, the father of modern smoking cessation and British psychiatrist, Michael Russell, once said a very famous saying: "People smoke for nicotine, but they died of tar ." Electronic cigarettes do not contain tar, but the aerosol formed by the evaporation of the flue liquid by the heating element and then cooling it quickly contains various substances with unclear long-term and short-term toxicity. There have been cases that e-cigarette aerosols can cause serious lung damage to adolescents.
The medical community’s cautious attitude towards the implementation of e-cigarettes is not only derived from clinical data that its auxiliary smoking cessation effect is not optimistic, but also because there is still a lack of sufficient evidence to measure the risk of e-cigarettes. Raskingly supporting e-cigarettes may leave a far-reaching and bad impact.
Written by | Caicai
The more you argue, the more you become clearer. Since its birth in 2003, the three keywords around it have become clearer and clearer in the mutual confrontation and chaos among all walks of life:
quit smoking·safety·teenagers
"quit smoking" disputes related to "quit smoking" have been sorted out in the previous article "Recommendation of government agencies, Medical tests slap in the face: Can e-cigarettes help quit smoking?" Although quitting smoking is not effective, some people may say that no matter what, e-cigarettes are better than cigarettes, right? E-cigarette companies have spared no effort to promote and create an innocent image of "non-toxic and harmless" (although there is nicotine).
But, is this really the case? Thousands of pages of paper materials are not in vain. I will continue to answer the following question in this article:
Q4: What are the controversies about e-cigarettes?
Q5: Will e-cigarettes affect health?
Q6: Why are e-cigarettes banned in San Francisco? What are the controversies about
Q3 e-cigarettes?
In February 2016, "The Lancet·Respiratory Medicine" published a review and integrated analysis article, which collected and analyzed 20 studies on e-cigarettes [1].
These studies were from Europe, North America and New Zealand, involving a total of 41,110 smokers. 15 studies compared the success rate of smoking cessation in the experimental group using e-cigarettes and the control group without e-cigarettes. Among the 13 studies, the success rate of smoking cessation in the experimental group of e-cigarettes was lower than that of the control group (what?!), and 6 of them achieved statistical significance. The author split out a batch of data from another five studies, and collected them together with these 15 studies, and analyzed them in a unified manner. The results of found that from a general perspective, the probability of people using e-cigarettes successfully quit smoking is 28% lower than the control group without e-cigarettes. In other words, e-cigarettes make quitting smoking more difficult...
Are you surprised? Amazing?
Friend, are you going to make trouble?
The magazine also issued a commentary article in the same period, admitting that the analysis results are "challenging", which not only directly impacts the marketing strategies of e-cigarette manufacturers, but also challenges the views of many scientists and e-cigarette advocates who believe that e-cigarettes can help quit smoking [2].
can be imagined. Such an article immediately caused quite a lot of controversy: some people said that British policy makers should first seriously consider the conclusions of this paper, and not rush to recommend e-cigarettes [3] to the public; some people whispered, believing that this analysis has great flaws and insufficient conclusions to accept [4, 5]; then the author responded to how he was reasonable and well-founded with limited resources, and mentioned that an independent new study in Switzerland also reached the same conclusion [6].
It is true that the man speaks well, and his strength demonstrates how scientists with different opinions dissipate and keep real with each other.
e-cigarette, a new product that has emerged and has become popular recently, and the huge stakes behind it, are destined to be in a vortex of controversy, and similar confrontations will certainly not be limited to scientists.
In April 2016, in the context of the traditional tobacco industry entering the e-cigarette market, The Royal College of Physicians (hereinafter referred to as RCP) issued a report questioning the intention of tobacco companies to invest in e-cigarettes: It is known that the first generation of e-cigarettes cannot provide nicotine efficiently, and tobacco companies focus on investing in these first-generation products - did tobacco companies deliberately do it, thus prompting smokers who failed to replace traditional cigarettes and become addicted to nicotine to return to traditional tobacco and minimize the impact of e-cigarettes on tobacco sales?
