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4. The invention of the modern electronic cigarette
can be traced to Chinese pharmacist Hon Lik.

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ENDS are promoted as a way to smoke where smoking is prohibited.

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9. Electronic nicotine delivery systems
(ENDS)
 Electronic nicotine delivery systems (ENDS), also called
electronic cigarettes, e-cigarettes, vaping devices, or
vape pens, are battery-powered devices used to
smoke or “vape” a flavored solution.
 ENDS solution often contains nicotine, an addictive
chemical also found in cigarettes.

16. What are e-cigarettes?
 Battery-powered heating devices, often resembling cigarettes,
cigars or pipes
 Designed to deliver nicotine to users in the form of a vapor
(instead of smoke)
 The vapor comes from heating liquid nicotine
o E-cigarette first entered the market in China in 2004
o Currently over 250 brands available

17. What are e-cigarettes?
 3 Main Components of the E-Cigarette:
o Battery
o Cartridge (containing water, flavouring and sometimes
nicotine in a base of propylene glycol and glycerin)
o Atomizer/vaporizer.

18.  Puffing on the device activates the atomizer to heat the
cartridge solution, producing vapour that is inhaled by
the user, an action that is often referred to as “vaping.”
 There is often an indicator light that mimics the end of a
conventional cigarette.
 A common term that refers to the act of using an electronic
cigarette is “vaping.”

21. Components of E-Cigarettes

23. How does an e-cigarette work?

24. When heated, the cartridge that contains the liquid nicotine converts
the contents into a vapor that the user inhales.

25. Variety of Flavours
ENDS and ENDS solutions are available in many flavors (bubble gum, chocolate,
peppermint, etc.) that appeal to youth. Flavors, design, and marketing
renormalize and glamorize smoking.

26. What is an e-cigarette?

27. E-cigarette liquid may contain:
 Nicotine
 Propylene glycol (or vegetable glycerin) for
vapour production
 Water
 Metal particles
 Flavourings

29.  It is difficult for consumers to know what e-cigarette
products contain.
 For example, some e-cigarettes marketed as containing
zero percent nicotine have been found to contain nicotine.
 Ninety percent of the world’s e-cigarettes are produced
in China with little to no quality control standards.

37.  A common ingredient in most e-cigarettes is nicotine. Nicotine
is a stimulant and is toxic at relatively low concentrations
when compared to other stimulants such as caffeine .
 It is the main addictive ingredient in cigarettes and has been
considered as addictive as heroin or cocaine.
 Persons under the age of 18 are highly susceptible due to
their still developing brains.
Nicotine is a toxin and is NOT harmless.

42.  Carcinogens such as formaldehyde and acrolein have been
found in e-cig aerosol to be at similar, but at lower levels
than the smoke produced by cigarettes.
 While nicotine is not a carcinogen, studies have shown
that it may act as a “tumor promoter.”
 While e-cigarettes may contain and produce fewer toxins than
traditional cigarettes, they are not harmless.

43. While nicotine is not a carcinogen, studies have shown that it may act as a “tumor
promoter.”22
The amount of nicotine listed on an e-cigarette product has been shown to
be inaccurate at times.23,24
This is most likely attributable to a lack of quality control
standards. It should be noted that all e-cigarette nicotine is derived from tobacco;
therefore, e-cigarettes are tobacco products.25

47. When Combined with Daily Cigarette Use, Heart Attack Risk
Rises Five-Fold, Study Finds

48.  Cases of nicotine poisoning related to electronic
cigarettes are dramatically increasing among children,
mostly under 5 years old.
 E-liquids usually contain nicotine, which if ingested can be
lethal; 10 mg or 2 teaspoon dose of nicotine can be fatal
to a child.
NICOTINE POISONING OF CHILDREN FROM
E-CIGARETTES

49.  Another common ingredient in e-cigarettes is propylene
glycol, which is the component of e-cigs that creates the
simulation of cigarette smoke.
 Propylene glycol is generally regarded as safe as a food
additive; however, propylene glycol can produce sore throat,
lung and eye irritation, and muscle soreness if inhaled in its
gaseous state.
 This can be particularly dangerous for persons with lung
conditions such as asthma.

52. HOW ARE E-CIGARETTES HARMFUL TO OTHERS?

53.  Passive vaping.
 This chemical aerosol is not “just” water vapour.
 Studies so far show it contains:
o Nicotine
o Propylene glycol
o Fine & ultrafine (UF) particles
o low levels of toxins known to cause cancer
o Nanoparticles of chromium, nickel, tin
o Volatile organic compounds (VOCs)
What do e-cigarette users exhale?

55.  When used, electronic cigarettes emit aerosol that often
contains nicotine, ultrafine particles and low levels of toxins,
introducing new pollutants into the air.
 Studies have found that non-smokers who were exposed
to passive vaping absorb nicotine (cotinine – a biomarker
of nicotine) at significantly higher levels than those who
are not exposed to e-cigarettes or traditional cigarettes.

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 The World Health Organization and ,American Industrial
Hygiene Association recommend that electronic cigarettes
should not be used indoors or in designated smoke-free
environments due to potential harm.
 San Francisco Health Code 19N prohibits the use of
electronic cigarettes in public places wherever the use of
cigarettes is prohibited to minimize second-hand harm to
others.
 In addition to potential second hand, there is evidence that
electronic cigarettes may be a source of thirdhand exposure
to nicotine

58. E-cigarettes may be a gateway to addiction
 E-cigarette products are attractive to teens and young
adults. These products may be a gateway to nicotine
addiction and future smoking and experimentation
with regular cigarettes, as well as other tobacco
products and substances.

71. FDA Vape Regulations

76. Concerns of Misuse
• E-cigarettes developers are making unfound claims
in marketing and packaging
• E-cigarettes are NOT an approved intervention for
tobacco cessation
• Concerns that “renormalizing smoking-like behavior”
can result in higher youth initiation rates and a slower
decline in adult cessation

82.  The electronic cigarette market initially consisted of
businesses selling products over the internet.
 Now, major tobacco companies have come into the
electronic cigarette market due to a decline in cigarette
sales in the United States and local vape shop
businesses are appearing.
 The growing e-cigarette market is an opportunity and
the tobacco industry is heavily investing in it.

83.  Business deals among major tobacco companies in the US
and internationally have changed the face of both the e-
cigarette and cigarette industries.
 Currently, each major tobacco company, such as Altria
(Philip Morris International), Lorillard, and Reynolds
American, owns an e-cigarette company.
 Analysis of sales shows that many e-cig users are either
returning to traditional cigarettes or using both products
(dual use).

88. World Health Organization
 “Has banned the sale of e-cigarettes to young children
and women of reproductive age, e-cigarette advertising,
public indoor use, and on claims that they aid smoking
cessation.”

93. Prohibit use of e-cigarettes indoors and in workplaces.

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