Electronic Nicotine Delivery Systems Devices Research Articles

Nicotine or marijuana vaping exposure during pregnancy and altered immune responses in offspring.

Electronic nicotine delivery systems (ENDS) - which include electronic cigarettes or e-cigarettes, or simply e-cigs, and marijuana vaping have become increasingly popular. ENDS devices have been established as one of the tobacco quit methods and promoted to be safer compared to traditional tobacco cigarettes. Emerging evidence demonstrates that e-cigarette and marijuana vape use can be harmful, with potential associations with cancer. Herein, we summarize the level of evidence to date for altered immune response, with a focus on cancer risks in the offspring after maternal use of, or aerosol exposures from, ENDS or marijuana vape during pregnancy. From 27 published articles retrieved from PubMed, we sought to find out identified carcinogens in ENDS aerosols and marijuana vapor, which cross the placental barrier and can increase cancer risk in the offspring. Carcinogens in vaping aerosols include aldehydes, metals, tobacco-specific nitrosamines, tobacco alkaloids, polycyclic aromatic hydrocarbons, and volatile organic compounds. Additionally, there was only one passive vaping exposure case study on a human fetus, which noted that glycerol, aluminum, chromium, nickel, copper, zinc, selenium, and lead crossed from the mother to the offspring's cord blood. The carcinogens (metals) in that study were at lower concentrations compared to the mother's biological matrices. Lastly, we observed that in utero exposures to ENDS-associated chemicals can occur in vital organs such as the lungs, kidneys, brain, bladder, and heart. Any resulting DNA damage increases the risk of tumorigenesis. Future epidemiological studies are needed to examine the effects of passive aerosol exposures from existing and emerging electronic nicotine and marijuana products on developing offspring to cancer.

Reasons for continued usage of ENDS: Differences by device and liquid characteristics among US adults.

Motivations for using electronic nicotine delivery systems (ENDS) include quitting or reducing cigarette smoking, flavor, and addiction. This study examines whether the primary reason for continued ENDS usage changes over time, and its association with device and liquid characteristics. Data are from a longitudinal cohort study and include 526 US adults (≥21 years) using ENDS frequently (≥5 days/week) as self-reported, and uploaded photos of their most used ENDS devices and liquids and self-reported primary reason for continued ENDS usage in wave 2 (December 2020-April 2021) and wave 5 (February-April 2023). Device-liquid grouping was defined by device (disposable/disposable pod/refillable pod/tank, adjustable/no adjustable settings) and liquid (salt/freebase) characteristics. A device was classified as having adjustable settings if it allowed users to modify the power, coil, or airflow. Data were analyzed using multivariable logistic regressions and McNemar tests. From wave 2 to 5, the primary reason for continued ENDS usage significantly changed, with more participants reporting addiction (29.2% vs 34.6%, p<0.001); and significantly more participants used disposable devices (salt, no adjustable settings) (7.9% vs 25.2%, p<0.001). Compared to those using tanks (freebase, adjustable settings), participants using devices with nicotine salt liquids were more likely to report addiction (AOR>2; 95% CI: 1.12-8.19); and participants using disposable devices (salt, no adjustable settings) were less likely to report quitting/reducing smoking as the primary ENDS use reason after controlling for smoking status and sociodemographic characteristics (AOR<0.6; 95% CI: 0.14-0.995). Over a 2.5-year period, the proportion of participants continuing to use ENDS at least 5 days/week because of addiction grew, and participants' motivations varied by device-liquid grouping. Restrictions on nicotine salts may disproportionately impact those using ENDS because of addiction; and regulations targeting tanks with freebase liquids may disproportionately impact those using ENDS for smoking cessation/reduction.

