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Juul’s C.E.O., Kevin Burns, who is fifty-four, has a friendly dad-who-loves-his-vacation-house demeanor. Burns described Juul to me as a "cigarette-killing company." Before he accepted the job, he said, he convened an informal focus group in his kitchen with his son, who’s in high school, and a few of his son’s friends. He asked them why they had these things, when they got them, how prevalent they were. "We have frustrations about how the product is glorified on social media," he told me. I admitted to Winickoff that I was probably endangering my lungs as a weed smoker. He gamely pointed out that I could look into ingested forms of marijuana, and noted that my brain was in a much more stable place than it had been when I was twenty-one.
Because there is no safe tobacco product, quitting use of all tobacco products is the best way to protect your health. Most e-cigarettes contain nicotine, which is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s. E-cigarettes can contain other harmful substances, including cancer-causing chemicals; chemicals linked to serious lung disease; and heavy metals, such as nickel, tin, and lead. Young people who use e-cigarettes may be more likely to smoke traditional cigarettes in the future. Vapor products produce aerosol by heating a liquid solution, which is inhaled as an aerosol. The process is referred to as "vaping." Vapor products often contain nicotine.
Cigarette smoking is still the No. 1 cause of preventable death in this country, killing nearly five hundred thousand people each year. (According to some studies, more than half of longtime smokers will die from smoking-related complications.) It’s incredibly hard to stop smoking; people spend lifetimes trying. Around seventy per cent of American smokers say that they want to quit, and for many of them e-cigarettes have been a godsend. But, according to a 2017 study by the C.D.C., about fifty per cent more high schoolers and middle schoolers vape than smoke. Young people have taken a technology that was supposed to help grownups stop smoking and invented a new kind of bad habit, one that they have molded in their own image. The potential public-health benefit of the e-cigarette is being eclipsed by the unsettling prospect of a generation of children who may really love to vape.
WASHINGTON (AP) — The Supreme Court took up an e-cigarette case Tuesday, weighing Food and Drug Administration decisions blocking the marketing of sweet flavored products amid a surge in vaping by young people. Despite not authorizing a single synthetic nicotine product, it has allowed these products – including e-cigarettes in kid-friendly flavors – to stay on the market well past the July 13 deadline. There is little research on the safety of vaping in pregnancy, but it's likely to be substantially less harmful for you and your baby than smoking. Unlike cigarettes, vapes do not produce carbon monoxide, which is very harmful to a developing baby in the womb. They also cause other serious illnesses, including lung disease, heart disease and stroke.
The ACS encourages adolescent users who find it difficult to quit to ask for help from health care professionals. Parents should learn all they can about e-cigarette use and be prepared to help their children get the assistance they need. In 2019, more than one in six (15.2%) New York City high school students reported using e-cigarettes.
The replaceable liquid cartridge contains nicotine mixed with a base (usually propylene glycol), along with flavorings and chemicals. The tip often contains LED lights that simulate the glow of a burning cigarette. Nicotine poisoning can occur when someone ingests, inhales, or absorbs nicotine through the skin or eyes. It can be particularly dangerous for children and young adults, as they are more susceptible to the effects of nicotine. The tax must be broken out as a separate amount from the products sold in any transaction.
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.
And nicotine use in young adults still can lead to other illicit substance use. The request from the Federal Trade Commission asks six companies to turn over data by January dealing with the sale and promotion of their products for the years 2015 to 2018. In the United States, states are a primary determinant of the total tax rate on cigarettes. As part of the Family Smoking Prevention and Tobacco Control Act, the federal government collects user fees to fund Food and Drug Administration (FDA) regulatory measures over tobacco.
E-cigarettes produce an aerosolized liquid (vapor) that usually contains nicotine and other chemicals inhaled by the user. Months after the release of that advisory, Yale researchers found that byproducts, called acetals, form when flavoring agents mix with solvents in the liquid. It is not yet known if this has negative effects on the body, but Sven-Eric Jordt, PhD, one of the study’s authors, says he hopes that the FDA will begin to study the short- and long-term effects of inhaled acetals. Under the PACT Act, delivery sales of electronic nicotine delivery systems must also comply with state, local or tribal laws involving excise taxes on these devices.
The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking. Vaping companies have long claimed their products can help blunt the toll of smoking, which is blamed for 480,000 U.S. deaths annually due to cancer, lung disease and heart disease. The FDA has not authorized any flavored e-cigarette products and reports that it has denied marketing applications for millions of flavored products. E-cigarette companies have filed over 60 lawsuits challenging the FDA’s marketing denial orders. In addition, while the FDA denied marketing applications for all Juul products in June 2022, it subsequently put that decision on hold in the face of a lawsuit by Juul. When e-cigarette products first became popular, we didn’t have much information about health risks.
Some people believe that e-cigarettes can help them quit smoking tobacco. However, nicotine patches and many other FDA-approved quit aids are available now to help people quit smoking. E-cigarettes are not currently approved by the FDA as aids to help stop smoking.
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.
