ABSTRACT
Introduction: Electronic cigarettes (e-cigarettes) are a rapidly evolving class of tobacco products intended to deliver nicotine to users. There are many types of e-cigarettes available and the most popular type today in the United States are ‘pod’ based devices that use high nicotine concentration liquids. Understanding the nicotine delivery capabilities of e-cigarettes is imperative for understanding their addictive potential and safety profile, informing regulation, and revealing their potential use as smoking cessation aids.
Areas covered: This review discusses nicotine content of e-cigarettes, effectiveness of nicotine aerosolization by devices, delivery of nicotine to users, and user and device characteristics that impact each of these.
Expert opinion: Modern e-cigarettes have the potential to deliver equal or more nicotine compared to a tobacco cigarette. Future research needs to identify the nicotine delivery profiles likely to benefit public health and the means to regulate them appropriately while also identifying those that are likely to cause harm. Public health benefit accrues if e-cigarettes help smokers quit combustible cigarettes completely. Harm is possible if inadequate nicotine delivery undermines cessation attempts, e-cigarettes facilitate continued combustible cigarette use, long-term e-cigarette use is associated with substantial morbidity/mortality, and/or e-cigarettes increase the initiation of combustible cigarette use among never smokers.
Article highlights
E-cigarettes are battery powered devices intended to deliver aerosolized nicotine to users.
There is a large amount of variation in the devices and e-cigarette liquids available to users, and the technology continues to evolve rapidly.
There is substantial variation in the nicotine delivery of e-cigarettes based on device, liquid, and user characteristics.
E-cigarettes have the potential to deliver equal or more nicotine compared to a tobacco cigarette.
Nicotine delivery is an important aspect of the potential for e-cigarettes either to benefit or harm public health.
This box summarizes key points contained in the article.
Declaration of interest
T Eissenberg is a paid consultant in litigation against the tobacco industry and is named on a patent for a device that measures the puffing behavior of electronic cigarette users. M Goniewicz received a research grant from Pfizer and served as a member of the scientific advisory board to Johnson&Johnson, manufacturers of smoking cessation medication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.