electronic cigarette; e-cigarette; juul; electronic nicotine delivery system (ENDS)

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Epidemiology

  • < 5% of adults report using e-cigarettes[39]
  • 13%[18] - 20%[3] of adults has tried an electronic cigarette
  • ever use higher among current cigarette smokers (48%) & recent quitters (55%)
  • among high school students, ever-use of e-cigarettes increased from 4.7% to 10.0% from 2011 to 2012[5][13]
  • among adult never smoker of cigarettes, younger adults try e-cigarettes more often than older adults (10% for adults age 18-24 vs 1% for adults age > 45 years of age)[18]
  • 24% of U.S. middle school & high school students report recent exposure to vapors of electronic cigarettes[30]
  • an increase in electronic cigarette use among adult smokers may be associated with an increase in smoking cessation rate[31]
  • may lead youth to start smoking, adults to stop smoking[34]
  • prevalence of nicotine vaping among 12 graders increased 11% to 21% from 2017 to 2018

Indications

Pharmacokinetics

  • peak serum nicotine concentration within 5 minutes, similar to conventional cigarettes[25]

Adverse effects

Complications

Notes

Device:

Products are:

  • marketed & sold to young people
    • FDA regulation prohibits sale of e-cigarettes to persons < 21 years of age [21[
  • readily available online & in shopping malls
  • available in different flavors which may appeal to young people
  • a juul is smaller than a typical e-cigarette
    • looks like a flash drive (see image)[43]
    • its oils come in flavors like mango
    • contains highest nicotine content of any e-cigarette[43]

Contain:

Warnings

  • none
  • do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes
  • two e-liquids sold by HelloCig Electronic Technology Co. Ltd. found to contain tadalafil &/or sildenafil[45]

FDA approval:

  • have not been submitted to the FDA for evaluation or approval
  • FDA has no way of knowing, except for its own limited testing, the levels of nicotine or the amounts or kinds of other chemicals present in the various brands
  • FDA's premarket approval process pass RJ Reynolds Vuse Solo device showing reduced harm compared with traditional tobacco products,

FDA regulation:

  • FDA extends its tobacco authority to e-cigarettes[9][21]
  • FDA threatens to take flavored e-cigarettes of the market[40]
  • FDA will ban sales of flavored e-cigarettes in most retail stores due to popularity & increased use among youths[44]

Most E-cigarettes are made in China

  • quality is inconsistent[8]
  • nicotine intake from e-cigarettes is highly variable[37]

electronic cigarettes are banned on commercial flights[20] 

, electronic cigarettes can be used to vaporize cannabis, including marijuana, tetrahydrocannabinol, or hash oil[41]

open-system, refillable devices popular among adolescents[42]

