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As the FDA continues to look at regulating the e-cigarette industry and many cities across the world are implementing no e-cigarette smoking bans, the latest study on the use of e-cigarettes may be clouding the picture.

On July 30th the journal Addiction published a study on the health risks of e-cigarettes. One of the study’s researchers is Thomas Eissenberg, the co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University (VCU) in Richmond, Virginia. Eissenberg stated, “current evidence suggests that there is a potential for smokers to reduce their health risks if electronic cigarettes are used in place of tobacco cigarettes and are considered a step toward ending all tobacco and nicotine use.” Some proponents of e-cigarettes are using this study as proof of the e-cigarette’s safety.  In the “for what it’s worth” category, keep in mind that VCU is located in the heart of tobacco country, the home of Philip Morris USA, the tobacco division of Altria Group, Inc.

Eissenberg says that the e-cigs are a safer alternative to tobacco cigarettes—which may be true at this point in time when we have little long-term research to speak safely about the health risks of e-cigs. He notes that e-cigs would be safer when used as a tool for “ending all tobacco and nicotine use”.  But,  unfortunately, e-cigarettes are not being used exclusively by people who want to stop using tobacco products. With their candy flavorings and clever marketing, e-cigs are attracting a much younger customer base, many of whom have never smoked traditional cigarettes.

Dr. Norman Edelman, a senior medical consultant for the American Lung Association feels we do not have enough information to effectively weigh the benefits with long-term risks.”It is imperative that the FDA finalize proposed e-cigarette regulations by the end of 2014,” he said. “The FDA needs to crack down on quit-smoking and other health claims that e-cigarette companies are making,” Edelman said. (HealthDay, 7/30)

It’s too soon to give e-cigarettes the seal of approval. And, while many of the proponents of e-cigarettes say e-cigs are mainly for tobacco users who are trying to quit, as discussed in earlier articles,  the CDC is reporting a significant increase in sales and use of e-cigarettes among middle-schoolers and teens.  According to the CDC, “altogether, in 2012 more than 1.78 million middle and high school students nationwide had tried e-cigarettes.”

What might be considered a small health risk for a tobacco-addicted adult is not the same for children as young as 10 years of age who are inhaling nicotine-laced products, which are known to contain the same chemicals found in antifreeze.

Last month the American Medical Association asked for tighter restrictions on the sale and marketing of e-cigarettes. “The AMA’s recommendations include a minimum age of purchase; childproof packaging; restrictions on flavors that appeal to young people, and a ban on unsupported claims that the devices help people quit smoking.”

Let’s not necessarily view this most recent study as a sign that e-cigarettes are safe. Perhaps they are safer than traditional, tobacco cigarettes, and perhaps they help cigarette smokers quit smoking, but classifying e-cigs as “safe” may be a bit premature.  The FDA can use this one piece of data as it gets an overall, broad picture of the uses and risks of e-cigarettes.  Until we know the whole story, a very cautious approach, at a minimum, should be used when discussing e-cigarettes.



  1. Gravatar for Carolyn Kohn

    "which are known to contain the same chemicals found in antifreeze." This is a very misleading statement. The chemical which is the same is propylene glycol. This chemical is utilized to make antifreeze safer and is regarded as safe by the FDA and is used in fog machines, medicines, cosmetics, and food.

    The report about middle school students "trying" e-cigarettes is also misleading. At the time of the study and still, many states do not have an age restriction on purchase of these devices making them easy to obtain. Cigarettes are used routinely at a much higher rate and it is illegal for youngsters to purchase them. The e-cigarette community and vendors support an age restriction.

    E-cigarettes companies cannot make claims as to being a "stop smoking device" or make health claims for legal reasons. They are marketed as a smoking alternative.

    Flavors are enjoyed by all people, not just the young. I enjoy gummy bears, life savers, and jolly rogers as much as the next child. Having these flavors, as well as many others, available greatly assisted me in my transition from smoking to vaping. Chai Tea is a big favorite of mine at the moment, but I have approximately 60 different flavors at home.

    "Classifying e-cigs as “safe” may be a bit premature" is also misleading. Driving is not safe, breathing polluted air is not safe, eating processed food is not safe. Nothing in life is completely safe. It is measured in degrees. Is using and electronic cigarette safer than burning tobacco and paper? Short answer, yes. There are many studies proving this if anyone cares to look. I'll even provide a resource comparing the two based on current evidence.

