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E-cigarettes and Electronic Nicotine Delivery Systems (ENDS)

E-cigarettes have not been fully studied for safety or effectiveness and are not currently regulated by anyone.

What are they?

E-cigarettes and Electronic Nicotine Delivery Systems (ENDS)Electronic nicotine delivery systems (ENDS) - like the e-cigarette, are battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol or vapor. There are currently multiple types of ENDS on the U.S. market,including: e-cigarettes, e-hookahs, hookah pens, vape pens, vaping, e-cigars, and others.

Because they contain nicotine, ENDS may be addictive, toxic to developing fetuses, and have lasting consequences for adolescent brain development. Some ENDS may be altered by the end user to deliver other psychoactive substances such as THC, the active ingredient in marijuana. Thus, ENDS are not “safe,” although if used by established adult smokers as a complete substitution for cigarettes, ENDS would likely be less dangerous for the smoker to use than conventional cigarettes or other combusted (burned) tobacco products.

There are safety concerns associated with E-cigarettes, especially for children. It is important to store all nicotine products out of reach of children. Nicotine can be poisonous, especially in liquid form. "E-juice" refills may be harmful to children. There are currently no requirements for child safety caps or safety information when selling E-cigarette refills. Refills come in bright colors, appealing flavors, and scents, making it more likely that children will put the liquid in their mouths.

Just a few drops of "E-juice" absorbed by the skin or swallowed can send a child to the emergency room. Ingesting as little as one-third of an ounce of "E-juice," which is less than the amount of liquid in a coffee creamer, may be fatal for children.

ENDS could cause harm to individuals and society if they:

  • Lead to regular use of nicotine and/or use of cigarettes by young people or adult non-tobacco users;
  • Lead to relapse among former smokers;
  • Delay quitting and/or diminish the chances a smoker will quit by leading to long-term use of ENDS and cigarettes at the same time (dual use;
  • Expose children and adolescents, pregnant women, and non-smokers involuntarily to aerosolized nicotine and, potentially if altered, to other psychoactive substances - the vapor contains lung irritants and particulate matter similar to that of tobacco smoke;
  • Result in poisonings among users or non-users (especially children) through ingestion, inhalation, or absorption of nicotine liquid on the skin; or
  • Glamorize or renormalize tobacco use, including by exposing children to images of tobacco use, by triggering cravings to smoke, and by undermining enforcement of clean indoor air policies.

E-cigarette Update

A recent study from Montana titled "Prevalence and Reasons for Initiating Use of Electronic Cigarettes Among Adults in Montana, 2013" found that 64% of those who initiated use of e-cigarettes started out curiosity or to try something new, with most of these being young adults. In contrast, 56% initiated use to quit/reduce cigarette use, with most of these participants being older adults.

Some studies show that E-cigarettes may be helpful to quit. Other studies show that people are more likely to use both E-cigarettes and traditional cigarettes at the same time. Using both increases the negative health impacts of tobacco and the risk of nicotine poisoning. For free help to quit tobacco call 1-800-QUIT-NOW (1-800-784-8669).

"E-cigarettes present a range of potential benefits and harms to individuals and society. We cannot predict the net impact of these combined benefits and harms. Thus, public health should focus on maximizing potential benefits and minimizing potential harms of ENDS. The promotion of noncombustible products is much more likely to provide public health benefits only in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced. ” (The 2014 Surgeon General's Report [SGR] p. 874)

Content provided by The Centers for Disease Control and Prevention, Office on Smoking and Health.

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