An electronic cigarette (e-cigarette) is a device that heats liquid nicotine and flavorings so they can be inhaled. The use of e-cigarettes is often called “vaping,” because many people believe it produces a vapor. E-cigarettes create an aerosol composed of tiny particles, which is different from a true vapor.

E-cigarettes are known by many different names. This includes e-cigs, vapes, vape pens, electronic nicotine delivery systems (ENDS), alternative nicotine delivery systems (ANDS), e-hookahs, mods, vaporizers, and tank systems. E-cigarettes are also sometimes known by their brand names.

Vaping works by heating liquid inside a small device, which turns it into an aerosol that is then inhaled into the lungs. Unlike smoking, which burns tobacco, vaping heats liquid to release particles suspended in air. The aerosol contains nicotine, flavorings, and other chemicals. When inhaled from the mouthpiece, these particles travel down the throat and into the lungs.

E-cigarettes are available in many shapes and sizes. They can look like cigarettes, cigars, pipes, pens, and USB flash drives. Most types of e-cigarettes have:

• A cartridge, tank or pod that holds liquid (can be refillable).
• A heating element for turning the liquid into breathable particles (aerosol, commonly called “vapor”).
• A battery to power the heating element.
• A power or control button (some are activated by sensors when you inhale).
• A mouthpiece to breathe in the aerosol.

E-cigarettes don’t have tobacco, but many of them have nicotine, which comes from tobacco. E-cigarettes heat liquid to make an aerosol; cigarettes burn tobacco, which creates smoke. Because of this, the U.S. Food and Drug Administration (FDA) classifies them as “tobacco products.”

Electronic cigarettes (e-cigarettes) were developed as a smoking cessation tool and a safer alternative to traditional cigarettes for people unable or unwilling to quit nicotine. The intention was to help people who smoke to reduce nicotine intake without exposure to the harmful tar and toxins in tobacco smoke, thus, reducing smoking-related diseases and deaths. However, 21 years since Chinese pharmacist Hon Lik, first introduced the modern e-cigarettes in 2003, to help himself quit smoking cigarettes, this did not work. He is now a dual user, both smoking and vaping. We must question whether they have achieved their intended objectives or if they have inadvertently become a Trojan horse in public health, presenting unforeseen risks and challenges.

Patterns of use

Some groups of adults use e-cigarettes at a higher percentage than others. For example:

• More men than women report current e-cigarette use.
• A higher percentage of young adults (18–24 years old) use e-cigarettes compared to older adults, usage declines with age.
• Use is higher among adults with less education, lower incomes, or without health insurance.
• Adults who identify as lesbian, gay, or bisexual report higher rates of use compared to heterosexual adults.
• Adults experiencing serious psychological distress are more likely to use e-cigarettes.

In 2024, e-cigarettes were the most used tobacco product among middle and high school students in the United States:

1. 63 million (5.9%) students currently used e-cigarettes. This includes:
   3. 410,000 (3.5%) middle school students.
   4. 21 million (7.8%) high school students.
2. Among students who had ever used e-cigarettes, 43.6% reported current use.
3. Among students who currently used e-cigarettes:
   38. 4% used an e-cigarette on at least 20 of the last 30 days.
   39. 3% used an e-cigarette every day.
4. 6% used flavored e-cigarettes. Vapes come in a variety of youth-friendly flavors, including fruit, candy, mint, and menthol.
5. Among students who currently used e-cigarettes; 55.6% used disposable e-cigarettes, 15.6% used prefilled or refillable pods or cartridges, and 7.0% used tanks or mod systems.

Most middle and high school students who vape both want to quit and have attempted to do so. In 2020, 63.9% of students who were current e-cigarette users reported wanting to quit, and 67.4% reported that they had tried to quit within the past year.

Why youth vape

Most tobacco use, including vaping, starts and is established during adolescence. There are many factors associated with youth tobacco product use. These include:

1. Tobacco advertising that targets youth: In 2021, 7 out of 10 U.S. middle and high school students reported exposure to e-cigarette marketing. Most students reported seeing e-cigarette advertisements or promotions in retail settings. Students also reported seeing advertisements on the internet, television, streaming services, movies, or in print media. In addition, about three out of four students (74%) who used social media reported seeing e-cigarette–related posts or content.
2. Product accessibility: Some e-cigarettes cost less than regular cigarettes, which may also contribute to youth vaping.
3. Availability of flavored products: A study from 2013–2015 showed that most youth who use e-cigarettes first start with a flavored variety. Availability of flavored vapes is among the top 10 reasons youth report ever trying an e-cigarette. In 2024, nearly 9 out of 10 middle and high school students who currently used e-cigarettes reported using a flavored product, with the most commonly used flavors being fruit, candy, and mint.
4. d) Social influences: The most common reason U.S. middle and high school students give for trying an e-cigarette is that a friend used them. Youth also report vaping because they are curious about e-cigarettes or because a family member used them.