    Finally, we know for a fact that millions die yearly due to smoking related diseases which are directly attributed to the burning of tobacco, paper, and additives. Should an alternative which could potentially save these lives be regulated into non-existence or celebrated as the useful tool to reducing public harm.

    1. Gravatar for Greg Webb

      Ms. Kohn:

      First, thank you for reading and commenting. Second, may I ask if you have a financial interest in either the tobacco or e-cig industry?

      Third, because I don't want to bore folks, I am not going to respond to your comments in a tit-for-tat fashion. But I will say that gummy bears, life savers, and Jolly Rogers are relatively harmless, setting aside the fact that the calories really go to my waist. And flavor is an integral part of the product. Flavoring a smoking device with flavors attractive to kids is a completely different can of worms in my view. That's my opinion. I understand that flavoring is important to adults as well, and many of the flavors seem reasonable to me. But I think we know when a company is marketing to a specific segment of the population, and candy flavors seem to me to be targeting youth. I think we need to be careful, that's all. If e-cigs have helped you quit smoking cigarettes, that's a good thing. But, if a non-smoker (e.g., a teenager) is enticed into the world of smoking via an e-cigarette, and then moves on to tobacco products, that's a bad thing. I think we would all hate to see a new generation of smokers - perhaps all of us except the tobacco industry. Drawing the line is not easy, I understand. Additionally, I am not convinced that e-cigarettes are safe in and of themselves. The jury is still out on that I believe.

      Lastly, your comment that "driving is not safe", "breathing polluted air is not safe", etc. is interesting. I have to drive to work, to get groceries, etc. - i.e., to live. That's a trade-off I accept. Same with breathing and eating. I have to do these to live. Necessary and, in conducting a risk-benefit analysis, I can reasonably choose to drive, breath the Los Angeles air when I visit for a few days, and eat a hot dog at the baseball game. I don't have to smoke to exist, however. The latter is something smokers choose to start doing, and then when they likely become addicted, it is hard for them to stop, but it is still a choice, albeit a very difficult one. So, I do not buy into your analogies. But I understand what you are saying.

      My father has smoked for 60 years, off an on. All things considered, I would prefer he smoke an e-cigarette rather than a tobacco cigarette. But, I would rather he not smoke at all, and that he had never started. I have children as well (teenagers), and I would be afraid that if they smoked e-cigs, they would then fall into smoking tobacco cigarettes - i.e., they would be "hooked" by the e-cigs. That is my main point.

      Again, thank you for commenting. This is an interesting and controversial issue, for sure. Time will tell how it plays out.


  2. Gravatar for Jon Krueger

    The major unsafety of e-cigarettes is they keep smokers smoking. That exposes customers to a staggeringly unsafe product: cigarettes. That's also what makes them so attractive to cigarette giant Philip Morris.

    The technical summary of this is "e-cigarette use in the real world is associated with significantly lower odds of quitting smoking cigarettes".

    That's right, lower. Less quitting. More smoking. This is a device that keeps smokers smoking.

    This is the finding from 5 population-level studies:

    Adkison SE, O’Connor RJ, Bansal-Travers M, Hyland A, Borland R, Yong HH, Cummings KM, McNeill A, Thrasher JF, Hammond D, Fong GT. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44:207–215.

    Grana R, Popova L, Ling P. A longitudinal analysis of electronic cigarette use and smoking cessation JAMA Int Med.

    Vickerman KA, Carpenter KM, Altman T, Nash CM, Zbikowski SM. Use of electronic cigarettes among state tobacco cessation quitline callers. Nicotine Tob Res. 2013;15:1787–1791

    Choi K, Forster JL. Response to Letter to the Editor Regarding “Beliefs and Experimentation with Electronic Cigarettes: A Prospective Analysis Among Young Adults.” Am J Prev Med. In press.

    Popova L, Ling PM. Alternative tobacco product use and smoking cessation: a national study. Am J Public Health. 2013;103:923–930.

    The vast majority of e-cig use is dual use: both the devices and continued smoking. Little of it leads to quitting. More of it leads to continued smoking. The e-cig becomes a bridge from the last cigarette to the next cigarette. In short, dual use keeps smokers smoking.

  3. Gravatar for Austin Goss

    Okay I guess I shall put my two sense here to help Mrs. Kohn's case.

    I will start out in stating that I am in now way financially related to either industry other than I am an avid vaper.

