User:QuackGuru/Sand C

Since e-cigarettes have not been in widespread use for a significant amount of time, the long-term biological effects are currently unknown.[2] The short-term health effects from the second-hand vapor is also not known.[3] There are limited information on the health effects for children inhaling second-hand vapor.[4] The long-term effects for children inhaling second-hand vapor is not known.[4]
E-cigarettes are marketed as "free of primary and second-hand smoke risk" due to no carbon monoxide or tar is expected to be generated during use.[5] However, there is a concern for the health impact of nicotine and other ingredients.[5] The available evidence demonstrates that the e-cigarette vapor emitted from e-cigarettes is not just "harmless water vapor" as is repeatedly stated in the advertising of e-cigarettes, and they can cause indoor air pollution.[2]
Some non-users have reported adverse effects from the second-hand vapor.[6] Exhaled vapor consists of nicotine and some other particles, primarily consisting of propylene glycol, glycerin, flavors, and aroma transporters.[7] Bystanders are exposed to these particles from exhaled e-cigarette vapor.[2] The exhaled vapor may involuntarily expose bystanders to toxicants that are in the range as some cigarettes.[8] This is due to the fact that some vaping devices generate toxicants in the range as some cigarettes do.[8]
There are benefits to banning vaping indoors in public and working areas, since there is a potential harm of renormalizing tobacco use in smoke-free areas, in addition to, vaping may result in spread of nicotine and other chemicals indoors.[9] Concerns exist that the increased rates of e-cigarette users who have never smoked could cause harms to public health from the increased nicotine addiction.[10] Vaping in areas where smoking is banned indoors could be a move in the wrong direction for public health when considering air quality in addition to being unfavorable for an individual who may have quit nicotine use if they did not vape.[11]
Limited research
Since e-cigarettes have not been in prevalent use for an extended period, the long-term biological consequences are currently unknown.[2] The short-term health effects from the second-hand vapor is also not known.[3] There is insufficient data to determine the impact on public health from e-cigarettes.[12]
The potential harm to bystanders from e-cigarettes is unknown.[13] This is because no long-term data is available.[7] Little research exists on the exhaled particles, nicotine, and cancer-promoting chemicals into indoor air.[14] There are limited information on the health effects for children inhaling second-hand vapor.[4] The long-term effects for children inhaling second-hand vapor is not known.[4]
Comparison to tobacco smoke
Emissions from e-cigarettes are not comparable to environmental pollution or to cigarette smoke as their nature and chemical composition are completely different.[15] The particles are larger, with the mean size being 600 nm in inhaled aerosol and 300 nm in exhaled aerosol.[16] E-cigarette exhaled aerosol particle concentration is 5 times lower than a traditional cigarette.[17] The density of particles in the e-cigarette vapor is lower than in cigarette smoke by a factor of between 6 and 880 times.[15]
For particulate matter emissions, e-cigarettes slightly exceeded the World Health Organization guidelines, but emissions were 15 times less than traditional cigarette use.[18] The dense vapor consists of liquid sub-micron droplets.[19] Each e-cigarette company generates different amounts of heating power.[20] Substantial levels of particulate matter with a diameter of 2.5 μm are exhaled by vapers.[21] Estimates indicate that more than 70% of inhaled e-cigarette aerosols are eventually exhaled, which may cause second-hand exposures.[22]
Passive inhalation of vapor might have significant adverse effects.[23] Though, e-cigarettes exposes non-users to nicotine but not to tobacco-related combustion toxicants.[23] Evidence has also shown that bystanders absorb nicotine when people around them use e-cigarettes at levels comparable with exposure to traditional cigarette second-hand smoke.[24]
In a study of non-smokers living with nicotine e-cigarette users, those living with traditional cigarette smokers, or those living in homes where no one used either product, cotinine (a metabolite of nicotine) levels in bystanders' urine were significantly elevated in both the people exposed to second-hand e-cigarette aerosol and those exposed to second-hand tobacco smoke compared with people living in aerosol- and smoker-free homes.[24] Interestingly, the levels of elevated urinary cotinine in the two exposed groups were not significantly different (although the passive smokers had higher point estimates), despite the fact that the increase in air pollution in the smokers' homes was much higher than in the e-cigarette users' homes (geometric mean air nicotine concentrations of 0.13 μg/m3 in e-cigarette users' homes, 0.74 μg/m3 in smokers' homes, and 0.02 μg/m3 in the control homes).[24]