However, more research is needed to fully understand emissions from e-cigarettes and their impact on human health. These aerosols can contain potentially harmful substances — including nicotine, formaldehyde and metals — some of which cause cancer and other harmful health effects. Some e-cigarette brands and other nicotine products state they contain synthetic nicotine rather than nicotine made from or derived from tobacco.
A lack of data has led to classification of methylgloxal as a Group 3 carcinogen (carcinogenicity to humans not classifiable) by IARC. Both compounds have been previously detected in e-cigarette emissions at concentrations of 0.07–0.94 and 0.09–33 µg puff–1, respectively86,88. In our study, glyoxal was present at lower levels (BB57 and BB18, 0.02 and 0.05 µg puff–1, respectively), while methylglyoxal was at concentrations of 0.13 and 0.19 µg puff–1 in BB57 and BB18, respectively (Table 3). Glyoxal was detected in the method air blank and therefore the actual levels in the e-cigarette emissions are potentially lower than reported in Table 3.
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.
It's free of heavy metals, pesticides, solvents, microbes, and fungal toxins. It contains nothing but hemp extract and terpenes (the molecules that give cannabis its piney, citrusy flavors). All of the above meet United States Pharmacopeia standards for purity and quality. Our ultra-simple formula means you know exactly what's going into your lungs when you take a puff of a HELO Air. Find out more about the tools and support available to help you stop smoking. Read more about the research into e-cigarettes so far and what we still need to find out.
This ban builds upon legislation signed in July by Governor Cuomo that immediately banned the use of e-cigarettes on all public and private school grounds in New York State. The CDC’s Office on Smoking and Health (OSH) developed this presentation to educate youth on e-cigarettes, including the health risks, the factors that lead to e-cigarette use, and what youth can do to avoid all tobacco products, including e-cigarettes. This resource is intended for adults who educate or serve youth ages (teachers, youth ministers, coaches, scout leaders, etc.). Utilizing the talking points and information for the users' document, the presenter does not require additional information, nor permission to deliver the presentation. Today, nicotine poisoning has become a growing concern because of new nicotine products on the market, particularly electronic cigarettes (e-cigarettes) and pure liquid nicotine. The concentration of nicotine in liquid products is higher than most other tobacco products.
More research needs to be done to understand the long-term health effects of secondhand exposure to e-cigarette vapor. Secondhand exposure to e-cigarette vapor is said to be less toxic than secondhand exposure to cigarette smoke. However, secondhand vapor is still a form of air pollution that probably poses health risks. N.L.B. serves as a consultant to pharmaceutical companies that market or are developing smoking cessation medications, and has provided expert testimony in litigation against tobacco companies. N.A.R. consults with and has received a research grant from Achieve Life Sciences for development of a smoking cessation medication, and receives royalties from UpToDate (an online medical textbook) as author of sections on e-cigarettes.
The program’s curriculum includes a four-part series of lessons, with one set for fifth through eighth graders and another for high schoolers. The lessons teach students about the dangers of vaping, vaping marketing and resources for quitting vaping. Students that go through the program are 45% less likely to vape, according to Bianco. This is Quitting was developed by Truth Initiative, a nonprofit focused on ending tobacco use, as a free and anonymous text messaging program to help young people quit vaping.
Vaping works by heating liquid in a small device so you can breathe it into your lungs. The e-cigarette, vape pen or other vaping device heats the liquid in the device to create an aerosol. Mist from e-cigarettes contains particles of nicotine, flavoring and other substances suspended in air. You breathe these particles into your mouth from the mouthpiece, where they go down your throat and into your lungs. But, Blaha says, interpreting the data is tricky, since young people change their preferences often, and, when surveyed, may not consider using disposable products such as "puff bars" as vaping. The same CDC report says disposable e-cigarette use has increased 1,000% among high school students and 400% among middle school students since 2019.
The Finnish Social and Health Data Permit Authority Findata grants permits to the secondary use of the SHP data. Conceptualized and designed the study, managed data, and conducted analyses. All authors contributed to manuscript revisions and have approved the final version of the article. The association between student- and school-level factors and susceptibility to e-cigarette use.
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.
Given that nicotine easily diffuses from the dermis to the bloodstream, acute nicotine exposure by e-liquid spilling (5 mL of a 20 mg/mL nicotine-containing refill is equivalent to 100 mg of nicotine) can easily be toxic or even deadly [8]. Thus, devices with rechargeable refills are another issue of concern with e-cigarettes, especially when e-liquids are not sold in child-safe containers, increasing the risk of spilling, swallowing or breathing. An E-cigarette is any device or delivery system sold in combination with nicotine for a single price which can be used to deliver to a person nicotine in aerosolized or vaporized form. An E-cigarettes may also be known as e-cigar, e-pipe, vape pen, or e-hookah or other names. The definition of E-cigarettes includes any liquid or substance containing nicotine, whether sold separately or sold in combination with any device that could be used to deliver to a person nicotine in aerosolized or vaporized form. For each 0.7 milliliters of e-cigarette e-liquid not sold due to these policies, the authors calculated that 15 additional cigarettes were purchased.
