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A 2015 meta-analysis on clinical trials found that e-cigarettes containing nicotine are more effective than nicotine-free ones for quitting smoking. [163] They compared their finding that nicotine-containing e-cigarettes helped 20% of people quit with the results from other studies that found nicotine replacement products helps 10% of people quit. [163] A 2016 review found low quality evidence of a trend towards benefit of e-cigarettes with nicotine for smoking cessation. [139] In terms of whether flavored e-cigarettes assisted quitting smoking, the evidence is inconclusive. [87] Tentative evidence indicates that health warnings on vaping products may influence users to give up vaping. [165] 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]
Worldwide, increasing numbers of young people are vaping. [76] [77] With access to e-cigarettes, young people's tobacco use has dropped by about 75%. [78] [79] [80] [81] It is unclear whether e-cigarettes are only helpful for particular types of smokers. [150] Vaping with nicotine may reduce tobacco use among daily smokers. [151] Whether vaping is effective for quitting smoking may depend on whether it was used as part of an effort to quit. [147] Linda Bauld; Kathryn Angus; Marisa de Andrade (May 2014). "E-cigarette uptake and marketing" (PDF). Public Health England. UK. pp.1–19. 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]E-cigarettes have evolved over time, and the different designs are classified in generations. First-generation e-cigarettes tend to look like traditional cigarettes and are called "cigalikes". [26] [27] Second-generation devices are larger and look less like traditional cigarettes. [28] Third-generation devices include mechanical mods and variable voltage devices. [26] The fourth-generation includes sub-ohm tanks (meaning they have electrical resistance of less than 1 ohm) and temperature control. [29] There are also pod mod devices that use protonated nicotine, rather than free-base nicotine found in earlier generations, [30] providing higher nicotine yields. [31] [32] E-liquid 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. 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 Tobacco smoke contains 100 known carcinogens and 900 potentially cancer-causing chemicals, but e-cigarette vapor contains less of the potential carcinogens than found in tobacco smoke. [122] A study in 2015 using a third-generation device found levels of formaldehyde were greater than with cigarette smoke when adjusted to a maximum power setting. [123] E-cigarettes cannot be considered safe because there is no safe level for carcinogens. [118] Due to their similarity to traditional cigarettes, e-cigarettes could play a valuable role in tobacco harm reduction. [124] The public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. [124] Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals. [124]
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. In 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]Since entering the market around 2003, e-cigarette use has risen rapidly. [44] [45] [46] In 2011 there were about 7 million adult e-cigarette users globally, increasing to 68 million in 2020 compared with 1.1 billion cigarette smokers. [47] There was a further rise to 82 million e-cigarette users in 2021. [48] This increase has been attributed to targeted marketing, lower cost compared to conventional cigarettes, and the better safety profile of e-cigarettes compared to tobacco. [49] E-cigarette use is highest in China, the US, and Europe, with China having the most users. [6] [50] Motivation Reasons for initiating e-cigarette use in the European Union, in a 2018 Eurobarometer poll [51] Nicotine is associated with cardiovascular disease, possible birth defects, and poisoning. [161] In vitro studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated in vivo. [161] There is inadequate research to show that nicotine is associated with cancer in humans. [182] The risk is probably low from the inhalation of propylene glycol and glycerin. [129] No information is available on the long-term effects of the inhalation of flavors. [34] David, Grégory; Parmentier, Evelyne A.; Taurino, Irene; Signorell, Ruth (December 2020). "Tracing the composition of single e-cigarette aerosol droplets in situ by laser-trapping and Raman scattering". Scientific Reports. 10 (1): 7929. Bibcode: 2020NatSR..10.7929D. doi: 10.1038/s41598-020-64886-5. PMC 7220912. PMID 32404884. Health and Care Excellence, The National Institute for (30 November 2021). "Recommendations on treating tobacco dependence Tobacco: preventing uptake, promoting quitting and treating dependence. Guidance NICE". www.nice.org.uk . Retrieved 13 November 2022. use of e‑cigarettes is likely to be substantially less harmful than smoking Also known as an e-cig, vaporizer, vape pen, hookah pen, e-pipe, or, formally, electronic nicotine delivery system ( ENDS). [1]
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.
No long-term trials have been conducted for their use as a smoking cessation aid. [140] It is still not evident as to whether vaping can adequately assist with quitting smoking at the population level. [141] A 2015 PHE report recommends for smokers who cannot or do not want to quit to use e-cigarettes as one of the main steps to lower smoking-related disease, [142] while a 2015 US PSTF statement found there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, pregnant women, and adolescents. [52]
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. 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] The health risks of e-cigarettes are not known for certain, but the risk of serious adverse events is thought to be low, [94] [21] and e-cigarettes are likely safer than combusted tobacco products. [note 5] [89] [96] However, this does not mean that e-cigarettes are harmless. E-cigarette use is associated with increased risk of chronic obstructive pulmonary disease, asthma, [97] chronic bronchitis, and emphysema. Those who use e-cigarettes daily have higher risk than those who use them occasionally. [98] According to the National Academies of Sciences, Engineering, and Medicine, "Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes." [11] Randomized controlled trials provide "high-certainty" evidence e-cigarette containing nicotine are more effective than nicotine replacement therapy for discontinuing tobacco smoking, and moderate‐certainty evidence that they are more effective than e-cigarettes free of nicotine. [22] [note 6]At least once recent review (2019) found that vaping did not seem to greatly increase the odds of quitting smoking. [138] As a result of the data being confronted with methodological and study design limitations, no firm conclusions can be drawn in respect to their efficacy and safety. [139] A 2016 review found that the combined abstinence rate among smokers using e-cigarettes in prospective studies was 29.1%. [135] The same review noted that few clinical trials and prospective studies had yet been conducted on their effectiveness, and only one randomized clinical trial had included a group using other quit smoking methods. [135] 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] Critics of vaping bans state that vaping is a much safer alternative to smoking tobacco products and that vaping bans incentivize people to return to smoking cigarettes. [338] For example, critics cite the British Journal of Family Medicine in August 2015 which stated, "E-cigarettes are 95% safer than traditional smoking." [339] Additionally, San Francisco's chief economist, Ted Egan, when discussing the San Francisco vaping ban stated the city's ban on e-cigarette sales will increase smoking as vapers switch to combustible cigarettes. [340] Critics of smoking bans stress the absurdity of criminalizing the sale of a safer alternative to tobacco while tobacco continues to be legal. Prominent proponents of smoking bans are not in favor of criminalizing tobacco either, but rather allowing consumers to have the choice to choose whatever products they desire. [338] Schraufnagel, Dean E.; Blasi, Francesco; Drummond, M. Bradley; Lam, David C. L.; Latif, Ehsan; Rosen, Mark J.; Sansores, Raul; Van Zyl-Smit, Richard (15 September 2014). "Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies". American Journal of Respiratory and Critical Care Medicine. 190 (6): 611–618. doi: 10.1164/rccm.201407-1198PP. ISSN 1073-449X. PMID 25006874. S2CID 43763340 . Retrieved 13 November 2022.
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