by Stahl RJ

IMAGE Electronic nicotine delivery systems (ENDS) are tools that contain liquid nicotine and other chemicals. They are more often called e-cigarettes, e-cigs, vape pens, or vapes. They may also be called by a brand name like JUUL. These tools heat a liquid until they become a vapor. The user then breathes in the vapor. Chemicals that makeup the liquid can differ between products. Some user or sellers may also add their own chemicals or oils.

E-cigs have been sold as a healthier choice than cigarettes. They may be used as a way to quit smoking or as a replacement to smoking. Lack of smell or ashes are clear benefits of the change. The effects on health are less clear.

Vape vs Smoke

Cigarette smoke has over 7,000 toxins. The vapor from e-cigs has far fewer toxins. This does not mean vapor is completely safe. E-cigs may have:

  • Flavor oils that are known to cause lung disease
  • Nicotine
  • Cancer causing chemicals
  • Heavy metals

Vaping liquids may not list all of its ingredients. Studies have also shown that labels may not always be correct. For example, a liquid may have nicotine even when it is labeled as nictoine-free. You may not know what you are breathing in.

Known Effects

Some chemicals found in e-cigs are well studied. Nicotine is one. It is a chemical that makes cigarettes so hard to quit. It can also be:

  • Harmful to pregnant women
  • Toxic to babies before birth
  • Harmful to growth of brain in teens and young adults

Nicotine makes these same problems whether it is in a cigarette or an e-cigarette. Other problem items found in vaping fluid include:

  • Flavor oil called diacetyl—known to cause lung disease when it is inhaled
  • Chemicals know to cause cancer
  • Heavy metals

The heating process also burns fluids to very tiny particles. They can find their way deep into the lungs. For these reasons, e-cigs should only be used by those that already smoke as a way to reduce smoking. Any other use of e-cigs increases the risk of illness without benefit.

In 2019, the US CDC released a notice about a link between a severe lung illness and e-cigs use. The exact cause is not clear though vitamin E acetate found in e-cigs may play a role. More research will be done to confirm the cause of the illnesses. There is enough information at this point to cause concern. Many groups now recommend that e-cigs use should be stopped.

Making an Informed Decision

There is no question that quitting smoking is one of the best things you can do for your health. Is vaping a good tool to help you quit?

Many e-cigs contain nicotine. This can help to lessen side effects you may feel when you stop smoking. It may also provide similar feelings as smoking. This may help to switch from smoking to vaping. However, it is not clear how safe vaping is. The main goal should be to stop both cigarettes and e-cigarettes.

The FDA has not approved vaping as a tool to quit smoking since there is not enough data to support or reject it. While some have reported success, many also end up using both cigarettes and vaping. There are also safety concerns that are still unclear with vaping. Look for proven ways to quit such as:

These may be safer options. It may take more than one try to quit but it is worth the effort. Your doctor can help you weigh the risks and benefits of each option and see which may be best for you.


Smoke Free 

US Food & Drug Administration 


Canadian Lung Association 

Health Canada 


About Electronic Cigarettes. Center for Disease Control and Prevention (CDC) website: Updated November 8, 2019. Accessed November 13, 2019.

Nicotine Replacement Therapy for Tobacco Cessation. EBSCO DynaMed website. Available at: . Updated September 18, 2019. Accessed November 13, 2019.

Outbreak of Severe Pulmonary Disease Associated with Using E-cigarette Products. Center for Disease Control and Prevention (CDC) website: Updated August 30, 2019. Accessed November 13, 2019.

Pokhrel P, Fagan P, Little MA, Kawamoto CT, Herzog TA. Smokers who try e-cigarettes to quit smoking: findings from a multiethnic study in Hawaii. Am J Public Health. 2013;103(9):e57-e62.

Policy guidance document regarding cigarettes. American Heart Association website. Available at: Published April 9, 2010. Accessed November 13, 2019.

Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS). World Health Organization website. Available at: Updated March 30, 2015. Accessed November 13, 2019.

Vaping. EBSCO DynaMed website. Available at: . Updated November 6, 2019. Accessed November 13, 2019.

Vaporizers, e-cigarettes, and other electronic nicotine delivery systems (ENDS). US Food & Drug Administration website. Available at: Updated April 18, 2017. Accessed November 13, 2019.

3/19/2015 DynaMed's Systematic Literature Surveillance : McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014;12:CD010216.

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