Electronic Nicotine Delivery Systems

male with ecigarettes

Electronic nicotine delivery systems (ENDS) such as e-cigarettes, e-hookahs, e-pipes and e-cigars are devices that deliver aerosolized nicotine, flavorings, and/or other chemicals into the lungs of users. Use of ENDS is sometimes referred to as “vaping.” A typical ENDS device contains three main components: a battery, a heating element, and a cartridge or tank that holds the e-liquid.1  The e-liquid is a solution that typically contains a mixture of  nicotine, propylene glycol and glycerin. Additionally, e-liquid may also contain flavoring chemicals.2-4 When an ENDS user takes a puff from a device, the e-liquid is heated by the heating element and forms an aerosol that the user inhales into their lungs. A portion of the aerosol taken into the ENDS user’s lung is exhaled, which may result in exposure to bystanders in proximity to the user.5

Use of ENDS is rising among never-tobacco smokers and former or current tobacco smokers.6-9 While ENDS aerosol may differ in some ways from tobacco smoke, users of ENDS and those around persons using ENDS are still exposed to many different types of chemical compounds (some of which are known carcinogens), very small particles, and numerous hazardous metals.10-12 Chemicals emitted in ENDS aerosols can include carcinogens such as formaldehyde, polyaromatic hydrocarbons, and other chemicals, as well as various organic compounds that are irritating to the lung, and flavoring compounds.11,13-15 Among flavoring compounds emitted in some ENDS aerosol are 2,3-pentanedione and diacetyl, which NIOSH has linked to causing obliterative bronchiolitis, a devastating lung disease in workers.4 In addition to concerns about chemicals emitted from ENDS, there is also a risk of burns following spontaneous combustion of the lithium battery in the device.16

The potential health risks to users or bystanders exposed to secondhand smoke from ENDS is still under investigation. NIOSH issued a Current Intelligence Bulletin 67: Promoting Health and Preventing Disease and Injury Through Workplace Tobacco PoliciesCdc-pdf, that recommends employers establish “smoke-free workplaces that protect those in workplaces from involuntary, secondhand exposures to tobacco smoke and airborne emissions from e-cigarettes and other electronic nicotine delivery systems.” This recommendation covers all varieties of ENDS including e-hookahs, e-pipes, e-cigars, e-cigarettes and advanced modular ENDS.

References

Grana R, Ling P, Neal B, Glantz S [2014]. Electronic Cigarettes. Circulation; 129: 1972-1986.

Barrington-Trimis J, Samet J, McConnell R [2015]. Flavorings in electronic cigarettes an unrecognized respiratory health hazard? J Am Med Assoc; 312: 2493- 2494.

Brown J, Luo W, Isabelle L, Pankow J [2014]. Candy flavorings in tobacco. Brown et al. N Eng J Med; 370:2250-2252.

Allen J, Flanigan S, LeBlanc M, Vallarino J, MacNaughton P, Stewart J, Christiani D [2015]. Flavoring chemicals in e-cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a sample of 51 products, including fruit, candy, and cocktail-flavored e-cigarettes. Environ Health Perspect. E-print http://ehp.niehs.nih.gov/15-10185/External

Czogala J, Goniewicz M, Fidelus B, Zielinska-Danch W, Travers M, Sobczak A, [2014]. Secondhand exposure to vapors from electronic cigarettes. Nic Tobac Res; 16:655–662.

Singh T, Arrazola R, Corey C, Husten C, Neff L, Homa D, King B [2016]. Tobacco use among middle and high school students – United States, 2011-2015. MMWR Morb Mortal Wkly Rep; 65:361–367.

Pearson J, Richardson A, Niaura R, Vallone D, Abrams D [2012]. E-Cigarette awareness, use, and harm perceptions in US Adults. Am J Public Health; 102:1758– 1766.

Grana R, Benowitz N, Glantz S [2014]. E-Cigarettes, A scientific review. Circulation; 129:1972-1986.

King B, Patel R, Nguyen K, Dube S [2015]. Trends in awareness and use of electronic cigarettes among US adults, 2010-2013. Nicotine Tob Res; 17:219–227.

Olmedo et al [2018]. Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils. PMID 29467105 PMCID PMC6066345 DOI: 10.1289/EHP2175. https://www.ncbi.nlm.nih.gov/pubmed/29467105External

Qu et al [2018]. The effect of flavor content in e-liquids on e-cigarette emissions of carbonyl compounds. PMID: 29909173 DOI: 10.1016/j.envres.2018.06.013. https://www.ncbi.nlm.nih.gov/pubmed/29909173External

Geiss O, Bianchi I, Barahona F, Barrero-Moreno J [2015]. Characterisation of mainstream and passive vapours emitted by selected electronic cigarettes. Int J Hyg Environ Health; 218:169-180.

Kim H, Shin H [2013]. Determination of tobacco-specific nitrosamines in replacement liquids of electronic cigarettes by liquid chromatography-tandem mass spectrometry. J Chromatog A; 1291: 48– 55.

Farsalinos K, Gillman I, Melvin M, Paolantonio A, Gardow W, Humphries K, Brown S, Poulas K, Voudris V [2015]. Nicotine levels and presence of selected tobacco-derived toxins in tobacco flavoured electronic cigarette refill liquids. Int J Environ Res Public Health; 12: 3439-3452.

Saliba et al. [2018]. Surface chemistry of electronic cigarette electrical heating coils: Effects of metal type on propylene glycol thermal decomposition. https://doi.org/10.1016/j.jaap.2018.07.019External

Walsh K, Sheikh Z, Johal K, Khwaja N [2016]. Case Report: Rare case of accidental fire and burns caused by e-cigarette batteries. BMJ Case Rep; doi:10.1136/ bcr-2015-212868.

Page last reviewed: November 16, 2016