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According to the 2021 National Youth Tobacco Survey, more than 2 million U.S. middle and high school students reported using e-cigarettes in 2021, with more than 8 in 10 of those youth using flavored e-cigarettes. The mid-to-long-term consequences of e-cigarettes are not yet known, as it's a new product and has been sold for less than a decade in the U.S. While much remains to be determined about these lasting health consequences of these products, we are very troubled by what we see so far. The inhalation of harmful chemicals can cause irreversible lung damage and lung diseases.
Dr Goel praised the central government’s initiatives to discourage tobacco consumption, including establishment of over 429 Tobacco Cessation Centers (TCCs), awareness campaigns, and the National Tobacco Quit Line. More information about youth vaping and CATCH My Breath is available on the program’s website. While the federal purchasing age of tobacco is 21, North Carolina law still lists it as 18, and many vape shops are operating under that age.
The prognosis depends on how much nicotine was taken and how quickly treatment was started. If a person is able to survive during the first four hours after poisoning, they’re usually likely to recover. If a person has been severely affected, they may have ongoing seizures or respiratory failure or other problems because of the damage done from low oxygen levels during the nicotine overdose event. Increased levels of nicotine or cotinine (nicotine metabolite) can be detected in urine or blood. Nicotine poisoning or overdose can also result from taking more than the recommended amount of nicotine replacement products (for example, chewing too much gum or dissolving lozenges) or taking too high of a dose of patches, inhalers or nasal sprays.
Revenues collected, including interest and penalties, from the CECET are deposited into the California Electronic Cigarette Excise Tax Fund. In addition to the HOPE Act, we administer other cigarette and tobacco products laws affecting retailers of electronic cigarettes containing or sold with nicotine. Retailers of electronic cigarettes containing or sold with nicotine also have responsibilities under the Cigarette and Tobacco Products Licensing Act of 2003. For more information, please visit our Tax Guide for Cigarettes and Tobacco Products. To address this problem, the Campaign for Tobacco-Free Kids and other public health organizations have called on the U.S.
The "e-juice" that fills the cartridges usually contains nicotine (which is extracted from tobacco), propylene glycol, flavorings and other chemicals. Studies have found that even e-cigarettes claiming to be nicotine-free contain trace amounts of nicotine. Additionally, when the e-liquid heats up, more toxic chemicals are formed. Among youth, e-cigarettes, especially the disposable kind, are more popular than any traditional tobacco product.
In this latter regard, no differences were encountered in the frequency of tumour appearance in rats subjected to long-term (2 years) inhalation of nicotine when compared with control rats [48]. Despite the lack of carcinogenicity evidence, it has been reported that nicotine promotes tumour cell survival by decreasing apoptosis and increasing proliferation [49], indicating that it may work as a "tumour enhancer". In a very recent study, chronic administration of nicotine to mice (1 mg/kg every 3 days for a 60-day period) enhanced brain metastasis by skewing the polarity of M2 microglia, which increases metastatic tumour growth [50]. Assuming that a conventional cigarette contains 0.172–1.702 mg of nicotine [51], the daily nicotine dose administered to these animals corresponds to 40–400 cigarettes for a 70 kg-adult, which is a dose of an extremely heavy smoker.
Although e-cigarettes do not give off smoke like tobacco cigarettes, they do expose people to secondhand aerosol or "vapor" that may contain harmful substances. Scientists are still learning about the health effects of being exposed to secondhand e-cigarette aerosol. The FDA monitors the national usage rates for all tobacco products, including an annual youth survey, and has seen a drastic increase in youth use of e-cigarette products in recent years.
However, a single e-cigarette can be harmful to the body’s blood vessels — even when the vapor is entirely nicotine-free — according to a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania. Tobacco products contain nicotine, which is highly addictive and can harm brain development as teens grow. Rural youth are at higher risk for harm, because they tend to begin using tobacco products at a younger age and use tobacco products more frequently. Products like e-cigarettes, vapes, and e-hookahs typically contain nicotine, which is highly addictive and can harm brain development as teens grow.
And, our starter kits and disposable vape pens are a great, simple way to make the switch from smoking to vaping. We also have a wide selection of advanced kits for vapers who prefer high-powered cloud chasing e-cigs. Increasing consumer awareness of the environmental toxicity and dangers posed by discarding e-cigarette waste into landfills and encouraging vapers to quit are the best ways to protect the environment from tobacco product waste. Currently, there is no standardized way to recycle e-cigarettes in the U.S. Starting in 2019, the Drug Enforcement Agency (DEA) began accepting e-cigarette devices and cartridges during their annual National Prescription Take Back Day, although the DEA cannot accept devices containing lithium ion batteries.
To date, no e-cigarette product has been approved by the FDA for smoking cessation. In contrast, nicotine replacement therapies (e.g., patch, gum, lozenge) and some prescription medications (i.e., varenicline, bupropion) have been evaluated by the FDA and found to be safe and effective at helping people quit smoking. Manufacturers and sellers of e-cigarettes aggressively target young people.
Truth Initiative forcefully rejects, however, the notion that this requires the further development of a huge commercial market in addictive nicotine products focused on growth and the acquisition of new users, most of whom are youth and young adults. Because the youth e-cigarette crisis in the United States and the youth appeal of flavored e-cigarettes go hand in hand, Truth Initiative strongly supports removing all flavored e-cigarettes from the market, regardless of device type. Based on the evidence already collected, the question shouldn’t be whether e-cigarettes are less dangerous than cigarettes, Christiani says, but whether vaping can be very harmful to health too. "To protect public health, I discourage the use of vaping—even to quit smoking," he stresses.
"From a public health perspective, we have always been concerned about dual-use of both traditional and e-cig products," said study lead author Marisa Bittoni, an oncology researcher at Ohio State University in Columbus. A second brand of e-cigarettes — marketed as Nixotine, Nixodine, Nixamide and Nic-Safe – contained a nicotine analog called nicotinamide, also at levels lower than the labels indicated, and combined with undisclosed amounts of 6-methyl nicotine. He emphasised that e-cigarettes are not an effective tobacco cessation tool, as they are not approved by food regulatory bodies. Additionally, they often lead to dual usage with people continuing to use traditional cigarettes along e-cigarettes.
