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Understanding the nicotine dose delivered by electronic nicotine delivery systems in a single puff: the importance of nicotine flux and puff duration
  1. Thomas Eissenberg1,2,
  2. Alan Shihadeh2,3
  3. the CSTP Nicotine Flux Work Group
    1. 1Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
    2. 2Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
    3. 3Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
    1. Correspondence to Professor Alan Shihadeh, Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon; as20{at}aub.edu.lb

    Abstract

    Electronic nicotine delivery systems (ENDS) may lead to public health benefit if they help people who smoke quit smoking, and may lead to public health harm if they recruit a new generation of nicotine-dependent people. Regulators intent on maximising ENDS’ public health benefit and minimising harm may be interested in regulating the nicotine dose delivered by ENDS in a single puff. The per-puff nicotine dose is the product of ENDS nicotine emission rate (or ‘nicotine flux’) and the duration of the puff taken by the person using the ENDS (or ‘puff duration’). Nicotine flux can be measured or predicted mathematically for any ENDS device/liquid combination. Puff duration can be controlled electronically, as demonstrated by several ENDS marketed today. Combining nicotine flux and puff duration regulation is feasible today and provides authorities the means to limit nicotine dose per puff to a level that may help people who smoke quit smoking while reducing the possibility that nicotine-naive individuals will engage in repeated ENDS use. Tobacco regulatory science and product regulation will both be improved by a rigorous approach to understanding, characterising, and reporting the nicotine dose emitted by ENDS.

    • Nicotine
    • Electronic nicotine delivery devices
    • Addiction
    • Smoking topography

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    Footnotes

    • Collaborators Andrew J Barnes, Department of Health Behavior and Policy and Center for the Study of Tobacco Products at VCU, Abarnes3@vcu.edu; Alison B Breland, Department of Psychology and Center for the Study of Tobacco Products at VCU, abbrelan@vcu.edu; Caroline O. Cobb, Department of Psychology and Center for the Study of Tobacco Products at VCU, cobbco@vcu.edu; Joanna E Cohen, Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, jcohen@jhu.edu; Rachel El Hage, Faculty of Arts and Sciences, Department of Chemistry at American University of Beirut, Rachel_elhage@hotmail.com; Ahmad El Hellani, College of Public Health, The Ohio State University, elhellani.1@osu.edu; Mario El Hourani, PhD, Mechanical Engineering Department, American University of Beirut, mge14@mail.aub.edu; Alisha N Eversole, Center for the Study of Tobacco Products at VCU, eversolea@mymail.vcu.edu; Ranti Fayokun, Department of Prevention of Noncommunicable Diseases, World Health Organization, fayokunr@who.int; Jeffrey J Hardesty, Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, jhardesty@jhu.edu; Cosima Hoetger, Private Universität Witten/Herdecke gGmbH, cosima.hoetger@uni-wh.de; Sarah F Maloney, Brown University, sarah_maloney@brown.edu; Alyssa K Rudy PhD, alyrudy0@gmail.com; Najat Aoun Saliba PhD, Professor of Chemistry, American University of Beirut, ns30@aub.edu.lb; Rola Salman, Mechanical Engineering Department, American University of Beirut, rs107@aub.edu.lb; Eric K. Soule, Department of Health Education and Promotion and College of Health and Human Performance at East Carolina University, and Center for the Study of Tobacco Products at VCU, soulee18@ecu.edu; Soha Talih, Department of Mechanical Engineering, American University of Beirut, and Center for the Study of Tobacco Products at VCU, st38@aub.edu.lb.

    • Contributors The ideas underlying this commentary were developed at a meeting and in subsequent discussions of the Center for the Study of Tobacco Products (CSTP) Nicotine Flux Work Group in Lisbon, Portugal, 25–27 October 2019, thus all CSTP Nicotine Flux Work Group members are listed as collaborators and the work group name is included in the author list. TE and AS prepared the first draft of the manuscript. Members of the Nicotine Flux Work Group, specifically AR, AB, CH, SM, NS, ST, AE, MH, RS, RH, RF, ES, JC, JH, TW, AB, CC, AB and AE provided input and helped to finalise the manuscript.

    • Funding This research is supported by grant number U54DA036105 from the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the US Food and Drug Administration.

    • Competing interests TE and AS are paid consultants in litigation against the tobacco industry and also the electronic cigarette industry and are named on one patent for a device that measures the puffing behaviour of electronic cigarette users and one patent for a smoking cessation intervention. TE is also named on a patent for a smartphone app that determines electronic cigarette device and liquid characteristics.

    • Provenance and peer review Not commissioned; externally peer-reviewed.