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E-cigarettes: Know the risks

Last Modified: November 09, 2023

Family Medicine, Diseases & Disorders


This post was written by Heather Willison, MSN, FNP-C, PPG – Allergy, Asthma & Immunology.

E-cigarettes are battery-operated devices that heat a liquid that usually contains nicotine, flavorings and other chemicals into an aerosol. Users inhale this aerosol into their lungs. You might have also heard e-cigarettes referred to by one of their many other names including e-cigs, vape pens, e-hookahs, mods, vapes, JUUL (a brand name) or electronic nicotine delivery systems (ENDS). In addition to nicotine, e-cigarettes can also be used to deliver marijuana and other drugs.

E-cigarettes were initially introduced in the United States in 2006 to help people stop smoking cigarettes. Since that time, e-cigs have evolved from cigarette look-a-likes to vape pens and pod-based systems. The introduction of the discreet and sleek appearing pod-based systems in 2015 led to a rapid rise in use of e-cigarettes by adolescents. This has created controversy, both due to the potential for harmful negative effects related to e-cig use and because teens who have never smoked cigarettes are now hooked on nicotine.  A study released by the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) in the fall of 2022 reported that over 2.5 million youth had used e-cigarettes in the prior month. 

E-cig devices

As a non-smoker, I was amazed by the many varieties of e-cigs that are available for purchase. E-cig devices may be open or closed systems, as well as tank or pod mods. Allow me to break it down for you.

An open system is where the device has a refillable reservoir for e-liquids. This allows for the system to be opened and the e-liquid to be customized (nicotine content or flavors). Closed systems use pre-filled cartridges that are disposable. The preference amongst teens seems to be to use a closed system as the vapor cloud is much smaller, thus less noticeable. 

Tank mods have an electronic control box that allows for more customization. This makes tank mods a preferred choice for those trying to stop smoking. Pod mods are the newest and seem to be the preference of teens and young adults due to their lower cost, discreet designs and less obvious vape cloud.  JUUL is a common pod mod brand and has hooked many teens due to the nicotine content and the appealing flavors available. They are also easily concealed from parents who are not savvy to e-cig devices as they are similar in appearance to USB drives.

The negative impact of e-cigs

Various studies have found that the negative health effects of e-cigarettes are like that of traditional cigarettes. However, it is thought that these negative effects are not only due to the highly addictive nicotine content but also due to chemicals found in the e-liquid. These chemicals include flavoring additives such as diacetyl, a chemical linked to a serious lung disease; volatile organic compounds; cancer-causing chemicals; and heavy metals such as nickel, tin, and lead. The aerosol produced by an e-cigarette is harmful to the user as well as to bystanders when these harmful substances are exhaled by the user.

The airways of e-cig users compared to nonsmokers and traditional cigarette smokers have been shown to be more susceptible to infection, with airway tissue being severely damaged in some cases. In fact, even when e-cigs do not contain nicotine, there is evidence that the e-liquid components and flavoring additives can result in irreversible airway damage. Studies have shown, and it has been my experience, that patients with asthma report increased coughing, shortness of breath, wheezing and/or chest tightness when using e-cigs. Asthma becomes more difficult to control, resulting in missed days of school or work, as well as a decrease in quality of life. In addition to being linked to chronic lung disease and asthma, e-cigs have also been associated with cardiovascular disease.   

Ready to quit?

E-cigs are not approved by the FDA as an aid to assist people in their endeavors to quit smoking and there is limited evidence showing that e-cigs are even helpful in doing so. 

Freedom from Smoking® is an American Lung Association course that is offered by Parkview free of charge.  The course strives to assist people in achieving freedom from nicotine dependence. Please contact the Parkview Center for Healthy Living at 260-266-6500 for more information.

Other resources

CDC: Quit Smoking                   


American Lung Association       

American Heart Association      













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