TIME E-Cigarettes

Teen Smoking Is Way Down. But What About E-cigs?

Cigarette smoking among high school students has dropped to lowest level in two decades

Rates of cigarette smoking among high school students has dropped to lowest level in 22 years, the CDC reports.

In 2013, the smoking rate among high school students hit 15.7%, which means the U.S. government has already reached its goal of lowing the teen smoking rate to 16% of less by 2020. That’s according to the National Youth Risk Behavior Survey (YRBS), which began in 1991. Another important data set on teen smoking and drug use—Monitoring the Future (MTF)—reports the rate is at 16.3%. Regardless, both surveys show fewer kids are smoking.

That’s good news, and it’s likely thanks to a combination of several factors, the most important being the rising costs of cigarettes. Others include the growing stigmatization of smoking, with half of states prohibiting smoking in places like bars and restaurants. The adult smoking rate is dropping too, which means teens have fewer smoking role models.

If teens are passing around fewer packs of cigarettes, does that mean they’re not smoking other things? Past data has shown a 123% increase in the consumption of other smokable tobacco products like cigars and pipes, though the recent numbers from the larger data sets show no change in smokeless tobacco use since 1999, and a drop in cigar use.

CDC

One question you’re likely going to see is whether teens are switching to e-cigarettes. E-cigarettes is a subject the public health community is uncharacteristically split on. On one side of the spectrum, you have critics arguing that it’s possible e-cigarettes serve as a gateway to regular cigarettes. One vocal critic being the head of the CDC himself. “The increased use of e-cigarettes by teens is deeply troubling,” said CDC Director Dr. Tom Frieden in a statement about teen tobacco use going down. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

Emerging data points to certain trends, but e-cigs are still so new. Earlier this fall, a CDC report showed that e-cig use among teens, while still low, had doubled in a year, from 3.3% in 2011 to 6.8% in 2012.

Dr. Kenneth Warner, a professor of health management and policy at the University of Michigan School of Public Health, looked back through the data and found that among kids who have never smoked a conventional cigarette, only 0.7% have ever tried an e-cigarette within the last 30 days. What this shows is that the same kids who are smoking regular cigarettes are smoking e-cigs.

“Everyone thinks they are right and the logical thing is that nobody knows,” says Warner. “This is a huge-stakes issue, because the proliferation of e-cigs has the potential to either reduce the cigarette problem or increase it over time among kids.”

The reality is we have a long way to go. It took 40 years to get the adult smoking rate down to around 20%, and it won’t be easy to cut it in half again. Warner and his colleague David Mendez have created a smoking-prevalence model that’s been used since the 1990s. Their predictions show that at the rate we are going, we might not be able to hit a 10% adult smoking rate until the middle of the century. But that’s if we don’t try anything radically different.

“I believe we will do better because I don’t think we’ll stick with just status quo tobacco control,” says Warner. “In my judgment, the future lies in how effectively FDA can regulate cigarettes and other [nicotine] products.”

The FDA announced it is expanding its regulatory powers to cover more tobacco products including e-cigs, but anti-smoking advocates are arguing it’s still not enough.

“The data on kids is great, but we have a long way to go before we can pack up and go home and say we solved the problem,” says Warner.

You can read more on the latest CDC numbers here.

 

 

 

TIME E-Cigarettes

Industry Is Winning the E-Cig Regulation Battle

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Correction appended: June 12, 2014

It’s a critical time for the e-cigarette industry. In April, the FDA announced proposed rules to regulate e-cigarettes as tobacco products. The announcement kicked off a period of public comment so that e-cig makers and public health experts can raise concerns and give the FDA the necessary facts to write an appropriate set of final rules. Regulation is just like writing the rules of a new game—on one side there are businesses vying for industry-friendly regs, and on the other are public health advocates.

So far, it looks like the businesses are winning. When the FDA first announced the start of the rule-making process, Time wrote about the positive reaction to them by e-cigarette executives, who saw them as a reasonable first step that would not greatly interfere with their businesses. Now, a few weeks into the rule-making process, business continues to be optimistic while public health advocates are getting worried.

