Background: Electronic cigarette (e-cigarette) use has increased substantially in recent
years. While e-cigarettes have been proposed as a potentially effective smoking cessation tool, dualuse
in smokers is common and e-cigarettes are widely used by non-smokers, including youth and
young-adult non-smokers. Nicotine, the primary addictive component in cigarettes, is present at
varying levels in many e-liquids. E-cigarettes may lead to initiation of nicotine use in adult and
youth non-smokers, re-initiation of nicotine dependence in ex-smokers or increased severity of
nicotine dependence in dual-users of cigarettes and e-cigarettes. As such, there are important clinical
and policy implications to understanding factors impacting nicotine exposure from e-cigarettes.
However, the broad and rapidly changing range of e-liquid constituents and e-cigarette hardware
which could impact nicotine exposure presents a challenge. Recent changes in regulatory oversight
of e-cigarettes underscore the importance of synthesizing current knowledge on common factors
which may impact nicotine exposure.
Methods: This review focuses on factors which may impact nicotine exposure by changing
e-cigarette use behavior, puff topography, altering the nicotine yield (amount of nicotine exiting the
e-cigarette mouth piece including nicotine exhaled as vapor) or more directly by altering nicotine
absorption and bioavailability.
Results: Topics reviewed include e-liquid components or characteristics including flavor additives
(e.g., menthol), base e-liquid ingredients (propylene glycol, vegetable glycerin), components commonly
used to dissolve flavorants (e.g., ethanol), and resulting properties of the e-liquid (e.g., pH),
e-cigarette device characteristics (e.g., wattage, temperature, model) and user behavior (e.g., puff
topography) which may impact nicotine exposure.
Conclusion: E-liquid characteristics and components, e-cigarette hardware and settings, and user
behavior can all contribute substantially to nicotine exposure from e-cigarettes.