Get the Facts - Electronic Cigarettes (E-cigarettes) and Similar Vapor Products

Pulmonary Illness Associated with Black Market Vaping Products

The New York State Department of Health (NYSDOH) has received numerous reports from New York State physicians of severe pulmonary (lung-related) illness among patients ranging from 14 to 71 years of age who were using at least one vape product prior to becoming ill.

Laboratory test results show very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by New York State’s Wadsworth Laboratory as part of this investigation. At least one vitamin E acetate containing vape product has been linked to nearly every patient that has submitted a product for testing.

Anyone using vape products and experiencing symptoms including shortness of breath, cough, chest pain, fever, nausea or vomiting should contact their health care provider immediately. Health care providers should report possible cases to their local poison control center (1-800-222-1222).

People should never use products purchased “off the street” because they may contain unknown and harmful ingredients. Cannabis-containing products are not legally available in New York State for recreational use.

New York State Press Releases:

For the Public: What You Need to Know (CDC)

Health Care Providers and State and Local Health Departments:

Total Reported Cases Statewide: 254

Electronic cigarettes and similar vapor products are tobacco products.1 Most contain a battery that heats a flavored liquid, usually containing nicotine, into an aerosol users inhale. The liquid is often called e-liquid or e-juice. E-liquids usually contain nicotine and flavorings in a base of propylene glycol (PG) and vegetable glycerin (VG). Nicotine is highly addictive and harms brain development. Some flavorings, such as diacetyl, can cause serious disease. PG and VG are generally recognized as safe to eat but inhaling them can irritate the eyes, nose and throat and make it hard to breathe.

Some other names for electronic cigarettes are:

  • e-cigarettes, e-smokes, e-cigs and cigalikes;
  • vapes, personal vaporizers (PVs) and advanced personal vaporizers (APVs);
  • mods, pod mods, pod vape devices, vape mods and box mods;
  • wop machines;
  • pens and vape pens; and
  • electronic nicotine delivery systems (ENDS).

Other electronic vaping products that that use e-liquids include e-cigars, e-pipes and hookah pens (e-hookah).

The top-selling e-cigarette brand is a USB-shaped device called JUUL. News outlets and social media sites report widespread use of JUUL by students in schools, including in classrooms and bathrooms. All JUUL e-cigarettes have a high level of nicotine. Similar products are available.

Use of an e-cigarette is often called "vaping" or "JUULing."

Who Is Using E-cigarettes and Why?

Youth and young adults are the primary users of e-cigarettes.1,2 High school students use e-cigarettes at rates five times higher than adults over age 25.3,4 Youth and young adults say their reasons for trying and using e-cigarettes are flavor and taste, curiosity and the belief that they are less harmful than other tobacco products.1

The U.S. Food and Drug Administration (FDA) regulates tobacco products, including e-cigarettes. Currently, e-cigarettes are not as strictly regulated as cigarettes. Except for menthol, the FDA does not allow cigarettes to contain flavored tobacco. This is not the case for e-cigarettes. E-cigarette companies know youth are attracted to many of the over 15,000 e-liquid flavors. Some of the sweet and fruity flavors that appeal to young people are cereal and milk, mango, cherry cola, bubblegum, crème, chocolate mint, blueberry cheesecake and fruit punch.

Nicotine is Addictive and Dangerous for Youth and Young Adults

Most e-liquids contain nicotine, the highly addictive chemical in all tobacco products. Nicotine is harmful for young people.1 Nicotine can harm the developing brain of adolescents and young adults, which can:

  • lead to lower impulse control and mood disorders;
  • disrupt attention and learning among youth and young adults; and
  • prime the developing brain for addiction to alcohol and other drugs, such as cocaine.1

E-cigarette Aerosol is Harmful

The e-cigarette aerosol users inhale and exhale is not harmless water vapor. Some e-liquids are advertised as nicotine free, but this may not be true. With or without nicotine, e-cigarette aerosol is unsafe. E-cigarette aerosol can contain:

  • fine and ultrafine toxic particles that can interfere with the growth and work of the lungs and increase the risk of heart disease, lung cancer and asthma attacks;
  • heavy metals such as lead, tin and nickel;
  • chemicals used for flavoring such as diacetyl that can cause a serious lung disease called bronchiolitis obliterans; and
  • volatile organic compounds (VOCs) that can cause long-term health effects including cancer.1

Many of the chemicals found in cigarette smoke are also found in e-cigarette aerosol. They include:

  • formaldehyde, also found in embalming fluid;1,7
  • cadmium, used in batteries;1,8
  • benzene, found in gasoline;1,9 and
  • toluene, an industrial solvent.1,10