Marketing claims
Heavy advertising and promotion included the assertion that vaping would present little risk to bystanders.[25] E-cigarettes are marketed as "free of primary and second-hand smoke risk" due to no carbon monoxide or tar is expected to be generated during use.[5] However, there is a concern for the health impact of nicotine and other ingredients.[5]
The available evidence demonstrates that the e-cigarette vapor emitted from e-cigarettes is not just "harmless water vapor" as is repeatedly stated in the advertising of e-cigarettes, and they can cause indoor air pollution.[2] A 2014 practice guideline by NPS MedicineWise states, "Although data on health effects of passive vapour are currently lacking, the risks are argued to be small, but claims that e-cigarettes emit only water vapour are nevertheless incorrect. Serum cotinine levels (a metabolite of nicotine) have been found to be similar in bystanders exposed to either e-cigarette vapour or cigarette smoke."[26]
Increased exposure
Vaping has quickly gained public awareness with greater use among adolescents and adults, resulting in greater inhaled second-hand vapor for adolescents, children, and infants.[4] Exposure to second-hand vapor may be common.[4]
A 2016 survey found a sizable percentage of middle and high school students were exposed to second-hand e-cigarette vapors.[21] Between January 2012 and December 2014, the US FDA noted 35 adverse effect reports regarding second-hand vaping exposure.[27]
Adverse effects
Overview

Some of the few studies examining the effects on health shown that being exposed to e-cigarette vapor may produce biological effects.[2] Some non-users have reported adverse effects from the second-hand vapor.[6] Second-hand vapor exhaled into the air by e-cigarette users can expose others to potentially harmful chemicals.[1] Vaping exposes non-users to particulate matter with a diameter of 2.5 μm, which poses health risks to non-users.[21]
A 2014 study demonstrated that non-smokers living with vaping device users were exposed to nicotine.[28] A 2015 study concluded that, for indirect exposure, two chemicals—nicotine and propylene glycol—exceeded California Environmental Protection Agency exposure level standards for noncarcinogenic health effects.[29]
Asthma
Second-hand exposure to vaping can increase the possibility of experiencing an asthma attack.[30] Among youth with asthma, exposure to second-hand vapors resulted in an increased risk of exacerbating their condition.[31] A 2016 Florida Youth Tobacco survey showed that among students with a self-reported diagnosis of asthma, second-hand e-cigarette aerosol exposure was associated with higher risk of asthma attacks in the past 12 months.[32]
Lungs
Exposure to e-cigarette vapor can reduce lung function.[33]
Nicotine versus non-nicotine effects
A 2016 study showed that most participated coughed right away and briefly following a single exposure to e-cigarette vapor, while after 15 minutes it induced a diminished cough reflex sensitivity in healthy never-smokers.[34] Nicotine-free e-cigarette vapor did not have this effect.[34] The health effects of passive exposure to e-cigarettes with no nicotine, as well as the extent of exposure to these products, have just begun to be studied in 2016.[29]
E-cigarettes that do not contain nicotine generate hazardous vapors[35] and could still present a risk to non-users.[36] A 2014 study found greater amounts of particulates with e-cigarette emissions from e-liquids that were free from nicotine compared with those made with nicotine.[37] This study indicates that flavored, nicotine-free e-cigarette vapor may still be harmful to non-users.[37] Research has not evaluated whether non-users can have allergic reactions from nut potential allergens in e-cigarette aerosol.[29]
Other effects
E-cigarettes produce propylene glycol aerosols at levels known to cause eye and respiratory irritation to non-users.[29]
Composition of exhaled e-cigarette aerosol
Overview
