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Eaton, Chair Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems SECTION I: E-CIGARETTE DEVICES, CONSTITUENTS, AND EXPOSURES 3 E-CIGARETTE DEVICES, USES, AND EXPOSURES Characteristics of E-Cigarette Devices Exposure to Aerosols and Particulates Secondhand Exposure to E-Cigarette Aerosol Concentration of Nicotine in Commercial E-Cigarettes Nicotine Concentration in E-Cigarette Emissions Toxicology and Modes of Action Exposure to Nicotine and Nicotine Derivatives from E-Cigarettes Relationship Between E-Cigarette Topography and Nicotine Exposure 5 TOXICOLOGY OF E-CIGARETTE CONSTITUENTS Humectants (Delivery Solvents) Free Radicals and Reactive Oxygen Species 6 RESEARCH NEEDS: E-CIGARETTE DEVICES, CONSTITUENTS, AND EXPOSURES Addressing Gaps in Substantive Knowledge SECTION II: EFFECTS OF E-CIGARETTES ON HEALTH 8 DEPENDENCE AND ABUSE LIABILITY Characterization of Disease Endpoints and Intermediate Outcomes Questions Addressed by the Literature Characterization of Disease Endpoints and Intermediate Outcomes Human Evidence from Studies of Cardiovascular Effects Characterization of Disease Endpoints and Intermediate Outcomes Case Reports and Other Clinical Studies Studies of Effects of Major Components of E-Cigarettes on Cancer Outcomes Vulnerable/Susceptible Populations Characterization of Disease Endpoints and Intermediate Outcomes In Vivo Animal Studies and In Vitro Mechanistic Studies Vulnerable/Susceptible Populations Characterization of Disease Endpoints and Intermediate Outcomes Questions Addressed by the Literature Studies in Humans (Clinical and Epidemiological) 13 DEVELOPMENTAL AND REPRODUCTIVE EFFECTS Characterization of Disease Endpoints and Intermediate Outcomes Questions Addressed by the Literature Case Reports and Other Clinical Studies In Vivo Animal and In Vitro/Mechanistic Studies Studies on Combustible Tobacco and Nicotine Intentional and Unintentional Exposure to E-Liquid 15 RESEARCH NEEDS: EFFECTS OF E-CIGARETTES ON HEALTH Addressing Gaps in Substantive Knowledge SECTION III: PUBLIC HEALTH IMPLICATIONS OF E-CIGARETTES 16 COMBUSTIBLE TOBACCO CIGARETTE SMOKING AMONG YOUTH AND YOUNG ADULTS Conceptual Framework: Patterns of Use Among Youth and Young Adults Evidence Review: Levels of Evidence Available 17 SMOKING CESSATION AMONG ADULTS Conceptual Framework: Patterns of E-Cigarette Use Among Established Smokers Evidence Review: Levels of Evidence Available Evidence Review: Levels of Evidence Available 19 MODELING OF E-CIGARETTE USE 20 RESEARCH NEEDS: PUBLIC HEALTH IMPLICATIONS OF E-CIGARETTES Addressing Gaps in Substantive Knowledge S-2 Levels of Evidence Framework for Conclusions S-3 Research Needs: E-Cigarette Devices, Constituents, and Exposures S-4 Research Needs: Effects of E-Cigarettes on Human Health S-5 Research Recommendations: Public Health Implications of E-Cigarettes 2-1 Levels of Evidence Framework for Conclusions B-1A Search Strategy for E-Cigarettes in Human Populations B-1B Search Strategy for E-Cigarettes in In Vivo Animal Populations B-1C Search Strategy for E-Cigarettes in In Vitro Populations B-1E Search Syntax for E-Cigarettes and Dermal and Ingestion Exposure B-2 Inclusion Criteria for the Literature Review on the Health Effects of E-Cigarettes B-3 Search Syntax for E-Cigarettes and Dependence B-4 Search Syntax for E-Cigarettes and Combustible Tobacco Cigarette Smoking Initiation B-6 Search Syntax for Original Studies on E-Cigarettes and Smoking Cessation B-7 Search Syntax for E-Cigarettes and Combustible Tobacco Cigarette Smoking Reduction 3-1 First-, second-, and third-generation e-cigarette devices 