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A 2021 review found people who used e-cigarettes to quit smoking, as well as having expert face-to-face support, can be up to twice as likely to succeed as people who used other nicotine replacement products, such as patches or gum. Vaping involves using a device known as an e-cigarette—also called a vape pen, mod, or tank—to heat up a small amount of liquid, turning it into a vapor that can be inhaled. Most vape liquids contain substances such as propylene glycol and glycerol as base ingredients that create the vapor.
Cessation strategies should be based on the best available evidence of efficacy, to go with other tobacco control measures and subject to monitoring and evaluation. Based on the current evidence, it is not recommended that governments permit sale of e-cigarettes as consumer products in pursuit of a cessation objective. While they may help some people stop smoking, vaping products do not have FDA approval as a tool for quitting. E-cigarettes may even keep people from trying proven methods of quitting smoking.
Learn more about the symptoms and overall effects of smoking on the body below. For example, in New York and Vermont, vaping is prohibited in all smoke-free venues (like workplaces, bars, restaurants, and gambling facilities) except e-cigarette stores. The makeup of these devices—combined with individual or group vaping patterns—can significantly impact what pollutants get into the air and how many. The program provides participants with tailored advice, cognitive and behavioral coping strategies, and social support to help them quit. Now that ebay is starting to allow sellers like myself to utilize the site again why cant they allow a process to become a pre approved seller for vape products.
More people began vaping in 2023 than initiated alcohol or illicit substances. A 2015 study suggests that people who vape nicotine are more likely to become dependent on nicotine than people who vape nicotine-free fluids. Vaping might appear to be a less harmful choice for people trying to quit smoking. However, that doesn’t mean there aren’t risks involved, even if the vape liquid is nicotine-free. For instance, a 2018 study reported that exposure to e-cigarette aerosol makes teeth surfaces more prone to developing bacteria.
Advertisements for vapes are also restricted in youth-centered areas like parks. Meanwhile, California was the least popular state for youth vaping, as just six percent of teens had picked up the habit. Louisiana and Montana tied to round out the top five, both with a quarter of teens using e-cigarettes.
Meanwhile, some influential conservatives are calling for the Trump administration to hold back on its plans to ban flavored tobacco. They argue such a move would hurt small vape business owners and people trying to quit smoking. Many governments impose restrictions on smoking tobacco, especially in public areas. The primary justification has been the negative health effects of second-hand smoke.[124] Laws vary by country and locality. Nearly all countries have laws restricting places where people can smoke in public, and over 40 countries have comprehensive smoke-free laws that prohibit smoking in virtually all public venues. During World War I and World War II, cigarettes were rationed to soldiers.
The cells are also less able to form new vascular tubes and to migrate and participate in wound healing. With a 399.73% increase in retail e-cigarette sales (excluding internet sales and tobacco-specialty stores) from 2015 through 2020, the environmental consequences of e-cigarette waste are enormous. The fourth-generation vaporizers can also be customized and come with different types of heating coils — some intended for vaporizing solids, not liquids. In general, people using e‑cigarettes did not report doing so in order to quit smoking regular tobacco cigarettes. In 2022–2023, only 1 in 5 (21%) people who had ever used e‑cigarettes reported that they first used e‑cigarettes to help them quit smoking (Figure 5). The most common reason people gave for using e‑cigarettes was out of curiosity (58%).
These devices are permitted on planes, but the FAA recently notified airlines that the lithium batteries used in these devices are fire hazards and should not be packed in checked baggage. This page may contain information that is outdated and may not reflect current policy or programs. But, CDC stats on teen smoking show that while use of e-cigs went up to 24% in 2015, cigarette smoking dropped to an historic low -- to just under 11%.
CATCH My Breath’s curriculum attempts to empower students with this information for them to decide whether to pick up an e-cigarette, Marcella Bianco, the program’s director of government partnerships, explained. Once the school year starts, the 34 middle and high schools in the district join 56 others across the state that have already implemented the prevention program since its launch in 2017. The participants were encouraged to set a quit date and were asked about their vaping behavior via follow-up text message assessments. The trial participants were recruited via ads on social media, including Instagram, Facebook and Snapchat. From October 2021 to October 2023, about half of the participants were randomly assigned to the This is Quitting text message program.
They are sometimes called e-cigs, e-hookahs, mods, vape pens, vapes, and tank systems. Using an e-cigarette is often called "vaping" or "JUULing." 2Most e-cigarette users do not consider themselves to be smokers. E-cigarettes, vapes, vape or hookah pens, e-pipes, and other vaping products are battery-powered devices that allow users to inhale, or vape, aerosolized liquid (e-juice).
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.