Since e-cigarettes do not burn tobacco, no side-stream smoke or any cigarette smoke is produced.[2] Only what is exhaled by e-cigarettes users enters the surrounding air.[7] It is not clear how much of inhaled e-cigarette aerosol is exhaled into the environment where non-users can be exposed.[29] Exhaled vapor consists of nicotine and some other particles, primarily consisting of propylene glycol, glycerin, flavors, and aroma transporters.[7] Bystanders are exposed to these particles from exhaled e-cigarette vapor.[2]
Clean air is safer than e-cigarette vapor.[38] A mixture of harmful substances, particularly nicotine, ultrafine particles, and volatile organic compounds can be exhaled into the air.[39] The liquid particles condenses into a viewable fog.[16] The e-cigarette vapor is in the air for a short time, with a half-life of about 10 seconds; traditional cigarette smoke is in the air 100 times longer.[16] This is because of fast revaporization at room temperature.[16]
E-cigarettes do pollute the air in the form of exhaled mainstream aerosol from people using e-cigarettes.[24] Nicotine, ultrafine particles, and products of heating propylene glycol and glycerin are increased in the air where e-cigarettes are being used, although, as expected, at lower levels than produced by smoking the same number of traditional cigarettes.[24] As with traditional cigarettes, however, when several people are using e-cigarettes indoors at the same time, the air can become polluted.[24] For example, levels of fine particulate matter (PM2.5) in a large hotel event room (4,023m3) increased from 2–3 μg/m3 to as high as 819 μg/m3 (interquartile range: 761–975 μg/m3) when 59–86 people were using e-cigarettes.[24] This level is comparable to a very (conventional tobacco) smoky bar or casino and dramatically exceeds the US Environmental Protection Agency annual time-weighted standard for PM2.5 of 12 μg/m3.[24]
Second-hand vapor exposes bystanders to numerous pollutants at amounts higher than background air.[36] The exhaled vapor may involuntarily expose bystanders to toxicants that are in the range as some cigarettes.[8] This is due to the fact that some vaping devices generate toxicants in the range as some cigarettes do.[8] The 2014 World Health Organization report stated that "it is unknown if the increased exposure to toxicants and particles in exhaled aerosol will lead to an increased risk of disease and death among bystanders."[8] E-cigarette vapor has notably fewer toxicants than cigarette smoke.[2]
Metals
In addition to additives, e-cigarette aerosol contains heavy metals.[40] Metal aerosol in e-cigarettes are produced from aerosolized fluid generated from the heating of metal filaments.[40] These filaments are in general made from nichrome or kanthal (ferritic iron–chromium–aluminum alloy).[40] Therefore, metals such as silver, aluminum, chromium, copper, iron, nickel, and zinc, are expected to be present in e-cigarette aerosols.[40]
Non-users living with e-cigarette users were found to contain detectable levels of metals in urine samples.[40] The exposure to second-hand e-cigarette aerosol is related to higher concentrations of many metals, including lead and cadmium, in biological samples.[40]
Variability in exhaled e-cigarette aerosol
The e-cigarette aerosol contains a wide variety of substances that have not been fully identified.[40] Second-hand vapor does vary depending on the e-liquid, the device, and in the way it is used.[41] There is an array in e-cigarette designs, which has an impact on the amounts of ingredients being exposed to non-users.[21]
Indoor air quality
Concern exists that the exhaled e-cigarette vapor may be inhaled by bystanders, particularly indoors.[22] People living with e‐cigarette users had increased salivary concentrations of cotinine.[21] Indoor air quality plays a crucial role in health outcomes, and estimates indicate that people spend about 75% of their day inside.[42] Around 25% of inhaled e-cigarette aerosols end up in the lungs.[42] This suggests that the majority of particles are exhaled and may lead to passive exposure indoors.[42]
A small number of e-cigarette studies exist on the effect of indoor air quality done on human test subjects in natural settings.[28] Though, the available studies presented conflicting scientific evidence on the exact exposure from the e-cigarette vapor contents which may be a result of the contrasting methodology used during the research process.[28] Vaping can expose non-users to aldehydes and it reduced indoor air quality due to their released aldehydes.[21] Since e-cigarettes involve an aerosolization process, it is suggested that no meaningful amounts of carbon monoxide are emitted.[43] Thus, cardiocirculatory effects caused by carbon monoxide are not likely.[43] However, in an experimental study, e-cigarettes increased levels of carcinogenic polycyclic aromatic hydrocarbons in the surrounding air.[43]
