In a Haze About e-Cigarettes? 5 Things to Know

John Watson


July 31, 2018

If you've ever walked down the sidewalk and passed through the scented plume of someone vaping away on an e-cigarette, you've had a firsthand encounter with what is essentially a nationwide experiment with our health. Poorly regulated and largely untested, these products are nonetheless experiencing a meteoric rise in popularity.

In 2016, it was estimated that 9 million Americans regularly used e-cigarettes[1]; middle- and high-school students comprised 2 million of those users.[2] And in 2015, 5% of middle-schoolers and 16% of high-schoolers reported use.[2]

This trend has added urgency to the search for answers about these products, what they may be doing to our bodies, and what can be done to curtail their use. Here, Medscape presents our review of some of the latest data.

How Much Nicotine Do e-Cigarettes Contain?


e-cigarettes use a battery-powered system that produces an inhalable aerosol by heating a liquid that includes nicotine, flavoring, and additives. The resulting aerosol vapor (hence, the terms "vaping" for the act of using these products and "vapers" for those who use them) is designed to avoid the carcinogenic byproducts of tobacco, which has led to their being marketed as a healthier choice than smoking.

These products do not stint, however, on the nicotine. The most popular e-cigarette product among adolescents is Juul, which offers users accompanying pods consisting of 5% liquid nicotine by volume, approximately double that of many other top-selling products.[3]

One of the key criticisms of e-cigarettes is that their often sweet and candy-like flavors are a thinly veiled inducement to adolescents. Indeed, in polling, nearly 80% of adolescent users say they would not use the products if they weren't available in flavors.[4] In addition, younger users may be drawn in by the fact that inhalation is less harsh than burned tobacco, which, when combined with a highly addictive delivery system, is "likely to be particularly problematic for public health."[5]

These products pose an additional indirect risk to children and adolescents. Nearly half of adults participating in a 2016 survey were not sure whether vaping around children exposed them to nicotine, and a majority did not know that the released vapor can remain on household surfaces.[6] Unsurprisingly, accidental ingestion of nicotine-containing products has been on the rise.[7,8] Nicotine poisoning can result in a full spectrum of adverse events, from mild nausea and agitation to coma and death.[9]


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