During the past few years, the use of electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes (e-cigarettes), has risen rapidly in the United States, with some analysts suggesting that ENDS sales could surpass sales of traditional cigarettes in the not-too-distant future. This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of ENDS and about how best to regulate them. The article by Dutra and Glantz1 highlights some of the concerns about the potential public health harms from ENDS, documenting the more than doubling of ever use among US teenagers between 2011 and 2012 and the associations of ENDS use with more established smoking and, among experimenters, reduced likelihood of abstinence from conventional cigarettes. At the same time, their article highlights the potential promise of ENDS, with their use associated with greater interest in quitting among current young smokers. The same phenomena are seen among adult smokers, with awareness and ever use of ENDS rising sharply from 2010 to 2011 and high rates of dual use among users of ENDS and conventional cigarettes, while many users report using ENDS in an effort to quit smoking.2 To date, however, the empirical evidence on the effectiveness of ENDS use in promoting smoking cessation is mixed at best, with some studies finding either no association or a negative association between ENDS use and quitting and others suggesting effectiveness equivalent to that of nicotine patches.3,4
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