Employee & Community Health

What's up with e-cigs?

8/22/2019 by Dr. Jon Ebbert

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E-cigarettes are sometimes called "e-cigs", "vapes", "e-hookahs", "vape pens" and "electronic nicotine delivery systems (ENDS)". Some look like regular cigarettes, cigars or pipes. Others resemble USB flash drives, pens and other everyday items. 

No matter what they're called, e-cigarettes are growing in popularity. Almost one in 20 Americans currently use them, and more than half of users are under age 35, according to a U.S. study. They're touted as a "safe" alternative to cigarettes and as a way to stop or cut back on smoking. But what do you really know about them? 

How do they work?

EcigAnatomyElectronic cigarettes consist of a lithium battery attached to a heating element ("atomizer") that vaporizes a "humectant" made up of propylene glycol and vegetable glycerin that contains liquid nicotine. The atomizer can be made of different types of metal that are heated or an ultrasonic device, which is activated to produce the vapor you see when people use an e-cigarette. 

Vaporizing produces an aerosol that looks like conventional cigarette smoke, but its makeup is completely different. The aerosol or vapor is inhaled — that's why it's referred to as "vaping". 

What are the different kinds?

There are more than 500 different e-cigarettes on the market. There also are about 8,000 unique flavors of e-juice available. E-cigs can be grouped into three main categories: 

  • Cigalikes resemble conventional cigarettes. 
  • Mods are larger than cigalikes and have "tanks" that can be filled and refilled with "e-juice" or "e-fluid" (nicotine combined with a humectant and flavoring). 
  • Pods have custom-fitted cartridges that come either prefilled or are refillable by the user. 

What are the pros and cons?

E-cigarettes have been shown to help cigarette smokers quit tobacco. 

For teens who never smoked tobacco before, using e-cigarettes may increase the risk for smoking tobacco, which is the riskiest product of them all. Drawbacks associated with e-cigarettes are related to ingredients in the e-juice, as well as formaldehyde, which is produced when the heated coil reaches certain temperatures. 

Juul™ is a pod-type system that delivers a highly concentrated form of nicotine called a nicotine salt. The amount of nicotine delivered with a salt is three to five times higher than the average e-juice. For adolescents who have never smoked tobacco, nicotine salts can produce symptoms of nicotine use such as irritability, as well as nicotine withdrawal, including cravings, poor sleep and mood changes when they try to stop. 

No therapies exist for treating teens who use e-cigarettes, so the best plan is not to start. 

Jon Ebbert, MD, is a physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). He also works with Mayo Clinic's Nicotine Dependence Center in Rochester.