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The Policy Scan Project, by the Institute for Global Tobacco Control (at Johns Hopkins University) tracks and reports regulatory approaches to e-cigarettes around the world. In 2012 and 2013 there was a flurry of tobacco company investment in e-cigarettes, both in the United Kingdom (UK) and in the United States (US), a trend which continued in subsequent years. In 2018, 8% of Pierce County 12th graders said they had smoked a cigarette in the past 30 days. NSW Health acknowledges the people of the many traditional countries and language groups of New South Wales.

This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources. Because of the lack of long-term data and the fact that patients have died from EVALI, the prognosis for those affected remains uncertain. Researchers are working hard to learn as much as possible about the illness, its causes, and the odds for making a full recovery. "We recommend that patients see a pulmonologist within one to two weeks after being discharged to undergo testing of lung function and pulse oximetry [level of oxygen in the blood]," she says.

To inform schools of intervention needs, the susceptibility measure could be utilized in school surveys and relevant student services as a screening tool. Simultaneously, it would support the evaluation of existing policies and programmes and monitoring of potential counter-effects. For example, an earlier study observed that school-based programmes and policies had resulted in higher susceptibility risk at some intervention schools [37]. Effective and non-counter-productive interventions are especially important for products where susceptibility is at a high level, like e-cigarettes. Interventions to reduce susceptibility therefore need to address product regulation and marketing as well as social influence, norms, and perceptions.

If you purchase e-cigarettes and nicotine refill products, store them out of reach of your children and pets. With these products, it’s the liquid nicotine that can be dangerous, especially to children. According to the American Academy of Pediatrics, as little as one teaspoon of liquid nicotine can be fatal to a 26-pound child.

WHO regularly monitors and reviews the evidence on ENDS and health and offers guidance to governments. "Yale physicians have been at the forefront in identifying EVALI cases," Dr. Weiss says. She explains that even before CDC guidelines on treating the illness were released, Yale doctors were successfully treating patients with a combination of antibiotics and steroids. Doctors at Yale Medicine also collaborate with researchers in the fields of tobacco and addiction medicine to provide care for patients with EVALI.

There is no single test for EVALI; it’s what is known as a "diagnosis of exclusion," which means that a doctor will conduct tests to rule out other potential diseases and conditions. The primary risk factor for EVALI is current or previous use of a vaping device. They can look like cigarettes, cigars, pipes, pens, USB flash drives, or may be in other forms. We fund research that explores how risk factors such as smoking, poor nutrition, and lack of physical activity can affect the development of cancer. For instance, 68 people died in an outbreak of vaping-related illness (EVALI) in 2019 and 2020. Links to E-Cigarette Resources Links other websites, reports educational materials, toolkits and more information on e-cigarettes.

The decision lends new credibility to vaping companies’ longstanding claim that their products can help blunt the toll of smoking, which is blamed for 480,000 U.S. deaths annually due to cancer, lung disease and heart disease. E-cigarettes have been sold in the U.S. since 2007 but in recent years their potential benefits for smokers have been overshadowed by their use by adolescents and teens. Vaping nicotine has not been thoroughly evaluated in scientific studies. For now, not enough data exists on the safety of e-cigarettes, how the health effects compare to traditional cigarettes, and if they are helpful for people trying to quit smoking.

New national laws to strengthen controls on the importation, manufacture, and supply of all e-cigarette products are now in place. If you prefer to stop vaping in one step, you can ask your pharmacist or stop smoking adviser about switching to a suitable nicotine replacement therapy (NRT) product. This is an alternative way of cutting down your nicotine use until you are ready to stop completely. Remember to keep vapes and e-liquid out of the reach of children and pets, as there is a risk of poisoning if nicotine is swallowed. It's important to choose an e-liquid with enough nicotine to reduce withdrawal symptoms and urges to smoke.

Enrollees in the program receive interactive daily text messages tailored to their sign-up date or their target quit date if they set one. Program users who set a quit date (which they can change) receive messages for at least one week prior to the quit date and for at least two months following the quit date. Those brands have been sold in the U.S. for years, awaiting FDA action on their scientific applications. To stay on the market, companies must show that their e-cigarettes provide an overall health benefit for smokers, without significantly appealing to kids.

Even if you’re a tobacco user, having an open, honest discussion with your teen can help. The most important thing to understand is that the liquid in e-cigarette cartridges is not regulated by the FDA. Keep reading to learn more about vaping and how it’s affecting young people.

E-cigarettes are not safe for youth, young adults, and pregnant women, and can be dangerous for adults who use tobacco products. The novel results for school-level factors indicate that prevention of nicotine use may be supported by facilitating nicotine-free schools through policies and programmes. This may address especially the peer selection processes, which have been observed both in school disengagement and smoking initiation [28, 29]. Further, it may influence the students’ descriptive and injunctive norms, which both predict smoking initiation among youth [27].

E-cigarettes and vape products are not FDA-approved cessation devices. For more information and support to help you quit contact the Georgia Tobacco Quit Line. maxx electronic cigarettes clarksville in cigarettes (e-cigarettes) and other vapor products are used to heat and aerosolize (turn into particles) liquid known as e-juice (vape juice) containing highly addictive nicotine or other substances that a person can inhale into their lungs.

Nicotine-free e-juice contains a number of potentially toxic chemicals, such as base liquids and flavoring agents. However, based on the experience with cigarettes, similar adverse health effects, including COPD, heart disease, and cancer, can be expected. Finally, a 2017 review of the cardiovascular effects of vaping indicates that e-cigarettes may pose certain risks to the heart and circulatory system, notably for people who already have some form of heart disease.

Friday’s action is part of a sweeping FDA review intended to bring scientific scrutiny to the multibillion-dollar vaping market after years of regulatory delays. Currently the U.S. market includes thousands of fruit- and candy-flavored vapes that are technically illegal but are widely available in convenience stores, gas stations and vape shops. Most teens who vape use disposable e-cigarettes, including brands like Elf Bar, which come in flavors such as watermelon and blueberry ice.

