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But e-cigarettes haven't proved to be safer or more effective than nicotine-replacement medications in helping people stop smoking. He was a founding member of the Society for Nicotine and Tobacco Research. As a public health researcher, he has studied numerous issues related to nicotine use and policy, with some recent work focused on cigarette and e-cigarette use among adolescents and young adults. Lynn T. Kozlowski is an internationally recognized expert on tobacco use, e-cigarettes and nicotine policy. He can speak to the media about these issues, including trends in both smoking and vaping (including Juuling). Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realised based on the evidence assessed by this important independent review.

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.

If used during pregnancy, nicotine may also cause premature births and low birthweight babies. The use of e-cigarettes is often referred to as "vaping" because many people believe e-cigarettes create a vapor, which is then inhaled. But in fact, e-cigarettes produce an aerosol made up of tiny particles, which is different from a vapor. Some vape shops may have legal responsibilities as both manufacturers and retailers of tobacco products.

Recent guidance from the Center for Tobacco Products indicates the importance of switching completely away from combustible cigarettes for those who are also using e-cigarettes," she added. The investigators revealed that daily vs nondaily use of e-cigarettes was linked to higher overall rates of quitting combustible cigarettes (12.8% vs 6.1%). The adults who used e-cigarettes in 2019 were more likely to stop smoking traditional cigarettes compared with those who used the e-cigarettes between 2014 and 2015 (12.0% vs 5.3%). There was limited evidence that flavor or device type impacted cigarette cessation. The findings suggest that daily e-cigarette use may help some patients to quit smoking combustible cigarettes.

The association between student- and school-level factors and susceptibility to smoking. Nationally, e-cigarette use among high school students doubled from 11.7% in 2017 to 27.5% in 2019. The researchers studied human endothelial cells generated in the laboratory from what are called induced pluripotent stem cells, or iPS cells. IPS cells can become many different cell types, and they provide an ideal way for researchers to closely study cells that would be difficult to isolate directly from a patient. A.C.—managed the analytical testing programme and co-authored the manuscript.

The inhaled vapor may contain nicotine (the addictive drug in tobacco), flavorings, and toxins—including ones that cause cancer. People who have already switched completely from smoking to e-cigarettes should not switch back to smoking (either solely or along with e-cigarettes), which could expose them to potentially devastating health effects. It's important to know the US Centers for Disease Control and Prevention (CDC) has stated that sometimes e-cigarette products are changed or modified and can have possibly harmful or illegal substances from unknown sources. Get regular updates on the health effects of tobacco, public health educational resources, and highlights on current tobacco issues and regulations.

This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources. Because of the lack of long-term data and the fact that patients have died from EVALI, the prognosis for those affected remains uncertain. Researchers are working hard to learn as much as possible about the illness, its causes, and the odds for making a full recovery. "We recommend that patients see a pulmonologist within one to two weeks after being discharged to undergo testing of lung function and pulse oximetry [level of oxygen in the blood]," she says.

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.

Experimenting with different ways of using vaping materials may be additionally risky. In addition, nicotine use can affect areas of a young person’s brain that are responsible for attention and learning. Primary spontaneous pneumothorax, or collapsed lung, occurs when there’s a hole in the lung through which oxygen escapes.

However, your local Stop Smoking Service may offer a free vaping starter pack. Make sure you buy your vaping products from a reputable retailer so you can be confident they are covered by UK safety and quality regulations. Get advice from a specialist vape shop or a local Stop Smoking Service. Finding the right device and strength of nicotine in your e-liquid may take time – so stick with it.

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.

Differences between schools exist, but having more students with no nicotine use showed protective associations, while having more students with positive attitudes towards product use in one’s age group increased the susceptibility. The results of the present study suggest that both interventions tailored by educational aspirations and universal school policies are needed to reach youth at high-risk of initiation. The concentration of nicotine in the BB57 emissions relative to BB18 was three times greater and followed the three-fold increase in nicotine strength of the e-liquid. In the cigarette smoke, the measured nicotine concentration of 0.23 ± 0.01 mg puff–1 (Table 1), equivalent to 2.07 ± 0.09 mg cig−1, is in accordance with the Ky1R6F certificate value of 1.9 ± 0.1 mg cig−1 (ISO Intense smoking regime)56.

