Electronic Nicotine Delivery Systems

Electronic nicotine delivery systems (ENDS) heat a liquid, which typically contains nicotine, to an aerosol that is inhaled.^2,54 ENDS include vaporizers, vape pens, hookah pens, e-pipes and e-cigarettes. On Dec. 20, 2019, the President signed legislation amending the Federal Food, Drug, and Cosmetic Act, and raising the federal minimum age for sale of tobacco products from 18 to 21 years. This legislation (known as “Tobacco 21” or “T21”) became effective immediately, and it is now illegal for a retailer to sell any tobacco product—including cigarettes, cigars, and e-cigarettes—to anyone under 21. The new federal minimum age of sale applies to all retail establishments and persons with no exceptions. Despite this new law, 10% of high school students and 4.6% of middle school students reported current use of e-cigarettes.⁷² Additionally, 4.5% of adults aged 18 and over were current e-cigarette users, with e-cigarette use highest among adults aged 18–24 (11.0%).⁹ Approximately 20% of 18-22 year olds believe that e-cigarette use is harmless and non-addictive. ²⁷ The CDC has issued statements that these products are not less harmful. Evidence to support ENDS as a tobacco cessation aid is limited and of low quality. As a result, ENDS are not an FDA-approved cessation aid.⁵