Their tactics include slick magazine ads, sponsorship of concerts and auto races, celebrity endorsements and sweet, colorful flavors.21 In addition, e-cigarettes are often aggressively placed in convenience stores near candy. Flavors, including mint and menthol, are one of the top reasons young people use e-cigarettes. Candy and fruit-flavored e-liquids can make e-cigarettes appealing and seem harmless. As of July 2020, the sale of flavored e-cigarettes is prohibited in NYC. Further, in 2018, one in 15 (6.7%) middle school students reported using e-cigarettes. E-cigarette use was higher among older students, with one in 11 (9%) seventh grade students reporting use, compared to one in 38 (2.6%) in sixth grade.
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].
According to the CDC, 15% of EVALI patients were less than 18 years old. In addition, e-cigarettes and e-cigarette vapor may contain the chemicals or substances listed below. E-cigarettes are known by many different names, and sometimes people find it hard to understand what is really known about these devices.
Once discarded into the environment, the filters create a large waste problem. Synthetic particulate filters may remove some of the tar before it reaches the smoker. The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study.
"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. The U.S. Food and Drug Administration and the European Union are grappling with these issues as they decide how to regulate the products. Unfettered access could leave people vulnerable to unknown health hazards, but there is also the chance that greater restrictions might hurt folks who are trying to forgo conventional—and more dangerous—tobacco products.
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).
Although there’s no definitive answer at this point, experts do have a theory about how vaping harms lungs. Young people who vape may be more likely to become addicted than adults. Nicotine exposure during this vital time can affect brain development in subtle and important ways. Research published in 2017 found that the high temperatures needed to form the mist for vaping can create dozens of toxic chemicals, such as formaldehyde, which is thought to cause cancer.
In many high and middle income countries lower socioeconomic status is a strong predictor of smoking. In North America, the common name for the remains of a cigarette after smoking is a cigarette butt. In Britain, it is also called a fag-end or a dog-end.[44] The butt is typically about 30% of the cigarette's original length. It consists of a tissue tube which holds a filter and some remains of tobacco mixed with ash. According to data from the World Health Organization,[39] the amount of tobacco per 1000 cigarettes fell from 1.03 kg (2.28 pounds) in 1960 to 0.41 kg (0.91 pounds) in 1999, largely as a result of reconstituting tobacco, fluffing, and additives. The epidemic use of e-cigarettes is a complicated problem which requires a cooperative effort between partners, organizations, and communities.
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’.
As a result, vaping THC may produce a faster, stronger high, but it may also mean that people experience more adverse effects. In a research letter appearing Aug. 7 in JAMA, study authors at Duke and Yale University also found that the quantity of these chemicals, known as nicotine analogs, are not accurately disclosed on the packaging. If you would like to make a complaint regarding the illegal sale of tobacco to minors or a related tobacco sales complaint, call 311. The study appears online as a pre-print prior to peer review at Social Science Research Network. Currently, over 80% of schools in Iowa have a comprehensive tobacco and nicotine-free policy.
Nicotine salts can be used in refill liquids and in cartridges for closed systems. In March 2019, the Secretariat of the WHO FCTC issued an Information Note which compiled all Conference of the Parties (COP) decisions related to e-cigarettes. Information on current e-cigarette regulation can also be found on relevant pages of government websites (see Relevant Links below). See this page for information on the situation in 2014, when there was little regulation in place.
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.
Moreover, we just don’t know the long-term effects of vaping," said Dr. Bhavna Barmi, a senior clinical psychologist. Vaping, still at epidemic levels among youth with about one in five high school students using e-cigarettes in 2020, generates a significant amount of toxic and plastic waste. Many popular e-cigarettes, like JUUL, are pod-based with single-use plastic cartridges containing nicotine. Generating even more waste are disposable e-cigarettes like Puff Bar, which are designed entirely for one-time use and have skyrocketed in popularity with a 1,000% increase in use among high school students between 2019 and 2020. Nicotine exposure during adolescence can affect learning, memory, and attention. It can also increase risk for future addiction to nicotine and other drugs.
The composition of e-liquids requires stricter regulation, as they can be easily bought online and many incidences of mislabelling have been detected, which can seriously affect consumers’ health. Beyond their unknown long-term effects on human health, the extended list of appealing flavours available seems to attract new "never-smokers", which is especially worrying among young users. Additionally, there is still a lack of evidence of e-cigarette consumption as a smoking cessation method. Indeed, e-cigarettes containing nicotine may relieve the craving for smoking, but not the conventional cigarette smoking habit.
"Vaping products containing nicotine are subject to federal laws that prohibit sales to people under the age of 21," said study co-author Sairam V. Jabba, D.V.M., Ph.D., a senior research scientist at Duke University School of Medicine. "Even with the current relatively low use of e-cigarettes among adults – 3.7 percent – health care costs are already substantial, and likely to increase in the future if youth continue to use this product," said Max. "Vaping products containing nicotine are subject to federal laws that prohibit sales to people under the age of 21," said study co-author Sairam V. Jabba, D.V.M., Ph.D., a senior research scientist at Duke University School of Medicine. The 2022–2023 NDSHS had a series of questions regarding policy measures designed to address e‑cigarette use. Support increased for all e‑cigarette policy options among the Australian population (Figure 6).
