Purpose: In 2007, electronic cigarettes (e-cigarette) were introduced as a smoking cessation device. Since then, its sale and marketing has been expanded annually. Concomitantly, there is an increase in the electronic cigarette (e-cigarette) and liquid nicotine exposure cases reported to the United States (US) poison control centers. The purpose of this review is to assess the exposure cases reported to US poison control centers to characterize the adverse health effects of e-cigarette and liquid nicotine use. Methods: The PubMed database was searched for e-cigarette and e-liquid exposure reports since 2010. The qualitative analysis was conducted to depict the characteristics related to the incident cases and health outcomes of e-cigarette and e-liquid exposure to support public awareness. Results: Since 2010, there was an increase in e-cigarette exposure incidents with ingestion, inhalation, ocular and dermal identified as the commonly reported routes of exposure in both children and adults. The clinical symptoms were well characterized based upon the specific route of exposure. The exposure incidents were categorized into age, sex, type of exposure, symptoms, management site and medical outcome. The children less than 5 years of age were unintentionally exposed followed by both unintentional and intentional exposure in adults. The reported medical outcomes have a range from minor effects exhibiting symptoms that were not bothersome to major effects with life-threatening symptoms, and death. The short-term or acute exposure was mostly associated with mishandling or misuse of the e-cigarette device or e-liquid. The case reports of young adult males who are linked to intensive use of e-cigarettes show lung injury. Conclusion: E-liquid and e-cigarette use continue to pose a serious health risk for both adults and children. There is accumulating data of incidents associated with short-term e-cigarette use or intensive use of e-cigarettes. However, monitoring of the long-term health effect of e-cigarettes is needed in order to raise public awareness among young adults.

Purpose: While there is a declining trend in the use of traditional methods of smoking tobacco, electronic nicotine delivery systems (ENDS) have gained popularity worldwide. ENDS are marketed as safe for the primary reason that they do not contain the well-established toxic ingredients found in traditional cigarettes. However, growing concerns over incidences of fire and explosion with specific types of ENDS, as well as their short and long-term effects, remain unaddressed. This review examines the under studied role of customized components such as batteries, e-liquid compositions, and methods of nicotine delivery that result in physical injuries and adverse health effects of ENDS. Methods: Using online reference databases (Web of Science, PubMed, Medline other, Google scholar, FDA website, FDA register), we analyzed the mechanisms through which ENDS may pose significant risk to human health. Results: An increase in the use and popularity of ENDS has been observed among youth and adults in the United States since 2007. The ENDS devices available to the public allow for custom alterations which can introduce incompatible components, resulting in overheating and explosion related injuries. Heavy metals have been found to leach from some devices into the e-liquid, and the heating of e-liquid ingredients can produce toxic byproducts. Conclusions: Overall, the current literature demonstrates that ENDS are not a safe alternative to traditional cigarettes due to explosion risks and negative health effects including addiction, adverse respiratory and cardiovascular effects, heavy metal leaching, and toxic byproducts exposure. These risks warrant regulation of ENDS devices and formulations, with urgency underscored by their increasing popularity among youth and adults.

Bovine spongiform encephalopathy (BSE), widely known as “mad cow disease”, has virtually crippled the British livestock industry. Even though, no cases of BSE have been reported in the United States (US), a similar epidemic in the US would be catastrophic. The added concern for the risk of introduction of the human disease called variant Creutzfeldt-Jacob disease that has been linked to eating meat of BSE infected cattle compounds the risk of BSE. Systems dynamics models based on the underlying transmission pathways of BSE can help to anticipate the spread of this disease in different cattle populations and assist in the evaluation of potential risk mitigations for preventing its introduction or controlling its spread if it was introduced. With this in mind, an age and health status structured systems dynamics model was developed. By making assumptions and setting up feasible scenarios, the model can be used to examine potential prevalence and incidences rates of BSE; the effect of mitigations including changes in feeding habits or rendering processes and/or other policies and regulations designed to prevent the introduction of BSE. The systems dynamics simulation model enabled us to create virtual experiments whose real-world analogues would otherwise be expensive, dangerous, or even impossible to carryout.