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A popular vaporizer named Juul was widely used by American young people until 2022, when the FDA banned its products from sale. [111] [112] Close to 80% of respondents in a 2017 Truth Initiative study aged 15–24 reported using Juul also used the device in the last 30 days. [113] In the 2010s, US teenagers used the verb "Juuling" to describe vaping, [114] and Juuling was the subject of widespread memes on social media. [115] Harm reduction Effects of vaping, compared to tobacco smoking [116] 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] Data from two states in the Pregnancy Risk Assessment System (PRAMS) show that in 2015—roughly the mid-point of the study period—10.8% of the sample used e-cigarettes in the three months prior to the pregnancy while 7.0%, 5.8%, and 1.4% used these products at the time of the pregnancy, in the first trimester, and at birth respectively. [106] According to National Health Interview Survey (NHIS) data from 2014 to 2017, 38.9% of pregnant smokers used e-cigarettes compared to only 13.5% of non-pregnant, reproductive age women smokers. [107] A health economic study found that passing an e-cigarette minimum legal sale age law in the United States increased teenage prenatal smoking by 0.6 percentage points and had no effect on birth outcomes. [108] Nevertheless, additional research needs to be done on the health effects of electronic cigarette use during pregnancy. [109]
A 2019 World Health Organization (WHO) report found that the scientific evidence "does not support the tobacco industry's claim that these products are less harmful relative to conventional tobacco products" and that there is insufficient evidence to support vaping as a smoking cessation tool. [233] [234] [235] Healthcare organizations in the UK (including the Royal College of Physicians and Public Health England) have encouraged smokers to switch to e-cigarettes or other nicotine replacements if they cannot quit, as this would potentially save millions of lives. [236] [237] The American Cancer Society, [note 8] American Heart Association, [note 9] and the surgeon general of the United States have cautioned that accumulating evidence indicates e-cigarettes may have negative effects on the heart and lungs and should not be used to quit smoking without sufficient evidence that they are safe and effective. [85] University of Pennsylvania communications professor Joseph Cappella stated that the setting of the advertisement near an ocean was meant to suggest an association of clean air with the nicotine product. [279] In 2012 and 2013, e-cigarette companies advertised to a large television audience in the US which included 24 million young people. [355] The channels to which e-cigarette advertising reached the largest numbers of young people (ages 12–17) were AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1. [355] From 2011 to 2014, e-cigarette use among young people in the US was rising as e-cigarette advertising increased. [356]
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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]
McNeill, A; Brose, LS; Calder, R; Hitchman, SC; Hajek, P; McRobbie, H (August 2015). "E-cigarettes: an evidence update" (PDF). Public Health England. UK. pp.1–113. 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 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] Nicotine is highly addictive. [12] [13] [14] Users become physically and psychologically dependent. [15] Scientists do not know how harmful e-cigarettes are over the long-term [16] [17] because it is hard to separate the effects of vaping from the effects of smoking when so many people both vape and smoke. [note 4] [18] E-cigarettes have not been used widely enough or for long enough to be sure. [19] [20] [21] 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.Jimenez Ruiz, CA; Solano Reina, S; de Granda Orive, JI; Signes-Costa Minaya, J; de Higes Martinez, E; Riesco Miranda, JA; Altet Gómez, N; Lorza Blasco, JJ; Barrueco Ferrero, M; de Lucas Ramos, P (August 2014). "The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes". Archivos de Bronconeumologia. 50 (8): 362–7. doi: 10.1016/j.arbres.2014.02.006. PMID 24684764. 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] The gateway hypothesis is the idea that using less harmful drugs can lead to more harmful ones. [59] Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes. [60] [61] [62] [63] People with mental illnesses, who as a group are more susceptible to nicotine addiction, are at particularly high risk of dual use. [64] [65]
million vapers worldwide in 2021: the GSTHR estimate". Global State of Tobacco Harm Reduction . Retrieved 13 November 2022. Hon Lik registered a patent for the modern e-cigarette design in 2003. [260] Hon is credited with developing the first commercially successful electronic cigarette. [264] The e-cigarette was first introduced to the Chinese domestic market in 2004. [259] Many versions made their way to the US, sold mostly over the Internet by small marketing firms. [259] E-cigarettes entered the European market and the US market in 2006 and 2007. [196] The company that Hon worked for, Golden Dragon Holdings, registered an international patent in November 2007. [265] The company changed its name to Ruyan (如烟, literally "like smoke" [259]) later the same month, [266] and started exporting its products. [259] E-cigarettes produce similar levels of particulates to tobacco cigarettes. [104] There is "only limited evidence showing adverse respiratory and cardiovascular effects in humans", with the authors of a 2020 review calling for more long-term studies on the subject. [104] E-cigarettes increase the risk of asthma by 40% and chronic obstructive pulmonary disease by 50% compared to not using nicotine at all. [97] Pregnancy 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] There is low quality evidence that vaping assists smokers to quit smoking in the long-term compared with nicotine-free vaping. [162] Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. [163] A 2013 study in smokers who were not trying to quit, found that vaping, with or without nicotine decreased the number of cigarettes consumed. [164] E-cigarettes without nicotine may reduce tobacco cravings because of the smoking-related physical stimuli. [118]Main article: Construction of electronic cigarettes An exploded view of an e-cigarette with transparent clearomizer and changeable dual-coil head. This model allows for a wide range of settings. a b c Balfour, David J. K.; Benowitz, Neal L.; Colby, Suzanne M.; Hatsukami, Dorothy K.; Lando, Harry A.; Leischow, Scott J.; Lerman, Caryn; Mermelstein, Robin J.; Niaura, Raymond; Perkins, Kenneth A.; Pomerleau, Ovide F.; Rigotti, Nancy A.; Swan, Gary E.; Warner, Kenneth E.; West, Robert (September 2021). "Balancing Consideration of the Risks and Benefits of E-Cigarettes". American Journal of Public Health. 111 (9): 1661–1672. doi: 10.2105/AJPH.2021.306416. PMC 8589069. PMID 34410826. Among potentially toxic substances common to both products, cigarette smoke generally contains substantially larger quantities than e-cigarette aerosol. However, e-cigarette aerosol contains some substances not found in cigarette smoke." Other motivations include reduced odor and fewer stains. [58] E-cigarettes also appeal to technophiles who enjoy customizing their devices. [58] Gateway theory
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