“The deeming rule that the FDA has proposed is very, very, very limited in its scope,” says Stanton Glantz, a cardiology professor at the University of San Fransisco and one of the most vociferous proponents of strict rules for e-cigs. “It requires a useless warning label and says they can’t be sold to kids under 18, but it doesn’t put any restrictions on internet sales, which means kids under 18 can easily get them. It has no restrictions on marketing at all.” This puzzles Glantz. “You would think that the Obama administration would be supporting tobacco control because it would reduce health care costs.” As far as Glantz is concerned, the administration has erred on the side of the tobacco interests.

Naturally, one of the biggest concerns among health advocates is children’s access to e-cigarettes—and marketing of e-cigs to teens is up 321%, as TIME recently reported. The Centers for Disease Control and Prevention estimates that almost 2 million students in the U.S. have tried e-cigarettes. Policies to address the issue run the gambit from the least controversial—like establishing an age restriction on purchasing e-cigs and child proof packaging—to the more divisive, like prohibiting marketing to teens, prohibiting internet sales, and restricting the use of kid-friendly candy-like flavors.

But even the most basic restrictions—like better product labeling, and child proofing—were absent from the FDA’s initial deeming rules, making other restrictions on advocates’ wish lists seem that much further away. “Any meaningful rules on marketing of e-cigarettes are years, and years, and years away,” says Glanz, pointing out that if restrictions were imposed, e-cog companies would likely sue over marketing restrictions on first amendment grounds.

Craig Weiss, the CEO of NJOY in Scottsdale, Arizona, one of the leading electronic cigarette brands, also thinks the FDA rules will stay fairly restrained. “The FDA are smart people,” he says. “They have to read everything and they will, but I think what you saw in the proposed regulations, that’s what you are going to see in the ultimate regulations as well.”

As for whether any child-marketing restrictions would make sense down the line, Weiss says there are appropriate curbs, but there is no reason e-cigarette marketing should be as strict as tobacco. “You are confusing the arsonist with the firefighter,” he says. “Why would you treat products that are part of the solution as products that are part of the problem?” he says. Though NJOY is careful not to make direct claims that their products can help smokers quit, Weiss is a big believer in the potential for electronic cigarettes to replace cigarettes. Weiss supports limits on the age of actors in ads and rules against e-cigs appearing in cartoons, but he rejects the idea that there is anything wrong with his ads, which do feature young adults.

That’s not good enough for public health advocates. “The best way to market to kids is to market to young adults,” says Glantz, “If you designed marketing to stop smoking in a 50 year old, it could be done. That’s not what they are doing. It wouldn’t be on MTV, it would be on evening news.”

Weiss responds: “I’m interested in converting every adult smoker in the country to these products. I think it would be a tragedy for smokers to be smokers for decades before we advertise in a way that is appealing to them.”

The battle over e-cig regulation isn’t settled, but if what’s going on now is any indication, that battle may have actually been over—and won by industry—before it even started.
Correction appended: The original version of this story incorrectly described which restrictions are absent from the FDA’s initial deeming rules.

TIME Advertising

What to Say to Your Kids About E-Cig Ads

A woman smokes an e-cigarette.
A woman smokes an e-cigarette. PAUL J. RICHARDS—AFP/Getty Images

What parents can do to offset the impact of a steep rise in TV ads for electronic cigarettes aimed at teens and young adults.

If your kids watch “The Bachelor,” “Big Brother” or “Survivor”—and there is a good chance that they do—odds are growing fast that they are seeing ads for one of the most controversial products to hit the market in years: e-cigarettes.

It’s time for parents to strike back.

A study published today in Pediatrics suggests that e-cigarette makers are aiming their products at young people, ages 12 to 24, by increasing advertising during the shows (such as those above) and on the channels (including AMC, Country Music Television, Comedy Central and TV Land) they watch most.

“If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults,” says the study, which was conducted by a team from the nonprofit research institute RTI International and the Florida Department of Health.