On the basis of emerging evidence, in 2014 the American Industrial Hygiene Association concluded that "e-cigarettes are not emission-free and that their pollutants could be of health concern for users and those who are exposed secondhand....[T]heir use in the indoor environment should be restricted, consistent with current smoking bans, until and unless research documents that they will not significantly increase the risk of adverse health effects to room occupants."[24] Similarly, in 2016 the American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) updated its standard for "Ventilation for Acceptable Indoor Air Quality" to incorporate emissions from e-cigarettes into the definition of "environmental tobacco smoke," which is incompatible with acceptable indoor air quality.[24] As of April 2017[update], 12 US states and 615 localities had prohibited the use of e-cigarettes in venues in which traditional cigarette smoking was prohibited.[24]
There are benefits to banning vaping indoors in public and working areas, since there is a potential harm of renormalizing tobacco use in smoke-free areas, in addition to, vaping may result in spread of nicotine and other chemicals indoors.[9] E-cigarettes used in indoor environments can put at risk non-smokers to elevated levels of nicotine and aerosol emissions.[17] Non-smokers exposed to e-cigarette aerosol produced by a machine and pumped into a room were found to have detectable levels of the nicotine metabolite cotinine in their blood.[2] The same study stated that 80% of nicotine is normally absorbed by the user, so these results may be higher than in actual second-hand exposure.[2] Of particularly noteworthy is the problem of vaping in small rooms, in close proximity to other people, and around children.[44]

A 2014 review suggested that the levels of inhaled contaminants from the e-cigarette vapor are not of significant health concern for human exposures by the standards used in workplaces to ensure safety.[45] The compounds that are present, are mostly below 1% of the corresponding levels permissible by workplace safety standards.[45] But workplace safety standards do not recognize exposure to certain vulnerable groups such as people with medical ailments, children, and infants who may be exposed to second-hand vapor.[2]
Some chemicals from e-cigarette exposures could surpass workplace safety standards.[46] E-cigarette convention studies indicate that second-hand e-cigarette vapor may be significant for workers in conventions where there are people using e-cigarettes, particularly those who encounter the vapor in more than one of these events.[47] Exposure studies suggest that e-cigarette use in indoor areas is higher than the smoke-free level put forth by the US Surgeon General and the WHO Framework Convention on Tobacco Control.[47] The use of e-cigarettes in a smoke-free area could expose non-users to toxicants.[48]
Positions of professional organizations
Several medical organizations advocate that vaping be banned in public places and workplaces.[11]
The British Medical Association reported in 2013 that there are "concerns that the use of e-cigarettes could threaten the norm of not smoking in public places and workplaces."[49] In January 2014, the International Union Against Tuberculosis and Lung Disease stated "Adverse health effects for exposed third parties (second-hand exposure) cannot be excluded because the use of electronic cigarettes leads to emission of fine and ultrafine inhalable liquid particles, nicotine and cancer-causing substances into indoor air."[50]
A white paper published in 2014 by the American Industrial Hygiene Association concluded e-cigarettes emit airborne contaminants that may be inhaled by the user and those nearby.[51] Due to this possible risk, they urged restriction of their use indoors, similar to smoking bans, until research has shown the aerosol does not significantly harm others in the area.[51]
A 2015 California Department of Public Health report states that "Mainstream and secondhand e-cigarette aerosol has been found to contain at least ten chemicals that are on California's Proposition 65 list of chemicals known to cause cancer, birth defects, or other reproductive harm."[52] These are acetaldehyde, benzene, cadmium, formaldehyde, isoprene, lead, nickel, nicotine, N-nitrosonornicotine, and toluene.[53] A 2016 World Health Organization report stated that "While some argue that exposure to SHA [second-hand aerosol] is unlikely to cause significant health risks, they concede that SHA can be deleterious to bystanders with some respiratory pre-conditions. It is nevertheless reasonable to assume that the increased concentration of toxicants from SHA over background [air] levels poses an increased risk for the health of all bystanders."[54]

