Cigarette smoking is still the single largest cause of preventable death in the United States. It kills about 480,000 people a year. This translates to 1,315 loved ones dying every single day. Now a new, modern version of the old-fashioned cigarette is attracting smokers into a new era of nicotine use.

Electronic cigarettes or “e-cigs” were introduced in Europe and the U.S. in the mid-2000s. Since then, they have been marketed as a safe alternative to smoking. Some groups have also promoted them as a cessation tool. Now, several recent studies — including one from the World Health Organization (WHO) — have brought the safety of using e-cigs, also known as “vaping,” into question. In fact, the early evidence suggests that e-cigs may pose a threat to public health.

Cigarettes versus vaping

A traditional tobacco cigarette is ignited by fire at one end and then allowed to smolder. Smoke from the smoldering tobacco is inhaled through a paper tube and passed into the body through the airways and lungs. The smoke contains tar, nicotine and thousands of chemicals. The chemicals are absorbed almost immediately into the bloodstream, and 70 percent of the inhaled tar sticks to the throat and lungs, killing healthy lung cells. A one-pack-a-day smoker ingests about a cup of tar every year.

Instead of burning tobacco, e-cigs use a battery-operated heating element to turn a nicotine solution into a vapor that users inhale. The solution, or “juice” as users call it, contains propylene glycol and vegetable glycerin. It also contains chemical flavorings and food preservatives.

Safer than smoking, but still not safe

So far, evidence suggests that e-cigarettes may be safer than regular cigarettes. Since nothing is burned in the process, e-cig vapor lacks the tar and carbon monoxide found in cigarette smoke. Most of the 7,000 chemicals in cigarette smoke are also missing from e-cig vapor. However, e-cigarette users do inhale chemicals that are known to be toxic and, in some cases, carcinogenic. When heated, ingredients in the nicotine solution can turn into formaldehyde, which is known to cause cancer. Newer e-cigs allow users to adjust the temperature to a point where the formaldehyde level can be as high — or even higher — than in traditional cigarettes. Studies have also found that the vapor can include chemicals released by the devices themselves. These include silicate particles, aluminum, lead and tin.

The ingredients used in e-cig juice have been generally recognized as safe by the FDA. But that designation is based on tests in which the ingredients are ingested, not inhaled. In other words, the FDA has neither investigated how these substances affect the respiratory system nor recognized them as safe for inhalation.

According to a report released in May by the Center for Tobacco Control Research and Education (CTCRE), vaping delivers high levels of nanoparticles. These tiny particles are able to enter the lungs’ smallest airways. They cause inflammation linked to asthma, stroke, heart disease and diabetes. As a result, researchers are finding diminished lung function, airway resistance and cellular changes in e-cigarette users. Even the lungs of users who used nicotine-free juice showed airway resistance and other signs of inflammation.

A cessation tool?

When e-cigs first hit the U.S. market in 2007, some advocates viewed them as a way for smokers to wean themselves off of traditional cigarettes. However, the FDA has not approved e-cigarettes as a safe or effective way to quit smoking. Recent studies have found that e-cigs do not help people give up smoking long-term. In fact, they may be having the opposite effect. For example, the Centers for Disease Control and Prevention (CDC) found that more than a quarter of a million young people who had never smoked traditional cigarettes used e-cigs in 2013. This was three times as many as in 2011. And nearly half of those young people said they have intentions to smoke traditional cigarettes within the next year.

The dangers of second-hand vapor

Just as with cigarette smokers, e-cig users aren’t the only ones who should be concerned about vaping. A study last year by the Bavarian Health and Food Safety Authority concluded that secondhand vapor released detectable levels of nicotine, particulate matter, chemicals and metals into the air. While the levels are lower than those found in secondhand tobacco smoke, any amount of these toxic compounds puts the health of non-users at risk. For this reason, the WHO has called for a worldwide ban on the use of e-cigs indoors.

Calls for regulation

In an effort to prevent a repeat of the public health crisis caused by traditional cigarettes, groups including the American Lung Association and the WHO have called for the regulation of e-cigs. These organizations are demanding that e-cigs be subject to the same rules and regulations as traditional cigarettes. This includes banning their use anywhere cigarette smoking is not allowed. It also means outlawing fruit- and candy-flavored e-cig juice, which they feel is aimed directly at children and young adults, and strictly enforcing youth access age restrictions. At the same time, proponents of e-cigs are arguing against the restrictions. They say there’s not enough hard evidence that proves they’re harmful. However, the fact is e-cigs produce measurable amounts of toxic chemicals and other airborne pollutants.

In order to protect themselves and their loved ones from the potentially harmful health effects of e-cigs, the American Lung Association has encouraged the public to take the following action:

  • Avoid both first- and secondhand exposure to e-cigarette vapor.
  • Instead of using e-cigs as a means to quit smoking traditional cigarettes, consult your doctor or Quit Coach when deciding on cessation tools or methods. These may include over-the-counter medications such as gums, lozenges and patches, as well as prescription drugs such as pills, nasal sprays and inhalers.
  • Contact your members of congress and voice your support for the regulation of e-cigarettes.

For more information on the American Lung Association’s statement on e-cigarettes, visit