Heterogeneity in sociodemographic characteristics of people who use different ENDS devices

BackgroundThe electronic nicotine delivery systems (ENDS) market is heterogeneous with a wide variety of devices and liquids available to consumers. People with distinct sociodemographic characteristics may have different ENDS device and liquid preferences. Methods1290 U.S. adults (21 + ) using ENDS 5 + days/week completed the Wave 5 (February-April 2023) VAPER study survey and submitted photos of their most used ENDS device and liquid. Latent class analysis (LCA) was performed based on sociodemographic characteristics and cigarette smoking status to identify groups among respondents. We examined the association between identified groups and the device (disposable device/disposable pod/refillable pod/tank, power/airflow/coil modifiability)/liquid (nicotine salt/freebase) groupings found by exploratory factor analysis. ResultsAmong our sample, there were three groups of adults frequently using ENDS: (1) group of women who are older, heterosexual, and have smoked cigarettes (62 % of the sample); (2) group of men who are higher-income and heterosexual (23 % of the sample); and (3) group of women who are younger and LGBTQ+ (16 % of the sample). The third group was more likely to use non-adjustable disposable devices with a nicotine salt liquid and less likely to use adjustable tanks with a freebase liquid than the other two groups (p < 0.001). ConclusionsWe found three distinct groups of adults frequently using ENDS. The group of younger LGBTQ + women was different from the other two groups in use of device and liquid characteristics. Our findings can enhance understanding of people using ENDS and inform the expected impacts of ENDS regulatory efforts to protect public health.

Effect of third-party components on emissions from a pod style electronic cigarette.

Electronic nicotine delivery systems (ENDS) have been associated with a dramatic increase in youth becoming addicted to nicotine following decades-long decline in cigarette smoking uptake. The United States Food and Drug Administration, Center for Tobacco Products (FDA/CTP) is responsible for regulating devices and consumable materials associated with ENDS. State and federal regulations regarding flavoring compounds in ENDS liquids (e-liquids) may be circumvented when vendors market refillable reservoirs side-by-side with noncompliant e-liquids. This study investigated the effect of third-party refillable versus manufacturer-supplied single-use reservoirs on total particulate matter (TPM) and nicotine emissions. The maximum TPM yield per puff was 5.6 times higher for the third-party (Blankz) reservoir (12.4 mg/puff) in comparison with the manufacturer's (JUUL) reservoir (2.2 mg/puff), whereas the maximum TPM concentration was over 7 times higher for third party (0.200 mg/ml) versus manufacturer (0.028 mg/ml) pod. The third-party pod was tested with nicotine concentrations ranging from 0% to 4%. The mass ratio of nicotine present in the aerosol (mg Nic/mg TPM) was found to be approximately the same as the mass ratio of the e-liquid (mg Nic/mg e-liquid) for both pods and all 3 nicotine laden e-liquids tested. Toxicant exposure may increase when consumers use third-party pods with ENDS devices. Refillable reservoirs are a significant barrier to regulatory restrictions on potentially toxic additives to e-liquids. It is recommended FDA/CTP require emissions characterization of third-party reservoirs used with each ENDS they are compatible with and should be required to demonstrate no increased potential toxicant exposure in comparison with manufacturer-provided reservoirs.

Detection of the Synthetic Coolant Menthone 1,2-Glycerol Ketal in an e-Liquid and in Electronic Waterpipe Aerosols Therefrom.

The presence and toxicological risks of synthetic coolants in electronic nicotine delivery systems (ENDS) have not been thoroughly studied. We identified the synthetic coolant menthone 1,2-glycerol ketal (MGK) in a menthol-flavored e-liquid at a concentration of ∼170 μg/mL. We also detected MGK in aerosols resulting from heating the e-liquid with an electronic waterpipe. MGK was initially detected in the e-liquid by two-dimensional gas chromatography-time-of-flight mass spectrometry. To avoid potential analytical artifacts that could result from heating samples in the injection port of the gas chromatograph, quantitation of MGK in the e-liquid was accomplished using a liquid chromatography-tandem mass spectrometry method. Following recent reports identifying other synthetic coolants in e-liquids, these results add knowledge about inhalation exposures from ENDS use and suggest the importance of future research to study the potential inhalation toxicity related to the use of MGK-containing e-liquids in ENDS devices. Furthermore, the results demonstrate the ability to quantify ketals in e-liquids using liquid chromatography methods.

