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I want to carry the stink and taste that won’t let me forget I’m damaging myself when I’m smoking. The way to quit isn’t through a device that made a nicotine hit easier, or fun. In other words, just because something is safe to eat doesn’t mean it’s safe to be inhaled. (Duh.) Vaping also seems to trigger potentially harmful immune responses in the lungs.
Youth vaping has declined from all-time highs in recent years, with about 10% of high schoolers reporting e-cigarette use last year. Vaping is not completely risk-free, but it poses a small fraction of the risk of smoking cigarettes. The aerosols generated by ENDS typically raise the concentration of particulate matter in indoor environments and contain nicotine and other potentially toxic substances. ENDS emissions therefore pose potential risks to both users and non-users. Accidental exposure of children to ENDS e-liquids pose serious risks as devices may leak or children may swallow the poisonous e-liquid.
Electronic nicotine delivery systems (ENDS), or e-cigarettes, are battery-powered devices used to vape a flavoured solution containing varying concentrations of nicotine, an addictive chemical found in tobacco products. Some people take up vaping – or inhaling vapor from electronic cigarettes – to avoid the health hazards of smoking cigarettes made with tobacco. But when it comes to your heart health, a pair of recent studies show e-cigarettes are just as dangerous – and possibly are even more dangerous – than traditional cigarettes. The long-term effects of smoking cigarettes are well-documented and include an increased risk of stroke, heart disease, and lung cancer.
E-cigarette waste is potentially a more serious environmental threat than cigarette butts since e-cigarettes introduce plastic, nicotine salts, heavy metals, lead, mercury, and flammable lithium-ion batteries into waterways, soil, and to wildlife. "Nicotine analogs are currently not subject to the FDA process and have not been studied for their health effects," Jabba said. This data brief dives deeper into rural youth tobacco use in Minnesota.
They produce a vapor that’s inhaled deep into the lungs, mimicking the feeling of smoking tobacco cigarettes. They are not yet regulated nor approved for smoking cessation by the U.S. Food and Drug Administration.The long-term health effects to users and bystanders are still unknown.
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.
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).
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.
Screen all patients, encourage them to quit, and refer patients to evidence-based services for help quitting. However, nicotine used in vaping liquids is often sourced and extracted from tobacco plants. More recently, products containing synthetic nicotine, which is created through chemical processes, have been made available in Canada.
Cumberland County piloted CATCH My Breath in 2022, and had teachers in the restorative justice classrooms of Howard Learning Academy Middle School and Pine Forest High School run the program. The pilot was enough of a success that the county is now training one person in every middle and high school in the district to implement the program on a needs-basis in restorative justice classrooms this school year. There were also participants in a "waitlist" group, who received neither text messages through the This is Quitting program nor the assessment-only follow-up messages. Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific publications (many of them can be found at /us). Scientific American maintains a strict policy of editorial independence in reporting developments in science to our readers.
The review authors conclude that further research could help untangle how vapers’ bodies develop disease. These types of studies, they say, promise to identify early indicators of—and ultimately treatments for—vaping-related disease. While some tout e-cigarettes as a solution to quitting conventional smoking, the truth about relative risks is complicated, says Crotty Alexander, who is a researcher in addition to providing patient care and teaching.
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.
E-cigarettes are not safe for youth, young adults, and pregnant women, and can be dangerous for adults who use tobacco products. The novel results for school-level factors indicate that prevention of nicotine use may be supported by facilitating nicotine-free schools through policies and programmes. This may address especially the peer selection processes, which have been observed both in school disengagement and smoking initiation [28, 29]. Further, it may influence the students’ descriptive and injunctive norms, which both predict smoking initiation among youth [27].
More research is needed to address the potential long-term adverse effects of vaping on vascular health, but he predicts that e-cigarettes are potentially much more hazardous than previously assumed. Earlier this year, for instance, his research group found that acute exposure to e-cigarettes causes vascular inflammation. One in four middle school and high school students in Minnesota had tried e-cigarettes (teens call it vaping or juuling). Half of high school seniors reported having tried e-cigarettes at least once. The growing popularity of e-cigarettes among Minnesota’s youth caused the first rise in overall tobacco use in over two decades.
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.
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].
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).
