Will Vaping Lead Teens to Smoking Cigarettes?

About Electronic Cigarettes (E-cigarettes)

Will Vaping Lead Teens to Smoking Cigarettes? | Johns Hopkins Medicine

  • E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.
  • E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—flavorings, and other chemicals that help to make the aerosol. Users inhale this aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales into the air.
  • E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
  • Some e-cigarettes are made to look regular cigarettes, cigars, or pipes. Some resemble pens, USB sticks, and other everyday items. Larger devices such as tank systems, or “mods,” do not resemble other tobacco products.
  • Using an e-cigarette is sometimes called “vaping.”
  • E-cigarettes can be used to deliver marijuana and other drugs.

Some e-cigarettes are made to look regular cigarettes, cigars, or pipes.
Some resemble pens, USB sticks, and other everyday items.

The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:

  • Nicotine
  • Ultrafine particles that can be inhaled deep into the lungs
  • Flavoring such as diacetyl, a chemical linked to a serious lung disease
  • Volatile organic compounds
  • Cancer-causing chemicals
  • Heavy metals such as nickel, tin, and lead1

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.2

What is in e-cigarette aerosol?

E-cigarettes are still fairly new, and scientists are still learning about their long-term health effects. Here is what we know now.

Most e-cigarettes contain nicotine, which has known health effects.1

  • Nicotine is highly addictive.
  • Nicotine is toxic to developing fetuses.
  • Nicotine can harm adolescent and young adult brain development, which continues into the early to mid-20s.
  • Nicotine is a health danger for pregnant women and their developing babies.

Besides nicotine, e-cigarette aerosol can contain substances that harm the body.1

  • This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.

E-cigarettes can cause unintended injuries.1

  • Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the e-cigarette batteries were being charged.
    • The Food and Drug Administration (FDA) collects data to help address this issue. You can report an e-cigarette explosion, or any other unexpected health or safety issue with an e-cigarette, hereexternal icon.
  • In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.

Most e-cigarettes contain nicotine, which is addictive and toxic to developing fetuses. Nicotine exposure can also harm adolescent and young adult brain development, which continues into the early to mid-20s.1 E-cigarette aerosol can contain chemicals that are harmful to the lungs. And youth e-cigarette use is associated with the use of other tobacco products, including cigarettes.

For more information about the risks of e-cigarettes for young people, visit Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults.

Yes—but that doesn’t mean e-cigarettes are safe. E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes.3 However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals lead, volatile organic compounds, and cancer-causing agents.1

E-cigarettes are not currently approved by the FDA as a quit smoking aid. The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, has concludedexternal icon that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, including pregnant women.3

However, e-cigarettes may help non-pregnant adult smokers if used as a complete substitute for all cigarettes and other smoked tobacco products.

  • To date, the few studies on the issue are mixed. A Cochrane Reviewexternal icon found evidence from two randomized controlled trials that e-cigarettes with nicotine can help smokers stop smoking in the long term compared with placebo (non-nicotine) e-cigarettes.4 However, there are some limitations to the existing research, including the small number of trials, small sample sizes, and wide margins of error around the estimates.
  • A recent CDC study pdf icon[PDF–197 KB] found that many adults are using e-cigarettes in an attempt to quit smoking.5 However, most adult e-cigarette users do not stop smoking cigarettes and are instead continuing to use both products (known as “dual use”).7 Dual use is not an effective way to safeguard your health, whether you’re using e-cigarettes, smokeless tobacco, or other tobacco products in addition to regular cigarettes. Because smoking even a few cigarettes a day can be dangerous,6 quitting smoking completely is very important to protect your health.

E-cigarettes are the most commonly used tobacco product among youth.