E-cigarettes (often called vape pens) are battery-operated vaping devices that heat a liquid until it becomes an aerosol (mist), which is inhaled. It usually contains nicotine, other harmful chemicals, and flavorings. Even e-cigarettes that claim to have no nicotine have been found to contain nicotine. A non-smoker who uses ENDS may become addicted to nicotine and find it difficult to stop using ENDS or become addicted to conventional tobacco products. Further, many e-cigarettes are designed to allow the control of nicotine (which can reach dangerously high levels).

However, to date, no e-cigarette product has been approved by the FDA for quitting smoking. Although e-cigarettes have been sold in the U.S. for nearly 20 years, use patterns have shifted dramatically. As newer iterations brought higher levels of nicotine in an increasing array of flavors and product designs, youth use skyrocketed.

Electronic smoking devices (or ESDs), which are often called e-cigarettes, heat and vaporize a solution that typically contains nicotine. The devices are metal or plastic tubes that contain a cartridge filled with a liquid that is vaporized by a battery-powered heating element. The aerosol is inhaled by the user when they draw on the device, as they would a regular tobacco cigarette, and the user exhales the aerosol into the environment. Electronic cigarettes (E-Cigarettes) are battery-powered devices that function by heating a liquid into an aerosol that is inhaled by the user.

"This is Our Watch" is a voluntary education program with resources to help tobacco retailers better understand and comply with FDA tobacco regulations. Tobacco retailers play a direct role in protecting kids from nicotine addiction and the deadly effects of tobacco use. Learn what tobacco retailers need to do to comply with the rules designed to prevent our nation's youth from becoming the next generation of Americans to die prematurely from tobacco-related disease.

EBook files are now available for a large number of reports on the NAP.edu website. If an eBook is available, you'll see the option to purchase it on the book page. An uncorrected copy, or prepublication, is an uncorrected proof of the book. We publish prepublications to facilitate timely access to the committee's findings. As an example, NIDA point to the practice of "dripping." This involves inhaling solutions dripped directly onto the heater coil "to produce a stronger throat hit." The specific risks of these practices are still unclear.

Most have a battery, heating element, and place to hold a liquid, usually containing highly addictive nicotine, that is added or included in the device. The heating element aerosolizes the liquid for the inhalation of the liquid nicotine or other substance. E-cigarettes are called many different names, including "vapes," "e-cigs," "vapor products," and "electronic nicotine delivery systems (ENDS)." The chemicals in electronic cigarettes, commonly called vapes, can severely damage the lungs, according to studies reviewed by the American Lung Association. The nicotine in them, which can be in higher quantities than traditional cigarettes, can also impact a child’s brain development. Several peer-reviewed studies found that nicotine negatively affects teens’ memory and attention and can increase their risk of developing other mental and behavioral problems later in life.

More research needs to be done to understand the long-term health effects of secondhand exposure to e-cigarette vapor. Secondhand exposure to e-cigarette vapor is said to be less toxic than secondhand exposure to cigarette smoke. However, secondhand vapor is still a form of air pollution that probably poses health risks. N.L.B. serves as a consultant to pharmaceutical companies that market or are developing smoking cessation medications, and has provided expert testimony in litigation against tobacco companies. N.A.R. consults with and has received a research grant from Achieve Life Sciences for development of a smoking cessation medication, and receives royalties from UpToDate (an online medical textbook) as author of sections on e-cigarettes.

Various studies suggest the vapors from e-cigarettes contain several cancer-causing substances, as well as incredibly tiny particles of tin, chromium, nickel and other heavy metals, which, in large enough concentrations, can damage the lungs. These particles likely fleck off the solder joints or metal coil in the devices when heated. Because they are so small, the tiniest bits of metal, known as nanoparticles, can travel deep into the lungs. There they could exacerbate asthma, bronchitis—an inflammation of the tubes that carry air to and from the lungs—and emphysema—a disease in which the lungs' many air sacs are destroyed, leaving patients short of breath. So far there are not enough data to say with certainty whether e-cigs worsen these disorders. E-cigarettes have a battery-operated component that heats liquid containing nicotine, flavorings, and other chemicals.

In 2022–‍2023, 2.3% of people in Australia both smoked regular cigarettes and used e‑cigarettes, an increase from 0.7% in 2016. In the second study, researchers analyzed heart blood flow, a measure of coronary vascular function, of 19 young adult smokers immediately before and after smoking either e-cigarettes or tobacco cigarettes. They examined coronary vascular function by a myocardial contrast echocardiography while participants were at rest and after performing a handgrip exercise to simulate physiologic stress. In the first study, researchers looked at the impact of e-cigarettes on lipids and glucose in the blood. They recruited 476 healthy human participants without cardiovascular disease who were either nonsmokers, e-cigarette-only smokers, smokers of e-cigarettes and tobacco cigarettes and those who smoked tobacco cigarettes only.

Even though you may not smell it, third-hand particulates cling to surfaces and dust and can be breathed deep into the lungs or absorbed through the skin.It’s easy to quit vaping.One vape pod delivers as much addictive nicotine as 20 cigarettes. Vaping trains the brain to expect more nicotine and creates the desire to vape even more. That makes it harder to stop vaping and also increases the chance that teens will go on to become smokers, too. E-cigarettes with nicotine are highly addictive and are harmful to health. Whilst long-term health effects are not fully understood, it has been established that they generate toxic substances, some of which are known to cause cancer and some that increase the risk of heart and lung disorders. Use of e-cigarettes can also affect brain development and lead to learning disorders for young people.

According to Blaha, there are three reasons e-cigarettes may be particularly enticing to young people. Second, e-cigarettes have a lower per-use cost than traditional cigarettes. State and local authorities can restrict the sale of flavored tobacco products, including e-cigarettes.

Of the participants who were not using e-cigarettes, only 5.8% had quit smoking altogether by the end of the survey, while 9.9% had stopped smoking daily. At the end of the survey, 28% of smokers using e-cigarettes daily had ceased smoking tobacco altogether, while 45.5% had ceased smoking tobacco daily. The AHA notes that while vaping liquids contain fewer contaminants than cigarettes, they are not entirely safe. Based on the available evidence, smoking appears more harmful than vaping, but this does not mean that vaping is safe.

E-cigarette waste is potentially a more serious environmental threat than cigarette butts since e-cigarettes introduce plastic, nicotine salts, heavy metals, lead, mercury, and flammable lithium-ion batteries into waterways, soil, and to wildlife. "Nicotine analogs are currently not subject to the FDA process and have not been studied for their health effects," Jabba said. This data brief dives deeper into rural youth tobacco use in Minnesota.