In e-cigarettes, tobacco combustion is replaced by e-liquid heating, leading some manufacturers to propose that e-cigarettes have less harmful respiratory effects than tobacco consumption. Other innovative features such as the adjustment of nicotine content and the choice of pleasant flavours have won over many users. Nevertheless, the safety of e-cigarette consumption and its potential as a smoking cessation method remain controversial due to limited evidence. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity. Numerous in vivo and in vitro studies have been performed to better understand the impact of these new inhalable compounds on human health.
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.
That’s about twice as many people as those who used other methods to quit smoking. Of people who used other methods, 91% kicked nicotine products altogether. People usually think vaping isn’t as bad as cigarette smoking, but the mist you breathe in still has nicotine and other harmful chemicals in it. Vaping isn’t safe and can cause health problems, including life-threatening lung injuries.
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.
While smoking can increase your risk of certain health conditions over years, like glaucoma, cancer, and issues with blood clotting, some of the bodily effects happen immediately. There's a lot that's still unknown about the harms of secondhand vaping, but research suggests that bystanders who breathe in the aerosol might be exposed to toxins. It's unclear how exposure to these toxins might impact health, but it's possible that repeated exposure could impact lung function in the long term.
Enter e-cigarettes, which were new, high-tech, and came with no proven health risks. There were no long-term studies yet, but common sense dictated that if you wanted to quit inhaling tobacco through smoking, the least you could do was switch to e-cigarettes. She added that there is also an "absence of studies" on the effects and dosage of nicotine replacement therapy, or NRT, for adolescents as a way to help them quit vaping. Nicotine replacement therapy is the family of medications used to help adults quit using nicotine, including over-the-counter patches, gums or lozenges or prescription inhalers or nasal sprays. California has some of the strictest regulations in the US, including a ban on the sale of flavored tobacco products to residents of any age.
There are also reports of lung illnesses and deaths related to inhalation of certain vaping oils into the lungs, which have no way to filter out toxic ingredients. You might be tempted to turn to electronic cigarettes (e-cigarettes, vape pens, and other nondisposable and disposable vaping devices) as a way to ease the transition from traditional cigarettes to not smoking at all. But is smoking e-cigarettes (also called vaping) better for you than using tobacco products? Michael Blaha, M.D., M.P.H., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, shares health information about vaping. Truth Initiative supports regulation that encourages the development of consistently safer nicotine delivery alternatives that allow smokers to quit tobacco altogether or switch completely to a much less harmful, well-regulated product.
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.
The new rules will allow FDA to review the safety of batteries and eventually take action to protect the public. "Diacetyl is a well-known harmful chemical, which, among other things, causes a lung disease called 'popcorn lung,'" says Erika Sward, assistant vice president for national advocacy at the American Lung Association. The Electronic Cigarette Company reserves the right to cancel any sales transaction based on its sole discretion where it reasonably believes the purchaser is purchasing products on behalf of a minor. More commonly known as e-cigs or vape kits, we stock a huge range of vaping hardware, from mouth to lung (MTL) to direct lung (DL). Our range of vape pods is ideal to use with nic salts and high-strength e-liquid.
All this evidence would suggest that e-cigarettes are potentially less harmful than conventional cigarettes (Fig. 2) [11, 14, 22, 24, 27,28,29]. Importantly, however, most of these studies have investigated only short-term effects [10, 14, 15, 22, 27,28,29, 31, 32], and the long-term effects of e-cigarette consumption on human health are still unclear and require further study. Vapes come in colorful, fun, and unique product designs, along with many flavors, all of which come together as part of the attraction for youth who believe that these products are not addictive and are safe to use. Many users believe vaping will reduce stress, anxiety, and depression.
If you think ENDS or other tobacco products are being sold to people who are underage, or you see another potential violation of the FD&C Act or FDA’s tobacco regulations, please report the potential tobacco product violation. Learn about public education efforts and resources that have been created to reach youth who are at higher risk of or more vulnerable to cigarette use and nicotine addiction. FDA created a toolkit, Resources for Professionals About Vaping & E-Cigarettes, for adults and professionals who work with youth. This FREE resource provides fast facts about youth vaping and e-cigarettes. Vaping exposes you to some of the same chemicals that cigarette smoking does. Vaping while pregnant can cause low birth weight, lung damage and brain damage in the developing fetus.
The most consistent predictors have been descriptive norms of parents’ and close friends’ smoking, indicating that addressing close network members might be the most effective in interventions [27]. In our study, parental smoking reported by adolescents increased all types of susceptibility when analysed independently. In the multivariate models, it did not have clear associations with S-SN and S-EC among girls.
