Electronic Cigarettes

History
• Electronic nicotine delivery systems (ENDS; also called e-cigarettes)
initially emerged in China in 2003 and have since become widely
available globally, particularly over the Internet.
• The EC industry is growing significantly; according to a 2014 study,
466 brands and 7764 unique flavors were identified.2 Between May
2012 and January 2014, a net increase of 10.5 brands and 242 flavors
were reported per month.

R: Adkison S, O'Connor R, Bansal-Travers M, Hyland A, Borland R, Yong H et al. Electronic Nicotine Delivery Systems. American Journal of Preventive Medicine.
2013;44(3):207-215.
R: Born H, Persky M, Kraus D, Peng R, Amin M, Branski R. Electronic Cigarettes. Otolaryngology-Head and Neck Surgery. 2015;153(1):5-14.
What is it?
• Electronic cigarettes (e-cigarettes or e-cigs) are designed to heat and
aerosolize mixtures of vegetable glycerin, propylene glycol, nicotine,
and flavoring additives, thus delivering nicotine by inhalation in the
absence of combustion.
• These devices were originally developed to facilitate smoking
cessation and have been available in the United States for over a
decade. Since 2010, e-cig use has expanded rapidly, especially among
adolescents, despite a paucity of short- and long-term safety data.

R: Chun L, Moazed F, Calfee C, Matthay M, Gotts J. Pulmonary toxicity of e-cigarettes. American Journal of Physiology - Lung Cellular and Molecular Physiology.
2017;313(2):L193-L206.
Health Risks to users and non-users:
• Limited testing has revealed wide variations in the nature of the toxicity of
contents and emissions.
• The capacity of ENDS to deliver nicotine to the user varies widely, ranging
from very low to levels similar to that of cigarettes, depending on product
characteristics, user puffing behaviour and nicotine solution concentration.
• Exposure to fine particles in the e-cigarettes may worsen respiratory
ailments such as asthma and bronchitis.
• Another concern is that relatively high concentrations of nicotine in the
cartridges pose increased risk of nicotine toxicity, especially in pets and
children who may be attracted to the flavorings if e-cigarettes are left
unattended.
Conference of the Parties to the WHO Framework Convention on Tobacco Control Sixth session Moscow, Russian Federation,13–18 October 2014 Provisional agenda
item 4.4.2 FCTC/COP/6/10 21 July 2014
R: Modesto-Lowe V, Alvarado C. E-cigs . . . Are They Cool? Talking to Teens About E-Cigarettes. Clinical Pediatrics. 2017;56(10):947-952.
Regulation is fairly
recent.

• In 2016, the Food and Drug Administration (FDA)

expanded their authority to regulate all tobacco-
related products, including e-cigarettes and vape-
pens.
• Most of the e-cigarettes tested for smoking
cessation contain nicotine which is known to
contribute to cardiopulmonary diseases,
neurodegenerative disorders and cancer.

R: Modesto-Lowe V, Alvarado C. E-cigs . . . Are They Cool? Talking to Teens About E-Cigarettes. Clinical Pediatrics. 2017;56(10):947-952.

R: Cai H, Wang C. Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology. 2017;13:402-406.
From: Cai H, Wang C. Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology. 2017;13:402-406.
From: Cai H, Wang C. Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology. 2017;13:402-406.
• The increase in uptake of ENDS has been
dramatic, including among youth. ENDS use
among youth is now far more popular than
any tobacco product category, although some
of that use appears to be non-nicotine. At the
same time, cigarette use is declining among
all groups, but particularly among young
people. It is possible that these trends are
related—more young people are using ENDS
and are not using combustibles.

R: Drope J, Cahn Z, Kennedy R, Liber A, Stoklosa M, Henson R et al. Key issues surrounding
the health impacts of electronic nicotine delivery systems (ENDS) and other sources of
nicotine. CA: A Cancer Journal for Clinicians. 2017;.
R: Drope J, Cahn Z, Kennedy R, Liber A, Stoklosa M, Henson R et al. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of
nicotine. CA: A Cancer Journal for Clinicians. 2017;.
R: Drope J, Cahn Z, Kennedy R, Liber A, Stoklosa M, Henson R et al. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS)
and other sources of nicotine. CA: A Cancer Journal for Clinicians. 2017;.
Public Health Concerns.
• According to the WHO, electronic cigarettes are used by tobacco and
normal cigarettes smokers to either quit or to be allowed to smoke in
smoke-free areas.
• It is stated that the false advertisement of these devices help the
early use of tobacco/cigarettes among young population, claiming
ENDS help either quit or it does not affect your health, besides, varios
flavors and colors are attractive to this public.
• Although smoking prevalence has declined over the last 20 years or
more, cessation rates remain stubbornly low. While research to
identify more effective cessation strategies continues, the evidence
suggests that it is not happening quickly or easily.
R:Conference of the Parties to the WHO Framework Convention on Tobacco Control Sixth session Moscow, Russian Federation,13–18 October 2014 Provisional agenda
item 4.4.2 FCTC/COP/6/10 21 July 2014
R: Drope J, Cahn Z, Kennedy R, Liber A, Stoklosa M, Henson R et al. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other
sources of nicotine. CA: A Cancer Journal for Clinicians. 2017;.