"I Get the Flavors and It Makes Me Love Vaping More": How and Why Youth Users Modify Electronic Nicotine Delivery Systems.

Youth in the United States are using electronic nicotine delivery systems (ENDS) at a high rate. Modifications to ENDS by youth can introduce additional health hazards which have not been previously considered. To better understand these risks, we need more information on what these modifications are, the motivations behind them, and the sources of information on modifications. Utilizing a trained moderator, in 2020-2021, we conducted one-on-one interviews with 19 youth ENDS users aged 16-17 living in the United States and analyzed their responses using a qualitative description approach. The most prominent modification was to the e-liquid; youth indicated they mixed e-juices to create new flavors and added substances not intended for vaping, including illicit drugs such as cannabis and cocaine. Few youths from our sample were interested in achieving a specific nicotine level to vape, and modifications to the battery, coil and wick were less frequently mentioned. Some of these modifications were motivated by a desire to achieve specific experiences with their device. At other times, modifications were made due to necessity because of limited access to ENDS devices and supplies. YouTube and peers were the main sources of information about modifying. Youth are making modifications that are both intended and unintended by the manufacturer. Adding illicit drugs and other substances not made for vaping is of particular concern. Understanding how youth modify ENDS and how that changes their use is important to guide regulatory policy intended to reduce harm to youth from ENDS use. Youth from our study indicated that they make modifications to the ENDS devices, specifically to the e-liquid. These modifications are both intended by the manufacturer, such as changing the e-liquid and replacing coils, and unintended, such as adding substances not meant for vaping. Future policies aimed at reducing youth ENDS use should consider mandating better safeguards against modifications that appeal to youth.

Electronic nicotine delivery systems (ENDS) flavours and devices used by adults before and after the 2020 US FDA ENDS enforcement priority: findings from the 2018 and 2020 US ITC Smoking and Vaping Surveys

BackgroundIn February 2020, the US Food and Drug Administration (FDA) prioritised enforcement efforts against flavoured prefilled cartridge/pod electronic nicotine delivery systems (ENDS), with the exception of tobacco and menthol. This...

General and Device-Specific Reasons for ENDS Use: A Qualitative Study with Adult ENDS Users.

Background: A scientific consensus on the public health impact of electronic nicotine delivery systems (ENDS) remains elusive. This is partly due to the wide variation in product characteristics often lumped together under one category. Research is needed to better understand what ENDS device type characteristics motivate their use by adults. Methods: Nine focus groups of 32 current ENDS users who were 18+ years old, had used ENDS in the previous 30 days, and had been using ENDS for more than two months were held either in person or online between February and June 2020. Results: Participants’ reasons for their choice of ENDS characteristics included both general, applying to all ENDS products, and specific, relating to particular ENDS devices. Health benefits and the lack of offensive odor were commonly identified as important reasons for using ENDS in general. Flavor and product discreteness were both general and device-specific determinants of ENDS use. Conversely, nicotine delivery, cloud size, battery properties, aesthetics, ease of use, and cost were device-specific drivers of participants’ choice. Conclusions: The reasons that adults choose to use ENDS are complex and sometimes related to both ENDS as a category and as specific ENDS product types. Regulations and public communication campaigns should reflect their ultimate objective and consider both general and specific motivations when attempting to achieve public health objectives.

Proposed Standard Test Protocols and Outcome Measures for Quantitative Comparison of Emissions from Electronic Nicotine Delivery Systems.