Again assuming a worst-case exposure of 300 puffs day–1 spread over 8 h, the levels of glyoxal exposure to a consumer would still be more than 40 times lower than the occupational exposure limit of 0.10 mg m–377,94,95. The high standard deviation for glyoxal and methylglyoxal observed in BB18 e-cigarette emissions is probably related to an analytical sample matrix effect and/or batch variability83,96,97. Despite the high standard deviation, the percentage reduction of glyoxal and methylglyoxal in both e-cigarette emissions relative to cigarette smoke was ≥ 97.0% and ≥ 94.5%, respectively (Table 3).
"Recent studies should make us all more concerned about the impact of traditional and e-cigarettes on the heart as well," Dr. Cireddu says. According to the 2018 NAP report, secondhand vapor contains nicotine, particulate matter, and volatile organic compounds (VOCs) at concentrations that are above recommended levels. The 2018 NAP report found that there’s some evidence that e-cigarette exposure has adverse effects on the respiratory system. Some studies suggest that vaping may have negative effects on the lungs, but more research is needed.
Originally, it was thought that vaping might be helpful for people trying to quit smoking. Some e-cigarette labels have claimed that the product had no nicotine when, in fact, it was in the vapor. For this reason, it’s important to use only trusted brands if you vape. E-cigarettes are still relatively new, so their long-term effects are unknown.
But e-cigarettes haven't proved to be safer or more effective than nicotine-replacement medications in helping people stop smoking. He was a founding member of the Society for Nicotine and Tobacco Research. As a public health researcher, he has studied numerous issues related to nicotine use and policy, with some recent work focused on cigarette and e-cigarette use among adolescents and young adults. Lynn T. Kozlowski is an internationally recognized expert on tobacco use, e-cigarettes and nicotine policy. He can speak to the media about these issues, including trends in both smoking and vaping (including Juuling). Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realised based on the evidence assessed by this important independent review.
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.
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.
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 2023 National Youth Tobacco Survey, released in November by the US Centers for Disease Control and Prevention and the US Food and Drug Administration, found that about 2.1 million middle and high school students were e-cigarette users. Get more information on small cell lung cancer, non-small cell lung cancer, and the diagnosis of lung cancer stages. Also, "it is clear from the scientific literature that a variety of toxic compounds besides nicotine are present in aerosolized e-liquid," the researchers added. These chemicals have been linked to lung inflammation, chronic coughs, shortness of breath and lung disease.
Separate studies have shown that newer e-cigarettes may deliver higher doses of nicotine more efficiently, which could explain the recent findings. The investigators acknowledged that more frequent use of e-cigarettes may also reflect greater determination to quit smoking combustible cigarettes. They noted that their study did not evaluate the risks of youth e-cigarette use. E-cigarettes are the most commonly used commercial tobacco product among youth,1 so it is critical that public health officials and the general public understand the potential risks of using them.
Research has also shown flavor chemicals to be toxic in both e-liquid and aerosol form. While many flavor chemicals used in vaping products have been approved for ingestion, they have not yet been tested for safety when aerosolized. Flavor chemicals are typically not listed on e-cigarette packaging, and most e-liquids contain more than one flavor chemical. Benzaldehyde (used in cherry-flavored products) and 2, 5-dimethyprazine (used in chocolate-flavored products), specifically, may harm human health.
Studies have found that nearly two-thirds of adult e-cigarette users plan to quit, and almost a quarter of adolescents want to quit and have made a quit attempt. We hope this article helps you feel a little more secure about your choice of vaping products. Remember that the safest way to use any vape is in moderation, so try not to overdo it, no matter which one you choose. Flavored vapes without nicotine (and other types of vapes) come in hundreds of different sizes and styles, and some are less risky than others. How can you decide which ones are safest and what's considered a healthy vape brand. Our only gripe with CAPNOS is that they're a little vague about where exactly their flavors come from.
While e-cigarette use prevalence has declined significantly since the heyday of JUUL — 10% of high school students reported using e-cigarettes in 2023 — e-cigarette use among young people remains a concern. Thousands of flavored, high-nicotine, and relatively cheap e-cigarette products remain on the market — many of them illegally — driving youth use and nicotine addiction. Equally concerning, nearly half of young people who have ever tried e-cigarettes continue to use them, and many do so daily. As encouraging as the data was a few years ago, it’s starting to look like that’s not the case. The FDA is yet to approve them as a smoking cessation aid and a recent CDC study found that most adult e-cigarette users — 58.8 percent of them — don't stop smoking cigarettes and instead wind up using both products. The few scientists actively trying to fill the gap in the research literature are running into obstacles.
E-cigarettes first entered the market in 2007 and have evolved many times since then, with older versions designed to resemble regular cigarettes, cigars, pipes, and pens. E-cigarettes next evolved into "pod mods" with e-liquid sold in disposable pods. In 2015, the emergence of the brand JUUL took pod mods to the next level with high tech design, high-nicotine delivery, and youth- appealing marketing that hooked a new generation to nicotine. Without regulations, it is the "Wild West" for e-cigarette companies, says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, and a self-described e-cigarette pessimist. He argues that given the paucity of health data, current indoor smoking bans should apply to e-cigs as well.