The impact of e-cigs, devices that vaporize an addictive nicotine-laced liquid solution into an aerosol mist that simulates the act of tobacco smoking, is hotly debated. On one side are those who argue that e-cigs are much safer than conventional tobacco cigarettes and help people addicted to them to quit. On the other side are those who say e-cigs still pose serious risks, including from liquid nicotine.

What can be said, with great certainty, is that we don’t know nearly enough about the long-term health effects of e-cigs to let young people get hooked on them. And as a parent, this is precisely why the study in Pediatrics and other analyses that have shown e-cigarette companies are spending tens of millions of advertising dollars targeting our kids are so alarming.

So, in the absence of any government regulation of e-cig advertising, here are a few things parents can do:

For starters, as always, the best thing we can do is talk to our kids. Let them know that e-cigarette companies have them in their sights and, as I’ve written, are trying to reel them in with fun flavors and sexy ads that are designed to make them feel all grown up. Tell them that these companies have a vested interest in promoting the idea that e-cigs aren’t bad for them—but the fact is, we aren’t really sure. And share that some experts are concerned that because they contain nicotine, e-cigs may be a gateway to real cigarettes.

Second, set clear expectations. We need to make sure that our kids understand that we don’t want them to vape and will be disappointed if they do. The Campaign for Tobacco-Free Kids has found that “parental attitudes, opinions, and feelings about their kids’ smoking status greatly influence whether or not kids will smoke, even when the parents smoke.” Vince Willmore, the organization’s vice president of communications, says the same principle is sure to hold true for vaping.

Third, set a good example. You should certainly express to your kids your own struggles to quit cigarette smoking, if that’s the case, but don’t vape around them. If you do, they may think it’s something to emulate—especially given the onslaught of ads reinforcing that vaping-is-cool message.

The Pediatrics study found that 50% of youth, ages 12 to 17, were exposed to an average of 21 e-cigarette ads from October 2012 to September 2013, and half of young adults, ages 18 to 24, were exposed to an average of 35 e-cigarette ads during the same period.

That’s a sharp rise from just a couple of years earlier, according to the study. In all, youth exposure to e-cigarette ads on TV increased 256% from 2011 to 2013, and exposure for young adults jumped 321%. More than 80% of the advertisements were for the brand blu eCigs.

The tactic seems to be working. The Centers for Disease Control reported last year that 1.8 million middle- and high-school students said they had tried e-cigarettes in 2012—double the number from the previous year.

“When I give talks about e-cigs I call them ‘Back to the Future’ because I feel like I’ve gotten into a DeLorean and gone back in time,” says Stanton Glantz, a professor of medicine at the University of California, San Francisco and the director of the Center for Tobacco Control Research and Education. “E-cig marking today looks a lot like what conventional advertising for tobacco looked like in its heyday.”

That shouldn’t be surprising. Many of the same companies that have long sold tobacco products—including R.J. Reynolds, Philip Morris parent Altria and Lorillard—have now gotten into the e-cigarette business.

Which leads me to the last thing that parents should do: Advocate. You can begin by writing in and supporting the Food and Drug Administration’s proposed new rules that include banning the sale of e-cigarettes to anyone under 18. But we need to go even further. Urge lawmakers and the White House to ban e-cigarette advertising from television—as has been the case with cigarette ads since 1971.

With e-cigs, tobacco companies are clearly taking a page out of their old playbook. It’s time for regulators to do the same.

 

 

 

TIME E-Cigarettes

E-Cig Ads Luring Teens and Young Adults Jumps 321%

186815315
Ary—Getty Images

E-cigarette marketing has increased dramatically on programming catering to young people

In the last several years, advertising for e-cigarettes has spiked. And since the product is not yet regulated in the same way as conventional cigarettes, that means some particularly impressionable populations are being targeted: young people.

Marketing has increased during programming that caters to adolescents and young adults, according to a new report published in the journal Pediatrics shows—something that has had activists and lawmaker up in arms for some time.