These products use an "e-liquid" that usually contains nicotine derived from tobacco, as well as flavorings, propylene glycol, vegetable glycerin, and other ingredients. The dangers of vaping include lung and other organ damage, breathing problems, addiction and more. People tend to think of vaping as "safer" than smoking, but it’s not safe. When the coronavirus pandemic first began, Blaha says, data show that e-cigarette sales went down, possibly because people were spending more time at home and avoiding stores and public areas. In light of the EVALI outbreak, the CDC advises people who use e-cigarettes for smoking cessation to weigh the risks and benefits and first consider use of other FDA-approved smoking cessation options. If you have thought about trying to kick a smoking habit, you’re not alone.

Health services in the United Kingdom say that vaping can be an effective tool for quitting smoking. Additionally, in 2021, the Food and Drug Administration (FDA) permitted the marketing of three e-cigarette products, specifically citing their potential benefit in helping people quit smoking. Quitting is your best option to reduce your risk from smoking and tobacco use-related diseases.

This mixture is typically made up of propylene glycol and/or glycerol (vegetable glycerin) and other chemicals. Flavouring ingredients include chemicals and blends of chemicals used to make different flavours. Disposable e-cigarettes are not covered by the flavor restrictions imposed by the Food and Drug Administration.

Tobacco urges are likely to be strongest in the places where you smoked or chewed tobacco most often, such as at parties or bars, or at times when you were feeling stressed or sipping coffee. Find out your triggers and have a plan in place to avoid them or get through them without using tobacco. Queries sent to the health ministry’s tobacco cell remained unanswered till press time. From October this year it will be an offence to sell e-cigarettes to anyone under the age of 18 or to buy e-cigarettes for them. The government is consulting on a comprehensive array of regulations under the European Tobacco Products Directive.

The liquid and vapour contain some potentially harmful chemicals also found in cigarette smoke, but at a much lower level. Find out more about e-cigarettes, e-liquids and vaping to quit smoking on the Better Health website. In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapor (called vaping).

Other compounds that have been detected in aerosols include acetamide, a potential human carcinogen [5], and some aldehydes [69], although their levels were minimal. Interestingly, the existence of harmful concentrations of diethylene glycol, a known cytotoxic agent, in e-liquid aerosols is contentious with some studies detecting its presence [4, 68, 70,71,72], and others finding low subtoxic concentrations [73, 74]. In this regard, either it was detected at concentrations that did not exceed the authorised limit [73], or it was absent from the aerosols produced [4, 71, 72]. Only one study revealed its presence at high concentration in a very low number of samples [5]. Nevertheless, its presence above 1 mg/g is not allowed by the FDA [73]. Figure 1 lists the main compounds detected in aerosols derived from humectant heating and their potential damaging effects.

That figure is controversial and might be a little high, says Kenneth Warner, a tobacco policy researcher at the University of Michigan. But, he adds, "The worst critics of e-cigarettes would probably argue they're a half to two-thirds less dangerous. But from a practical view, they're probably on the order of 80% to 85% less dangerous, at least." A 2015 expert review from Public Health England estimated e-cigs are 95% less harmful than the real thing.

Silica was commonly the first material to be used as a wick, followed by cotton and ceramic3,13,14,15. Cotton has good wicking properties but is less thermally stable than silica14,16,17, while ceramic is chemically stable and heat-resistant18. The use of microporous ceramic as a wicking material has increased in the past few years14,16,18,19,20. Its application has been reported to improve heating efficiency and reduce charring14,16,18,19,20. Additional research is ongoing to clarify the dangers from vaping, and how vaping damages the lungs and other organs. Long-term human studies, in particular, could bring the risks from e-cigarettes into better focus, Crotty Alexander says.

The program’s curriculum includes a four-part series of lessons, with one set for fifth through eighth graders and another for high schoolers. The lessons teach students about the dangers of vaping, vaping marketing and resources for quitting vaping. Students that go through the program are 45% less likely to vape, according to Bianco. This is Quitting was developed by Truth Initiative, a nonprofit focused on ending tobacco use, as a free and anonymous text messaging program to help young people quit vaping.

He also highlighted the ban on e-cigarettes in India under the Prohibition of Electronic Cigarettes Act, 2019, aimed at preventing health risks and curbing their use among youth. These ingredients pose significant health risks, particularly to pregnant women, children, and adolescents, and leads to issues like impaired brain development and respiratory diseases, said Dr Goel. Cumberland County Schools is implementing a national vaping and nicotine prevention program in each of its middle and high schools to try and curb rates of youth vaping. Cigarettes pushed me back to shivering outside the bar where a nicotine habit belongs.

To vape is to inhale vapor created from a liquid heated up inside a device. The devices have many names—vape pens, pod mods, tanks, electronic nicotine delivery devices (ENDS), e-hookahs and e-cigarettes. Most e-cigarettes contain nicotine and their repeated use can lead to nicotine addiction or increase the user's risk of addiction. Some e-cigarette brands contain nicotine salts to mask the harshness of nicotine and make it more palatable. As of 2018, all tobacco products must bear the required nicotine addictiveness warning statement on product packages and advertisements in order to warn consumers about the presence of and addictive nature of nicotine.

Many are already working on efforts to combat this crisis, and we now ask for redoubled efforts and increased coordination. Below are recommended actions that different groups can take to address this issue. Cross-tabulations and Pearson χ2-tests were conducted with IBM SPSS 27.0, and multilevel logistic regression analyses with MlwiN 3.05. The associations between the student- and school-level independent variables and S-SM, S-EC, and S-SN were tested with two-level logistic regression models, with students on level one and schools on level two. The estimation procedure in the random intercept models was second-order predictive quasi-likelihood (PQL2). Analyses were stratified by gender due to significant interactions between gender and educational aspirations for all three outcomes in the unadjusted analyses.