3-5 Event room PM 2.5 concentrations before, during, and after an e-cigarette convention 3-6 Real-time changes of PM 10 , CO 2 , and TVOC concentrations during a vaping convention in Maryland 4-1 Nicotine metabolic pathways 5-4 Distribution of metal concentrations within and across brands of disposable e-cigalike devices 7-1 Publications by year on e-cigarettes and in vitro systems 7-2 Endothelial cell dysfunction by tobacco smoke 7-4 Publications by year on e-cigarettes and oxidative stress 7-5 Principal component analysis of top 2,000 genes by median absolute deviation 7-6 Changes in glutathione status and generation of reactive oxygen species 8-2 Dependence score as a function of nicotine concentration 9-2 Endothelial progenitor cells (EPCs) during e-cigarette inhalation and control 17-1 Conceptual framework of smoking cessation and e-cigarette use 18-2 Urinary metabolite levels for selected toxins and carcinogens, by group 18-3 Forced expiratory volume (FEV1) at the four time points of assessment for all 18 patients 1-2 Summary of the Key Events in the History of E-Cigarette Regulation 3-1 Summary of E-Cigarette Puffing Topography Studies 3-2 Particle Size Distribution Parameters Determined from Cascade Impactor Analysis 4-2 Summary of Clinical Studies Examining Nicotine Exposure from E-Cigarette Use 5-2 Plasma Pharmacokinetics of Propylene Glycol Given as a 4-Hour Intravenous Infusion 5-3 Acute Lethal Dose (LD 50 ) of Propylene Glycol in Rats, Mice, Guinea Pigs, and Rabbits 5-4 Overview of Common Flavorings and Their Inhalation Toxicity 5-5 Summary of Experimental Studies Determining Carbonyl Compounds in E-Cigarette Aerosols 5-6 Volatile Compounds Detected in E-Cigarette Aerosol 8-1 Epidemiological Studies on E-Cigarettes and Dependence 8-2 Laboratory/Experimental Studies on Dependence and Abuse Liability 9-1 Clinical Studies of Short-Term Effects of E-Cigarette Use on Cardiovascular Endpoints 9-2 Epidemiological Studies on Chronic E-Cigarette Use and Cardiovascular Endpoints 10-1 In Vitro Mutagenicity/DNA Damage Assessment of E-Cigarette Liquids and Aerosols 17-1 Systematic Reviews of E-Cigarettes and Smoking Cessation Identified by Literature Search 17-3 Selected Systematic Reviews: Part 1 17-4 Selected Systematic Reviews: Part 2 18-1 Comparison of Toxicant Levels Among Combustible Tobacco Cigarette Smoke and E-Cigarette Aerosol 19-1 Summary of Simulation Runs Considered by the Committee 19-2 Model-Estimated Life-Years Lost During 20152050 Due to E-Cigarettes 19-3 Model-Estimated Life-Years Lost During 20152070 Due to E-Cigarettes 19-4 Model-Estimated Life-Years Lost During 20152050 Due to E-Cigarettes 19-5 Model-Estimated Life-Years Lost During 20152070 Due to E-Cigarettes 19-6 Model-Estimated Life-Years Lost During 20152050 Due to E-Cigarettes 19-7 Model-Estimated Life-Years Lost During 20152070 Due to E-Cigarettes 19-8 Model-Estimated Life-Years Lost During 20152050 Due to E-Cigarettes 19-9 Model-Estimated Life-Years Lost During 20152070 Due to E-Cigarettes D-3 Summary of Results from In Vitro Studies of E-Cigarettes Assessing Cytotoxicity
Smoking and vaping are generally NOT allowed: Inside ride queues On attractions Inside restaurants Inside shops During indoor shows Inside theatres On parade viewing areas Inside hotel rooms Near childrens play areas In most busy walkthrough pathways Yes, even vaping
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Serving size for meal products and main dish products in multiserving containers shall be based on the reference amount applicable to the product in 101.12(b) if the product is listed in 101.12(b)
One size fits most is size 4-10