However, to date, no e-cigarette product has been approved by the FDA for quitting smoking. Although e-cigarettes have been sold in the U.S. for nearly 20 years, use patterns have shifted dramatically. As newer iterations brought higher levels of nicotine in an increasing array of flavors and product designs, youth use skyrocketed.
Do we really know the composition of the inhaled vapour during the heating process and its impact on health? In the present review, we have attempted to clarify these questions based on the existing scientific literature, and we have compiled new insights related with the toxicity derived from the use of these devices. With the rise in electronic cigarettes (e-cigarette, e-cigs or vapes) and vaping use among youth, teens and young adults, the Health Department and our team are working to prevent initiation and reduce vaping of all substances in Vermont. As of 2021, 16% of Vermont high school students said they used e-cigarettes at least once in the past 30 days. Students who smoke cigarettes, tried flavored tobacco before age 13, binge drink or use cannabis vape at the highest rates.
There's always a chance that the fail-safe could fail, though, which is why we don't consider these as safe as other vaping devices. The biggest risks in vaping devices come when you get into highly customizable "mods." These devices allow for lots of fine-tuning in terms of the internal electrical setup. But this added flexibility means more possibilities for health hazards. You'll have to be careful not to buy knock-off vape liquids with unhealthy contaminants, for one thing.
This includes banning the sale of all non-prescription e-cigarettes and prohibiting the sale of any disposable or single-use e-cigarettes. Health experts are concerned about the various chemical ingredients within e-cigarettes. Even though it is illegal to sell e-cigarettes and e-liquids containing nicotine in Victoria, there is no guarantee that products purchased will not contain nicotine. Research now shows that young people who initially use e-cigarettes, who have never smoked before, are 3 times more likely to take up tobacco smoking. That aerosol is often called ‘vapour’ and inhaling it from an e-cigarette is known as ‘vaping’.
E-cigarettes are not safe for youth, young adults, and pregnant women, and can be dangerous for adults who use tobacco products. The novel results for school-level factors indicate that prevention of nicotine use may be supported by facilitating nicotine-free schools through policies and programmes. This may address especially the peer selection processes, which have been observed both in school disengagement and smoking initiation [28, 29]. Further, it may influence the students’ descriptive and injunctive norms, which both predict smoking initiation among youth [27].
"These products appear to be designed to circumvent the laws and regulations in place to protect people—especially children—from the harmful effects of smoking and tobacco use," Jordt said. The CDC advises people who have asthma to avoid tobacco smoke, yet Minnesota teens who have asthma are more likely to breathe someone else’s tobacco smoke or e-cigarette aerosol than teens who do not have asthma. Minnesota’s teens who have asthma are less likely to be protected by rules against smoking in the family’s homes or vehicles. Individuals included from the PATH study were 21 years and older daily cigarette smokers and reported any use of e-cigarettes within the previous 30 days. The new study findings follow on the heels of a report from the Substance Abuse and Mental Health Services Administration (SAMHSA) showing growing numbers of e-cigarette users.
Sales data did not include e-cigarette sales made online, in vape shops, or via illicit markets. While the study was not a randomized experiment, the analytical methods used were robust enough to identify causal relationships. ESD aerosol is a new source of pollution and toxins being emitted into the environment. We do not know the long-term health effects of ESD use and although the industry marketing of the product implies that these products are harmless, the aerosol that ESD emit is not purely water vapor. These figures coincide with additional research that indicates an overall increase in e-cigarette use. Vaping is the act of inhaling and exhaling an aerosol produced by a vaping product, such as an electronic cigarette.
As one addiction expert has said, "The modern cigarette does to nicotine what crack does to cocaine." Pax Labs discovered that by adding benzoic acid to nicotine salts, which occur naturally in tobacco, they could mimic a cigarette’s rapid nicotine delivery. Both British American Tobacco Plc and Altria are prodding the FDA for heightened enforcement on "illicit" synthetic nicotine electronic cigarettes in the U.S. vaping market. The companies have estimated those synthetic products represent about half of the overall domestic e-cigarette market.
Nicotine use can have an impact on learning, memory and attention and increase the likelihood of addiction to other drugs in the future. While some people have reported that using e-cigarettes has helped them quit smoking, there are other proven, safe and effective options that should be explored first. It's important to help protect children and teens from using or being exposed to the harmful vapor from e-cigarettes. Talk with your pediatrician for more information about these products and keeping your child safe and healthy. Your regional Pediatric Environmental Health Specialty Unit (PEHSU) also have staff who can also talk with you about environmental toxins.
However, within the adult demographic, 12.7 percent of 18- to 24-year-old adults and 21.3 percent of males, ages 18-24, are "current users" of e-cigarettes. The e-cigarette device (Vype ePod1.0, Nicoventures Trading Ltd., Blackburn, UK) consists of a metallic outer device case, a printed circuit board to control the device, a lithium-ion rechargeable battery (350 mAh) and an e-cigarette cartridge (Fig. 1). The voltage ranges from 2.2 to 3.1 V and is not adjustable by the user. The device has dimensions (h × w × d) of 104.2 × 19.1 × 10.5 mm and a power output of 6.5 ± 0.5 W. The cartridges or pods consist of a plastic case holding the ceramic wick material and a flat metal heating element (NiCr, 0.8 –1.4-Ω resistance). Each pod is pre-filled with Vype e-liquid (1.9 mL) and is magnetically attached to the device.
Parental smoking, positive attitude towards e-cigarette use in one’s age group, current smoking, and snus use increased S-EC, whereas liking school lowered it. At school level, both among girls and boys, a higher proportion of students liking school and being never-users lowered S-EC, whereas a higher proportion of students with positive attitudes towards e-cigarette use increased it. Among girls, a higher proportion of girls in the school, students with a high parental education and planning for GUSS lowered S-EC, but a higher proportion of students with parental smoking increased it.
Although PG and glycerol are the major components of e-liquids other components have been detected. Of note, the analysis identified formaldehyde, acetaldehyde and acrolein [4], 3 carbonyl compounds with known high toxicity [63,64,65,66,67]. While no information was given regarding formaldehyde and acetaldehyde concentrations, the authors calculated that one puff could result in an acrolein exposure of 0.003–0.015 μg/mL [4]. However, given that e-cigarette units of vaping are not well established, users may puff intermittently throughout the whole day. Thus, assuming 400 to 500 puffs per cartridge, users could be exposed to up to 300 μg of acrolein.