Youth often obtain the e-cigarettes from others. Among U.S. middle and high school students who used e-cigarettes in 2021:

• 3% got them from a friend.
• 1% bought the products themselves.
• 7% had someone else buy the products for them.
• 7% had someone offer the products to them.

Dual use of e-cigarettes: Many young people who vape also use other tobacco products, including cigarettes and cigars. This is called dual use. In 2024:

• Among U.S. students who currently use a tobacco product, more than one-third report using more than one type of product, including 6%of high school students and 38.9% of middle school students.

Cannabis content of e-cigarettes: E-cigarettes can also be used to deliver other substances, including cannabis. In 2016, nearly one out of three (30.6%) of U.S. middle and high school students who had ever used an e-cigarette reported using marijuana in the device.

Health risks of E-cigarettes

The term “vapor” might sound harmless. But the aerosol that comes out of an e-cigarette is not water vapor, and it can be harmful. The aerosol from an e-cigarette can contain nicotine and other substances that are addictive.

1. Nicotine content: The e-liquid in most e-cigarettes has nicotine, the same addictive chemical in regular cigarettes, cigars, hookah, and other tobacco products. But nicotine levels are not the same in all types of e-cigarettes. Sometimes, product labels do not list the true nicotine content. There are some e-cigarette brands that have been found to contain nicotine even though they claim to be nicotine-free.

Young people can start showing signs of nicotine addiction quickly, sometimes before the start of regular or daily use. Because the adolescent brain is still developing, it is uniquely susceptible to nicotine.

The nicotine content of e-cigarettes has increased over time. Many e-cigarettes contain nicotine salts. These allow people to consume high levels of nicotine without experiencing the harshness of freebase nicotine.

High-nicotine products dominate US e-cigarette unit sales. In March 2022, products with a nicotine strength of 5% or more made up 81% of total e-cigarette unit sales. In recent years, the price of high-nicotine products decreased or stayed the same while the price of low-nicotine products increased.

2. Cancer risk: E-cigarettes contain chemicals that can cause cancer (carcinogens), like acetaldehyde and formaldehyde but their long term effect on cancer development is not yet clear.
3. Heart and lung disease: E-cigarettes contain chemicals known to cause lung disease, such as acrolein, diacetyl and diethylene glycol. A Johns Hopkins Medicine-led analysis of medical information gathered on a diverse group of almost 250,000 people over four years has significantly clarified the link between the “exclusive” use of e-cigarettes and chronic obstructive pulmonary disease, as well as high blood pressure in a sub-group of adults 30 to 70 years of age.

E-cigarettes and other similar products have been linked to lung problems. Using them can increase your risk of breathing problems. This includes worsening asthma symptoms, more frequent bronchitis, and lung infections.

The nicotine in e-cigarettes also increases heart rate, raises blood pressure, and might irritate blood vessels.

4. Vitamin E acetate, linked to lung injury caused by vaping (EVALI): An outbreak of EVALI in late 2019 and early 2020 put thousands of people in the hospital. At least 68 people died. Since then, EVALI cases have been declining, but people who vape can still get EVALI. Among people hospitalized with severe EVALI, most were younger than 35 and used THC-containing vapes from informal sources, such as online sellers or family and friends. However, EVALI can occur in anyone who uses either nicotine or THC-containing vapes.

Symptoms of EVALI included:

• Cough, trouble breathing, or chest pain
• Nausea, vomiting, or diarrhea
• Fatigue, fever, or weight loss

Some people had to be hospitalized, and some died from their illness. Some of these lung injuries were linked to products that were changed, including products that had vitamin E acetate. But there were also many EVALI cases that did not involve added vitamin E.

The number of EVALI cases has since dropped, but there are still people being diagnosed with EVALI. More studies are being done to look for other possible causes.