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.

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].

WASHINGTON (AP) — The Supreme Court took up an e-cigarette case Tuesday, weighing Food and Drug Administration decisions blocking the marketing of sweet flavored products amid a surge in vaping by young people. Despite not authorizing a single synthetic nicotine product, it has allowed these products – including e-cigarettes in kid-friendly flavors – to stay on the market well past the July 13 deadline. There is little research on the safety of vaping in pregnancy, but it's likely to be substantially less harmful for you and your baby than smoking. Unlike cigarettes, vapes do not produce carbon monoxide, which is very harmful to a developing baby in the womb. They also cause other serious illnesses, including lung disease, heart disease and stroke.

Television advertisements for cigarettes have been banned in the U.S. since 1971, but in the past few years supposedly healthier, battery-powered alternatives have landed numerous prime-time appearances. Electronic cigarettes, or e-cigs, as they are known, soaked up the spotlight in recent Super Bowl commercials, on late-night talk shows and in a comedy sketch during the 2014 Golden Globe Awards. Indeed, a recent survey shows that nearly 60 percent of Americans are now familiar with the sleek, smokeless devices.

Their actions should come as no surprise as e-cigarette manufacturers fail to provide consumers with guidance or take responsibility for appropriate disposal methods. In a separate study conducted by Truth Initiative in 2019, almost half (46.9%) of e-cigarette device owners said that the e-cigarette device they used currently did not provide any disposal information, such as where to send used batteries or empty pods. Additionally, when e-cigarette device owners were asked about e-cigarette waste disposal, the majority (73.7%) believed that it was difficult to find e-cigarette drop off sites. Principal investigator Wendy Max, PhD, director of the Institute for Health & Aging, noted that from 2013 to 2018, e-cigarette use among high school students soared from 4.5% to 20.8%. The Australian Government’s new Public Health (Tobacco and Other Products) legislation commences from April 2024 and incorporates new controls governing the advertising and promotion of e‑cigarettes (Department of Health and Aged Care 2024). According to the National Tobacco Strategy 2023–‍2030 (Department of Health and Aged Care 2023b), strengthening regulations on e‑cigarettes has been listed as a priority area, and actions such as prohibiting the sale of flavoured e‑cigarettes have been proposed.

Whilst long-term health effects are not fully known, we do know that they generate toxic substances, some of which are known to cause cancer and some that increase the risk of heart and lung disorders. Electronic delivery systems have also been linked to a number of physical injuries, including burns from explosions or malfunctions, when the products are not of the expected standard or are tampered with by users. The Preventing Online Sales of E-Cigarettes to Children Act was created in 2019 to reduce children and teens access to online sales of smokeless tobacco products. According to a 2020 study by the Centers for Disease Control and Prevention (CDC), 85% of high school students and 74% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time. The electronic cigarette (e-cigarette), for many considered as a safe alternative to conventional cigarettes, has revolutionised the tobacco industry in the last decades.

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.

To learn more about tobacco and its health effects, see Tobacco and Cancer. There have been reports of e-cigarettes exploding and causing serious injuries. Usually the explosions are caused by faulty batteries or because the batteries were not handled as they should be. Visit the Food and Drug Administration website for safety tips to help avoid an e-cigarette battery explosion. Among people who were hospitalized with severe EVALI, most were younger than 35 and used THC-containing vapes from informal sources (online, family or friends). However, EVALI can happen in anyone using either nicotine or THC-containing vapes.

