Electronic Nicotine Delivery Systems

Suggested Reading

Also referred to as ENDS, electronic cigarettes, or e-cigarettes

ENDS and Cessation

Although e-cigarette consumption may reduce the number of conventional cigarettes a person uses, the use of these products can not be recommended as a cessation strategy at the present time.

Alternative tobacco product use and smoking cessation: a national study. 
(American Journal of Public Health, 2013)

Effect of an Electronic Nicotine Delivery Device (e-cigarette) on Smoking Reduction and Cessation: A Prospective 6-Month Pilot Study
(BMC Public Health, 2011)

Electronic cigarettes for smoking cessation: a randomized controlled trial
(The Lancet, 2013)

Use of Electronic Cigarettes Among State Tobacco Cessation Quitline Callers
(Nicotine & Tobacco Research, 2013) 

Use of ENDS

Despite expert concerns about the safety of these products, e-cigarette use is increasing, especially with youth and young adults. Current smokers of conventional cigarettes try and use e-cigarettes, and dual use of conventional cigarettes and e-cigarettes is often seen. Former smokers and those who have never smoked have been found to initiate e-cigarette use as well. The CDC Morbidity and Mortality Weekly Report, stated that e-cigarette use among middle and high school students in the US doubled between 2011 and 2012.

A longitudinal study of electronic cigarette users
(Addictive Behaviors, 2013)

Adolescent Males’ Awareness of and Willingness to Try Electronic Cigarettes
(Journal of Adolescent Health, 2012)

e-Cigarette Awareness, Use, and Harm Perceptions in US Adults 
(American Journal of Public Health, 2012)

E-Cigarette Awareness and Perceived Harmfulness 
(American Journal of Preventive Health, 2014) 

Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents
(JAMA Pediatrics, 2014)

Electronic Cigarette Use and Outcome Expectancies Among College Students
(Addictive Behaviors, 2014)

Electronic Cigarette Use Among Middle and High School Students – United States 2011-2012
(CDC Morbidity and Mortality Weekly Report, 2013)

Electronic cigarette use by college students
(Drug and Alcohol Dependence, 2013)

Electronic-Cigarette Smoking Experience Among Adolescents
(Journal of Adolescent Health, 2011) 

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration, Dual Use, and Relationship to Quit Attempts and Former Smoking
(Journal of Adolescent Health, 2013)

Electronic Cigarette: users profile, utilization, satisfaction and perceived efficacy
(Addiction, 2011)

Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review
(Tobacco Control, 2013) 

Intentions to Smoke Cigarettes Among Never-Smoking U.S. Middle and  High School Electronic Cigarette Users, National Youth Tobacco Survey, 2011-2013
(Nicotine & Tobacco Research, 2014)

More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013
(Centers for Disease Control and Prevention, 2014)

Trends in use of electronic nicotine deliver systems by adolescents
(Addictive Behaviors, 2013)

Use and Perception of Electronic Cigarettes Among College Students
(Journal of American College Health, 2013)

Use of E-Cigarettes by Individuals with Mental Health Conditions
(Tobacco Control, 2014) 

Use of emerging tobacco products in the United States
(Journal of Environmental Public Health, 2012)

Health Effects of ENDS

E-cigarettes are a relatively recent phenomenon. There is limited data on current health effects and no data on long term health effects. Common side effects of e-cigarettes include throat irritation, mouth irritation, dry mouth, mouth ulcers, dry cough, dizziness, headache and nausea. Researchers found that one cause of the toxicity of e-cigarettes may be due to the chemicals used to flavor these products. Heavy metals and silicate particles, which may be harmful to health have been discovered in the aerosol of e-cigarettes. Another emerging concern with e-cigarettes is the risk of explosion. ENDS have been known to explode, causing serious injury as well as property damage. E-cigarette refill fluid poses the risk of nicotine overdose poisoning to people (especially children) and pets.

Abstract B16: The Effect of E-Cigarette Exposure on Airway Epithelial Gene Expression and Transformation
(Clinical Cancer Research, 2014)

Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models
(Reproductive Toxicology, 2012) 

E-cigarettes Affect Cells
(Nature, 2014)

Evaluation of Electronic Cigarette Liquids and Aerosol for the Presence of Selected Inhalation Toxins
(Society for Research on Nicotine and Tobacco, 2014)

Health Related Effects Reported by Electronic Cigarette Users in Online Forums
(Journal of Medical Internet Research, 2013)

FDA Warns of Health Risks Posed by E-Cigarettes
(FDA, 2009)

Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
(Tobacco-Related Disease Research Program, 2013)

Variable and potentially fatal amounts of nicotine in e-cigarette nicotine solutions
(Tobacco Control, 2013)

Secondhand and Thirdhand Exposure to ENDS

Passive exposure to secondhand and thirdhand aerosol from ENDS is harmful to health, just as secondhand and thirdhand smoke from conventional cigarettes is toxic.