Where there is interests, there is capital, and where there is capital, there is undercurrent. There is nothing new under the sun.
And RCP's report to criticize capitalists itself was also criticized. skeptics believe that the report evaluates e-cigarettes as a low-risk product and is irresponsible (a reckless and irresponsible suggestion) [7].
So in November 2016, "The Lancet Respiratory Medicine" published another commentary article "E-cigarettes: controversies within the controversy" (E-cigarettes: controversies within the controversy) [8].
Time quietly passed and left a small controversy. You guessed that in 2018, is there any more evidence or less noise about e-cigarettes?
"The Lancet Respiratory Medicine" published a commentary article in January 2018, this time the title is: E-cigarettes: further flavours of controversies within the controversy ("E-cigarettes: Advanced Edition of Controversies in Controversy") [14].
You can feel from the title that the debate has not subsided from the period from 2016 to 2018, but instead the argument has become more intense...
For example, after the Royal Society of Physicians expressed support for e-cigarettes to replace traditional tobacco, the National Institute of Health and Clinical Optimization of the UK then emphasized in a draft clinical guide that there is currently no sufficient evidence to support the view that e-cigarettes are harmless, and hopes that doctors will adopt a cautious attitude [9].
In October 2017, Norman Lamb, chairman of the Science and Technology Committee of the British Parliament, said: The current research on e-cigarettes still have great flaws, which is not enough to guide the regulation and sale of [9].
At the same time, the UK's House of Commons Science and Technology Committee (UK's House of Commons Science and Technology Committee) began a survey on e-cigarettes, and publicly solicited opinions and materials on e-cigarettes in health, supervision and finance with December 8, 2017 as the deadline. By August 17, 2018, the committee released a 66-page report on e-cigarettes, which believed that e-cigarettes were less harmful than ordinary cigarettes, providing British society with an opportunity to significantly reduce smoking rates.
https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/505.pdf full text can be downloaded
This report also acknowledges that there is uncertainty in the use of e-cigarettes. Especially due to the short history of e-cigarettes, it is impossible to judge the impact of long-term use on health.
The report believes that when measuring the risk of e-cigarettes, it is necessary to consider that if smokers continue to smoke traditional cigarettes, the harm is greater than the use of e-cigarettes. Therefore, if smokers cannot completely quit smoking, they should be encouraged to use e-cigarettes as a less harmful alternative to traditional cigarettes .
The report's outing is a pouring pot of oil into the hot debate surrounding e-cigarettes.
A week later, The Lancet published a comment on the report. The title was clear at a glance and it was straightforward: E-cigarettes—is the UK throwing caution to the wind? [10]——The Lancet is so angry that he directly criticized the relevant British departments for letting themselves go too far and their minds are in.
Melon Eaters roughly translate this short comment from the Lancet:
The impact of e-cigarettes on public health has always been a highly polarized debate. Most of the evidence held by both sides is not reliable, and those who support the views of both sides are very enthusiastic... Therefore, the content of this e-cigarette report issued by the Science and Technology Committee of the House of Commons of the UK is basically positive testimony from experts and relevant organizations, which is surprising. If the controversy surrounding e-cigarettes usually revolves around the two issues of "prevention" and "harm reduction", then this report obviously adds fuel to the debate on "harm reduction".