You can feel confident buying rechargeable vape kits and e-cigarettes from our range of popular brands, including blu, IQOS, JUUL, Caliburn, VUSE and many more. According to data from the ministry's tobacco cell, there were 44 violations so far this financial year, 263 in FY24, and 33 in FY23, indicating the presence of vapes in the black market. According to government data, in FY22, 48 violations were reported, with no cases in FY21. Emerging evidence suggests some of the highest successful quit rates are now seen among smokers who use an e-cigarette and also receive additional support from their local stop smoking services. The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people. Following the review PHE has published a paper on the implications of the evidence for policy and practice.
In contrast, other studies found acute microvascular endothelial dysfunction, increased oxidative stress and arterial stiffness in smokers after exposure to e-cigarettes with nicotine, but not after e-cigarettes without nicotine (reviewed in [20]). In women smokers, a study found a significant difference in stiffness after smoking just one tobacco cigarette, but not after use of e-cigarettes (reviewed in [20]). However, research updates on, and analysis of, the potential health benefits/risks of e-cigarettes are outside the scope of TobaccoTactics. These devices come in a variety of shapes and sizes, as pictured below, with several different names. Some e-cigarettes look like regular cigarettes, but many resemble pens or USB flash drives, and are not recognized as tobacco products. Larger e-cigarettes such as tank systems, or "mods," do not resemble other tobacco products.
In January, the Cumberland County Board of Commissioners passed a new ordinance that prevents new vape shops from opening within 1,000 feet of a school to address youth nicotine consumption. On the rare occasions I partake, instead of filling my nostrils with the taste of a warm crème brûlée, my mouth tastes like a street gutter for an hour. I like the nicotine, but everything else about the experience is viscerally revolting. About 43% of the study participants were LGBTQ+ adolescents, for instance, and research suggests that LGBTQ+ young people smoke and vape at a higher prevalence than their non-LGBTQ+ peers. The new study included a diverse group of adolescents, indicating how to use glo electronic cigarette the text message program could be helpful for marginalized communities, said Dr. Suchitra Krishnan-Sarin, a professor of psychiatry at the Yale School of Medicine. "Text messaging is a scalable and cost-efficient approach to delivering vaping cessation treatment on a population basis," the researchers wrote in the study.
In 2022, PMI launched a "disposable" e-cigarette called VEEBA (see below). However, PMI’s interests in e-cigarettes are relatively minor compared to its interests in HTPs. This page gives an overview of TTCs interests in e-cigarettes, which have been acquired, developed and sold by these companies since 2012. Products produced by other companies which do not have links to TTCs are not covered on TobaccoTactics. JUUL is a type of e-cigarette/vapor product that has become increasingly popular, especially among youth.
In 2022–2023, 2.3% of people in Australia both smoked regular cigarettes and used e‑cigarettes, an increase from 0.7% in 2016. In the second study, researchers analyzed heart blood flow, a measure of coronary vascular function, of 19 young adult smokers immediately before and after smoking either e-cigarettes or tobacco cigarettes. They examined coronary vascular function by a myocardial contrast echocardiography while participants were at rest and after performing a handgrip exercise to simulate physiologic stress. In the first study, researchers looked at the impact of e-cigarettes on lipids and glucose in the blood. They recruited 476 healthy human participants without cardiovascular disease who were either nonsmokers, e-cigarette-only smokers, smokers of e-cigarettes and tobacco cigarettes and those who smoked tobacco cigarettes only.
The inhaled vapor may contain nicotine (the addictive drug in tobacco), flavorings, and toxins—including ones that cause cancer. People who have already switched completely from smoking to e-cigarettes should not switch back to smoking (either solely or along with e-cigarettes), which could expose them to potentially devastating health effects. It's important to know the US Centers for Disease Control and Prevention (CDC) has stated that sometimes e-cigarette products are changed or modified and can have possibly harmful or illegal substances from unknown sources. Get regular updates on the health effects of tobacco, public health educational resources, and highlights on current tobacco issues and regulations.
A growing body of research indicates that truth campaigns to prevent young people from vaping are poised to move in the same direction as the organization’s successful smoking prevention campaigns. See " Quitting Tobacco " for more information on quitting tobacco products. Let's say you love the feel and flavor you get from puffing on a vape — but you can't quite bring yourself to trust that it's safe. It uses a puff of pressurized, flavored air to simulate the "throat hit" of a vape, with no heating element whatsoever.
We want to make a difference in the lives of our users, and create products that can fit all levels and styles of vapers, to help as many as possible. Stanford Medicine Tobacco Prevention ToolkitTheory-based and evidence-informed resources created by educators, parents, and researchers aimed at preventing middle and high school students' use of tobacco and nicotine. There are several resources available to assist with learning more about e-cigarettes and educating youth about the risks. Resources are available for parents, educators, and health care providers. According to the 2017 Behavior Risk Factor Survey (BRFS) conducted by DHSS, 4.8 percent of Delaware adults currently use e-cigarettes, roughly the same percentage reported in the 2016 survey.
Due to what has been called an ‘epidemic’ of youth use of these products, FDA has prioritized prevention efforts. The agency has taken a multitude of actions to keep ENDS out of the hands of youth, from policy making to enforcement to education. While e-cigarettes can generally be a lower-risk alternative for adults who smoke cigarettes, the use of e-cigarettes is not risk-free. These products deliver harmful chemicals and contain nicotine, which is highly addictive. Moreover, given the harmful chemicals found in e-cigarettes, further high-quality research on both short- and long-term health outcomes is needed. The longer ENDS and other e-cigarettes are on the market, the more information we know about their impacts on health.
E-cigarettes contain many of the same cancer-causing chemicals that regular cigarettes do. Nicotine is highly addictive, and most e-cigarettes include it as a main ingredient. The AMA promotes the art and science of medicine and the betterment of public health. The rise of e-cigarettes and vaping has raised concerns that another generation may become dependent on nicotine. The AMA has been a leading force to eliminate public smoking and warn people about the dangers of smoking, including secondhand smoke, since the 1960s.
