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Sadie Moss, manager and bartender at the Eagles in Billings Heights, takes a drag off her electronic cigarette.

A colleague of mine recently attended a family gathering where a relative puffed away on an electronic cigarette. The relative assured everyone that she was trying to quit tobacco and that the “smoke” from her device wouldn’t hurt them. My colleague was rightly skeptical.

I applaud the relative’s desire to quit. Tobacco is still the leading cause of death and disease in our country. In Montana, it’s responsible for almost 1,400 deaths a year. Quitting -- hard as it is -- is one of the best steps any of us can take to improve our health.

But there’s no proof that e-cigarettes are the answer. Because they contain nicotine, a highly toxic and addictive substance, they may even serve as a gateway to the use of other tobacco products.

Most health experts recommend using methods that have been proven effective -- like counseling and nicotine-replacement therapies.

And many health organizations have called for strict regulation of e-cigarettes – including the World Health Organization, American Medical Association, American Public Health Association, American Lung Association, and American Cancer Society, just to name a few.

How e-cigs work

E-cigarettes (or e-cigs) are typically shaped like conventional cigarettes. Each holds a replaceable cartridge of liquid nicotine. A rechargeable, battery-operated heating coil vaporizes the liquid so it can be inhaled. That’s why some people refer to the use of e-cigarettes as “vaping.”

The vapor (or, more accurately, the aerosol) is not harmless water vapor. The nicotine is usually dissolved in propylene glycol, a clear and colorless liquid that can irritate the eyes, throat, and airway and trigger asthma symptoms. Heavy metals and cancer-causing substances like formaldehyde have also been found in the aerosol.

The amount of nicotine in the cartridges can vary significantly.

More than 400 e-cig brands have flooded the market since they first became available in 2007, and sales have increased significantly since 2011. According to the state health department, they’re especially popular with young adult Montanans. Nearly one in four aged 18-34 has tried them, mostly because of their novelty.

Completely unregulated

As the controversy around e-cigarettes smolders, the U.S. Food and Drug Administration (FDA) has been developing regulations that would allow it to restrict the manufacture, sales, and marketing of e-cigarettes in much the same way it restricts tobacco products.

For example, the FDA bans tobacco advertising in the media. There are no such prohibitions against advertising e-cigs. There’s also no federal age restriction on who can buy e-cigs, although individual states and stores can set their own.

Montana has not barred the sale of e-cigs to minors, but the state attorney general has indicated he plans to propose legislation during the 2015 session.

For the moment, even an 8-year-old could theoretically buy an e-cig -- over the internet if necessary. And tobacco companies appear to be luring youth with bright-colored packaging and candy-flavored products like gummy bear, cotton candy, and cookies and cream.

That may be one reason the popularity of e-cigs among middle- and high-schoolers in Montana doubled from 2011 to 2012.

Dangers to children

The combination of easy access and uncontrolled nicotine content make e-cigs especially dangerous for children and youth. The cartridges typically contain enough nicotine to poison a child.

Poison centers are reporting an uptick in calls about exposure to e-cigarette devices and liquid nicotine. Slightly more than half have involved children under the age of 6 who inhaled, ate, or simply touched the products. Some of these children became very ill. Some required emergency room visits.

The state health department reports that nine Montanans, including four children under age 6, have been treated for nicotine poisoning since 2011.

The American Association of Poison Control Centers recommends that users lock up e-cigs and liquid nicotine to keep them out of the reach of children. If you think someone has been exposed, call your local poison center at 1-800-222-1222 immediately.

Rely on science

The bottom line is this: Until the FDA and others fully research e-cigs, any claims about using them to quit smoking or reduce its harm are not backed by science. Why risk your health on claims made by the tobacco industry?

We need conclusive evidence of what impact e-cigarettes -- or secondhand exposure to their aerosol -- could have on our health.

What the science does tell us is that there’s already a safe and effective way to quit. A combination of counseling and FDA-approved nicotine-replacement therapies have been proven to work.

Montanans can get free or reduced-cost access to these therapies by calling the Montana Tobacco Quit Line at 1-800-QUIT NOW or emailing

Melanie Reynolds is the Lewis and Clark County health officer. 

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