  • In the United States, youth are more ly than adults to use e-cigarettes.
  • In 2019, over 5 million U.S. middle and high school students used e-cigarettes in the past 30 days, including 10.5% of middle school students and 27.5% of high school students.8
  • In 2017, 2.8% of U.S. adults were current e-cigarette users.9
  • In 2015, among adult e-cigarette users overall, 58.8% also were current regular cigarette smokers, 29.8% were former regular cigarette smokers, and 11.4% had never been regular cigarette smokers.7
  • Among current e-cigarette users aged 45 years and older in 2015, most were either current or former regular cigarette smokers, and 1.3% had never been cigarette smokers. In contrast, among current e-cigarette users aged 18–24 years, 40.0% had never been regular cigarette smokers.7
  • Guide for quitting smoking: Provides free resources, including a mobile app and quit guide.
  • E-cigarette, or Vaping, Products Visual Dictionary pdf icon[PDF – 3 MB]: This product is intended for educational purposes only for public health officials and healthcare providers. The devices and brands presented in this pamphlet are intended to highlight the different e-cigarette, or vaping, product generations and substances used in these devices.
  • Federal regulation of e-cigarettes: Provides an overview of FDA regulations of e-cigarettes and other tobacco products.external icon
  • Information for parents, caregivers, and influencers of youth and young adults about e-cigarettesexternal icon: Features comprehensive information about the impact of e-cigarette use among young people, and includes resources such as a tip sheet for parents to talk to their teens about e-cigarettes.
  • State laws and policies regarding e-cigarettes: This CDC fact sheet reports on laws pertaining to sales, use, and taxation of e-cigarettes in the 50 states and the District of Columbia.
  • Surgeon General’s Report on E-cigarette Use Among Youth and Young Adults pdf icon[PDF–8.47 MB]external icon: Released in 2016, this is the first report issued by a federal agency to comprehensively review the public health issue of e-cigarette use among youth and young adults. The report’s scientific findings are the best available evidence regarding a variety of topics, including trends in e-cigarette use; health effects of e-cigarettes, nicotine, and secondhand e-cigarette aerosol; e-cigarette marketing and advertising; and evidence-based strategies to reduce e-cigarette use among youth and young adults.

CDC has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about medication with your health care provider. The mention of any product, service, or therapy is not an endorsement by CDC.

  1. US Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the Surgeon General pdf icon[PDF–8.47 MB]. Atlanta, GA: US Department of Health and Human Services, CDC; 2016.
  2. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the U.S., Korea, and Poland. Int J Drug Policy. 2015;26(6):583–588.
  3. Patnode CP, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. 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. Evidence Synthesis No. 134. AHRQ Publication No. 14-05200-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
  4. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Can electronic cigarettes help people stop smoking, and are they safe to use for this purpose?external icon Published 13 September 2016.
  5. Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA. Quit Methods Used by US Adult Cigarette Smokers, 2014–2016external icon. Prev Chronic Dis 2017; 14:160600.
  6. Bjartveit K, Tverdal A. Health Consequences of Smoking 1-4 Cigarettes Per Day. Tobacco Control 2005;14(5):315–20.
  7. QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group — National Health Interview Survey, United States, 2015external icon. MMWR Morb Mortal Wkly Rep 2016;65:1177.
  8. Cullen KA, Gentzke AS, Sawdey MD, et al. e-Cigarette Use Among Youth in the United States, 2019. JAMA. Published online November 05, 2019. doi:10.1001/jama.2019.18387
  9. Wang T, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225-1232

Multimedia

Source: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html

Electronic Cigarettes. Potential Harms and Benefits

Will Vaping Lead Teens to Smoking Cigarettes? | Johns Hopkins Medicine

1 . Terry L.Smokingand health: report of the Advisory Committee to the Surgeon General of theUnited States. In: U-23 Department of Health, Education and Welfare. WashingtonDC: Public Health Service Publication No. 1103;1964[accessed 2013 Oct 15]. Available from: http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBMQ

2 . Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, Hartge P, Gapstur SM. 50-yeartrends in smoking-related mortality in the UnitedStates. N Engl JMed. 2013;368:351–364. [PMC free article] [PubMed] [Google Scholar]

3 . World Health Organization. World HealthOrganization Report on the global tobacco epidemic,2011. warning about the dangers of tobacco [accessed 2013Oct 15]. Available from: http://www.who.int/tobacco/global_report/2011/en/

4 . Rigotti N. Smokingcessation in patients with respiratory disease: existing treatments andfuture directions. Lancet RespiratoryMedicine. 2013;1:241–250. [PubMed] [Google Scholar]

5 . World Health Organization. World HealthOrganization Fact Sheet 2009- Tobacco. 2009[accessed 2013Dec 17]. Available from: http://www.who.int/nmh/publications/fact_sheet_tobacco_en.pdf

6 . Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st-centuryhazards of smoking and benefits of cessation in the UnitedStates. N Engl JMed. 2013;368:341–350. [PubMed] [Google Scholar]

7 . Godtfredsen NS, Prescott E, Osler M. Effectof smoking reduction on lung cancerrisk. JAMA. 2005;294:1505–1510. [PubMed] [Google Scholar]