More general terms

More specific terms

Additional terms

References

  1. ↑ FDA MedWatch http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm173327.htm
  2. ↑ Yamin CK et al. E-cigarettes: A rapidly growing Internet phenomenon. Ann Intern Med 2010; Nov 2; 153:607. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21041581
  3. ↑ 3.0 3.1 CDC Newsroom. Press Release. Feb 28, 2013 Centers for Disease Control and Prevention About one in five U.S. adult cigarette smokers have tried an electronic cigarette. http://www.cdc.gov/media/releases/2013/p0228_electronic_cigarettes.html
  4. ↑ Prescriber's Letter 20(5): 2013 Electronic Cigarettes and Hookah Pipes Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290503&pb=PRL (subscription needed) http://www.prescribersletter.com
  5. ↑ 5.0 5.1 Centers for Disease Control and Prevention (CDC) Notes from the Field: Electronic Cigarette Use Among Middle and High School Students - United States, 2011-2012 MMWR. September 6, 2013 / 62(35);729-730 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm
  6. ↑ 6.0 6.1 Bullen C et al Electronic cigarettes for smoking cessation: a randomized controlled trial. Lancet. September 7, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24029165 <Internet> http://download.thelancet.com/flatcontentassets/pdfs/S0140673613618425.pdf
    Hajek P Electronic cigarettes for smoking cessation. Lancet. September 7, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24029168 <Internet> http://download.thelancet.com/flatcontentassets/pdfs/S0140673613615342.pdf
  7. ↑ 7.0 7.1 Dutra LM and Glantz SA Electronic Cigarettes and Conventional Cigarette Use Among US AdolescentsA Cross-sectional Study. JAMA Pediatr. Published online March 06, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24604023 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1840772
    Chaloupka FJ Tobacco Control Policy and Electronic Cigarettes. JAMA Pediatr. Published online March 06, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24603982 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1840771
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Herman AO E-Cigarette Injuries on the Rise. Physician's First Watch, April 18, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  9. ↑ 9.0 9.1 FDA News Release. April 24, 2014 FDA proposes to extend its tobacco authority to additional tobacco products, including e-cigarettes. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm
    DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 1100, 1140, and 1143 [Docket No. FDA-2014-N-0189] RIN 0910-AG38 Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-09491.pdf
  10. ↑ Prescriber's Letter 21(6): 2014 Electronic Cigarettes and Hookah Pipes: Safety and Regulations Update Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300602&pb=PRL (subscription needed) http://www.prescribersletter.com
  11. ↑ 11.0 11.1 11.2 11.3 Hajek P et al Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. Online July 31, 2014 http://onlinelibrary.wiley.com/doi/10.1111/add.12659/abstract
  12. ↑ 12.0 12.1 Bhatnagar A et al Electronic Cigarettes: A Policy Statement From the American Heart Association. Circulation. August 24, 2014; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25156991 <Internet> http://circ.ahajournals.org/content/early/2014/08/22/CIR.0000000000000107.full.pdf+html
  13. ↑ 13.0 13.1 Bunnell RE et al Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011-2013. Nicotine Tob Res. Aust 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25143298 <Internet> http://ntr.oxfordjournals.org/content/early/2014/08/18/ntr.ntu166.abstract?sid=77ea08b2-97f5-423f-bbe2-2bd45523712d
  14. ↑ 14.0 14.1 Gupta S, Gandhi A, Manikonda R Accidental nicotine liquid ingestion: emerging paediatric problem. Arch Dis Child. Sept 8, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25202128 <Internet> http://adc.bmj.com/content/early/2014/07/24/archdischild-2014-306750
  15. ↑ 15.0 15.1 Leventhal AM, Strong DR, Kirkpatrick MG et al Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA. 2015;314(7):700-707 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26284721 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2428954
    Rigotti NA e-Cigarette Use and Subsequent Tobacco Use by Adolescents. New Evidence About a Potential Risk of e-Cigarettes. JAMA. 2015;314(7):673-674 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26284717 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2428937
  16. ↑ 16.0 16.1 16.2 16.3 Press release. Public Health England. August 2015 E-cigarettes around 95% less harmful than tobacco estimates landmark review. https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
    McNeill A, Brose LS, Calder R, Hitchman SC E-cigarettes: an evidence update, A report commissioned by Public Health England. August 2015 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454516/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England.pdf
