Prof. Juliana Shanthi Rosy
Principal, Droan College of Nursing, Vill and Post Khanpur Purab, Dineshpur Road, Rudrapur, Udham Singh Nagar, 263153. Uttarakhand.
An electronic cigarette or e cigarette is a battery-operated device that emits doses of vaporized nicotine, or non-nicotine solutions, for the user to inhale. The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances. Health experts say e-cigarettes are mostly being used by children and youth. Though not generally available in stores, they are widely promoted through social media, and e-mail marketing with discount offers. Almost eight states in India have banned e cigarettes.
Tobacco use is epidemic among young people. Despite thousands of programmes to reduce youth smoking and thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products and family after family continue to suffer the devastating consequences. The current trend of smoking is electronic cigarette. An electronic cigarette is a battery-operated device that emits doses of vaporized nicotine, or non-nicotine solutions, for the user to inhale. It aims to provide a similar sensation of inhaling tobacco smoke. Also known as e-cigarettes, e-cigs, electronic nicotine delivery systems (ENDS), vaporizer cigarettes, and vape pens, they are marketed as a way to stop or cut down on smoking 1.
E-cigarettes have been taken up by millions around the world since they first appeared on the Chinese market in 2004. By 2014, around 3.7 percent of adults in the United States (U.S) were using them, and 12.6 percent had tried them. "Vaping" is now the most popular form of tobacco use among teenagers in the U.S. E-cigarette use rose by 900 percent among high school students from 2011 to 20152.
What is e cigarette and how it looks:
An e-cigarette is a long tube that usually resembles a cigarette, a cigar, a pipe, or a pen. Most are reusable, with replaceable and refillable cartridges, but some are disposable. The e-cigarette was invented by Hon Lik, a Chinese Pharmacist, working for Golden Dragon Holdings, now known as Ruyan. The company started exporting into major markets in 2005 to 2006. There are now over 460 different brands on the market3.
Figure 1 Different models of e- cigarette
Most e-cigarettes have: a mouthpiece, cartridge, heating element, rechargeable battery and electronic circuits. As the user sucks on the mouthpiece, a sensor activates a heating element that vaporizes a flavored, liquid solution held in the mouthpiece and then the person “vapes," or inhales, the aerosol solution4.
Figure 2- Parts of an e- cigarette
What is e- cigarette aerosol?
The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including: Nicotine, Ultrafine particles that can be inhaled deep into the lungs, Flavoring 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. It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine4.
Figure 3 contents of e cigarette aerosol
Health risks of e cigarette:
A World Health Organization (WHO) report released in 2014 on Electronic Nicotine Delivery Systems or ENDS had this to say about nicotine in the bloodstream: “Although nicotine itself is not a carcinogen, it may function as a tumor promoter. Nicotine seems involved in fundamental aspects of the biology of malignant diseases, as well as of neurodegeneration.
· Most e-cigarettes contain nicotine, which is addictive and toxic to developing fetuses. Nicotine exposure can also harm adolescent brain development. E-cigarette aerosol can contain chemicals that are harmful to the lungs5.
· It is hazardous during pregnancy as it can affect fetal development.
· The aerosol contains solvents, flavorings, and toxicants, which is either "harmful" or "potentially harmful."
· E-cigarettes expose the lungs to different substances. One of these is Dicetyl, which can cause "popcorn lung," a severe and irreversible lung disease.
· Potentially fatal poisoning has resulted from accidentally swallowing and from inhaling c-cigarette liquid.
· Teenagers who use e-cigarette products are more likely to start using regular tobacco as well.
· Continued use of nicotine can make other drugs, such as cocaine, more pleasurable.
· The flavorings, the marketing, and the concept that it is not harmful all tempt teenagers to start vaping. There is concern that this increases the chance that they will smoke conventional cigarettes later.
· Second-hand smoking is not eliminated by vaping, as vaping releases carcinogenic emissions.
· There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is also a decreased immune response, and additionally, it also negatively impacts reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, and DNA mutation by various mechanisms which lead to cancer. It also affects the proliferation of tumors and metastasis and causes resistance to chemo and radio therapeutic agents. (Study published in the Indian journal of medical pediatric oncology-2015).
Action taken by the government:
The American Academy of Pediatrics (AAP) strongly recommend that the minimum age to purchase any tobacco product, including e-cigarettes, be raised to 21 years in all states6. In India the sale, manufacture, distribution and advertisement of e-cigarettes were banned in various states including Karnataka, Kerala, Punjab and Maharashtra, Mizoram, Jammu and Kashmir and Uttar Pradesh. Bihar recently became the eighth Indian state to ban e-cigarettes in January 2018. Rajasthan is planning to ban e cigarette7.
Health experts say e-cigarettes are mostly being used by children and youth. Though not generally available in stores, they are widely promoted through social media, and e-mail marketing with discount offers. Market research also projects the compound annual growth rate of the Indian e cigarette industry at 63.38% in the period 2013- 2018. (Research and Markets report on e cigarette market in India 2014-18)
There is a slow but gradual increase in the use of electronic cigarettes or e-cigarettes in some North East states of India, revealed a latest Global Adult Tobacco Survey (GATS) released during December 2017. Most e commerce websites sell e cigarettes as therapeutic products which enable people to quit smoking. The current unregulated sale of e cigarette is dangerous for a country like India where the number of smokers is on the decline. (WHO global report, 2015).
The government should take action regarding incorporating e-cigarettes into smoke free policies, preventing access to e-cigarettes by youth, price and tax policies, retail licensure, regulation of e-cigarette marketing, and educational initiatives targeting youth and young adults.
1. Knight-West, O., and Bullen, C. (2016). E-cigarettes for the management of nicotine addiction. Substance Abuse and Rehabilitation 7, 111-118. Available from https://www.ncbi.nlm.nih.gov/
2. U.S. Department of Health and Human Services. E-Cigarette Use among Youth and Young Adults: A Report of the Surgeon General. (2016) Available from
3. What are electronic cigarettes? (2017, June). Available from https://www.drugabuse.gov/
4. Goniewicz ML, Hajek P, McRobbie H. Nicotine Content of Electronic Cigarettes, its Release in Vapour and its Consistency Across Batches: Regulatory Implications. Addiction. 2014; 109:500-7. Available from
5. Farsalinos KE, Kistler KA, Gillman G, Voudris V. Evaluation of Electronic Cigarette Liquids and Aerosol for the Presence of Selected Inhalation Toxins. Nicotine Tob Res. 2014; 17:168-74.
6. Schoenborn, C., and Gindi, R. M. Electronic cigarette use among adults: United States, 2014. Available from https://www.cdc.gov/
7. Shreya Garg. Smoking e cigarette is injurious to health. The Hindu.16 Jan 2017. Available from
Received on 26.09.2018 Modified on 11.10.2018
Accepted on 31.10.2018 ©A&V Publications All right reserved