American Lung Association Statement on E-Cigarettes

The American Lung Association is concerned about the potential health consequences of electronic cigarettes (e-cigarettes), as well as the unproven claims that they can be used to help smokers quit. Presently there is no government oversight of these products. Absent Food and Drug Administration (FDA) regulation, there is no way for the public health and medical community or consumers to know what chemicals are contained in e-cigarettes (also known as electronic nicotine delivery systems or ENDS) or what the short- and long-term health implications might be.

Early studies show that e-cigarettes contain nicotine and other harmful chemicals, including carcinogens. The Surgeon General has found that nicotine has negative health impacts on fetal development and adolescent brain development. Nicotine is believed to contribute to increased incidence of premature birth, and low birth weight. Research has also shown a negative impact on pulmonary function in newborns, an issue of paramount concern to the Lung Association.

A 2014 study showed wide ranging nicotine levels in e-cigarettes and substantial variability between listed and actual nicotine levels in these products. In 2009, the FDA conducted lab tests and found detectable levels of toxic cancer-causing chemicals, including an ingredient used in antifreeze, in two leading brands of e-cigarettes and 18 various cartridges. A 2014 study found that e-cigarettes with a higher voltage level have higher amounts of formaldehyde, a carcinogen. It is urgent for FDA to begin its regulatory oversight of e-cigarettes, which would require ingredient disclosure to FDA, warning labels and youth access restrictions.

Also unknown is what the potential harm may be to people exposed to secondhand emissions from e-cigarettes. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (all carcinogens) coming from those secondhand emissions. Other studies have shown that chemicals exhaled by users also contain formaldehyde, acetaldehyde and other potential irritants. While there is a great deal more to learn about these products, it is clear that there is much to be concerned about, especially in the absence of FDA oversight.

The American Lung Association is concerned about e-cigarettes becoming a gateway to regular cigarettes, especially in light of the aggressive industry marketing tactics targeted at youth—including the use of candy flavors and the glamorization of e-cigarette use. Studies are showing a dramatic increase in usage of e-cigarettes, especially among youth. For the first time ever, a national study released in December 2014 found e-cigarette use among teens exceeds traditional cigarette smoking. The study also found that e-cigarette use among 8th and 10th graders was double that of traditional cigarette smoking. CDC studies have also shown e-cigarette use among high school students increased by 61 percent from 2012 to 2013.

The American Lung Association is troubled about unproven claims that e-cigarettes can be used to help smokers quit. The FDA's Center for Drug Evaluation and Research has not approved any e-cigarette as a safe and effective method to help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT-NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.

In extensive comments filed with the FDA in August 2014, the American Lung Association called on the Obama Administration to finalize this regulation so that all tobacco products, including e-cigarettes, can be subject to basic FDA oversight.

Updated March, 2015