E-cigarette Use Among Youth and Young Adults is a Major Public Health Concern

  • Youth use e-cigarettes more than cigarettes, cigars, smokeless tobacco and hookah.3
  • Almost five times as many high school students in New York State use e-cigarettes than smoke cigarettes.3
  • The New York State smoking rate among youth is at a record low (4.3%), but their e-cigarette use doubled between 2014 and 2016 (from 10.5% to 20.6%).3
  • Few high school students say they plan to try smoking, but increasing numbers are open to trying e-cigarettes.5
  • More than half of teens believe nondaily e-cigarette use causes little or some harm.1
  • Of young people who use e-cigarettes, a third falsely believe nondaily e-cigarette use is harmless.1
  • E-cigarette use does not prevent from smoking. Adolescents and young adults who use e-cigarettes are at increased risk for starting smoking and continuing to smoke.1,6
  • More than half of high school students and young adults who smoke cigarettes also use e-cigarettes (called dual use).1

What New York State is Doing to Protect Youth from Nicotine Addiction

Almost all adults addicted to nicotine started smoking or using other tobacco products in their teens. Nearly 9 out of 10 adult smokers started smoking by age 18, and 99 percent started by age 26.11

New York State's strong laws and programs protect youth from accessing tobacco products and denormalize tobacco use to prevent lifelong addiction, illness and early death.

As of November 22, 2017, e-cigarettes and similar devices are included in the state's Clean Indoor Air Act, which prohibits their use and tobacco smoking in virtually all indoor public areas, including workplaces, bars and restaurants.

State law also prohibits the use of tobacco products and e-cigarettes on the grounds of all public and private pre-schools, nursery schools, and elementary and secondary schools as well as in school vehicles used to transport children or school personnel.

E-cigarettes are not Proven to Help People Quit Smoking

Most youth and young adults do not report using e-cigarettes to quit smoking.1

Most adult smokers want to quit.12 Every year, more than half of smokers quit for at least one day as an attempt to stop smoking.12,13 But, highly addictive nicotine makes it hard to quit for good, and fewer than one in 10 smokers successfully quits for good.12 Some smokers have heard that e-cigarettes can help them quit. Researchers are investigating if substituting e-cigarettes for cigarettes may help adults quit smoking, but this is unproven.14,15

E-cigarettes are not an FDA-approved smoking cessation product. However, the FDA has approved seven products proven to help smokers quit:

  • Five nicotine replacement therapies (NRTs):
    • patch (available over-the-counter and by prescription for Medicaid enrollees)
    • gum (available over-the-counter and by prescription for Medicaid enrollees)
    • lozenge (available over-the-counter and by prescription for Medicaid enrollees)
    • nasal spray (by prescription)
    • inhaler (by prescription); and
  • Two non-nicotine oral medicines:
    • varenicline tartrate, brand name Chantix® (by prescription)
    • bupropion hydrochloride, brand names Zyban® and Wellbutrin® (by prescription).14

People who smoke or use other tobacco products can improve their chances of quitting for good with treatment from their health care provider.13 Treatment that includes brief counseling and FDA-approved medication can double or triple the chances of permanently quitting.15 To learn more, talk to your health care provider. For additional assistance, call or visit the New York State Smokers' Quitline at 1-866-NYQUITS (1-866-697-8487).

E-cigarette Infographics and Fact Sheets

For More Information about E-cigarettes

  1. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
  2. New York State Department of Health. Prevalence of Cigarette Smoking, Use of Electronic Nicotine Delivery Systems, and Dual Use by Youth, Young Adults, and Adults in NYS, 2014. StatShot November 2015; Vol. 8, No. 5.
  3. New York State Department of Health. Youth Cigarette Use at All‐Time Low, ENDS Use Doubles. StatShot March 2017; Vol. 10, No. 1.
  4. QuickStats: Percentage of Adults Who Ever Used an E-cigarette and Percentage Who Currently Use E-cigarettes, by Age Group — National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:892.
  5. New York State Department of Health. Openness to Smoking Conventional Cigarettes and Openness to Using Electronic Cigarettes and Similar Devices among NYS Youth. July 2017; Vol. 10, No. 4.
  6. New York State Department of Health. Use of Electronic Cigarettes and Similar Devices among NYS Youth, 2014‐2016. StatShot December 2017; Vol. 10, No. 5
  7. National Cancer Institute. Formaldehyde and Cancer Risk. (last reviewed 2011 June 10)
  8. Occupational Safety and Health Administration. Cadmium - Overview.
  9. Centers for Disease Control and Prevention. Benzene – Facts About Benzene. (last reviewed 2013 Feb 14)
  10. Agency for Toxic Substances & Disease Registry. Toxic Substances Portal – Toluene. (last reviewed 2015 Jan 21)
  11. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.
  12. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
  13. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults — United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2017;65:1457–1464.
  14. U.S. Food and Drug Administration. FDA 101: Smoking Cessation Products. (page last updated: 2017 August 23)
  15. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guidelines. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.