As with high school students, e-cigarette use was much more common than cigarette use. E-cigarettes come in many shapes and sizes and can also be called e-cigs, e-hookahs, vapes, vape pens, personal diffusers or diffuser sticks. But one vape can contain the equivalent of 50 cigarettes of nicotine in the one product. They also contain a complex combination of chemicals including nicotine, nickel, tin, arsenic, chlorine and lead. These substances can be harmful to the body, with different flavourings helping to mask these poisons when they are taken into the body. An electronic cigarette (e-cigarette) is a battery-operated device that heats liquid nicotine, flavoring, and other additives to create an aerosol.
At that point, levels of formaldehyde exceeded limits set by the California Office of Environmental Health Hazard Assessment (OEHHA), though other compounds didn’t come close. About a quarter of middle and high school students surveyed in 2017 said they had been around someone vaping at least once in the past 30 days. In 2021, only about 11 percent of high school students and 3 percent of middle school students surveyed said they had tried e-cigarettes. Results from a clinical trial published by JAMA Internal Medicine found that young adults ages who used This is Quitting from Truth had nearly 40% higher odds of quitting compared to a control group.
Electronic cigarettes (e-cigarettes) are devices made to resemble cigarettes. Despite making great strides to reduce smoking, tobacco is still our biggest killer. Our region has always kept an open mind towards using electronic cigarettes as we can see the massive potential health benefits from switching.
Silica was commonly the first material to be used as a wick, followed by cotton and ceramic3,13,14,15. Cotton has good wicking properties but is less thermally stable than silica14,16,17, while ceramic is chemically stable and heat-resistant18. The use of microporous ceramic as a wicking material has increased in the past few years14,16,18,19,20. Its application has been reported to improve heating efficiency and reduce charring14,16,18,19,20. Additional research is ongoing to clarify the dangers from vaping, and how vaping damages the lungs and other organs. Long-term human studies, in particular, could bring the risks from e-cigarettes into better focus, Crotty Alexander says.
Scroll to the top of the page and click on the blue "Order Publications" box for ordering information and to complete the order form. Our editors will review what you’ve submitted and determine whether to revise the article. Any person or business that sells, transfers or ships for profit any ENDS in interstate commerce must now register with ATF according to 15 U.S.C. §§ 375 and 376. E-cigarettes are not currently available from the NHS on prescription, so you cannot get one from your GP.
The study was supported by the National Institutes of Health, the American Heart Association, the Stanford Diabetes Research Center, the University of California Tobacco Related Disease Research Program and the FDA. We acknowledge the assistance of Belinda Zonnestein in sourcing and testing of the products. We further acknowledge My-Linh Tran and Joseph Sutton for their contribution to product development and provision of product details and to Sandra Costigan and Elaine Brown for the toxicological inputs. Death typically happens due to paralysis of the muscles that control your breathing, fluid buildup in your airways and heart and blood vessel failure (cardiovascular collapse).
Research from The Johns Hopkins University on vape ingredients published in October 2021 reveals thousands of chemical ingredients in vape products, most of which are not yet identified. Among those the team could identify were several potentially harmful substances, including caffeine, three chemicals never previously found in e-cigarettes, a pesticide and two flavorings linked with possible toxic effects and respiratory irritation. "These cases appear to predominantly affect people who modify their vaping devices or use black market modified e-liquids. This is especially true for vaping products containing THC," explains Blaha. The American Lung Association will continue to urge FDA and Congress to remove all flavored tobacco products from the marketplace.
A Foundation-led study presented at the 2024 Society for Research on Nicotine and Tobacco annual meeting found that monthly e-cigarette sales in California declined by 41% after statewide restrictions on the sale of flavored tobacco products took effect. However, the report also noted that the tobacco industry continues to market products to offset these declines, including non-menthol cigarettes that contain other cooling chemicals. Continuing to monitor flavored tobacco product sales is key to assessing policies like these and informing further policy development and implementation. Toxicity is not the only factor in considering risk to an individual or a population from exposure to ENDS emissions.
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.
E-liquid physical properties are also important in carbonyl formation15,47,84,86. The viscosity and density of the e-liquid determine its mobility, capillary action, and delivery to the wick and coil, influencing the likelihood of a dry puff15. Sub-ohm vapes (sometimes called cloud kits) are more advanced vaping devices that are capable of outputting huge amounts of power; if you’ve ever noticed someone exhaling gigantic clouds from their kit, they were probably using one of these! Using a sub-ohm device requires a working knowledge of battery safety and Ohm’s Law, so it’s best to do some reading before investing in one. "India should be taking lessons from the West where vaping has become an epidemic. Claims that e-cigarettes aid cessation is a big lie, rather they are gateway devices.
Long periods of dual use of cigarettes and e-cigarettes can result in harms to health similar to, or in addition to, the harms from exclusive use of cigarettes. Nicotine is the primary agent in regular cigarettes and e-cigarettes, and it is highly addictive. It causes you to crave a smoke and suffer withdrawal symptoms if you ignore the craving.
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 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.