E-cigarettes are known by many different names, including "vapes," "e-cigs," "puff bars," and "electronic nicotine delivery systems (ENDS)." E-cigarettes are devices which produce an aerosol by heating a liquid that usually contains nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—flavorings, and other chemicals that help to make the aerosol. Bystanders can also breathe in this aerosol when the user exhales into the air. The nicotine in e-cigarettes and regular cigarettes is highly addictive. While these devices may help some people quit smoking, there is growing evidence that e-cigarettes can pose serious health risks, especially to people who do not smoke traditional cigarettes.
Though not all flavors have yet been scientifically studied, there is a strong chance others may also be harmful. We work with community partners to raise awareness of the harms of e-cigarettes and vaping and flavored tobacco products that attract youth, through the Unhyped and CounterBalance campaigns. We also review and share e-cigarette use data and trends and tailor our education efforts accordingly. Learn more about potential health hazards of secondhand aerosol (a.k.a. vapor) emitted by electronic cigarettes and electronic smoking devices.
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.
This is why it took as long as it did for the negative health effects of cigarettes to be widely recognized. There is abundant evidence that e-cigarettes can help some individuals to quit smoking, so they should be more widely recommended as smoking cessation aids. Vaping and smoking share similar negative effects on the body, such as damage to the lungs and increased cancer risk.
The Policy Scan Project, by the Institute for Global Tobacco Control (at Johns Hopkins University) tracks and reports regulatory approaches to e-cigarettes around the world. In 2012 and 2013 there was a flurry of tobacco company investment in e-cigarettes, both in the United Kingdom (UK) and in the United States (US), a trend which continued in subsequent years. In 2018, 8% of Pierce County 12th graders said they had smoked a cigarette in the past 30 days. NSW Health acknowledges the people of the many traditional countries and language groups of New South Wales.
We would argue that further studies with chronic administration of low doses of nicotine are required to clearly evaluate its impact on carcinogenicity. In this line, a study compared the acute impact of CS vs. e-cigarette vaping with equivalent nicotine content in healthy smokers and non-smokers. Both increased markers of oxidative stress and decreased NO bioavailability, flow-mediated dilation, and vitamin E levels showing no significant differences between tobacco and e-cigarette exposure (reviewed in [20]). Inasmuch, short-term e-cigarette use in healthy smokers resulted in marked impairment of endothelial function and an increase in arterial stiffness (reviewed in [20]). Similar effects on endothelial dysfunction and arterial stiffness were found in animals when they were exposed to e-cigarette vapor either for several days or chronically (reviewed in [20]).
Currently, e-cigarettes are not mentioned in the Illinois Smoke-free Illinois Act, which prohibits smoking in virtually all public places and workplaces, but some local ordinances do include e-cigarettes. E-cigarette aerosol is not harmless; it can contain harmful and potentially harmful substances, including nicotine and cancer-causing chemicals. While e-cigarettes typically have fewer chemicals than regular cigarettes, researchers found e-cigarettes present their own unique health risks and can increase the odds of chronic cough, phlegm, bronchitis, and asthma. Some cigarette smokers have replaced traditional smoking with electronic cigarettes (e-cigarettes) or vaping, thinking it is not as dangerous. There are significant negative health effects from smoking cigarettes such as cancer, chronic obstructive pulmonary disease (COPD), heart disease, birth defects, and other health problems relating to nearly every organ of the body.
This was especially the case for people aged 14 to 17 (74%) and 18 to 24 (68%). The 2022–2023 NDSHS was conducted before these restrictions were put into place. At the time, in most jurisdictions, it was legal for adults to purchase e‑cigarettes that did not contain nicotine from a broad range of retail settings, including those used to purchase tobacco products. Prior to 2024, adults could also import nicotine e‑cigarettes with a prescription via the personal importation scheme. The first study found that vaping can worsen several heart disease risk factors at levels equal to tobacco cigarettes, while the second found that e-cigarettes decrease blood flow in the heart even more than tobacco cigarettes. However, e-cigarettes still pose health risks, even without nicotine.
Aug. 9, 2023, News Staff — New CDC data suggest that e-cigarette use is becoming more popular among young adults, even as their use of tobacco decreases. Freebase nicotine is nicotine that has been dissolved in a liquid mixture, typically propylene glycol and/or vegetable glycerin, and other chemicals such as flavouring ingredients. E-cigarettes contain nicotine and lithium batteries, making them hazardous waste.
An assessment from the agency, issued in 2008, references only a couple of studies that cover inhalation exposures—all with laboratory animals rather than people. The minimum age to purchase e-cigarettes and other tobacco products has also been raised to 21. A bill was also introduced in 2022 to raise the minimum age to purchase tobacco products and vapes from 19 to 21, but it was vetoed by Governor Mike Dunleavy.