These products use an "e-liquid" that usually contains nicotine derived from tobacco, as well as flavorings, propylene glycol, vegetable glycerin, and other ingredients. The dangers of vaping include lung and other organ damage, breathing problems, addiction and more. People tend to think of vaping as "safer" than smoking, but it’s not safe. When the coronavirus pandemic first began, Blaha says, data show that e-cigarette sales went down, possibly because people were spending more time at home and avoiding stores and public areas. In light of the EVALI outbreak, the CDC advises people who use e-cigarettes for smoking cessation to weigh the risks and benefits and first consider use of other FDA-approved smoking cessation options. If you have thought about trying to kick a smoking habit, you’re not alone.

In 2021 "other" flavored devices made up 71 percent of all disposable devices sold or given away, with the most-popular subcategories being fruit-flavored and fruit & menthol/mint flavored products. These two subcategories alone made up more than half of all disposable e-cigarette devices sold or given away in 2021. Researchers said that the study’s prospective observational design allows them to infer, but not conclusively determine, a causal relationship between e-cigarette use and heart failure. However, with its large sample size and detailed data on substance use and health information, Bene-Alhasan said the study is one of the most comprehensive studies to assess this relationship to date. This guide is intended to provide general information about the California Electronic Cigarette Excise Tax and registration, collection, filing, and payment responsibilities of retailers of electronic cigarettes containing or sold with nicotine. When the liquid is used up or the battery dies, the user throws the device away.

However, within the adult demographic, 12.7 percent of 18- to 24-year-old adults and 21.3 percent of males, ages 18-24, are "current users" of e-cigarettes. The e-cigarette device (Vype ePod1.0, Nicoventures Trading Ltd., Blackburn, UK) consists of a metallic outer device case, a printed circuit board to control the device, a lithium-ion rechargeable battery (350 mAh) and an e-cigarette cartridge (Fig. 1). The voltage ranges from 2.2 to 3.1 V and is not adjustable by the user. The device has dimensions (h × w × d) of 104.2 × 19.1 × 10.5 mm and a power output of 6.5 ± 0.5 W. The cartridges or pods consist of a plastic case holding the ceramic wick material and a flat metal heating element (NiCr, 0.8 –1.4-Ω resistance). Each pod is pre-filled with Vype e-liquid (1.9 mL) and is magnetically attached to the device.

For information about ENDS products that are authorized for marketing in the U.S., view FDA’s "Searchable Tobacco Products Database." These problems can seriously hurt the person using the ENDS product and others around them. There may be added dangers, for example if a vape battery catches fire near an oxygen tank, a propane tank (such as used in backyard grills), or a gas pump, or if a person has a vape-related seizure while driving. Enlist in our movement, explore youth activism programs, share quitting resources, and learn about more ways you can get involved. By using our website or products, you agree that you have read and agree to our terms of service, disclaimer, age policy, refund policy, and privacy policy.

The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. The products available in Australia are often made up of many parts, from all over the world, which makes it difficult to assess the safety of the overall product. Most e-cigarettes available in retail stores have not been tested or approved by the TGA, which means their safety cannot be guaranteed. Children are exposed to e-cigarette advertising online and on TV, in magazines and billboards. Although it is illegal for e-cigarettes to be sold to youth under age 21, they can be ordered online. While flavors were nationally banned in 2019, this ban excludes mint and menthol flavors.

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.

If you are not sure whether disposables are for you, these kits would be a great place to start. The leading disposable vape kits are Elf Bars, Lost Mary and Crystal Bar. Both come in a wide range of tastes to suit anyone looking to switch from smoking but also work well as a cheap back up kit for existing vapers. The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Data from the 2019 Minnesota Student Survey shows a steep rise in e-cigarette use among students. This study was supported by funding from the National Institute on Drug Abuse of the NIH and the FDA Center for Tobacco Products.

FDA published a rule clarifying when products made or derived from tobacco are regulated as tobacco products, drugs, and/ or devices. Vaping is when you use a handheld electronic device to breathe a mist ("vapor") into your lungs. An e-cigarette, vape pen or other electronic nicotine delivery system (ENDS) heats a liquid of nicotine, flavoring, propylene glycol and other additives into an aerosol that you inhale through a mouthpiece.