Nicotine yields for different e-cigarette brands have been reported from 2 to 313 µg puff−1 while for conventional cigarettes smoke the values ranged from 170 to 232 µg puff−16,31,36,48,64. Nicotine poisoning refers to the toxic effects of consuming nicotine, a chemical in all tobacco products. A recent increase in poisonings is due to liquid nicotine, a product in the popular e-cigarette. Symptoms include vomiting, rapid heart rate, unsteadiness and increased salivation. The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes. It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).
However, the long-term effects of all flavour chemicals used by this industry (which are more than 15,000) remain unknown and they are not usually included in the product label [78]. Furthermore, there is no safety guarantee since they may harbour potential toxic or irritating properties [5]. In addition to its toxicological effects on foetus development, nicotine can disrupt brain development in adolescents and young adults [44,45,46]. Several studies have also suggested that nicotine is potentially carcinogenic (reviewed in [41]), but more work is needed to prove its carcinogenicity independently of the combustion products of tobacco [47].
"It’s young people doing something terrible for them that’s supposed to be healthy," he said. There’s a whole genre of throwing-away-my-Juul videos on social media, with people tossing their vape into a river or a snowbank as dramatic music plays. New research led by Roswell Park experts in health behavior and published today in the journal JAMA Network Open suggests that daily e-cigarette use may help some people to quit using combustible cigarettes.
Beginning July 1, 2019, Illinois law prohibits the sale of tobacco products, including these products, to people younger than age 21. The smoke also caused damage to the lungs and bladders of mice, indicating that it may increase the risks of developing lung and bladder cancer. Since e-cigarettes arrived in the U.S. in 2007, they have been investigated by addiction researchers as possible cessation devices for adults trying to quit combustible, or regular, cigarettes.
Carbonyls in cigarette smoke are formed mainly by pyrolysis of tobacco sugars83, whereas those in e-cigarettes are formed mainly by thermal degradation of PG and/or VG83,84,85. Flavourings may also contribute to the formation of carbonyls, as well as the characteristics of the e-cigarette devices, especially the applied voltage, coil resistance and wicking material47,48,49,86,87. Poor wicking efficiency may lead to a dry wick and overheated e-liquid (dry puff), which promotes the formation of carbonyls and other toxic compounds2,10,13,15. Coil location, orientation, resistance and wick material, as well as power output, have been shown to affect carbonyl generation significantly13,15,86.
Both vaping and smoking are addictive and bring potentially dangerous chemicals into your body. The levels of many of these chemicals is higher when you burn tobacco. Vaping hasn’t been around long enough to know what kind of long-term damage it might cause. Although they’ve been promoted as an aid to help you quit smoking, e-cigarettes have not received Food and Drug Administration approval as smoking cessation devices. A recent study found that most people who intended to use e-cigarettes to kick the nicotine habit ended up continuing to use traditional and e-cigarettes.
E-cigarettes are not risk-free but are believed to cause less harm than smoking. They do not burn tobacco or produce tar or carbon monoxide — two of the most harmful parts of tobacco smoke. Smoking can raise your risk for periodontal disease or disease affecting the gums.
And using overly high temperatures could increase the stress on your lungs. Long-term users may not want to keep buying new vapes every time, though, as we touch on in our article on the best 0 nicotine rechargeable vapes. If you're not using disposables, the next safest option is a closed-system vape.
The cytotoxic and pro-inflammatory effects of different e-cigarette flavouring chemicals were also tested on two human monocytic cell lines—mono mac 6 (MM6) and U937 [86]. Also, all the tested flavours produced significant levels of ROS in a cell-free ROS production assay. Finally, diacetyl, pentanedione, O-vanillin, maltol, coumarin, and CAD induced significant IL-8 secretion from MM6 and U937 monocytes [86]. It should be borne in mind, however, that the concentrations assayed were in the supra-physiological range and it is likely that, once inhaled, these concentrations are not reached in the airway space.
District Court for the District of Columbia ruled that e-cigarettes did not meet the criteria for drug-delivery devices and therefore were exempt from regulation under the FFDCA. The court did rule, however, that the FDA could regulate e-cigarettes as tobacco products under the Family Smoking Prevention and Tobacco Control Act (TCA), since the nicotine contained in some of the e-cigarette cartridges was derived from tobacco. Reports in 2018 of increased e-cigarette use among adolescents and teenagers in the United States prompted the FDA to identify strategies for combating e-cigarette use by minors. Altria’s data showed Njoy e-cigarettes helped smokers reduce their exposure to the harmful chemicals in traditional cigarettes, the FDA said. The agency stressed the products are neither safe nor "FDA approved," and that people who don’t smoke shouldn’t use them. The FDA regulates the manufacture, distribution, and marketing of tobacco products, such as cigarettes, cigars, and e-cigarettes (sometimes called "vapes").
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.
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.
And studies show that brands claiming to be "nicotine-free" may still have trace amounts. Developing teenage brains are especially sensitive to nicotine's addictive properties. Urgent action is needed to control e-cigarettes to protect children, as well as non-smokers and minimize health harms to the population. E-cigarettes as consumer products are not shown to be effective for quitting tobacco use at the population level. Instead, alarming evidence has emerged on adverse population health effects. Without urgent and effective public health action, e-cigarettes will lead to a new generation of nicotine-addicted individuals.
