Woman holding cigarettes and e-cigarette

Ask the Expert: Vaping

Publication Date: Jan 07, 2019

January 2019

Expert: Dr. Doug Jorenby, Director of Clinical Services
UW Center for Tobacco Research and Intervention (UW-CTRI)


1. How does vaping differ from smoking cigarettes? Is there any scientific evidence that points towards use of vaping as a smoking cessation aid?

The most important difference between smoking conventional cigarettes and vaping with e-cigarettes is combustion. In a conventional cigarette, tobacco is burned, creating carbon monoxide (a toxic gas), a variety of carcinogenic and other dangerous substances that are created when tobacco is burned, reaching temperatures as high as 900o C at the tip of the cigarette. By comparison, e-cigarettes heat their “e-juice” solution to between 200-4000 C [some types of e-cigarette allow users to adjust voltage and vaporizing temperature across a wide range, so reactions are not as consistent as with burning tobacco]. Vaping does not create carbon monoxide, and generally creates fewer hazardous substances for both the user to inhale and to go in to the surrounding environment (what is known as environmental tobacco smoke, or secondhand smoke). While cigarettes can differ in the amount of nicotine they deliver, and may be regular tobacco-flavored or menthol, e-juice can contain a wide range of nicotine concentrations (including no nicotine at all) and is sold with a massive number of flavors added to the e-juice. The US Food and Drug Administration has recently expressed concern that e-juice with fruit, candy, and/or cereal flavors are particularly appealing to young people and be a contributing factor in the rapid uptake of vaping among that age group.

Very limited scientific research has evaluated e-cigarettes as a method for stopping smoking. A Cochrane meta-analysis (2016) found evidence from two studies that vaping may help people stop smoking, but the quality of the evidence was “low.” The US FDA has not approved e-cigarettes as an evidence-based smoking cessation treatment.


2. Recently, the Surgeon General declared teen vaping as an epidemic. What factors have made youth more susceptible to vaping, specifically to use of JUUL-brand vaping products?

According to a recent national Monitoring the Future survey by the University of Michigan, the percentage of high school seniors vaping nicotine in the past 30 days rose from 11% to 21% of the course of a year’s time (NEJM, 2018). In a very few years, JUUL has captured more than 60% of the US e-cigarette market. It has been particularly popular among young people, which has been attributed to a variety of factors. The JUUL vaping device resembles a large USB drive, and can be recharged by plugging it in to a USB port. It also produces a smaller vapor cloud, making its use less obvious than other vaping devices. JUUL uses disposable “pods” that are available in flavors such as mango, fruit medley, and crème brûlée; these flavors have been more popular among young users. JUUL also uses a nicotine salt technology that delivers nicotine in a manner more similar to what is seen with cigarettes and is perceived as more rewarding by users.


 3. Is there evidence that vaping serves as a gateway to use of other drugs or addictive substances?

At least in the US, e-cigarettes were initially used almost exclusively by persons who already smoked and were likely dependent on nicotine. As e-cigarettes became more widely publicized and available, use became more prevalent. A 2013-14 survey conducted in among 9th graders in California found that those who used e-cigarettes were 4.85 to 2.65 times more likely to have used combustible cigarettes, cigars, hookah, or a combination of those in the previous 6 months.


Related Resources:

UW-CTRI: Electronic Cigarettes (E-CIGS) and Vaping

SAMHSA: Implementing Tobacco Cessation Programs IN Substance Use Disorder Treatment Settings

Surgeon General: Know the Risks: E-Cigarettes & Young People


ATTC Network Resources:

Virtual Coffee Break: Tobacco Use Screening and Cessation Counseling for Reproductive Age Women Free online course on HealtheKnowledge

Central East ATTC
Marijuana & Vaping-the Triangulum: The Future is Now
What’s Menthol Got to Do With It? Everything!

Pacific Southwest ATTC
Smoking and HIV: What Providers Need to Know