In fact, they are widely used as alimentary and pharmaceutical products [2]. In an analysis of 54 commercially available e-liquids, PG and glycerol were detected in almost all samples at concentrations ranging from 0.4% to 98% (average 57%) and from 0.3% to 95% (average 37%), respectively [35]. According to a 2018 study examining infrequent cannabis smoking in adults, vaping THC produced stronger mind-altering effects than smoking a similar amount of weed. However, nicotine alone is relatively harmless, and switching from daily tobacco smoking to daily e-cigarette use can be an important step for people to stop smoking completely. However, researchers found that only daily e-cigarette use had a statistically significant effect on smoking cessation rates. Research generally accepts that while vaping can harm the lungs and other bodily systems, its impact is much less than tobacco smoking.
Despite being marketed as a safer alternative to traditional cigarettes, e-cigarettes contain numerous harmful substances such as formaldehyde, heavy metals, and carcinogens, he added. Part of the difficulty in curbing youth e-cigarette use has been the intensity of the industry’s marketing towards kids, particularly through social media influencers, said Bianco. In the 2021 Youth National Tobacco Survey, 73.5% of youth that use social media reported seeing e-cigarette–related content.
Whichever vape you choose, make sure you use it daily to help you make the switch from cigarettes. A vape bar, pod device or vape pen are good choices, as they are discreet, make small clouds and can give high amounts of nicotine. You can use patches with a vape if you need to, as these give ongoing support by releasing nicotine slowly. Some people find vaping helps them because the hand-to-mouth action is like smoking, plus you get similar sensations, like throat hit (the "kick" in the back of your throat when you inhale).
Many grants on this topic are funded through the Tobacco Regulatory Science Program, an NIH partnership with FDA’s Center for Tobacco Products to fund research to inform FDA’s tobacco regulatory activities. Interestingly, most of these reports linking COVID-19 harmful effects with smoking or vaping, are based on their capability of increasing the expression of angiotensin-converting enzyme 2 (ACE2) in the lung. It is well known that ACE2 is the gate for SARS-CoV-2 entrance to the airways [106] and it is mainly expressed in type 2 alveolar epithelial cells and alveolar macrophages [107]. To date, most of the studies in this field indicate that current smokers have higher expression of ACE2 in the airways (reviewed by [108]) than healthy non-smokers [109, 110]. While tobacco products have been a long-standing public health issue, e-cigarette (aka e-cigs, vape pens, vapes) use has continued to gain popularity throughout the last decade. Poison centers began receiving calls about e-cigarettes and liquid nicotine products in 2010, which overlaps with the initial period where these products reached the U.S. market.
This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources. Because of the lack of long-term data and the fact that patients have died from EVALI, the prognosis for those affected remains uncertain. Researchers are working hard to learn as much as possible about the illness, its causes, and the odds for making a full recovery. "We recommend that patients see a pulmonologist within one to two weeks after being discharged to undergo testing of lung function and pulse oximetry [level of oxygen in the blood]," she says.
No amount of nicotine is safe for youth as there may be long-term, damaging effects on learning, memory, attention, behavior problems, and future addiction. Electronic cigarettes or vapes (referred to collectively as ‘e‑cigarettes’) are personal vaping devices where users inhale aerosol rather than smoke. The inhaled aerosol usually contains flavourings, a range of toxic chemicals, and may contain nicotine as well (Department of Health and Aged Care 2023a).
However, we do allow certain pre-approved sellers to list e-cigarettes, Electronic Nicotine Delivery Systems (ENDS), and e-liquids on the US eBay website (eBay.com) provided they follow federal, state, local, and other applicable laws and regulations. This policy is applicable to those approved sellers, and buyers who transact with them. Our team of vaping experts regularly updates our blog to bring you the latest trends, product reviews, and tips for optimizing your vaping experience. Sit back, relax, and start exploring our insightful articles and informative guides to take your vaping journey to the next level. We also offer heat-not-burn tobacco devices, and an extensive selection of cannabis vaporizers for dry herb and concentrates.
Health services in the United Kingdom say that vaping can be an effective tool for quitting smoking. Additionally, in 2021, the Food and Drug Administration (FDA) permitted the marketing of three e-cigarette products, specifically citing their potential benefit in helping people quit smoking. Quitting is your best option to reduce your risk from smoking and tobacco use-related diseases.
E-cigarette waste is potentially a more serious environmental threat than cigarette butts since e-cigarettes introduce plastic, nicotine salts, heavy metals, lead, mercury, and flammable lithium-ion batteries into waterways, soil, and to wildlife. "Nicotine analogs are currently not subject to the FDA process and have not been studied for their health effects," Jabba said. This data brief dives deeper into rural youth tobacco use in Minnesota.
In our study, there were between-school differences, which appeared larger for girls than boys. In the univariate analyses, most school-level factors either increased or lowered susceptibility. This was especially the case among girls in S-EC and S-SN, and among boys in S-SM. In the multivariate models, most of the school-level associations were weakened.
You can turn to our smoking cessation resource center, which has tips for how to stop smoking, information on smoking cessation therapies, and more. Doctors may also recommend prescription and nonprescription medications to help you quit. For people with vaginas, it can result in sexual dissatisfaction by decreasing lubrication and the ability to reach orgasm. Babies may be born with underdeveloped lungs if the pregnant person smokes during pregnancy. Smoking damages the airways, air sacs (alveoli) in the lungs, and cilia, which are tiny hair-like structures that prevent dirt and mucus from entering your lungs.
E-cigarettes have been allowed to stay on the market for years without undergoing a full review of their public health impact, sparking a sustained and ongoing crisis of youth use. As of November 2023, the FDA has not completed reviewing all applications from e-cigarette makers to market their products, leaving many e-cigarettes on the market while waiting for a decision. To date, the FDA has denied permission to market flavored and menthol e-cigarette products such as Vuse Solo, Vuse Vibe, Vuse Ciro, and Vuse Alto. The FDA has denied permission to market many non-tobacco and non-menthol flavored e-cigarette products, however, many of those denials are currently under judicial or supervisory review. In recent years, the FDA has increased enforcement efforts around e-cigarette manufacturers and retailers for continuing to sell youth-appealing e-cigarettes. These actions include issuing warning letters, fines, injunctions, and joint operations with other federal officials to seize imports of unauthorized e-cigarette products.
