Benowitz, Neal L.; Burbank, Andrea D. (August 2016). "Cardiovascular toxicity of nicotine: Implications for electronic cigarette use". Trends in Cardiovascular Medicine. 26 (6): 515–523. doi: 10.1016/j.tcm.2016.03.001. PMC 4958544. PMID 27079891. It is difficult to distinguish the independent roles of nicotine vs tobacco combustion products in cigarette smokers because all smokers are exposed to both. Long-term exposure to nicotine can also result in downregulation of glutamate transporter 1. [209] Long-term nicotine exposure upregulates cortical nicotinic receptors, but it also lowers the activity of the nicotinic receptors in the cortical vasodilation region. [210] These effects are not easily understood. [210] With constant use of nicotine, tolerance occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain. [206] Linda Bauld; Kathryn Angus; Marisa de Andrade (May 2014). "E-cigarette uptake and marketing" (PDF). Public Health England. UK. pp.1–19. The use of e-cigarettes for quitting smoking is controversial. [135] Limited evidence suggests that e-cigarettes probably do help people to stop smoking when used in clinical settings. [23] However, according to a review article by Hussein Traboulsi et al. in May 2020, a study by Dr Peter Hajek also resulted in more smokers becoming dual users than succeeded in complete abstinence; "Nonetheless, the continued use of and dependence on nicotine and the creation of dual users were issues in this trial...Additionally, while 18% of the e-cigarette users achieved complete abstinence, 25% (110/438) became dual users of e-cigarettes and conventional cigarettes." [136] Data regarding their use includes at least 26 randomized controlled trials [23] and a number of user surveys, case reports, and cohort studies. [137] a b Drope, Jeffrey; Cahn, Zachary; Kennedy, Rosemary; Liber, Alex C.; Stoklosa, Michal; Henson, Rosemarie; Douglas, Clifford E.; Drope, Jacqui (November 2017). "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine". CA: A Cancer Journal for Clinicians. 67 (6): 449–471. doi: 10.3322/caac.21413. ISSN 0007-9235. PMID 28961314. S2CID 32928770.

Bourke, Liam; Bauld, Linda; Bullen, Christopher; Cumberbatch, Marcus; Giovannucci, Edward; Islami, Farhad; McRobbie, Hayden; Silverman, Debra T.; Catto, James W.F. (2017). "E-cigarettes and Urologic Health: A Collaborative Review of Toxicology, Epidemiology, and Potential Risks" (PDF). European Urology. 71 (6): 915–923. doi: 10.1016/j.eururo.2016.12.022. hdl: 1893/24937. ISSN 0302-2838. PMID 28073600. France's e-cigarette market was estimated by Groupe Xerfi to be €130 million in 2015. [393] Additionally, France's e-liquid market was estimated at €265 million. [393] In December 2015, there were 2,400 vape shops in France, 400 fewer than in March of the same year. [393] Industry organization Fivape said the reduction was due to consolidation, not to reduced demand. [393] Environmental impact Tobacco product waste A 2015 meta-analysis on clinical trials found that e-cigarettes containing nicotine are more effective than nicotine-free ones for quitting smoking. [163] They compared their finding that nicotine-containing e-cigarettes helped 20% of people quit with the results from other studies that found nicotine replacement products helps 10% of people quit. [163] A 2016 review found low quality evidence of a trend towards benefit of e-cigarettes with nicotine for smoking cessation. [139] In terms of whether flavored e-cigarettes assisted quitting smoking, the evidence is inconclusive. [87] Tentative evidence indicates that health warnings on vaping products may influence users to give up vaping. [165] Jankowski, Mateusz; Brożek, Grzegorz; Lawson, Joshua; Skoczyński, Szymon; Zejda, Jan (2017). "E-smoking: Emerging public health problem?". International Journal of Occupational Medicine and Environmental Health. 30 (3): 329–344. doi: 10.13075/ijomeh.1896.01046. ISSN 1232-1087. PMID 28481369.

2. Offline Affiliates - Resellers or Distributors

The potential adverse effects such as normalizing smoking have not been adequately studied. [158] While some surveys reported improved quitting smoking, particularly with intensive e-cigarette users, several studies showed a decline in quitting smoking in dual users of cigarettes and e-cigarettes. [3] Compared to many alternative quitting smoking medicines in early development in clinical trials including e-cigarettes, cytisine may be the most encouraging in efficacy and safety with an inexpensive price. [159] Other kinds of nicotine replacement products are usually covered by health systems, but because e-cigarettes are not medically licensed they are not covered. [157]