Similar results emerged when they excluded individual states with statewide policies from the analysis, showing that no one state was driving this effect. Bans on all vapes, including both flavored and unflavored, also resulted in more cigarette sales. The authors used rigorous statistical tools to estimate long-term effects of e-cigarette flavor restrictions on electronic and conventional cigarette sales in jurisdictions across 16 states. They also examined how these effects varied between brands disproportionately used by underage youth versus adults. Find more information on Iowa’s e-cigarette-related laws and regulations from the Public Health Law Center at Mitchell Hamline School of Law. As a parent or caregiver, you have an important role in protecting children from e-cigarettes.

To our knowledge, no studies in Europe have examined susceptibility to e-cigarette (S-EC) use and snus use (S-SN). Glyoxal and methylglyoxal are formed by thermal degradation or oxidation of PG and VG87. Glyoxal is considered mutagenic, while the related compound methylglyoxal has been identified as a metabolite during glycolysis and is thus naturally present in the body. Methylglyoxal is also present in foods and drinks such as honey and coffee.

Death from nicotine poisoning is not common in adults because of their larger body size. However, using more than one type of nicotine-containing product at the same time can increase your risk. As the name suggests, cigalike kits are designed to look and feel like tobacco cigarettes. Cigarette-style vape kits are easy to use and, rather than being refillable, take prefilled flavour cartridges known as cartomizers or refills.

The SKE Crystal Bar has an auto-shutoff that powers it down after 15 minutes, preventing it from overheating while idle. It also shuts down in response to a short circuit so that wiring or battery issues won't cause it to ignite. And its reverse polarity protection keeps the device from being damaged if the battery is improperly installed (though this shouldn't be an issue since it's a pre-assembled vape). We appreciate the elegant design of the SKE Crystal Bar, and it's got a reputation for delivering rich, long-lasting flavor.

Strong decisive action is needed to prevent the uptake of e-cigarettes based on the growing body of evidence of its use by children and adolescents and health harms. 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. Vape explosions have been linked to faulty batteries in vaping devices.

The prognosis depends on how much nicotine was taken and how quickly treatment was started. If a person is able to survive during the first four hours after poisoning, they’re usually likely to recover. If a person has been severely affected, they may have ongoing seizures or respiratory failure or other problems because of the damage done from low oxygen levels during the nicotine overdose event. Increased levels of nicotine or cotinine (nicotine metabolite) can be detected in urine or blood. Nicotine poisoning or overdose can also result from taking more than the recommended amount of nicotine replacement products (for example, chewing too much gum or dissolving lozenges) or taking too high of a dose of patches, inhalers or nasal sprays.

Perhaps contrary to what many would expect, vaping marijuana may have as many negative health effects as nicotine-based vaping. This may have more to do with how vape liquids are processed than the THC itself. The tobacco industry profits from destroying health and is using these newer products to get a seat at the policy-making table with governments to lobby against health policies. The tobacco industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily promoting these products to children and non-smokers and continuing to sell billions of cigarettes.

Indeed, one of the limitations of the study was that human cells are not exposed to e-liquids per se, but rather to the aerosols where the concentrations are lower [86]. In this line, the maximum concentration tested (1000 µM) would correspond to approximately 80 to 150 ppm, which is far higher than the levels found in aerosols of some of these compounds [84]. Moreover, on a day-to-day basis, lungs of e-cigarette users are not constantly exposed to these chemicals for 24 h at these concentrations. Similar limitations were found when five of seven flavourings were found to cause cytotoxicity in human bronchial epithelial cells [87]. It is well known that nicotine is extremely addictive and has a multitude of harmful effects. Nicotine has significant biologic activity and adversely affects several physiological systems including the cardiovascular, respiratory, immunological and reproductive systems, and can also compromise lung and kidney function [41].

It may also increase the risk of developing mood disorders and problems with impulse control. They appeared on the U.S. market in 2015 and are now the top-selling brand of e-cigarette in the country. Although secondhand vapor may not affect the lungs the same way as vaping, it is better to avoid it, if possible. E-cigarettes have been strongly linked to continued tobacco use and are not recommended for young people.

Still, many people, including teens and young adults drawn to vaping, may not realize that, Bittoni said. Other popular brands, like Puff Bar, have received warnings from regulators about the sale of flavored devices as well. Following the Golden State, Washington had the second-lowest amount of youth vapers, at eight percent. In the Evergreen state, the legal age to purchase vapes is 21, and there is a ban on all flavored varieties. Last year, Alaska Senate President Gary Stevens, a Republican, introduced Senate Bill 89, aimed at imposing the state's first-ever tax on e-cigarette products. Wyoming had the highest rate of youth vapers, with 30 percent of kids under 18 reporting they had used e-cigarettes in 2023.

The Centers for Disease Control and Prevention (CDC) report that vaping nicotine can permanently affect brain development in people under the age of 25. The researchers concluded that vaping with and without nicotine disrupts typical lung function in otherwise healthy people. The researchers reported a number of adverse effects on both types of cells, including toxicity, oxidation, and inflammation. However, these results aren’t necessarily generalizable to vaping in real life. A 2019 study assessed data from a nationwide survey of nearly 450,000 participants and found no significant association between e-cigarette use and heart disease. The authors also described moderate evidence suggesting that taking a puff from an e-cigarette increases blood pressure.

The program offers specially-trained coaches, real-time text or chat support, easy enrollment and youth-focused promotional and educational materials. The majority of cases reported to poison centers are due to accidental exposures in children less than 6 years old. This reflects the increasing availability of these products in the home due to use by guardians or older siblings. Additionally, in the last 5 years, the FDA has warned companies selling e-cigarette devices made in the shape of toys, foods or cartoons that specifically appeal to use by young people. Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months. As e-cigarettes deliver flavorings, additives, and, typically, nicotine through an inhaled aerosol, they are harmful to both the user and those who are exposed secondhand.

More people began vaping in 2023 than initiated alcohol or illicit substances. A 2015 study suggests that people who vape nicotine are more likely to become dependent on nicotine than people who vape nicotine-free fluids. Vaping might appear to be a less harmful choice for people trying to quit smoking. However, that doesn’t mean there aren’t risks involved, even if the vape liquid is nicotine-free. For instance, a 2018 study reported that exposure to e-cigarette aerosol makes teeth surfaces more prone to developing bacteria.

