Top Ten Things Every Clinician Should Know about E-Cigarettes

Authors:
Elizabeth S. Yett, PharmD, BCACP, CTTS
Kirk E. Evoy, PharmD, BCACP, BC-ADM, CTTS

Reviewers:
Rory O. Kim, PharmD. MACM, BCACP
Kelly Kepley, PharmD
Helen Berlie, BHS, PharmD, BCACP

Introduction

For decades, the proportion of US adults who smoke cigarettes has steadily declined, down from 42.6% in 1965 to 11.6% in 2022.¹ Yet despite abundant research regarding the negative health consequences of smoking tobacco cigarettes and the availability of effective smoking cessation medications, smoking cessation has slowed, with 1 in 9 US adults still smoking cigarettes. Thus, new tools to the smoking cessation armamentarium would be welcomed.

Electronic cigarettes (e-cigarettes; also known as e-cigs, electronic nicotine delivery systems [ENDS], vapes, mods, pods, and vape pens) have surged in popularity since their market introduction in 2007. Some view e-cigarettes as a less harmful alternative to traditional cigarettes and a potential harm reduction strategy.  Indeed, emerging research indicates potential utility in that role. However, others see them as a major risk to the 60+ years of progress toward a tobacco-free society.^2-3

Unfortunately, these products, with unique delivery systems and appealing flavors like Bubblegum and Fruity Cereal, have become particularly popular among adolescents and young adults.⁴ This has resulted in a rise in nicotine use among those aged 13 to 30 years old and concerns that e-cigarettes could be a gateway to a new generation of tobacco cigarette users. For this reason, the US Surgeon General cited e-cigarette use among youth as a significant public health concern and made reducing the use of any nicotine-containing product, including electronic nicotine products, a Healthy People 2030 objective.⁵

Are e-cigarettes a harm reduction tool or causing more harm than good? Here are the top ten things every clinician should know about e-cigarettes.