Electronic Nicotine Delivery Systems

Abstract

Electronic nicotine delivery systems (ENDS) are rapidly growing in popularity among youth. ENDS are handheld devices that produce an aerosolized mixture from a solution typically containing concentrated nicotine, flavoring chemicals, and propylene glycol to be inhaled by the user. ENDS are marketed under a variety of names, most commonly electronic cigarettes and e-cigarettes. In 2014, more youth reported using ENDS than any other tobacco product. ENDS pose health risks to both users and nonusers. Nicotine, the major psychoactive ingredient in ENDS solutions, is both highly addictive and toxic. In addition to nicotine, other toxicants, carcinogens, and metal particles have been detected in solutions and aerosols of ENDS. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. The concentrated and often flavored nicotine in ENDS solutions poses a poisoning risk for young children. Reports of acute nicotine toxicity from US poison control centers have been increasing, with at least 1 child death reported from unintentional exposure to a nicotine-containing ENDS solution. With flavors, design, and marketing that appeal to youth, ENDS threaten to renormalize and glamorize nicotine and tobacco product use. There is a critical need for ENDS regulation, legislative action, and counter promotion to protect youth. ENDS have the potential to addict a new generation of youth to nicotine and reverse more than 50 years of progress in tobacco control. DEFINITIONS• Secondhand aerosol: emissions from electronic nicotine delivery systems (ENDS) that are discharged into the surrounding environment with ENDS use, both directly from the ENDS and exhaled from the lungs of the user.• Thirdhand aerosol: ENDS emissions that remain on surfaces and in dust after ENDS use, which can be reemitted into the gas phase or react with oxidants in the environment to yield secondary pollutants.

Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation

“…In addition, health care providers need to understand basic facts concerning e-cigarettes as well as adolescents’ attitudes towards these products since e-cigarettes are becoming a more predominant tobacco product amongst adolescents. Healthcare providers need to regularly screen for e-cigarette use, and educate patients and parents about misconceptions associated with e-cigarettes (AAP, 2015). …”

Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015

“…Largely unregulated e-cigarette marketing and the extensive array of product flavors may disproportionately appeal to youth [8–11]. Concerns regarding adolescent e-cigarette use include exposure to potentially harmful toxins, renormalization of smoking behavior, nicotine dependence, and subsequent initiation and long-term use of cigarettes and other tobacco products [10–12].…”

Nicotine concentration of e-cigarettes used by adolescents

“…Third, e-cigarette use confers risk for the uptake of combustible tobacco products including cigarettes (Leventhal et al, 2015). Fourth, e-cigarettes expose users to a range of toxicants, carcinogens, and metal particulates, so even using nicotine-free e-liquid may carry health risks (Walley et al, 2015). Finally, some adolescents may be exposing themselves to nicotine inadvertently because they are unaware of the nicotine content of the e-cigarettes they use.…”