Public health concerns
Concerns exist that the increased rates of e-cigarette users who have never smoked could cause harms to public health from the increased nicotine addiction.[10] The growing experimentation with vaping among people under that age of 18 is especially concerning in respect to public health.[56] Ethical concerns arise from possibly vulnerable bystanders being exposed to the not yet known health effects of second-hand vapor.[10] According to a 2017 review, the evidence that nicotine harms adolescent development justifies the need for public health initiatives to safeguard young individuals from being exposed to nicotine.[57]
Overall, there is a possibility they may greatly harm the public's health.[58] Vaping in areas where smoking is banned indoors could be a move in the wrong direction for public health when considering air quality in addition to being unfavorable for an individual who may have quit nicotine use if they did not vape.[11] A 2017 review found that the "rapid production of new products has made it hard for the concerned stakeholders such as researchers in the public health field and policy makers to ensure that the products introduced to the public are safe for the users and non-users who are involuntarily exposed to e-cigarette vapors."[28]
Summary of ethical concerns
Ethical considerations[10] | Supporting arguments[10] | Opposing arguments[10] |
---|---|---|
Tobacco harm reduction[10] | ||
Potential for smoking cessation[10] | E-cigarettes may be as effective as the nicotine patch.[10] | Inconclusive evidence of efficacy for smoking cessation.[10] |
Potential for smoking reduction[10] | Demonstrated in multiple studies.[10] | Unlikely that cigarette reduction results in significant health benefits.[10] |
Product safety[10] | ||
Potential for long-term adverse effects[10] | Unknown impact of long-term propylene glycol inhalation.[10] | There were no publicized serious adverse events in 2016.[10] |
Propylene glycol inhalation causes short-term respiratory irritation.[10] | ||
Autonomy to use a product of unknown risk[10] | Ethical imperative given informed consent.[10] | Public health concerns trump individual rights.[10] |
Use among non-smokers[10] | ||
Potential to lead to nicotine addiction[10] | Perceived harmlessness may lead never smokers to initiate e-cigarettes.[10] | No evidence for increased nicotine addiction to cause net public health harms.[10] |
Potential gateway effect[10] | Nicotine acts as a priming agent for the brain.[10] | Unclear implications for transitioning to tobacco cigarettes.[10] |
Use among youth[10] | ||
Potential to lead to nicotine addiction[10] | Minors require protection.[10] | No evidence of increased nicotine addiction causing net public health harms.[10] |
E-liquid flavorings are attractive to youth.[10] | ||
Potential gateway effect[10] | Nicotine is a priming agent for the brain.[10] | Unclear implications for transitioning to tobacco cigarettes.[10] |
Nicotine poisoning among children[10] | Increased calls to poison control centers.[10] | None.[10] |
E-liquid flavors are appealing to youth.[10] | ||
Use in public places[10] | ||
Potential for passive vaping[10] | Stem cell cytotoxicity.[10] | Limited evidence that passive vaping poses significant health concerns.[10] |
Aerosolized nicotine emissions.[10] | ||
Renormalized smoking culture[10] | ||
Potential to subvert decades of anti-smoking efforts[10] | Increased acceptability of smoke-like vapor and smoking behavior.[10] | No evidence that e-cigarettes would be conflated with tobacco cigarettes.[10] |
Market ownership[10] | ||
Unethical collaboration with the tobacco industry[10] | Public health endorsement of e-cigarettes increases tobacco company market share.[10] | Possible necessity to collaborate with the tobacco industry to achieve public health gains.[10] |
See also
- Health effects of tobacco
- Health effects of electronic cigarettes
- Regulation of electronic cigarettes
- Positions of medical organizations on electronic cigarettes
References
- ↑ 1.0 1.1 "Surgeon General Reports Youth and Young Adult E-Cigarette Use Poses a Public Health Threat". United States Department of Health and Human Services. 8 December 2016.
This article incorporates text from this source, which is in the public domain.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Grana, Rachel; Benowitz, Neal; Glantz, Stanton A. (13 May 2014). "E-Cigarettes: A Scientific Review". Circulation. 129 (19): 1972–1986. doi:10.1161/circulationaha.114.007667. PMC 4018182. PMID 24821826.
