Tobacco and Nicotine

Page last updated June 11, 2020 by Doug McVay, Editor/Senior Policy Analyst.

21. Electronic Nicotine Delivery Systems (ENDS), or E-Cigarettes, Explained

Electronic Nicotine Delivery Systems (ENDS) or E-Cigarettes

"PRODUCT DESIGN AND CONTENTS
"3. ENDS, of which electronic cigarettes are the most common prototype, deliver an aerosol by heating a solution that users inhale. The main constituents of the solution by volume, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents.
"4. Although some ENDS are shaped to look like their conventional tobacco counterparts (e.g. cigarettes, cigars, cigarillos, pipes, or hookahs), they also take the form of everyday items such as pens, USB memory sticks, and larger cylindrical or rectangular devices.
"5. Battery voltage and unit circuitry differences can result in considerable variability in the products' ability to heat the solution to an aerosol and, consequently, may affect delivery of nicotine and other constituents, and may contribute to the formation of toxicants in the emissions.
"6. User behaviour may affect nicotine absorption – length of puffs, depth of inhalation and frequency of use may be factors. However, while a faster, deeper puff increases nicotine delivery from a conventional cigarette, it might diminish it from ENDS due to cooling of the heating element.
"7. In addition to manufacturer differences, some users modify products at home to alter delivery of nicotine and/or other drugs. Products vary widely in the ease with which they can be modified and the ease with which they can be filled with substances other than nicotine solutions."

Electronic Nicotine Delivery Systems, Report by World Health Organization to 6th Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control, July 21, 2014, p. 2.
http://apps.who.int/gb/fctc/PD...

22. E-Cigarettes (Electronic Nicotine Delivery Systems) Explained

"Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1).*"

"* Currently, e-cigarettes and their components, such as the nicotine they contain, that are intended for therapeutic purposes (e.g., for smoking cessation) are drug/device combination products. When they are marketed for therapeutic purposes they are regulated by the FDA's Center for Drug Evaluation and Research. FDA’s Center for Tobacco Products currently regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. FDA has stated its intention to issue a proposed rule extending FDA's tobacco product authorities beyond these products to include other products like e-cigarettes not intended for therapeutic purposes."

Kevin Chatham-Stephens, MD, Royal Law, MPH, Ethel Taylor, DVM, Paul Melstrom, PhD, Rebecca Bunnell, ScD, Baoguang Wang, MD, Benjamin Apelberg, PhD, Joshua G. Schier, MD, "Calls to Poison Centers for Exposures to Electronic Cigarettes - United States, September 2010-February 2014, Morbidity and Mortality Weekly Report (MMWR) (Atlanta, GA: Centers for Disease Control, April 4, 2014, Vol. 63, No. 13, p. 292.
http://www.cdc.gov/mmwr/pdf/wk...
http://www.cdc.gov/mmwr/previe...

23. Estimated Global Market for E-Cigarettes (Electronic Nicotine Delivery Systems (ENDS))

"THE ENDS MARKET
"8. The use of ENDS is apparently booming. It is estimated that in 2014 there were 466 brands1 and that in 2013 US$ 3 billion was spent on ENDS globally. Sales are forecasted to increase by a factor of 17 by 2030.2 Despite this projection, transnational tobacco companies are divided about the prospects of the growth of ENDS sales and some companies have reported a slowdown in sales in some markets.3, 4, 5 There are no data on ENDS use at the global level and for many countries. However, data mainly from North America, the European Union (EU) and Republic of Korea indicate that ENDS use at least doubled among both adults and adolescents from 2008 to 2012.6 In 2012, 7% of EU citizens aged 15 years and over had tried electronic cigarettes. However, only 1% of the total population used them regularly.7 In 2013, 47% of smokers and ex-smokers in the United States of America had tried e-cigarettes, but prevalence of established use was 4% in this group.1 Users report that the main reasons for using ENDS are to reduce or stop smoking and because they can be used in smoke-free places.2
"9. According to the recent WHO survey, ENDS availability is widespread. Slightly over half of the world’s population live in 62 countries that report the availability of ENDS in their jurisdictions, 4% live in countries reporting that ENDS are not available, while the rest live in countries that did not respond concerning the availability of ENDS.
"10. Recently, the transnational tobacco companies have entered the ENDS market. Some of them are aggressively competing with the independent companies to gain market share. Given the economic power of the tobacco industry, recent moves to sue other companies alleging patent infringement may be an indicator of how difficult it will be for ENDS to remain a business niche dominated by independent companies."

Electronic Nicotine Delivery Systems, Report by World Health Organization to 6th Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control, July 21, 2014, pp. 2-3.
http://apps.who.int/gb/fctc/PD...

24. Health Effects of E-Cigarette Use (Electronic Nicotine Delivery System) Use

"Propylene glycol and glycerin are the main base ingredients of the e-liquid. Exposure to propylene glycol can cause eye and respiratory irritation, and prolonged or repeated inhalation in industrial settings may affect the central nervous system, behavior, and the spleen.66 In its product safety materials, Dow Chemical Company states that "inhalation exposure to [propylene glycol] mists should be avoided,"67 and the American Chemistry Council warns against its use in theater fogs because of the potential for eye and respiratory irritation.68 When heated and vaporized, propylene glycol can form propylene oxide, an International Agency for Research on Cancer class 2B carcinogen,69 and glycerol forms acrolein, which can cause upper respiratory tract irritation.70,71
"Major injuries and illness have resulted from e-cigarette use,72 including explosions and fires.73,74 Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting.72"

Rachel Grana, Neal Benowitz and Stanton A. Glantz, "Contemporary Reviews in Cardiovascular Medicine: E-Cigarettes: A Scientific Review," Circulation (Dallas, TX: American Heart Association, May 13, 2014). 2014;129:1972-1986. doi: 10.1161/CIRCULATIONAHA.114.007667, p. 1978.
http://circ.ahajournals.org/co...
http://circ.ahajournals.org/co...

25. Calls to US Poison Centers About Human Exposures to E-Cigarettes, 2010-2014

"During the study period, PCs reported 2,405 e-cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).
"E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls, increasing from 0.3% in September 2010 to 41.7% in February 2014. A greater proportion of e-cigarette exposure calls came from health-care facilities than cigarette exposure calls (12.8% versus 5.9%) (p<0.001). Cigarette exposures were primarily among persons aged 0–5 years (94.9%), whereas e-cigarette exposures were mostly among persons aged 0–5 years (51.1%) and >20 years (42.0%). E-cigarette exposures were more likely to be reported as inhalations (16.8% versus 2.0%), eye exposures (8.5% versus 0.1%), and skin exposures (5.9% versus 0.1%), and less likely to be reported as ingestions (68.9% versus 97.8%) compared with cigarette exposures (p<0.001)."

Kevin Chatham-Stephens, MD, Royal Law, MPH, Ethel Taylor, DVM, Paul Melstrom, PhD, Rebecca Bunnell, ScD, Baoguang Wang, MD, Benjamin Apelberg, PhD, Joshua G. Schier, MD, "Calls to Poison Centers for Exposures to Electronic Cigarettes - United States, September 2010-February 2014, Morbidity and Mortality Weekly Report (MMWR) (Atlanta, GA: Centers for Disease Control, April 4, 2014, Vol. 63, No. 13, p. 292.
http://www.cdc.gov/mmwr/pdf/wk...
http://www.cdc.gov/mmwr/previe...

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