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].
A 2016 report indicated that many vape fluids contain flavoring agents at concentrations that may pose risks to users. It carries the same health risks as vaping with any other e-cigarette brand. There’s limited evidence to date of the long-term effects of vaping because we know the lung effects of vaping will take decades to develop.
Overall, comparisons of the particle-size distribution in aerosols from e-cigarettes found that the substances tested had particle distributions similar to the traditional e-liquids containing nicotine. "Our finding indicates that health care expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn’t use any tobacco products," said lead author Yingning Wang, PhD, of the UCSF Institute for Health & Aging. Use of electronic cigarettes costs the United States $15 billion annually in health care expenditures – more than $2,000 per person a year – according to a study by researchers at the UC San Francisco School of Nursing. Between 2016 and 2022–2023, the proportion of people who both smoked regular (combustible) tobacco cigarettes and used e‑cigarettes increased, as did the proportion who currently used e‑cigarettes but did not use regular cigarettes.
If you are not sure whether disposables are for you, these kits would be a great place to start. The leading disposable vape kits are Elf Bars, Lost Mary and Crystal Bar. Both come in a wide range of tastes to suit anyone looking to switch from smoking but also work well as a cheap back up kit for existing vapers. The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Data from the 2019 Minnesota Student Survey shows a steep rise in e-cigarette use among students. This study was supported by funding from the National Institute on Drug Abuse of the NIH and the FDA Center for Tobacco Products.
It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include e-cigarettes, vape pens, hookah pens, personal vaporizers and mods, e-cigars, e-pipes and e-hookahs, deliver nicotine in aerosol form without combustion. Since they were first introduced in the U.S. in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has led to increased concern about potential negative health effects. Some individuals who smoke choose to try e-cigarettes to help them stop smoking. Since smoking kills fully half of all long-time users, successfully stopping smoking leads to well-documented health benefits.
For those who currently use, My Life My Quit offers resources tailored to support youth ages on their journey to quitting. Youth and teens can text Start My Quit to or visit the website for free, confidential quit help. Other appeals courts have sided with the FDA, which regulates new tobacco products under a 2009 law aimed at curbing youth tobacco use.
A 2018 report from the National Academies Press (NAP) found significant evidence that taking a puff from a nicotine e-cigarette triggers an increase in heart rate. In summary, it seems that either smoking or nicotine vaping may adversely impact on COVID-19 outcome. However, additional follow up studies are required in COVID-19 pandemic to clarify the effect of e-cigarette use on lung and cardiovascular complications derived from SARS-CoV-2 infection. It is also noteworthy that among the 3 most cytotoxic vapours for HUVEC evaluated in the Putzhammer et al. study, 2 were nicotine-free, which suggests that nicotine is not the only hazardous component in e-cigarettes [24]. However, while vape products can reduce the amount of tar and other chemicals a person inhales, they can increase a person’s nicotine dependency. The National Institute on Drug Abuse (NIDA) states that around half of all smokers try to quit every year, while only 6% manage to do so.
Beginning August 1, 2019, Minnesota law prohibits the use of these products indoors where cigarette use is prohibited, including bars and restaurants. A 2021 study found that daily e-cigarette usage among tobacco smokers can increase the likelihood of quitting smoking eightfold. Researchers assessed data from the 2014–2019 Population Assessment of Tobacco and Health (PATH) study, focusing on smokers who were not planning to quit smoking at the start of the period. However, a 2019 study into the long-term health effects of vaping found that people using e-cigarettes had a higher risk of respiratory disease than people who never smoked. The authors first created a comprehensive database of tobacco product flavor prohibition and restriction laws across the United States, including both state and local statutes. To date, there is no state excise or special tax placed on e-cigarettes.
According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes. Although JUUL is currently the top-selling e-cigarette in the U.S., other e-cigarettes are becoming available that look like USB flash drives. Because of their shape, school teachers, administrators, and parents may not notice students using these devices in school, including in classrooms and bathrooms. Adults who use tobacco and are trying to quit should use proven quit tools, like group or phone counseling, paired with medications or nicotine replacement therapy patches, gum or lozenges. The agency says the sweet flavored e-liquids pose a "serious, well-documented risk" of enticing more young people to pick up a nicotine habit. In 2020, nearly 20% of high school students and almost 5% of middle-school students used e-cigarettes, and almost all of those kids used flavored products, the agency said in court documents.
These findings can reflect general openness to nicotine use, indicated by a previous study showing considerable overlap between susceptibility types [24]. Several school-level factors have a role in both youth tobacco use and educational pathways. These include school rules and policies, physical environment, curriculum, discipline, school health services, school social and learning environment, student commitment to learning and school community as well as parents and the broader community [26]. Further, school influence partly occurs through the perceptions of smoking behaviour in the social network (descriptive norms) and perceptions of social network beliefs (injunctive norms), which both predict smoking initiation among youth [27].
