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Structure of the electronic cigarette. The electronic cigarette is a battery-powered electronic nicotine-delivery device resembling a cigarette designed for the purpose of providing inhaled doses of nicotine by way of a vaporized solution to the respiratory system. This device provides a flavor and physical sensation similar to that of inhaled tobacco smoke, while no smoke or combustion is actually involved in its operation. It is composed of the following key components: the inhaler, also known as the 'cartridge' (a disposable plastic mouthpiece, resembling a tobacco cigarette's filter, containing an absorbent material saturated with a liquid solution of propylene glycol and vegetable glycerin in which nicotine may be dissolved); the atomizing device (the heating element that vaporizes the liquid in the mouthpiece and generates the mist with each puff); and the battery component (the body of the device-resembling a tobacco cigarette-which houses a lithium-ion rechargeable battery to power the atomizer). The body of the device also houses an electronic airflow sensor to automatically activate the heating element upon inhalation and to light up a red LED indicator to signal activation of the device with each puff. The LED indicator also signals low battery charge.

Structure of the electronic cigarette. The electronic cigarette is a battery-powered electronic nicotine-delivery device resembling a cigarette designed for the purpose of providing inhaled doses of nicotine by way of a vaporized solution to the respiratory system. This device provides a flavor and physical sensation similar to that of inhaled tobacco smoke, while no smoke or combustion is actually involved in its operation. It is composed of the following key components: the inhaler, also known as the 'cartridge' (a disposable plastic mouthpiece, resembling a tobacco cigarette's filter, containing an absorbent material saturated with a liquid solution of propylene glycol and vegetable glycerin in which nicotine may be dissolved); the atomizing device (the heating element that vaporizes the liquid in the mouthpiece and generates the mist with each puff); and the battery component (the body of the device-resembling a tobacco cigarette-which houses a lithium-ion rechargeable battery to power the atomizer). The body of the device also houses an electronic airflow sensor to automatically activate the heating element upon inhalation and to light up a red LED indicator to signal activation of the device with each puff. The LED indicator also signals low battery charge.

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The need for novel and more effective approaches to tobacco control is unquestionable. The electronic cigarette is a battery-powered electronic nicotine delivery system that looks very similar to a conventional cigarette and is capable of emulating smoking, but without the combustion products accountable for smoking's damaging effects. Smokers who...

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... E-cigarettes, or electronic nicotine delivery systems (ENDS), produce nicotine-containing aerosols or vapors by heating a solution referred to as 'e-liquid' or 'e-juice' (Zainol Abidin et al., 2017). E-liquids typically consist of propylene glycol or glycerol, nicotine, and a variety of flavoring agents (Caponnetto et al., 2012;Grana et al., 2014;Omaiye et al., 2019;Tierney et al., 2016). These liquids are heated at a temperature between 100 • C and 350 • C, producing an aerosol of submicron liquid droplets which appear as a cloud of fog or smoke (Rowell and Tarran, 2015;Schripp et al., 2013). ...
... Most e-liquids contain nicotine suspended in glycols, glycerols and water, with additional additives and flavors (Caponnetto et al., 2012;Grana et al., 2014;Omaiye et al., 2019;Tierney et al., 2016). As such, ecigarette emissions have also been found to contain these components, along with thermal degradation compounds of glycerol, propylene glycol (PG), benzoic acid and benzaldehyde, such as benzene (under high power ENDS settings in a two-tank ENDS; Pankow et al., 2017), formaldehyde, acetaldehyde and acrolein (See Supplementary Information, Table S3) (Liu et al., 2017;Logue et al., 2017;McAuley et al., 2012;Sleiman et al., 2016). ...
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A source of chemical exposure to humans, thirdhand smoke (THS) refers to the contamination that persists indoors following the cessation of a smoking event. The composition of thirdhand smoke depends on the type of substance from which it originates. Although past studies have investigated the effects of tobacco THS on indoor air quality and human health, few have focused on the chemical composition and health impacts of other sources and components of THS. Here we review the state of knowledge of the composition and partitioning behavior of various types of indoor THS, with a focus on THS from tobacco, e-cigarettes, cannabis, and illicit substances (methamphetamine and cocaine). The discussion is supplemented by estimates of human exposure to THS components made with a chemical fate and exposure model. The modeling results show that while very volatile THS compounds (i.e., aromatics) are likely to be taken up by inhalation, highly water-soluble compounds tended to be dermally absorbed. Conversely, minimally volatile THS compounds with low solubility are predicted to be ingested through hand-to-mouth and object-to-mouth contact.