has similar opinions on e-cigarettes recently, including the British Ministry of Public Health and the Royal College of Physicians. This report also concluded that e-cigarettes are far less harmful than traditional tobacco. Although there is no complete evidence to support it, the committee recommends that traditional smokers switch to e-cigarettes, which may be approved for medical treatment and prescriptions. Not only that, the recommendation also requests relaxation of regulation of e-cigarettes and licenses of supplemental flue liquids with higher nicotine content, reconsider e-cigarette-related taxes and rules on the use of e-cigarettes in public places, and the full opening of e-cigarettes in mental health institutions. Most worryingly, the committee recommended rethinking the regulatory approach of new tobacco products after Brexit, so that e-cigarette non-combustible tobacco products and snuff type tobacco products can be easily accessed. They even further proposed relaxing regulation of e-cigarette advertising, believing that there is no need to worry that e-cigarette products will open the door to the tobacco world for teenagers - because this has not happened yet. (After the translation, I can't help but "Damn!" I just want to say that in terms of teenagers, the committee's heart is really broad! It's a bit incredible... No wonder the Lancet is angry. In 2019, there is a solid evidence that this situation will happen, have happened, and is happening. Let's talk about this later.)
Although there is not enough evidence to support it at present, people have reason to believe that e-cigarettes can play a less harmful alternative than traditional tobacco in quitting smoking. However, the traditional tobacco industry has already occupied a considerable share of the big business of e-cigarettes. It is very immature to confuse "the lack of evidence to prove harmful" with "harmless". Some of the more extreme suggestions in this report lack strong evidence to support it. At this stage, it is wrong and disappointing to make such suggestions.
Q5 Will e-cigarettes affect health?
E-cigarettes, as a replacement for traditional cigarettes that may be used for a long time, are safety important factors that cannot be ignored: compared with cigarettes, is the lighter of two harms, or is it the front door driven away the tiger or the back door a wolf?
Judging from the two documents of the British and American teams with a total of 1017 pages, e-cigarettes should be safer than traditional cigarettes, but how safe are e-cigarettes? The report of the Ministry of Public Health is largely based on the questionnaire, with only one set of charts showing the reduction of certain biomarkers (243-page report, page 171, Fig36), and there is not enough solid evidence in the books of the National Institutes of Science and Engineering and Medicine. On the contrary, both documents emphasize that e-cigarettes are not harmless, the data is insufficient, and more research is needed ("More research is needed"). It is not surprising that
lacks a solid hammer, because the solid hammer takes time to forge it.
Take traditional cigarettes as an example. Cigarettes entered the European and American markets around 1850. Around 1950, there were medical documents linking smoking with lung cancer. Most people did not start to face the harm of smoking to health until around 1970. There are now more than 20,000 papers on "lung cancer smoking" on pubmed. The Centers for Disease Control and Prevention (hereinafter referred to as CDC) lists smoking as the number one risk factor for lung cancer, and believes that 80 to 90% of lung cancer cases in the United States are related to smoking.
As a new thing in less than 20 years, e-cigarettes are currently missing for long-term safety data related to lung cancer.
In this case, to compare the hazards/safety of e-cigarettes and traditional cigarettes, we must start from the structure of the e-cigarettes.
Many of the research data on e-cigarettes come from the second generation of e-cigarettes. According to the October 2016 review of NEJM (New England Journal of Medicine) The Health Effects of Electronic Cigarettes ("Electronic Cigaretteshtml"), a typical second-generation e-cigarettes include a battery, a container for liquids and a vaporization chamber with heating elements. It is a device that generates aerosol by heating the flue liquid through electronic components [11].
Typical second-generation electronic cigarette structure
e-cigarette liquid is usually composed of glycerin, propylene glycol, flavoring agents and nicotine (there are also electronic cigarette liquids that are claimed to contain nicotine, otherwise). The aerosol generated by the user directly inhales through the cigarette holder can make the nicotine content in the serum peak within five minutes.
Data shows that sucking 13 aerosols from 18mg/ml nicotine cigarettes can consume about 0.5mg of nicotine, which is equivalent to smoking traditional cigarettes. Moreover, using electronic cigarettes has a similar feeling of sucking clouds and vomiting. It is probably the closest nicotine substitute to traditional cigarettes, right?
In traditional cigarettes, the main addictive substance is nicotine, and the most toxic substance is not nicotine, but carcinogens, carbon monoxide and thousands of other toxins produced by tobacco burning.
