Electronic Nicotine Delivery Systems

From the Academy of Pediatrics:

Electronic Nicotine Delivery Systems (ENDS), also called e-cigarettes, personal vaporizers, vape pens, e-cigars, e-hookah, or vaping devices, are products that produce an aerosolized mixture containing flavored liquids and nicotine that is inhaled by the user. ENDS can resemble traditional tobacco products like cigarettes, cigars, pipes, or common gadgets like flashlights, flash drives, or pens.

These products have grown rapidly, particularly among youth and young adults. Youth use of ENDS products​​​ is a significant public health concern.

Quick Facts about ENDS

• ENDS are the most commonly-used tobacco products among youth. In 2016, 11% of high schoolers and 4% of middle schoolers reported using e-cigarettes in the last 30 days.¹
   
• Youth who use ENDS products are more likely to use cigarettes or other tobacco products.^​2,6
   
• ENDS contain a liquid solution that is usually flavored. Flavors, which are appealing to children, can include fruit flavors, candy, coffee, piña colada, peppermint, bubble gum, or chocolate. You can read more about the ways the Tobacco Industry uses flavors to lure kids into using tobacco products in “The Flavor Trap​,” a report issued by AAP and four partner organizations.
  
• ENDS solution has chemicals (ie, anti-freeze, diethylene glycol, and carcinogens like nitrosamines).³​​
  
• ENDS devices mimic conventional cigarette use and help re-normalize smoking behaviors.
  
• ENDS are not approved for smoking cessation, and the long-term health effects to users and bystanders are st​ill unknown. The chemical compounds in an ENDS device can vary between brands.³
  
• E-liquid from ENDS devices and refill packs can contaminate skin, leading to nicotine poisoning. Symptoms of nicotine poisoning include vomiting, sweating, dizziness, increased heart rate, lethargy, seizures, and difficulty breathing.³
  
• In 2014, poison centers in the US reported 3,783 exposures to e-cigarette devices and nicotine liquid, compared to only 1,543 exposures in 2013. In 2015, 3,073 exposures were reported.⁴
  
• Some states have enacted legislation to require child-resistant packaging for ENDS devices and liquids, and a bill to do this at the national level was signed into law by President Obama in early 2016.
  
• ENDS users should always keep e-cigarettes and liquid nicotine locked up and out of the reach of children and follow the specific disposal instructions on the label.⁵
  
• In 2016, US Surgeon General Vivek Murthy, MD MBA released a report, "E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General." The report concluded that youth should not use e-cigarettes due to the health effects on users and on others exposed to secondhand e-cigarette aerosol.^6​

AAP Resources about ENDS

• JUULing: What Pediatricians and Families Need to Know​​

• Understanding the ​201​6​​ Surgeon General's Report on Youth and E-Cigarettes: What Clinicians Need to Know​

• AAP Policy Statement: Electronic Nicotine Delivery Systems

• ENDS fact sheet for parents 

• ENDS fact sheet for physicians​
  This resource was created via a collaboration by 5 major medical organizations: the American Academy of pediatrics, American Academy of Family Physicians, American College of Physicians, American Congress of  Obstetricians and Gynecologists, and American Medical Association.

• ENDS reference guid​e for clinicians

• Infographic about E-cigarettes

Sources

1) Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2011–2016. Morbidity and Mortality Weekly Report, 2017;66(23):597-603. Accessed July 28, 2017

2) Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatr. 2014;168(7):610–617pmid:24604023​

3) American Academy of Pediatrics Section on Tobacco Control. Policy statement: Electronic Nicotine Delivery Systems. Pediatrics. 2015; 136(5):1018—1026.

4) American Association of Poison Control Centers. January 31, 2016. Electronic Cigarettes and Liquid Nicotine Data. Accessed February 10, 2016.

5) American Association of Poison Control Centers. E-Cigarette Devices and Liquid Nicotine. Accessed October 16, 2015.

6) US Department of Health and Human Services (2016). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health