ENDS have transformed nicotine delivery with discreet devices, high-nicotine salts, and flavors that change initiation and dependence patterns—especially among youth—while some adults use vaping as a bridge away from combustion. Vaping and Electronic Nicotine Delivery Systems clarifies how to navigate this ambivalent reality with patient-centered counseling and risk framing. We start with the tech: open vs. closed systems, power/coil materials, solvent ratios, and nicotine salts that enable rapid delivery at low throat hit. Chemistry is half the picture; the other half is behavior—puff topography, stealth use at school or work, dual use with cigarettes, and “stress puffs” that cluster with screens, caffeine, and alcohol. Clinical assessment covers dependence (time to first vape, nocturnal use), respiratory symptoms, sleep, mood, and co-occurring psychiatric conditions; pregnancy, cardiovascular disease, and youth require special caution. Counseling focuses on goals: complete cessation vs. harm reduction. For cessation, regulated NRT or varenicline plus behavioral supports remain first-line; for harm reduction where allowed, structured substitution plans and dual-use minimization are essential, with frequent check-ins to avoid compensatory overuse. We address safety issues—battery/charger risks, counterfeit pods/liquids, flavor toxicants—and emphasize responses to lung-injury alerts from authorities. Public health responsibilities include age verification, clean indoor air adherence, and messaging that deters youth uptake. Equity matters: cost, language, and rural access influence choices and outcomes. Measurement is pragmatic—days without combustion, puffs/day or pod/week, cough/wheeze change, sleep/energy, and quit readiness. With transparent risk communication and consistent follow-up, Vaping and Electronic Nicotine Delivery Systems, the debate and data at a vaping and ENDS conference, and understanding of nicotine salts help clinicians support safer paths while keeping “quit” in sight.