The father of modern smoking cessation and British psychiatrist Michael Russell, a British psychiatrist, said a famous saying in a 1976 article: "People smoke for nicotine but they die from the tar." [12] ("People smoke for nicotine, but they died of tar.") This old Mr. Russell was one of the first people to discover that nicotine is the main addictive ingredient in tobacco. He believes that using less toxic sources of nicotine can effectively reduce the health harm of smoking. His theory still affects the UK Health Organization and the official policy of promoting e-cigarettes as a long-term nicotine substitute for smoking cessation.
The process of the flue liquid of the electronic cigarette being evaporated by the heating element and then quickly cooled to form aerosol, which is very different from the combustion process of traditional tobacco. Therefore, the components of electronic cigarette aerosol and traditional cigarette smoke are also very different (modified from[11]):
Note: Chinese translation author added
. When comparing the differences in the composition of electronic cigarette aerosol and traditional cigarette smoke, many current literature, including the 774-page review of the National Institutes of Science and Engineering and Medicine, all referenced data points to 2014 Tobacco A paper in Control ("Smoking Control") [13].
In this paper, which is the source of data and has been reprinted one after another, scientists obtained aerosols from 12 kinds of electronic cigarettes through the smoking robot Palaczbot and analyzed the components. Then, compared with a 2003 study on the smoke components of traditional cigarettes, it was found that some toxic ingredients contained in the aerosols of electronic cigarettes were lower than those of traditional cigarettes, with a difference of 9 to 450 times respectively. Therefore, from the six components analyzed, the toxicity of electronic cigarettes is much lower than that of traditional tobacco.
Note: The Chinese translation author added
In addition, in a study published by a team in the UK in 2017, five groups of subjects used traditional cigarettes, traditional cigarettes + nicotine substitutes, traditional cigarettes + e-cigarettes, nicotine substitutes, and e-cigarettes. After half a year, the toxic metabolites in the urine were analyzed and compared, and it was found that the levels of these metabolites were the lowest in the e-cigarette use group [14].
Note: Chinese translation is added by the author (click to see the larger picture)
So is e-cigarette safe? The two pictures above
have already told us that e-cigarettes are not non-toxic and harmless.
Not long ago, at the 2019 annual meeting of the American Society of Cardiology, the CDC published a new study: Although the possibility of e-cigarette users suffering from heart disease, coronary artery disease and depression is lower than that of people who smoke traditional cigarettes, it is much higher than those who neither smoke nor use e-cigarettes.
Source: https://www.sciencedaily.com/releases/2019/03/190307103111.html
This should be the largest research on the correlation between e-cigarettes and cardiovascular diseases to date. The CDC conducted a survey in 2014, 2016 and 2017, analyzing data from 96,467 Americans and found that compared with people who neither smoke nor use e-cigarettes, e-cigarette users are 56% more likely to have heart attacks, 30% more likely to have strokes, 10% more likely to have coronary heart disease, 44% more likely to have blood circulation problems, including thrombosis, and 200% more likely to have depression or anxiety.
In this study, the average age of e-cigarette users was 33 years old, while the average age of non-e-cigarette users was 40.4 years old. After adjusting for other risk factor variables related to cardiovascular disease (such as age, weight, cholesterol, blood pressure, and smoking), e-cigarette users are still 34% more likely to have a heart attack, 34% more risk of coronary heart disease, and 55% more risk of depression or anxiety than those who neither smoke nor use e-cigarettes.
These data are undoubtedly a wake-up call for those who previously believed that e-cigarettes are not harmful to health and intend to use them for a long time.
As for those who smoke traditional cigarettes, compared with those who do not smoke, the chances of heart disease, coronary heart disease and stroke are 165%, 95% and 78% higher, respectively, and there are also significant increases in hypertension, diabetes, circulatory diseases, and depression/anxiety.
Therefore, the safety of e-cigarettes has a lot to do with the specific usage method: Should e-cigarettes be used as a short-term use of smoking cessation assistance, or as a long-term use of traditional cigarettes?