Vape products are taxed at the sales tax rate rather than the tobacco or cigarette tax rate. While vape products are not covered by the Smoke-free Air Act, each business can prohibit the use of vape devices indoors, but this is not required by state law. Iowa law places several restrictions on youth access to e-cigarettes, including but not limited to, prohibiting the sale, distribution, possession, purchase and use of vapor products to anyone under the age of 21. There are health and safety concerns related to the use of vapor products.
He also highlighted the ban on e-cigarettes in India under the Prohibition of Electronic Cigarettes Act, 2019, aimed at preventing health risks and curbing their use among youth. These ingredients pose significant health risks, particularly to pregnant women, children, and adolescents, and leads to issues like impaired brain development and respiratory diseases, said Dr Goel. Cumberland County Schools is implementing a national vaping and nicotine prevention program in each of its middle and high schools to try and curb rates of youth vaping. Cigarettes pushed me back to shivering outside the bar where a nicotine habit belongs.
Collectively, these devices are known as electronic nicotine delivery systems. E-cigarette use is often referred to as "vaping" and the aerosol created from their use referred to as "vapor." E-cigarettes come in many colors, shapes, and sizes and can look like USB flash drives, pens, highlighters, or toys. The liquid in e-cigarettes is sometimes called e-juice, e-liquid, vape juice, or vape liquid.
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.
Middle and high school students are the largest users of these smoking replacements. Recent youth tobacco surveys found e-cigarette use had surpassed conventional cigarettes as the most commonly used tobacco product among youth. These surveys also revealed that many young people consider vaping to be safe and are not aware that e-cigarettes contain nicotine. It is easy for middle school and high school students to conceal their use of vaping devices because of their appearance as everyday objects.
Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website. The last reviewed date indicates when the evidence for this resource last underwent a comprehensive review. Reviewed by Kenneth Uy, a health coach and tobacco treatment specialist at Henry Ford Health. Patrick O’Connor, MD, Yale Medicine’s chief of general internal medicine, who has dedicated his career to researching opioid and alcohol drug abuse, points to similarities between epidemic cigarette use in the 1940s and 50s, and e-cigarette use now.
They observed, on average, a 34 percent reduction in the femoral artery’s dilation. These findings suggest that vaping can cause significant changes to the inner lining of blood vessels, said study lead author Alessandra Caporale, PhD, a post-doctoral researcher in the Laboratory for Structural, Physiologic, and Functional Imaging at Penn. In this study, the researchers examined the impact of an e-cigarette that contained propylene glycol and glycerol with tobacco flavoring, but no nicotine, which study participants took 16, three-second puffs from. To evaluate vascular reactivity, researchers constricted the vessels of the study participants’ thigh with a cuff and then measured how quickly the blood flowed after its release. Using a multi-parametric MRI procedure, researchers scanned the femoral artery and vein in the leg before and after each vaping episode to see how vascular function changed.
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.
This was a large increase from 2019, when only 11.3% of people had ever used e‑cigarettes, and 2.5% were currently using them (Figure 1). The proportion of people who used e‑cigarettes daily in 2022–2023 was 3.5%, rising from 1.1% in 2019. In smokers who smoke tobacco cigarettes, blood flow increased modestly after cigarette inhalation and then decreased with subsequent stress. However, with those who vaped, blood flow decreased after inhalation at rest and also after handgrip stress. Finally, lung health effects are not expected to be seen for 20 to 30 years.
And, our starter kits and disposable vape pens are a great, simple way to make the switch from smoking to vaping. We also have a wide selection of advanced kits for vapers who prefer high-powered cloud chasing e-cigs. Increasing consumer awareness of the environmental toxicity and dangers posed by discarding e-cigarette waste into landfills and encouraging vapers to quit are the best ways to protect the environment from tobacco product waste. Currently, there is no standardized way to recycle e-cigarettes in the U.S. Starting in 2019, the Drug Enforcement Agency (DEA) began accepting e-cigarette devices and cartridges during their annual National Prescription Take Back Day, although the DEA cannot accept devices containing lithium ion batteries.
If you think this is why your child vapes, talk to them about healthier ways to stay at a healthy weight or lose weight. Start by asking your child in a nonjudgmental, concerned way if they have tried vaping. Even if you don’t think your kids vape, talk about it with them anyway so they know it’s unhealthy. Vaping is the inhaling of an aerosol (mist) created by an electronic cigarette (e-cigarette). Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.