However, it has been reported that the heating process can lead to the generation of new decomposition compounds that may be hazardous [4, 5]. The levels of nicotine, which is the key addictive component of tobacco, can also vary between the commercially available e-liquids, and even nicotine-free options are available. For this particular reason, e-cigarettes are often viewed as a smoking cessation tool, given that those with nicotine can prevent smoking craving, yet this idea has not been fully demonstrated [2, 6, 7].

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.

E-cigarettes (often called vape pens) are battery-operated vaping devices that heat a liquid until it becomes an aerosol (mist), which is inhaled. It usually contains nicotine, other harmful chemicals, and flavorings. Even e-cigarettes that claim to have no nicotine have been found to contain nicotine. A non-smoker who uses ENDS may become addicted to nicotine and find it difficult to stop using ENDS or become addicted to conventional tobacco products. Further, many e-cigarettes are designed to allow the control of nicotine (which can reach dangerously high levels).

It can damage your heart, arteries, and lungs, increasing the risk for heart attack, stroke, and chronic lung disease. E-cigarettes recently surpassed conventional cigarettes as the most commonly used tobacco product among youth.1 It is critical that public health officials and the general public understand the potential risks of using them. The FDA recently approved its first menthol-flavored electronic cigarettes for adult smokers. In contrast to the clear evidence that flavored products fueled the youth e-cigarette epidemic, every major U.S. public health authority – including the U.S. Preventive Services Task Force, the CDC and even the FDA itself – has found there is inadequate evidence to conclude that e-cigarettes are effective at helping smokers quit. E-cigarettes are battery-operated devices used for a type of smoking called vaping.

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.

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.

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.

However, more research is needed to fully understand emissions from e-cigarettes and their impact on human health. These aerosols can contain potentially harmful substances — including nicotine, formaldehyde and metals — some of which cause cancer and other harmful health effects. Some e-cigarette brands and other nicotine products state they contain synthetic nicotine rather than nicotine made from or derived from tobacco.

Research has also shown flavor chemicals to be toxic in both e-liquid and aerosol form. While many flavor chemicals used in vaping products have been approved for ingestion, they have not yet been tested for safety when aerosolized. Flavor chemicals are typically not listed on e-cigarette packaging, and most e-liquids contain more than one flavor chemical. Benzaldehyde (used in cherry-flavored products) and 2, 5-dimethyprazine (used in chocolate-flavored products), specifically, may harm human health.

"Most people know that tobacco smoke contains cancer-causing chemicals but, overall, there is less knowledge about the chemicals that are inhaled through vape vapors," he added. The research, published today in the journal JAMA Network Open, suggests that daily e-cigarette use may help some people quit using combustible cigarettes. The program, called CATCH My Breath, is an evidence-based youth vaping prevention program geared towards fifth through 12th graders. It is the only school-level youth vaping intervention program recognized by the Substance Abuse and Mental Health Services Administration. FRIDAY, Aug. 2, 2024 (HealthDay News) -- 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. "Most people know that tobacco smoke contains cancer-causing chemicals but, overall, there is less knowledge about the chemicals that are inhaled through vape vapors," he added.

The evidence for e-cigarettes as a tool to help adults quit smoking is limited. To date, no e-cigarettes have been approved by the FDA as smoking-cessation devices. The report also discusses the changing landscape of tobacco products, including smoked products, smokeless products, and e-cigarettes. The liquid solution used in e-cigarettes, sometimes called vape juice or e-liquid, usually contains nicotine and other chemicals.

If you’re scratching your head and wondering what @AskTSA is, it’s a small team of TSA professionals from various agency offices who answer TSA related questions from the traveling public that are sent via Twitter. You can read more about the program in this recent USA Today article. "It has become clear to me that e-cigarettes cause their own set of diseases that seem to impact just about every organ in the body—from the brain to the bladder." Critics of e-cigarettes fear that vaping will get kids hooked on nicotine and that they'll "graduate" to cigarettes when they want a bigger kick, Warner says. Vaping worked in a month, and she's been off cigarettes for more than two years. "I'm breathing, sleeping, and eating much better since I started vaping. My 'smoker's laugh' went away, and I no longer smell like an ashtray."