This study introduces and demonstrates a comprehensive, accurate, unbiased approach to robust quantitative comparison of electronic nicotine delivery systems (ENDS) appropriate for establishing substantial equivalence (or lack thereof) between inhaled nicotine products. The approach is demonstrated across a family of thirteen pen- and pod-style ENDS products. Methods employed consist of formulating a robust emissions surface regression model, quantifying the empirical accuracy of the model as applied to each product, evaluating relationships between product design characteristics and maximum emissions characteristics, and presenting results in formats useful to researchers, regulators, and consumers. Results provide a response surface to characterize emissions (total particulate matter and constituents thereof) from each ENDS appropriate for use in a computer model and for conducting quantitative exposure comparisons between products. Results demonstrate that emissions vary as a function of puff duration, flow rate, e-liquid composition, and device operating power. Further, results indicate that regulating design characteristics of ENDS devices and consumables may not achieve desired public health outcomes; it is more effective to regulate maximum permissible emissions directly. Three emissions outcome measures (yield per puff, mass concentration, and constituent mass ratio) are recommended for adoption as standard quantities for reporting by manufacturers and research laboratories. The approach provides a means of: (a) quantifying and comparing maximal emissions from ENDS products spanning their entire operating envelope, (b) comparative evaluation of ENDS devices and consumable design characteristics, and (c) establishing comparative equivalence of maximal emissions from ENDS. A consumer-oriented product emissions dashboard is proposed for comparative evaluation of ENDS exposure potential. Maximum achievable power dissipated in the coil of ENDS is identified as a potentially effective regulatory parameter.

"It's Cool, Modifying and All, but I Don't Want Anything Blowing Up on Me:" A Focus Group Study of Motivations to Modify Electronic Nicotine Delivery Systems (ENDS).

Introduction: Modifications to electronic nicoti ne delivery systems (ENDS) can pose health risks to users. This study explored users’ motivations for modifying ENDS devices and how perceived risks of modifications influenced modification behaviors as product availability and device characteristics changed over time. Method: We conducted nine focus groups (February–June 2020) with 32 current ENDS users (18+, used ENDS in the past 30 days, and had been using ENDS for more than 2 months). Results: Participants primarily modified ENDS devices to improve their experiences, such as experimenting with flavor, controlling nicotine levels, or using cannabis products with ENDS. Another reason for modifying was routine maintenance to ensure a satisfactory experience, including maintaining coils and keeping batteries charged. The broader availability of ENDS products shifted modification behaviors over time, with newer devices making some modifications (e.g., coil replacement) easier and making more intricate modifications (e.g., building coil from scratch) less common. Participants were aware of modification dangers and cited perceived risk as the reason for avoiding certain modifications, such as battery alterations. Conclusions: Modifications of ENDS are ongoing and evolving among users and should be considered by the Food and Drug Administration (FDA) and other regulatory decision-makers as product authorization reviews are conducted and product standards are developed.

Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking

BackgroundAlthough the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking.MethodsWe identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs).ResultsThe respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking.ConclusionsThis analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS).

Explosions, Burn Injuries and Adverse Health Effects of Electronic Nicotine Delivery Systems: A Review of Current Regulations and Future Perspectives

While there is a declining trend in the use of traditional methods of smoking tobacco, electronic nicotine delivery systems (ENDS) have gained popularity worldwide. ENDS are marketed as safe for the primary reason that they do not contain the well-established toxic ingredients found in traditional cigarettes. However, growing concerns over incidences of fire and explosion with specific types of ENDS, as well as their short and long-term effects, remain unaddressed. This review examines the under studied role of customized components such as batteries, e-liquid compositions, and methods of nicotine delivery that result in physical injuries and adverse health effects of ENDS. Using online reference databases (Web of Science, PubMed, Medline other, Google scholar, FDA website, FDA register), we analyzed the mechanisms through which ENDS may pose significant risk to human health. An increase in the use and popularity of ENDS has been observed among youth and adults in the United States since 2007. The ENDS devices available to the public allow for custom alterations which can introduce incompatible components, resulting in overheating and explosion related injuries. Heavy metals have been found to leach from some devices into the e-liquid, and the heating of e-liquid ingredients can produce toxic byproducts. Overall, the current literature demonstrates that ENDS are not a safe alternative to traditional cigarettes due to explosion risks and negative health effects including addiction, adverse respiratory and cardiovascular effects, heavy metal leaching, and toxic byproducts exposure. These risks warrant regulation of ENDS devices and formulations, with urgency underscored by their increasing popularity among youth and adults.