Comparison of the Effects of E-Cigarette Vapor and Cigarette Smoke on Indoor Air Quality
(Inhalation Toxicology, 2012)

Does e-cigarette consumption cause passive vaping?
(Indoor Air, 2013)

Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider
(International Journal of General Medicine)

Electronic Cigarettes are a Source of Thirdhand Exposure to Nicotine
(Nicotine and Tobacco Research, 2014) 

Particulate metals and organic compounds from electronic and tobacco-containing cigarettes: comparison of emission rates and secondhand exposure
(Environmental Science Process Impacts, 2014)

Secondhand Exposure to Vapors From Electronic Cigarettes
(Oxford University Press, 2013)

Use of Electronic Cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers
(International Journal of Hygiene and Environmental Health)

Science on ENDS

Contrary to what is advertised by e-cigarette distributors, these products are more complicated than consumers are led to believe. They do not emit simply “harmless water vapor” as frequently advertised by proponents of these products, but emit a chemical aerosol. In fact, the construction of the devices and chemical composition of the fluid/aerosol varies widely. It is not uncommon for nicotine content to be mislabeled, with fluid labeled to contain nicotine sometimes containing none, and fluid labeled nicotine-free often containing some level of nicotine.

Analysis of electronic cigarette cartridges, refill solutions, and smoke or nicotine and nicotine related impurities 
(Journal of Liquid Chromatography & Related Technologies, 2011)

Conventional and electronic cigarettes (e-cigarettes) have different smoking characteristics
(Nicotine and Tobacco Research, 2010)

Electronic Cigarettes, an Overview
(Tobacco Prevention and Tobacco Control, 2013)

Influential parameters of particle concentration and size distribution in the mainstream of e-cigarettes
(Environmental Pollution, 2014)

Nicotine content of electronic cigarettes, it’s release in vapour, and its consistency across batches: Regulatory implications
(Addiction, 2013) 

Nicotine Levels in Electronic Cigarettes
(Nicotine and Tobacco Research, 2012)

Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted by FDA
(FDA, 2009)

Regulation of ENDS

In 2010 it was decided that the FDA could not regulate e-cigarettes as drug delivery devices. In April 2011, the FDA announced plans to regulate e-cigarettes as a tobacco product under the 2009 Family Smoking Prevention and Tobacco Control Act. Opportunities for regulating e-cigarettes exist on the federal, state, and local level. Options for regulation include regulating sale, regulating marketing, and regulating use.

A Baseline Understanding of State Laws Governing E-Cigarettes
(Tobacco Control, 2014) 

Electronic Cigarettes Hold Both Promise and Risk, Require FDA Regulation (Legacy, 2014)

Electronic Cigarettes, How they are and could be regulated
(Change Lab Solutions, 2011)

Electronic Nicotine Delivery Systems, Is There a Need for Regulation? 
(Tobacco Control, 2010)

Federal Approaches to the Regulation of Noncigarette Tobacco Products
(American Journal of Preventive Medicine, 2012)

Options for State and Local Governments to Regulate Non-Cigarette Tobacco Products
(Annals of Health Law, 2012) 

Regulating Electronic Cigarettes and Similar Devices 
(Tobacco Control Legal Consortium, 2013)

Research Support for Effective State and Community Tobacco Control Programme Response Electronic Nicotine Delivery Systems
(Tobacco Control, 2014)

State Electronic Smoking Device Legislation
(Legal Resource Center for Maryland)

The Availability of Electronic Cigarettes in US Retail Outlets, 2012: Results of Two National  Studies
(Tobacco Control, 2014)

The Impact of Price and Tobacco Control Policies on the Demand for Electronic Nicotine Delivery Systems
(Tobacco Control, 2014)

The Importance of Product Definitions in US E-Cigarette Laws and Regulations
(Tobacco Control, 2014)

U.S. State and Local Laws Regulating the Use of Electronic Cigarettes
(Americans for Nonsmokers’ Rights, 2013) 