We constantly monitor the latest topics and trends in commercial tobacco and substance use. These statements have not been evaluated by the Food and Drug Administration or other medicinal products evaluation agency. Melo Labs Inc. expressly makes no health or medical claims for this product. This product is not intended to diagnose, treat, cure or prevent any disease. As you can probably guess from the name, these lack the sophisticated internal controllers that help safeguard regulated mods.

The last wave analyzed took place during the COVID-19 pandemic in March to November 2021 and was administered via audio computer-assisted self-interviews and telephone interviews. The study featured 1,985 participants; 49.4% were male and the average age was 40. The patient population was 80.7% white, 11.4% Black, 9.2% Hispanic, and 8% of another race. You can get health news and information from The Science of Health blog delivered right to your inbox every month.

This guide supports health care providers, systems, and communities seeking to prevent vaping. These resources and others are on the AAFP’s Tobacco and Nicotine Prevention and Control webpage. Familydoctor.org, the Academy’s patient-facing web resource, has additional materials on tobacco addiction, the harms of vaping and several related topics. Young adults with family incomes of less than 200% of the federal poverty level also were more likely to use e-cigarettes than those with greater family income.

In this article, we discuss the risks of vaping versus smoking and consider the long-term effects and risks of both. In light of these results, policymakers might want to consider other approaches to protect public health where tobacco is concerned, the authors wrote in the study. Of the increase in cigarette sales, 71% were of non-menthol cigarettes, suggesting that restrictions on menthol cigarettes would not counteract this effect. The primary outcome of interest was volume sales of conventional cigarettes and e-cigarettes per capita, during each four-week period, both overall and by type of flavor. Cigarette volumes are measured in packs, while e-cigarettes are standardized to 0.7-milliliter units, given past industry claims that one 0.7-milliliter vape pod is equivalent to 20 conventional cigarettes, or one pack.

In December 2019, the legislation was included in the federal year-end legislative package and passed by both houses of Congress. President Trump signed the bill into law on December 20, 2019 and it immediately took effect. This legislation, which applies to all states, raises the minimum age of sale for all tobacco products— including e-cigarette—to 21. We provide the facts about smoking, vaping, nicotine, and the tobacco industry. We engage individuals and groups to make change in their communities, innovate ways to end nicotine addiction, and join forces with collaborators committed to preventing youth and young adult nicotine addiction and empowering quitting for all. That's hard to say — the potential health risks of vaping CBD are still hotly debated.

Again assuming a worst-case exposure of 300 puffs day–1 spread over 8 h, the levels of glyoxal exposure to a consumer would still be more than 40 times lower than the occupational exposure limit of 0.10 mg m–377,94,95. The high standard deviation for glyoxal and methylglyoxal observed in BB18 e-cigarette emissions is probably related to an analytical sample matrix effect and/or batch variability83,96,97. Despite the high standard deviation, the percentage reduction of glyoxal and methylglyoxal in both e-cigarette emissions relative to cigarette smoke was ≥ 97.0% and ≥ 94.5%, respectively (Table 3).

These refills are cheaper than disposables, but they're almost as foolproof. Switching from cigarettes to e-cigarettes could also save you a lot of money. Some people spend more than others but in general smoking costs more than vaping. Now there is an option available to me that is far less harmful or offensive as cigarettes and, for now, I am allowed to enjoy the company of my friends and family indoors with the rest of society. No longer do I have to huddle under the awning of a building, trying to avoid the rain, nor do I have to freeze my fingers off trying to rush through a cigarette just so everyone else can be satisfied.

There are different types of e-cigarette, including vape pens, vape bars, pod devices, mods, and cigalikes. Strong decisive action is needed to prevent the uptake of e-cigarettes based on the growing body of evidence of use by children and adolescents and health harms. How a country approaches ENDS will depend on factors particular to its situation. In others they are regulated as consumer products, as pharmaceutical products, as tobacco products, in other categories or totally unregulated. Nicotine exposure in pregnant women can adversely affect the development of the fetus. Further, the consumption of nicotine in children and adolescents has negative impacts on brain development, leading to long-term consequences for brain development and potentially leading to learning and anxiety disorders.

For a summary of Iowa youth vaping/e-cigarette use statistics from the 2018 IYS, check out our infographic and factsheet. Adolescents are more likely to use e-cigarettes than any other tobacco product, and rates of e-cigarette use have risen sharply in recent years. Population-level interventions to reduce tobacco use include price increases, mass media campaigns, and smoke-free policies that include e-cigarettes. E-cigarettes, also known as electronic smoking devices (ESD) and vaporizer cigarettes, are battery-operated devices that emit doses of nicotine and non-nicotine vaporized solutions that are inhaled.

The main danger with a closed-system vape comes from the lithium-ion battery. If you try to charge it using an incompatible device, there's a small but real chance of a fire or explosion. If you're new to vaping, we'd suggest starting out with a disposable vape pen. Because these devices are pre-assembled and standardized, there's no need to worry about making a dangerous mistake with the power supply that causes overheating. There's no e-liquid at all in this device, just natural, food-grade flavor extracts. And third-party testing has confirmed that the E-Z contains no allergens, carcinogens, or toxins of any kind.

However, a major concern about vaping is its attraction for young people. And, while it’s safe when taken orally as a supplement or used on the skin, it’s likely an irritant when inhaled. It’s been found in the lungs of people with severe, vaping-related damage. Some of these additives have health risks, such as diacetyl, which has a buttery taste. Diacetyl has been found to cause a severe lung disease similar to bronchiolitis. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers.

The increasing number of adolescent users and reported deaths in the United States prompted the government to ban the sale of flavoured e-cigarettes in 2020. The difference in opinion worldwide may be due to different restrictions imposed. For example, while no more than 20 ng/mL of nicotine is allowed in the EU, e-liquids with 59 mg/dL are currently available in the United States. Nevertheless, despite the national restrictions, users can easily access foreign or even counterfeit products online. Is there sufficient toxicological data on all the components employed in e-liquids?

The flavored vape juice inside contains only vegetable glycerine and organic fruit extracts. That means it's free from all the harmful chemicals we mentioned above. It's a stripped-down, vegan-friendly, nicotine-free vaping experience. When I smoked cigarettes, I dealt with inconveniences due to my addiction. I would be forced to leave the company of my friends and family to go stand outdoors, like an outcast or lesser human, so that I could prevent myself from having a withdrawal meltdown.