5. Heavy metals: E-cigarettes may contain heavy metals like nickel, tin, lead and cadmium which have been shown to have adverse health effects.
6. Tiny particles: E-cigarettes may contain tiny (ultrafine) particles that can get deep into your lungs passing the filtration system of the lungs.
7. Seizures: There have been reports of people having seizures after vaping. This has been reported most often in young people. These seizures are thought to be caused by nicotine, but more studies are being done.
8. Dental problems: Studies are also starting to show a link between e-cigarette use and damage to teeth and other oral tissues. This includes cavities in the teeth and irritation of gums and other membranes in the mouth.
9. Secondhand aerosol: E-cigarettes expose people to secondhand aerosol or vapor that can contain harmful chemicals. Scientists are still learning about the health effects of being exposed to secondhand e-cigarette aerosol. Secondhand aerosol can expose others to nicotine and possibly to other harmful chemicals.
10. Explosions: There have been reports of e-cigarettes exploding and causing serious injuries. The explosions are thought to be caused by faulty batteries or because the batteries were not handled as they should be.

Can e-cigarettes help people quit?

E-cigarettes are not approved by the FDA and European Medicines Agency as smoking cessation devices due to limited data on safety and effectiveness. This is because there is not enough research to show that they help people to stop using tobacco.

Recent research indicates that people who use both cigarettes and e-cigarettes have a higher risk of getting lung cancer than people who only use cigarettes. People should not use both products at the same time and are strongly encouraged to completely stop using all tobacco products.

Globally, regulation varies:

• 88 countries have no minimum purchase age.
• 74 countries lack regulations entirely.
• E-cigarettes are banned in about 35 countries.
• Others regulate them as consumer, pharmaceutical, or tobacco products.

Marketing frequently targets youth, with over 16,000 flavors, cartoon packaging, and sleek designs resembling toys or tech gadgets. Alarmingly, in many countries, e-cigarette use among adolescents exceeds adult use. Even brief exposure to vaping content on social media increases the likelihood of trying these products.

One of the greatest public health risks is that vaping could “re-normalize” smoking after decades of successful tobacco control. Smoking remains the leading preventable cause of death, killing more than 480,000 people annually in the United States alone.

Conclusion

Taken together, these findings show that no tobacco products, including e-cigarettes, are safe. Most e-cigarettes contain nicotine, a highly addictive substance that poses serious health risks, particularly for youth, pregnant women, and developing fetuses. In addition to nicotine, e-cigarette aerosol can contain harmful and potentially harmful substances, including cancer-causing chemicals and ultrafine particles that can be inhaled deep into the lungs. For these reasons, e-cigarettes should not be used by youth, young adults, or individuals who are pregnant. Moreover, e-cigarettes pose potential health risks not only to those who vape but also to others exposed to secondhand emissions, while placing an added burden on public health systems and government healthcare budgets. Compounding these concerns, the short- and long-term health effects of e-cigarette use remain unclear, and much is still unknown about their full impact on human health. Until more is understood, this evidence underscores the importance of prevention, education, and informed decision-making.

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2. Centers for Disease Control and Prevention. (n.d.). E-cigarettes. Retrieved October 9, 2025, from https://www.cdc.gov/tobacco/e-cigarettes/
3. American Cancer Society. (n.d.). E-cigarettes and vaping. Retrieved October 9, 2025, from https://www.cancer.org/cancer/risk-prevention/tobacco/e-cigarettes-vaping.html
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6. Hajek, P., Etter, J. F., Benowitz, N., Eissenberg, T., & McRobbie, H. (2014). Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction, 109(11), 1801–1810. https://doi.org/10.1111/add.12659
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Psychologists have uncovered and grouped intelligence into three main groups: abstract intelligence (the ability to understand and manipulate using verbal and mathematical symbols), concrete intelligence (the ability to understand and manipulate with objects), and social intelligence (the ability to understand and relate to people).¹

Emotional intelligence (EI) has its roots in the concept of “social intelligence,” first identified by E.L. Thorndike in 1920. The influence of this concept on popular culture and the academic community has been rapid and widespread.

As we all know, emotions are a fundamental part of who we are, and play an important part in our relationships with others. They cannot be removed from the picture. However, most of us have traditionally been conditioned “to leave our emotions at home,” believing that in order to be more effective we need to base all our strategies and decisions only upon cold, logical “intelligence.”²

In fact, to do so often guarantees that the suppressed emotions will flare, causing increased conflict and affecting the mood of the individual negatively. But what if we continue to expand our knowledge of emotions in a different way altogether, as another kind of “intelligence,” beyond reason and logic? An intelligence that – if we could learn to access it – could become nothing less than a touchstone to greater collaboration, giving us greater influence with others, motivating us to be more productive and effective.