Based on the current literature, it seems that several factors have led to the success of e-cigarette use as a smoking cessation tool. First, some e-cigarette flavours positively affect smoking cessation outcomes among smokers [102]. Second, e-cigarettes have been described to improve smoking cessation rate only among highly-dependent smokers and not among conventional smokers, suggesting that the individual degree of nicotine dependence plays an important role in this process [97]. Third, the general belief of their relative harmfulness to consumers' health compared with conventional combustible tobacco [103]. And finally, the exposure to point-of-sale marketing of e-cigarette has also been identified to affect the smoking cessation success [96].
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).
Children and adults can develop nicotine poisoning from swallowing, breathing, or absorbing e-liquid through their skin or eyes. E-cigarette use can also result in serious injury due to defective batteries that have caused fires and explosions. Vaping and smoking both involve inhaling nicotine and other substances into the lungs. While cigarettes burn tobacco that produces smoke, e-cigarettes heat liquid to make an aerosol that often contains nicotine, various chemicals, heavy metals (nickel, tin, and lead) and small particles that can be inhaled deeply into the lungs.
While vaping might help you quit smoking, it probably won’t help you quit nicotine altogether. The CDC has identified vitamin E acetate as a chemical of concern among people with EVALI. Vitamin E acetate is a thickening agent often used in THC vaping products, and it was found in all lung fluid samples of EVALI patients examined by the CDC. Unlike traditional cigarettes, e-cigarettes are generally battery-operated and use a heating element to heat e-liquid from a cartridge (usually refillable), releasing a chemical-filled aerosol. Below are answers to common questions about e-cigarettes, including health consequences, risks of secondhand emissions, kids and e-cigarettes and FDA oversight. This is Quitting is tailored based on age (13-24 years old) and product usage to give teens and young adults appropriate recommendations about quitting.
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.
Rates of e-cigarette use among Cumberland students aren’t available, but across North Carolina, 21.4% of high school respondents to the state’s 2023 Youth Risk Behavior Survey said they currently vaped. The state’s rates are significantly higher than the national rates of 10% for high schoolers and 4.6% of middle schoolers, according to the National Youth Tobacco Survey. The combo could raise your odds for lung cancer even higher, new research warns. But now that I’ve gotten rid of the endless, all-day vaping, and a nicotine hit makes me stink like a dive bar ashtray, makes my mouth taste like dirt, and makes my friends recoil from my presence, I’ve got reasons to cut back.
There are hundreds of brands, and they're sometimes marketed as a way to get your nicotine fix without the danger of cigarettes. The Electronic Cigarette Company is one of the original online vape stores in the UK, founded in 2008. We stock a wide range of electronic cigarettes, vape starter kits, and vaping accessories from leading manufacturers such as Elf Bar, Lost Mary, SMOK, Aspire, Vaporesso, VOOPOO, Innokin, Double Drip, ElfLiq and Riot Squad. Many of those who vape were likely to report issues that kept them from being able to safely dispose of their used and empty e-cigarette products. More than half (57.8%) of those who had used e-cigarettes in the past month found it inconvenient to dispose of e-cigarette waste responsibly.
Upon the selection of the educational track, students may already have normative perceptions of smoking in vocational schools, such as understanding of smoking as an integral and expected practice in these schools and professions [8]. These perceptions may increase S-SM and other nicotine product use, also among students with better academic performance. Student network characteristics and their associations with smoking vary between schools [28].
Still, many people, including teens and young adults drawn to vaping, may not realize that, Bittoni said. Other popular brands, like Puff Bar, have received warnings from regulators about the sale of flavored devices as well. Following the Golden State, Washington had the second-lowest amount of youth vapers, at eight percent. In the Evergreen state, the legal age to purchase vapes is 21, and there is a ban on all flavored varieties. Last year, Alaska Senate President Gary Stevens, a Republican, introduced Senate Bill 89, aimed at imposing the state's first-ever tax on e-cigarette products. Wyoming had the highest rate of youth vapers, with 30 percent of kids under 18 reporting they had used e-cigarettes in 2023.