Advertising exposure for e-cigarettes increased 256% for young people ages 12 to 17 from 2011 to 2013. During the same period, exposure for young adults ages 18 to 24 spiked 321%. Over 75% of this advertising was shown on TV networks that cater to these age groups including AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1. Over 80% of these ads were for the e-cigarette brand, blu eCigs.

Specifically, the researchers report advertising was present on the top rated shows, “The Bachelor,” “Big Brother,” and “Survivor.” More than 80% of the advertisements were for a single brand, blu eCigs.

Also troubling is the fact that the study authors noted a lack of public health messaging against e-cigarettes. This off-balance poses health risks, they propose.

There is still much we don’t know about the safety of e-cigs, or about how well they work to help people quit (see our recent 5 sketchy things we still don’t know about e-cigs), but recent reports have shown they produce carcinogens, and another recent report found they had only a modest impact on helping highly motivated people to quit.

The FDA recently announced the agency is expanding its jurisdiction to cover e-cigarettes (which thrilled the makers of such devices, as we reported). It proposed a first-time ban on their sale to minors and a requirement for health warnings on products nationwide. However, at the current time, advertising for e-cigs are not regulated like conventional cigarettes.

TIME Addiction

Scientists to WHO: Don’t Classify E-Cigs As Tobacco Products

A woman smokes a "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes a "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The move by the WHO would push 178 countries to impose tough restrictions on the products, which some scientists say provide a less harmful alternative for smokers.

A group of 53 top scientists warned the World Health Organization Thrusday not to classify e-cigarettes in the same category as other tobacco products, a move that would lead to significant restrictions on the devices in most countries around the world.

The scientists say that electronic cigarettes are in fact “part of the solution” in the fight against smoking because they can provide a healthier alternative to traditional cigarettes, Reuters reports.

“Even though most of us would prefer people to quit smoking and using nicotine altogether, experience suggests that many smokers cannot or choose not to give up nicotine and will continue to smoke if there is no safer alternative available that is acceptable to them,” the scientists wrote.

The devices have exploded in use and spawned a $3 billion industry worldwide, but the scientific research on their safety and their potential to be a “gateway” to other tobacco products is still developing.

If the WHO were to classify e-cigarettes as tobacco products—a move they are rumored to be considering, according to Reuters—178 signatories to the Framework Convention on Tobacco Control would be expected to impose strict measures on them to restrict demand, like raising taxes and banning some forms of advertising. The U.S. is one of the few non-signatories to the FCTC, though the Food and Drug Administration has moved to regulate e-cigs.

The FCTC is scheduled to meet in October in Moscow, where it will consider any proposed regulations.

[Reuters]

TIME

Here’s Why Bacteria Like E-Cigs

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Barbara Rich—Getty Images/Flickr Open

The vapor from e-cigarettes is supposed to be safer than cigarette smoke, but not when it comes to fighting bacteria

There’s quite a bit that we still don’t know about e-cigarettes when it comes to how safe they are — if they cause lung cancer like traditional cigarettes do, whether they are as addictive as cigarettes, and more. That’s reflected by the fact that fewer smokers believe that e-cigs are safer for their health than traditional cigarettes; in 2010, 85% did, but that percentage dropped to 65% in 2013, according to a study published in the American Journal of Preventive Medicine.

But for bacteria, e-cigs may not be so bad. Dr. Laura Crotty Alexander, from the University of California at San Diego and the VA San Diego Healthcare System, found that the vapor from e-cigs prompts bacteria to become more resistant to antibiotics. In the presence of e-cig vapor, for example, methicillin resistant staphylococcus aureus (MRSA) became more resistant to the natural anti-microbial agents that the body makes. Cigarette smoke also produces the same effect, but Crotty Alexander was surprised that the e-cig vapors did as well, given that they were not supposed to contain the health-harming carcinogens that tobacco smoke does.

MORE: The FDA Plans to Ban E-Cigarette Sales to Minors

“I was hoping that maybe e-cigarettes would be safer and that they would not stress the bacteria as much as cigarette smoke,” she says of her findings, which she presented at the American Thoracic Society International Conference. “But we found that the e-cig vapor also made bugs become more resistant to killing by antimicrobial peptides.”

