Electronic Nicotine Delivery Systems
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 are exploding in popularity, and are being used by both adolescents and adults. ENDS are now estimated to be a $1.5 billion market, and are projected to grow 24.2% per year through 20181. In 2015, more teens used e-cigarettes than regular cigarettes- 10% of 8th graders, 14% of 10th graders, and 16% of 12th graders used e-cigarettes, compared to 4%, 6%, and 11% for cigarettes, respectively2.
Quick Facts about ENDS
- ENDS contain a liquid solution that is usually flavored. Flavors, which are appealing to children, often are things like peach schnapps, java jolt, piña colada, peppermint, bubble gum, or chocolate
- ENDS solution has chemicals (ie, anti-freeze, diethylene glycol, and carcinogens like nitrosamines)3
- ENDS are not yet regulated nor approved for smoking cessation by the US Food and Drug Administration (FDA), and the long-term health effects to users and bystanders are still unknown. Due to the lack of regulation, the chemical compounds in an ENDS device can vary between brands3
- These devices mimic conventional cigarette use and help re-normalize smoking behaviors
- ENDS solutions can poison children and adults through ingestion or skin absorption. A child can be killed by very small amounts of nicotine- less than one highly-concentrated teaspoon3
- Symptoms of nicotine poisoning include vomiting, sweating, dizziness, increased heart rate, lethargy, seizures, and difficulty breathing3
- 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 reported4
- Some states have enacted legislation to require child-resistant packaging, and a bill to do this at the national level was supported by the AAP before being signed into law by President Obama in early 2016.- see below section
- 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 label5
AAP Resources about ENDS
- AAP Policy Statement: Electronic Nicotine Delivery Systems
- Infographic about E-cigarettes
- ENDS fact sheet for parents
- Physician fact sheet on ENDS*
*Please note: this fact sheet has not yet been updated to reflect recent changes in FDA regulation. Please see "ENDS Reference Guide for Clinicians" below for updated content.
This fact sheet, based on common recommendations from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Medical Association, discusses the facts about and harms of electronic nicotine delivery systems (ENDS) and stresses the use of evidence-based cessation resources for those who want to quit smoking.
- ENDS reference guide for clinicians; contains screening questions
- Slides presented by Dr. Susanne Tanski at the 2015 AAP Annual Leadership Forum, "E-cigarettes: What Every Pediatric Leader Should Know"
- Slides presented by Dr. Jonathan Klein at the 2015 Society for Adolescent Health and Medicine conference, "E-cigarettes: What Every Clinician Should Know"
- April 2015 letter urging President Obama to finalize FDA proposed regulation
- Comments from the Academy on the proposed rule to extend the jurisdiction of the FDA to all types of tobacco products, including ENDS, cigars, hookah, and others
- Information about the Academy-backed Nicotine Poisoning bill, including testimony to the Senate Commerce Committee by AAP Richmond Center Faculty Expert Dr. Susanne Tanski
- September 2013 letter to President Obama from health organizations requesting FDA regulation of e-cigarettes
1) Fortune. June 10, 2014. U.S. e-cigarette sales seen rising 24.2% per year through 2018. Available at http://fortune.com/2014/06/10/e-cigarette-sales-rising/. Accessed October 16, 2015.
2) Johnston, L., et al. (2016). Monitoring the Future national survey results on drug use: 1975-2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.
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. Available at https://aapcc.s3.amazonaws.com/files/library/E-cig__Nicotine_Web_Data_through_01.2016.pdf. Accessed February 10, 2016.
5) American Association of Poison Control Centers. E-Cigarette Devices and Liquid Nicotine. Available at http://www.aapcc.org/alerts/e-cigarettes/. Accessed October 16, 2015.