While FDA has made progress in reviewing marketing applications for flavored e-cigarettes, it has repeatedly missed deadlines to complete its review of major products and failed to clear the market of these illegal flavored products. Here you will find the facts on vaping, based on scientific evidence and research, plus advice on how to use vapes (sometimes called e-cigarettes or e-cigs) as a tool to quit smoking. Battery-powered vape devices create an aerosol that looks like water vapor but contains nicotine, flavoring, and more than 30 other chemicals. The aerosol is inhaled into the lungs where to buy electronic cigarettes online the nicotine and chemicals cross over into the bloodstream.The earliest vape devices looked like cigarettes. With Americans puffing less each year, the cigarette industry sees ESDs and other smokeless products as financial saviors. E-cigarette sales tripled between 2012 and 2013 rising from $500 million to over $1.5 billion and are expected to soon exceed the sales of traditional cigarettes, motivating giant tobacco and other non-cigarette companies to market this product.
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.
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.
New 'pod-mod' style vape products are similar in shape and size to JUUL
One study detected vitamin E acetate in the lung fluid of 48 out of 51 EVALI patients sampled across 16 states. By contrast, lung fluid samples taken from healthy people did not contain the vitamin. EVALI is a serious medical condition in which a person’s lungs become damaged from substances contained in e-cigarettes and vaping products. The smoke-free and tobacco-free policies at schools, businesses, healthcare institutions, and other organizations should also cover e-cigarettes. This will help non-users avoid being exposed to potentially harmful e-cigarette aerosol.
The agency says companies were blocked because they couldn’t show the possible benefits for adult smokers outweighed the risk of underage use. The companies say they had prepared detailed plans to avoid appealing to young people. Vaping is the inhaling of an aerosol (mist) created by an electronic cigarette (e-cigarette) or other vaping device. As a result of the FDA’s missed deadlines and inadequate enforcement, flavored e-cigarettes remain widely available online and in stores across the country. Every day flavored e-cigarettes remain on the market, our kids remain at risk.
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.
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.
"When you are out and about with your children and see an advertisement, for example, take the opportunity to talk about it," she says. As they grow older, parents can expand on their thoughts and expectations. "It’s also important to give teens and young adults the space to ask questions," she says. The 2023 NYTS showed that about 2 million middle and high school students reported using e-cigarettes in the last 30 days. Another study that year found that the rates of youth who say they vaped with nicotine in the past month more than doubled in two years. About 11% of high school seniors reported this habit in 2017, compared to 25%, or one in four seniors, in 2019.
A priority of the New York State Tobacco Control Program is to prevent the initiation of tobacco use, including combustible tobacco and electronic cigarettes, by youth and young adults. The Program funds Reality Check, the youth engagement component for New York State teens, ages 13-18, to increase support for New York State's tobacco-free and vape-free norms through youth action and community engagement. Evidence-based, policy-driven, and cost-effective approaches are implemented to decrease youth tobacco use, protect youth from exposure to tobacco marketing and imagery, and eliminate exposure to secondhand smoke. Visit Reality Check for more information and to find your local Reality Check group. According to a 2019 CDC industry update, one out of every 10 high school students reported using tobacco products, due in part to easy access through mail deliveries and online sellers.
No amount of nicotine is safe for youth as there may be long-term, damaging effects on learning, memory, attention, behavior problems, and future addiction. Electronic cigarettes or vapes (referred to collectively as ‘e‑cigarettes’) are personal vaping devices where users inhale aerosol rather than smoke. The inhaled aerosol usually contains flavourings, a range of toxic chemicals, and may contain nicotine as well (Department of Health and Aged Care 2023a).
Researchers noted that they were unable to assess any association between e-cigarette nicotine formulation and cigarette cessation outcomes. Another potential limitation was that the study only included adult participants who reported smoking within the previous 30 days, limiting information about younger smokers and former smokers. In that same vein, 5.9 million people began vaping, bringing the total use of tobacco products among those 12 and older to 64.4 million.
E-Cigarettes, also called personal vaporizers or "vapes", present another way for smokers to ingest nicotine. E-Cigarettes have been marketed to young adults and adolescents through the use of candy and fruit flavors. They are also touted by some users as a "safer" alternative to smoking, and as a way to either quit smoking cigarettes, or to smoke in places where cigarette smoking is not allowed.
You should use the vape as much as you need to manage your cravings and withdrawal symptoms. Here are some of the most common myths, and the facts based on scientific evidence and data. Nicotine itself is not very harmful and has been used safely for many years in medicines to help people stop smoking. E-liquids come in different nicotine strengths, so you control how much nicotine you need to help with cravings and other withdrawal symptoms, such as feeling irritable and having low mood. Electronic cigarettes and ESDs also pose a risk of fire and explosions, which result in serious injuries and property damage.