These refills are cheaper than disposables, but they're almost as foolproof. Switching from cigarettes to e-cigarettes could also save you a lot of money. Some people spend more than others but in general smoking costs more than vaping. Now there is an option available to me that is far less harmful or offensive as cigarettes and, for now, I am allowed to enjoy the company of my friends and family indoors with the rest of society. No longer do I have to huddle under the awning of a building, trying to avoid the rain, nor do I have to freeze my fingers off trying to rush through a cigarette just so everyone else can be satisfied.

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.

In a major recent undertaking to help clarify the effects of e-cigarettes, the physician-investigator conducted a review of the best available evidence about vaping and lung harms. She and her co-authors published their roundup of the evidence in an article titled "Vaping and Lung Inflammation and Injury," which appeared online Feb. 10 in the journal Annual Review of Physiology. A study in the Journal of the American Medical Association in 2015 found a connection too. Researchers surveyed 2,500 Los Angeles high school students who had never smoked.

Simply select your manager software from the list below and click Download.For more information or tips please see 'Downloading to a citation manager' in the Help menu. The Vital Records service window in the Lucas State Office Building will be closed on August 6-7 due to construction. As of April 1st, 2024, 1,061 municipalities, plus 26 states, commonwealths, and territories restrict e-cigarette use in 100% smokefree venues.

Electronic smoking devices (or ESDs), which are often called e-cigarettes, heat and vaporize a solution that typically contains nicotine. The devices are metal or plastic tubes that contain a cartridge filled with a liquid that is vaporized by a battery-powered heating element. The aerosol is inhaled by the user when they draw on the device, as they would a regular tobacco cigarette, and the user exhales the aerosol into the environment. Electronic cigarettes (E-Cigarettes) are battery-powered devices that function by heating a liquid into an aerosol that is inhaled by the user.

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.

Youth ENDS use raises concerns about nicotine addiction, negative effects of nicotine on adolescent brain development, and other potential health harms, including increased risk of initiating cigarette smoking. Electronic nicotine delivery systems (ENDS), also called electronic cigarettes, e-cigarettes, vaping devices, or vape pens, are battery-powered devices used to smoke or "vape" a flavored or unflavored solution which usually contains nicotine. The American Academy of Family Physicians (AAFP) recognizes the increased use of ENDS, especially among youth and young adults, as well as its use by those attempting to quit smoking tobacco. Although e-cigarettes do not contain tobacco, for regulatory purposes, they are considered "tobacco products" by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). E-cigarettes can go by different names, including vapes, vape pens or sticks, e-hookahs, hookah sticks, mods, and personal vaporizers.

This data brief demonstrates that teens whose environments put them at risk for use of e-cigarettes are more likely to try them. The study, published on May 23, 2022, in Tobacco Control, is the first to look at the health care costs of e-cigarette use among adults 18 and older. The second most supported measure, strengthening restrictions on the advertising and promotion of e‑cigarettes, was supported by 82% of people. In 2019, only 67% of people in Australia supported strengthening these restrictions. The proportion of people neither smoking regular cigarettes nor using e‑cigarettes has remained stable (Figure 3).

Similarly, a 2014 review reported that vaping may trigger gum, mouth, and throat irritation. In particular, a 2015 study examined the effects of flavored e-juices on both human lung cells and lung cells in mice. Here’s what we currently know about the effects of vaping fluids with and without nicotine and vaping cannabis or CBD. In cultured human airway epithelial cells, both e-cigarette aerosol and CS extract induced IL-8/CXCL8 (neutrophil chemoattractant) release [28]. Researchers noted that study participants using both types of cigarettes had a higher nicotine dependence in relation to e-cigarettes. Find more resources on tobacco, e-cigarettes, and vaping on the SAMHSA Store.

