Battery-operated nicotine vapor delivery systems designed to look like traditional cigarettes, widely known as “electronic cigarettes” or e-cigarettes, are being promoted online via peer-to-peer social networking as an effective smoking-cessation device. There is scant evidence for such claims, however, and e-cigarettes might even undermine tobacco control efforts, some critics say. But e-cigarette users and advocates have organized to oppose regulation of these devices.

E-cigarettes originated in China, where a large number of the devices are still manufactured. Users drip a liquid nicotine solution into the device, which vaporizes nicotine and propylene glycol into a mist that visually resembles tobacco smoke.

Although e-cigarette nicotine is derived from tobacco, it does not contain other tobacco products, and e-cigarettes have not been taxed or regulated as tobacco products. A 2010 federal appeals court ruling, Sottera, Inc vs. the US Food and Drug Administration, ruled that e-cigarettes are “derived from tobacco” and are not marketed with therapeutic claims by manufacturers – and that these products are therefore tobacco products rather than drugs or medical devices. The FDA appears to be moving toward regulation of e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, despite court challenges to its implementation of other components of that law, like graphic warning labels for cigarette packages.

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Although actual data is scant, it seems reasonable to assume, as proponents do, that e-cigarettes are less harmful than smoked cigarettes. E-cigarettes tend to contain much lower nicotine doses-per-puff than do cigarettes – as little as 10% of the nicotine found in tobacco smoke–and e-cigarette vapor does not contain carcinogenic combustion products or N-nitrosamines (TSNAs) found in cigarette smoke. 

A 2009 FDA analysis of 18 e-cigarette products found trace TSNA concentrations that were much lower than tobacco smoke levels and that were similar to levels found in nicotine-maintenance/tobacco-replacement products, like nicotine gums and patches. (The study noted variable nicotine levels in the e-cigarette vapors, both between and within particular brands, however.) FDA scientists found nicotine solution from one type of e-cigarette, the Smoking Everywhere 555 High e-cigarette cartridge, to contain toxic diethylene glycol at a 1% concentration.

To say that e-cigarettes are less hazardous than tobacco smoking, however, is a far cry from saying they are truly safe or harmless, caution critics. Nicotine itself is toxic, they note, and may reduce oral cancer cells’ apoptosis rates. Lack of rigorous product quality-control in China could result in variable dose delivery and potentially even accidental poisonings, some contend.

Critics also worry that low nicotine doses, lower cost than tobacco cigarettes, and flavorings might all come together to make e-cigarettes an attractive gateway device for adolescents – some or many of whom might wind up smoking. The FDA bans fruit and other sweet flavorings from cigarettes that could encourage children to try smoking, but smokeless tobacco products like snuff come in various flavors and research suggests that adolescent boys who use smokeless tobacco are three times as likely to become cigarette smokers in early adulthood.

It is not yet clear whether or not e-cigarette users compensate for the lower nicotine dose-per-puff compared to doses from traditional cigarettes by puffing more. But seemingly innocuous, flavored e-cigarettes may be attractive to teens and contribute to nicotine dependence rates, critics worry. If some young users then switch to traditional tobacco cigarettes to increase nicotine doses, e-cigarettes would indeed be a gateway or bridge to smoking.