If it is a short-term smoking cessation assistance, e-cigarettes are likely to be the lightest one among the "two harms are the mildest".
If used for a long time, even smaller health risks must be taken seriously.
Just two weeks ago, eight teenagers in Wisconsin, USA had to be admitted to the hospital for treatment due to severe lung damage caused by using e-cigarettes. At about the same time, two American teenagers said at a congressional hearing that sales representatives of an e-cigarette company have promoted the students at closed-door meetings more than once that e-cigarettes are absolutely safe and harmless. Such publicity has made students who have already started using e-cigarettes feel relieved and can continue with confidence and boldness - but! e-cigarettes are definitely not "absolutely safe" ! !
(News source: FOX, NEW YORK DAILY NEWS)
Just shortly after this hearing, on August 2, 2019, the Wisconsin Department of Health issued a public report: Recently, several teenagers in the state have suffered from severe lung diseases due to using e-cigarettes, of which 11 have been confirmed and 7 are under investigation.
Source: https://www.dhs.wisconsin.gov/news/releases/080219.html
These patients have suffered severe symptoms of dyspnea, fatigue, chest pain, cough, weight loss, etc. within weeks or months after using e-cigarettes, and have to be hospitalized for treatment. Some of them even need tracheal intubation. The symptoms of these patients improve after steroid treatment, but the sequelae of these patients still need to be observed for a long time.
Coincidentally, the American Association of Poison Control Center (AAPCC) has received 2439 reports of poisoning related incidents from to January to July this year.
These currently known cases are all symptoms that appear in the short term after using e-cigarettes, which is enough to tell us that e-cigarettes are not non-toxic and harmless.
What if I use e-cigarettes for years?
Although most of the ingredients such as glycerol, propylene glycol and flavoring agents in e-cigarettes are orally safe food additives, there are only a few animal experimental data at present, and there is no clinical data for reference for reference. Experts at
RCP believe that even if it does not contain nicotine, e-cigarettes are unlikely to be harmless. Long-term use is likely to produce sequelae such as COPD and lung cancer, and may also increase the risk of smoking-related chronic diseases such as cardiovascular disease [15].
—When the voltage in the electronic cigarette is too high, the aerosol composition may change significantly and reduce safety.
- A typical second-generation e-cigarette produces aerosol containing approximately 0.4 mg/m3 formaldehyde.
- Some specific brands of smoke liquids will contain the toxic ingredient of ethylene glycol after aerosolization.
——Acrolein has a strong correlation with COPD in chronic obstructive pulmonary disease.
- Flavoring agents often contain irritating aldehyde ingredients, which have certain risks; sometimes they contain diacetyl, acetyl and propionyl. If they are inhaled too much, there will be a risk of respiratory diseases. For example, diacetyl used as flavoring agents will increase the risk of occlusive bronchiolititis.
- The smoke liquid seasoned with tobacco extract may contain low concentrations of nitrosamines, nitrates and phenols in the aerosol. What is more complicated than alternatives such as traditional cigarettes and nicotine patches is that the ever-evolving e-cigarette technology and new products also continue to challenge the safety of e-cigarettes.
In recent years, new e-cigarette products have emerged like mushrooms after a rain. In 2014, there were 466 brands and 7764 different flavors [16]. Maybe there are more now, right?
In the research on poisons and metabolites cited in the previous article, electronic cigarettes that have not been fancy-seasoned. Today, the various flavoring agents used in the flavors of these more than 7,000 e-cigarettes will have on the health of users? At this stage, it is almost unpredictable. Why are
Q6 e-cigarettes banned in San Francisco?
The various flavors of e-cigarettes that bloom in a variety of flowers can be imagined.
Take the recently popular Juul e-cigarette in the United States as an example. This e-cigarette is beautiful and light, looks like a USB flash drive, consumes less power, contains high concentration of nicotine, has a rich taste, and does not have the pungent and pungent taste like traditional tobacco. It has quickly become popular among teenagers, and most of these minor users do not even know that it contains nicotine...
