Electronic cigarettes, or e-cigarettes, are a popular new tobacco product that have still largely unknown public and individual health effects. Since they were introduced, e-cigarettes have sparked controversy.

e-cigarette mechanism

How an E-Cigarette Works

E-cigarettes are designed to look like the real thing. The end glows as you inhale. As you exhale, you puff out a cloud of what looks like smoke. It’s actually vapor, similar to the fog you might see at rock shows. All e-cigarettes work in basically the same manner. Inside, there’s a battery, a heating element, and a cartridge that holds nicotine and other liquids and flavorings. Features and costs vary. Some are disposable. Others have a rechargeable battery and refillable cartridges. The process of using an e-cigarette is called “vaping.”

The Debate About E-cigarette Safety

Just as with regular tobacco products, the nicotine inside the cartridges is addictive. When you stop using it, you can get withdrawal symptoms including feeling irritable, depressed, restless and anxious. It can be dangerous for people with heart problems. It may also harm your arteries over time. Also, even one teaspoon of liquid nicotine can be lethal to a child, and smaller amounts can cause severe illness. Because the e-liquid containers vary in size and are not required to be childproof, it’s likely that the incidence of problems from the ingestion of liquid nicotine by small children will rise.

e-cigarette vaping

So far, evidence suggests that e-cigarettes may be safer than regular cigarettes. The biggest danger from tobacco is the smoke, and e-cigarettes don’t burn. Tests show the levels of dangerous chemicals they give off are a fraction of what you’d get from a real cigarette. But what’s in them can vary.

E-cigarettes have triggered a fierce debate among health experts who share the same goal — reducing the disease and death caused by tobacco. But they disagree about whether e-cigarettes make the problem better or worse.

Opponents contend that because nicotine is addictive, e-cigarettes could be a “gateway drug,” leading nonsmokers and kids to use tobacco. They also worry that manufacturers — with huge advertising budgets and celebrity endorsements — could make smoking popular again. That would roll back decades of progress in getting people to quit or never start smoking.

Others look at possible benefits for smokers. “Obviously, it would be best if smokers could quit completely,” says Michael Siegel, MD, MPH, a professor at Boston University’s School of Public Health. “But if that’s not possible, I think they’d be a lot better off with e-cigarettes. They’re a safer alternative.” Siegel compares replacing tobacco with e-cigarettes to heroin users switching to the painkiller methadone. The replacement may have its own risks, but it’s safer.

Some supporters believe that e-cigarettes could help people quit, just like nicotine gum. Initial research looks promising, but more long term, in-depth studies are needed.

Future Regulation?

Unlike regular cigarettes (and nicotine replacement products used to help smokers quit), e-cigarettes are not regulated by the U.S. Food and Drug Administration. However, the FDA has expressed “great concern” over the dramatic rise in e-cigarette use among youth and is discussing regulating these products. Currently 44 states have prohibited the sale of e-cigarettes to minors.

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