Electronic cigarettes, or e-cigarettes, are battery-operated delivery systems for the inhalation of nicotine or other liquids. They consist of a battery, a cartridge that contains liquid, the carrier for nicotine, and an atomizer that converts the liquid into a mist.

When the user inhales or presses a button on the e-cigarette, a small amount of liquid gets released into the vaporizer and is transformed into a fine mist which is then inhaled into the lungs. After entering the lung, the nicotine contained in the mist gets absorbed almost instantly and is transported via the blood into the brain where it exerts its effect.

E-cigarettes were originally invented in 2003 by a Chinese pharmacist and have spread from China across the globe at an extremely rapid pace. Many different brands exist today that deliver varying amounts of nicotine. They have become increasingly popular in the United States with a sharp increase in the number of users over the past few years. Marketing for the devices is aggressive and they are becoming more easily accessible.

An astonishingly rapid rise of their use in middle and high school students triggered a press release by the Centers for Disease Control and Prevention last month. The reported numbers are concerning. More than 1.78 million middle and high school students tried e-cigarettes in 2012. This number is twice as high as in 2011.

In addition, smoking e-cigarettes was also strongly associated with smoking tobacco. Tobacco smoking has tremendous health consequences and it is estimated that 435,000 people die prematurely because of smoking.

The findings from this report raise serious concerns for the future health of our children. Exposure to small amounts of nicotine for a brief period of time can set the path for lifelong addiction in a child. It is known that almost all smokers start their habit before reaching adulthood. In addition, exposure to nicotine at a younger age is associated with higher risk for chronic dependence as less mature brains are more susceptible to the effects of nicotine.

It is said that a journey of a thousand miles begins with a single step. Unfortunately, a lifelong addiction to nicotine can start with one e-cigarette.

Nicotine is a highly addictive drug, and inhalation into the lungs is a powerful delivery route as the drug reaches the brain within seconds after inhalation. The nicotine effect is instant and many people will experience a sensation of relaxation, pleasure, reduced stress and improved alertness. On the flip side, once the brain has become accustomed to daily exposure to nicotine, it becomes dependent on its stimulating effect. Any attempt to quit smoking leads to unpleasant sensations that are associated with strong craving for nicotine to seek relief. This in in turn makes it extremely hard to kick the addiction.

What are some of the concerns regarding e-cigarettes?

1. E-cigarettes are heavily promoted and children are increasingly exposed to advertisement through nontraditional media like the internet. Some e-cigarettes are sold with enticing flavors like bubble gum or chocolate that makes them more appealing to children and teenagers. The greatest concern is that they are exposing children and teenagers to nicotine with the potential to set up lifelong nicotine dependence.
2. Nicotine is a highly addictive drug that leads to measurable changes in the brain and body.
3. Even if you assume that e-cigarettes are “cleaner” than tobacco, they still deliver a potent drug that can lead to lifelong dependence in many teenagers.
4. Even though e-cigarettes deliver a highly potent drug, the quality of their production and reliability of nicotine dose and delivery are not under formal supervision by the Food and Drug Administration. A preliminary analysis by the FDA found inconsistent or non-existent quality control in the manufacturing process. The amount of nicotine varied substantially from cartridge to cartridge and tobacco specific impurities were detected. The FDA has announced that it will begin to regulate e-cigarettes soon. However, no specific rules have been announced yet.
5. The health effect of the inhalation of e-cigarette vapor over many years into the lung is unknown. Even though they do not contain tobacco, the vapor contains chemicals that have not been proven to be safe when inhaled for many years.
6. E-cigarettes are being promoted as a safe alternative to smoking or as a tool for smoking cessation. However, they are attractive to children that do not currently smoke.

So what can a parent do about this?

Pick a time to talk to your teenager when she/he is in a good and cooperative mood. Ask if she/he has heard about e-cigarettes. If not, offer to talk about it. If your teenager knows peers that are smoking e-cigarettes or is using herself/himself offer support in a non-judgmental way.

You can also call 1-800-QUIT –NOW to obtain free advice on how to get started – also a good idea to call if you are a smoker and thinking about quitting smoking.

Holger Link, M.D., M.R.C.P.
Clinical Associate Professor of Pediatrics, Division of Pediatric Pulmonary Medicine
OHSU Doernbecher Children’s Hospital