    When it comes to the "chemicals known to be in anti-freeze" this is a common miss conception. Polypropylene glycol is used in anti-freeze, not propylene glycol. The other ingredients (when buying from a US seller) will contain that and Vegetable Glycol, both may I add are up to medical standards in usage in nebulizers. The other ingredients are the same flavorings that would go into the food and drinks you consume everyday, and then Nicotine. The bad guy nicotine that everyone seems to like to paint the bad picture of because of its association with tobacco. When it really comes down to it, nicotine's chemical reaction on the body is very much like caffeine.

    When it comes to the flavors, nobody making these flavors are using them as marketing for children. You can talk to any vapor that used vaping as a way to quit smoking, and they will tell you the same thing, the variety of different flavors is something that really helps with the process. Eliminating these flavors, will only leave the tobacco flavors on the market, and at that point how does that give a variety.

    I would like to point out, that everyone sees the word "cigarette" after that e, (e-cigarettes) and they assume that the same marketing strategies are going to be used as the people in the Big Tobacco industry. This is another reason the people (like myself) who don't use cig-a-like products, don't even use the word e-cigarette as to not cast confusion, we use the words personal vaporizer and what have you.

    The vaping community in general also agrees that children should not be getting their hands on the product and this is also represented in the larger vendors as well. So the idea that this new industry, trying to help people quit smoking, would also be trying to lure kids into actual smoking through their products is ludicrous to say the least. All of the vendors that I use have the safety measures proposed to keep them out of reach of children already.

    One last thing on the flavors, since it seems that everyone else is hung up on them, when I made the switch to vaping it took a little bit to drop the analogs so once in a while I would fall back into them, but after vaping, I noticed how repulsive the analogs did taste. So why anyone would go from a better tasting, 0 carcinogen product to a terrible smoke flavored cancer stick is beyond me.

    This is all food for thought, and if you have any arguments I would love to debate this subject as it seems the public is a little bit misinformed and are so brainwashed at the word cigarette that the run to the hills and get up in arms.

  4. Gravatar for Jacque Damon

    So this argument that candy flavors are attracting kids to smoking, how is it then that in the 1950's when the majority of people smoked and none of these flavors existed in tobacco products did we end up with so many kids smoking? When I started the only flavors were tobacco and menthol, the first time I tried anything flavored was pipe tobacco and they have candy flavors yet you don't seen kids running around with corn cob pipes hanging from their mouths. Really paranoia from the media is so silly it's now better to laugh that them then take them seriously. I think the biggest reason people hate E-cigs is the lack of taxation. Non-smokers have gotten so use to squeezing tobacco smokers of every dime possible they can't stand the idea of a non-taxed safer alternative! I'm now 10 days tobacco free thanks to an e-cig, I tried the patch it gave me hives, I tried the gum and ended up going in to anaphylactic shock, I then tried pills which are actually anti-depresents that gave me suicidal thoughts. I finally find something that works and then the media throughs out the scare tactics! So you want me to go back to smoking tobacco? You won't get the taxes you hoped for since I'm a registered tribal member and only have to pay federal tobacco taxes. As for the antifreeze nonsense I'm a mechanic and I can tell you propylene glycol is use to make anti-freeze safer, ethylene glycol is the dangerous one! Then there is the fact that you can use e-liquids made with vegetable glycerin, which is even safer. I can buy vegetable glycerin, and propylene glycol in pharmaceutical grade from walmart, then buy my own pharmaceutical grade nicotine, and an my own flavorings. If you really want to worry about the health of young people ban car exhaust it will kill you much faster then smoking or vaping.

    1. Gravatar for Greg Webb

      Mr. Damon,

      Please show me evidence of car exhaust killing people faster than smoking. I recognize that pollution from car exhausts is certainly not helpful, and even harmful at certain high levels, I haven't seen the medicine or science showing that breathing the air in Los Angeles, for example, is more dangerous than being a smoker. I would like to see that. Thanks for commenting.


