Electronic Cigarettes: Common Questions and Answers
Am Fam Physician. 2019 Aug 15;100(4):227-235.
Related letter: Electronic Cigarettes: More Questions Than Answers
Patient information: See related handout on e-cigarettes, vaping, and Juuls, written by the authors of this article.
Electronic cigarettes (e-cigarettes) are popular devices designed to heat a liquid solution, often containing nicotine, that generates an inhaled aerosol, or vapor. e-Cigarettes have been marketed as healthier alternatives to traditional cigarettes. Thus, most adult users are current or former smokers who use e-cigarettes to reduce or quit cigarette smoking. Switching completely from cigarettes to e-cigarettes is associated with reduced toxicant exposure and reduced short-term respiratory symptoms; however, long-term health effects of e-cigarettes are unknown. Although a recent randomized trial suggests that e-cigarettes may promote smoking cessation, systematic reviews have had low certainty of evidence regarding cessation. e-Cigarettes pose several potential health risks, including exposure to heavy metals and toxicants, and nicotine poisoning. e-Cigarettes are also popular among youth, with rates of e-cigarette use surpassing those of cigarette use in this population. Youth e-cigarette use is associated with increased risk of subsequent cigarette and marijuana use. Screening for e-cigarette use in youth and adults, including pregnant women, in conjunction with screening for tobacco use, is advised. Education and interventions to prevent e-cigarette use should be provided to all youth. Youth should be counseled to stop using nicotine/tobacco products, including e-cigarettes. Although the impact of e-cigarette use in pregnancy is unknown, nicotine is a teratogen; thus, pregnant women should be counseled to abstain from using all nicotine/tobacco products.
What Is an e-Cigarette?
Electronic cigarettes (e-cigarettes) are battery-operated devices that heat a liquid solution to generate an aerosol that users inhale. The liquid solution in most e-cigarettes contains nicotine, the primary addictive agent in traditional cigarettes, and is available in a variety of flavors. Because e-cigarette aerosol is commonly called vapor, patients may refer to e-cigarette use as vaping. Currently, the most popular e-cigarette brand is Juul, which uses small, rectangular flavored cartridges that resemble a thumb drive. Most adults report using e-cigarettes to reduce or stop cigarette smoking.
WHAT IS NEW ON THIS TOPIC
Among U.S. youth, rates of e-cigarette use surpassed rates of traditional cigarette use in 2014. In 2017, one in five U.S. high school students reported using e-cigarettes in the previous year.
A recent meta-analysis indicated that among teens and young adults who have never smoked, the odds of smoking initiation are three to six times greater in those who have ever used e-cigarettes than in those who have never used e-cigarettes.
The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to recommend e-cigarettes for tobacco cessation in adults, including pregnant women.
e-cigarette = electronic cigarette.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
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