Electronic Nicotine Delivery Systems (ENDS) Flavorants Act As Non‐Competitive Antagonists of nAChRs and Contribute To Reinforcement‐Related Behavior

Significance Approximately 42% of the American population who use ENDS are between the ages of 12 and 18. The dramatic rise in adolescent ENDS use is likely attributed to the continuously growing flavor market, with more than 15,000 options available. In an attempt to combat this rise in vaping, it is crucial we determine the pharmacological impact of ENDS flavorants on nicotinic acetylcholine receptors (nAChRs) in the addiction-related circuitry of the brain. Methods We utilized cultured neuroblastoma-2a cells transiently transfected to contain α4β2 and α6β2β3 nAChRs and Ca2+ influx assays to examine the pharmacology of ENDS flavorants on nAChR function. In parallel, flavorants were also examined for their impact on nAChR upregulation using confocal microscopy. Lastly, we utilized vapor self-administration assays with male and female mice to study how these flavorants alter reinforcement-related behaviors. To determine significance, we used one- and two-way ANOVAs with appropriate post-hoc analyses. Results Menthol and two green apple flavorants (farnesol and farnesene) exhibited pharmacology consistent with the designation of NCAs on α4β2 nAChRs (IC50 values of 50–100μM). Further, both menthol and farnesol induced nAChR upregulation, whereas farnesene uniquely induced a stoichiometric shift towards high-sensitivity nAChRs. In self-administration assays, we observed that male mice self-administered menthol + nicotine, green apple + nicotine, or green apple alone, and both green apple and menthol enhanced nicotine reinforcement-related behavior. However, only green apple flavorants contributed to reinforcement-related behavior in the absence of nicotine. Conclusions Although ENDS flavors have been deemed “generally recognized as safe” by the FDA, we have identified several chemical flavorants that act as NCAs of α4β2 nAChRs and exert an impact on reinforcement-related behavior in a mouse model of vaping-related behavior. Given the constant rise in flavored ENDS use, further studies on flavors, ENDS devices, and the underlying mechanisms that take place while using these products is necessary to contribute in the regulation of ENDS use.

Study of nicotine content in the aerosols of ENDS of various designs

The aim of the research is to study the features of aerosol mixture on various types of electronic nicotine delivery systems (ENDS) on a laboratory linear smoking machine to develop requirements both for the devices themselves and for the nicotine content in aerosol of liquids for ENDS. The analysis of data on aerosol collection on various types of nicotine-containing products (NCP) is relevant and in the future will allow to develop recommendations and proposals for establishing safety requirements for such devices and the composition of the aerosol produced. Since manufacturers position ENDS (e-cigarettes) as low-risk for health devices, the study of ENDS is an urgent task. The principle of operation of the devices is not associated with the combustion of tobacco as when smoking cigarettes. The article presents the results of the analysis of the nicotine content in the solid-liquid phase of the aerosol of ENDS devices. The issues of assessing the content of nicotine in the aerosol of the solid-liquid phase of innovative nicotine-containing products of such brands as «LUXLITE», «Von Erl My» and «eGo AIO» have been considered. Currently, a unified approach to the regulation of NCP and control of the content of toxic substances in the aerosol has not been developed, which leads to the use of various modes of aerosol collection on laboratory smoking machines. The article presents the aerosol collection parameters, since there are no regulatory measures to control the safety of electronic nicotine delivery systems. To determine the nicotine content in ENDS aerosol, it is recommended to use the ISO 20768 method, since when using ISO 20768exp, the stable operation of ENDS devices decreases. It has been found that different devices produce different amounts of nicotine according to the ISO 20768: 2018 aerosol collection regime. The nicotine content in the solid-liquid phase of the ENDS aerosol is influenced by the duration of the puff, and the nicotine content in the aerosol of the ENDS solid-liquid phase depends on the individual characteristics of the device operation.