... The main purpose of harm reduction is to decrease the impact of behaviours that are typically associated with negative consequences, 37 which, in the case of smoking, involve inhalation of toxins related to the combustion of tobacco. Because ENDS do not require tobacco combustion, 38 they are felt to be safer than cigarettes, and can therefore act as harm reduction tools by helping smokers transition to a less harmful habit. ...
... In addition, having been created in 2003, ENDS represent a fairly new technology, and long-term safety data are not yet available, making long-term assumptions difficult. 38 Finally, in the prescription-only scenario, we based our ENDS-related smoking cessation estimate on individuals who used ENDS to quit smoking in the last two years. A scenario in which ENDS are prescribed by health care professionals would likely change risk perceptions and social norms around vaping, as well as potentially reduce the cost of ENDS, because they might then become subsidized by provincial health programs. ...
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Introduction We determined the impact of electronic nicotine delivery systems (ENDS) on health outcomes and costs in Canada, based on their effect on smoking cessation and smoking initiation rates. Methods We used gender-specific Markov models to estimate lifetime discounted life years, quality-adjusted life years (QALYs) and smoking-related health care costs for cohorts of males and females aged 15 to 19 years, in scenarios in which (1) ENDS areavailable (status quo); (2) ENDS are completely unavailable; and (3) ENDS are available for smoking cessation through health care provider prescription, in addition to currently recognized smoking cessation tools. Analysis was from the perspective of a publicly funded health care system. Results Outcomes are expressed per 1000 individuals and based on expected values obtained through a Monte Carlo simulation of 10 000 replications. For males aged 15 to 19 years, life years, QALYs and smoking-related health care costs were 41 553, 35 871 and CAD 79 645 964, respectively, when ENDS were available; 41 568, 35 894 and CAD 79 645 960 when ENDS were unavailable; and 41 570, 35 897 and CAD 79 605 869 when ENDS were available through prescription only. For females, life years, QALYs and smoking-related health care costs were 43 596, 37 416 and CAD 69 242 856, respectively, when ENDS were available; 43 610, 37 438 and CAD 69 085 926 when ENDS were unavailable; and 43 611, 37 438 and CAD 69 076 034 when ENDS were available through prescription only. Thus, situations in which ENDS are unavailable, or available through prescription only are dominant over the status quo. Conclusion These results show that a policy change whereby ENDS were unavailable to the Canadian population or available through prescription only would likely increase population health and reduce health care costs.
... L'objectif principal de la réduction des méfaits est de diminuer l'incidence des comportements qui sont généralement associés à des conséquences négatives 37 , ce qui, dans le cas du tabagisme, implique l'inhalation de toxines liées à la combustion du tabac. Comme les inhalateurs électroniques de nicotine ne nécessitent pas la combustion du tabac 38 Cependant, les résultats de notre étude sont préoccupants : le fait que le scénario 2 (inhalateurs électroniques de nicotine totalement inaccessibles) l'emporte sur le statu quo donne à penser que les méfaits engendrés à long terme par l'augmentation de l'initiation au tabagisme chez les jeunes vapoteurs sont plus importants que les avantages des inhalateurs électroniques de nicotine sur l'arrêt du tabagisme. On le voit encore plus dans le scénario 3, dans lequel les inhalateurs électroniques de nicotine ne sont pas accessibles aux jeunes, mais le demeurent pour l'arrêt du tabagisme, ce qui se traduit par les résultats les plus positifs. ...
... Il est donc plausible qu'il en résulte une sous-estimation des coûts présentés dans notre analyse, notamment des coûts des soins de santé. De plus, ayant été créés en 2003, les inhalateurs électroniques de nicotine représentent une technologie relativement nouvelle et les données d'innocuité à long terme ne sont donc pas encore disponibles, ce qui rend la formulation d'hypothèses à long terme difficile38 . ...
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... E-cigs do not use tobacco leaves, do not have curing byproducts, do not contain tobacco specific nitrosamines (TSNAs), and the process of generating E-cig aerosols (ECAs) (or vapor) does not involve burning. Therefore, ECAs do not contain incomplete combustion byproducts [29]. E-cig aerosol (ECA) contains only aerosolized nicotine and organic solvents, therefore, E-cigs are promoted as delivering a TS 'high' without its negative effects [30]. ...
