What Is the Problem with E-Cigarettes?

The reality is that e-cigarettes really are less problematic than regular cigarettes in terms of future health risk, but they are not risk-free.

The seven most important health concerns for teen users of e-cigarettes are these:

• Users of e-cigarettes can become addicted to nicotine. They could satisfy their nicotine cravings with e-cigarettes and avoid exposure to the carcinogens in tobacco smoke, but most teens don't. 

• By a ratio of about 3 to 1, teens who use electronic cigarettes also smoke regular cigarettes.

• Teens often express the idea that regular cigarettes are bad, and any alternatives to regular cigarettes are OK. Smoking cigars and using water pipes, however, are probably as dangerous to long-term health as smoking tobacco cigarettes.

• E-cigarettes are often the gateway to a smoking habit. A researcher who analyzed tweets about e-cigarettes noted a number of exchanges on the lines of "Do you smoke?" with the response "Want to start?"

• Only 10 to 13 puffs on an e-cigarette are necessary to maximize the amount of nicotine in the user's bloodstream. This means it is easy for users to get a nicotine fix from e-cigarettes (and studies indicate that people addicted to regular cigarettes may find it easier to quit if they use e-cigarettes), but it is also easier for smoking novices to get addicted to nicotine.

• The nicotine in cigarette smoke from either electronic cigarettes or regular cigarettes concentrates its effects in a part of the brain called the hippocampus, which is involved in the formation of short-term memories. The nicotine actually makes it easier for smokers to pay attention to more details as they study, but it also creates more memories, a flood of information, when they take tests.

• Electronic cigarettes can become a hobby. Some users collect different flavors of nicotine cartridges. The more fun the user has with the product, the harder it can be to quit using it.

• Just twelve states (Wisconsin, Utah, Tennessee, New York, New Hampshire, New Jersey, Minnesota, Maryland, Iowa, Idaho, Colorado, and California) ban the sale of e-cigarettes to minors. Most states, however, have strict laws regarding the sale of regular cigarettes to minors. It's not rare for a seller to get six months in jail for a sale. Users of e-cigarettes may not be aware of criminal liability for related activities in their states.

Electronic cigarettes are even more popular among teens aged 15 to 19 outside the United States. A study of e-cigarettes by older teens found that 23% of older teens in Poland used them. 

There is no doubt e-cigarettes are here to stay. But if teens use them, they should at least use the lower-nicotine cartridges to minimize their risk of addiction. Or even better, teens should not use them at all. Leave them for middle-aged adults struggling to beat their tobacco addiction.