e-cigarettes and tobacco

Electronic cigarettes (e-cigarettes) are battery-operated nicotine delivery systems consisting of a cartridge containing a liquid, a chamber that vaporizes liquid using a small heating element, and a battery that heats a liquid that typically contains nicotine, producing a vapor that the user inhales. Most e-cigarettes entered the consumer market without regulation, and information regarding the devices is often vague and inconclusive. There remains uncertainty about the long-term health effects of e-cigarettes and whether they will help individual tobacco users to stop smoking. There are also public health concerns about the effect of e-cigarettes on smoking prevalence as well as their potential use by adolescents as an entryway to using combustible tobacco products.

Interestingly, in the 2011-2016 National Youth Tobacco Surveys (NYTS), the prevalence of e-cigarette use declined from 16% in 2015 to 11% in 2016 among high school students and from 5.3 to 4.3% among middle school students. However, it is believed that most tobacco user surveys failed to account for the full scope of e-cigarette use by youth, mostly because the survey questions have not contained the terms that youth recognize to describe e-cigarettes (e.g., “dabbing”). Most data show increases in the use of e-cigarettes in youth and adult cohorts. Certain e-cigarette brands feature a device that looks much like a small computer jump drive that is more discreet than a standard electronic cigarette. The e-cigarette device, although marketed as being much safer than standard cigarettes, also contains metals such as tin, lead, nickel, chromium, manganese, and arsenic.

A variety of large surveys have been performed to identify what populations of individuals are more likely to use e-cigarettes or convert to other forms of tobacco abuse or dependence. These surveys found that compared with nonusers and conventional cigarette smokers, e-cigarette users are younger, more educated, and have higher incomes. The 2014 National Adult Tobacco Survey and the National Youth Tobacco Survey (NYTS) for 2017 reported a higher use of e-cigarettes among males and a higher rate of e-cigarette use among whites than nonwhites. Most adult and adolescent regular users of e-cigarettes already smoke conventional cigarettes, rather than those who have never smoked. E-cigarettes have varying amount of nicotine, from none to concentrations greater than the average combustible cigarette, and also come in a wide variety of flavors, which has created concerns about its addictive potential in youth users.

E-cigarette users are generally nondaily users of the product, and published data suggest that approximately 12 to 14% of smokers who try e-cigarettes progress to daily use.1

Footnotes

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