The term "vaping" comes from the act of inhaling and exhaling e-cigarette vapor (which is actually an aerosol). E-cigarettes heat up liquid from replaceable cartridges, producing the vapor. Just like a smoker does, an e-cigarette user inhales the vapor through the device, then exhales. People who switch from traditional cigarettes to e-products may put off getting medical help or trying proven tools that can help with quitting. United States federal law does not allow the sale of tobacco products to people under the age of 21.
Read this paper by NCI’s Dr. Ned Sharpless and CRUK’s Dr. Iain Foulkes. Drug forums and e-liquid vendors were monitored by the researchers for e-liquids that "purportedly contained alternative pharmaceuticals." A clue in searching for e-liquids that contain illicit drugs is cost, the scientists said. Most nicotine e-liquids range from $5 to $10, while alternative drug e-liquids go for five to twenty times as much. In comparison to the general population, support for these measures varied greatly among people who currently used e‑cigarettes. The most supported measure was prohibiting the sale of e‑cigarettes to people under 18 years of age (67%), while the least supported measure was banning all additives in e‑cigarettes, to make them less attractive to young people (33%) (Figure 7).
The researchers said that the findings suggest that if tobacco cigarette smokers who use e-cigarettes for a healthier alternative to tobacco won’t benefit by the switch. Cannabis and CBD e-liquids usually contain other chemicals, such as base liquids or flavoring agents. They may cause side effects similar to those of nicotine-free e-cigarettes. Young people who vape nicotine are more likely to start smoking cigarettes in the future. The 2018 NAP report concluded there’s some evidence that nicotine and nicotine-free e-cigarettes can damage oral cells and tissues in people who don’t smoke cigarettes.
Reynolds’ Velo nicotine pouches, while holding just a 1.2% market share, has had a 25.8% year over year sales growth, as well as up 96.7% for the four-week period. Nicotine pouches have a 5.1% market share with sales up 73.4% over the year. Dr Goel underscored the importance of dispelling misinformation and promoting evidence-based approaches to tobacco cessation.
Cumberland County piloted CATCH My Breath in 2022, and had teachers in the restorative justice classrooms of Howard Learning Academy Middle School and Pine Forest High School run the program. The pilot was enough of a success that the county is now training one person in every middle and high school in the district to implement the program on a needs-basis in restorative justice classrooms this school year. There were also participants in a "waitlist" group, who received neither text messages through the This is Quitting program nor the assessment-only follow-up messages. Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific publications (many of them can be found at /us). Scientific American maintains a strict policy of editorial independence in reporting developments in science to our readers.
Use of microporous ceramic as a wicking material improves heating efficiency, but how it affects the chemical emissions of these devices is unclear. We assessed the emissions of a pod e-cigarette with innovative ceramic wick-based technology and two flavoured e-liquids containing nicotine lactate and nicotine benzoate (57 and 18 mg mL−1 nicotine, respectively). Among the studied harmful and potentially harmful constituents (HPHCs) listed by the US FDA and/or WHO TobReg, only 5 (acetone, acetaldehyde, formaldehyde, naphthalene and nornicotine) were quantified at levels of 0.14 to 100 ng puff−1. In the combustible cigarette (Kentucky reference 1R6F), levels were from 0.131 to 168 µg puff−1.
The 2019 outbreak of EVALI cases emerged against a backdrop of an ongoing vaping epidemic among youth. The amount, quantity and toxicity of substances that e-cigarettes release depend on several factors, such as the type of device, how the device operates and is used, and the e-liquid used. Drop the Vape also directs users to the New York State Quitline for free and confidential quit-coaching via telephone, internet, and text, and free starter kits of nicotine replacement therapy (NRT) for eligible New Yorkers. In absence of federal law, states are acting to remove flavored nicotine products from the shelves. All the e-cigarettes previously authorized by the FDA have been tobacco, which isn’t widely used by young people who vape.
When the human body breaks down a foreign substance, one can typically find chemical by-products in hair or urine that provide clues about how it has interacted with cells. This is true for nicotine, but in the case of propylene glycol, no one has established what the relevant by-product is or how to best detect it. Boston, MA – Diacetyl, a flavoring chemical linked to cases of severe respiratory disease, was found in more than 75% of flavored electronic cigarettes and refill liquids tested by researchers at Harvard T.H. Chan School of Public Health. Two other potentially harmful related compounds were also found in many of the tested flavors, which included varieties with potential appeal to young people such as Cotton Candy, Fruit Squirts, and Cupcake. In conclusion, the prevalence of susceptibility among adolescents differs by product type. Liking school and academically oriented educational aspirations appear as consistent protective factors, while the use of other tobacco or nicotine products and positive attitudes towards product use in one’s age group appear as risk factors.
The length of time spent vaping can be much longer than smoking a standard cigarette. While most cigarettes are smoked within two to five minutes, e-cigarettes can last up to 20 minutes, delivering more nicotine and damaging chemicals to the lungs. In addition, some vaping mixtures can contain 20 times the nicotine that a single cigarette contains. This study builds on the findings of an earlier randomized clinical trial of This is Quitting conducted among roughly 2,600 young adults ages 18 to 24.
Among adolescents who both vaped and smoked traditional cigarettes, a higher proportion in the This is Quitting program, about 51%, reported not vaping nor smoking at seven months, compared with 30% of the assessment-only group. Withdrawal from tobacco products can cause temporary congestion and respiratory discomfort as your lungs and airways begin to heal. Increased mucus production right after quitting smoking may be a positive sign that your respiratory system is recovering. What might be considered safe for the average workplace employee could still pose serious health risks for more medically vulnerable populations.
They produce a vapor that’s inhaled deep into the lungs, mimicking the feeling of smoking tobacco cigarettes. They are not yet regulated nor approved for smoking cessation by the U.S. Food and Drug Administration.The long-term health effects to users and bystanders are still unknown.
Almost 9 in 10 people (86%) supported prohibiting the sale of e‑cigarettes to people under 18 years of age, a substantial increase from 2019 (79%). Social and economic factors shape people’s behaviours of vaping or smoking. Generally, people living in the most disadvantaged socioeconomic areas were the most likely to currently smoke regular cigarettes but not use e‑cigarettes (13.2%). In contrast, people living in the most advantaged socioeconomic areas were the most likely to use e‑cigarettes but not smoke regular cigarettes (6.6%) (Figure 4). Young people aged 18 to 24 were the most likely to have used e‑cigarettes in 2022–2023, with almost 1 in 2 (49%) having used them at least once in their lifetime, and over 1 in 5 (21%) currently using e‑cigarettes in 2022–2023. More information on young people’s use of vapes and e-cigarettes can be found online.