    Public Health England. August 2015 E-cigarettes: a new foundation for evidence-based policy and practice. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454517/Ecigarettes_a_firm_foundation_for_evidence_based_policy_and_practice.pdf
    McKee M, Capewell S Evidence about electronic cigarettes: a foundation built on rock or sand? BMJ 2015;351:h4863 http://www.bmj.com/content/351/bmj.h4863
  17. ↑ 17.0 17.1 Siu AL for the U.S. Preventive Services Task Force Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 22 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26389730 <Internet> http://annals.org/article.aspx?articleid=2443060
    Patnode CD et al Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 22 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26389650 <Internet> http://annals.org/article.aspx?articleid=2443059
  18. ↑ 18.0 18.1 18.2 NCHS Data Brief. Number 217, October 2015 Electronic Cigarette Use Among Adults: United States, 2014. http://www.cdc.gov/nchs/data/databriefs/db217.htm
  19. ↑ 19.0 19.1 Wang MP et al. Electronic cigarette use and respiratory symptoms in Chinese adolescents in Hong Kong. JAMA Pediatr 2016 Jan 1; 170:89 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26551991
  20. ↑ 20.0 20.1 20.2 US Department of Transportation News Briefing. March 2, 2016 U.S. Department of Transportation Explicitly Bans the Use of Electronic Cigarettes on Commercial Flights. https://www.transportation.gov/briefing-room/us-department-transportation-explicitly-bans-use-electronic-cigarettes-commercial
  21. ↑ 21.0 21.1 FDA News Release. May 5, 2016 FDA takes significant steps to protect Americans from dangers of tobacco through new regulation. Rule extending oversight to all tobacco products, including e-cigarettes, allows agency to address public health concerns such as youth access to tobacco products. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm499234.htm
  22. ↑ Alisha Kamboj, Henry A. Spiller, Marcel J et al Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States/ Pediatrics May 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27244861
  23. ↑ 23.0 23.1 Barrington-Trimis JL, Urman R, Berhane K et al E-Cigarettes and Future Cigarette Use. Pediatrics Jun 2016, e20160379 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27296866
  24. ↑ 24.0 24.1 Beard E, West R, Michie S et al Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ 2016;354:i4645 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27624188 Free Article <Internet> http://www.bmj.com/content/354/bmj.i4645
    Britton J Electronic cigarettes and smoking cessation in England. BMJ 2016;354:i4819 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27623862 <Internet> http://www.bmj.com/content/354/bmj.i4819
  25. ↑ 25.0 25.1 Dinakar C, O'Connor GT The Health Effects of Electronic Cigarettes. N Engl J Med 2016; 375:1372-1381. October 6, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27705269 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1502466
  26. ↑ Know the Risks. e-Cigarettes and Young People. http://e-cigarettes.surgeongeneral.gov/
    E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. http://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Fact_Sheet_508.pdf
  27. ↑ 27.0 27.1 27.2 Moheimani RS, Bhetraratana M, Yin F et al Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette UsersImplications for Cardiovascular Risk. JAMA Cardiol. Published online February 1, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28146259 <Internet> http://jamanetwork.com/journals/jamacardiology/article-abstract/2600166
    Bhatnagar A Are Electronic Cigarette Users at Increased Risk for Cardiovascular Disease? JAMA Cardiol. Published online February 1, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28146233 <Internet> http://jamanetwork.com/journals/jamacardiology/article-abstract/2600160
  28. ↑ 28.0 28.1 Shahab L, Goniewicz ML, Blount BC et al Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross- sectional Study. Ann Intern Med. 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28166548 <Internet> http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement
  29. ↑ 29.0 29.1 Shahab L et al. Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users: A cross-sectional study. Ann Intern Med 2017 Feb 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28166548
  30. ↑ 30.0 30.1 30.2 Wang TW, Marynak KL, Agaku IT et al Secondhand Exposure to Electronic Cigarette Aerosol Among US Youths. JAMA Pediatr. Published online March 20, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28319226 <Internet> http://jamanetwork.com/journals/jamapediatrics/article-abstract/2611944
  31. ↑ 31.0 31.1 Zhu SH, Zhuang YL, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys BMJ 2017;358:j3262 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28747333 <Internet> http://www.bmj.com/content/358/bmj.j3262
    Bullen C Rise in e-cigarette use linked to increase in smoking cessation rates. BMJ 2017;358:j3506 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28747300 <Internet> http://www.bmj.com/content/358/bmj.j3506