EBook files are now available for a large number of reports on the NAP.edu website. If an eBook is available, you'll see the option to purchase it on the book page. An uncorrected copy, or prepublication, is an uncorrected proof of the book. We publish prepublications to facilitate timely access to the committee's findings. As an example, NIDA point to the practice of "dripping." This involves inhaling solutions dripped directly onto the heater coil "to produce a stronger throat hit." The specific risks of these practices are still unclear.
Even liquid nicotine spilled on the skin can be poisonous within minutes. A standard vape kit is usually an electronic cigarette - this usually consists of a battery and tank that allows you to fill it with e-liquid. But you can get many types of vapes, such as pod mods, sub-ohm kits, cigalikes, and many more. We have a wide range of vape kits available, whether you’re looking for a refillable pod vape, a heated tobacco product or a prefilled pod kit.
Some public health experts believe that e-cigarettes are an essential alternative to smoking tobacco that can help smokers quit. Others argue that e-cigarettes could be a route into nicotine addiction and point out that their long-term safety has not yet been proven. There are also those that believe that e-cigarettes may offer public health benefits but that e-cigarettes should be regulated, particularly when it comes to the marketing of such products.
A great example of this is the Riot Connex Pod Kit which uses magnets to attach replaceable cartridge-like flaovured pods to the batter. You can also get refillable pod mod kits, which use pods with built-in coils but require filling with your e-liquid. These can also appeal to beginners who like to experiment with different flavours but wish to keep the set-up as minimal as possible.
While there appears to be some consensus that vaping may be less harmful to health than tobacco cigarette smoking, the dangers of e-cigarettes remain unclear. The range of e-liquid flavours available to consumers is extensive and is used to attract both current smokers and new e-cigarette users, which is a growing public health concern [6]. In fact, over 5 million middle- and high-school students were current users of e-cigarettes in 2019 [75], and appealing flavours have been identified as the primary reason for e-cigarette consumption in 81% of young users [76]. Since 2016, the FDA regulates the flavours used in the e-cigarette market and has recently published an enforcement policy on unauthorised flavours, including fruit and mint flavours, which are more appealing to young users [77].
There is no single test for EVALI; it’s what is known as a "diagnosis of exclusion," which means that a doctor will conduct tests to rule out other potential diseases and conditions. The primary risk factor for EVALI is current or previous use of a vaping device. They can look like cigarettes, cigars, pipes, pens, USB flash drives, or may be in other forms. We fund research that explores how risk factors such as smoking, poor nutrition, and lack of physical activity can affect the development of cancer. For instance, 68 people died in an outbreak of vaping-related illness (EVALI) in 2019 and 2020. Links to E-Cigarette Resources Links other websites, reports educational materials, toolkits and more information on e-cigarettes.
In December 2019, Congress raised the minimum age to buy tobacco products, including e-cigarettes, from 18 to 21. Because of the popularity of certain flavored e-cigarette products among children, FDA stated in January 2020 that it would prioritize enforcement actions against the manufacture and sale of most flavors in cartridge-based e-cigarettes. In April 2020, FDA extended from May to September 2020 the deadline for manufacturers to apply for premarket authorization, a process that includes the scientific evaluation of risks and benefits of e-cigarettes for the U.S. population. NCI supports research to understand the potential impact of ENDS use on both individual and population health, as it relates to cancer control and prevention.
Krishnan-Sarin points to progress that has been made—finally—in recent years to reduce regular cigarette smoking rates among young adults. In her opinion, the significant decline is due to the success of large-scale public health campaigns and a general awareness among youth that cigarettes are harmful to health. The liquid they contain also has many monikers—it might be called e-juice, e-liquid, cartridges, pods, or oil.
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.
Nationally, more than 8 of every 10 youth, aged years who use e-cigarettes said they use flavored e-cigarettes. More than 9 of every 10 young adult e-cigarette users said they use e-cigarettes flavored to taste like menthol, alcohol, candy, fruit, chocolate, or other sweets. E-cigarettes and vaping devices are not covered by federal law restricting cigarette advertising. Like other e-cigarettes, these are battery-powered device that heats a nicotine liquid to produce an aerosol that is inhaled.
Njoy’s products accounted for less than 3% of U.S. e-cigarette sales in the past year, according to retail data from Nielsen. Vuse, owned by Reynolds American, and Juul control about 60% of the market, while hundreds of disposable brands account for the rest. The market share of disposable e-cigarette products increased from 52.0% to 57.8% between 2022 and 2023. Among disposable e-cigarette products, those with flavors other than tobacco accounted for 94.7% of the market in 2023. Research indicates that e-cigarettes may emit harmful substances, which means there could be health risks to the user and others through secondhand exposure. The Texas Tobacco Quitline offers free, confidential, and convenient cessation services to Texas residents ages 13 and older.
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.