- ↑ 3.0 3.1 Fernández, Esteve; Ballbè, Montse; Sureda, Xisca; Fu, Marcela; Saltó, Esteve; Martínez-Sánchez, Jose M. (2015). "Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study". Current Environmental Health Reports. 2 (4): 423–429. doi:10.1007/s40572-015-0072-x. ISSN 2196-5412. PMID 26452675.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Collaco, Joseph M.; McGrath-Morrow, Sharon A. (2018). "Electronic Cigarettes: Exposure and Use Among Pediatric Populations". Journal of Aerosol Medicine and Pulmonary Drug Delivery. 31 (2): 71–77. doi:10.1089/jamp.2017.1418. ISSN 1941-2711. PMC 5915214. PMID 29068754.
- ↑ 5.0 5.1 5.2 5.3 Kleinstreuer, Clement; Feng, Yu (2013). "Lung Deposition Analyses of Inhaled Toxic Aerosols in Conventional and Less Harmful Cigarette Smoke: A Review". International Journal of Environmental Research and Public Health. 10 (9): 4454–4485. doi:10.3390/ijerph10094454. ISSN 1660-4601. PMC 3799535. PMID 24065038.
- ↑ 6.0 6.1 Breland, Alison; Soule, Eric; Lopez, Alexa; Ramôa, Carolina; El-Hellani, Ahmad; Eissenberg, Thomas (2017). "Electronic cigarettes: what are they and what do they do?". Annals of the New York Academy of Sciences. 1394 (1): 5–30. Bibcode:2017NYASA1394....5B. doi:10.1111/nyas.12977. ISSN 0077-8923. PMC 4947026. PMID 26774031.
- ↑ 7.0 7.1 7.2 7.3 Hajek, P; Etter, JF; Benowitz, N; Eissenberg, T; McRobbie, H (31 July 2014). "Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit". Addiction. 109 (11): 1801–10. doi:10.1111/add.12659. PMC 4487785. PMID 25078252.
- ↑ 8.0 8.1 8.2 8.3 8.4 "Electronic nicotine delivery systems" (PDF). World Health Organization. 21 July 2014. pp. 1–13.
- ↑ 9.0 9.1 Dautzenberg, B.; Adler, M.; Garelik, D.; Loubrieu, J.F.; Mathern, G.; Peiffer, G.; Perriot, J.; Rouquet, R.M.; Schmitt, A.; Underner, M.; Urban, T. (2017). "Practical guidelines on e-cigarettes for practitioners and others health professionals. A French 2016 expert's statement". Revue des Maladies Respiratoires. 34 (2): 155–164. doi:10.1016/j.rmr.2017.01.001. ISSN 0761-8425. PMID 28189437.
- ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 10.34 10.35 10.36 10.37 10.38 10.39 10.40 10.41 10.42 10.43 10.44 10.45 10.46 10.47 10.48 10.49 10.50 10.51 10.52 10.53 Franck, Caroline; Filion, Kristian B.; Kimmelman, Jonathan; Grad, Roland; Eisenberg, Mark J. (2016). "Ethical considerations of e-cigarette use for tobacco harm reduction". Respiratory Research. 17 (1): 53. doi:10.1186/s12931-016-0370-3. ISSN 1465-993X. PMC 4869264. PMID 27184265.
This article incorporates text by Caroline Franck, Kristian B. Filion, Jonathan Kimmelman, Roland Grad, and Mark J. Eisenberg available under the CC BY 4.0 license.
- ↑ 11.0 11.1 11.2 Rinkoo, ArvindVashishta; Kaur, Jagdish (2017). "Getting real with the upcoming challenge of electronic nicotine delivery systems: The way forward for the South-East Asia region". Indian Journal of Public Health. 61 (5): S7–S11. doi:10.4103/ijph.IJPH_240_17. ISSN 0019-557X. PMID 28928312.
- ↑ Callahan-Lyon, P. (2014). "Electronic cigarettes: human health effects". Tobacco Control. 23 (Supplement 2): ii36–ii40. doi:10.1136/tobaccocontrol-2013-051470. ISSN 0964-4563. PMC 3995250. PMID 24732161.
- ↑ "American Lung Association Statement on E-Cigarettes". American Lung Association. 25 August 2014.
- ↑ "WHO Right to Call for E-Cigarette Regulation". World Lung Federation. 26 August 2014.
- ↑ 15.0 15.1 Farsalinos, K. E.; Polosa, R. (2014). "Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review". Therapeutic Advances in Drug Safety. 5 (2): 67–86. doi:10.1177/2042098614524430. ISSN 2042-0986. PMC 4110871. PMID 25083263.
