Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine

Abstract

Answer questions and earn CME/CNE Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core-and highly addictive-constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of "harm," their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use. CA Cancer J Clin 2017;67:449-471. © 2017 American Cancer Society.

A blueprint for the primary prevention of cancer: Targeting established, modifiable risk factors

“…To evaluate the net public health benefit of ENDS, it is necessary to consider at least the following: 1) the harm from using ENDS, 2) the influence of ENDS on adult cigarette cessation, and 3) youth initiation of ENDS, leading either to long‐term ENDS use or to eventual combustible tobacco use. Major recent reviews concluded that the exclusive use of current‐generation ENDS is likely to be significantly less harmful than using combustible tobacco products (with or without concurrent use of ENDS), but there are not yet sufficient data to evaluate the long‐term health effects of using ENDS. Although carcinogens, including tobacco‐specific nitrosamines, are found in ENDS aerosol, the levels are significantly lower than those in tobacco smoke, and there are considerably fewer toxicants in ENDS aerosol compared with tobacco smoke .…”

Vaping: The new wave of nicotine addiction

“…nickel, and lead; and particles of copper, nickel, and silver have been found in electronic nicotine delivery system aerosol in higher levels than in conventional cigarette smoke. 41 The specifi c chemicals detected can vary greatly between brands, even when the fl avoring and nicotine content are equivalent, which frequently results in inconsistent and confl icting study fi ndings. The chemicals detected also vary with the voltage or power used to generate the aerosol.…”

Sistemas electrónicos de administración de nicotina: ¿una amenaza para el neurodesarrollo de los adolescentes?

“…Además, se estableció una edad mínima de compra de 18 años (aquellos estados con edades mínimas de compra mayor de 18 años no tienen que cambiarlas), presencia de etiquetado que advierta los potenciales riesgos para la salud y prohibición de su venta en máquinas expendedoras, a menos que estén en un lugar en el que no se acepten menores de edad a toda hora. Cabe aclarar que algunos estados son menos flexibles y establecen edades mínimas superiores (52,53,54).…”