Electronic cigarettes, or e-cigarettes, are tobacco products that have been sold in the U.S. for about a decade. They include e-pens, e-pipes, e-hookah, and e-cigars, known collectively as ENDS—electronic nicotine delivery systems. They're also sometimes called JUULs, "vapes" and "vape pens." E-cigarettes are the most commonly used tobacco products among kids—and it's become an epidemic. While much remains to be determined about the lasting health consequences of e-cigarettes, there’s evolving evidence about the health risks of e-cigarettes on the lungs—including irreversible lung damage and lung disease.
The American Lung Association is very concerned that we are at risk of losing another generation to tobacco-caused diseases as the result of e-cigarettes. The Lung Association remains extremely troubled about the rapid increase of youth using these products and has repeatedly called upon the Food and Drug Administration (FDA) to increase their oversight and scrutiny of these products to protect kids.
What You Need to Know About E-Cigarettes
Below are answers to common questions about e-cigarettes, including health consequences, risks of secondhand emissions, kids and e-cigarettes and FDA oversight.
Electronic cigarettes, or e-cigarettes, include e-pens, e-pipes, e-hookah, and e-cigars are known collectively as ENDS— electronic nicotine delivery systems. According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol containing nicotine or other substances.
Unlike traditional cigarettes, e-cigarettes are generally battery-operated and use a heating element to heat e-liquid from a cartridge (usually refillable), releasing a chemical-filled aerosol.
The main component of e-cigarettes is the e-liquid contained in cartridges or tanks. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals (such as formaldehyde and acrolein, which can cause irreversible lung damage).
The National Academies of Science, Engineering and Medicine concluded there is "substantial evidence" that if a youth or young adult uses an e-cigarette, they are at increased risk of using traditional cigarettes.
20% (5 million) of all youth use e-cigarettes, a 135% increase in just two years. Additional data, rates and trends can be found in the American Lung Association’s Tobacco Trends Brief.
A recent study from the University of North Carolina found that even in small doses, inhaling the two primary ingredients found in e-cigarettes—propylene glycol and vegetable glycerin—is likely to expose users to a high level of toxins and that the more ingredients a user is inhaling, the greater the toxicity.1
The mid-to-long-term consequences of e-cigarettes are not yet known, as it's a new product and has been sold for less than a decade in the U.S. While much remains to be determined about these lasting health consequences of these products, we are very troubled by what we see so far. The inhalation of harmful chemicals can cause irreversible lung damage and lung diseases.
The Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit. If smokers are ready to quit smoking for good, they should call 1-800-QUITNOW or talk with their doctor about finding the best way to quit using proven methods and FDA-approved treatments and counseling.
The American Lung Association believes everyone who uses tobacco products can quit using methods that are proven safe and effective by the FDA, including the seven FDA-approved medications and individual, phone (available by calling 1-800-QUITNOW and 1-800-LUNGUSA) and group counseling (such as the Lung Association's Freedom from Smoking® program). Learn more about quitting smoking at Lung.org/stop-smoking.
The American Lung Association urges everyone to quit – don’t switch!
In 2016, the Surgeon General concluded that secondhand emissions contain, "nicotine; ultrafine particles; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead."2
In March 2018, the American Lung Association and our public health partners filed a lawsuit against the Food and Drug Administration challenging its decision that allows electronic cigarettes and cigars—including candy-flavored products that appeal to kids—to stay on the market for years without being reviewed by the agency. The lawsuit contends that the FDA's decision leaves on the market tobacco products that appeal to kids, deprives the FDA and the public of critical information about the health impact of products already on the market, and relieves manufacturers of the burden to produce scientific evidence that their products have a public health benefit.
On May 15, 2019 a federal judge sided with the American Lung Association and our partners in this lawsuit. The judge concluded that FDA acted unlawfully by delaying requiring e-cigarettes and other newly deemed tobacco products to go through a pre-market review process. The judge subsequently ruled that the filing deadline for all premarket review applications is May 12, 2020. Any product that does not submit an application by this deadline must be removed from the marketplace, which if properly enforced, could lead a significantly smaller marketplace.
In December 2019, the legislation was included in the federal year-end legislative package and passed by both houses of Congress. President Trump signed the bill into law on December 20, 2019 and it immediately took effect. This legislation, which applies to all states, raises the minimum age of sale for all tobacco products— including e-cigarette—to 21.
Despite a promise from the Trump Administration in September to “clear the markets” of all flavored e-cigarettes after new surveys show high school use of e-cigarettes climbed to 27.5 percent in 2019, on January 2, 2020, the Trump Administration announced it would leave thousands of flavored e-cigarettes on the market. The American Lung Association will continue to urge FDA and Congress to remove all flavored tobacco products from the marketplace.
More Information on E-Cigarettes
The Surgeon General reports e-cigarette use among youth is a significant public health concern and steps must be taken by parents, educators and especially policymakers to discourage use of e-cigarettes. Learn more about e-cigarettes lung health risks and get downloadable resources for parents, schools and teens.
The Impact of E-Cigarettes on the Lung
There's evolving evidence about the health risks and impact of e-cigarettes on the lungs.
E-cigarettes, Vapes and JUUL: What Parents Should Know
Information for parents to learn more about e-cigarettes, "vaping" and JUULS and the health effects on kids.
E-cigarettes, Vapes and JUULs - What Schools Should Know
Information on e-cigarettes, "vapes" and JUULs for schools to learn more about what they are, why kids use them and health risks.
What Teens Should Know
Information for teens on e-cigarettes, "vapes" and JUULs, including what they are and health effects.
Links to E-Cigarette Resources
Links other websites, reports educational materials, toolkits and more information on e-cigarettes.
The Impact of E-Cigarettes on the Lung [PDF]Download
E-Cigarettes, "Vapes" and JUULS: What Teens Should know [PDF]Download
E-Cigarettes, "Vapes" and JUULs: What Schools Should Know [PDF]Download
E-cigarettes, "Vapes" and JUULs: What Parents Should Know [PDF]Download
Sassano MF, Davis ES, Keating JE, Zorn BT, Kochar TK, Wolfgang MC, et al. (2018) Evaluation of e-liquid toxicity using an open-source high-throughput screening assay. PLoS Biol 16(3): e2003904. https://doi.org/10.1371/journal.pbio.2003904
U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016
Page last updated: July 13, 2020