Rates of e-cigarette use among Cumberland students aren’t available, but across North Carolina, 21.4% of high school respondents to the state’s 2023 Youth Risk Behavior Survey said they currently vaped. The state’s rates are significantly higher than the national rates of 10% for high schoolers and 4.6% of middle schoolers, according to the National Youth Tobacco Survey. The combo could raise your odds for lung cancer even higher, new research warns. But now that I’ve gotten rid of the endless, all-day vaping, and a nicotine hit makes me stink like a dive bar ashtray, makes my mouth taste like dirt, and makes my friends recoil from my presence, I’ve got reasons to cut back.

An assessment from the agency, issued in 2008, references only a couple of studies that cover inhalation exposures—all with laboratory animals rather than people. The minimum age to purchase e-cigarettes and other tobacco products has also been raised to 21. A bill was also introduced in 2022 to raise the minimum age to purchase tobacco products and vapes from 19 to 21, but it was vetoed by Governor Mike Dunleavy.

] have been offset by the increasing consumption in low income countries, especially China. The Chinese market now consumes more cigarettes than all other low- and middle-income countries combined. Levels of naphthalene were slightly higher than those of pyrene in e-cigarette emissions, while the respective air blank was lower. Nevertheless, it seems likely that these compounds were detected in e-cigarette emissions due to their presence as low-level contaminants in the background air, rather than originating from the vaping product. E-cigarettes are devices that use an electric battery to heat up a liquid (commonly called an "e-liquid") into an aerosol, which the user inhales. Vitamin E acetate, diacetyl, formaldehyde, and acrolein are just a few among hundreds of potentially hazardous substances commonly found in e-liquids and their aerosols.

A 2018 study assessed the lung function of 10 people who had never smoked cigarettes immediately after vaping fluids, either with or without nicotine. However, the researchers concluded that, overall, vaping is thought to be less harmful to the heart than smoking cigarettes. However, they found that people who smoked conventional cigarettes and e-cigarettes were more likely to have heart disease. In a recently published randomised trial of 886 subjects who were willing to quit smoking [100], the abstinence rate was found to be twice as high in the e-cigarette group than in the nicotine-replacement group (18.0% vs. 9.9%) after 1 year.

This includes quit coaching, up to 2 weeks of nicotine replacement therapy, and a youth digital program for those ages 13-17. Vuse, owned by Reynolds American, and Juul control about 60% of the market, while hundreds of disposable brands account for the rest. While nicotine is the addictive substance in cigarettes, most of the harm from smoking comes from the thousands of other chemicals in tobacco smoke, many of which are toxic.

Do we really know the composition of the inhaled vapour during the heating process and its impact on health? In the present review, we have attempted to clarify these questions based on the existing scientific literature, and we have compiled new insights related with the toxicity derived from the use of these devices. With the rise in electronic cigarettes (e-cigarette, e-cigs or vapes) and vaping use among youth, teens and young adults, the Health Department and our team are working to prevent initiation and reduce vaping of all substances in Vermont. As of 2021, 16% of Vermont high school students said they used e-cigarettes at least once in the past 30 days. Students who smoke cigarettes, tried flavored tobacco before age 13, binge drink or use cannabis vape at the highest rates.

To be clear, I never even used to smoke during the day when I was using cigarettes. But if a project is particularly stressful (or just slightly vexatious, any excuse will do), my sleek little e-cig is just sitting in my bag at my feet. Like a never-ending pipe, you don’t know when you’ve had enough, when you’ve had a cigarette’s worth of nicotine. One quick puff to slay your stress can turn into one puff every few minutes, then whenever I get the slightest urge.

"Vaping products containing nicotine are subject to federal laws that prohibit sales to people under the age of 21," said study co-author Sairam V. Jabba, D.V.M., Ph.D., a senior research scientist at Duke University School of Medicine. "Even with the current relatively low use of e-cigarettes among adults – 3.7 percent – health care costs are already substantial, and likely to increase in the future if youth continue to use this product," said Max. "Vaping products containing nicotine are subject to federal laws that prohibit sales to people  under the age of 21," said study co-author Sairam V. Jabba, D.V.M., Ph.D., a senior research scientist at Duke University School of Medicine. The 2022–2023 NDSHS had a series of questions regarding policy measures designed to address e‑cigarette use. Support increased for all e‑cigarette policy options among the Australian population (Figure 6).

To truly help tobacco users quit and to strengthen global tobacco control, governments need to scale up policies and interventions that we know work. Tried and tested interventions, such as brief advice from health professionals, national toll-free quit lines and mobile and digital cessation services are recommended. Where economically feasible, governments should also consider promoting nicotine replacement therapies and non-nicotine pharmacotherapies for cessation. E-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users and non-users who are exposed to the aerosols second-hand.

This ban excludes disposable e-cigarette devices, which are sold in many appealing flavors and are relatively inexpensive. And are now the most popular type of e-cigarette used by adolescents. Nicotine is highly addictive and may lead to nicotine cravings and development of tolerance (the need to use more often in order to have the same effect). Nicotine addiction can negatively affect relationships and impair performance at school, at work, or in other activities. Researchers have also identified vitamin E acetate, a chemical added to some THC-containing vaping products, as the main—but possibly not the only—cause of the illness.

Collectively, these devices are known as electronic nicotine delivery systems. E-cigarette use is often referred to as "vaping" and the aerosol created from their use referred to as "vapor." E-cigarettes come in many colors, shapes, and sizes and can look like USB flash drives, pens, highlighters, or toys. The liquid in e-cigarettes is sometimes called e-juice, e-liquid, vape juice, or vape liquid.

In fact, the overall evidence points to e-cigarettes actually helping people to give up smoking tobacco. There is no evidence that e-cigarettes are undermining England’s falling smoking rates. Instead the evidence consistently finds that e-cigarettes are another tool for stopping smoking and in my view smokers should try vaping and vapers should stop smoking entirely. E-cigarettes not only pose substantial health risks to youth and young adults, they pose a significant environmental threat (see the Truth Initiative fact sheet on Tobacco and the Environment). Almost half (49.1%) of young people don’t know what to do with used e-cigarette pods and disposable devices. A second brand of e-cigarettes—marketed as Nixotine, Nixodine, Nixamide and Nic-Safe—contained a nicotine analog called nicotinamide, also at levels lower than the labels indicated, and combined with undisclosed amounts of 6-methyl nicotine.