Nicotine levels ranged 0.10–0.32 mg puff−1 across the 3 study products. From the 19 proposed HPHCs specifically of concern in e-cigarettes, only 3 (glycerol, isoamyl acetate and propylene glycol) were quantified. As crucial as it is to health to quit smoking conventional cigarettes, it is unwise, as a rule, to take up vaping as a substitute, Christiani emphasizes.
E-cigarette companies also take advantage of other marketing outlets, including the internet, retail environments, and recreational venues and events. This resource presents an overview of key aspects of e-cigarettes, including health effects, marketing practices, and regulations based on research and evidence available at the time of publication. Since the sixties, cigarette companies, starting with Philip Morris, have freebased nicotine using ammonia, which liberates the nicotine so that it can be speedily absorbed into the lungs and the brain.
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).
"If there was good evidence that people were using e-cigarettes just to quit smoking, there would be wide support," Benowitz says. "The problem is most of the e-cigarette use in the U.S. is dual use with cigarettes." People use e-cigs in places or situations where they can't smoke, like in a restaurant, but continue lighting up when they can, he explains. "My reading of the evidence is that it is quite convincing that e-cigarettes are helping some people quit smoking." Many young e-cigarette users reported throwing away, improperly recycling, or littering the devices. Only 15% of young e-cigarette users reported disposing of empty pods or disposable vapes by dropping them off or sending them for electronic recycling.
However, no rigorous scientific studies have shown that they are safe for use. Some people who smoke choose to try e-cigarettes to help them stop smoking. But switching to e-cigarettes still exposes users to potentially serious ongoing health risks. It’s important to stop using all tobacco products, including e-cigarettes, as soon as possible both to reduce health risks and to avoid staying addicted to nicotine.
Be sure to meet all the following terms and conditions when buying or selling e-cigarettes, ENDS, or e-liquids on eBay. These terms and conditions may change over time and it is your responsibility to visit these pages to see if and how it may have changed, so that you can remain compliant. There is no data to show nicotine pouches as a safe or effective way to quit. University Health Center medical experts and Nebraska Medicine certified tobacco treatment specialist Jill Selzle, PA, do not recommend these products. Many providers ask their patients about alcohol, drug use and smoking, yet forget to ask about vaping. Project for Teens is an example of a local outreach program that provides support and education on the dangers of vaping.
This includes quit coaching, up to 2 weeks of nicotine replacement therapy, and a youth digital program for those ages 13-17. Vuse, owned by Reynolds American, and Juul control about 60% of the market, while hundreds of disposable brands account for the rest. While nicotine is the addictive substance in cigarettes, most of the harm from smoking comes from the thousands of other chemicals in tobacco smoke, many of which are toxic.
They do contain propylene glycol, but the concentrations are far below levels usually considered harmful. Though this might make the VITAs hit slightly harsher than vapes without this ingredient, it shouldn't pose much risk to your health. But levels are usually low and generally far lower than in tobacco cigarettes. I don’t sit around inhaling lungful after lungful of vape for seven minutes at a time, like I would a real cigarette, so the lingering aura from my habit certainly isn’t hovering for extended periods of time.
Taken together, the studies provide strong evidence that an interactive, tailored text message program can help teens and their older peers break free from nicotine addiction. These findings are especially important given the recent youth mental health crisis documented by the U.S. Adolescents in this study were characterized by high severity of past-year problems with depression, sleep, anxiety, trauma, and substance use. In addition, moderate to high levels of nicotine dependence were observed across multiple measures, with more than three-quarters (76.2%) of teens vaping within 30 minutes of waking — a common way to measure addiction. Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses.
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.
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.
Simply select your manager software from the list below and click Download.For more information or tips please see 'Downloading to a citation manager' in the Help menu. The Vital Records service window in the Lucas State Office Building will be closed on August 6-7 due to construction. As of April 1st, 2024, 1,061 municipalities, plus 26 states, commonwealths, and territories restrict e-cigarette use in 100% smokefree venues.
They found that the amounts of nicotine in the blood were similar between the two groups after 10 minutes of smoking at a constant rate. The flavoring liquid for electronic cigarettes, or e-cigarettes, may increase the risk of cardiovascular disease when inhaled, according to a study led by researchers at the School of Medicine. My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health. Smokers differ in their needs and I would advise them not to give up on e-cigarettes if they do not like the first one they try. It may take some experimentation with different products and e-liquids to find the right one. An expert independent evidence review published today by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.
In this particular aspect, again the composition of the e-liquid varies significantly among different commercial brands [4, 35]. The most common and major components of e-liquids are PG or 1,2-propanediol, and glycerol or glycerine (propane-1,2,3-triol). Both types of compounds are used as humectants to prevent the e-liquid from drying out [2, 53] and are classified by the Food and Drug Administration (FDA) as "Generally Recognised as Safe" [54].
Nicotine poisoning refers to the toxic effects of consuming nicotine. Nicotine poisoning is the result of having too much nicotine in your body. Most cases resulted from the use of nicotine as an insecticide, accidental ingestion of tobacco or ingestion of nicotine-containing plants. The best vape kit for beginners requires little to assemble and maintain - for example, a disposable device such as the Crystal Bar or Lost Mary or a pod device like the Riot Connex vape kit where the pods simply 'snap' on with magnets - it couldn't be easier! You can get closed pod mod systems, which use cartridges prefilled with e-liquid. This type of device is suitable for beginners as it eliminates the hassle of messy refills and fiddly coil changes.