Any product that does not submit an application by this deadline must be removed from the marketplace, which if properly enforced, could lead a significantly smaller marketplace. The main component of e-cigarettes is the e-liquid contained in cartridges or tanks. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals (such as formaldehyde and acrolein, which can cause irreversible lung damage). The American Lung Association is very concerned that we are at risk of losing another generation to tobacco-caused diseases as the result of e-cigarettes.
The harmful effects of CS and their deleterious consequences are both well recognised and widely investigated. However, and based on the studies carried out so far, it seems that e-cigarette consumption is less toxic than tobacco smoking. This does not necessarily mean, however, that e-cigarettes are free from hazardous effects. Indeed, studies investigating their long-term effects on human health are urgently required. In this regard, the main additional studies needed in this field are summarized in Table 3.
In a major recent undertaking to help clarify the effects of e-cigarettes, the physician-investigator conducted a review of the best available evidence about vaping and lung harms. She and her co-authors published their roundup of the evidence in an article titled "Vaping and Lung Inflammation and Injury," which appeared online Feb. 10 in the journal Annual Review of Physiology. A study in the Journal of the American Medical Association in 2015 found a connection too. Researchers surveyed 2,500 Los Angeles high school students who had never smoked.
We are within out states laws and obtained all the proper licensing ect. At 180 Smoke, we prioritize the customer and guarantee an ideal vaping experience with our expansive product selection and knowledgeable staff. We will be there every step of the way, guaranteeing a satisfying vaping journey for you with excellent customer service. Unfortunately, today’s teens, and even tweens, often know more about vaping than their parents. The newly announced campaign by Ohio Attorney General Dave Yost to combat the flood of illegal e-cigarettes streaming into the state represents an...
We also left out propylene glycol, a petroleum byproduct often used as a flavor enhancer. This stuff isn't considered toxic, but it adds a harsh edge to your inhale, and we wanted to stick to strictly plant-based components. I understand that for a few moments during your meal you may have a sniff of my vape that you don’t care for, but I’m sure that it isn’t as horrible as you make it sound in your rant. Life is full of mild unpleasantries that we all must deal with on a daily basis, but we can choose to deal with them or let them torment us.
Participants took one vape from an e-cigarette, with at least 12 mg/mL of nicotine, or inhaled a conventional cigarette, every 20 s for 10 min. Blood samples were collected 1, 2, 4, 6, 8, 10, 12 and 15 min after the first puff, and nicotine serum levels were measured by liquid chromatography-mass spectrometry (LC–MS). The results revealed higher serum levels of nicotine in the conventional CS group than in the e-cigarette group (25.9 ± 16.7 ng/mL vs. 11.5 ± 9.8 ng/mL). However, e-cigarettes containing 20 mg/mL of nicotine are more equivalent to normal cigarettes, based on the delivery of approximately 1 mg of nicotine every 5 min [40].
In short, the ingredients in e-cigarette liquid have caused users health problems. The health effects of e-cigarettes are still being studied but nicotine addiction, harmful chemical additives, battery explosions causing injury, acute nicotine poisoning and vaping related lung injury have all been linked to use of e-cigarettes and vaping. An e-cigarette is a battery-operated device that heats liquid into an aerosol that the user inhales. E-cigarettes typically operate on a rechargeable lithium-ion battery.
Here we address some of the common questions people ask about e-cigarettes. ENDS may be manufactured to look like conventional combusted cigarettes, cigars, or pipes. Larger devices, such as tank systems or mods, bear little or no resemblance to cigarettes.
Most have a battery, heating element, and place to hold a liquid, usually containing highly addictive nicotine, that is added or included in the device. The heating element aerosolizes the liquid for the inhalation of the liquid nicotine or other substance. E-cigarettes are called many different names, including "vapes," "e-cigs," "vapor products," and "electronic nicotine delivery systems (ENDS)." The chemicals in electronic cigarettes, commonly called vapes, can severely damage the lungs, according to studies reviewed by the American Lung Association. The nicotine in them, which can be in higher quantities than traditional cigarettes, can also impact a child’s brain development. Several peer-reviewed studies found that nicotine negatively affects teens’ memory and attention and can increase their risk of developing other mental and behavioral problems later in life.
A recent study compared the acute effects of e-cigarette vapor (with PG/vegetable glycerine plus tobacco flavouring but without nicotine) generated from stainless‐steel atomizer (SS) heating element or from a nickel‐chromium alloy (NC) [92]. Neither the air‐exposed rats nor those exposed to e-cigarette vapor using SS heating elements developed respiratory distress. In contrast, 80% of the rats exposed to e-cigarette vapor using NC heating units developed clinical acute respiratory distress when a 70‐W power setting was employed. Thus, suggesting that operating units at higher than recommended settings can cause adverse effects. Nevertheless, there is no doubt that the deleterious effects of battery output voltage are not comparable to those exerted by CS extracts [30] (Figs. 1 and 2). "Our findings are consistent with earlier evidence that sufficient nicotine replacement can be helpful for quitting smoking.
Dual use, which is common, is at least as dangerous and likely more dangerous than smoking conventional cigarettes or using e-cigarettes alone. Further, not all ENDS are the same and the risks to health may differ from one product to another, and from user to user. E-cigarettes are still fairly new, and more research is needed over a longer period of time to know what the long-term effects may be.
Smoking is the leading cause of lung cancer, and people who smoke are 20 times more likely than nonsmokers to be diagnosed with lung cancer. Tobacco products contain unsafe substances, from acetone and tar to nicotine and carbon monoxide. The inhaled substances can affect your lungs and the other organs in your body.
So, if you are vaping to quit smoking, you should aim to eventually stop vaping too. In 2022, UK experts reviewed the international evidence and found that "in the short and medium term, vaping poses a small fraction of the risks of smoking". Vapes are electronic devices that let you inhale nicotine in an aerosol, or vapour, instead of smoke. This is done by heating a solution (e-liquid) that typically contains propylene glycol, vegetable glycerine, flavourings and nicotine. Vapes come in many shapes and sizes but they have the same basic components, including a battery, sensor, and atomizer/ flavor cartridge.