I can go for six months at a time without catching a nasty, lingering cough. My clothing doesn’t reek of smoke all of the time and my car actually smells nice. So, though they are far from perfect, I am enjoying the changes that not smoking cigarettes has brought to my life. "Since there is no safe tobacco product, eventual abstinence from all tobacco products is the end goal," says Dr. Hyland, who is senior author on the new work. Adults in the U.S. who used e-cigarettes daily and also smoked combustible cigarettes were more likely to quit smoking than those who smoked but used e-cigarettes less frequently. Justice announced the task force that they say will address the illegal domestic distribution and sale of electronic cigarettes.
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].
most famous electronic cigarette factory-made cigarettes are equipped with a filter; those who roll their own can buy them separately. Filters can reduce some substances from smoke but do not make cigarettes any safer to smoke. A recipe-specified combination of brightleaf, burley-leaf, and oriental-leaf tobacco is mixed with various additives to improve its flavors. Most commercially available cigarettes today contain tobacco that is treated with sugar to counter the harshness of the smoke. At the start of the 20th century, the per capita annual consumption in the U.S. was 54 cigarettes (with fewer than 0.5% of the population smoking more than 100 cigarettes per year), and consumption there peaked at 4,259 per capita in 1965. The authors wish to thank all adolescents and schools that participated in the SHP study in 2017, and the SHP study coordinators from the Finnish Institute for Health and Welfare who prepared the initial data and provided practical support with it.
I would sit in freezing weather and torrential downpours so that people like you could enjoy your meals without the offensive and unhealthy fumes of my cigarettes. Reynolds Vapor Co.’s top-selling Vuse electronic cigarette slipped again in the latest report, this time below the 40% threshold it had been above since September. "In many countries and regions, nicotine pouches fall outside of existing tobacco control laws because they do not contain tobacco.
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.
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.
So I must ask that you not make them about you and respectfully let me and my vape alone. I can be conscious not to blow my vapor in your direction, if you will be conscious not to send your judgment and complaints in mine. Dr Sonu Goel, a distinguished public health expert and chairperson of the Tobacco Control Section explained that e-cigarettes, also known as Electronic Nicotine Delivery Systems (ENDS), vaporise a nicotine solution instead of burning tobacco leaves.
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.
The Centers for Disease Control and Prevention (CDC) report that vaping nicotine can permanently affect brain development in people under the age of 25. The researchers concluded that vaping with and without nicotine disrupts typical lung function in otherwise healthy people. The researchers reported a number of adverse effects on both types of cells, including toxicity, oxidation, and inflammation. However, these results aren’t necessarily generalizable to vaping in real life. A 2019 study assessed data from a nationwide survey of nearly 450,000 participants and found no significant association between e-cigarette use and heart disease. The authors also described moderate evidence suggesting that taking a puff from an e-cigarette increases blood pressure.
Most modern cigarettes are filtered, although this does not make the smoke inhaled from them contain fewer carcinogens and harmful chemicals. Nicotine, the psychoactive drug in tobacco, makes cigarettes highly addictive. About half of cigarette smokers die of tobacco-related disease and lose on average 14 years of life.
Some of the research for Tobacco Tactics was funded by Cancer Research UK Limited and Bloomberg Philanthropies. This work has previously received funding from The New Venture Fund, Smokefree South West, and the Economic and Social Research Council (ESRC) Knowledge Exchange Opportunities scheme. These funders have had no input into the research reported on this website or its conclusions. They are not responsible for its content or publication, nor do they necessarily endorse it.
According to the 2023 National Youth Tobacco Survey, more than 2 million teens reported vaping nicotine, and there was an increase in current overall tobacco product use among middle school students (4.5% to 6.6%) and multiple tobacco product use (1.5% to 2.5%). They are not technically categorized as smokeless tobacco, so the Food and Drug Administration (FDA) does not regulate them as strictly as smoked tobacco products or combustible tobacco. Without long-term data, we cannot be certain if or how reduced exposure will prevent harm to one’s health. In Canada, most of the provinces require smokers to be 19 years of age to purchase cigarettes (except for Quebec and the prairie provinces, where the age is 18). However, the minimum age only concerns the purchase of tobacco, not use. Alberta, however, does have a law which prohibits the possession or use of tobacco products by all persons under 18, punishable by a $100 fine.
Many thousands of people in the UK have already stopped smoking with the help of an e-cigarette. An e-cigarette is a device that allows you to inhale nicotine in a vapour rather than smoke. E-cigarettes refers to the device and vaping is the use of the device.
In general, most of the cytokines detected in BALF were significantly increased in WT mice exposed to PG with nicotine compared to PG alone or air control [42]. Some of these effects were found to be through nicotine activation of NF-κB signalling albeit in females but not in males. In addition, PG with nicotine caused increased macrophage and CD4+/CD8+ T-lymphocytes cell counts in BALF compared to air control, but these effects were ameliorated when animals were sub-chronically exposed to PG alone [42]. Researchers know more about the long-term effects of smoking than those of vaping. However, vaping products contain a great deal fewer harmful chemicals than cigarettes and can be an effective tool in quitting smoking altogether.
