title: Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors.
abstract: To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements.
  
  
  METHODS
  We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis.
  
  
  RESULTS
  Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred.
  
  
  CONCLUSIONS
  Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states.
authors.affiliation: School of Nursing, North Dakota State University, Fargo, ND. Electronic address: Kelly.buettner-schmidt@ndsu.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Buettner-Schmidt
authors.affiliation: School of Pharmacy, North Dakota State University, Fargo, ND.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.affiliation: Department of Chemistry and Biochemistry, North Dakota State University, Fargo, ND.
authors.forename: Narayanaganesh
authors.initials: N
authors.lastname: Balasubramanian
mesh_terms: D000293:Adolescent; D002648:Child; D003132:Commerce / Q000331:legislation & jurisprudence*; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D005421:Flavoring Agents; D033161:Government Regulation; D006801:Humans; D008297:Male; D033242:Minors; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects*; D011050:Policy Making; D011356:Product Labeling / Q000592:standards*; D019064:Product Packaging; D017751:Safety Management; D014481:United States
chemical_list: D005421:Flavoring Agents; D009538:Nicotine
keywords: Child safety; E-cigarette; Nicotine; Product packaging; Public policy; Regulation