  5. Gravatar for Kim

    Just wanted to add few things, first, in 2 weeks I will have not a real cigarette in a year thanks to my personal vapor devices. I might add that none of them look like a cigarette! Lol I've had people tell me they thought I was holding a screwdriver. I just wanna point out some things as I see them. I started smoking cigarettes when I was bout 14 years old. No matter whether they're are personal vaporizers out there or not kids will be kids and they will either attempt smoking, drinking or drugs. It's a very rare kid who tries none of these things. Just stating a fact. In my opinion, I don't see how ANYONE adult or younger who might start out with a vaporizer, who would then turn to a traditional cigarette, as they do not taste good or smell good at all. Funny when I was smoking I never noticed. But I can say unless forced to give up vaporizers, I would NEVER go back to smoking cigarettes. Theses claims on advertisements for ecigarettes.... It's funny how everyone fails to mention that ALL of these advertisements are made by the big tobacco companies, NOT Brick and Morter shops, and these are the creators of what works. They DO NOT advertise. News travels by word of mouth of those who have quit smoking to the ones who need to quit. In the 11 months I have been cigarette free I have not come across one vendor who doesn't have warning labels and child proof bottles in place. And almost all state ingredients in bottle. Ingredients I might add that are found in a lot of things we use every single day, including those who are freaking out over this new alternative to quit smoking the cigarettes that for years they have been trying to get us to do, now all of a sudden, we found what works to give them what they so venomously wanted and now they say oh no, it's attracting the young because it has flavors. Come on, that's like banning all flavors from the world, is sugar good for u? So let's ban all candy, baked goods, no sugar in any food or drink, why cuz it makes people gain weight. Oh and let's not forget alcohol, so many people drinking and driving, putting everyone at risk, killing people, injuring themselves and others, ending up addicted and dying of liver disease. Why not ban THAT? Alcohol has all kinds of flavors too!!

    Why not shut down all these bars that serve this stuff knowing full well one of the group will be driving outta there. Here our world is falling apart, so many people outta work, and the rest of us struggling to live and paying for those outta work, why not focus on the important stuff instead of once again, attacking the ex smokers who are finally onto the right path to a healthier way of life. Give them what they want and STILL the find fault in the effort! And might I add that u have a choice with personal vaporizers, and that means everything, u start out at current level of nicotine and slowly decrease the amount till your vaping nothing but flavoring. That's the beauty of it, u can do at your own pace without all the drugs with aweful side effects. Personally I have no use for any mind altering drug alternative to smoking. I can happily say, I don't smoke cigarette, I don't drink alcohol and I don't do drugs. And my lungs are proof that vaporizers are better for you then smoking. And last but not least, I just want to add I totally support the regulation to ban 18 or younger from buying ecigarettes. Maybe even to the age of 21 as with alcohol. I was just simply stating a fact earlier that no ban will stop the younger generation from trying things that are not meant or intended for them. Everyone making these demands for regulations on devices and banning of flavors need to take into consideration of ATLEAST 72,000 of us who have finally found something to help us break the cigarette habit and those who wish to do so because it's not ONLY about the younger generation. Also all of those who now have jobs working in the industry, to meet these people is a wonderful experience. They are extremely passionate about helping people quit cigarettes for good.

    1. Gravatar for Greg Webb


      Thank you for responding. You make some good and interesting points. I think it is great you have not smoked tobacco cigarettes in a year. I hope you can stay on track in that regard. As I said in my blog, if the only option to smoking tobacco cigarettes is a vapor device, or E-cig, it appears as if that is a better choice, based upon what we do know. But, all things considered, not smoking any device is the best choice. With regard to your analogies on drinking and sugar, those products are not designed to be addictive. Although people can become alcoholics, most people can drink alcohol without becoming addicted. Many, many people eat sweet food and do not become overweight. Sugar is in many products. So is alcohol. The fact of the matter is, smoking is highly addictive, primarily because of nicotine, which is also a powerful stimulant. And, the other fact is that smoking is extremely harmful because of, in large part, that fact. Doctors will tell you that smoking is likely the most harmful habit that a person can form. The medicine, science and epidemiology prove overwhelmingly that smoking cigarettes dramatically increases one's chance of dying prematurely. Eating sugar products and drinking beer or wine or vodka are not in that class, although they certainly can be very harmful if overindulged.

      Regardless, I think your comments were thoughtful and thought-provoking. Thank you for taking time out to respond. Good luck with your smoking cessation.


  6. Gravatar for Dianne Hall

    I have somed for 42 years. I quit in Jan 2014 with the help of e cigs for the first 4 months. I am 57, no willpower, female.

    The benefit is they ABSOLUTELY help a smoker quit!! And if you don't quit at least you are vaping, not smoking, a product which is healthier than tobacco.

    1. Gravatar for Greg Webb

      Ms. Hall,

      I am glad you are no longer smoking cigarettes. Do you intend to stop vaping at some point as well?


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