Other studies show that these peptides, known as the body’s natural antibiotics, are structurally similar to antibiotic drugs, so while Crotty Alexander did not test bacteria exposed to e-cig vapor against antibiotics, she expects they would be resistant to the medications as well.

MORE: Study: E-Cigarettes Do Not Help People Quit Smoking

How did the bugs fight back? When stressed by the e-cig vapors to defend themselves, the bacteria produced copious amounts of biofilm, a sticky, slimy polymer that acts as their armor against things like antibiotics.

But the vapors may be doing much more than disturbing the bacteria. Earlier studies showed that traditional cigarette smoke, with its tar and tobacco-burning byproducts, can also weaken the ability of the body’s immune cells to defend against the insult, making it harder to fight off infections. Crotty Alexander is starting to analyze human cells to see if e-cig vapors have the same effect. She’s narrowing down which components of e-cigs contribute to the antibiotic resistance – some e-juices are made with propylene glycol, while others contain a vegetable-based glycol, and not all contain nicotine.

MORE: E-Cigs Still Produce Carcinogens, Study Shows

So far, it looks like the nicotine may be driving the MRSA biofilms, but Crotty Alexander is doing more research to determine how e-cigs are affecting human immune cells. As the survey of smokers shows, however, they may already know the answer.

TIME Smoking

The Weird Link Between E-Cigarettes and Mental Health Disorders

US-HEALTH-TOBACCO-E CIGARETTE
This September 25, 2013 photo illustration taken in Washington, DC, shows a woman smoking a "Blu" e-cigarette (electronical cigarette). PAUL J. RICHARDS—AFP/Getty Images

A new study finds elevated rates of depression, anxiety and other mental disorders among users of e-cigarettes

A new study has found that people suffering from depression, anxiety and other mental disorders are more than twice as likely to spark up an e-cigarette and three times as likely to “vape” regularly than those without a history of mental issues.

Researchers at the University of California, San Diego drew their findings from an extensive survey of American smoking habits. Among 10,041 respondents, 14.8% of individuals suffering from mental health disorders said they had tried an e-cigarette, compared with 6.6% of individuals who had no self-reported history of mental disorders.

The e-smokers’ elevated rates of mental disorders reflected the elevated rates of mental illness among smokers in general. The authors note that by some estimates, people suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.

Many respondents said they switched to e-cigarettes as a gateway to quitting. The FDA has not yet approved e-cigarettes as a quitting aide.

“People with mental health conditions have largely been forgotten in the war on smoking,” study author Sharon Cummins said in a university press release. “But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon.”

The study will run in the May 13 issue of Tobacco Control.

TIME

E-Cigs Still Produce Carcinogens, Study Shows

New research suggests that some e-cigarettes get hot enough to produce cancer-causing compounds

Vaping may not be the benign drug-delivery system some have thought. E-cigarettes are touted by some to help people curb smokers’ conventional cigarette habit, but new research suggests e-cigs can still produce carcinogens.

E-cigarettes are considered healthier than conventional cigarettes, since smokers are inhaling vaporized nicotine instead of carcinogen-filled smoke. But soon to be published research shows that some popular e-cigarettes can get so hot that they produce some of the same carcinogens as traditional cigarettes. The study looked at higher-voltage e-cigarettes—referred to as “tank-style”—which are heated with larger batteries compared to smaller disposable brands. The new study, which will be published in the journal Nicotine and Tobacco Research, found that tank e-cigarettes can produce the carcinogen formaldehyde when the liquid nicotine is heated at high temperatures, which users can inhale. “This finding suggests that in certain conditions, [e-cigarettes] might expose their users to the same or even higher levels of carcinogenic formaldehyde as tobacco smoke,” the Roswell study says, according to the New York Times.

