Surgeon General: THE FACTS on e-cigarette use among youth and young adults

The Impact of E-Cigarettes on the Lung

Facts For Parents About E-Cigarettes & Vaping

5 Vaping Facts You Need to Know

Vaping and Lung Cancer: What You Should Know

Illinois Department of Public Health

E-cigarettes seem to be everywhere these days, and many think of them as a useful tool for people looking to quit smoking and relatively risk-free for new users. But are they safe? Before you or someone you care about uses e-cigarettes to quit smoking or for other reasons, get the facts.

1. E-cigarettes and other vaping devices are NOT risk-free.

Although it’s generally agreed that these products are less harmful than smoked cigarettes, there is no evidence that they are, in fact, safe. Rather, a growing body of research indicates that they may lead to negative health consequences, including:

  • Damage to the brain, heart and lungs
  • Cancerous tumor development
  • Preterm deliveries and stillbirths in pregnant women
  • Harmful effects on brain and lung development, when use occurs during fetal development or adolescence
2. They contain nicotine, a highly addictive drug with known health risks.

Using nicotine, regardless of how it is delivered, increases the risk of addiction. Nicotine addiction is notoriously difficult to reverse, and use of e-cigarettes frequently leads to use of other nicotine products, including smoked cigarettes, as well as alcohol and other drugs.

3. Using e-cigarettes and other vaping products is not a proven method for quitting smoking.

E-cigarettes and other vaping devices would be a preferred alternative to traditional cigarettes when used exclusively as a replacement and only among smokers who have been unable to quit smoking using proven, medically approved methods. However, there is little evidence that they reliably reduce cigarette smoking or lead to smoking cessation. In fact, the nicotine contained in e-cigarettes and other vaping products may actually perpetuate addiction, in some cases making it even harder to quit smoking.

4. E-cigarettes and other vaping devices are not used exclusively by people trying to quit smoking.

Rather, they are increasingly popular with young people, including those who had never smoked cigarettes previously and never intended to. Research shows that some young people begin to smoke cigarettes only after using e-cigarettes.

5. E-cigarettes and other vaping devices are frequently used in addition to smoked cigarettes, rather than in place of them.

Many smokers use these products alongside traditional cigarettes, often at times and in places where smoking is not allowed or is not convenient. The end result is an increase in total exposure to nicotine and its harmful effects.

6. Nicotine can affect brain development and functioning in young people.

Young people are particularly vulnerable to using e-cigarettes and vaping devices and to their effects. The younger a person is when he or she tries nicotine, the greater the risk of addiction. The developing brain is more vulnerable to the effects of addictive substances than a fully developed adult brain. Additionally, nicotine can disrupt brain development, interfere with long-term cognitive functioning, and increase the risk of various mental and physical health problems later in life.

7. E-cigarettes and other vaping devices are not FDA approved. 

These products are not approved by the U.S. Food and Drug Administration (FDA) as a smoking cessation aid. Until very recently, manufacturers and distributors of e-cigarettes and other vaping devices were not bound by standards of safety set by the FDA for smoked tobacco products. Despite the new regulations, e-cigarette manufacturers are free to project a risk-free image in their marketing, and offer enticing, candy-like flavors that appeal to children, adolescents and young adults.

8. There is little consistency across different products. 

There is limited federal oversight over e-cigarettes and other vaping devices making it difficult to assess the dangers of any specific product. Across products, there is considerable variation in the nature and concentration of the ingredients, including nicotine and other known toxins.

9. There is no evidence that the aerosol from these products is safe.

There is growing concern about the long-term health effects of aerosolizing nicotine and other chemicals in e-cigarettes and other vaping devices. The additives, heavy metals, ultrafine particles, and other ingredients they contain include toxins and carcinogens.

10. The spread of e-cigarettes and other vaping devices may be re-normalizing smoking behavior.

The increase in popularity of nicotine devices and their widespread availability is reversing the progress made over decades of intense global, national, and local efforts to reduce cigarette smoking, especially among young people.

What’s the bottom line?

If you’re a long-term cigarette smoker and haven’t been able to cut back or stop smoking using approved cessation methods, e-cigarettes and other vaping devices products appear to be a safer alternative than continuing cigarette smoking, even if they do not help you reduce your nicotine intake. However, if you do not smoke or use other forms of tobacco or nicotine, steer clear of e-cigarettes and other vaping devices. The potential risks to your long-term health outweigh any enjoyment in the moment.


Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults

What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young Adults?
  • The use of e-cigarettes is unsafe for kids, teens, and young adults.
  • Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.1
  • E-cigarettes can contain other harmful substances besides nicotine.
  • Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

A young diverse group of teenagers.

The use of e-cigarettes is unsafe for kids, teens, and young adults.

What Are E-cigarettes?
  • E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.
  • E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.
  • Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or “mods,” do not look like other tobacco products.
  • E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
  • Using an e-cigarette is sometimes called “vaping” or “JUULing.”
How Do E-cigarettes Work?
  • E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.
  • The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called “e-juice,” “e-liquid,” “vape juice,” or “vape liquid.”
  • Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.
  • E-cigarette devices can be used to deliver marijuana and other drugs.
What Is JUUL?

classroom with diverse students

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

  • JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.
  • All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2
  • News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.
  • Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.
  • Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC’s Infographic pdf icon
Why Is Nicotine Unsafe for Kids, Teens, and Young Adults?
  • Most e-cigarettes contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products.
  • Nicotine can harm the developing adolescent brain.1 The brain keeps developing until about age 25.
  • Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.1
  • Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.
  • Using nicotine in adolescence may also increase risk for future addiction to other drugs.1
Nicotine can harm the developing adolescent brain. The brain keeps developing until about age 25. There is an illustration of a brain with an exclamation point.
What Are the Other Risks of E-cigarettes for Kids, Teens, and Young Adults?
  • Scientists are still learning about the long-term health effects of e-cigarettes.
  • Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1
  • Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.
  • Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.
What Is in E-cigarette Aerosol?
  • E-cigarette aerosol is NOT harmless “water vapor.”
  • The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:
    • Nicotine
    • Ultrafine particles that can be inhaled deep into the lungs
    • Flavoring such as diacetyl, a chemical linked to a serious lung disease
    • Volatile organic compounds
    • Cancer-causing chemicals
    • Heavy metals such as nickel, tin, and lead1
  • It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.3
Can Using E-cigarettes Lead to Future Cigarette Smoking Among Kids, Teens, and Young Adults?
  • Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.
  • Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.4
  • But e-cigarette use among young people is unsafe, even if they do not progress to future cigarette smoking.
Aren’t E-cigarettes Safer Than Cigarettes?
  • E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1 But burned cigarettes are extraordinarily dangerous, killing half of all people who smoke long-term.
  • The use of any tobacco product, including e-cigarettes, is unsafe for young people.
What Can I Do to Prevent My Child from Using E-cigarettes or to Help Them Stop?

Parent talking to his teenage son

Talk to your child or teen about why e-cigarettes are harmful for them. It’s never too late.

  • Set a good example by being tobacco-free. If you use tobacco, it’s never too late to quit. For free help, visit smokefree.gov external icon or call 1-800-QUIT-NOW.
  • Talk to your child or teen about why e-cigarettes are harmful for them. It’s never too late.
  • Get the Talk With Your Teen About E-cigarettespdf iconexternal icon [PDF – 5.2MB] tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.
  • Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.
    • Set up an appointment with your child’s health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.
    • Speak with your child’s teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.
    • Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov external icon.
Where Can I Learn More?
Resources

Teachers and Parents: That USB Stick Might Be an E-cigarette

E-Cigarette Infographic

E-cigarettes Shaped Like USB Flash Drives: Information for Parents, Educators and Health Care Providers.

E-Cigarette Fact Sheet

pen on a planner

Know the Risks: A Youth Guide to E-cigarettes Presentation

Doctor talking to patient

Fact Sheet for Health Care Providers

Teacher helping students.

Fact Sheet for Educators
Multimedia about E-cigarettes
Sources
  1. US Department of Health and Human Services. E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon Generalpdf icon [PDF – 8.47MB]. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. Accessed July 27, 2018.
  2. Willett JG, Bennett M, Hair EC, et al Recognition, use and perceptions of JUUL among youth and young adults. Tobacco Control Published Online First: 18 April 2018. doi: 10.1136/tobaccocontrol-2018-054273
  3. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the United States, Korea, and Poland. Int J Drug Policy. 2015;26(6):583–588.
  4. National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettesexternal icon. Washington, DC: The National Academies Press.

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