Australia, New Zealand, Poland, and Pakistan have a nationwide ban on the selling of all tobacco products to people under the age of 18. "Since most of the health concerns about e-cigarettes have focused on nicotine, there is still much we do not know about e-cigarettes. The present study utilized a nationwide school survey which covers the majority of the respective Finnish student population and a validated measure for susceptibility, adapted to cover also e-cigarettes and snus. The limitations include self-reporting, lack of class-level data and a measure on school performance, and potential bias in parental education and smoking when reported by students. Further, no causal conclusions can be made from this cross-sectional data. Some adolescents experience first dependence symptoms early [2], which makes prevention of nicotine use essential.
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.
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.
"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.
It may also increase the risk of developing mood disorders and problems with impulse control. They appeared on the U.S. market in 2015 and are now the top-selling brand of e-cigarette in the country. Although secondhand vapor may not affect the lungs the same way as vaping, it is better to avoid it, if possible. E-cigarettes have been strongly linked to continued tobacco use and are not recommended for young people.
In December 2019, the federal government raised the legal minimum age of sale of tobacco products from 18 to 21 years, and in January 2020, the FDA issued a policy on the sale of flavored vaping cartridges. The e-liquid in most e-cigarettes contains nicotine, the same addictive drug that is in regular cigarettes, cigars, hookah, and other tobacco products. However, nicotine levels are not the same in all types of e-cigarettes, and sometimes product labels do not list the true nicotine content. Products marketed for therapeutic purposes (for example, marketed as a product to help people quit smoking) are regulated by FDA’s Center for Drug Evaluation and Research (CDER).
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.
Heating the liquid (e-juices) causes formation of an aerosol which users inhale into their lungs. These electronic smoking devices come in different shapes and sizes and can look like regular cigarettes, pens, and even flash drives (similar to the popular brand "JUUL"). E-cigarettes go by many names including vapes, e-cigs, e-pens, e-hookahs and mods. The Food and Drug Administration (FDA) extended its regulatory authority over tobacco products to include e-cigarettes in May 2016.
Electronic nicotine and vapor delivery systems, which include e-cigarettes, vaping pens, e-hookah and similar devices, typically contain nicotine. Some ingredients found in e-cigarettes are considered toxic and there is no regulation of what chemicals e-cigarettes contain or how much nicotine the user is inhaling. These factors could lead to long-term adverse health effects for e-cigarette users and bystanders. This new law will reduce exposure to the potentially dangerous chemicals for e-cigarette users and those around them. Prior to electronic cigarettes being added to the Clean Indoor Air Act, only the smoking of substances containing tobacco, including cigars, cigarettes or pipes, were restricted in public places. While many counties have already banned the use of e-cigarettes in public places, including restaurants, bars and other work places, this bill makes the law consistent across New York State.
According to the 2021 National Youth Tobacco Survey, more than 2 million U.S. middle and high school students reported using e-cigarettes in 2021, with more than 8 in 10 of those youth using flavored e-cigarettes. The mid-to-long-term consequences of e-cigarettes are not yet known, as it's a new product and has been sold for less than a decade in the U.S. While much remains to be determined about these lasting health consequences of these products, we are very troubled by what we see so far. The inhalation of harmful chemicals can cause irreversible lung damage and lung diseases.
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.
Vapor products have many names, including electronic nicotine delivery systems (ENDS), electronic cigarettes (e-cigarettes), JUULs or vape pens. All adults who smoke conventional cigarettes or other combustible (burned) tobacco products should be advised to quit smoking at the earliest opportunity, recognizing that quitting is hard and often takes repeated, dedicated efforts. Individuals can also seek cessation support by calling QUIT-NOW or ACS-2345.
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.
However, there is no requirement that the Electronic Cigarette tax needs to be broken out separately from the sales tax on an invoice or receipt, but both taxes must be collected on the transaction for products subject to the tax. To report transactions and taxes due for the preceding month, Form ECG-103 must be filed the 15th day of each month using INTIME. The sale by a merchant of closed system cartridges, vapor products, open system containers and consumable material are retail transactions that are subject to Sales tax. Therefore, a retailer must register as a retail merchant with DOR and collect and remit Sales tax on these items and all other tangible personal property sold by the store. Youth vaping has declined from all-time highs in recent years, but 2.8 million middle and high school students still use it, according to federal survey data. Vaping can damage your lungs and put you at higher risk of respiratory infections, including COVID-19.