  32. ↑ FDA News Release. Aug 8, 2017 FDA to expand public education campaign to focus on prevention of youth e-cigarette use. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570501.htm
  33. ↑ 33.0 33.1 Boyles S, E-Cigs May Still Damage Blood Vessels Arterial stiffness increased immediately after vaping session. MedPage Today. September 10, 2017 https://www.medpagetoday.com/MeetingCoverage/ERS/67802
  34. ↑ 34.0 34.1 34.2 National Academy of Science & Engineering
    News Release. January 23, 2018
    New Report One of the Most Comprehensive Studies on Health Effects of E-Cigarettes; Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking. http://www8.nationalacademies.org/onpinews/newsitem.aspx
    Publication Released: January 23, 2018 Public Health Consequences of E-Cigarettes http://nationalacademies.org/hmd/Reports/2018/public-health-consequences-of-e-cigarettes.aspx
  35. ↑ 35.0 35.1 Rubinstein ML, Delucchi K, Benowitz NL, Ramo DE. Adolescent Exposure to Toxic Volatile Organic Chemicals From E-Cigarettes. Pediatrics. March 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29507165 <Internet> http://pediatrics.aappublications.org/content/early/2018/03/01/peds.2017-3557
  36. ↑ 36.0 36.1 Rigotti NA, Chang Y, Tindle HA, et al Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study. Ann Intern Med. 2018. March 27. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29582077 <Internet> http://annals.org/aim/article-abstract/2676738/association-e-cigarette-use-smoking-cessation-among-smokers-who-plan
  37. ↑ 37.0 37.1 37.2 St. Helen G, Eaton DL. Public Health Consequences of e-Cigarette Use. JAMA Intern Med. Published online May 7, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29801158 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2680315
  38. ↑ 38.0 38.1 Boyles S. E-Cigarette Flavorings May Harm Blood Vessels, Cell studies show short-term endothelial disruption with exposure. MedPage Today, June 14, 2018 https://www.medpagetoday.com/pulmonology/smoking/73507
    Fetterman JL, Weisbrod RM, Feng B et al Flavorings in Tobacco Products Induce Endothelial Cell Dysfunction. Arterioscler Thromb Vasc Biol. 2018 Jun 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29903732
  39. ↑ 39.0 39.1 39.2 39.3 Mirbolouk M, Charkhchi P, Kianoush S et al Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med. 2018. Aug 28. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30167658 <Internet> http://annals.org/aim/article-abstract/2698112/prevalence-distribution-e-cigarette-use-among-u-s-adults-behavioral
    Rigotti NA Monitoring the Rapidly Changing Landscape of E-Cigarettes. Ann Intern Med. 2018. Aug 28. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30167664 <Internet> http://annals.org/aim/article-abstract/2698113/monitoring-rapidly-changing-landscape-e-cigarettes
  40. ↑ 40.0 40.1 Kelley KJ, Sadoughi S FDA Threatens to Take Flavored E-Cigarettes off the Market. Physician's First Watch, Sept 13, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    FDA News Release. Sept 12, 2018 FDA takes new steps to address epidemic of youth e-cigarette use, including a historic action against more than 1,300 retailers and 5 major manufacturers for their roles perpetuating youth access. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620184.htm
    FDA Statement. Sept 12, 2018 Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to address epidemic of youth e-cigarette use. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620185.htm
  41. ↑ 41.0 41.1 Trivers KF, Phillips E, Gentzke AS Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth. JAMA Pediatr. Published online September 17, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30242366 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2702200
  42. ↑ 42.0 42.1 McMillen R, Tanski S, Wilson K, Klein JD, Winickoff JP. Adolescent use of different e-cigarette products. Pediatrics 2018 Sep 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30201626 <Internet> http://pediatrics.aappublications.org/content/early/2018/09/06/peds.2018-0260
  43. ↑ 43.0 43.1 43.2 King BA, PhD, Gammon DG, Marynak KL et al Electronic Cigarette Sales in the United States, 2013-2017. JAMA. 2018;320(13):1379-1380 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30285167 https://jamanetwork.com/journals/jama/fullarticle/2705175
    Hariprakasha S (image) The JUUL: A New Avenue of Nicotine Addiction National Cancer Institute Poster. July 30, 2018 https://ncifrederick.cancer.gov/about/theposter/content/juul-new-avenue-nicotine-addiction
  44. ↑ 44.0 44.1 FDA Statement. Nov. 15, 2018 Statement from FDA Commissioner Scott Gottlieb, M.D., on proposed new steps to protect youth by preventing access to flavored tobacco products and banning menthol in cigarettes. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm625884.htm
    Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep 2018;67:1276-1277 https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm
    FDA News Release. Nov 15, 2018 Results from 2018 National Youth Tobacco Survey show dramatic increase in e-cigarette use among youth over past year. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm625917.htm
  45. ↑ 45.0 45.1 FDA Safety Alert. Dec 11, 2018 FDA alerts consumers not to use two e-liquids sold by HelloCig Electronic Technology. https://www.fda.gov/Drugs/DrugSafety/ucm628135.htm
  46. ↑ Miech R, Johnston L, O'Malley PM et al Adolescent Vaping and Nicotine Use in 2017-2018 - U.S. National Estimates. N Engl J Med. Dec 17, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30554549 https://www.nejm.org/doi/full/10.1056/NEJMc1814130
  47. ↑ 47.0 47.1 Brooks M. FDA Investigating Reports of Seizures After Vaping. Medscape - Apr 03, 2019. https://www.medscape.com/viewarticle/911298
    FDA Special Announcement. April 3, 2019 Some E-cigarette Users Are Having Seizures, Most Reports Involving Youth and Young Adults. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm635133.htm
  48. ↑ Centers for Disease Control & Prevention (CDC) CDC, FDA, States Continue to Investigate Severe Pulmonary Disease Among People Who Use E-cigarettes Media Statement. Aug 21, 2019 https://www.cdc.gov/media/releases/2019/s0821-cdc-fda-states-e-cigarettes.html
  49. ↑ FDA Safety Alert Aug 30, 2019. E-Cigarette Products: Safety Communication - Due to the Incidents of Severe Respiratory Disease Associated with Use of an E-Cigarette Product. https://www.fda.gov/safety/medwatch-safety-alerts-human-medical-products/e-cigarette-products-safety-communication-due-incidents-severe-respiratory-disease-associated-use-e
    CDC Health Alert Network. Aug 30, 2019. Severe Pulmonary Disease Associated with Using E-Cigarette Products. https://emergency.cdc.gov/han/han00421.asp
  50. ↑ 50.0 50.1 50.2 Jackson County Health Department Oregon Public Health Division. Sept 2019
  51. ↑ 51.0 51.1 Jabba SV, Jordt SE Risk Analysis for the Carcinogen Pulegone in Mint- and Menthol- Flavored e-Cigarettes and Smokeless Tobacco Products. JAMA Intern Med. Published online September 16, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31524930 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2751245
  52. ↑ Jatlaoui TC, Wiltz JL, Kabbani S, et al. Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use- Associated Lung Injury - United States, November 2019. MMWR Morb Mortal Wkly Rep. ePub: 19 November 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31751322 Free Article https://www.cdc.gov/mmwr/volumes/68/wr/mm6846e2.htm
    Chatham-Stephens K, Roguski K, Jang Y, et al. Characteristics of Hospitalized and Nonhospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use- Associated Lung Injury - United States, November 2019. MMWR Morb Mortal Wkly Rep. ePub: 19 November 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31751326 Free Article https://www.cdc.gov/mmwr/volumes/68/wr/mm6846e1.htm
  53. ↑ 53.0 53.1 Blount BC, Karwowski MP, Morel-Espinosa M, et al. Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury - 10 States, August-Octeober 2019. MMWR Morb Mortal Wkly Rep 2019;68:1040-1041 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31725707 Free PMC Article https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e2.htm
  54. ↑ 54.0 54.1 Oransky I, Kincaid E 'Evidence That e-Cigs Cause Heart Attacks' Retracted. Medscape - Feb 19, 2020. https://www.medscape.com/viewarticle/925461
    Bhatta D, Glantz S. Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health. J Am Heart Assoc. 2019 Jun 18;8(12):e012317. Retraction in: J Am Heart Assoc. 2020 Feb 18;9(4):e014519. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31165662 Free PMC Article
  55. ↑ Phend C FDA Gives First Greenlight to E-Cig. New approval pathway used for the first time for an ENDS device. MedPage Today October 12, 2021 https://www.medpagetoday.com/publichealthpolicy/healthpolicy/94993
  56. ↑ 56.0 56.1 Xie W et al. Association of electronic cigarette use with respiratory symptom development among U.S. young adults. Am J Respir Crit Care Med 2022 Jun 1; 205:1320. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35089853 https://www.atsjournals.org/doi/10.1164/rccm.202107-1718OC
  57. ↑ 57.0 57.1 Lin H-X et al. Efficacy of electronic cigarettes vs varenicline and nicotine chewing gum as an aid to stop smoking: A randomized clinical trial. JAMA Intern Med 2024 Jan 29; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38285562 PMCID: PMC10825782 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2814489
    Hatsukami DK, Prochaska JJ. Electronic cigarettes for smoking cessation - A clinician's dilemma. JAMA Intern Med 2024 Jan 29; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/38285557 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2814496
  58. ↑ 58.0 58.1 58.2 Tackett AP, Urman R, Barrington-Trimis J et al. Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults. Thorax 2024 Jan 18; 79:163 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37582630 https://thorax.bmj.com/content/79/2/163
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