The SKE Crystal Bar has an auto-shutoff that powers it down after 15 minutes, preventing it from overheating while idle. It also shuts down in response to a short circuit so that wiring or battery issues won't cause it to ignite. And its reverse polarity protection keeps the device from being damaged if the battery is improperly installed (though this shouldn't be an issue since it's a pre-assembled vape). We appreciate the elegant design of the SKE Crystal Bar, and it's got a reputation for delivering rich, long-lasting flavor.
Steer clear of unregulated mods unless you have lots of experience vaping and a decent knowledge of electronics. Like disposable vapes, these devices don't allow modification to the battery and heating element. The difference is that they're rechargeable and refillable, letting you swap in a fresh pod or cartridge of vape juice when the old one runs out.
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.
In response to this issue, the PACT Act Amendment prohibits sellers from using the U.S. Post Office to ship e-cigarettes, vapes, flavored and smokeless tobacco products. The PACT Act applies to all shipments in interstate commerce (15 U.S.C. § 376) as well as to all delivery sales. Some people who smoke choose to use both cigarettes and e-cigarettes at the same time on an ongoing basis, whether they are trying to quit or not.
A 2016 study found that people who use or have used e-cigarettes are less likely to stop smoking altogether. Flavors vary widely, from "traditional" and menthol to watermelon and "lava flow." Some e-cigarettes taste like traditional cigarettes and even mimic the tastes of specific brands. When the user sucks on the mouthpiece, the heating element vaporizes the solution, which the person then "vapes," or inhales. The nicotine content of the liquid can range from "very high" to zero. Refills come in flavors such as cool cucumber, mango, and mint, which may seem natural and harmless, but a single JUUL refill contains as much nicotine as a pack of 20 cigarettes. To inform this work and evaluate the effectiveness of policy, the CDC Foundation is collecting and analyzing information about e-cigarette sales, teen e-cigarette use, and teens’ attitudes about the epidemic.
The availability of "vape wear," such as backpacks and hoodies, also allow the user to vape while concealing the product. The study showed that the e-liquids of certain cig-a-like brands contain high levels of nickel and chromium, which may come from the nichrome heating coils of the vaporizing device. Cig-a-likes may also contain low levels of cadmium, a toxic metal also found in cigarette smoke that can cause breathing problems and disease.11 More research is needed on the health consequences of repeated exposure to these chemicals.
Next, we examined the e-cigarette emissions of flavouring compounds, together with acetic acid and propionic acid, as listed by the U.S. These compounds were not analysed in cigarette smoke because the Ky1R6F cigarette used in the study is an unflavoured US-blended cigarette and validated analytical methods for these compounds were not available. From the studied carbonyls, only acetaldehyde, acrolein and formaldehyde are included in the nine WHO TobReg priority smoke toxicants55. Relative to cigarette smoke, their percentage of reduction in the e-cigarette emissions was ≥ 98.8%. Liquid refills are sold in quantities of 10 mL to more than 30 mL (about two to six teaspoons) in a variety of nicotine strengths. The products come in flavors with attractive scents and inviting packaging.
Of note, the abstinence rate found in the nicotine-replacement group was lower than what is usually expected with this therapy. Nevertheless, the incidence of throat and mouth irritation was higher in the e-cigarette group than in the nicotine-replacement group (65.3% vs. 51.2%, respectively). Also, the participant adherence to the treatment after 1-year abstinence was significantly higher in the e-cigarette group (80%) than in nicotine-replacement products group (9%) [100]. These data overall indicate that the harmful effects of nicotine should not be underestimated. Despite the established regulations, some inaccuracies in nicotine content labelling remain in different brands of e-liquids.
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.
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.
Where e-cigarette flavor restrictions had been in effect for at least a year, sales of cigarette brands favored by adults went up by 10%, while sales of cigarette brands that disproportionately attract underage smokers saw a 20% bump. During the study period, hundreds of localities and seven states restricted or prohibited flavored e-cigarette sales. While these policies did reduce per-capita vape sales, they also substantially boosted cigarette sales. To date, there is no state excise or special tax placed on e-cigarettes. In vaping liquids, nicotine and/or flavouring ingredients are dissolved in a liquid mixture.
Nonetheless, adults who smoke who switch to using e-cigarettes expose themselves to potentially serious ongoing health risks. If they are unable to quit e-cigarettes on their own, they should seek help from a health care professional or quitline. Individuals who are not yet able to stop using e-cigarettes should be strongly discouraged from simultaneous, or "dual," use of any combustible tobacco products, including cigarettes. Continuing to smoke exposes the individual to enormous harms, irrespective of whether the individual is using e-cigarettes part of the time. All individuals should also be strongly counseled to not revert to smoking. Some look like a regular cigarette, but many resemble everyday products like pens, USB drives, highlighting markers, or colorful toy-like items.