8 . Bolliger CT, Zellweger JP, Danielsson T, vanBiljon X, Robidou A, Westin A, Perruchoud AP, Säwe U. Influenceof long-term smoking reduction on health risk markers and quality oflife. Nicotine TobRes. 2002;4:433–439. [PubMed] [Google Scholar]

9 . Wennike P, Danielsson T, Landfeldt B, Westin A, Tønnesen P. Smokingreduction promotes smoking cessation: results from a double blind,randomized, placebo-controlled trial of nicotine gum with 2-yearfollow-up. Addiction. 2003;98:1395–1402. [PubMed] [Google Scholar]

10 . Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotinereplacement therapy for smokingcessation. Cochrane Database SystRev. 2012;11:CD000146. [PubMed] [Google Scholar]

11 . Bolliger CT, Zellweger JP, Danielsson T, vanBiljon X, Robidou A, Westin A, Perruchoud AP, Säwe U. Smokingreduction with oral nicotine inhalers: double blind, randomised clinicaltrial of efficacy andsafety. BMJ. 2000;321:329–333. [PMC free article] [PubMed] [Google Scholar]

12 . Rennard SI, Glover ED, Leischow S, Daughton DM, Glover PN, Muramoto M, Franzon M, Danielsson T, Landfeldt B, Westin A. Efficacyof the nicotine inhaler in smoking reduction: a double-blind, randomizedtrial. Nicotine TobRes. 2006;8:555–564. [PubMed] [Google Scholar]

13 . Cahill K, Stevens S, Perera R, Lancaster T. Pharmacologicalinterventions for smoking cessation: an overview and networkmeta-analysis. Cochrane Database SystRev. 2013;5:CD009329. [PubMed] [Google Scholar]

14 . Yamin CK, Bitton A, Bates DW. E-cigarettes:a rapidly growing Internetphenomenon. Ann InternMed. 2010;153:607–609. [PubMed] [Google Scholar]

15 . Caponnetto P, Campagna D, Papale G, Russo C, Polosa R. Theemerging phenomenon of electroniccigarettes. Expert Rev RespirMed. 2012;6:63–74. [PubMed] [Google Scholar]

16 . Noel JK, Rees VW, Connolly GN. Electroniccigarettes: a new ‘tobacco’industry? TobControl. 2011;20:81. [PubMed] [Google Scholar]

17 . Vansickel AR, Eissenberg T. Electroniccigarettes: effective nicotine delivery after acuteadministration. Nicotine TobRes. 2013;15:267–270. [PMC free article] [PubMed] [Google Scholar]

18 . Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. Aclinical laboratory model for evaluating the acute effects of electronic“cigarettes”: nicotine delivery profile and cardiovascular andsubjective effects. Cancer EpidemiolBiomarkersPrev. 2010;19:1945–1953. [PMC free article] [PubMed] [Google Scholar]

19 . Centers for Disease Control andPrevention, US Department of Health and HumanServicesNational Youth Tobacco Survey. Atlanta;2013[accessed 2013 Oct 15]. Available from: http://www.cdc.gov/tobacco/data_statistics/surveys/nyts

20 . Corey C, Wang B, Johnson S, Apelberg B, Husten C Centersfor Disease Control and Prevention(CDC) Notes from the field: electroniccigarette use among middle and high school students – United States,2011-2012. MMWR Morb Mortal WklyRep. 2013;62:729–730. [PMC free article] [PubMed] [Google Scholar]

21 . Centers for Disease Control andPrevention, US Department of Health and HumanServicesPress release: About one in five U.S. adult cigarettesmokers have tried electronic cigarette. Atlanta;2013[accessed 2013 Nov 10] Available from: http://www.cdc.gov/media/releases/2013/p0228_electronic_cigarettes.html

22 . Adkison SE, O’Connor RJ, Bansal-Travers M, Hyland A, Borland R, Yong HH, Cummings KM, McNeill A, Thrasher JF, Hammond D, et al. Electronicnicotine delivery systems: international tobacco control four-countrysurvey. Am J PrevMed. 2013;44:207–215. [PMC free article] [PubMed] [Google Scholar]

23 . Goniewicz ML, Lingas EO, Hajek P. Patternsof electronic cigarette use and user beliefs about their safety andbenefits: an internet survey. DrugAlcoholRev. 2013;32:133–140. [PMC free article] [PubMed] [Google Scholar]