Marketing of ENDS

E-cigarette marketing centers around common themes, which include health claims (harm reduction and cessation), freedom claims (circumventing current smoking regulations), environmental claims (reduced waste from conventional cigarette butt litter and reduced secondhand smoke) which may misinform consumers of the realities of using these products. E-cigarette sellers are not permitted to claim their products help people quit tobacco, but they often do so by using deceptive strategies with affiliate advertisers who run ad content which directs viewers to vendors. These affiliate advertising schemes often make cessation claims through spam text or email messages, banner ads, and search engine results. E-cigarettes are marketed through television and radio channels. Smokers are receptive to e-cigarette advertisements and report intention to try the products after viewing these ads.

7 Ways E-Cigarette Companies are Copying Big Tobacco’s Playbook
(Tobacco Free Kids, 2013)

A Content Analysis of Electronic Cigarette Retail Websites
(American Journal of Preventive Medicine, 2014)

A Cross-Sectional Examination of Marketing of Electronic Cigarettes on Twitter
(Tobacco Control, 2014) 

Adult Smokers’ Receptivity to a television advert for electronic nicotine delivery systems
(Tobacco Control, 2013)

Effects of Advertisements on Smokers’ Interest in Trying E-Cigarettes: The Roles of Product Comparison and Visual Cues
(Tobacco Control, 2014)

Electronic Cigarette Advertising at the Point-of-Sale: A Gap in Tobacco Control Research
(Tobacco Control, 2014)

Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults
(Pediatrics, 2014)

Forensic analysis of online marketing for electronic nicotine delivery systems
(Tobacco Control, 2013)

News Media Representations of Electronic Cigarettes: An Analysis of Newspaper Coverage in the UK and Scotland
(Tobacco Control, 2013)

Promotion of electronic cigarettes: tobacco marketing reinvented? 
(BMJ, 2013)

Smoking Revolution: A Content Analysis of Electronic Cigarette Retail Websites
(American Journal of Preventive Medicine, 2014)

The Marketing of Electronic Cigarettes in the UK
(Cancer Research UK, 2013)

Tobacco on the Web: Surveillance and Characterization of Online Tobacco and E-Cigarette Advertising
(Tobacco Control, 2014)

Wanna Know About Vaping? Patterns of Message Exposure, Seeking and Sharing Information about E-Cigarettes Across Media Platforms
(Tobacco Control, 2014) 

General ENDS Literature

The following articles contain general information related to electronic cigarettes.

ATOD Section Newsletter
(American Public Health Association, 2013)

(Circulation, 2014)

E-Cigarettes: A Scientific Review
(Circulation, 2014) 

E-Cigarettes: Promise or Peril?
(The Nursing Clinics of North America, 2012)

Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. A Literature Review
(Frontiers in Public Health Education and Promotion, 2013)

Electronic Cigarettes (e-cigs): views of aficionados and clinical/public health perspectives
(The International Journal of Clinical Practice, 2011) 

Five Things to Know about Electronic Cigarettes
(Canadian Medical Association, 2013)

Four Hundred and Sixty Brands of E-Cigarettes and Counting: Implications for Product Regulation
(Tobacco Control, 2014)

Healthcare Providers’ Beliefs and Attitudes About Electronic Cigarettes and Preventive Counseling for Adolescent Patients
(Journal of Adolescent Health, 2013)

Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey
(International Journal of Environmental Research and Public Health, 2013)

Nicotine Control: E-cigarettes, smoking, and addiction
(International Journal of Drug Policy, 2012)

Novel Nicotine Delivery Systems and Public Health: The Rise of the Electronic Cigarette
(American Journal of Public Health, 2010)

Tracking the Rise in Popularity of Electronic Nicotine Delivery Systems (Electronic Cigarettes) Using Search Query Surveillance
(American Journal of Preventive Medicine, 2011)

Pro ENDS Literature

The following articles represent articles in favor of e-cigarette use.

8 Biggest Electronic Cigarette Myths
(Consumer Advocates for Smokefree Alternatives Association)

Electronic Cigarettes as Harm Reduction
(Journal of Public Health Policy, 2010)

Electronic Cigarettes As a Smoking-Cessation Tool
(American Journal of Preventive Medicine, 2011)

Nicotine Blood Levels and Short-term Smoking Reduction with an Electronic Nicotine Delivery System
(American Journal of Health Behavior, 2014)

The emerging phenomenon of electronic cigarettes
(Expert Reviews, 2012)