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Introduction: The use of electronic cigarettes (ECs) is controversial. Among the issues of concern is safety: some people think ECs are safer alternatives to conventional cigarettes (CCs), while others are concerned about the possible health effects of using ECs. Although many studies have identified hazards in EC emissions, there is only limited information about exposure levels and the likely health risks of using ECs. Methods: This study aimed to characterise the health risks of using ECs and compare them with the risks of using CCs by utilizing the U.S. EPA health risk assessment model. Hazards were identified and profiled (toxicological and exposure) using document review. The risk from exposure to hazards was thus identified and the overall health risks of using ECs and CCs were compared, and then benchmarked with international guideline levels for each hazard to evaluate whether the detected hazards might pose a significant health risk to users or not, given comparable exposures. Results: Exposures to toxicants of concern identified in EC emissions (acetaldehyde, acrolein, formaldehyde, diethylene glycol, propylene glycol, cadmium, nickel, NNK, and NNN) are almost all far lower than in CC emissions, indicating EC use under standard use conditions is likely to be far safer than smoking. As most hazards’ exposure levels in EC emissions are lower than the defined guideline levels, ECs are also likely to be of low risk to health. Conclusions & Recommendations: The health risks of using ECs are lower than CCs. In a few studies of some ECs, some toxicant levels exceeded levels regarded as safe by international standards. However, studies of ECs lack standardisation in the assessment methods for EC product performance, usage patterns and exposure. Future studies should adhere to a standard methodology to enable ready comparisons. Regulation of EC manufacture and sales is needed to prevent the sale of low quality ECs. Lastly, health professionals and the general public need more information on ECs as safer alternatives to cigarette smoking.
Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes. Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.
This booklet for schools, medical personnel, and parents contains highlights from the 2012 Surgeon General's report on tobacco use among youth and teens (ages 12 through 17) and young adults (ages 18 through 25). The report details the causes and the consequences of tobacco use among youth and young adults by focusing on the social, environmental, advertising, and marketing influences that encourage youth and young adults to initiate and sustain tobacco use. This is the first time tobacco data on young adults as a discrete population have been explored in detail. The report also highlights successful strategies to prevent young people from using tobacco.
This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.
This open access book offers the first in-depth study of the history and current debates surrounding electronic cigarettes comparing the UK, US and Australia. Since their introduction, e-cigarettes have been the subject of much public, media and regulatory attention, with discussion centring on whether these devices encourage or discourage smoking. This study delves into the history of policymaking and institutions in three countries which have taken different approaches to the regulation of e-cigarettes. In the UK, the tradition of harm reduction through nicotine has helped form a response which has endorsed e-cigarettes, though not without considerable controversy. In contrast, the US has a cessation-only anti-tobacco agenda, and Australia has effectively banned e-cigarettes. This book argues that each country frames the long-term use of nicotine differently and prioritises the health of different groups within the population of smokers or non-smokers, set against a broad backdrop of national responses to addiction. By taking this comparative approach, the authors explore the relationship between history, evidence and policy in public health more widely.
This eighth report of the Study Group addresses electronic nicotine delivery system (ENDS), electronic non-nicotine delivery system (ENNDS) and heated tobacco product (HTPs); however, it does not cover all aspects of these products, because many of the papers were written to meet the request of COP8, which was to review understanding on novel and emerging tobacco products (FCTC/COP8). Continued research is necessary on these products; the Study Group will cover other products of interest (including traditional products, such as waterpipes, cigarettes and smokeless tobacco) in its next report, guided by countries’ regulatory requirements and pertinent issues in tobacco product regulation. This will ensure continued, timely technical support to all countries and address all products, recognizing that their availability depends on the jurisdiction.
This article collection reviews key research on e-cigarette use and includes 28 open access research papers by various authors. Topics include: Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes; Electronic cigarettes: a survey of users; Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study; Study protocol for a randomised controlled trial of electronic cigarettes versus nicotine patch for smoking cessation; Multicentric cohort study on the long-term efficacy and safety of electronic cigarettes: study design and methodology; Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks; Nonsmokers' responses to new warning labels on smokeless tobacco and electronic cigarettes: an experimental study; Portrayal of electronic cigarettes on YouTube; A fresh look at tobacco harm reduction: the case for the electronic cigarette; Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues; Influence of E-smoking liquids on human periodontal ligament fibroblasts; Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series; Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach; Associations between e-cigarette access and smoking and drinking behaviours in teenagers; Use of electronic cigarettes among Romanian university students: a cross-sectional study; Contexts of cigarette and e-cigarette use among dual users: a qualitative study; Nicotine delivery, tolerability and reduction of smoking urge in smokers following short-term use of one brand of electronic cigarettes; Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers; Electronic cigarettes have a potential for huge public health benefit; Why public health people are more worried than excited over e-cigarettes; E-cigarettes: methodological and ideological issues and research priorities; Electronic cigarette use and harm reversal: emerging evidence in the lung; E-cigarette use and relations to tobacco and alcohol use among adolescents; Electronic cigarettes and nicotine dependence: evolving products, evolving problems; Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis; Electronic cigarettes: overview of chemical composition and exposure estimation; E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness: secondary analysis of data from the ASCEND trial; Associations between perceptions of e-cigarette advertising and interest in product trial amongst US adult smokers and non-smokers: results from an internet-based pilot survey.