24 . Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB. e-Cigaretteawareness, use, and harm perceptions in USadults. Am J PublicHealth. 2012;102:1758–1766. [PMC free article] [PubMed] [Google Scholar]

25 . Etter JF, Bullen C. Electroniccigarette: users profile, utilization, satisfaction and perceivedefficacy. Addiction. 2011;106:2017–2028. [PubMed] [Google Scholar]

26 . Dawkins L, Turner J, Roberts A, Soar K. ‘Vaping’profiles and preferences: an online survey of electronic cigaretteusers. Addiction. 2013;108:1115–1125. [PubMed] [Google Scholar]

27 . Dwyer JB, McQuown SC, Leslie FM. Thedynamic effects of nicotine on the developingbrain. PharmacolTher. 2009;122:125–139. [PMC free article] [PubMed] [Google Scholar]

28 . Kralikova E, Novak J, West O, Kmetova A, Hajek P. Doe-cigarettes have the potential to compete with conventional cigarettes?: asurvey of conventional cigarette smokers’ experiences withe-cigarettes. Chest. 2013;144:1609–1614. [PubMed] [Google Scholar]

29 . U.S. Food and DrugAdministrationRegulation of e-cigarettes and other tobaccoproducts. 2011[accessed 2013 Dec 6]. Available from:http://www.fda.gov/newsevents/publichealthfocus/ucm252360.htm

30 . Benowitz NL, Goniewicz ML. Theregulatory challenge of electroniccigarettes. JAMA. 2013;310:685–686. [PubMed] [Google Scholar]

31 . Cobb NK, Cobb CO. Regulatorychallenges for refined nicotineproducts. Lancet RespiratoryMedicine. 2013;1:431–432. [PubMed] [Google Scholar]

32 . Elliott S.E-cigarettemakers’ ads echo tobacco's heyday. New York Times August 30,2013[accessed 2013 Oct 15]. Available from:http://www.nytimes.com/2013/08/30/business/media/e-cigarette-makers-ads-echotobaccos-heyday.html

33 . Rodu B.Thee-cigarette revolution. Rstreet.org December 12,2012[accessed 2013 Nov 11]. Available at http://www.rstreet.org/op-ed/the-e-cigarette-revolution/

34 . Robehmed N.E-cigarettesales surpass $1 billion as big tobacco moves in. Forbes Magazine OnlineSeptember 17, 2013[accessed 2013 Oct 15]. Available from:http://www.forbes.com/sites/natalierobehmed/2013/09/17/e-cigarette-sales-surpass-1-billion-as-big-tobacco-moves-in/

35 . Trtchounian A, Williams M, Talbot P. Conventionaland electronic cigarettes (e-cigarettes) have different smokingcharacteristics. Nicotine TobRes. 2010;12:905–912. [PubMed] [Google Scholar]

36 . Goniewicz ML, Kuma T, Gawron M, Knysak J, Kosmider L. Nicotinelevels in electroniccigarettes. Nicotine TobRes. 2013;15:158–166. [PubMed] [Google Scholar]

37 . Djordjevic MV, Stellman SD, Zang E. Dosesof nicotine and lung carcinogens delivered to cigarettesmokers. J Natl CancerInst. 2000;92:106–111. [PubMed] [Google Scholar]

38 . Counts ME, Morton MJ, Laffoon SW, Cox RH, Lipowicz PJ. Smokecomposition and predicting relationships for international commercialcigarettes smoked with three machine-smokingconditions. Regul ToxicolPharmacol. 2005;41:185–227. [PubMed] [Google Scholar]

39 . U.S. Department of Health and HumanServices. How tobacco smoke causes disease: the biology andbehavioral basis for smoking-attributable disease: a report of the surgeongeneral. Atlanta, GA: U.S.

Department of Health and Human Services, Centers forDisease Control and Prevention, National Center for Chronic Disease Preventionand Health Promotion, Office on Smoking andHealth2010 [Google Scholar]

40 . Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, et al. Levels ofselected carcinogens and toxicants in vapour from electroniccigarettes. TobControl. (Inpress) [PMC free article] [PubMed] [Google Scholar]

41 . Westenberger BJ.Evaluationof e-cigarettes. US Food and Drug Administration Release. Silver Spring, MD[accessed 2013 Oct 15]. Available from: http://www.fda.gov/downloads/drugs/scienceresearch/ucm173250.pdf

42 . US Food and DrugAdministrationFDA warns of health risks posed bye-cigarettes: consumer update, 2009[accessed 2013 Oct 15].Available from: http://www.fda.gov/forconsumers/consumerupdates/ucm173401.htm