Current Perspectives on Characteristics, Compositions, and Toxicological Effects of E-Cigarettes Containing Tobacco and Menthol/Mint Flavors.

Electronic nicotine delivery systems/devices (ENDS) such as electronic cigarettes (e-cigarettes) have been made available globally, with the intent to reduce tobacco smoking. To make these products more appealing to young adults, many brands have added flavoring agents. However, these flavoring agents are shown to progressively result in lung toxicity when inhaled via e-cigarettes. While recent federal regulations have banned the sale of flavored e-cigarettes other than tobacco or menthol flavors, concerns have been raised about the health effects of even these flavors. In this review, we evaluate the current toxicological data with regard to effects upon exposure in animal models and in vitro cell culture for these popular flavorants. We have tabulated the current e-cigarette products containing these most common flavors (menthol, mint, and tobacco) in the market. We have also indicated the prevalence of tobacco and menthol-flavor use among e-cigarette users and highlighted the possible challenges and benefits that will result from new federal regulations.

Examining electronic nicotine delivery system use and perception of use among college students with and without asthma across the South

Background The effects of environmental tobacco smoke is a risk factor for everyone, but more so for individuals living with asthma. Most studies have focused on youth and young adults as the vulnerable population affected by secondhand smoke with policies related to secondhand smoke enacted to lessen such exposure given the known negative health effects. Most individuals are aware that secondhand exposure to tobacco smoke is not healthy, yet there is a shortage of literature on the secondhand vapor associated with electronic nicotine delivery systems (ENDS). Suggestions for nicotine, metals, and carcinogens in secondhand vapor are beginning to emerge in the literature but are still not common knowledge to the public. This study aims to look at the demographic differences among young adults (college students) with asthma and non-asthma concerning ENDS use. A secondary aim will also look at the difference in perceived health status and perception of harm in the relationship between asthma and ENDS use in these two populations. Methods: A cross-sectional online survey was designed and disseminated to two independent southeastern colleges. The survey was prepared following a comprehensive review of the literature by a group of experts focused on ENDS usage. The survey examined self-reported usage of and perceptions of ENDS within college students with and without asthma. Results: Approximately 50% of college-age students' perceived ENDS vapor as less harmful than traditional cigarette smoke. Around 24% of the students stated they use ENDS daily with over 50% of these students utilizing ENDS in the past 30 days. Asthma was a significant predictor in reporting lower perceived health status than students without asthma and perceived health status was a significant predictor of reporting fewer ever use of ENDS. Higher than the national average, 19% of students self-identified with an asthma diagnosis, and the use of ENDS was 20% in students without asthma and 27% in students with asthma. Conclusions: There are limited studies on perceptions related to ENDS and exposures in college students with and without asthma. Since 2007, various alternative forms of ENDS devices have been marketed. ENDS have gained popularity with young adults and college-age students, while rates of traditional cigarette usage have declined. College students report less perceived harm with ENDS over traditional cigarettes, yet studies acknowledge the high levels of the addictive substance nicotine. Of great concern is the lack of knowledge that college students have regarding nicotine based on their perceptions and the increasing use of these devices in those individuals with underlying respiratory conditions.

Method for Quantifying Variation in the Resistance of Electronic Cigarette Coils.

In electronic nicotine delivery systems (ENDS), coil resistance is an important factor in the generation of heat energy used to change e-liquid into vapor. An accurate and unbiased method for testing coil resistance is vital for understanding its effect on emissions and reporting results that are comparable across different types and brands of ENDS and measured in different laboratories. This study proposes a robust, accurate and unbiased method for measuring coil resistance. An apparatus is used which mimics the geometric configuration and assembly of ENDS reservoirs, coils and power control units. The method is demonstrated on two commonly used ENDS devices—the ALTO by Vuse and JUUL. Analysis shows that the proposed method is stable and reliable. The two-wire configuration introduced a positive measurement bias of 0.086 (Ω), which is a significant error for sub-ohm coil designs. The four-wire configuration is far less prone to bias error and is recommended for universal adoption. We observed a significant difference in the coil resistance of 0.593 (Ω) (p < 0.001) between the two products tested. The mean resistance and standard deviation of the reservoir/coil assemblies was shown to be 1.031 (0.067) (Ω) for ALTO and 1.624 (0.033) (Ω) for JUUL. The variation in coil resistance between products and within products can have significant impacts on aerosol emissions.

