What is an e-cigarette?

E-cigarette is an umbrella term for a variety of devices that produce an aerosol users inhale. These devices come in a wide range of shapes and sizes, are typically battery-powered and are referred to by many names, such as:

  • E-cigs
  • E-hookahs
  •  Electronic nicotine delivery systems (ENDS)
  • JUULs
  • Mods
  • Tank systems
  • Vapes
  • Vape pens


Many e-cigarettes contain nicotine, the addictive substance found in combustible tobacco cigarettes. For example, one JUUL pod contains as much nicotine as an entire pack of cigarettes. Additionally, there have been numerous cases of individuals using these products with THC, the psychoactive, addictive chemical in marijuana. Using e-cigarettes with marijuana is sometimes referred to as “dabbing.”

Health Concerns

Since July 2019, the Centers for Disease Control and Prevention (CDC) has been investigating cases of severe lung injury associate with vaping. All cases have reported use of e-cigarettes, with a majority reporting use of THC-containing products.  However, no single product has been linked to all cases. CDC and the Food and Drug Administration (FDA) are working with state health departments to determine what might be causing the illnesses.

Reported symptoms include cough, shortness of breath and fatigue, with symptoms growing worse over days or weeks leading to difficulty breathing and, in many cases, admission to the hospital. Other symptoms may include fever, chest pain, nausea and diarrhea. Patients report “vaping” (i.e. the practice of inhaling and exhaling the vapor produced by an e-cigarette or similar device) in the weeks and months before becoming ill. Although no specific product has been linked with the disease, many of the patients vaped marijuana oil, extracts, or concentrates.

Reported cases of injury and death

As of  February 4, 2020 , there have been 2,758 hospitalized e-cigarette or vaping product use-associated lung injury cases or deaths in 50 states, the District of Columbia, and 2 U.S. territories. There have been 64 deaths confirmed in 28 states and the District of Columbia. 

As of October 11, 2019, in Virginia there have been 50 cases and one death. Eighteen of the cases were reported in the Northern Health Region, which includes Alexandria, Arlington, Fairfax, Loudon and Prince William.

Other dangers associated with e-cigarettes

  • Between 2009 and 2016, there were 195 e-cigarette explosion-related injuries and fires, resulting in 38 “severe” injuries.

  • From 2015 to 2017, there were an estimated 2,035 e-cigarette explosion and burn injuries presenting to US hospital emergency departments

  • In the past several years, e-cigarettes have resulted in more than 30 smoke or fire incidents on planes and at airports

Seeking medical attention

Individuals with a history of vaping who are experiencing breathing problems should seek medical care right away. Visit https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html to learn more about vaping-related illnesses. 

Facts about e-cigarettes

  • E-cigarettes produce an aerosol, not water vapor, when the inserted liquid is heated. The user inhales this aerosol into their lungs.
  • Many e-cigarettes contain nicotine, the addictive substance found in tobacco. This includes products labeled as “nicotine-free,” due to a lack of regulation by the FDA.
  • One JUUL pod contains as much nicotine as an entire pack of cigarettes.
  • Teen e-cigarette users are more likely to start smoking. 30% of youth who used e-cigarettes started smoking combustible tobacco products within six months. 
  • Many flavored e-cigarettes contain a chemical (diacetyl) that can cause permanent damage to the respiratory system.
  • E-cigarettes are not approved by the FDA as an aid to quit smoking.
  • If a person has not smoked by age 18, they are 3 times more likely to never start.
  • The brain is especially vulnerable to tobacco addition between the ages of 18-25. If teens are exposed to nicotine while brain is still developing, they are more likely to develop an addiction.
  • As of July 1, 2019, it is illegal for anyone under the age of 21 to purchase, use or possess any tobacco, nicotine vapor or alternative tobacco product in Virginia. This includes e-cigarettes.
  • Secondhand aerosol, similar to secondhand smoke, is the plume of chemicals released into the environment directly from the e-cigarette/pod-based devices and from the lungs of the user. Common places for exposure to secondhand aerosol include restaurants, parks, vehicles, and designated smoking areas. Chemicals that are released include harmful substances such as nicotine, heavy metals, ultrafine particles that fall deep into the lungs, cancerous chemicals, and volatile organic compounds. Exposure can lead to cancer, respiratory infections, and make someone’s asthma worse among other problems.
  • E-cigarettes also pose a danger to people other than the user through thirdhand aerosol. Thirdhand aerosol is the mixture of chemicals in e-cigarette/vape pen aerosol that remain on surfaces and in dust, even after the aerosol is gone, and react with other chemicals in the environment to form toxic chemicals. These potentially harmful chemicals can be exposed to other people or animals through the respiratory system, through ingestions, and through skin exposure. Small children are especially at risk for thirdhand aerosol exposure because they tend to put things into their mouths and they have more vulnerable skin.
  • Learn more about e-cigarettes from these sources:

What parents can do

  • Talk to your child about the risks of e-cigarette use. Unsure how to start the conversation? Here are some resources:
  • Make your values clear: express your expectation that your children remain drug-free.
  • Emphasize local data: most teens in Alexandria are not using e-cigarettes. From 2016-2017, 7.5% of 10th and 6.0% of 8th graders reported using e-cigarettes in the past 30 days. 
  • Encourage youth to educate themselves using credible sources in order to make informed choices
  • Clarify misconceptions. The term “vaping” is commonly used informally to refer to e-cigarette use. However, many youth and adults do not recognize that e-cigarette use and vaping are the same. Help make the connection that vaping is the same as e-cigarette use. 

Get help to quit using e-cigarettes and other tobacco products

SAPCA's work addressing e-cigarettes
SAPCA has been taking the following steps to educate and inform the community about these concerns:

  • Formed a vaping work group comprised of Alexandria City Public Schools students to brainstorm ways to address vaping systemically. This group is creating and implementing a strategic plan and is actively looking for youth and adults interested in addressing this issue. To get involved, contact Fredy Martinez at Fredy.Martinez@acps.k12.va.us or 703-619-8278

  • Crafted a seminar for Red Ribbon Week, the longest running drug prevention program, to provide information about vaping and to encourage youth to take a drug-free pledge.  This seminar was delivered to 10,000 students at the elementary, middle and high school level. 

  • Presented to the T.C. Parent Teacher Association about e-cigarettes.  

  • Educated lawmakers about Tobacco 21, a law that was successfully passed and signed into law on July 1, 2019. This law prevents anyone under the age of 21 from purchasing, using or possessing any tobacco, nicotine vapor or alternative tobacco product.

  • Delivering classroom presentations and assemblies to middle and high school students about the facts and consequences of substance use and abuse. During these presentations, students also have an opportunity to brainstorm creative ways to resist peer pressure.

  • Presenting to students caught using substances at school as part of a collaborative program delivered in partnership with the Court Services Unit and the Department of Community and Human Services. Students referred to the program are screened and attend with a parent to engage in a restorative practice regarding the violation to the school code of conduct through a combination of engaging group presentations and one-on-one activities.

  • Distributing a coach’s resource packet that provides information about substance use and abuse. The packet can be found here and it educates and encourages coaches to discuss the dangers of these substances with their athletes. It also provides them with concrete ways to take action, including taking a clear stance on vaping and ensuring students they work with know that using these substances is not allowed.

  • Presented to the Children Youth and Families Collaborative Commission about e-cigarettes. Click here to view the presentation.