November 2, 2009


A brief TRAC consult regarding e-cigarettes, electronic nicotine delivery systems

—by Deb Hrouda

CLEVELAND, OH—The topic of e-cigarettes came up at a recent "Tobacco: Recovery Across the Continuum (TRAC)" Program Leader Training on October 1st, sponsored by the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University, so we present a few thoughts and a summary of what is known to date about what are commonly called e-cigarettes.

1.) "e-cigarette" is a misleading name.

These products are better referred to as "electronic nicotine delivery systems" (ENDS). The definition of a cigarette is "a roll of finely ground tobacco wrapped in paper that is burned." The e-cigarette does not have tobacco, nor does it burn.

2.) What is in an e-cigarette?

We don't know for sure. The U.S. Food and Drug Administration (FDA) (see links below) recently did a study where it examined two existing ENDS products. In short, the products differed widely on what was in them and in their concentrations of nicotine (even from the same manufacturer).

NOTE: If you ordered the high nicotine cartridge, you could get 18 mg of nicotine, or you could get 1.6 mg of nicotine. It wasn't consistent. Similarly, if you ordered the product with 0 mg of nicotine, you might get nicotine.

3.) How does an e-cigarette work?

"E-cigarette" is a misleading name. These products are better referred to as "electronic nicotine delivery systems" (ENDS).

Essentially, there's a mouthpiece that has a cartridge with the nicotine in it (some have a sponge that's soaked in a nicotine solution which is refillable). There is also a battery (most are rechargeable) and a vaporizer that heats the nicotine solution, not to the point of burning, to make vapor. When you inhale, the suction turns on the vaporizer which turns the liquid (which includes propylene glycol) into vapor. This vapor has the nicotine in it. The vapor is also what looks like smoke.

NOTE: The nicotine solution is basically nicotine in propylene glycol, which is used in cosmetics and fog machines, but there is nothing that shows that directly inhaling this is safe.

4.) They say there's no tobacco, but . . .

Some of the tests showed evidence of the cancer-causing chemicals that are found only in tobacco.

5.) So, are e-cigarettes good or bad?

We don't know. There isn't enough research that shows whether or not they're safe, or if they deliver the nicotine they say they do. The little we do know is that quality control is seriously lacking. In addition, a few people who have tried them say they fall apart.

NOTE: In one of the tests, the amount of nicotine from the e-cigarette was twice that from a prescription nicotine inhaler.

6.) Other interesting e-cigarette tidbits:

  • The refills are vials of nicotine and can be bought in up to 1,000 mg bottles. There is the potential for people to misuse the refill liquid (30 to 60 mg could be fatal for an adult).
  • Creative people have already found some potentially harmful adaptations through Internet-based recipes that add alcohol and other substances to the refill cartridges.



  • FDA report on the only independent test of ENDS (click here)
  • Summary of FDA report on the only independent test of ENDS (click here)
  • FDA web page about e-cigarettes (click here)


  • A two-page document that outlines some of the information about electronic nicotine delivery systems (ENDS) (click here)
  • A webinar held by the American Legacy Foundation. The video is two hours long, but the last hour includes questions and answers. Even if you can only watch the first 45 minutes, you'll get to hear some of the concerns floating around out there. Keep in mind that American Legacy Foundation has as part of its mission to eliminate tobacco use in the US (click here).

Deb Hrouda, MSSA ('94), LISW-S, is director of quality improvement at the Center for Evidence-Based Practices at Case Western Reserve University. She is also the project lead for "Tobacco: Recovery Across the Continuum (TRAC)."