Nicotine is an addictive chemical. Researchers found that mice exposed to e-cigarette aerosol for 54 weeks developed carcinomas of the lungs and abnormal bladder cell growth.
TAGS: e-cigarettes the truth about. Action needed on e-cigarettes. Quitting e-cigarettes. Local restrictions on flavored tobacco and e-cigarette products. Home Research and resources E-cigarettes: Facts, stats and regulations. Fact Sheet E-cigarettes: Facts, stats and regulations. See where we stand on e-cigarettes. E-cigarettes are devices that operate by heating a liquid solution to a high enough temperature so that it produces an aerosol that is inhaled.
Solutions, sometimes called e-liquids, almost always include nicotine, flavoring and a humectant, such as propylene glycol, to retain moisture and create the aerosol when heated. While many of the flavorings and humectants used in e-liquids have been approved by the Food and Drug Administration for oral consumption, they have not been approved for inhalation. Thus, their health consequences are not well known when consumed in this manner.
There is an ongoing outbreak of significant lung illness and death 2, reported cases and 39 deaths as of November 5, due to vaping. On November 8, , the CDC identified vitamin E acetate as a significant concern in the outbreak finding the chemical in all 29 samples it had analyzed from victims.
The most recent generation of e-cigarettes on the market, which include pre-filled pod systems like JUUL and refillable systems like Suorin Drop and Kandypens, use nicotine salts in the e-liquids. The nicotine salt formulas allow for much higher levels and efficient delivery of nicotine with less irritation compared to earlier generations of e-cigarettes — prompting questions about the use, purpose and safety of this novel form of nicotine.
Unlike vapor, which is simply a substance in gas form, the aerosol from an e-cigarette contains tiny chemical particles from both the liquid solution and the device e. There is evidence to suggest that these particles lead to cardiovascular injury, with links to negative effects on resting heart rate, blood pressure and the cells that line the blood vessels. When e-cigarettes first began entering the market around , some devices were designed to resemble regular cigarettes, while others looked more like cigars, pipes, pens and even USB flash drives.
To account for the diversity in product design, some researchers have classified e-cigarettes as first, second or third generation devices. A first generation e-cigarette is one that closely resembles a cigarette and is disposable. A second generation e-cigarette is a larger, usually pen-shaped device, that can be recharged. A third generation e-cigarette refers to devices that do not resemble a combustible cigarette and often have very large and sometimes customizable batteries.
More recently, e-cigarettes that have a sleek, high-tech design and easily rechargeable batteries have entered the market. The most popular, JUUL, emerged in and quickly established itself as a leading e-cigarette product, comprising nearly three-quarters Labeling is not always a reliable indicator of nicotine content, as studies have found mislabeling to be a common issue in the category. The way an e-cigarette is used or modified also affects the delivery of nicotine to an individual user.
Some e-cigarette products deliver nicotine as efficiently as a cigarette. The use of nicotine salts also lowers the pH of e-liquids, which allows higher concentrations of nicotine to be delivered with less irritation. For example, the maker of JUUL claims the product has a nicotine content like traditional cigarettes, and that it delivers the nicotine up to 2. In the U. In addition to the rate of nicotine delivery, the nicotine content of products like JUUL also raises concerns about the potential for addiction.
Anecdotally, youth are reporting signs of severe dependence, such as inability to concentrate in class, using an e-cigarette upon waking, and using e-cigarettes at night after waking with a craving. Compared with the very small amount of youth use in 1. The current use rate among middle schoolers rose from 0.
Using e-cigarettes has been shown to increase the likelihood of smoking cigarettes among young people, raising concerns that e-cigarettes are acting as entry nicotine products that may lead to use of more dangerous nicotine products. According to a recent study, U. Many young e-cigarette users do not know what is in the products they are using. In fact, a Truth Initiative study showed that nearly two-thirds of JUUL users aged were not aware the product always contains nicotine.
As rates of use increase, we are also seeing the frequency of use how many times a user vapes in a day go up, indicating that users are not simply experimenting with e-cigarettes but are instead using them habitually. The National Youth Tobacco Survey data show that Youth e-cigarette users cite flavors as a top reason they began using e-cigarettes, second only to use by a family member or friend. As much as Research suggests that mint and menthol, which remain available for sale, have continued to increase in popularity.
Young adult use of e-cigarettes every day or some days increased from 2. Compared with adults aged 25 and older, young adults are more likely to try e-cigarettes and report having used e-cigarettes in the past 30 days. It concluded that the continued use of JUUL by Mississippi undergraduate students was more likely than the continued used of other e-cigarettes after an initial trial. The study found that day use was three times higher among those who had tried JUUL than a different e-cigarette.