In April, the U.S. Food and Drug Administration (FDA) announced that it extended its regulatory jurisdiction over more tobacco products, including electronic cigarettes. The agency said it plans to crack down on e-cigarettes by proposing a ban of their sale to people under 18 and by requiring health warnings on packaging.

The trouble with e-cigarettes is that their risks and benefits are still unknown. It remains uncertain whether they help people quit, or if they’re servings as a gateway to regular cigarettes for young people. According to data from the National Youth Tobacco Survey, the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012. There are also questions over whether liquid nicotine is dangerous when put in the wrong hands, given that some tobacco control agencies have seen an uptick in poisonings.

There’s an overall lack of research on e-cigs, but researchers are beginning to fill that hole, and lately, the findings haven’t looked good for e-cigarettes.

 

TIME

E-Cig Execs Are Actually Thrilled With New FDA Regulations

Customers at Henley Vaporium in New York, Dec. 2013.
Customers at Henley Vaporium in New York, Dec. 2013. Timothy Fadek—Redux

E-cigarette makers have hailed the Food and Drug Administration's proposed regulations for new tobacco products—including electronic cigarettes, pipe tobacco and hookah, among others—as fair and moderate and a sign of a business-friendly approach

“It’s a great day,” says Christian Berkey, CEO of Johnson Creek, a leading maker of electronic cigarette liquid based in Wisconsin.

Berkey was referring to the FDA’s issuance Thursday of proposed federal regulation of electronic cigarettes, a nascent industry that has grown to nearly $2 billion a year in U.S. sales. The move extended the FDA’s authority to regulate new tobacco products, including electronic cigarettes, pipe tobacco, and hookah, among others.

The FDA will take comments from various stakeholders on the rules over the next 75 days, and it could be a year or more before the regulations take effect, but today’s proposed rules were a big step toward bringing the e-cig wild west under control. Currently, there are no federal rules governing e-cigarettes (though many states prohibit the sale to minors).

“People worried the regulations would be unreasonable and onerous,” says Berkey. “What we are seeing is they are not.” Upon seeing the FDA’s proposed rules today, the businesses are cheering. They see the proposal as a signal that the agency plans to take a business-friendly approach.

Craig Weiss, the President and CEO of NJOY, a popular e-cigarette maker, was even more ecstatic in a press statement: “By resisting calls to regulate ahead of – and indeed in opposition to – the science and data, today the FDA has brought NJOY a giant step closer to achieving its corporate mission of obsoleting cigarettes.”

“I would say that there were certain people that went into this thinking the FDA would be a foe — an irrational, illogical opponent to these devices,” says Miguel Martin, president of Logic Premium Electronic cigarettes, another top e-cigarette manufacturer, “[But] they’ve hit the ball right down the middle of the fairway. It is early, I might change opinion,but the original set up on the process seems extremely fair.”

The proposed regulations would ban the sale of e-cigarettes to minors and in vending machines where minors are allowed, require labels that list the ingredients and warn of the addictive properties of nicotine, and require companies to register new products with the FDA with a rigorous application process before they can put them on the market.

The FDA has not yet proposed to ban flavors, which some anti-smoking advocates say appeal to kids, nor have they banned internet sales or advertising of e-cigarettes. And the FDA has given electronic cigarette companies a two-year window after the regulations go into effect to keep their products on the market while they apply to register new products.

Currently, it is illegal for e-cigarette companies to make health claims that their products are healthier than regular cigarettes or can help people quit—a question that needs more thanks to a court decision ruling in 2009. But in today’s deeming regulations, the FDA opened a pathway for companies to make health claims by submitting supporting research to the FDA.

“I suspect that many companies are going to take a run at that,” says Martin.

The proposals are really just a starting point. Mitchell Zeller, the director of the Center for Tobacco Products at the FDA, called the proposed rules “foundational” today in a call with reporters, signaling that future regulations could ban or restrict things like internet sales, flavors, or advertising. And after the first two year grace period, e-cigarettes will still be subject to potentially long application processes for new products that might hurt business, say manufacturers.

“It’s not time for a victory lap,” says Martin. “A lot can change.”