- ↑ 16.0 16.1 16.2 16.3 Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (2013). "Electronic Cigarettes: A Short Review". Respiration. 86 (5): 433–8. doi:10.1159/000353253. ISSN 1423-0356. PMID 24080743.
- ↑ 17.0 17.1 Drummond, MB; Upson, D (February 2014). "Electronic cigarettes. Potential harms and benefits". Annals of the American Thoracic Society. 11 (2): 236–42. doi:10.1513/annalsats.201311-391fr. PMC 5469426. PMID 24575993.
- ↑ Biyani, S; Derkay, CS (28 April 2015). "E-cigarettes: Considerations for the otolaryngologist". International Journal of Pediatric Otorhinolaryngology. 79 (8): 1180–3. doi:10.1016/j.ijporl.2015.04.032. PMID 25998217.
- ↑ Offermann, Francis (June 2014). "The Hazards of E-Cigarettes" (PDF). ASHRAE Journal. 56 (6).
- ↑ Naik, Pooja; Cucullo, Luca (2015). "Pathobiology of tobacco smoking and neurovascular disorders: untied strings and alternative products". Fluids and Barriers of the CNS. 12 (1): 25. doi:10.1186/s12987-015-0022-x. ISSN 2045-8118. PMC 4628383. PMID 26520792.
- ↑ 21.0 21.1 21.2 21.3 21.4 21.5 Qasim, Hanan; Karim, Zubair A.; Rivera, Jose O.; Khasawneh, Fadi T.; Alshbool, Fatima Z. (2017). "Impact of Electronic Cigarettes on the Cardiovascular System". Journal of the American Heart Association. 6 (9): e006353. doi:10.1161/JAHA.117.006353. ISSN 2047-9980. PMC 5634286. PMID 28855171.
- ↑ 22.0 22.1 22.2 Li, Liqiao; Lin, Yan; Xia, Tian; Zhu, Yifang (2020). "Effects of Electronic Cigarettes on Indoor Air Quality and Health". Annual Review of Public Health. 41 (1): 363–380. doi:10.1146/annurev-publhealth-040119-094043. ISSN 0163-7525. PMC 7346849. PMID 31910714.
This article incorporates text by Liqiao Li, Yan Lin, Tian Xia, and Yifang Zhu1 available under the CC BY 4.0 license.
- ↑ 23.0 23.1 Rom, Oren; Pecorelli, Alessandra; Valacchi, Giuseppe; Reznick, Abraham Z. (2014). "Are E-cigarettes a safe and good alternative to cigarette smoking?". Annals of the New York Academy of Sciences. 1340 (1): 65–74. doi:10.1111/nyas.12609. ISSN 0077-8923. PMID 25557889.
- ↑ 24.00 24.01 24.02 24.03 24.04 24.05 24.06 24.07 24.08 24.09 24.10 Glantz, Stanton A.; Bareham, David W. (January 2018). "E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications". Annual Review of Public Health. 39 (1): 215–235. doi:10.1146/annurev-publhealth-040617-013757. ISSN 0163-7525. PMC 6251310. PMID 29323609.
This article incorporates text by Stanton A. Glantz and David W. Bareham available under the CC BY 4.0 license.
- ↑ Heydari, Gholamreza; Ahmady, ArezooEbn; Chamyani, Fahimeh; Masjedi, Mohammadreza; Fadaizadeh, Lida (2017). "Electronic cigarette, effective or harmful for quitting smoking and respiratory health: A quantitative review papers". Lung India. 34 (1): 25–28. doi:10.4103/0970-2113.197119. ISSN 0970-2113. PMC 5234193. PMID 28144056.
- ↑ "e-Cigarettes: a safe way to quit?". NPS MedicineWise. 11 June 2014. Archived from the original on 19 March 2017.
- ↑ Glasser, Allison M.; Collins, Lauren; Pearson, Jennifer L.; Abudayyeh, Haneen; Niaura, Raymond S.; Abrams, David B.; Villanti, Andrea C. (2016). "Overview of Electronic Nicotine Delivery Systems: A Systematic Review". American Journal of Preventive Medicine. 52 (2): e33–e66. doi:10.1016/j.amepre.2016.10.036. ISSN 0749-3797. PMC 5253272. PMID 27914771.
