E-cigarettes: What We Don’t Know Could Hurt You

Cmdr. Daniel Seidensticker, MD,  Internal Medicine Specialty Leader, Staff Cardiologist, Naval Medical Center Portsmouth and Dr. Mark Long, Public Health Educator, Health Promotion and Wellness Department, Navy and Marine Corps Public Health Center

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Navy Medicine discourages the use of all tobacco products including e-cigarettes.


Electronic cigarettes are everywhere. You can buy them online, at retail stores, at kiosks in the mall, and they are even available at many Exchanges. The widespread availability of these battery-powered vaporizers has no doubt contributed to their popularity and advertising has created perceived safety among consumers. In fact, there is a growing trend among Sailors and Marines to use these aerosol producing devices due to the perception that they are less harmful than traditional tobacco products. But, are e-cigarettes really safe? What are the health concerns associated with use of e-cigarettes? Let’s look at what we know and what we don’t know about these emerging products.

What We Know

E-cigarettes have been on the market for less than 10 years. At this time, our knowledge and understanding of the products’ ingredients and their long-term health effects are limited. As a result, few policies and procedures governing the manufacturing, sale, and use of these devices have been put in place. Here’s what we know:

  • Navy Medicine discourages the use of all tobacco products including e-cigarettes.
  • The Food and Drug Administration (FDA) does not regulate these devices. This means tobacco companies and manufacturers do not have to submit a list of ingredients and amounts of these ingredients or notify the FDA when changes to the products occur. Additionally, information on packaging may be inaccurate or incomplete because regulation is not occurring.
  • E-cigarettes do not come with federal warning labels that identify health concerns, caution against possible addiction, or list harmful ingredients.
  • E-cigarettes are banned for use within Navy Medical and Dental Treatment facilities. Use is also prohibited in many cities and states that have indoor air laws and smoking bans and some airlines have banned their use on aircraft. In addition, numerous countries have placed limitations on the importation of these products or have banned them altogether.
  • E-cigarettes are not an FDA-approved cessation device.
  • There are no known health benefits associated with use of e-cigarettes.

What We Don’t Know

A recent study revealed that the short-term effect of e-cigarettes (both nicotine and non-nicotine varieties) on lung function is the same as that of traditional cigarette.

Compared to what we know about e-cigarettes, what we don’t know is substantial. Questions surround the quality control of these devices, the long-term health implications, the possible use as a cessation aid, and exposing others to potentially harmful vapor, similar to exposure to secondhand smoke. Until we have more answers, these products should be considered harmful. Here is what we don’t know:

Device and Content

In the absence of FDA regulation, e-cigarette manufacturers are under no obligation to disclose the content of these devices. Some products contain nicotine, while others have been found to contain different chemicals, such as nitrosamine (a carcinogen found in tobacco) and diethylene glycol (a component of antifreeze).  Since manufacturers are not required to provide a list of ingredients, those ingredients can change without warning. That means that the e-cigarette you buy today may be very different from the e-cigarette you buy tomorrow, even if it’s the same brand.

Health Implications

The negative effects that traditional cigarettes can have on your body are well studied and documented, but the impact of e-cigarettes on your overall health is not fully understood. A recent study1 revealed that the short-term effect of e-cigarettes (both nicotine and non-nicotine varieties) on lung function is the same as that of traditional cigarettes. The products equally reduced the lung’s ability to exhale nitric oxide, which affects the ability of the airways and vessles to open and contract. This could potentially worsen respiratory illnesses such as asthma and bronchitis. While further research is greatly needed, this indicates that e-cigarettes could cause immediate harm and negatively impact your ability to perform at your peak.

If you are using or considering quitting e-cigarettes or tobacco, you need to be in the know. Please contact your health care provider, medical treatment facility (MTF), local tobacco cessation facilitator, or health promotion coordinator for information and assistance with quitting. Additional resources are also available in the HPW Tobacco Free Living toolbox. For more information on the myths circulating about e-cigarettes check out HPW’s factsheet.


1Marini, S., et al., Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide. Toxicol. Appl. Pharmacol. April 13, 2014. http://www.ncbi.nlm.nih.gov/pubmed/24732441. Accessed October 9, 2014.

2 Bullen, C., et al., Electronic cigarettes for smoking cessation: a randomized controlled trial. The Lancet. 2013;382(9905):1629-1637. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961842-5/abstract
Accessed October 9, 2014.