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Posted on: August 23, 2018

Facts about E-Cigarettes and Public Health

2018 E-Cigarettes and Public Health_Page_1

With the first day of school less than two weeks away and as parents prepare to send their kids back to school, they should be aware that E-cigarettes are the most commonly used tobacco product among U.S. middle/ high school students and that a new e-cigarette shaped like a USB flash drive is being used in schools. With more high school students using e-cigarettes than regular cigarettes, the use of e-cigarettes is higher among high school students than adults. Some studies show that non-smoking youth who use e-cigarettes are more likely to try conventional cigarettes in the future than non-smoking youth who do not use e-cigarettes. Among high school students and young adults who use tobacco, more use both e-cigarettes and burned tobacco products than use e-cigarettes alone. Parents should take time to learn about the different shapes and types of e-cigarettes and the risks of all forms of e-cigarette use for young people.

E-cigarettes are electronic devices that produce an aerosol by heating a liquid. 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 are made to look like regular cigarettes, while some look like USB flash drives, pens, and other everyday items. Larger e-cigarettes such as tank systems, or “mods,” do not resemble 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.” Using an e-cigarette is sometimes called “vaping” or “JUULing.”


JUUL is a popular brand of e-cigarette that is shaped like a USB flash drive. The use of JUUL is sometimes called “JUULing.” Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine liquid to produce an aerosol that is inhaled. All JUUL e-cigarettes have a high level of nicotine. JUUL’s nicotine liquid refills are called “pods.” JUUL became available for sale in the United States in 2015. As of December 2017, JUUL is the top-selling e-cigarette brand in the United States. JUUL is available in several flavors such as Cool Cucumber, Fruit Medley, Mango, and Mint. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes. Although JUUL is currently the top-selling e-cigarette in the U.S., other e-cigarettes are becoming available that look like USB flash drives. Examples include the Mark Ten Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL. Because of their shape, school teachers might not notice students using JUUL in school, including in classrooms and bathrooms.


E-cigarette use poses a significant and avoidable health risk to young people in the United States. The aerosol from e-cigarettes is not harmless. It can contain harmful and potentially harmful chemicals, including nicotine, the addictive drug in regular cigarettes, cigars, and other tobacco products; ultrafine particles that can be inhaled deep into the lungs; flavoring such diacetyl, a chemical linked to a serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead. Scientists are still working to understand more fully the health effects and harmful doses of e-cigarette contents when they are heated and turned into an aerosol, both for active users who inhale from a device and for those who are exposed to the aerosol secondhand. Another risk to consider involves defective e-cigarette batteries that have been known to cause fires and explosions, some of which have resulted in serious injuries. Most of the explosions happened when the e-cigarette batteries were being charged.


Here are some key points why e-cigarettes are unsafe for kids, teens and young adults:


  • Nicotine can harm the developing adolescent brain. 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.
  • 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.
  • E-cigarette use among youth and young adults is strongly linked to the use of other tobacco products, such as regular cigarettes, cigars, hookah, and smokeless tobacco.
  • Using nicotine in adolescence may also increase risk for future addiction to other drugs. Some evidence suggests that e-cigarette use is linked to alcohol use and other substance use, such as marijuana.
  • Scientists are still learning about the long-term health effects of e-cigarettes. Some of the ingredients in e-cigarettes 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.
  • Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.


Parents and other adults can do their part to reduce young people's exposure to e-cigarettes. They can start by learning about and talking to their kids about the dangers of e-cigarettes. Parents can discuss the harm that nicotine can do to kid’s developing brain. To confirm this and other health risks, parents can schedule an appointment with their health care provider to discuss these health risks, including nicotine addiction, the impact of nicotine on the developing brain, and the dangers of using other substances (like marijuana) in e-cigarette devices. When school reopens, parents can speak with their child’s teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum that include all tobacco products, including e-cigarettes. Parents can let their children know that they stand strong against them using any tobacco products, including e-cigarettes, now or in the future.


In addition, parents can make their home and vehicle tobacco-free by prohibiting use of all tobacco products, including e-cigarettes, by family members, friends and guests. This is an important step for parents protecting their children from exposure to secondhand cigarette smoke or secondhand aerosol from e-cigarettes. Parents can also be an example to youth by living tobacco-free. 


Attached is a fact sheet from the American Heart Association on “E-cigarettes and Public Health.” For additional information and/or fact sheets, visit or


Please network this information to your personal and professional contacts, particularly parents of children attending middle school, high schools, colleges and universities.

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