Dear Alice,

Can you tell me about electronic cigarettes and their effects on health? Pros and cons, and a comparison to actual cigarettes? How do they compare to the patch and gum for someone who wants to quit smoking?

— E-Cig

Dear E-Cig,

E-cigarettes (e-cigs) are one of varieties of electronic nicotine delivery systems (known as ENDS).  While some users attest to e-cigarettes' power in weaning them off of traditional cigarettes and helping to nix their nicotine addiction, there is currently no proof that e-cigarettes can help you quit smoking. In fact, they may be just as harmful as their non-battery powered counterparts, though much research still needs to be done.

E-cigarettes have gained attention as potentially less harmful than smoking actual cigarettes, though much about the risks associated with them is still unknown. Some versions are designed in size, shape, and color to resemble the real thing, while others are the same general shape/size but are trying to appear visually different from actual cigarettes. E-cigs are actually small, battery-powered vaporizers, thus the term “vaping” to describe using them. The act of inhaling triggers a sensor that causes a tiny heating element to heat up the nicotine-containing cartridge inside, creating an odorless vapor. Cartridges come in varying levels of nicotine and some come without nicotine. While once only reliably available for purchase online, e-cigs are now widely available at drug and retail stores.

Are they a "quit smoking" aid? Not currently. Again, we don't yet know if e-cigs can help people quit smoking. If e-cig manufacturers wanted to make this claim, they would have to adhere to specific FDA standards. They have yet to apply for such status, probably because studies conducted thus far indicate that e-cigs likely fail to meet FDA standards. The few studies that have been done on using e-cigs to help people quit have garnered mixed results.

Aside from being addictive, nicotine itself is toxic to humans. The nicotine vapor in e-cigarettes may send a more concentrated dose of nicotine into e-cig "smokers" bodies. As the World Health Organization noted, e-cigarettes deliver nicotine directly to the lungs, unlike approved cessation aids like the patch or nicotine gum where the nicotine is absorbed via other means. The health impacts of inhaling nicotine vapor via the lungs is largely unknown.  Additionally, because e-cigs are not regulated, the dosage can’t be adequately gauged and most health professionals don’t recommend the use of electronic cigarettes as an appropriate substitute for smoking cessation.

E-cigs are available at varying nicotine levels and some are labeled as "nicotine-free." Sadly, choosing a lower-dose e-cig isn't necessarily a reliable solution for decreasing nicotine intake. FDA tests found that similarly labeled e-cig cartridges released widely varying levels of nicotine per puff and that even cartridges labeled as nicotine-free still contained nicotine. Another concern is that e-cigs contain a variety of chemicals in the cartridges, not all of which may be fully disclosed by the various manufacturers. One of the more concerning substances is called propylene glycol, which is also used in anti-freeze. The short-term and long-term consequences of inhaling this chemical have yet to be determined.

Other concerns with e-cigs include:

  • Batteries – recharging issues and several fires have been reported from overheated batteries
  • Secondhand Vapor – while manufacturer claim it’s only water, there are no reliable studies to confirm this is true
  • Cartridge Refilling – some brands allow users to buy materials in bulk to refill cartridges. There is less quality and dose control when users self-refill
  • Public Confusion – allowing the use of e-cigs has resulted in confusion regarding where smoking is permitted. A number of businesses, organizations, cities, states, and countries are prohibiting the use of e-cigs in any place smoking is not allowed.
  • Cost – e-cig starter kits can run from $60 to over $150. Refills generally cost about $10
  • Targeting Children – the flavors appeal to kids (and adults) and there is less regulation regarding age restrictions for purchasing e-cigs

Overall, your best bet is to avoid both traditional and e-cigarettes. Both types of smoking present health risks. Quitting smoking has immense health benefits, so if you are considering it, that's great. Visit for resources on quitting. Gums and patches are a safer bet (and research suggests more effective) than the e-cig. For more tips on quitting, check out the articles below.

Here's to happy lungs,


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