Electronic cigarettes (E-cigarettes), also known as vape devices or by trade names such as JUUL, are handheld devices that aerosolize liquid commonly containing nicotine, humectants and flavorings. Used by 1 in 5 high school students in 2020, they are the most common tobacco product used by youth. E-cigarette use has been associated with a variety of health issues such as nicotine addiction, e-cigarette or vaping associated lung illness (EVALI), seizures, and increased risk of cardiovascular disease. This first-of-its-kind book begins with an introduction and background on the historical context of tobacco products. The next chapters provide an overview of the e-cigarette landscape and reviews the e-cigarette devices and solutions and the evolution of these products. This is followed by reviews of the health effects of e-cigarettes on users and non-users and includes recommendations for prevention and treatment of youth e-cigarette use. The last few chapters address the public health impact of e-cigarettes with a review of the evidence of e-cigarettes in smoking cessation. The book closes with policy and advocacy approaches and a resource page. E-cigarette and vape device use pose a public health crisis. This book contains succinct practical information and is a key reference for pediatricians as well as clinicians of all specialities. It also serves as a resource for health professionals, including tobacco dependence treatment providers and public health experts.
The National Institutes of Health Publication 07-6242, The Role of the Media in Promoting and Reducing Tobacco Use, NCI Tobacco Control Monograph 19, (the 19th of the Tobacco Control Monograph series of the National Cancer Institute (NCI) provides a critical, scientific review and synthesis of current evidence regarding the power of the media both to encourage and discourage tobacco use. The work presented is the most current and comprehensive distillation of the scientific literature on media communications in tobacco promotion and tobacco control. The six main parts of this monograph deal with aspects of media communications relevant to tobacco promotion and tobacco control. Part 1, an overview, frames the rationale for the monograph's organization and presents the key issues and conclusions of the research as a whole and of the individual chapters. This section describes media research theories that guided this assessment of the relationship between media and tobacco use, which can be viewed as a multilevel issue ranging from consumer-level advertising and promotion to stakeholder-level marketing aimed toward retailers, policymakers, and others. Part 2 further explores tobacco marketing—the range of media interventions used by the tobacco industry to promote its products, such as brand advertising and promotion, as well as corporate sponsorship and advertising. This section also evaluates the evidence for the influence of tobacco marketing on smoking behavior and discusses regulatory and constitutional issues related to marketing restrictions. Part 3 explores how both the tobacco control community and the tobacco industry have used news and entertainment media to advocate their positions and how such coverage relates to tobacco use and tobacco policy change. The section also appraises evidence of the influence of tobacco use in movies on youth smoking initiation. Part 4 focuses on tobacco control media interventions and the strategies, themes, and communication designs intended to prevent tobacco use or encourage cessation, including opportunities for new media interventions. This section also synthesizes evidence on the effectiveness of mass media campaigns in reducing smoking. Part 5 discusses tobacco industry efforts to diminish media interventions by the tobacco control community and to use the media to oppose state tobacco control ballot initiatives and referenda. Finally, Part 6 examines possible future directions in the use of media to promote or to control tobacco use and summarizes research needs and opportunities. Key lessons from this volume can inform policymakers as well as scientists and practitioners. Most critical from a policy standpoint is the conclusion, supported by strong evidence, that both exposure to tobacco marketing and depictions of tobacco in movies promote smoking initiation. In the United States in 2005—the same year in which 2.7 million American adolescents aged 12 to 17 used cigarettes in the past month1 and 438,000 Americans died prematurely from diseases caused by tobacco use or secondhand smoke exposure2—the tobacco industry spent $13.5 billion (in 2006 dollars) on cigarette advertising and promotion,3 an average of $37 million per day. The tobacco industry continues to succeed in overcoming partial restrictions on tobacco marketing in the United States, and tobacco marketing remains pervasive and effective in promoting tobacco use. Efforts to curb the depiction of tobacco use in movies have increased in recent years, and the evidence reviewed here indicates that progress in this area could be expected to translate into lower rates of youth smoking initiation in the future. Strong evidence indicates that media campaigns can reduce tobacco use. This volume highlights the complexities of assessing the media's influence on tobacco-related attitudes and behavior. A vast range of research is reviewed.~
Toxicological Evaluation of Electronic Nicotine Delivery Products (ENDP) discusses the scientific basis for the toxicological assessment and evaluation of ENDPs. The book covers aerosol chemistry, in vitro and in vivo studies as well as clinical studies. It provides the basis for the evaluation of short and long term-effects, along with relative risks. It also examines the potential role of ENDPs in tobacco harm reduction and how they may reduce the risk of disease in smokers who switch to them. This book is a comprehensive resource for toxicologists, health practitioners and public health professionals who want the scientific information necessary to assess the relative risk of ENDPs when compared with cigarette smoking and cessation. Delivers a comprehensive overview of current state of science Offers an integrated analysis of e-cigarettes and heated tobacco products Provides guidance for methodologies