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The Latest on the Health Impacts of E-Cigarettes

by Pamela J. Luna, DrPH, MEd

Electronic cigarettes or “e-cigs” have become a hot topic and have left many of us wondering about the safety of this and other “electronic nicotine delivery systems (ENDS)” such as hookahs and e-pens. E-cigs have skyrocketed in popularity, especially among youth. The University of Michigan’s highly regarded Monitoring the Future study, which tracks national drug-use trends among teens, found that in 2014 e-cigarette use exceeded that of conventional cigarettes. This rapid rise in popularity has out-paced credible evidence of their long-term health effects. Some say e-cigs are the answer to the many problems and consequences related to conventional cigarette use; yet, others fear they will reverse the gains made in tobacco use reduction as a new crop of youth become addicted to nicotine and hence find their fix in tobacco.


Recently, two important publications came out which have begun to give us answers about the health impacts of e-cigarette use. The first was a 2015 health advisory from the California Department of Public Health, State Health Officer's Report on E-Cigarettes: A Community Health Threat. The second was a 2015 study published in the New England Journal of Medicine by researchers at Portland State University, Hidden Formaldehyde in E-Cigarette Aerosols.


The State Health Officer’s report is a critical read for anyone giving guidance on use of e-cigarettes. Some of the report’s key points relevant to our work are:

  • Nicotine is a “highly addictive neurotoxin, proven as addictive as heroin and cocaine…causing blood vessels to constrict, raising the pulse and blood pressure.”
  • “Preliminary studies have shown that using a nicotine containing e-cigarette for just 5 minutes causes similar lung irritation, inflammation, and effect on blood vessels as smoking a traditional cigarette…”
  • “…the mainstream and secondhand e-cigarette aerosol has been found to contain at least ten chemicals that are on California’s list of chemicals known to cause cancer, birth defects or other reproductive harm including acetaldehyde, benzene…formaldehyde…”
  • “…people passively exposed to e-cigarette aerosol absorb nicotine at levels comparable to passive smokers. They are also exposed to volatile organic compounds (VOCs) and fine/ultrafine particles. These ultrafine particles can travel deep into the lungs and lead to tissue inflammation.”
  • “There is no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes or that they reduce their consumption.”


The study published in the New England Journal of Medicine confirming that e-cigarettes contain formaldehyde made international news. In an interview I conducted with study researcher Dr. Jim Pankow, Professor of Chemistry and Civil and Environmental Engineering at Portland State University, he noted that the study found that e-cigarette aerosol (vapor) contained a large amount of formaldehyde which came from the propylene glycol, glycerol, and the flavorants in the liquid, or “e-juice,” that is heated in the vaping process. Dr. Pankow noted, “Formaldehydes, like all aldehydes, are ‘primary irritants,’ thus causing inflammation and irritation in the respiratory system.” Pankow further acknowledged aldehydes as known carcinogens.


Although epidemiological studies on e-cigarettes are yet to come, those of us working with youth should feel confident in advising them to avoid not only the use of e-cigarettes but also the secondhand exposure to the vapor/aerosol in addition to avoiding the same with conventional cigarettes.


Director’s Note: Project ALERT workshops now include how to integrate information about e-cigarettes into the lessons. Recently Contra Costa, Sacramento and Kern counties in California hosted such trainings for educators. If you are interested in hosting a Project ALERT training at a reasonable rate, please contact RAND at 1-800-ALERT-10 or projectalert@rand.org.




“A Creative Way to Address the Increase in Electronic Cigarette Use by Teens” and “Integrating E-Cigarette Content into Project ALERT.” The ALERT Educator, Winter, 2015: http://www.projectalert.com/newsletters/winter-2015


Monitoring the Future 2014 Overview Key Findings on Adolescent Drug Use: http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2014.pdf


Monitoring the Future: E-Cigarettes surpass Tobacco Cigarettes in Use, University of Michigan Press Release: http://www.monitoringthefuture.org//pressreleases/14cigpr_complete.pdf


California Department of Public Health “State Health Officer’s Report on E-Cigarettes: A Community Health Threat”, Sacramento, CA 2015: http://www.cdph.ca.gov/programs/tobacco/Documents/Media/State%20Health-e-cig%20report.pdf


Hidden Formaldehyde in E-cigarette Aerosols, New England Journal of Medicine, January 22, 2015: http://www.nejm.org/doi/full/10.1056/NEJMc1413069

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