- ↑ 28.0 28.1 28.2 28.3 Zainol Abidin, Najihah; Zainal Abidin, Emilia; Zulkifli, Aziemah; Karuppiah, Karmegam; Syed Ismail, Sharifah Norkhadijah; Amer Nordin, Amer Siddiq (2017). "Electronic cigarettes and indoor air quality: a review of studies using human volunteers". Reviews on Environmental Health. 0 (3): 235–244. doi:10.1515/reveh-2016-0059. ISSN 2191-0308. PMID 28107173.
- ↑ 29.0 29.1 29.2 29.3 29.4 U.S. Department of Health and Human Services (2016). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General (PDF) (Report). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Surgeon General of the United States. pp. 1–298.
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- ↑ Berlinski, Ariel (2020). "2019 Year in Review: Aerosol Therapy". Respiratory Care. 65 (5): 705–712. doi:10.4187/respcare.07738. ISSN 0020-1324. PMID 32345761.
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- ↑ Wilder 2016, p. 84.
- ↑ 42.0 42.1 42.2 Gordon, Terry; Karey, Emma; Rebuli, Meghan E.; Escobar, Yael-Natalie H.; Jaspers, Ilona; Chen, Lung Chi (6 January 2022). "E-Cigarette Toxicology". Annual Review of Pharmacology and Toxicology. 62 (1): 301–322. doi:10.1146/annurev-pharmtox-042921-084202. PMC 9386787. PMID 34555289.
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- ↑ Merecz-Sadowska, Anna; Sitarek, Przemyslaw; Zielinska-Blizniewska, Hanna; Malinowska, Katarzyna; Zajdel, Karolina; Zakonnik, Lukasz; Zajdel, Radoslaw (19 January 2020). "A Summary of In Vitro and In Vivo Studies Evaluating the Impact of E-Cigarette Exposure on Living Organisms and the Environment". International Journal of Molecular Sciences. 21 (2): 652. doi:10.3390/ijms21020652. ISSN 1422-0067. PMC 7013895. PMID 31963832.
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- ↑ Clapp, Phillip W.; Jaspers, Ilona (November 2017). "Electronic Cigarettes: Their Constituents and Potential Links to Asthma". Current Allergy and Asthma Reports. 17 (11): 79. doi:10.1007/s11882-017-0747-5. ISSN 1529-7322. PMC 5995565. PMID 28983782.
- ↑ 47.0 47.1 National Academies of Sciences, Engineering, and Medicine 2018, p. 84, Secondhand Exposure to E-Cigarette Aerosol–Synthesis.
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- ↑ Bam, T. S.; Bellew, W.; Berezhnova, I.; Jackson-Morris, A.; Jones, A.; Latif, E.; Molinari, M. A.; Quan, G.; Singh, R. J.; Wisotzky, M. (1 January 2014). "Position statement on electronic cigarettes or electronic nicotine delivery systems [Official statement]". The International Journal of Tuberculosis and Lung Disease. 18 (1): 5–7. doi:10.5588/ijtld.13.0815. PMID 24365545.
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- ↑ WHO 2016, p. 4.
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- ↑ Dinakar, Chitra; Longo, Dan L.; O'Connor, George T. (2016). "The Health Effects of Electronic Cigarettes". New England Journal of Medicine. 375 (14): 1372–1381. doi:10.1056/NEJMra1502466. ISSN 0028-4793. PMID 27705269.
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{{cite book}}
: CS1 maint: multiple names: authors list (link) CS1 maint: ref duplicates default (link) Summary - "Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)". World Health Organization. 1 August 2016. pp. 1–11.
- Wilder, Natalie; Daley, Claire; Sugarman, Jane; Partridge, James (April 2016). "Nicotine without smoke: Tobacco harm reduction". UK: Royal College of Physicians. pp. 1–191.
- "State Health Officer's Report on E-Cigarettes: A Community Health Threat" (PDF). California Tobacco Control Program. California Department of Public Health. January 2015. pp. 1–21.
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Further reading
- "Exposure to electronic cigarettes in indoor workplaces". Centers for Disease Control and Prevention. 1 February 2022.