What are the Health Risks of E-Cigarettes? Are E-Cigarettes a Safer Alternatives to Tobacco Cigarettes?

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Posted May 12, 2016

Nicole T. Wasylyk, MSEd, LAT, ATC

By Nicole T. Wasylyk, MSEd, LAT, ATC

Electronic cigarettes (e-cigarettes) are a type of electronic nicotine delivery system (ENDS), which are battery powered products delivering nicotine in the form of an aerosol or vapor.  ENDS, which include e-cigarettes, e-hookahs, hookah pens and vape pens, contain a liquid solution commonly composed of propylene glycol, glycerin, nicotine and flavoring agents. These agents are then heated to create an inhalable aerosol.

E-cigarettes were first invented in Beijing, China by Pharmacist Hon Lik in 2003. Hon created the e-cigarette as a means to reduce tobacco smoking dependency; however, its efficacy in reducing dependency is now highly debated. Many of the ENDS products are marketed as healthier alternatives to tobacco or as a means of tobacco cessation, yet there is no current evidence to suggest ENDS are efficacious smoking cessation aids.1

E-cigarette use is rapidly increasing. The CDC reported in 2014 that approximately 12.6% of adults have tried an e-cigarette at one time in their lifetime with 3.7% being current everyday users.3  In teenage populations ENDS use more than doubled from 4.7% in 2011 to 10% in 2012.4  Sales have also risen over the past years with an estimated $3 billion spent globally in 2013.5  Although there is little evidence on the healthcare associated cost resulting from ENDS use, we do know the US healthcare costs for smoking-related illnesses are more than $300 billion annually.6

ENDS products are currently unregulated whereas tobacco cigarettes are regulated by the FDA. ENDS and e-cigarettes may contain any number of chemicals, and companies are not currently obligated to disclose this information. Lab tests conducted by the FDA in 2009 found cancer-causing chemicals in some e-cigarettes to include diethylene glycol, a chemical commonly found in antifreeze that is toxic to humans. They also found nicotine levels vary greatly even in products of the same label.7

So why do some think e-cigarettes are a safer alternative to tobacco smoking?

Smoking has known cancer causing effects and profound effects on tissue microenvironment. It affects both the inflammatory response and reparative cell function, which can lead to delayed healing. Tobacco has been shown to delaying the inflammatory response and impairing bactericidal activity. This delay reduces the body’s ability to control wound contamination, thus leading to a higher risk of infection.8 Tobacco also causes a vasoconstrictive response, believed to be an effect of nicotine. ENDS are thought to be safer since they lack tobacco. They do however contain nicotine along with a number of unknown chemical compounds. Further research is needed on ENDS regarding y their safety and their effects for both users and second-hand exposure.

As ENDS and e-cigarettes become more prevalent in our society, it is important to understand the associated risks with these unregulated items. It’s also important to consider counselling patients and student-athletes on risks of tobacco and nicotine use, especially in regard to their detrimental effects on healing and recovery from injury or surgery. Most importantly, ENDS should not be considered a safer alternative to tobacco or used as a means of tobacco cessation. Effective ways to quit smoking and ENDS use can include avoidance, individual or group counseling; behavioral therapy; over-the-counter or prescription medication or a combination of treatments. The US Public Health service has found combination therapy (medication and counselling) to be most effective in smoking cessation.9

For more information and resources on smoking cessation please visit or call 1-800-QUIT-NOW (1-800-784-8669)






6. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual Healthcare Spending Attributable to Cigarette Smoking: An Update[PDF–157 KB]. American Journal of Preventive Medicine 2014;48(3):326–33 [accessed 2015 Aug 17].


8. Sorensen LT Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012 Jun; 255(6): 1069-79


About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 




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