43 . Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Secondhandexposure to vapors from electroniccigarettes. Nicotine TobRes. (Inpress) [Google Scholar]

44 . Varughese S, Teschke K, Brauer M, Chow Y, vanNetten C, Kennedy SM. Effectsof theatrical smokes and fogs on respiratory health in the entertainmentindustry. Am J IndMed. 2005;47:411–418. [PubMed] [Google Scholar]

45 . Wieslander G, Norbäck D, Lindgren T. Experimentalexposure to propylene glycol mist in aviation emergency training: acuteocular and respiratory effects. OccupEnvironMed. 2001;58:649–655. [PMC free article] [PubMed] [Google Scholar]

46 . Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Short-termpulmonary effects of using an electronic cigarette: impact on respiratoryflow resistance, impedance, and exhaled nitricoxide. Chest. 2012;141:1400–1406. [PubMed] [Google Scholar]

47 . Flouris AD, Chorti MS, Poulianiti KP, Jamurtas AZ, Kostikas K, Tzatzarakis MN, WallaceHayes A, Tsatsakis AM, Koutedakis Y. Acuteimpact of active and passive electronic cigarette smoking on serum cotinineand lung function. InhalToxicol. 2013;25:91–101. [PubMed] [Google Scholar]

48 . Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effectof an electronic nicotine delivery device (e-Cigarette) on smoking reductionand cessation: a prospective 6-month pilotstudy. BMC PublicHealth. 2011;11:786. [PMC free article] [PubMed] [Google Scholar]

49 . Polosa R, Morjaria JB, Caponnetto P, Campagna D, Russo C, Alamo A, Amaradio M, Fisichella A. Effectivenessand tolerability of electronic cigarette in real-life: a 24-monthprospective observationalstudy. Intern EmergMed. (In press) [PubMed] [Google Scholar]

50 . Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. EffiCiencyand Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettessubstitute: a prospective 12-month randomized control designstudy. PLoSONE. 2013;8:e66317. [PMC free article] [PubMed] [Google Scholar]

51 . Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electroniccigarettes for smoking cessation: a randomised controlledtrial. Lancet. 2013;382:1629–1637. [PubMed] [Google Scholar]

52 . Cahn Z, Siegel M. Electroniccigarettes as a harm reduction strategy for tobacco control: a step forwardor a repeat of past mistakes? JPublic HealthPolicy. 2011;32:16–31. [PubMed] [Google Scholar]

53 . Hastings G, deAndrade M, Moodie C. Tobaccoharm reduction: the devil is in thedeployment. BMJ. 2012;345:e8412. [PubMed] [Google Scholar]

54 . Britton J, McNeill A. Nicotineregulation and tobacco harm reduction in theUK. Lancet. 2013;381:1879–1880. [PubMed] [Google Scholar]

55 . Zeller M, Hatsukami D StrategicDialogue on Tobacco Harm Reduction Group. TheStrategic Dialogue on Tobacco Harm Reduction: a vision and blueprint foraction in the US. TobControl. 2009;18:324–332. [PMC free article] [PubMed] [Google Scholar]

56 . American ThoracicSocietyATS policy position: e-cigarettes.2013[accessed 2013 Nov 11]. Available from: http://www.thoracic.org/advocacy/press-releases/ATS_Policy_Position_eCigarettes.pdf

57 . American College ofPhysiciansTobacco Control and Prevention: PolicyMonograph. Philadelphia: American College of Physicians;2010 [Google Scholar]

58 . World HealthOrganizationQuestions and answers on electronic cigarettes orelectronic nicotine delivery systems (ENDS). July 9,2013[accessed 2013 Nov 11]. Available from: http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/

59 . British MedicalAssociationBMA response to MHRA’s announcement one-cigarettes. Press Release June 12, 2013[accessed 2013 Nov9]. Available from: http://web2.bma.org.uk/pressrel.nsf/wall/1F182180B5D17A6B80257B8800472B4D

60 . US Food and DrugAdministrationModified risk tobacco products.2012[accessed 2013 Dec 6]. Available from: http://www.fda.gov/tobaccoproducts/labeling/tobaccoproductreviewevaluation/ucm304465.html

61 . Wollscheid KA, Kremzner ME. Electroniccigarettes: safety concerns and regulatoryissues. Am J Health SystPharm. 2009;66:1740–1742. [PubMed] [Google Scholar]

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469426/