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electronic cigarette; e-cigarette; juul; electronic nicotine delivery system (ENDS)

Indications: - smoking cessation - may be as effective as nicotine patches for smoking cessation [6] - can reduce smoking urges - help motivated smokers to quit [11] - American Heart Association policy concludes - other proven methods of smoking cessation 1st line - e-cigarettes may be option when other methods have failed [12] - may help smokers quit (Public Health England) [16] - recommendations (claims) questioned [16] - USPSTF concludes that the evidence is insufficient to recommend for or against use of electronic cigarettes for smoking cessation in adults [17] - availability of e-cigarettes associated with more success in smoking cessation [24] - use of e-cigarettes intermittently & concurrently with other cessation aids not useful for smoking cessation [36] - electronic cigarettes are similar to varenicline & better than nicotine gum for smoking cessation [57] Epidemiology: - < 5% of adults report using e-cigarettes [39] - e=cigarette use 9% among persions age 18-24 years [39] - gay, lesbian, bisexual, or transgender use 7-9% - 15% of e-cigarette users had never used traditional cigarettes [39] - 13% [18] - 20% [3] of adults has tried an electronic cigarette - ever use higher among current cigarette smokers (48%) & recent quitters (55%) - among high school students, ever-use of e-cigarettes increased from 4.7% to 10.0% from 2011 to 2012 [5,13] - among adult never smoker of cigarettes, younger adults try e-cigarettes more often than older adults (10% for adults age 18-24 vs 1% for adults age > 45 years of age) [18] - 24% of U.S. middle school & high school students report recent exposure to vapors of electronic cigarettes [30] - an increase in electronic cigarette use among adult smokers may be associated with an increase in smoking cessation rate [31] - may lead youth to start smoking, adults to stop smoking [34] - prevalence of nicotine vaping among 12 graders increased 11% to 21% from 2017 to 2018 Pharmacokinetics: - peak serum nicotine concentration within 5 minutes, similar to conventional cigarettes [25] Adverse effects: - shortness of breath, difficulty breathing, wheezing, bronchitis [58] - users twice as likely to report respiratory symptoms as non users [19] (never smokers) - wheezing-related respiratory symptoms more likely [56,58] - headache - cough - dizziness - sore throat - nose bleeds - chest pain - evidence that e-cigarettes cause heart attacks retracted [54] - nausea, vomiting, diarrhea [50] - fatigue, fever, weight loss [50] - allergic reactions [8] - increased sympathetic tone & increased oxidative stress [27] - lower heart rate variability, higher LDL oxidizability [27] - transient increase in arterial stiffness [33] - flavoring compounds (vanillin, menthol, cinnamaldehyde, eugenol, & acetylpyridine) induce endothelial cell dysfunction [38] - higher levels of volatile carcinogen metabolites in urine [35] - safer than real cigarettes [11,20] - carcinogen content negligible - potential for nicotine poisoning minimal [11] - 95% safer than real cigarettes [16] - e-cigarettes with lower levels of the carcinogenic metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol than current smokers [28] - substantially lower levels of measured carcinogens & toxins than tobacco cigarettes (N-nitrosamine, ethylene oxide ...) [29] - safer option than tobacco cigarettes [34] Complications: - may encourage use of conventional cigarettes among teens [7,15] - adolescents who use electronic cigarettes more likely to buy conventional cigarettes when the reach legal age (RR=5) [23] - may blow up in mouth while inhaling (consumer report) [8] - burning gums, lips & fingers (consumer report) [8] - accidental nicotine exposure in children [14] - children may put reusable nicotine cartridges in mouth - reports of seizures [47] - vitamin E acetate linked to vaping-associated lung injury [53] Notes: Device: - battery-operated - plastic tube with an illuminated orange or blue tip - generally contain cartridges filled with nicotine, flavor & other chemicals - vaporizes nicotine & other chemical ingedients for inhalation by the user Products are: - marketed & sold to young people - FDA regulation prohibits sale of e-cigarettes to persons < 21 years of age [21[ - readily available online & in shopping malls - available in different flavors which may appeal to young people - chocolate - mint - a juul is smaller than a typical e-cigarette - looks like a flash drive (see image) [43] - its oils come in flavors like mango - contains highest nicotine content of any e-cigarette [43] Contain: - diethylene glycol (at least some) - carcinogens (at least some) - pulegone [51] - heavy metals, ultrafine particulate, & formaldehyde [30] - 2nd-hand exposure to potentially toxic substances is lower compared with combustible cigarette smoking [37] Warnings - none - do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes - two e-liquids sold by HelloCig Electronic Technology Co. Ltd. found to contain tadalafil &/or sildenafil [45] FDA approval: - have not been submitted to the FDA for evaluation or approval - FDA has no way of knowing, except for its own limited testing, the levels of nicotine or the amounts or kinds of other chemicals present in the various brands - FDA's premarket approval process pass RJ Reynolds Vuse Solo device showing reduced harm compared with traditional tobacco products, FDA regulation: - FDA extends its tobacco authority to e-cigarettes [9,21] - FDA threatens to take flavored e-cigarettes of the market [40] - FDA will ban sales of flavored e-cigarettes in most retail stores due to popularity & increased use among youths [44] Most E-cigarettes are made in China - quality is inconsistent [8] - nicotine intake from e-cigarettes is highly variable [37] electronic cigarettes are banned on commercial flights [20] , electronic cigarettes can be used to vaporize cannabis, including marijuana, tetrahydrocannabinol, or hash oil [41] open-system, refillable devices popular among adolescents [42]

Related

electronic cigarette dripping

Specific

IQOS system

General

smoking; cigarette smoking; tobacco smoking

References

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