It could be said that the greatest distance there is is the distance between the mind (IQ) and the heart (EQ). By learning about and utilizing EI, we will be able to shorten that distance, and we will be working with astonishing capacity and effectiveness. Let us address some important questions and issues about Emotional Intelligence.

What Is EI?

When Salovey and Mayer coined the term “emotional intelligence” (EI) in 1990,³ they were aware of the previous work on non-cognitive aspects of intelligence. They described emotional intelligence as “a form of social intelligence that involves the ability to monitor one’s own and others’ emotions, to discriminate among them, and to use the information to guide one’s thinking and actions.”⁴

Esther Orioli and Robert Cooper state the following in explaining EI: “EI is far more than being ‘nice’ to people. It is the ability to sense, understand, and effectively apply the power and acumen of emotions as a source of energy, information, creativity, trust, and connection.”⁵

Another way to describe EI is the ability to sense and use emotions to more effectively manage ourselves and influence positive outcomes in our relationships.

Why Do We Need EI?

Primitive emotional responses of our EI hold the keys to better health, experiencing greater joy and closer connections, achieving stronger leadership, a clearer vision, greater efficacy, higher goals, expanding our personal power, enhancing our self-awareness, augmenting learning, magnifying clarity, ensuring healthier relationships and finer perception, and finally, the provision of greater satisfaction. These emotional reflexes, rarely conscious but powerful, motivate our choices. In short, we need EI for utilizing the power of emotions.

What Are the Competencies of EI?

In Goleman’s model of EI there are five key steps:⁶ self-awareness, self-regulation, self-motivation, empathy, and effective relationships; each includes a set of different competencies. All the competencies to be successful are not necessary, but the two core competencies (emotional self-awareness and accurate self-assessment) are essential. These are the two foundational abilities upon which all others rest (see Chart).

1. Self-Awareness

The cornerstone or foundation of EI is self-awareness. It supports all the other EI skills. Self-awareness must come first because if we do not know ourselves or what we are feeling, how can we possibly know the needs of others or understand someone else and how they feel?

The more we know about ourselves, the better we are able to control and choose what kind of behavior we will display in any given situation. Self-awareness is about knowing where we are now and where we want to go, so that we will be willing to change to get there. Without self-awareness, our emotions can blind us and guide us to do things or to become people we do not want to be.

To become more self-aware, one must follow these steps:

• Learn the difference between thoughts and feelings. It is extremely important to know the difference between “I think” and “I feel” if you are to know yourself better.

• Ask yourself how you are feeling throughout the day and be honest. If your heart races or you blush or if you are short of breath – this is usually a gut reaction. Ask yourself, “What is the feeling behind it?” Name that feeling – fear, anxiety, love, eagerness.

• Be open to input from others. Friends and associates can often enlighten us about our behavior.

2. Self-Regulation

While we are listening and learning from our gut feelings as a step toward self-awareness, self-regulation is regulating those same feelings and managing them so that they do more good than harm. Self-regulation is giving the rational side time to temper our feelings when needed. It also helps us to act intentionally rather than reactively. When we act intentionally, we mean what we say rather. The other side of the coin is to just spout off without thinking and later regret an impulsive act.

Here are some tips to help you with self-regulation:

• Monitor your self-talk (what you say to yourself in your mind).

• Accept responsibility for your emotional responses in your life. When you are feeling that you are accountable, you are acknowledging your own power.

• Anticipate emotional “triggers” and prepare to manage them.

• Reframe an irritating situation into a problem-solving exercise. When you encounter a situation that provokes an undesirable emotional response, decrease your anger by focusing on the behavior. Reframe it to make the behavior the problem, and not the person.

• Use humor!

• Never underestimate the power of taking deep breaths. Increasing the flow of oxygen to the brain eases tension, clarifies thinking and has a relaxing effect on our psyche and body. It also gives you a moment to collect your thoughts and to think before speaking.

• Remove yourself from the situation and keep moving. There are major benefits in distancing yourself from a bad situation and re-directing your energy into a new activity. This will help you regain your perspective, increase your alertness and re-energize.

