Electronic Nicotine Delivery Systems (ENDS) Use

Electronic Nicotine Delivery Systems (ENDS) represent a rapidly changing class of tobacco products known by many different names, including e-cigarettes, e-cigs, vapes, mods, and tank systems. ENDS deliver an aerosol to the user that typically contains nicotine, propylene glycol, vegetable glycerin and flavoring chemicals. The first ENDS products entered the U.S. marketplace around 2007. In 2018, 3.2% of U.S. adults (age 18 and older) reported current (“every day” or “someday”) use of ENDS. Since 2014, ENDS have been the most used tobacco product among U.S. youth. In 2020, about 3.6 million U.S. youth, including about 1 in 5 high school students and 1 in 20 middle school students, reported current (past 30 day) use of ENDS.

Despite rapidly accumulating research, there are significant gaps in our understanding of the health harms and potential benefits of ENDS products due in part due to their relatively recent entry to the U.S. market, the rapidly evolving nature of the ENDS marketplace, and changes in the policy landscape at the federal, state and local level. For example, although many adult smokers report using ENDS to help them quit smoking or to reduce their cigarette consumption, the Surgeon General stated in the most recent report on smoking cessation (2020) that there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation. Youth ENDS use raises concerns about nicotine addiction, negative effects of nicotine on adolescent brain development, and other potential health harms, including increased risk of initiating cigarette smoking.

NCI supports research to understand the potential impact of ENDS use on both individual and population health, as it relates to cancer control and prevention. NCI’s portfolio includes grants that examine health effects of ENDS use, perceptions and communication of ENDS’ harms, youth and young adult ENDS use behaviors, ENDS marketing and promotion, and the influence of ENDS use on other tobacco product use behaviors, especially cigarette smoking. Many grants on this topic are funded through the Tobacco Regulatory Science Program, an NIH partnership with FDA’s Center for Tobacco Products to fund research to inform FDA’s tobacco regulatory activities.