9 10 ENDS are now the second most common tobacco product in the USA, with 4.5% of adults reporting current use. In 2019, Altria purchased a stake in JUUL. 4–8 JUUL launched in 2015 and quickly became the predominant ENDS brand in the USA. Originally marketed by Ruyan (later NJOY), the initial offerings were slow to capture market share, but interest in ENDS rose with the marketing of blu in 2009. 3 These products have changed substantially over the past decade, starting with disposable cigalikes that resembled a cigarette, then rechargeable devices with refillable tanks and more modifiability (eg, adjustable power) and, more recently, pod-style devices like JUUL.
In 2007, a new type of product was launched for sale-electronic nicotine delivery systems (ENDS) (also called e-cigarettes or vaping products)-a class of products that commonly contain a battery that powers a heating element to aerosolise a liquid typically containing nicotine, flavourings and humectants. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade. The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers.
These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery.
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