What is the nicotine delivery profile of electronic cigarettes?

Abstract

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. 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. 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.