Jabba and colleagues, including co-senior author Sven Eric Jordt, Ph.D., analyzed an e-cigarette product sold under the brand name Spree Bar, which comes in at least nine flavors and is listed as containing 5 percent 6-methyl nicotine. Study results showed the actual amount of the chemical was about 88% less than labeled. The e-cigarettes also included an artificial sweetener that is up to 13,000 times sweeter than table sugar, and an artificial coolant that mimics menthol’s effects. Talk to your patients, including youth and young adults, about the dangers of tobacco use.

Vaping may also have specific adverse effects on certain groups, particularly young people. The full magnitude of effects of toxic e-cigarette ingredients may not be known for another three decades. Yale’s Tobacco Center of Regulatory Science received funding support for the study from the National Institute on Drug Abuse, which is part of the National Institutes of Health (U54DA036151), and the Center for Tobacco Products of the FDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA. For information on products eligible to be sold in San Francisco, please visit the FDA website of Tobacco Product Marketing Orders. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice.

However, this is still one of the safest vape-like devices on the market. Overall, it's one of the best no nicotine vapes on the market for health conscious users. Because vaping is far less harmful than smoking, your health could benefit from switching from smoking to vaping. They can cause side effects such as throat and mouth irritation, headache, cough and feeling sick.

Nearly five times as many high school students use e-cigarettes than smoke cigarettes. The particle matter (PM) that is emitted by e-cigarettes is also potentially dangerous to those who inhale it, just as passive smoking is harmful to those who share a contained space with regular smokers. Nicotine is a poison which is particularly dangerous if ingested (swallowed or inhaled) by young children which has led to poisoning and even death when swallowed by infants. It is also highly addictive and use by teenagers can have a long-term effect on the development of the brain, which continues until the age of 25 years.

Although there’s no definitive answer at this point, experts do have a theory about how vaping harms lungs. Young people who vape may be more likely to become addicted than adults. Nicotine exposure during this vital time can affect brain development in subtle and important ways. Research published in 2017 found that the high temperatures needed to form the mist for vaping can create dozens of toxic chemicals, such as formaldehyde, which is thought to cause cancer.

Differences between schools exist, but having more students with no nicotine use showed protective associations, while having more students with positive attitudes towards product use in one’s age group increased the susceptibility. The results of the present study suggest that both interventions tailored by educational aspirations and universal school policies are needed to reach youth at high-risk of initiation. The concentration of nicotine in the BB57 emissions relative to BB18 was three times greater and followed the three-fold increase in nicotine strength of the e-liquid. In the cigarette smoke, the measured nicotine concentration of 0.23 ± 0.01 mg puff–1 (Table 1), equivalent to 2.07 ± 0.09 mg cig−1, is in accordance with the Ky1R6F certificate value of 1.9 ± 0.1 mg cig−1 (ISO Intense smoking regime)56.

They found that the amounts of nicotine in the blood were similar between the two groups after 10 minutes of smoking at a constant rate. The flavoring liquid for electronic cigarettes, or e-cigarettes, may increase the risk of cardiovascular disease when inhaled, according to a study led by researchers at the School of Medicine. My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health. Smokers differ in their needs and I would advise them not to give up on e-cigarettes if they do not like the first one they try. It may take some experimentation with different products and e-liquids to find the right one. An expert independent evidence review published today by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

Currently, e-cigarettes are not mentioned in the Illinois Smoke-free Illinois Act, which prohibits smoking in virtually all public places and workplaces, but some local ordinances do include e-cigarettes. E-cigarette aerosol is not harmless; it can contain harmful and potentially harmful substances, including nicotine and cancer-causing chemicals. While e-cigarettes typically have fewer chemicals than regular cigarettes, researchers found e-cigarettes present their own unique health risks and can increase the odds of chronic cough, phlegm, bronchitis, and asthma. Some cigarette smokers have replaced traditional smoking with electronic cigarettes (e-cigarettes) or vaping, thinking it is not as dangerous. There are significant negative health effects from smoking cigarettes such as cancer, chronic obstructive pulmonary disease (COPD), heart disease, birth defects, and other health problems relating to nearly every organ of the body.

This is why it took as long as it did for the negative health effects of cigarettes to be widely recognized. There is abundant evidence that e-cigarettes can help some individuals to quit smoking, so they should be more widely recommended as smoking cessation aids. Vaping and smoking share similar negative effects on the body, such as damage to the lungs and increased cancer risk.

While their manufacturers say they are an alternative for tobacco smokers who want to avoid inhaling smoke, critics say too little is known about the safety of ESDs because they are not regulated. All tobacco products, including e-cigarettes, pose a risk to the health of the user. Beginning smoking, switching to smoking, or reverting to smoking exposes the user to potentially devastating health effects.

In addition, the VITA only heats its vape liquid to about 240 degrees Fahrenheit. That's much lower than many other kinds of vapes, so it won't be as rough on your lungs. LUVV also says their products are tested to "safeguard against" harmful byproducts of heating metal and vape fluid. They don't provide much detail to support this claim, though, so take it with a grain of salt. Like HELO, LUVV vapes are free of diacetyl, vitamin E acetate, and nicotine.

Next, we examined the e-cigarette emissions of flavouring compounds, together with acetic acid and propionic acid, as listed by the U.S. These compounds were not analysed in cigarette smoke because the Ky1R6F cigarette used in the study is an unflavoured US-blended cigarette and validated analytical methods for these compounds were not available. From the studied carbonyls, only acetaldehyde, acrolein and formaldehyde are included in the nine WHO TobReg priority smoke toxicants55. Relative to cigarette smoke, their percentage of reduction in the e-cigarette emissions was ≥ 98.8%. Liquid refills are sold in quantities of 10 mL to more than 30 mL (about two to six teaspoons) in a variety of nicotine strengths. The products come in flavors with attractive scents and inviting packaging.

