The e-cigarette is an electronic device that uses a battery to heat up liquid that usually contains nicotine and flavourings in order to create an aerosol that users inhale. The liquid is known as e-liquid or e-juice. In the United States, there are several different types of e-cigarettes, also called vapes, hookah sticks, vape pens or mods and they are collectively referred to as electronic nicotine delivery systems (ENDS).
Although there is an extensive list of appealing flavours available to entice new consumers, the long-term impact of e-cigarette consumption on human health remains unknown. Nevertheless, the use of e-cigarettes has increased significantly in recent years among smokers and non-smokers. The popularity of these devices has been attributed to the perceived lower harm from smoking compared to conventional combustible cigarettes and their ability to help people quit smoking. However, the success of e-cigarettes as smoking cessation tools has been questioned because they only improve smoking cessation rates among highly dependent smokers.
A recent report showed that a large proportion of middle and high school students were current e-cigarette users. In fact, the number of students using e-cigarettes is higher than ever before. According to the MMWR, more than 5 million middle and high school students used e-cigarettes in 2019 alone. The extended list of appealing flavours offered to consumers is a major factor that attracts youth. The use of these products is also associated with a lack of knowledge about health risks and the increased likelihood of trying other drugs, including cannabinoids such as marijuana and tetrahydrocannabinol (THC).
The current regulatory status of ENDS in the US and other countries differs from country to country. In many cases, these devices are not subject to the same rigorous safety and quality control as traditional tobacco products. Moreover, e-liquids that are used in ENDS contain nicotine, which can be toxic if consumed by children. The absence of safety features such as child-resistant caps on the e-liquid bottles increases the risk of accidental ingestion or poisoning.
Many studies have evaluated the toxicity of e-liquids and their decomposition products through in vitro and in vivo testing, but less is known about the material and manufacturing processes used to manufacture these devices. This is important because it could lead to the presence of harmful substances in e-cigarettes, such as volatile carbonyls that can be released during the heating process and have been shown to have neurobehavioral effects in zebrafish (Danio rerio) when inhaled.
The public is encouraged to share any adverse experiences they have with ENDS on the FDA’s Tobacco Product Problem Experience Reporting page. In addition, the FDA monitors national usage rates of all tobacco products and ENDS and takes a variety of preventive actions, from policy making to enforcement to education, to keep these products out of the hands of youth. 電子煙