Experts have long suspected it, but a new study confirms that folks who vape and smoke tobacco face higher risks for lung cancer than if they'd done either alone. Propylene glycol, for example, is usually eaten (in cupcakes, soft drinks and salad dressings) or slathered onto the body (in soaps, shampoos and antiperspirants)—not breathed into the lungs. Many things that can be safely eaten—such as flour—can damage the lungs when inhaled. "We have little information about what happens to propylene glycol in the air," the federal Agency for Toxic Substances and Disease Registry says on its Web site.
Similarly, a 2014 review reported that vaping may trigger gum, mouth, and throat irritation. In particular, a 2015 study examined the effects of flavored e-juices on both human lung cells and lung cells in mice. Here’s what we currently know about the effects of vaping fluids with and without nicotine and vaping cannabis or CBD. In cultured human airway epithelial cells, both e-cigarette aerosol and CS extract induced IL-8/CXCL8 (neutrophil chemoattractant) release [28]. Researchers noted that study participants using both types of cigarettes had a higher nicotine dependence in relation to e-cigarettes. Find more resources on tobacco, e-cigarettes, and vaping on the SAMHSA Store.
There's no evidence so far that vaping causes harm to other people around you. If you're pregnant, licensed NRT products such as patches and gum are the recommended option to help you stop smoking. Nicotine replacement therapy (NRT) has been widely used for many years to help people stop smoking and is a safe treatment. In the UK, e-cigarettes are tightly regulated for safety and quality.
Nicotine pouches, led by top-selling Zyn by Swedish Match, have become increasingly popular among adult tobacco consumers, particularly those trying to lower or end their traditional or electronic cigarette consumption. Chalmers said some students are realizing the dangers of vaping after seeing their peers struggle with nicotine addictions. She believes that adding the CATCH My Breath education only solidifies it for them.
As registered members of UKVIA, we prioritise industry standards, ensuring top-notch product quality and safety for the user. With over two million successfully shipped orders, we've built a reliable reputation. Count on The Electric Tobacconist for premium vape kits backed by a legacy of expertise and customer satisfaction. Or read a quitter's blog and post encouraging thoughts for someone else who might be dealing with tobacco cravings.
What may be the most important message of all is that e-cigarettes and vaping come with many health unknowns, Dr. O’Connor adds. "You see plumes of what looks like steam coming out of people’s mouths on the street when they are vaping, and I think they assume it’s mostly safe, mostly water. But these liquids used in vaping are filled with all kinds of stuff [like nicotine, marijuana, flavoring agents, chemicals], and we don’t always know what else is in there," he says. When potentially risky behaviors experience an uptick in popularity, health researchers are never far behind—gathering data.
"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.
The use of e-cigarettes has increased exponentially in recent years, and vaping has become preferred to traditional cigarette smoking among today’s young people and those looking for alternative to traditional tobacco and nicotine products. As use and availability of these products increases, reports have cast more light on the health effects of e-cigarettes. Here, Kenneth Uy, a health coach at Henry Ford Health, clarifies some information about these products and how their use can impact your health.
The tobacco industry profits from destroying health and is using these newer products to get a seat at the policy making table with governments to lobby against health policies. WHO is concerned that the tobacco industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily promoting these products to children and non-smokers and continuing to sell billions of cigarettes. Nicotine affects the development of the brain’s reward system and brain circuits that control attention and learning. Continued use of nicotine can lead to addiction and raise the risk for addiction to other drugs. In a recent study, about 18% of people who switched to vaping had been able to quit smoking.
Many people diagnosed with EVALI need to be treated in a hospital where medications can be closely monitored, and respiratory support is readily available. "I screen all of my patients, any child over age 12, since [vaping] can exacerbate underlying conditions like asthma," says Yale Medicine pediatric pulmonologist Pnina Weiss, MD. To learn more about e-cigarettes, here are resources from the American Cancer Society and the FDA. There are some e-cigarette brands that claim to be nicotine-free but have been found to contain nicotine. For medical questions, we encourage you to review our information with your doctor.
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.
While their manufacturers say they are an alternative for tobacco smokers who want to avoid inhaling smoke, critics say too little is known about the safety of ESDs because they are not regulated. All tobacco products, including e-cigarettes, pose a risk to the health of the user. Beginning smoking, switching to smoking, or reverting to smoking exposes the user to potentially devastating health effects.
This ban excludes disposable e-cigarette devices, which are sold in many appealing flavors and are relatively inexpensive. And are now the most popular type of e-cigarette used by adolescents. Nicotine is highly addictive and may lead to nicotine cravings and development of tolerance (the need to use more often in order to have the same effect). Nicotine addiction can negatively affect relationships and impair performance at school, at work, or in other activities. Researchers have also identified vitamin E acetate, a chemical added to some THC-containing vaping products, as the main—but possibly not the only—cause of the illness.
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