Several companies including Canada’s Eagle Energy Vapor are selling caffeine-based e-cigarettes instead of containing nicotine. As of 2018, 95% of e-cigarette devices were made in China, mainly in Shenzhen. Since combustible cigarettes are relatively inexpensive in China a lower price may not be large factor in marketing vaping products over there. Fire Administration conclude that electronic cigarettes have been combusting and injuring people and surrounding areas. The composition of a cigarette is the cause of this, as the cartridges that are meant to contain the liquid mixture are in such close proximity to the battery. Fire Administration supports this, stating that, “Unlike mobile phones, some e-cigarette lithium-ion batteries within e-cigarettes offer no protection to stop the coil overheating” .
Given that most smokers who switch to e-cigarettes begin with either tobacco or menthol flavors,10 other flavor categories that attract youths are likely unnecessary. Tellingly, only 1 individual in the study by McKelvey and colleagues2 reported that their first pod was tobacco flavored. JUUL recently began selling lower nicotine concentrations for 2 flavors , but not for their other fruit and dessert flavors that may directly appeal to adolescents. If left unaddressed, the combination of appealing flavors and high nicotine concentrations in pod mods could undermine tobacco control efforts. คอยล์ reported here revealed that the new generation of pod designs and formulations of the popular pod liquids do not necessarily provide a decrease in toxic metal concentrations in aerosols compared to previous designs. All the aerosol metals detected may represent health risks for ENDS users; however, there is limited evidence for specific dose/response disease relations.
What is the benefit of vaping?
We conducted power analyses prior to the start of the studies to identify the number of animals per group to use, based on our past studies of inflammatory changes induced by inhalants, infections and asthma. We set the target number of mice at that time, such that these studies would be powered to detect a 25% change in cytokine expression. We did go through and reviewed all of the data with our biostatisticians, we came to the conclusion that it would not be statistically appropriate to run more mice to increase the n when our primary outcome remains the same.
Between 2010 and 2014, e-cigarettes were second only to cigarettes as the top advertised product in magazines. As cigarette companies have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction. This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry. There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some stating to want to cooperate in “harm reduction”. E-cigarette advertising for using e-cigarettes as a quitting tool have been seen in the US, UK, and China, which have not been supported by regulatory bodies. In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013.
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However, we agree that the neuroinflammation is of great interest and is highly likely to impact behavior and mood. Further studies are needed to best assess potential psychological and behavioral changes. We believe this work is important to share such that dedicated behavioral science labs can undertake these important studies. We have added further discussion regarding the potential consequences of inflammation in each of the organs (pages 13-19), with an emphasis on the effects of neuroinflammation on behavior and psychology. Thank you for the detailed review of this original research manuscript. We appreciate the reviewer identifying it as “of high interest and timely.” Of note, part of working in a new field such as e-cigarettes involves assessing for and detecting signals of potential clinical relevance.