Commentary: Electronic Nicotine Delivery Systems

Abstract

HE PUBLIC has become increasingly aware that tobacco use is the leading cause of preventable disease and death in the United States (US), and the tobacco industry has been highly successful at circumventing resulting antitobacco sentiment through well-funded marketing efforts. Despite scientific evidence, new and current tobacco users still perceive marketing terms such as "light," "natural," or "additive free" to indicate that these products are safer alternatives to conventional cigarettes. 1 The tobacco industry has again spent hundreds of millions of US dollars advertising electronic nicotine delivery systems (ENDS; eg, e-cigarettes), which has resulted in the public impression that ENDS are a safe alternative to smoking. 2 The result has been sea change in which new nicotine users, who tend to be young, prefer using ENDS over conventional cigarettes. Numerous current and former smokers are also transitioning to these products to reduce lifetime risk exposure or quit smoking. 2 How did this happen? Is there a scientific basis for the safety of ENDS and the efficacy of using ENDS for smoking cessation? What are the potential risks and benefits? TYPES OF ENDSENDS are grouped by generations: first-generation devices ("cig-a-likes") are prefilled cartridges, second-generation devices ("vape pens") are refillable tank models, and third-generation devices are refillable tank models that allow users to adjust the wattage of the product. 3 The latter products provide users with the option to select various flavors and nicotine concentrations. Flavored or unflavored pod devices that use varying concentrations of a nicotine salt are also highly popular,