A recent study funded by the North Dakota Center for Tobacco Prevention and Control Policy and published in the Journal of Pediatric Nursing determined that half (51 percent) of the labels on e-cigarette liquid nicotine in North Dakota do not accurately reflect the levels of nicotine found in the products. Actual nicotine levels in some products were 172 percent higher than labeled.
“It is alarming to consider the effects of consuming e-cigarette liquids that are incorrectly labeled,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy. “Users may unexpectedly experience nausea or jitteriness when overexposed to nicotine. A nicotine overdose is dangerous and can even be deadly, especially in cases of accidental ingestion by children.”
Prom said that in spite of FDA’s new ruling to regulate e-cigarettes, there is more work to be done to protect the public’s health. “It’s a step in the right direction,” said Prom, “but more regulation is needed to fill the gaps to ensure that all e-juice products are labeled correctly.”
The cross-sectional study of e-liquids included products purchased between June 9 and June 26, 2015 from 16 North Dakota retail stores that sell electronic nicotine devices. Contents were measured by the North Dakota State University Core Synthesis & Analytical Services Facility using a high-performance liquid chromatography method adapted from Trehy et al. (2011). Results allowed for +/- 10 percent variation in nicotine concentration.
Of the 93 e-liquid containers examined, 70 claimed to contain nicotine ranging from 3-24 mg/mL. Among those containers, 51 percent had nicotine outside the labeled amount, with 34 percent having less and 17 percent having more. Actual content of nicotine ranged from 66 percent under the labeled concentrations to 172 percent over the labeled concentrations.
Twenty-three e-liquid containers in the study claimed to contain no nicotine, or 0 mg/mL. Of those, 43 percent did, in fact, contain nicotine. Amounts averaged 0.19 mg/mL, with the highest level found at 0.48 mg/mL.
This is yet more confirmation in a long line of research debunking the myth that e-cigarettes are safe alternatives to smoking. In January, The Lancet Respiratory Medicine journal published a study concluding that people who use e-cigarettes to quit smoking are approximately 28 percent less likely to quit than people who don’t use e-cigarettes. In December, researchers at Harvard T.H. Chan School of Public Health found that several popular flavors of e-cigarettes contain diacetyl, a chemical linked to irreversible lung disease.
Find out more about the dangers of e-cigarettes and other tobacco products.
Detailed information about the study can be found at the National Center for Biotechnology Information and The Journal of Pediatric Nursing.

Journal of Pediatric Nursing
The article is “Nicotine Content and Packaging of Electronic Cigarette Refill Liquids and Vape Store Compliance With Legal and Ethical Standards in North Dakota” by Kelly Buettner-Schmidt, PhD, RN, Donald Miller, PharmD, FASHP, Narayanaganesh Balasubramanian, PhD (doi: 10.1016/j.pedn.2016.03.019) It appears in the Journal of Pediatric Nursing, 2016 Apr 11. pii: S0882-5963(16)00077, published by Elsevier
Copies of this paper are available to credentialed journalists upon request; please contact Elsevier's Newsroom at newsroom@elsevier.com or +31 20 485 2492.
About the Journal of Pediatric Nursing

The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) is interested in publishing evidence-based practice, quality improvement, theory, and research papers on a variety of topics from US and international authors. JPN is the official journal of the Society of Pediatric Nurses and the Pediatric Endocrinology Nursing Society. Cecily L. Betz, PhD, RN, FAAN is the Founder and Editor in Chief. Journal content covers the life span from birth to adolescence. Submissions should be pertinent to the nursing care needs of healthy and ill infants, children, and adolescents, addressing their biopsychosocial needs. JPN also features the following regular columns for which authors may submit brief papers: Research Commentary, Clinical Practice, Hot Topics, and Technology.