Other important components in the aerosols include silicate particles from the fiberglass wicks or silicone [89,90,91]. Many of these products are known to cause abnormalities in respiratory function and respiratory diseases [89,90,91], but more in-depth studies are required. Interestingly, the battery output voltage also seems to have an impact on the cytotoxicity of the aerosol vapours, with e-liquids from a higher battery output voltage showing more toxicity to A549 cells [30]. The lethal dose of nicotine for an adult is estimated at 30–60 mg [52].
If you're not interested in giving up nicotine but you want to leave smoking behind, an Elf Bar disposable vape might be your best choice. We make a living building vape pens that are free from potentially harmful substances. Our disposable vapes are designed to give you the closest thing possible to a pure dose of caffeine or melatonin, without the harmful ingredients sometimes found in vape juice. This list of the 9 safest vapes will help you avoid those toxic components and puff away without fear. There is no good evidence that second-hand vapour from e-cigarettes is harmful.
Vapes are often viewed and marketed as a safe alternative to smoking. Secondhand smoke can cause heart disease, stroke, and lung cancer in people who don’t smoke. They compared this information against vape and cigarette sales data over four-week intervals from January 2018 through March 2023, a period during which flavor restrictions went from affecting 1.3% of the U.S. population to affecting 38%.
Since This is Quitting launched as a text message program in 2019, more than 750,000 young people have enrolled from across the U.S. Grounded in clinical guidelines for treating tobacco dependence, This is Quitting incorporates powerful messages from other young e-cigarette users who have offered their advice about how to quit. Teens and young adults can text DITCHVAPE to to receive free quit vaping support from the program. This study is the first published randomized clinical trial of a quit vaping program among teens, filling an important gap in the scientific literature and providing much needed evidence for pediatricians, school administrators, and public health agencies. Although stopping smoking can cause short-term side effects such as reversible weight gain, smoking cessation services and activities are cost-effective because of the positive health benefits. Further, educational aspirations and school engagement are tied to student composition and school-based networks and norms, which have had different associations with smoking between schools [28].
Friday’s action is part of a sweeping FDA review intended to bring scientific scrutiny to the multibillion-dollar vaping market after years of regulatory delays. Currently the U.S. market includes thousands of fruit- and candy-flavored vapes that are technically illegal but are widely available in convenience stores, gas stations and vape shops. Most teens who vape use disposable e-cigarettes, including brands like Elf Bar, which come in flavors such as watermelon and blueberry ice.
Watch the UK Health Security Agency's video demonstration on the impact of smoking versus vaping. As of July 1, 2024, 1,061 municipalities, plus 26 states, commonwealths, and territories restrict e-cigarette use in 100% smokefree venues. The Royal Children’s Hospital (RCH) acknowledges the traditional owners of the land on which the RCH is situated, the Wurundjeri people of the Kulin Nation, and we pay our respects to their Elders past and present. Dr. Tan provides care to adults alongside an entire team of lung specialists at Loma Linda University Health.
The agency says companies were blocked because they couldn’t show the possible benefits for adult smokers outweighed the risk of underage use. The companies say they had prepared detailed plans to avoid appealing to young people. Vaping is the inhaling of an aerosol (mist) created by an electronic cigarette (e-cigarette) or other vaping device. As a result of the FDA’s missed deadlines and inadequate enforcement, flavored e-cigarettes remain widely available online and in stores across the country. Every day flavored e-cigarettes remain on the market, our kids remain at risk.
E-cigarettes are available in flavors like cherry, bubble gum, and cotton candy, and are allowed to be advertised on TV, which may increase their appeal for children and teens. As of July 31, 2024, Poison Centers have managed 4,955 e-cigarette and liquid nicotine related exposure cases. For more information about the health effects of e-cigarettes, visit CardioSmart.org/StopSmoking. People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them, according to one of the largest prospective studies to date investigating possible links between vaping and heart failure. The findings are being presented at the American College of Cardiology’s Annual Scientific Session.
For a summary of Iowa youth vaping/e-cigarette use statistics from the 2018 IYS, check out our infographic and factsheet. Adolescents are more likely to use e-cigarettes than any other tobacco product, and rates of e-cigarette use have risen sharply in recent years. Population-level interventions to reduce tobacco use include price increases, mass media campaigns, and smoke-free policies that include e-cigarettes. E-cigarettes, also known as electronic smoking devices (ESD) and vaporizer cigarettes, are battery-operated devices that emit doses of nicotine and non-nicotine vaporized solutions that are inhaled.
Upon the selection of the educational track, students may already have normative perceptions of smoking in vocational schools, such as understanding of smoking as an integral and expected practice in these schools and professions [8]. These perceptions may increase S-SM and other nicotine product use, also among students with better academic performance. Student network characteristics and their associations with smoking vary between schools [28].
] have been offset by the increasing consumption in low income countries, especially China. The Chinese market now consumes more cigarettes than all other low- and middle-income countries combined. Levels of naphthalene were slightly higher than those of pyrene in e-cigarette emissions, while the respective air blank was lower. Nevertheless, it seems likely that these compounds were detected in e-cigarette emissions due to their presence as low-level contaminants in the background air, rather than originating from the vaping product. E-cigarettes are devices that use an electric battery to heat up a liquid (commonly called an "e-liquid") into an aerosol, which the user inhales. Vitamin E acetate, diacetyl, formaldehyde, and acrolein are just a few among hundreds of potentially hazardous substances commonly found in e-liquids and their aerosols.
FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS, including components and parts of ENDS but excluding accessories. An outbreak of EVALI in late 2019 and early 2020 put thousands of people in the hospital. Since then, EVALI cases have been declining, but people who vape can still get EVALI. Research from the CDC shows that vaping among youth has declined somewhat since 2020.
Vaping may also have specific adverse effects on certain groups, particularly young people. The full magnitude of effects of toxic e-cigarette ingredients may not be known for another three decades. Yale’s Tobacco Center of Regulatory Science received funding support for the study from the National Institute on Drug Abuse, which is part of the National Institutes of Health (U54DA036151), and the Center for Tobacco Products of the FDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA. For information on products eligible to be sold in San Francisco, please visit the FDA website of Tobacco Product Marketing Orders. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice.