The growth in the popularity of e-cigarettes among young adults has caused concerns that use will lead to the initiation of cigarette s and other tobacco products. JUUL also hired social media influencers for product promotion. A study published in reported that within two randomized control trials, e-cigarettes with nicotine helped individuals quit better than non-nicotine e-cigarettes. A study by the U. However, a majority of e-cigarette users were still using e-cigarettes at the one-year follow-up.
Researchers noted the study was based on a middle-aged adult population median age of 41 actively seeking to quit smoking and receiving at least four weeks of behavioral support. Notably, the U. Quit smoking and vaping tools. A recent and robust research literature review of e-cigarette health effects found that use of these products has been associated with increased odds of chronic cough, phlegm and bronchitis, as well as asthma diagnoses. Ongoing case studies and in vitro research that exposed human tissue to e-cigarette aerosol suggested that e-cigarettes may be causing quantifiable injury to the small airways of the lungs and were associated with a number of inflammatory diseases of the respiratory system, like pneumonia and interstitial lung disease.
Human cells exposed to vaped e-liquid have also been found to have decreased viability, with certain flavor compounds posing particular cell toxicity risks. There is uncertainty regarding the way these infections may manifest given the potential for other lung injury and inflammation in lung tissue from e-cigarette use.
The first study to link e-cigarette use to cancer was published in October Researchers found that mice exposed to e-cigarette aerosol for 54 weeks developed carcinomas of the lungs and abnormal bladder cell growth. Research has also found that some flavors are potentially more toxic than others. Researchers found that exposure to increased cinnamon flavoring caused significant cell death compared to other flavors.
Another concern related to flavoring stems from pulegone — a compound found in prepared oil extracts of certain mint plants. Pulegone is a known carcinogen and the tobacco industry has in the past reduced the amount of this compound in menthol tobacco products as a result of toxicity concerns.
The FDA banned pulegone as a food additive in , yet studies have identified that substantial amounts of this additive are found in mint and menthol e-liquid in the U. Research also indicates that mixing multiple flavors can be more toxic to cells than exposure to just one flavor at a time.
Research regarding the impact of e-cigarettes on cardiovascular health has yielded mixed results. Some studies have shown that short-term exposure to e-cigarette aerosol has no measurable harm on cardiovascular health. However, others suggest negative effects on resting heart rate, blood pressure and the cells that line the blood vessels.
More extensive research is needed to gain perspective on the long-term effects of e-cigarette use on heart health, which have yet to be identified. Another pressing concern of e-cigarette use on cardiovascular health is the creation of carbonyl compounds from e-cigarette aerosol. Carbonyls are created when propylene glycol and glycerol — common solvents in e-liquid — are exposed to the high heat of an e-cigarette coil.
Many of these carbonyl compounds have been previously associated with an increased risk of blood clot and atherosclerosis — a disease in which plaque builds on the walls of arteries, narrowing blood flow. Exposure to nicotine among youth is particularly dangerous since it has been shown to have an effect on key brain receptors, making young people more susceptible to nicotine addiction. There is some evidence that the effect of nicotine on developing brains may prime not just nicotine addiction, but greater vulnerability to addiction to other drugs as well.
PREGNANCY Because most e-cigarettes contain nicotine, which can alter nerve cell functioning in developing organisms, especially during fetal development, they should not be used by youth or pregnant women. Pregnant women who use nicotine are also at a greater risk for stillbirth and preterm delivery. At least 60 chemical compounds have been found in e-liquids, and still more are present in the aerosol produced by e-cigarettes.
Heavy metals such as cadmium, lead, nickel, tin and copper have all been detected in aerosols produced by e-cigarettes. E-cigarettes produced fewer free-radicals than combustible cigarettes, however, even low levels of repeated exposure to free-radicals can cause oxidative stress, which increases the risk for cardiovascular and respiratory diseases. Researchers have identified several substances which are either harmful or potentially harmful to e-cigarette users, including delivery solvents and propylene glycol, which can cause dry mouth and upper respiratory infections as well as pulegone, a known carcinogen.
While e-cigarettes contain far fewer toxins than combustible cigarettes, they are not free of toxins and still deliver harmful chemicals. More than 8, accidental liquid nicotine exposures were reported by U. Nearly 5, 4, children under the age of 5 were treated in U. More than half The rate of explosions is unknown, but both hospitals and burn centers have reported injuries from e-cigarettes.
However, exposure among vulnerable populations, including pregnant women and children, could still be dangerous. As of August , the agency had received reports of seizure or other neurological symptoms that occurred between and The CDC, FDA and state and local health departments are investigating a multistate outbreak of severe lung injury associated with e-cigarette or vaping product use.