Emerging Chemicals of Health Concern in Electronic Nicotine Delivery Systems.

Electronic nicotine delivery systems (ENDS), by virtue of their highly engineered construction (plastics, glass, e-liquids), may contain a number of emerging chemicals of concern (ECCs), including phthalates, phenolic compounds, and flame retardants. Current knowledge regarding the safety of ENDS may underestimate the health risks from ECCs. In this study, we examined the types and levels of those three groups of chemicals in the components and parts of ENDS devices, including refill liquids, tanks/cartridges, atomizers, drip tips/mouthpieces, and sealing materials. Our results suggest that phthalates were the most prevalent chemicals in all tested samples, followed by parabens and organophosphate flame retardants (OPFRs). Particularly, all measured chemicals had significantly higher detection rates in cartridges/tanks, drip tips/mouthpieces, and sealing materials in contrast to e-liquids and coil samples. Among all those three types of ENDS components, phthalates generally had the highest concentrations (0.279–3790 ng/unit) in the drip tip/mouthpiece samples, followed by the sealing materials (0.380–508.8 ng/unit) and the empty tank/cartridge samples (up to 761.7 ng/unit). For parabens, highest concentrations were observed in drip tip/mouthpiece samples (1.152–130.1 ng/unit), followed by sealing materials (0.220–30.08 ng/unit) and the tank/cartridge samples (1.794–34.24 ng/unit). For OPFRs, tris(1,3-dichloro-2-propyl) phosphate had the highest concentrations (39.40–774.1 ng/unit) in all component samples. High concentrations (20.25–260.4 ng/unit) were also observed for several OPFRs in sealing materials and drip tip/mouthpiece samples. These findings will contribute to addressing the information gaps pertinent to the presence of ECCs in ENDS and will warrant further studies for understanding the potential negative health effects and to what extent those chemicals may cause potential negative health effects when using the ENDS. The findings will also contribute to developing evidence-based standards for the regulatory control of the types and levels of ECCs in ENDS products.

Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos.

BackgroundAs user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking.ObjectiveThis study aimed to analyze the content of YouTube videos depicting modifications of ENDS.MethodsYouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos.ResultsVideos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative).ConclusionsThis study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.

A Qualitative Analysis of Maori and Pacific people's Experiences of Using Electronic Nicotine Delivery Systems (ENDS).

If electronic nicotine delivery systems (ENDS) are to bring public health benefits, members of population groups most affected by smoking must find them an easily adopted and satisfying replacement for smoking. We explored experiences of ENDS uptake and use among Māori and Pacific peoples living in New Zealand and probed factors that assisted transitions from smoking to vaping. We recruited 16 participants using whānaungatanga and community advertising. All were aged 18 or over, identified as Māori or Pacific (or both), had smoked at least 100 cigarettes, and were current ENDS users. We undertook in-depth interviews and analyzed the data using a thematic analysis approach. We identified two key challenges that participants reported facing: their search for a satisfying ENDS experience and resisting social cues that could trigger relapse. Two supportive factors facilitated and reinforced smoking to vaping transitions: improved financial and physical well-being, and feeling connected to vaping communities. Learning about ENDS devices from those who had successfully switched from smoking to vaping provided much-needed information, reinforced the financial benefits of switching, and could inspire those making this transition to persist until they too become smoke free. Measures to support transitions from smoking to ENDS use could reduce inequities in smoking prevalence that indigenous people experience. Collective cessation interventions that draw on communities' knowledge and connections may enable smokers to access support that helps them navigate the potentially complex pathway from smoking to vaping.