The FDA does not currently require testing of all the substances in e-cigarettes to ensure they are safe. It's also hard to know exactly what chemicals are in an e-cigarette because most products do not list all of the harmful or potentially harmful substances contained in them. E-cigarettes do not contain tobacco, but many of them contain nicotine, which comes from tobacco. Because of this, the Food and Drug Administration (FDA) classifies them as "tobacco products." For adults who smoke, switching completely from cigarettes to e-cigarettes may reduce exposure to many harmful chemicals present in cigarettes. However, it is important that they switch completely from cigarettes to e-cigarettes to get the full health benefit.
That legal decision allowed sales of e-cigarettes to proceed but left many questions about their safety unaddressed. To lower the potential risks posed by secondhand aerosol exposure from vaping, some U.S. states, territories, and cities have started restricting where people can vape. There are currently more than 7,000 varieties of flavored e-cigarettes and e-juice (liquid containing nicotine that is used in refillable devices) on the market. Although the popularity and use of e-cigarettes continues to increase, there is a lack of data on their potential health effects. Food and Drug Administration (FDA) has issued a proposed rule to include e-cigarettes under its authority to regulate certain tobacco and nicotine-containing products. Fourth-generation ‘pod’ e-cigarette devices have been driven by technological advances in electronic atomization of the e-liquid.
To vape is to inhale vapor created from a liquid heated up inside a device. The devices have many names—vape pens, pod mods, tanks, elite electronic cigarette karachi nicotine delivery devices (ENDS), e-hookahs and e-cigarettes. Most e-cigarettes contain nicotine and their repeated use can lead to nicotine addiction or increase the user's risk of addiction. Some e-cigarette brands contain nicotine salts to mask the harshness of nicotine and make it more palatable. As of 2018, all tobacco products must bear the required nicotine addictiveness warning statement on product packages and advertisements in order to warn consumers about the presence of and addictive nature of nicotine.
Youth and young adults who want to quit vaping are invited to text DITCHVAPE to to sign up for a totally free, anonymous texting service that provides 24/7 support, daily tips and motivation to keep you focused on your end goal. This service incorporates messages from young people who have attempted to quit, or successfully quit, e-cigarettes. Visit Truth Initiative to learn more about the This is Quitting campaign. According to a 2017 study, teens who use e-cigarettes are more likely to smoke regular tobacco products later on, compared with their peers. An electronic cigarette is a battery-operated device that emits a vaporized solution to inhale. These devices have various names, including e-cigarettes, e-hookahs, vaporizer cigarettes, vapes, and vape pens.They come in a range of shapes.
As with all rechargeable electrical devices, the correct charger should be used and the device should not be left charging unattended or overnight. There have been instances of e-cigarettes exploding or catching fire. A worldwide technology outage is causing disruption to some State of Illinois online systems.
This happens because smoking causes inflammation around the teeth and increases your risk for bacterial infections. The gums may become swollen and bleed (gingivitis) and eventually begin to pull away from the teeth (periodontitis). Smoking also has an effect on insulin, making it more likely that you’ll develop insulin resistance. People who smoke cigarettes have a 30% to 40% greater risk of developing type 2 diabetes and its complications. Smoking can increase the risk of developing squamous cell carcinoma (skin cancer) on the lips.
You may have heard the benefits of vaping are that it’s safe or that it helps you quit smoking. Some people vape because they think it’ll help them quit smoking if they’ve already tried other methods and haven’t been able to quit. Unfortunately, you may end up addicted to vaping instead, so the benefits of vaping for smoking cessation may not be as good as they seem.
In general, e-cigarettes are not safe for young people or people who are pregnant. Vaping is no safer for developing fetuses than smoking traditional cigarettes. They may also resemble sleek electronic devices, making them appealing to younger users.
Parents and anti-tobacco groups immediately criticized the decision, which follows years of advocacy efforts to keep menthol and other flavors that can appeal to teens off the market. The FDA said it authorized four menthol e-cigarettes from Njoy, the vaping brand recently acquired by tobacco giant Altria, which also sells Marlboro cigarettes. This is in contrast to passive smoking (secondhand smoke), which is known to be very harmful to health.
Electronic smoking devices (or ESDs), which are often called e-cigarettes, heat and vaporize a solution that typically contains nicotine. The devices are metal or plastic tubes that contain a cartridge filled with a liquid that is vaporized by a battery-powered heating element. The aerosol is inhaled by the user when they draw on the device, as they would a regular tobacco cigarette, and the user exhales the aerosol into the environment. Electronic cigarettes (E-Cigarettes) are battery-powered devices that function by heating a liquid into an aerosol that is inhaled by the user.
If you purchase e-cigarettes and nicotine refill products, store them out of reach of your children and pets. With these products, it’s the liquid nicotine that can be dangerous, especially to children. According to the American Academy of Pediatrics, as little as one teaspoon of liquid nicotine can be fatal to a 26-pound child.
Not to mention the smell that lingers on a person’s body after finishing a cigarette, even if it was outside, far outlasts a vape any day. At Cornell, Jason told me, people Juuled in bathrooms and classrooms, in "every nook and cranny of this campus." In the fall, he’d started a group text, with a few friends, to coördinate pod runs. He called the group Juuluminati, and it has since grown to three hundred and twenty-four members. Jason was Juuling while he talked to me, on the third floor of an academic building. "I know for a fact that there are two or three of my good friends sitting on the first floor of this building eating ham sandwiches and just Juuling away," he said.
Several states have imposed restrictions on the sale of e-cigarettes. There are also restrictions on liquids with flavors that may be more attractive to younger people. The researchers also noted a lack of evidence that vaping is an effective means of quitting smoking. The marketing of e-cigarettes and their range of flavors can give the impression that vaping is not harmful.
Consequently, stricter regulation and a higher quality control in the e-liquid industry are required. The mislabelling of nicotine content in e-liquids has been previously addressed [8, 34]. Of note, several studies have detected nicotine in those e-liquids labelled as nicotine-free [5, 35, 36]. Among the 17 samples tested in this latter study 14 were identified to be counterfeit or suspected counterfeit. A third study detected nicotine in 7 of 10 nicotine-free refills, although the concentrations were lower than those identified in the previous analyses (0.1–15 µg/mL) [5].