Dr Goel praised the central government’s initiatives to discourage tobacco consumption, including establishment of over 429 Tobacco Cessation Centers (TCCs), awareness campaigns, and the National Tobacco Quit Line. More information about youth vaping and CATCH My Breath is available on the program’s website. While the federal purchasing age of tobacco is 21, North Carolina law still lists it as 18, and many vape shops are operating under that age.
The most important points to know are that the long-term health effects of e-cigarettes are still unknown, and all tobacco products, including e-cigarettes, can pose health risks to the user. The tobacco industry has co-opted the term harm reduction to further its own interests of reduced tobacco product regulation and expand its user base. E-cigarette use among adults has been more stable, with adult use remaining relatively low since around 2012. Recent data, however, showed a slight uptick in adult e-cigarette use from 4.5% in 2021 to 6% in 2022. While switching completely from cigarettes to e-cigarettes can be less harmful than smoking, many adult smokers use e-cigarettes and cigarettes concurrently — increasing overall exposure to nicotine. Randomized control trials provide growing evidence that e-cigarettes with nicotine can increase quitting rates when compared to nicotine replacement therapies.
Because of this and other studies, vitamin E acetate is considered the main cause of EVALI. Other chemicals found in nicotine- and THC-containing vaping products may also play a role in the condition. It is important to know that most e-cigarettes contain addictive nicotine. There is evidence that nicotine harms the brain development of teenagers. Again, it is important to know that most e-cigarettes contain nicotine.
Vape aerosols may also increase the risk of heart disease, lung cancer, and asthma complications. The substitution was especially evident among cigarette brands popular with young people aged 20 and under, suggesting that flavor restrictions may increase smoking among youth as well as adults. The immense popularity of electronic cigarettes, or e-cigarettes, among young people has led many policymakers to restrict the sale of flavored varieties. Proponents of e-cigarettes claim they’re safer than smoking because they don’t contain the more than 60 cancer-causing chemicals in tobacco smoke and are not combustible. But e-cigs still deliver harmful chemicals, including nicotine, the extremely addictive substance in cigarettes.
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.
Others can be refilled with liquid, recharged, and used over and over. Our Board of Health is a leader in protecting people from the dangers of e-cigarettes and vapor products. Vapes contain nicotine and other substances like THC that negatively affect brain development in youth. Nicotine is also highly addictive and can lead to smoking later in life. Vapes are electronic devices designed to deliver vapourised liquids into your lungs when you breathe in.
They usually contain nicotine, which is the addictive chemical in cigarettes. E-cigarettes do not contain tobacco, which is the harmful part of cigarettes that causes cancer. By comparison, traditional cigarette sales have fallen by 5.2% since July 2023, while smokeless and oral nicotine products — led foremost by Zyn products — are up 11.8% as a category. Amid the increasing popularity of e-cigarettes and vapes among young people, health experts from PGIMER have raised concerns. They pointed out that many young people mistakenly think that e-cigarettes are "cool" because of their flavours, sleek designs, and social appeal. Experts warn that this misconception greatly increases the chances of non-smoking youth using regular cigarettes.
This includes data on youth use of these products, which has led to development of several educational programs designed to prevent adolescents and teens from using these products. Through tobacco product problem reports and tobacco product violation reports, the FDA also knows much more about many safety and health hazards they may pose. The Surgeon General reports e-cigarette use among youth is a significant public health concern and steps must be taken by parents, educators and especially policymakers to discourage use of e-cigarettes.
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.
However, a single e-cigarette can be harmful to the body’s blood vessels — even when the vapor is entirely nicotine-free — according to a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania. Tobacco products contain nicotine, which is highly addictive and can harm brain development as teens grow. Rural youth are at higher risk for harm, because they tend to begin using tobacco products at a younger age and use tobacco products more frequently. Products like e-cigarettes, vapes, and e-hookahs typically contain nicotine, which is highly addictive and can harm brain development as teens grow.