In the United States, 1.8% of minors had used e-cigarettes in 2010, and this proportion quickly rose to 13.0% in 2013, and further increased to 16% in 2015. A survey of more than 4,000 undergraduate students in North Carolina showed that these young people did not use e-cigarettes to quit smoking, and many people had no history of smoking traditional cigarettes at all. On the contrary, studies have shown that teenagers who have used e-cigarettes are more likely to start smoking [16].
Whether it is the nicotine in e-cigarettes, the messy flavoring agents, or the gateway effect that e-cigarettes prompt teenagers to start smoking, it is worrying. In 2016, the U.S. Food and Drug Administration (FDA) classified e-cigarettes into tobacco products and banned the sale of [17] to people under the age of 18. This age limit was implemented in June 2016. In the same year, the proportion of minors using e-cigarettes in the United States dropped from 16% in 2015 to 11% [14].
Even so, the number of teenage e-cigarette users in the United States has increased rapidly, from 1.5 million in 2017 to 3.6 million in 2018, and more than one in five American high school students use e-cigarettes.
(Data source: https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.html)
Survey also shows that nearly 70% of teenage e-cigarette users will use e-cigarette products of various flavors (think about the 7,000 different e-cigarette flavors...), and 50% of teenage e-cigarette users will use e-cigarettes with mint and menthol flavors.
Because teenagers who have been exposed to tobacco products from using e-cigarettes are more likely to turn to traditional tobacco. In order to curb the growth momentum of teenage e-cigarette users, the FDA announced that it will ban retail stores from selling various flavors of e-cigarettes that cater to the curiosity of teenagers. In addition to traditional tobacco flavors, mint and menthol flavors, they will only be sold in tobacco stores or websites that must undergo age review. If the number of teenagers with mint-flavored and menthol-flavored e-cigarettes continues to increase, it is not ruled out that they will be banned in the future.
Accordingly, Juul, which accounts for 75% of the US e-cigarette market, announced that in addition to stop selling various flavor products in retail stores, it will also close FB and Instagram accounts in the United States, as a way to avoid teenagers and non-smokers being interested in their products.
Compared with the US official conservative attitude towards the use of e-cigarettes for teenagers, the British House of Commons Science and Technology Committee declared in an e-cigarette report published in August 2018 that the portal effect of e-cigarettes to teenagers has not been observed in the UK, so there is no need to worry about this situation and the supervision of e-cigarette advertising should be further relaxed accordingly. This really makes people wonder what to say... No wonder the Lancet rolled up his sleeves and angrily criticized this report [10].
The different attitudes of the UK and the United States towards e-cigarettes on the issue of teenagers also reflect the various contradictory views of e-cigarettes in the current public health community.
Some people think that e-cigarettes should not be promoted as they will scare away people who originally wanted to give up traditional cigarettes and switch to e-cigarettes. Given that the toxicity of e-cigarettes is likely to be lower than that of traditional cigarettes, such publicity consequences will harm those who could have switched to e-cigarettes.
Some people believe that e-cigarettes should not be promoted as harmless, because they will mislead the public, especially teenagers, and the portal effect will harm more people.
In fact, in the United States, e-cigarettes have brought quite troublesome teenage problems.
New data disclosed at the end of December 2018 shows that despite the FDA taking a series of measures and increasing supervision, e-cigarettes continue to remain popular among American teenagers, and have caused the growth of American teenagers to grow at a shocking rate, doubling in the past year, a huge increase that has never been seen in the monitoring period so far 44 years [18].
Some people have predicted that the popularity of e-cigarettes among American teenagers, as well as hundreds of different flavors such as mint, vanilla, blueberries, etc. will unconsciously push some teenagers on the path of nicotine addiction: start with various novel and fun flavors, and when nicotine addiction becomes addicted, you will reduce your interest in various flavors and focus on nicotine cigarette liquid.
