Smoke Signals

Brandon Smith was never interested in tobacco cigarettes. But the 20-year-old from Norristown, Pennsylvania, has been using e-cigarettes since he was 17. 

“Regular cigarettes smell,” says Smith, “but mostly, they taste bad. I got into vaping mainly because of the flavor and the lack of odor.” 

Smith’s story is not uncommon. Since they appeared in the U.S. in early 2007, e-cigarettes have grown in popularity, especially among young people, who are often attracted to flavors like Yummi Gummi Bear, Cotton Candy, and Banana Split. But a lack of research on the long-term health effects of e-cigs means there are serious questions about their safety. And health experts worry that e-cigs can be a gateway, leading young people down the path to smoking tobacco cigarettes. 

“These products are obviously geared toward targeting the underage market,” says Cliff Douglas of the American Cancer Society. “We’re unsure of the long-term health risks, so the users of these products are, in fact, guinea pigs at this point.” 

While tobacco use among teens and young adults has steadily declined in the last 10 years, e-cigarette use has significantly increased, according to the Centers for Disease Control and Prevention (see graph). The sharp increase prompted the federal government to take action last spring, when the Food and Drug Administration released guidelines that govern the sale of e-cigarettes and related products. But some critics say the new regulations may do more harm than good and could push young people toward using tobacco.

E-cigarettes—handheld, battery-powered devices that vaporize liquid—were invented in 2003 in China as a way to deliver nicotine without the cancer-causing tar and chemicals in tobacco cigarettes. A typical device consists of a battery, a heating coil, and a tank that can be filled with different types of liquid. When the coil gets hot, the liquid—which is often flavored and usually contains nicotine—vaporizes into an aerosol and is inhaled, leading many to refer to e-cig use as “vaping.” 

One of the big questions about e-cigs is what happens when the liquid is heated and the chemical compounds begin to change. Critics say that heating the liquid creates potentially harmful by- products that are inhaled by the user. 

Recent research by scientists at the Lawrence Berkeley National Laboratory in California found that heating e-cig liquid to a high temperature produces a vapor containing several cancer-causing chemicals, including formaldehyde. E-cigarette makers and some health experts disagree with the findings and say more tests are needed. 

But everyone agrees that nicotine, an ingredient in tobacco and many e-cig liquids, is highly addictive and can lead to brain, heart, and vision issues. 

“It’s clear that there are health risks associated with e-cigarettes,” says Douglas. “Whether you are talking about the carcinogens in the vapor or not, nicotine in high-enough doses has acute toxicity, and exposure during adolescence may have consequences for brain development.” 

Critics say e-cigarette makers are targeting young people with marketing campaigns designed to make vaping seem fashionable. Big tobacco companies have long been accused of marketing their products to young people. The most famous example was the Joe Camel mascot in Camel cigarette ads in the 1980s and 90s.

A spokesman for Blu, one of the most popular e-cigarette brands, declined to comment on the product’s potential side effects and the industry’s marketing methods. Several other manufacturers didn’t respond to requests for comment. 

Even experts who see e-cigarettes as a possibly less harmful alternative to tobacco insist that they’re not completely safe and that it’s healthier not to use them.

“We don’t know enough about the long-term effects of e-cigarettes,” says Andrea Villanti, director of the Schroeder Institute for Tobacco Research, a public health organization that studies tobacco use. “The ideal situation is to be tobacco- and nicotine-free.”

The presence of nicotine in many e-cig liquids–combined with the increase in vaping by young people–led to the FDA’s recent decision to regulate them as tobacco products, despite the fact that they don’t contain tobacco. The new rules prohibit the sale of e-cigarettes to minors and ban sales on the internet and from vending machines. They also establish an expensive application process to introduce new products.

“We are very pleased that the FDA finally released this rule,” says Katie McMahon, a policy expert at the American Cancer Society. “We’ve been waiting years for this kind of regulation to happen.”

Some, however, think that the strict new regulations could cripple the e-cigarette market and lead to unanticipated consequences for users.

“The approach the FDA is taking is going to hurt public health more than help it,” says Michael Siegel of Boston University’s School of Public Health. “It will decimate the market, and when 99 percent of products available now are gone, people are going to go back to tobacco. So it actually promotes smoking.”

Smith, the 20-year-old e-cig user, is concerned about the FDA’s action. Still, he insists that he will continue using e-cigs as long as they’re available.  

“I just hope e-cigarettes don’t disappear now,” says Smith, “I can’t see myself smoking tobacco cigarettes, but if I can’t vape, you never know.”