALERT Educator (Winter, 2015). Santa Monica, Calif.: RAND Corporation. Available at: http://www.projectalert.com/newsletters/winter-2015

Mailing List

Sign-up for The ALERT Educator