Refillable pod mods use replaceable pods that contain either a built-in or removable coil. They are designed to be easier to use than vape pens as they adopt a secure magnetic connection between the pod and battery instead of a tank with a screw mechanism. They have few features and are compact, appealing to those new to the world of vaping and those wanting to upgrade to something simple. The term " vape pen" normally refers to a vape kit consisting of a refillable tank and a rechargeable battery; they are often slim and shaped like a pen, but not always!
But with its plant-derived, additive-free formula and rigorous testing, this device from Tribe Tokes is one of the safest vape products for CBD lovers. Like the previous entries on our list, the BC5000 uses e-liquid that's free of diacetyl and vitamin E acetate. This is one of the safest vapes for quitting smoking while still enjoying the effects of nicotine.
With so many adults kicking the cigarette smoking habit, Altria was looking for ways to sustain its financial stability. Outside of addiction, nicotine can also have other long-term and permanent effects on developing brains. Because vaping has only recently gained popularity, we don’t yet have the data to tell us all its health effects. E-cigarettes are also called e-cigs, vape pens, vapes, mods, and other terms.
To our knowledge, no studies in Europe have examined susceptibility to e-cigarette (S-EC) use and snus use (S-SN). Glyoxal and methylglyoxal are formed by thermal degradation or oxidation of PG and VG87. Glyoxal is considered mutagenic, while the related compound methylglyoxal has been identified as a metabolite during glycolysis and is thus naturally present in the body. Methylglyoxal is also present in foods and drinks such as honey and coffee.
E-cigarettes can help people stop smoking and are an effective stop smoking tool. There’s no safe level of smoking, so it is important to stop tobacco-use completely. You may have heard different things in the media about the side effects of vaping. This page gives an overview of what we know so far about how vaping can affect your health. Our information relates to legal e-cigarettes – ones that are registered with the UK Medicines and Healthcare products Regulatory Authority (MHRA).
However, many young users report they began using e-cigarettes because of the flavors and, according to CDC, do not realize they are inhaling nicotine. E-cigarettes are relatively new, and their long-term effects are not yet known. Although they may potentially be less harmful substitutes for traditional cigarettes, risks of addiction, injury, and death from e-cigarettes are becoming more apparent. Wehrli noted that they observed these striking changes after the participants (all of whom never smoked previously) used an e-cigarette a single time.
The survey also found that Minnesota youth are ill-informed about the health risks of e-cigarettes with 76.1% of 11th graders saying there is either no, slight, or a moderate risk to using e-cigarettes. 11th grade students responding to the student survey said that the top ways they got e-cigarettes included getting products from friends (72.3%), getting products at a vape shop (14.0%), and on the Internet (9.6%). Among 8th grade students, e-cigarette use nearly doubled from 2016 to 2019, and one in four 11th graders now use e-cigarettes. Students in all grades surveyed now use e-cigarettes and vapes at five times the rate of conventional cigarettes. In Australia, during the survey period, it was not legal to obtain e‑cigarettes containing nicotine without a prescription (TGA 2020).
Despite the general decline in smoking, it remains more prevalent among youth with lower socio-economic position (SEP). This has been observed with family-level SEP indicators, including parental education [3, 4] and family affluence [5]as well as individual-level indicators of adulthood SEP such as academic performance [4, 5] and vocational education [6–8]. For smokeless tobacco (snus) use and electronic cigarette liquid cigarette (e-cigarette) use, the associations with SEP have been mixed [7, 9, 10]. The scientists investigated the effect of the e-liquids on cells called endothelial cells that line the interior of blood vessels.
"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.
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.
Children 13–15-years old are using e-cigarettes at rates higher than adults in all WHO regions. In Canada, the rates of e-cigarette use among 16–19-year-olds has doubled between 2017–2022, and in England (the United Kingdom) the number of young users has tripled in the past three years. The Alabama Tobacco Quitline is a free telephone and online coaching service for any Alabamian who is ready to quit tobacco or e-cigarette use. A PDF is a digital representation of the print book, so while it can be loaded into most e-reader programs, it doesn't allow for resizable text or advanced, interactive functionality. The eBook is optimized for e-reader devices and apps, which means that it offers a much better digital reading experience than a PDF, including resizable text and interactive features (when available).
Nicotine-free e-juice contains a number of potentially toxic chemicals, such as base liquids and flavoring agents. However, based on the experience with cigarettes, similar adverse health effects, including COPD, heart disease, and cancer, can be expected. Finally, a 2017 review of the cardiovascular effects of vaping indicates that e-cigarettes may pose certain risks to the heart and circulatory system, notably for people who already have some form of heart disease.
With millions of teens and young adults using e-cigarettes, a new generation could become addicted to nicotine and face other health risks. For some adult smokers, e-cigarettes may offer a less harmful substitute for traditional cigarettes. However, long-term effects on users, second-hand exposure, and environmental effects are not yet fully known. The e-liquid typically contains humectants and flavourings, with or without nicotine; once vapourised by the atomiser, the aerosol (vapour) provides a sensation similar to tobacco smoking, but purportedly without harmful effects [3].
