What exactly are e-cigarettes? Are they safe?

DEAR DOCTOR K:

I caught my son and his friends smoking e-cigarettes. My son tells me I have no reason to worry, and that they’re safer than regular cigarettes. What exactly are e-cigarettes? Are they safe?

DEAR READER:

E-cigarettes are battery-operated devices that look like cigarettes. They are built around a heating element, a cartridge that contains nicotine and other chemicals, and an atomizer that converts the chemicals into a vapor. Instead of inhaling smoke from e-cigarettes, the user inhales this vapor. (This is sometimes called “vaping.”)

Both regular and e-cigarettes contain nicotine — the substance that smokers become addicted to. E-cigarette smokers inhale nicotine, water and propylene glycol (a fluid that helps nicotine dissolve). But, unlike smokers of regular cigarettes, they don’t inhale tar, carbon monoxide, or the thousands of other substances in tobacco smoke that can cause cancer.

It’s for this reason that e-cigarettes have been marketed as safe, or safer than cigarettes. It’s true that e-cigarettes can provide a nicotine fix without exposing smokers to cancer-causing tobacco, and they provide something to hold and inhale. This might help to break the behavioral and emotional hold of regular cigarettes. However, I’m not aware of any strong evidence that e-cigarettes actually help people stop smoking.

Your son is not unusual: E-cigarette use has jumped in middle and high school students. This is probably, at least in part, because of e-cigarette advertising aimed at teens. Cartridges even come in flavors designed to appeal to kids, like bubble gum and chocolate.

E-cigarette companies would like teens — and their parents — to think of e-cigarettes as safe. But it’s not true. Nicotine is a stimulant. E-cigarettes are not regulated, so different e-cigarettes may contain different amounts of nicotine. High levels of nicotine can cause dangerous disturbances in heart rhythm. Granted, there is no strong evidence that e-cigarettes can cause dangerous heart rhythms — but that is because there are no large, high-quality studies of the safety of e-cigarettes.

Also, using e-cigarettes can lead to a nicotine addiction. It’s entirely possible that e-cigarettes could be a “gateway” to smoking regular cigarettes, particularly in kids.

There are also still many things we don’t know about e-cigarettes. For example, we don’t yet know whether there are possible adverse long-term effects of inhaling the vapor. As I mentioned in an earlier column, the vapor includes an array of chemicals, including diethylene glycol, a highly toxic substance; formaldehyde, a powerful carcinogen; and at least four other chemicals suspected of being harmful to humans.

The truth is that we’re in the early stages of learning about the possible benefits and risks of e-cigarettes. So, I would discourage my child from using them.

And when smokers ask me if e-cigarettes could help them to stop smoking, I tell them we just don’t know. And I remind them that there are many well-studied, FDA-approved nicotine replacement products on the market, including patches, gums, lozenges, inhalers and nasal sprays. They are vastly preferable to smoking. And, until we have more studies, to electronic cigarettes.