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a b c Cai, Hua; Wang, Chen (2017). "Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns". Redox Biology. 13: 402–406. doi: 10.1016/j.redox.2017.05.013. ISSN 2213-2317. PMC 5493817. PMID 28667909. Kim, Sooyong; Selya, Arielle S (12 June 2020). "The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors". Nicotine & Tobacco Research. 22 (7): 1123–1130. doi: 10.1093/ntr/ntz157. PMC 7291806. PMID 31680169. past research remains inconclusive due to heavy confounding between cigarette and e-cigarette use 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
Since 2016 the US Food and Drug Administration (US FDA) regulated e-cigarettes under the classification of tobacco products and labeled them as electronic nicotine delivery systems. [191] A 2018 report commissioned by the US FDA decided to use the term e-cigarettes, indicating that for some use e-liquids containing no nicotine. [191] Medical organizations differ in their views about the health implications of vaping. [232] There is general agreement that e-cigarettes expose users to fewer toxicants than tobacco cigarettes. [162] Some healthcare groups and policy makers have hesitated to recommend e-cigarettes for quitting smoking, because of limited evidence of effectiveness and safety. [162] Some have advocated bans on e-cigarette sales and others have suggested that e-cigarettes may be regulated as tobacco products but with less nicotine content or be regulated as a medicinal product. [160] They are marketed to men, women, and children as being safer than traditional cigarettes. [346] They are also marketed to non-smokers. [50] E-cigarette marketing is common. [230] There are growing concerns that e-cigarette advertising campaigns unjustifiably focus on young adults, adolescents, and women. [174] Large tobacco companies have greatly increased their marketing efforts. [126] This marketing trend may expand the use of e-cigarettes and contribute to re-glamorizing smoking. [347] Some companies may use e-cigarette advertising to advocate smoking, deliberately, or inadvertently, is an area of concern. [152] A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s." [83]Vaping is likely far less harmful than smoking, but still harmful. [9] [10] [11] E-cigarette vapor contains fewer toxins than cigarette smoke. It contains traces of harmful substances not found in cigarette smoke. [11] Tobacco harm reduction has been a controversial area of tobacco control. [118] Health advocates have been slow to support a harm reduction method out of concern that tobacco companies cannot be trusted to sell products that will lower the risks associated with tobacco use. [118] A large number of smokers want to reduce harm from smoking by using e-cigarettes. [119] The argument for harm reduction does not take into account the adverse effects of nicotine. [46] There cannot be a defensible reason for harm reduction in children who are vaping with a base of nicotine. [120] Quitting smoking is the most effective strategy to tobacco harm reduction. [121]
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] Jankowski, Mateusz; Brożek, Grzegorz; Lawson, Joshua; Skoczyński, Szymon; Zejda, Jan (2017). "E-smoking: Emerging public health problem?". International Journal of Occupational Medicine and Environmental Health. 30 (3): 329–344. doi: 10.13075/ijomeh.1896.01046. ISSN 1232-1087. PMID 28481369. a b c d Siu, AL (22 September 2015). "Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement". Annals of Internal Medicine. 163 (8): 622–634. doi: 10.7326/M15-2023. PMID 26389730. 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]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. E-cigarettes containing nicotine have been listed as drug delivery devices in a number of countries, and the marketing of such products has been restricted or put on hold until safety and efficacy clinical trials are conclusive. [336] Since they do not contain tobacco, television advertising in the US is not restricted. [337] Some countries have regulated e-cigarettes as a medical product even though they have not approved them as a smoking cessation aid. [178] A 2014 review stated the emerging phenomenon of e-cigarettes has raised concerns in the health community, governments, and the general public and recommended that e-cigarettes should be regulated to protect consumers. [130] It added, "heavy regulation by restricting access to e-cigarettes would just encourage continuing use of much unhealthier tobacco smoking." [130] A 2014 review said regulation of the e-cigarette should be considered on the basis of reported adverse health effects. [178] Criticism of vaping bans France's e-cigarette market was estimated by Groupe Xerfi to be €130 million in 2015. [393] Additionally, France's e-liquid market was estimated at €265 million. [393] In December 2015, there were 2,400 vape shops in France, 400 fewer than in March of the same year. [393] Industry organization Fivape said the reduction was due to consolidation, not to reduced demand. [393] Environmental impact Tobacco product waste Despite these earlier efforts, Hon Lik, a Chinese pharmacist and inventor, who worked as a research pharmacist for a company producing ginseng products, [259] is frequently credited with the invention of the modern e-cigarette. [242] Hon quit smoking after his father, also a heavy smoker, died of lung cancer. [259] In 2001, he thought of using a high frequency, piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine. [260] This design creates a smoke-like vapor. [259] Hon said that using resistance heating obtained better results and the difficulty was to scale down the device to a small enough size. [260] Hon's invention was intended to be an alternative to smoking. [260] Hon Lik sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera." [261] Ultimately, Hon Lik did not quit smoking. He is now a dual user, both smoking and vaping. [262] The Ruyan e-cigar was first launched in China in 2004. [263] McNeill, A; Brose, LS; Calder, R; Bauld, L; Robson, D (February 2018). "Evidence review of e-cigarettes and heated tobacco products 2018" (PDF). Public Health England. UK. pp.1–243.
Henry, Travis S.; Kligerman, Seth J.; Raptis, Constantine A.; Mann, Howard; Sechrist, Jacob W.; Kanne, Jeffrey P. (2020). "Imaging Findings of Vaping-Associated Lung Injury". American Journal of Roentgenology. 214 (3): 498–505. doi: 10.2214/AJR.19.22251. ISSN 0361-803X. PMID 31593518. S2CID 203985885. E-Liquid Manufacturing Standards (PDF). US: American E-Liquid Manufacturing Standards Association (AEMSA). 4 September 2015. pp.1–13. Wang, Meng; Wang, Jian-Wei; Cao, Shuang-Shuang; Wang, Hui-Qin; Hu, Ru-Ying (2016). "Cigarette Smoking and Electronic Cigarettes Use: A Meta-Analysis". International Journal of Environmental Research and Public Health. 13 (1): 120. doi: 10.3390/ijerph13010120. ISSN 1660-4601. PMC 4730511. PMID 26771624.a b c d Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (2013). "Electronic Cigarettes: A Short Review". Respiration. 86 (5): 433–8. doi: 10.1159/000353253. ISSN 1423-0356. PMID 24080743.
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] One of the challenges in studying e-cigarettes is that there are hundreds of brands and models of e-cigarettes sold that vary in the design and operation of the devices and composition of the liquid, and the technology continues to change. [160] E-cigarettes have not been subjected to the same type of efficacy testing as nicotine replacement products. [161] There are also social concerns - use of e-cigarettes may normalize tobacco use and prolong cigarette use for people who could have quit instead, or it could put extra pressure on smokers to stop cigarette smoking because e-cigarettes are a more socially acceptable alternative. [124] The evidence indicates smokers are more frequently able to completely quit smoking using tank devices compared to cigalikes, which may be due to their more efficient nicotine delivery. [162] 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]
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Vaping correlates with smoking among young people, even in those who would otherwise be unlikely to smoke. [88] Experimenting with vaping encourages young people to continue smoking. [89] A 2015 study found minors had little resistance to buying e-cigarettes online. [90] Teenagers may not admit to using e-cigarettes, but use, for instance, a hookah pen. [91] As a result, self-reporting may be lower in surveys. [91]
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