Virgin Islands. Thirty-nine deaths in 24 states have been confirmed. E-cigarettes are promoted heavily online through e-cigarette company-sponsored advertisements, and on YouTube and Twitter. More recently, mobile ads have become a popular place to advertise e-cigarettes. Mobile ads, or paid advertisements on smartphone applications and websites optimized for mobile, have the potential to reach millions of young people. Some e-liquids have been marketed to look like common food items — many of which appeal to kids.
Those were removed, or at least renamed, after the companies owning those copyrights took action to protect their intellectual property. Other food and candy flavors remained on the market. Since May , the FDA, often in conjunction with the FTC, has taken action against several e-liquid companies that marketed their products to look like candy or other kid-friendly food items, such as Reddi-wip, Nilla wafers and Warheads candy.
The FDA has also recently announced moves to restrict the sale of candy- or fruit-flavored e-cigarettes. The deeming regulation also includes requirements for pre-market review for e-cigarettes as new tobacco products. In other words, every e-cigarette on the market right now is illegal because it has not gone through an FDA review, and is only allowed to be sold because the FDA gave them a temporary pass.
Additionally, when the deeming regulation was finalized, the FDA indicated that no products could come on the market after August without pre-market review and authorization by the FDA. Many companies have not complied with that and the FDA has sent warning letters to these companies. For example, in October , the FDA sent a letter to Eonsmoke regarding nearly flavored e-cigarette products that came on the market after August without pre-market review and authorization.
This delay in the compliance deadline enabled the proliferation of e-cigarettes that have never undergone an FDA review. In March , a group of public health organizations, including Truth Initiative, sued the FDA for unlawfully delaying the implementation of the deeming rule. In May , a federal judge ruled that the FDA had acted illegally by allowing e-cigarettes, including those with flavors that appeal to youth, to remain on the market without formally reviewing their impact on public health.
In addition, the Trump administration has indicated it will take all flavored e-cigarettes off the market if they have not undergone premarket review. By early November, the Administration had signaled it may walk back from that policy. As of November 8, , no policy has been released. In March , the FDA issued an advance notice of proposed rulemaking to request public comment to better understand the role that flavors in tobacco products play in attracting youth, as well as the role they may play in helping some smokers switch to potentially less harmful forms of nicotine delivery.
However, this request for comment is not a guarantee of agency action on this issue and no further rule-making action on flavors has been taken or announced by the FDA as of this writing. In March , the FDA proposed to restrict the sales of flavored e-cigarettes, except mint, menthol and tobacco flavors, to age-restricted locations and online retailers that place a limit on the quantity that a customer may purchase within a certain time period and have independent, third-party age-verification services.
As of October , a final guidance had not yet been issued by the FDA. As of Aug. Paul, Minnesota; and Providence, Rhode Island. However, a large majority of the U. In September and October , governors in several states Michigan, Montana, New York, Oregon, Rhode Island and Washington used their emergency executive powers or directed their state health departments to temporarily ban in-store and online sales of flavored e-cigarettes, citing the youth e-cigarette epidemic and recent health concerns regarding seizures and lung illnesses.
As of late October , however, the New York, Michigan and Oregon bans had been temporarily suspended. In Massachusetts, the governor took the extraordinary step of suspending the sale of all e-cigarettes. And while the ban has not been overturned, a judge recently ruled that it must be resubmitted with an opportunity for public comment.
Several other governors have ordered their legislatures to consider legislation to restrict e-cigarette sales. The Utah Department of Health also issued a temporary emergency rule to restrict the sale of flavored e-liquids to licensed specialty tobacco stores. On Sept. Many consumers have recognized e-cigarettes as a better alternative to traditional combustible cigarettes. There are still many areas that require further long-term research, such as the actual harm reduction elements of e-cigarettes, the maximization of their harm reduction, and other potential effects of vaping.
We want to collect evidence through a scientific approach and strive to prove the potential for e-cigarettes to be less harmful, and in doing so, provide users the option to choose an alternative. The laboratory is certified by the internationally recognized China National Accreditation Service for Conformity Assessment. RELX started its groundbreaking research on the toxicological and pharmacological study on its products in , and the new bioscience lab will focus on vivo and in vitro tests, as well as conduct pre-clinical safety assessments in There is still a lot of research to be done.
Among these were that according to the data, the levels of harmful substances such as benzene and four TSNAs Tobacco-specific N-nitrosoamines emitted by RELX products are lower than those found in combustible cigarette smoke by over RELX is currently conducting research projects on different topics with six universities including the Sun Yat-sen University and Shenzhen Institutes of Advanced Technology, the Chinese Academy of Sciences, two hospitals and nine scientific research institutions.
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