As with high school students, e-cigarette use was much more common than cigarette use. E-cigarettes come in many shapes and sizes and can also be called e-cigs, e-hookahs, vapes, vape pens, personal diffusers or diffuser sticks. But one vape can contain the equivalent of 50 cigarettes of nicotine in the one product. They also contain a complex combination of chemicals including nicotine, nickel, tin, arsenic, chlorine and lead. These substances can be harmful to the body, with different flavourings helping to mask these poisons when they are taken into the body. An electronic cigarette (e-cigarette) is a battery-operated device that heats liquid nicotine, flavoring, and other additives to create an aerosol.

Refillable pod mods use replaceable pods that contain either a built-in or removable coil. They are designed to be easier to use than vape pens as they adopt a secure magnetic connection between the pod and battery instead of a tank with a screw mechanism. They have few features and are compact, appealing to those new to the world of vaping and those wanting to upgrade to something simple. The term " vape pen" normally refers to a vape kit consisting of a refillable tank and a rechargeable battery; they are often slim and shaped like a pen, but not always!

Electronic cigarettes, or e-cigarettes, include e-pens, e-pipes, e-hookah, and e-cigars are known collectively as ENDS— electronic nicotine delivery systems. According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol containing nicotine or other substances. Other studies show that newer e-cigarettes deliver higher doses of nicotine more efficiently, which could be a reason why these findings were observed. The authors acknowledge that more frequent use of e-cigarettes may also reflect greater determination to quit smoking combustible cigarettes and that their study did not evaluate risks of youth e-cigarette use. Over the next few years, the optimism over e-cigarettes waned as their popularity skyrocketed. Juul’s sales increased over 600 percent each year to become the best brands for electronic cigarette selling device on the market while I inhaled an atmosphere’s worth of vanilla vapor into my lungs.

Screen all patients, encourage them to quit, and refer patients to evidence-based services for help quitting. However, nicotine used in vaping liquids is often sourced and extracted from tobacco plants. More recently, products containing synthetic nicotine, which is created through chemical processes, have been made available in Canada.

The Therapeutic Goods Administration (TGA) has not approved any e-cigarette products as a medicine to help people quit smoking. This is because the quality and safety of e-cigarettes has not yet been thoroughly tested, and it is not clear whether they are actually helpful for people trying to quit. Electronic cigarettes (e-cigarettes or vapes) simulate the act of smoking, but you don’t burn tobacco when you use them. Instead, the e-cigarette is a battery-powered device that works by heating liquid into an aerosol, which you then inhale into your lungs. These electronic devices, also known as e-cigarettes, vapes, vape pens, personal vaporizers, e-cigars, pod systems, mods and e-hookah, are not a safe alternative to cigarette smoking. Talk with your teens about the health effects of nicotine and e-cigarettes.

According to the 2023 National Youth Tobacco Survey, more than 2 million teens reported vaping nicotine, and there was an increase in current overall tobacco product use among middle school students (4.5% to 6.6%) and multiple tobacco product use (1.5% to 2.5%). They are not technically categorized as smokeless tobacco, so the Food and Drug Administration (FDA) does not regulate them as strictly as smoked tobacco products or combustible tobacco. Without long-term data, we cannot be certain if or how reduced exposure will prevent harm to one’s health. In Canada, most of the provinces require smokers to be 19 years of age to purchase cigarettes (except for Quebec and the prairie provinces, where the age is 18). However, the minimum age only concerns the purchase of tobacco, not use. Alberta, however, does have a law which prohibits the possession or use of tobacco products by all persons under 18, punishable by a $100 fine.

A Foundation-led study presented at the 2024 Society for Research on Nicotine and Tobacco annual meeting found that monthly e-cigarette sales in California declined by 41% after statewide restrictions on the sale of flavored tobacco products took effect. However, the report also noted that the tobacco industry continues to market products to offset these declines, including non-menthol cigarettes that contain other cooling chemicals. Continuing to monitor flavored tobacco product sales is key to assessing policies like these and informing further policy development and implementation. Toxicity is not the only factor in considering risk to an individual or a population from exposure to ENDS emissions.

Nicotine poisoning refers to the toxic effects of consuming nicotine. Nicotine poisoning is the result of having too much nicotine in your body. Most cases resulted from the use of nicotine as an insecticide, accidental ingestion of tobacco or ingestion of nicotine-containing plants. The best vape kit for beginners requires little to assemble and maintain - for example, a disposable device such as the Crystal Bar or Lost Mary or a pod device like the Riot Connex vape kit where the pods simply 'snap' on with magnets - it couldn't be easier! You can get closed pod mod systems, which use cartridges prefilled with e-liquid. This type of device is suitable for beginners as it eliminates the hassle of messy refills and fiddly coil changes.

A recent study compared the acute effects of e-cigarette vapor (with PG/vegetable glycerine plus tobacco flavouring but without nicotine) generated from stainless‐steel atomizer (SS) heating element or from a nickel‐chromium alloy (NC) [92]. Neither the air‐exposed rats nor those exposed to e-cigarette vapor using SS heating elements developed respiratory distress. In contrast, 80% of the rats exposed to e-cigarette vapor using NC heating units developed clinical acute respiratory distress when a 70‐W power setting was employed. Thus, suggesting that operating units at higher than recommended settings can cause adverse effects. Nevertheless, there is no doubt that the deleterious effects of battery output voltage are not comparable to those exerted by CS extracts [30] (Figs. 1 and 2). "Our findings are consistent with earlier evidence that sufficient nicotine replacement can be helpful for quitting smoking.

In this particular aspect, again the composition of the e-liquid varies significantly among different commercial brands [4, 35]. The most common and major components of e-liquids are PG or 1,2-propanediol, and glycerol or glycerine (propane-1,2,3-triol). Both types of compounds are used as humectants to prevent the e-liquid from drying out [2, 53] and are classified by the Food and Drug Administration (FDA) as "Generally Recognised as Safe" [54].

But e-cigarettes haven't proved to be safer or more effective than nicotine-replacement medications in helping people stop smoking. He was a founding member of the Society for Nicotine and Tobacco Research. As a public health researcher, he has studied numerous issues related to nicotine use and policy, with some recent work focused on cigarette and e-cigarette use among adolescents and young adults. Lynn T. Kozlowski is an internationally recognized expert on tobacco use, e-cigarettes and nicotine policy. He can speak to the media about these issues, including trends in both smoking and vaping (including Juuling). Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realised based on the evidence assessed by this important independent review.