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“You’re basically trading one known, dramatically harmful product — regular cigarettes — for a product that has an unknown degree of harm,” says Michael Weaver, MD, medical director of the Center for Neurobehavioral Research on Addiction at Houston’s University of Texas Health Science Center.

Some 3.5 million Americans smoke e-cigarettes. While their vaporized liquid may do less lung damage than tobacco smoke, the long-term effects are unknown. “We do know that there are carcinogens, impurities, and a lot of variability in the ingredients,” says Weaver.

Currently only e-cigarettes marketed for therapeutic use are regulated, but the FDA has proposed a rule to extend tobacco laws to govern them. Currently, ingredients vary by brand: Some contain nicotine and other chemicals at levels similar to regular cigarettes; others may contain no nicotine at all. That makes it difficult for consumers to know what they’re getting.

One known danger: Users can modify e-cigs to deliver toxic amounts of nicotine. “There’s something called ‘dripping,’ which bypasses the cigarette mechanism, so users are inhaling the nicotine vapor directly,” Weaver explains.

“You can also get different forms of electronic cigarettes where you can adjust the voltage: A higher voltage means higher nicotine delivery.”

With sweet-treat flavors like cotton candy and gummy bear, the targeting of youths is a serious concern. According to the Centers for Disease Control and Prevention, e-cig use by middle and high school students doubled between 2011 and 2012. There are some state age restrictions, but none at the federal level.

While many adult users say they “vape” because they want to quit smoking, about only 10 percent who use e-cigs for this purpose are successful, Weaver notes. “Even if they stop smoking tobacco, they’ll keep using the electronic cigarette to get their nicotine fix.”

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