E-Cigarettes

What Are ENDS?

    ENDS, or Electronic Nicotine Delivery Systems, encompass a wide range of noncombustible tobacco products. They may vary widely in design and appearance and go by a variety of names such as: “e-cigarettes,” “e-cigs,” “cigalikes,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tanks,” and “tank systems.” Despite the differing nomenclature, they generally operate in a comparable manner and are composed of similar components¹.

    ENDS can be made to look like combustible cigarettes or other objects, including screwdrivers, lipstick, USBs, and pens². Utilizing battery-powered atomizers, these devices deliver nicotine and other chemicals in vapor form to the user^{2, 3}.  Unlike combustible tobacco products where the tobacco is burned, ENDS contain cartridges filled with aerosolizing liquid, sometimes referred to as e-liquids, e-fluid, or e-juice. These liquids typically contain a humectant, like propylene glycol or vegetable which are the base of the liquid, nicotine, flavorings, and other additives¹ that are heated into an aerosol and then inhaled².

 

    Some manufacturers state that the fluids and flavors for their ENDS products are approved as “food grade” or “generally recognized as safe”². However, these labels can be misleading because they refer to safety for ingestion, not inhalation². Exhaled ENDS vapor has been tested to show that it contains chemicals that are known to cause cancer, cause harm in utero, and create indoor air pollution⁴. The U.S. Food and Drug Administration (FDA) expanded regulations to cover all tobacco products, including ENDS, in 2016⁴. This law places regulations on the manufacture, import, packaging, labeling, advertising, etc. of all tobacco products⁴.

    Based on the current understanding of the latest research, tobacco products that are noncombustible, including e-cigarettes, are likely less dangerous on most health measures than continued smoking with combustible, conventional cigarettes. However, this does not mean that e-cigarettes are harmless.  A recent review of the literature has found that e-cigarettes containing nicotine have probable negative effects on cardiovascular⁵ and reproductive health⁶. The e-liquids used in ENDS can contain a variety of flavorings that have been shown to have negative effects on dental⁷ and cardiovascular health⁸ as well.

    Some individuals have reported using ENDS as a tool for helping them quit smoking or prevent relapse from smoking⁵. Although some people report success using ENDS to quit using traditional cigarettes, the FDA has not approved ENDS as smoking cessation devices².

 

For more information about the risks of ENDS, methods to screen and counsel patients and families and identify resources to help understand the risks of ENDS, please watch this video from the American Academy of Pediatrics entitled "JUUL, Vaping, and Electronic Cigarettes: A Public Health Crisis."