... The fact that TS contains numerous carcinogens, which by themselves can cause DNA damage, mutations and tumorigenesis, yet TS, as a whole, is a weak mutagen and carcinogen in animal models [28,29], raises the possibility that TS-induced DNA damage is not a sum of potential DNA damage from all TS DNA damaging agents. If this is true, then determining the major DNA damage induced by TS, and not focusing on the minute novel DNA adducts, is crucial for understanding the mechanisms of TS carcinogenesis. ...
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... Electronic nicotine delivery systems, commonly known as e-cigarettes, are batteryoperated devices that heat a liquid containing nicotine, propylene glycol or glycerol, and flavoring agents into an inhaled aerosol [119][120][121][122]. E-cigarettes have rapidly increased in popularity, particularly among youth and young adults [5][6][7]123,124]. ...
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... In 2018, 3.2% of US adults (8.1 million) were suggested to be current users of e-cigarettes, which was an increase from 2.8% in 2017 [4]. Ecigarettes may have fewer toxic substances than traditional cigarettes and have therefore been claimed to be a healthier alternative with perceived health benefits by electronic cigarette users [5][6][7]. The use of ecigarettes has also been suggested to be helpful for traditional cigarette smoking cessation [8][9][10]. ...
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Introduction Electronic cigarette (e-cigarette) use has many potential effects, including damage to the skin. Limited research has assessed e-cigarette use with the incidence of nonmelanoma skin cancer. The current study was conducted to determine if a relationship exists between nonmelanoma skin cancer diagnosis and e-cigarette use among US adults. Methods Data from the National Health Interview Survey (NHIS) were used to assess if a relationship exists between e-cigarette use and the diagnosis of nonmelanoma skin cancer. Data within the sample adult files for years 2014 through 2018, along with the adult cancer file for the year 2015, were analyzed. Participants who reported having a diagnosis of nonmelanoma skin cancer were included. Participants who reported never being diagnosed with any type of cancer were included as a comparison group. Results Males and those of older age were significantly more likely to be diagnosed with nonmelanoma skin cancer compared to females and younger adults. Cigarette use was significantly associated with an increased risk of nonmelanoma skin cancer. There was no relationship between e-cigarette use and diagnosis of nonmelanoma skin cancer. Conclusions Although the current study did not find an association between e-cigarette use and nonmelanoma skin cancer diagnosis, a longer study period and larger sample size may more clearly determine if an association exists.
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This study aims at investigating the Jordanian students' knowledge, perceptions, and beliefs regarding e-cigarettes, as well as their motivation and triggers to try e-cigarettes in the future. A cross-sectional study design was utilized using a questionnaire that was constructed and validated by the study investigators before the start of the study. Undergraduate and postgraduate students attending the Middle East University (MEU), Amman, Jordan were asked to fill in a questionnaire from February to May 2019. Out of 787 students who successfully completed the study questionnaire 75% were males and 25% were females. Most of the study participants were aware of the concept of the e-cigarette; however, only 28.1% of them were active smokers, and 15.8 % of them use/have ever used the e-cigarettes. About 12% of the study participants were of medical background, and the majority of them were first-and second-year students. Most of the information acquired about e-cigarettes were from social media, followed by online advertising, and friends or family members. More than half of the participants rejected the idea of trying e-cigarettes in the future. Taken together; Jordanian students hold a good level of knowledge and perceptions regarding e-cigarettes. However, there is still a room for improvement and educational interventions. The good knowledge of students of medical background can help organizing social campaigns and public educational programs. Thus, the current study also highlights the pivotal role of social media nowadays, and enhances its consideration in any future interventions.
... Electronic cigarette (e-cigarette) is a battery-powered device that resembles tobacco cigarette and delivers nicotine that is vaporized electronically to simulate tobacco smoke [1]. E-cigarettes have been made available commercially as a "healthier" substitute to tobacco and its use has become progressively common, predominantly among the youth [2][3][4]. ...
