What Are Electronic Smoking Devices (ESDs)?
Electronic smoking devices, often called e-cigarettes or vape pens, heat and aerosolize a liquid that contains a cocktail of ingredients, including flavorings and varying levels of nicotine. Using these devices is called vaping. The metal or plastic devices contain a cartridge filled with a liquid that is vaporized by a battery-powered heating element. The aerosol is inhaled by the user when they draw on the device, as they would a regular cigarette. The user then exhales secondhand aerosol, which includes chemicals and other pollutants. Most electronic smoking devices contain nicotine, and some companies claim to sell nicotine-free cartridges. They come in a wide variety of shapes, sizes, flavors, and nicotine levels. These are not one uniform product but hundreds of different products. It should be noted that youth and adults are also using these devices to vape marijuana, hash oil, and other substances. The design and look of these devices evolves quickly, so policy makers, parents, and communities need to be aware of the products and their impact on smokefree air.
What Is JUUL?
Juul is the top-selling e-cigarette brand in the U.S., and it is very popular among youth and young adults. Juuls are high-tech devices: they look like thumb drives, charge in USB ports, use replaceable “pods” filled with flavored nicotine liquid, and are easy to use discreetly. Using a Juul is often called “juuling.”
ESD Aerosol Is Not Water Vapor
Supporters claim that electronic smoking devices release “nothing but water vapor.” However, the “smoke” you see is NOT a “vapor”: it is a chemical aerosol containing substances and toxins like those in the graphic from the U.S. Centers for Disease Control and Prevention (CDC). The aerosol (incorrectly called vapor) contains nicotine, hazardous ultrafine particles that lodge deeply in the lungs, and chemicals and toxins known to cause lung disease and cancer. This is why it is not safe to use these products in smokefree spaces, like workplaces.
Electronic Smoking Devices Are Not Emission-Free
The scientific evidence on the short-term and long-term health effects of ESD use and exposure to ESD secondhand aerosol is growing. Current research indicates there are risks associated with both use and exposure. ESD aerosol is made up of a high concentration of ultrafine particles. Exposure to fine and ultrafine particles may exacerbate respiratory ailments like asthma, and constrict arteries which could trigger a heart attack. An August 2018 study found that the risk of heart attacks is double for daily ESD users, and the dual use of ESDs and conventional cigarettes—the most common use pattern among ESD users—is more dangerous than using either product alone. Additionally, many of the elements identified in ESD aerosol are known to cause respiratory distress and disease. Non-smokers who are exposed to conventional cigarette smoke and ESD aerosol absorb similar levels of nicotine. ESD exposure damages lung tissues. Human lung cells exposed to ESD aerosol and flavorings, especially cinnamon, show increased oxidative stress, inflammatory responses, and DNA fragmentation. Short-term ESD use increased respiratory resistance and impaired lung function, which may result in difficulty breathing. The use of ESDs containing nicotine has a significant impact on vascular functions, and ESDs increase cardiovascular risk as much as cigarettes. ESD aerosol is a new source of pollution and toxins being emitted into the environment.
Hooking a New Generation on Nicotine
ESDs are not a proven smoking cessation device. They are an alternative nicotine delivery device that will maintain or restore the habit, and can addict a new generation to nicotine. ESD proponents are deceptively marketing the products to the public—especially to young adults via social media—as a “safe” alternative to smoking and an easy way to quit smoking tobacco cigarettes. ESDs come in an impossibly long list of enticing flavors that historically have appealed to youth, from Gummy Bear to Sour Worms to Cookie Dough to Apple Juice. Refillable ESDs allow users to mix their own “e-juice” to create their own flavor combinations and potentially create higher nicotine levels. Research shows that some chemicals used as flavorings in ESD liquid—which are approved by the FDA for food use (ingestion) but are not approved for inhalation—are associated with respiratory disease when inhaled. In 2018, both the FDA Commissioner and US Surgeon General declared e-cigarette use among youth an epidemic.
MYTHS & FACTS ABOUT ESDs
Myth: Electronic smoking devices (ESDs) are harmless! They only emit water vapor.
Fact: The aerosol emitted by ESDs is not water vapor. The aerosol is a mixture of many substances, including nicotine, ultrafine particles, volatile organic compounds, and toxins known to cause cancer. There is enough peer-reviewed, published scientific evidence to determine that secondhand aerosol is not harmless. It’s a new source of air pollution that should not be permitted in smokefree environments.
Myth: It’s just flavoring.
Fact: Vapes get their flavors from chemicals. While these flavorings are safe to eat in food, they’re not safe to inhale. Inhaling flavor chemicals can harm your lungs. Want an example? Some buttery-flavored vapes like caramel can contain diacetyl and acetoin. Inhaling diacetyl has been linked to popcorn lung, a lung disease that doesn’t have a cure.
Myth: I quit smoking by using an ESD! Do you want to prevent people from quitting tobacco?
Fact: ESDs are not proven cessation devices. While some individuals have quit smoking tobacco by using ESDs, studies indicate that ESDs may not be helpful at the population level. Many people become dual-users who use both cigarettes and ESDs. Including ESDs in smokefree laws does not prohibit people from using these products; rather they simply must step outside to use them, just like people do to smoke cigarettes.
Myth: Nicotine is no more harmful than caffeine!
Fact: Not true! Nicotine is an addictive and poisonous drug in even small amounts. Nicotine exposure can negatively impact developing fetuses as well as teenage brain development. Nicotine also reacts with other chemicals to create tobacco-specific carcinogens. The potential hazards to non-users in a shared air space are due to more than just nicotine.
For additional information, please visit the Indiana Tobacco Control Program's web page on e-cigarette resources.