The FDA lists 93 harmful or potentially harmful chemicals found in regular cigarettes, and the National Cancer Institute (NCI) describes cigarettes as having more than 7,000 chemicals in them. Because e-cigarettes contain fewer chemicals the industry has presented them as a healthier alternative to regular cigarettes. But vape liquids can still contain nicotine, a highly addictive drug.
Jabba and colleagues, including co-senior author Sven Eric Jordt, Ph.D., analyzed an e-cigarette product sold under the brand name Spree Bar, which comes in at least nine flavors and is listed as containing 5 percent 6-methyl nicotine. Study results showed the actual amount of the chemical was about 88% less than labeled. The e-cigarettes also included an artificial sweetener that is up to 13,000 times sweeter than table sugar, and an artificial coolant that mimics menthol’s effects. Talk to your patients, including youth and young adults, about the dangers of tobacco use.
Electronic cigarettes, or e-cigarettes, include e-pens, e-pipes, e-hookah, and e-cigars are known collectively as ENDS— electronic nicotine delivery systems. According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol containing nicotine or other substances. Other studies show that newer e-cigarettes deliver higher doses of nicotine more efficiently, which could be a reason why these findings were observed. The authors acknowledge that more frequent use of e-cigarettes may also reflect greater determination to quit smoking combustible cigarettes and that their study did not evaluate risks of youth e-cigarette use. Over the next few years, the optimism over e-cigarettes waned as their popularity skyrocketed. Juul’s sales increased over 600 percent each year to become the best selling device on the market while I inhaled an atmosphere’s worth of vanilla vapor into my lungs.
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.
A Yale study in 2019 found that, among students at three Connecticut public schools, those who used e-cigarettes were more likely to smoke regular cigarettes in the future. Most e-cigarettes have a battery, a heating element, and place to hold a liquid (such as a cartridge or pod). The e-liquid usually contains nicotine, flavorings, and other chemicals. As the user draws on the device, the battery heats the e-liquid to produce aerosol (not water vapor).
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.
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.
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.
New 'pod-mod' style vape products are similar in shape and size to JUUL
In addition to these laws, e-cigarettes are prohibited from being used in child care facilities, and people purchasing tobacco products have to pay a 15 percent tax. While not all the effects of smoking are immediate, the complications and damage can last for years. The good news is that quitting smoking can reduce many risk factors for the conditions and diseases below. For a long time, e-cigarettes and other electronic aerosolizers weren’t regulated by the Food and Drug Administration (FDA). They only came under the purview of the FDA in 2016, after they had been on the market for nearly a decade.
This can be the result of an injury — such as a gunshot or knife wound — or when air blisters on the top of the lungs rupture and create tiny tears. Single-use, disposable e-cigarettes cost anywhere from $1 to $15 each or more. Rechargeable starter kits with multiple pods can cost anywhere from $25 to $150 or more. They may also have added flavors and contain a variety of other chemicals. 15 State of California Environmental Protection Agency Office of Environmental Health Hazard Assessment Safe Drinking Water and Toxic Enforcement Act of 1986. (2013).Chemicals known to the State of California to cause cancer or reproductive toxicity.
Vaping has exploded into a national crisis, and tobacco companies are helping to fuel it by targeting kids with flavors such as gummy bear and cotton candy. E-cigarette companies have promoted unsubstantiated health claims about their products as healthier than traditional cigarettes, when, in fact, e-cigarettes are uniquely dangerous for kids due to nicotine’s impact on their developing brains. Since being introduced to the U.S. market in 2007, e-cigarette use among youth has increased to epidemic levels (Surgeon General's Advisory on E-cigarette Use Among Youth, 2018). The availability of flavored e-cigarettes is one of the most commonly cited reasons for e-cigarette use among youth (Tsai et al., 2018). Given the importance of flavors contributing to use of e-cigarettes among youth, these data briefs build on this previously published article, providing an update on trends in unit sales of e-cigarettes in the U.S. by product and flavor type.
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.
That said, there are some concerns about how repeatedly inhaling e-cigarette aerosol over an extended period of time could affect bystanders’ long-term lung function and risk of allergic reactions. "I applaud Governor Cuomo for taking action to prevent exposure to secondhand e-cigarette emissions in public places for all New Yorkers." ALBANY, NY (November 22, 2017) - The New York State Department of Health is reminding all New Yorkers that beginning today the use of electronic cigarettes is banned indoors everywhere that smoking tobacco products are prohibited in New York. Despite these uncertainties, the use of e-cigarettes has skyrocketed since their introduction about a decade ago, particularly among young people. The Food and Drug Administration estimates that more than 3.5 million middle and high school students used e-cigarettes in 2018, though sales to minors are prohibited. In 2018, the FDA restricted the sale of flavored e-cigarettes to adult-only venues, with the exception of tobacco, menthol and mint flavors, which can be sold wherever traditional cigarettes are sold.