Unlike Intelligence Quotient, which is fixed for life, Emotional Quotient can be continually developed to enable people to increase their awareness of their selves and others, to develop.

3. Self-Motivation

Self-motivation is directing the power of our emotions toward a purpose that will motivate and inspire us. It is also visualizing the achievement of a goal and taking whatever the necessary steps are to get there. Various ways to bolster your self-motivation are: — Be aware of how you explain setbacks to yourself… stay realistic. Realize that you can control and choose what you are thinking and feeling. Increase your persistence by keeping things in perspective. — Connect your goals with your values to get energized. Keep your eyes on the goal and follow through so you can enjoy the satisfaction of completing whatever projects you’ve begun. — Strive for reaching a —flow— state while working on projects. — Visualize! — Keep learning! The pursuit of knowledge will build on your areas of strength. You will be more valuable and versatile.

4. Empathy

Once we have become more honest and intentional with our emotions, it is time to look outward. EI is both tuning into our feelings and tuning into the feelings of those around us. It means responding to others appropriately, with sensitivity and compassion. Empathy is being able to see a problem from another person’s perspective. It is good to acknowledge other people’s emotions while still remembering that those are their emotions, not ours. Empathy begins with listening. This means making a connection with people. Individuals who lack empathy are more focused on their needs and pay little or no attention to anyone else’s. Empathy is the glue that will bind a group together to work successfully. Some of the techniques for enhancing your empathy are: — Look for nonverbal cues as well as listening for verbal ones. Studies show that words account for only 7% of communication. Tone and the speed of speech accounts for 38% of the message, while 55% is unspoken and revealed through body language, such as posture, eye contact, facial expressions, and so on. — Share and be honest about your feelings. Good communication leads to trust. — Your spoken and unspoken messages should be consistent. You want what you are saying to uphold what you are doing. This proves that you are being honest, or authentic, which builds trust. — Take the kinder road whenever possible. There are many ways to deliver opinions and criticism. You can be honest and still give positive feedback, which increases confidence. Construc-tive feedback increases competence. — Try to see a situation from the other person’s perspective. Empathy is about imagining what it would be like to walk in someone else’s shoes. We ought to assume that everyone is doing the best they can with the resources that they have at the moment.

5. Effective Relationships

Mastering the abilities of self-awareness, self-regulation, self-motivation, and empathy paves the way to attaining greater skill in effective relationships. This competency is about interacting with people successfully and being adept at managing emotions in others. With heightened social skills, leaders are better communicators and better collaborators. Some EI techniques for having more effective relationships at work: — Share your passion and enthusiasm for your job and the organization’s vision — it’s contagious! Keep the vision in view by relating your own excitement for a project or goal. — Create an inspiring work environment. If you show honesty, trust, and appreciation toward your team, you create the perfect environment for them to do their best work. — Engage in creative brainstorming. Not only is brainstorming good for generating fresh ideas, but the process builds rapport and trust among team members. This could smooth the way to future collaborations because of the creative bond that has been formed. — Be willing to coach or mentor others and be open to being coached yourself. This is the most important relationship skill in the workplace. By sharing your knowledge and expertise with other team members, you are nurturing the next generation. And by allowing someone to coach you, you are showing that you are receptive to others’ ideas and that you do not —know it all.— In conclusion, quite simply the EI competencies of intra-personal and inter-personal skills are central to our life and are a different way of being intelligent. They are the tools that our brains use to define ourselves, to shape the meaning of major concepts like love, success, and happiness. EI has been found to be more important than IQ, technical ability, or experience in determining life success. Unlike IQ, which is fixed for life, EQ can be continually developed to enable people to increase their awareness of their selves and others, to develop self-management strategies, and to connect with others to create collaboration and harmony. In practice, EI also enables people to tap into their true power and creativity and to consciously choose the most effective response to any situation rather than merely reacting impulsively.

Footnotes

1. Ruisel, I., Social Intelligence: Conception and Methodological Problems, 34(4-5), 281-296.
2. Emotional Intelligence Workbook, CRM Learning, Carlsbad, 2001.
3. Salovey, P., & Mayer, J. Emotional Intelligence, Imagination, Cognition, and Personality, 1990.
4. Salovey, P., & Mayer, J., The Intelligence of Emotional Intelligence, 1993, 17, 433-442. 5 See http://www.qmetricseq.com/
5. Goleman, D., Emotional Intelligence, Bantam Books, New York, 1995.