Article
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Background: Electronic cigarette (e-cigarette) use has risen dramatically since its introduction in 2004. Nurses play a critical role in screening, disease prevention and smoking cessation for their patient. Their knowledge and attitude related to e-cigarettes will play a major part in development of tobacco control activities. Aim: Thus, this study was conducted to determine the knowledge and attitude toward e-cigarettes among undergraduate nursing students in the Philippines. Methods: The participants of the study were 122 level four nursing students of West Visayas State University, Iloilo city, Philippines. A standardized self-administered questionnaire was used to collect the data and statistical analyses were performed. Results: Majority of the participants were female, were never smokers and were aware or conscious of the existence of the e-cigarettes but had poor knowledge on e-cigarettes. Furthermore, in terms of attitude the students as an entire group had a positive attitude opposing e-cigarette use. Never and former smokers had positive attitude opposing e-cigarette use while current smokers had negative attitude supporting e-cigarette use. There was no significant relationship between knowledge and attitude of nursing students towards e-cigarettes. Conclusion: Nursing students did not have adequate knowledge regarding e-cigarettes but maintained a positive attitude opposing e-cigarette use. Poor knowledge did not influence the attitude of participants towards e-cigarettes.
... On the other hand, the possibility that smoker status was underreported in junior and senior students should also be considered, as it is not socially acceptable for future health professionals to use EC. Interestingly, 95.8% of the senior group, declared themselves non-smokers, but 12.5% reported using or having used EC; this inconsistency may reflect the underreporting of the smoker status or the possibility that EC users do not consider themselves to be smokers, as previously mentioned 12,21 . In all groups there were EC users. ...
... However, it should be made clear that smoking cessation in the studies is considered as the decrease or interruption of conventional (combustible) cigarettes use, which is often simply replaced by the EC 2,4,6,7 . Because the EC does not involve the burning of tobacco, it has been considered safer than conventional cigarettes 21,26 . For many authors, the EC is comparable to other nicotine replacement methods (such as patches or chewing gums), with the advantage of simulating the sensory and motor sensations of smoking 5,14 . ...
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The electronic cigarette has emerged as an alternative to the conventional cigarette, being considered by some as a smoking cessation aid. The device has attracted the interest of many young people in search of new experiences, sensations, and recreation. The aim of this study was to assess, using a questionnaire, the level of knowledge of undergraduate dental students from the Federal University of Santa Catarina (Florianópolis, Brazil) about electronic cigarettes. Information was also collected on the interest in trying the device, the approach of the subject in the course, and the self-perceived ability to inform patients about electronic cigarettes. The questionnaire was applied in April and May 2019 to 209 students over 18 years old, who were divided into 3 groups: freshmen (1st and 2nd semesters of the course), junior (4th and 5th semesters), and senior (9th and 10th semesters). The descriptive and statistical analyses were performed, and the significance level of 95% was adopted. The results showed that senior students had higher knowledge about electronic cigarettes than freshmen or junior students. However, the level of knowledge was considered unsatisfactory, as about 40% of the senior students had adequate level of knowledge (at least 60% of correct answers). Most students reported not having had contact with the topic during the undergraduate course. Likewise, most senior students reported not feeling prepared to advise patients on electronic cigarettes. The results of this study indicate the dental curriculum should include this topic in the training of future dentists, enabling them to inform their patients about the risks and benefits of using electronic cigarettes.
... High nicotine delivery via ECs could increase the risk of abuse liability. However, if ECs can provide a viable alternative to cigarettes, they might have a public health benefit (24,281,282) and some degree of abuse liability might be acceptable (283,284). A standard methodology has been established to assess the abuse liability of pharmaceuticals (285) and is largely adaptable for tobacco products (280,286). ...
Article
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While smoking remains a main global cause of preventable morbidity and mortality, a potential inflection point has arrived where it could become possible for non-combustible nicotine products to displace cigarettes and reduce risk for smokers who transition completely from smoking. These have proven consumer satisfaction and are now widely and increasingly available globally. One of the most prominent of these nicotine products are electronic cigarettes (ECs), which are used daily by millions of current and former smokers. The category is not without controversy as these products are not risk free and can cause nicotine dependence. The differing interpretation of science assessing ECs has transpired into inconsistent regulation and product standards, providing an environment for its fragmented manufacturing base which allows for variable product quality and in turn, product quality variability has impacted on how they are viewed. In this review, we assess published scientific evidence to evaluate whether, on balance, ECs fulfil a tobacco harm reduction role by reducing health risks relative to smoking and providing a viable alternative for smokers while having limited appeal to non-smokers.