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Once again, there is a strong potential for confounding, such that comparisons of dual users with smokers who do not use e-cigarettes will not yield meaningful causal estimates" [8] Konstantinos Farsalinos (2015). "Electronic cigarette evolution from the first to fourth generation and beyond" (PDF). Global Forum on Nicotine. p.23. Archived from the original (PDF) on 8 July 2015. According to the CDC, E-cigarettes are not safe during pregnancy. "Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby's brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby." [110] A 2014 review found "In addition to the uniqueness of the liquid compositions in each brand, inconsistency of both the device performance properties and the data collection methodologies used by researchers contribute to the observed variation in constituent levels and to the range of particle size distributions among products." [2] The American Association of Public Health Physicians (AAPHP) suggests those who are unwilling to quit tobacco smoking or unable to quit with medical advice and pharmaceutical methods should consider other nicotine-containing products such as e-cigarettes and smokeless tobacco for long-term use instead of smoking. [134] A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both. [61] This report found that such "dual-use" of e-cigarettes and tobacco "will have much smaller beneficial effects on overall survival compared with quitting smoking completely." [61] Smoking cessation
a b Drope, Jeffrey; Cahn, Zachary; Kennedy, Rosemary; Liber, Alex C.; Stoklosa, Michal; Henson, Rosemarie; Douglas, Clifford E.; Drope, Jacqui (November 2017). "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine". CA: A Cancer Journal for Clinicians. 67 (6): 449–471. doi: 10.3322/caac.21413. ISSN 0007-9235. PMID 28961314. S2CID 32928770. Nicotine is a parasympathomimetic stimulant [205] that binds to and activates nicotinic acetylcholine receptors in the brain, [149] which subsequently causes the release of dopamine and other neurotransmitters, such as norepinephrine, acetylcholine, serotonin, gamma-aminobutyric acid, glutamate, endorphins, [206] and several neuropeptides, including proopiomelanocortin-derived α-MSH and adrenocorticotropic hormone. [207] Corticotropin-releasing factor, Neuropeptide Y, orexins, and norepinephrine are involved in nicotine addiction. [208] Continuous exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor desensitization and subsequent receptor upregulation. [206] a b c Weaver, Michael; Breland, Alison; Spindle, Tory; Eissenberg, Thomas (2014). "Electronic Cigarettes". Journal of Addiction Medicine. 8 (4): 234–240. doi: 10.1097/ADM.0000000000000043. ISSN 1932-0620. PMC 4123220. PMID 25089953. Companies should not be able to claim that e-cigarettes are a cessation aid unless they are approved by the FDA for that purpose...There is not yet enough evidence for clinicians to counsel their patients who are using combustible tobacco products to use e-cigarettes as a primary cessation aid. The association will continue to monitor the evidence concerning e-cigarettes as cessation devices to determine whether they might be integrated into comprehensive cessation strategies. For patients with existing cardiovascular disease and stroke, or at risk of a cardiovascular disease event, intensive cessation counseling should be offered as soon as possible." [27] Main article: Usage of electronic cigarettes Popularity Estimated trends in the global number of vapersIn 1927, Joseph Robinson applied for a patent for an electronic vaporizer to be used with medicinal compounds. [243] The patent was approved in 1930 but the device was never marketed. [244] In 1930, the United States Patent and Trademark Office reported a patent stating, "for holding medicinal compounds which are electrically or otherwise heated to produce vapors for inhalation." [245] In 1934 and 1936, further similar patents were applied for. [245]
