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The Evolution of Smoking: All You Should Know about E-Cigarettes. By Our Student Pharmacist, Malcolm White.

The war on tobacco started in 1964 with the Surgeon General landmark report titled, Nicotine Effects on Smoking and Health.

Following the report, anti-tobacco campaigns on quitting strategies and legislation helped decrease the use and reduce the appeal of tobacco products. One would say that the war on tobacco was successful. However, in the past few years the use of tobacco has increased. This increase has contributed to the use of electronic nicotine delivery system (ENDS).

ENDS is an e-cigarette, also known as vape pen, e-cigars, vaping devices, mod systems, or pod systems. ENDS products contain a flavor solution that also often contain nicotine to produce an aerosolized mixture. These devices are very appealing and popular among youth and young adults.

Are e-cigarettes safe?

The safety of e-cigarettes is unknown at this point. There are currently multiple studies being conducted to answer this question.

So far, this is what we know about vape products.

First, ENDS do not contain many of the carcinogens found in conventional tobacco products. However, they do contain many chemicals that appear to be equally or even more damaging. These chemicals include volatile organic compounds (VOCs) which can lead to eye, nose, throat irritation, headaches, as well as nausea. There have been a few reports that believe e-cigarettes cause damage to the liver, kidney, and nervous system. Some reports show that e-cigarettes produce formaldehyde, which is a cancer causing substance. There is even evidence that shows flavoring chemicals are linked to serious lung disease.

What long term complications are associated with e-cigarettes?

E-cigarettes were first approved in the United States in 2008. In 2016, the Center for Tobacco Products was given authority to regulate e-cigarettes as tobacco products. Based on this short timeline, the product has not been on the market long enough to observe the long term effects associated with e-cigarettes. Some recent reports have shown e-cigarettes to cause serious lung disease in some people.

Do e-cigarettes deliver a consistent nicotine concentration? 

No, recent findings show that e-cigarettes can deliver high concentrations of nicotine. E-cigarettes which provide inconsistent levels of nicotine delivery pose health concerns for the user. Increasingly, there have been reports of nicotine overdose in users.

Can vape help with quitting tobacco attempts?

A major statement that is used to market e-cigarettes is the thought that they will help smokers quit. There are studies that showed e-cigarettes decrease nicotine consumption while other studies showed little to no evidence to support they assisted with helping individuals quit.

When reviewing the studies on this statement, many studies were flawed because of two factors.

First, the studies enrolled patients who had no intention of quitting.

Second, the e-cigarettes could not be counted on to provide consistent levels of nicotine.

These two factors, therefore, show that there have not been any appropriate studies performed that prove e-cigarettes help with smoking cessation. The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to recommend ENDS for smoking cessation.

My interpretation of the data is that ENDS could potentially, in the future, be used as a device to help smokers quit who are highly motivated to quit.

Worku., D. & Worku, E. report that, in motivated smokers with clinician support, e-cigarettes can provide superior outcomes than traditional nicotine replacement therapy (NRT), but these results need further confirmation.

Currently, I would still recommend smokers use conventional resources (NRT) when it comes to helping them quit.

Smoking Cessation

Clinically, behavior therapy, as well as NRT, is recommended to help an individual stop smoking.

An individual looking to quit smoking should seek out a motivational or coaching program dedicated to helping individuals quit. If one can not be found, regularly scheduled therapy visits can suffice as a replacement. Be wary of programs that charge high fees. Smoking Cessation services are usually free or low cost.

The next step would be to talk to your doctor about prescription or over-the-counter nicotine replacement therapy. NRT products range from patches, to gums, to inhalers.

Both therapies should be used together to help increase your chance of successfully quitting.

Smoking Cessation Resources:

CDC Free quit help:

1-800-QUIT-NOW or 1-800-787-8669

CDC How to Quit Smoking Campaign – offers quit plans, tips from former smokers, and quitSTART app


Smokefree.gov’s Make Your Quit Plan


American Cancer Society’s Great American Smokeout


NiAnon by Recovery.org


QuitLogix – Offers coaching and an online support community.


NSW Cancer institute and Quitline Team

Quit Kit and a diary to help you quit smoking



Nicole van Hoey. Nicotine addiction and the evolution of tobacco products: How can pharmacists counter new trends? America’s Pharmacist. Published April 2, 2020 Accessed August 11, 2020

E-Cigarettes. American Academy of Pediatrics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages/Electronic-Nicotine-Delivery-Systems.aspx. Published … Accessed August 11, 2020

The American Cancer Society Medical and Editorial Team. What Do We Know About E-cigarettes? American Cancer Society. https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html.Published November 19, 2019 Accessed August 11, 2020

Jenssen BP, Wilson KM. What is new in electronic-cigarettes research?. Curr Opin Pediatr. 2019;31(2):262-266. doi:10.1097/MOP.0000000000000741

Bhalerao, A., Sivandzade, F., Archie, S.R. et al. Public Health Policies on E-Cigarettes. Curr Cardiol Rep 21, 111(2019). https://doi-org.proxy.lib.ohio-state.edu/10.1007/s11886-019-1204-y 

Farsalinos K. Electronic cigarettes: an aid in smoking cessation, or a new health hazard?. Ther Adv Respir Dis. 2018;12:1753465817744960. doi:10.1177/1753465817744960

Worku, D., & Worku, E. (2019). A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE Open Medicine. https://doi.org/10.1177/2050312119871405

Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions. U.S. Preventive Services Task Force Published June 02, 2020  Accessed. August 14, 2020


Picture References: 

E-Cigarette Dangers – 5 facts you need to know. Columbia Doctors Nurse Practitioner Group.https://www.columbianps.org/healthy-life-blog/e-cigarette-dangers-5-facts-you-need-to-know/. Published September 24, 2019 Accessed September 12, 2020 


Curr Opin Pediatr. Author manuscript; available in PMC 2020 Apr 1.Published in final edited form as:Curr Opin Pediatr. 2019 Apr; 31(2): 262–266.doi: 10.1097/MOP.0000000000000741

Components of the e cigarettes components:

Rom, O, Pecorelli, A, Giuseppe, Vet al. Are E-cigarettes a safe and good alternative to cigarette smoking. Ann N Y Acad Sci 2015; 1340: 65–74.


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