- This has now been indirectly confirmed by statistics: the use of nicotine cigarettes has surged, but the usage rate of those diverse flavored e-cigarettes has increased relatively slowly.
Previously, there have been studies that some users who obtain nicotine through e-cigarettes will then turn to seek nicotine from traditional tobacco.
In other words, today when traditional tobacco is no longer so fashionable, many teenagers may not be able to smoke, but now they are getting started with electronic cigarettes.
survey shows that when many teenagers start using e-cigarettes for reasons such as curiosity, trends, and shelter, they do not even realize that the e-cigarette liquid contains nicotine, and the content is not low!
E-cigarettes were originally created by adults to try to help quit smoking, but now they have become an accomplice to drag more teenagers into the nicotine quagmire and push them towards cigarettes... This is very sad.
Now, 20% of senior high school students in the United States use nicotine-containing e-cigarettes. Teens who are addicted to e-cigarettes can't stop. Dr. Sharon Levy, an expert at Boston Children's Hospital in treating teenage addiction, said in an interview with the New York Times: "(The child who is addicted to e-cigarettes) is like an addict who has stopped using heroin but is still constantly injecting himself with empty needles."
and parents and doctors are helpless.
They found that many teenagers do not know or admit that they are addicted. Because e-cigarettes are more hidden than traditional cigarettes, it is often difficult for parents and doctors to detect and control the continued use of e-cigarettes by addicted teenagers.
Nicotine is the main addictive substance in tobacco. It is very addictive, so strong that it is similar to cocaine, far more than cannabis and ecstasy. After being addicted, it is difficult to quit. Since e-cigarettes are not as easy to estimate the nicotine content as traditional cigarettes, nicotine addiction produced through e-cigarettes is more difficult to quit than traditional cigarette addiction.
. What’s more troublesome than adults is that the brain of adolescents is still in the development stage, and nicotine addiction will cause some permanent damage. The nicotine abstinence program for adults is therefore not suitable for adolescents.
In short, the problem of nicotine addiction in the United States caused by e-cigarettes is becoming increasingly serious, and there is currently no effective treatment for nicotine addiction in adolescents.
To this end, US Health Director Jerome Adams issued a call to parents, politicians and the medical industry take joint action to curb the rapid growth of e-cigarette usage among young people in the United States. He believes that e-cigarettes should be included in the indoor smoking ban, e-cigarette advertising and marketing targeting young people should be banned, and official measures should be taken to limit teenagers' exposure to flavored tobacco products, treat e-cigarettes the same as traditional cigarettes, and inform users of the relevant risks.
(Initiative: https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf full text can be downloaded )
It is also why, on June 19, 2019, San Francisco passed a local legislation to restrict the sale of e-cigarettes, prohibiting the sale of tobacco products that have not been approved by the FDA, including e-cigarettes.
Source: https://www.sfcityattorney.org/2019/06/18/herrera-statement-on-passing-of-e-cigarette-legislation/
Since the electronic cigarette products on the US market have been sold well without FDA approval, now if the electronic cigarette products on San Francisco City cannot pass the FDA approval before the legislation takes effect, they will face a situation where all sales are banned. Therefore, this legislation should be considered as a conditional sale of e-cigarettes, rather than simply and roughly banning them - although the result may be equivalent to a ban on sales.
The San Francisco District Attorney said in the statement: "If e-cigarettes do bring some benefit to smokers as they claim, as e-cigarette manufacturers/dealers claim, why have they not submitted these products that are beneficial to people to the FDA for review? If e-cigarettes are actually good for public health, rather than tempting a younger generation of nicotine addiction, then e-cigarette manufacturers have a full chance to get FDA certification and sell them legally in San Francisco before legislation takes effect."
will wait and see.
Author (self) Introduction
Caicai, a young female science, lecturer at Harvard Medical School.
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