REVIEW ARTICLEOverview of Electronic Nicotine Delivery Systems: A Systematic Review
Section snippets
Context
Electronic nicotine delivery systems (ENDS), or e-cigarettes, produce an inhaled aerosol instead of smoke, providing an alternative mode of nicotine delivery.1, 2, 3, 4, 5, 6 The U.S. Food and Drug Administration’s Center for Tobacco Products finalized a rule to regulate ENDS.7 Thus, there is a pressing need to identify the pathways by which to manage ENDS and how to strike a balance between potential benefits and harms to public health.4, 8, 9
Reviews have been published on ENDS in general10, 11
Evidence Acquisition
A systematic review of empirical articles on ENDS was conducted via a PubMed search through May 31, 2016 (Appendix Table 1 [available online] shows search strategy and eligibility criteria).107 Analyses were conducted from October 2015 to August 2016. Included studies (Figure 1) were catalogued into one or more of the following topics:
- 1.
Product Features;
- 2.
Health Effects;
- 3.
Consumer Perceptions;
- 4.
Patterns of Use;
- 5.
Potential to Induce Dependence;
- 6.
Smoking Cessation;
- 7.
Marketing and Communication;
- 8.
Sales; and
- 9.
Evidence Synthesis
Of 1,634 articles identified through PubMed, 675 were included in the review (Figure 1). An additional twelve studies were included through targeted searches or discussion with experts.
Discussion
This review highlights several major findings. First, ENDS are a heterogeneous and evolving product category, with variation in physical factors that can influence vapor production (e.g., tank style, battery power, temperature). E-liquids contain various combinations of nicotine, flavors, and carriers. These factors affect nicotine delivery, appeal, and ease of product use and underscore the degree to which individual preferences may play a role in use patterns. Second, detectable levels of
Conclusions
There are a number of factors to consider when synthesizing the results. First, ENDS products are highly variable. A standardized method is needed to characterize products with respect to nicotine and toxicant delivery and their potential harms, both relative to smoking and relative to no use (absolute harm). Second, the field lacks consistent definitions of types of users and patterns of use, which complicates the interpretation of research findings. Third, many studies have small sample or
Acknowledgments
Financial support for this study was provided by the Schroeder Institute at Truth Initiative, the Robert Wood Johnson Foundation (Grant ID: 72208 and 72390), and a NIH K01 Career Development Award in Tobacco Control Regulatory Research (Principal Investigator, Pearson; 1K01DA037950-01). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. All authors are employed by Truth Initiative. No financial
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