Linda Bauld; Kathryn Angus; Marisa de Andrade (May 2014). "E-cigarette uptake and marketing" (PDF). Public Health England. UK. pp.1–19. Thirión-Romero, Ireri; Pérez-Padilla, Rogelio; Zabert, Gustavo; Barrientos-Gutiérrez, Inti (2019). "Respiratory Impact of Electronic Cigarettes and Low-Risk Tobacco". Revista de investigación Clínica. 71 (1): 17–27. doi: 10.24875/RIC.18002616. ISSN 0034-8376. PMID 30810544. S2CID 73511138. Other motivations include reduced odor and fewer stains. [58] E-cigarettes also appeal to technophiles who enjoy customizing their devices. [58] Gateway theory There are varied reasons for e-cigarette use. [6] Most users are trying to quit smoking, [52] but a large proportion of use is recreational or as an attempt to get around smoke-free laws. [6] [7] [53] [52] Many people vape because they believe vaping is safer than smoking. [54] [55] [56] The wide choice of flavors and lower price compared to cigarettes are also important factors. [57] A 2019 review concluded that, "no long term vaping toxicological/safety studies have been done in humans; without these data, saying with certainty that e-cigarettes are safer than combustible cigarettes is impossible." [95]
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Long-term exposure to nicotine can also result in downregulation of glutamate transporter 1. [209] Long-term nicotine exposure upregulates cortical nicotinic receptors, but it also lowers the activity of the nicotinic receptors in the cortical vasodilation region. [210] These effects are not easily understood. [210] With constant use of nicotine, tolerance occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain. [206] The ACS does not recommend the use of e-cigarettes as a cessation method. No e-cigarette has been approved by the Food and Drug Administration (FDA) as a safe and effective cessation product. The long-term risks of exclusive use of e-cigarettes are not fully known but evidence is accumulating that e-cigarette use has negative effects on the cardiovascular system and lungs. Without immediate measures to stop epidemic use of these products, the long-term adverse health effects will increase." [238] Aguilar, Carmen (11 June 2018). "Lung cancer deaths on the rise in two thirds of European countries". VoxEurop/The European Data Journalism Network (EDJNet). The later-generation and "tank-style" e-cigarettes with a higher voltage (5.0V [177]) may generate equal or higher levels of formaldehyde compared to smoking. [3] A 2015 report by Public Health England found that high levels of formaldehyde only occurred in overheated "dry-puffing". [179] Users detect the "dry puff" (also known as a "dry hit" [180]) and avoid it, and they concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes." [179] However, e-cigarette users may "learn" to overcome the unpleasant taste due to elevated aldehyde formation, when the nicotine craving is high enough. [181]
Pax Labs has developed vaporizers that heats the leaves of tobacco to deliver nicotine in a vapor. [408] [409] In June 2015, they introduced Juul a type of e-cigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to an actual cigarette puff. [385] Juul was spun off from Pax Labs in June 2017 and is now available by the independent company Juul Labs. [410] The eTron 3T from Vapor Tobacco Manufacturing, launched in December 2014, [411] employs a patented, aqueous system whereby the tobacco is extracted into water. [412] The e-liquid contains organic tobacco, organic glycerin, and water. [411] A 2022 study showed that E-cigarettes could actually lead people to smoke tobacco. Because the nicotine in e-cigarettes is addicting, it can cause new smokers to try tobacco and can cause current smokers to revert to using cigarettes [93]
While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in several countries may be indirectly encouraging traditional cigarette use. [83] E-cigarette advertisements are also in magazines, newspapers, online, and in retail stores. [349] Between 2010 and 2014, e-cigarettes were second only to cigarettes as the top advertised product in magazines. [350] As cigarette companies have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction. [124] This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry. [124] There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some stating to want to cooperate in "harm reduction". [83] E-cigarette advertising for using e-cigarettes as a quitting tool have been seen in the US, UK, and China, which have not been supported by regulatory bodies. [351] National Academies of Sciences, Engineering, and Medicine; etal. (Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems) (January 2018). Stratton, Kathleen; Kwan, Leslie Y.; Eaton, David L. (eds.). Public Health Consequences of E-Cigarettes. Washington, DC: National Academies Press. doi: 10.17226/24952. ISBN 978-0-309-46834-3. PMID 29894118 . Retrieved 15 January 2023. Summary
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