E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke. [90] The majority of toxic chemicals found in cigarette smoke are absent in e-cigarette vapor. [187] E-cigarette vapor contains lower concentrations of potentially toxic chemicals than with cigarette smoke. [188] Those which are present, are mostly below 1% of the corresponding levels permissible by workplace safety standards. [96] 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. [83] David, Grégory; Parmentier, Evelyne A.; Taurino, Irene; Signorell, Ruth (December 2020). "Tracing the composition of single e-cigarette aerosol droplets in situ by laser-trapping and Raman scattering". Scientific Reports. 10 (1): 7929. Bibcode: 2020NatSR..10.7929D. doi: 10.1038/s41598-020-64886-5. PMC 7220912. PMID 32404884. University of Pennsylvania communications professor Joseph Cappella stated that the setting of the advertisement near an ocean was meant to suggest an association of clean air with the nicotine product. [279] In 2012 and 2013, e-cigarette companies advertised to a large television audience in the US which included 24 million young people. [355] The channels to which e-cigarette advertising reached the largest numbers of young people (ages 12–17) were AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1. [355] From 2011 to 2014, e-cigarette use among young people in the US was rising as e-cigarette advertising increased. [356]In November 2020, the New Zealand government passed a vaping regulation that requires vape stores to register as specialist vape retailers before they can sell e-cigarettes, the wider range of flavoured e-liquids, and other related vaping products. Vaping products are required to be notified by the government before they can be sold to ensure that the products are following safety requirements and ingredients in liquids do not contain prohibited substances. [335] A 2014 review found "In addition to the uniqueness of the liquid compositions in each brand, inconsistency of both the device performance properties and the data collection methodologies used by researchers contribute to the observed variation in constituent levels and to the range of particle size distributions among products." [2] In October 2021, researchers at Johns Hopkins University reported over 2,000 unknown chemicals in the vape clouds that they tested from Vuse, Juul, Blu and Mi-Salt vape devices. [183] E-cigarettes containing nicotine have been listed as drug delivery devices in a number of countries, and the marketing of such products has been restricted or put on hold until safety and efficacy clinical trials are conclusive. [336] Since they do not contain tobacco, television advertising in the US is not restricted. [337] Some countries have regulated e-cigarettes as a medical product even though they have not approved them as a smoking cessation aid. [178] A 2014 review stated the emerging phenomenon of e-cigarettes has raised concerns in the health community, governments, and the general public and recommended that e-cigarettes should be regulated to protect consumers. [130] It added, "heavy regulation by restricting access to e-cigarettes would just encourage continuing use of much unhealthier tobacco smoking." [130] A 2014 review said regulation of the e-cigarette should be considered on the basis of reported adverse health effects. [178] Criticism of vaping bans

a b Gibson, Laura A.; Creamer, MeLisa R.; Breland, Alison B.; Giachello, Aida Luz; Kaufman, Annette; Kong, Grace; Pechacek, Terry F.; Pepper, Jessica K.; Soule, Eric K.; Halpern-Felsher, Bonnie (2018). "Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity". Addictive Behaviors. 79: 219–225. doi: 10.1016/j.addbeh.2017.11.017. ISSN 0306-4603. PMC 5807230. PMID 29175027. Critics of vaping bans state that vaping is a much safer alternative to smoking tobacco products and that vaping bans incentivize people to return to smoking cigarettes. [338] For example, critics cite the British Journal of Family Medicine in August 2015 which stated, "E-cigarettes are 95% safer than traditional smoking." [339] Additionally, San Francisco's chief economist, Ted Egan, when discussing the San Francisco vaping ban stated the city's ban on e-cigarette sales will increase smoking as vapers switch to combustible cigarettes. [340] Critics of smoking bans stress the absurdity of criminalizing the sale of a safer alternative to tobacco while tobacco continues to be legal. Prominent proponents of smoking bans are not in favor of criminalizing tobacco either, but rather allowing consumers to have the choice to choose whatever products they desire. [338]Main article: Construction of electronic cigarettes An exploded view of an e-cigarette with transparent clearomizer and changeable dual-coil head. This model allows for a wide range of settings. How does the nicotine in e-cigarettes affect the brain? [204] Until about age 25, the brain is still growing. [204] Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. [204] Young people's brains build synapses faster than adult brains. [204] Because addiction is a form of learning, adolescents can get addicted more easily than adults. [204] The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for addiction to other drugs such as cocaine. [204]

There is low quality evidence that vaping assists smokers to quit smoking in the long-term compared with nicotine-free vaping. [162] Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. [163] A 2013 study in smokers who were not trying to quit, found that vaping, with or without nicotine decreased the number of cigarettes consumed. [164] E-cigarettes without nicotine may reduce tobacco cravings because of the smoking-related physical stimuli. [118] Worldwide, increasing numbers of young people are vaping. [76] [77] With access to e-cigarettes, young people's tobacco use has dropped by about 75%. [78] [79] [80] [81] Jimenez Ruiz, CA; Solano Reina, S; de Granda Orive, JI; Signes-Costa Minaya, J; de Higes Martinez, E; Riesco Miranda, JA; Altet Gómez, N; Lorza Blasco, JJ; Barrueco Ferrero, M; de Lucas Ramos, P (August 2014). "The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes". Archivos de Bronconeumologia. 50 (8): 362–7. doi: 10.1016/j.arbres.2014.02.006. PMID 24684764. The risk of early death is anticipated to be similar to that of smokeless tobacco. [172] Since vapor does not contain tobacco and does not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke, [173] such as ash, tar, and carbon monoxide. [174] However, e-cigarette use with or without nicotine cannot be considered risk-free [175] because the long-term effects of e-cigarette use are unknown. [21] [162] [172] Possible side effects of nicotine [176] Wilder, Natalie; Daley, Claire; Sugarman, Jane; Partridge, James (April 2016). "Nicotine without smoke: Tobacco harm reduction". Royal College of Physicians. UK. pp.1–191.

1. Online Affiliates

Vaping correlates with smoking among young people, even in those who would otherwise be unlikely to smoke. [88] Experimenting with vaping encourages young people to continue smoking. [89] A 2015 study found minors had little resistance to buying e-cigarettes online. [90] Teenagers may not admit to using e-cigarettes, but use, for instance, a hookah pen. [91] As a result, self-reporting may be lower in surveys. [91] McNeill, A; Brose, LS; Calder, R; Hitchman, SC; Hajek, P; McRobbie, H (August 2015). "E-cigarettes: an evidence update" (PDF). Public Health England. UK. pp.1–113.