E-cigarettes have been allowed to stay on the market for years without undergoing a full review of their public health impact, sparking a sustained and ongoing crisis of youth use. As of November 2023, the FDA has not completed reviewing all applications from e-cigarette makers to market their products, leaving many e-cigarettes on the market while waiting for a decision. To date, the FDA has denied permission to market flavored and menthol e-cigarette products such as Vuse Solo, Vuse Vibe, Vuse Ciro, and Vuse Alto. The FDA has denied permission to market many non-tobacco and non-menthol flavored e-cigarette products, however, many of those denials are currently under judicial or supervisory review. In recent years, the FDA has increased enforcement efforts around e-cigarette manufacturers and retailers for continuing to sell youth-appealing e-cigarettes. These actions include issuing warning letters, fines, injunctions, and joint operations with other federal officials to seize imports of unauthorized e-cigarette products.
The 2019 outbreak of EVALI cases emerged against a backdrop of an ongoing vaping epidemic among youth. The amount, quantity and toxicity of substances that e-cigarettes release depend on several factors, such as the type of device, how the device operates and is used, and the e-liquid used. Drop the Vape also directs users to the New York State Quitline for free and confidential quit-coaching via telephone, internet, and text, and free starter kits of nicotine replacement therapy (NRT) for eligible New Yorkers. In absence of federal law, states are acting to remove flavored nicotine products from the shelves. All the e-cigarettes previously authorized by the FDA have been tobacco, which isn’t widely used by young people who vape.
One in five Minnesota teens (grades 6-12) have asthma, a serious chronic disease that can make it difficult to breathe. Minnesota youth who have asthma are more likely than their peers to smoke or vape, and people who have asthma who smoke or vape are likely to experience worsening symptoms and require medical treatment. Coauthors reported relationships with Pfizer and Johnson & Johnson, grants from nonprofits, and personal fees from public health authorities and from plaintiff law firms. Nine challenges have been released as part of this effort, including a challenge to address the impact of e-cigarette use. Expressions of interest for the challenges are now open, and final teams will be announced in 2022.
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.
The FDA does not currently require testing of all the substances in e-cigarettes to ensure they are safe. It's also hard to know exactly what chemicals are in an e-cigarette because most products do not list all of the harmful or potentially harmful substances contained in them. E-cigarettes do not contain tobacco, but many of them contain nicotine, which comes from tobacco. Because of this, the Food and Drug Administration (FDA) classifies them as "tobacco products." For adults who smoke, switching completely from cigarettes to e-cigarettes may reduce exposure to many harmful chemicals present in cigarettes. However, it is important that they switch completely from cigarettes to e-cigarettes to get the full health benefit.
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.
Many grants on this topic are funded through the Tobacco Regulatory Science Program, an NIH partnership with FDA’s Center for Tobacco Products to fund research to inform FDA’s tobacco regulatory activities. Interestingly, most of these reports linking COVID-19 harmful effects with smoking or vaping, are based on their capability of increasing the expression of angiotensin-converting enzyme 2 (ACE2) in the lung. It is well known that ACE2 is the gate for SARS-CoV-2 entrance to the airways [106] and it is mainly expressed in type 2 alveolar epithelial cells and alveolar macrophages [107]. To date, most of the studies in this field indicate that current smokers have higher expression of ACE2 in the airways (reviewed by [108]) than healthy non-smokers [109, 110]. While tobacco products have been a long-standing public health issue, e-cigarette (aka e-cigs, vape pens, vapes) use has continued to gain popularity throughout the last decade. Poison centers began receiving calls about e-cigarettes and liquid nicotine products in 2010, which overlaps with the initial period where these products reached the U.S. market.
These retail sales data briefs are intended to provide information about population trends in sales for participating retailers; they do not include online sales or vape store sales and cannot be used to make conclusions about subgroup purchasing or behaviors. These estimates are based on the information available at the time of publication and may be subject to updates as more information becomes available. The nicotine in e-liquids is readily absorbed from the lungs into the bloodstream when a person vapes an e-cigarette.
Turkey, which has one of the highest percentage of smokers in its population,[126] has a legal age of 18. Japan is one of the highest tobacco-consuming nations, and requires purchasers to be 20 years of age. Since July 2008, Japan has enforced this age limit at cigarette vending machines through use of the taspo smart card. In other countries, such as Egypt, it is legal to use and purchase tobacco products regardless of age.[citation needed] Germany raised the purchase age from 16 to 18 on September 1, 2007. In the unadjusted analyses (Table 3), those planning for vocational education or extra year/discontinuation had higher S-EC compared with those planning for GUSS. Among girls, those without educational aspirations also had higher S-EC.