TIME Addiction

5 Sketchy Things We Still Don’t Know About E-Cigarettes

The FDA has cracked down on e-cigs by asserting its regulatory power and proposing a ban on sales to minors

On Thursday, the U.S. Food and Drug Administration (FDA) flexed its regulatory muscles and extended its authority over more tobacco products, including the highly debated electronic cigarettes, or e-cigarettes. In the announcement, the agency said it now has jurisdiction over items that meet the statutory definition of tobacco products—which includes e-cigarettes, pipe tobacco, and hookah tobacco, among others. The FDA says it also plans to crack down on e-cigarettes by proposing a ban of their sale to people under 18 and by requiring health warnings on packaging.

The UK already has stiff regulations on e-cigarettes and some cities in the U.S., like Los Angeles, have banned them in several public places. The trouble with e-cigarettes is that they are so new, and there’s not enough evidence to definitively determine either how effective they are at helping people quit smoking—or the health risks associated with inhaling vaporized nicotine. Here are five things we are still scratching our heads over.

1. Do e-cigarettes actually help people quit—or are they a gateway for new smokers?
Some e-cigarette brands claim that they can help people wean themselves off regular cigarettes by supplying would-be quitters with nicotine (but without the carcinogens in conventional cigarette smoke). However, recent research is questioning whether they really help people quit. A recent study published in the journal JAMA Internal Medicine looked at self-reports from 949 smokers–88 of whom used e-cigarettes at the start of the study–in order to determine if e-cigarettes were helping people kick or cut back on nicotine. Researchers found that e-cigarettes did not help people quit, concluding, for now at least, that the case for e-cigarettes as a cessation tool is flimsy at best. (The study size was small, signaling a need for more research.)

There’s also the worry that e-cigarettes are tempting people into trying the real thing. Another study published in March found that adolescents who use e-cigarettes are more likely to smoke other tobacco products and regular cigarettes, which suggests that e-cigarettes are not always the lesser of two evils, but instead, just another vector for nicotine exposure. According to data from the National Youth Tobacco Survey, the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012. Of course, there are still not enough studies to reach a firm conclusion that e-cigarettes make people more likely to smoke tobacco—and the FDA says this is not yet determined.

2. How dangerous is liquid nicotine?
The health risks associated with the liquid nicotine used in e-cigarettes are not fully understood. A recent New York Times article found that the liquid could be linked to poisonings; the number of poisonings linked to e-cigarette liquids rose to 1,351 in 2013, which is a 300% increase from 2012. The CDC also released a report earlier this month that showed what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. The spike went from one call a month in September 2010 to 215 calls a month in February 2014. Over half of the calls involved kids age five and under, and 42% involved people ages 20 and older. Known symptoms of liquid nicotine ingestion include vomiting, nausea, and eye irritation.

3. Are the vaporizers safe?
Though the numbers are small, there have been a few cases of e-cigarettes exploding and harming users and the people around them. E-cigs contain a small lithium battery that heats up the liquid inside. The liquid is made up of nicotine dissolved in a colorless liquid called propylene glycol, with added synthetic flavor and sometimes dyes. When an e-cigarette exploded in a Florida man’s face, Thomas Kiklas, co-founder of the Tobacco Vapor Electronic Cigarette Association, told the Associated Press that the industry does not know of issues with the cigarettes or batteries exploding.

4. Is propylene glycol dangerous?
Propylene glycol is a a clear, colorless liquid that becomes vapor when it’s heated. It can also be found in food, cosmetics, and pharmaceutical products, and the small amounts people are typically exposed to are largely believed to be benign. However, it’s uncertain whether inhaling propylene glycol could come with unique health risks. “As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Thomas Glynn, the director of science and trends at the American Cancer Society told ABC News. “No one knows the answer to that.”

5. Can you get addicted to e-cigarettes?
As the FDA says, nicotine is “highly addictive.” The FDA says they still don’t know how much nicotine or other potentially harmful chemicals are being inhaled during e-cigarette use. Therefore, it’s hard to tell how much or little damage is being done.

 

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