Without immediate measures to stop epidemic use of these products, the long-term adverse health effects will increase. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults.

Although e-liquids do not contain tobacco, they contain chemicals, usually including flavorings, and often contain nicotine, which is addictive. Aerosol from e-cigarettes can also include cancer-causing chemicals, and diacetyl, a chemical used in some e-cigarette flavorings, has been linked with serious lung disease. Some people (most commonly youths or young adults) have experienced seizures while using e-cigarettes.

Needing no extra coils or e-liquid to use they are an all-in-one package. They have become one of the best alternatives to smoking because of the easy setup and delicious flavours. Did you know you can buy 10ml vape juice that tastes just like your favourite disposables? Bar salt liquids are made with extra strong flavours to give you the same great taste for a fraction of the cost.

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).

This happens because smoking causes inflammation around the teeth and increases your risk for bacterial infections. The gums may become swollen and bleed (gingivitis) and eventually begin to pull away from the teeth (periodontitis). Smoking also has an effect on insulin, making it more likely that you’ll develop insulin resistance. People who smoke cigarettes have a 30% to 40% greater risk of developing type 2 diabetes and its complications. Smoking can increase the risk of developing squamous cell carcinoma (skin cancer) on the lips.

Since ditching e-cigarettes for cigarettes, I’m back to smoking on weekends only. I couldn’t do cardio to save my life; walking up stairs sucked the wind out of me. My stamina and day-to-day life was vastly more affected by this vaping habit than when I used to just smoke a few cigarettes on Saturday nights. Firstly that propylene glycol, largely responsible for making your breath look like a cloud of mist, is also found in fog machines used in concerts and has been linked to chronic lung problems among stagehands. It’s actually FDA-approved for use in food (believe it or not it’s common in pre-made cake mix) but when heated to vaping temperature it can produce the carcinogen formaldehyde. "Furthermore, the US Food and Drug Administration has not approved NRTs for anyone younger than 18 years (although many health care professionals prescribe NRTs for adolescents, as is recommended by the American Academy of Pediatrics).

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].

WHO regularly monitors and reviews the evidence on ENDS and health and offers guidance to governments. "Yale physicians have been at the forefront in identifying EVALI cases," Dr. Weiss says. She explains that even before CDC guidelines on treating the illness were released, Yale doctors were successfully treating patients with a combination of antibiotics and steroids. Doctors at Yale Medicine also collaborate with researchers in the fields of tobacco and addiction medicine to provide care for patients with EVALI.

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.

A growing body of research indicates that truth campaigns to prevent young people from vaping are poised to move in the same direction as the organization’s successful smoking prevention campaigns. See " Quitting Tobacco " for more information on quitting tobacco products. Let's say you love the feel and flavor you get from puffing on a vape — but you can't quite bring yourself to trust that it's safe. It uses a puff of pressurized, flavored air to simulate the "throat hit" of a vape, with no heating element whatsoever.

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.

Researchers in a 2018 study found that cinnamaldehyde (found in cinnamon), o-vanillin (found in vanilla), and pentanedione (found in honey) all had toxic effects on cells. Studies suggest that nicotine-free vaping can irritate the respiratory system, cause cell death, trigger inflammation, and harm blood vessels. The e-liquid comes in a Juul pod or J-pod cartridge, which usually contains nicotine.

As a non-profit organization, we accept no government or tobacco industry funding. We rely on contributions from individuals, philanthropic foundations, corporations and other non-profit organizations to continue working toward a tobacco-free future. The U.S. Surgeon General declared vaping an epidemic among our youth in 2018. Additional collection points are being added all the time, you can use your postcode to find your nearest vape recycling locations. You can take vapes for recycling to the shop where you buy your replacements or to your local authority household waste recycling centre. Once you have bought the kit, it's been estimated that vaping costs about a third as much as smoking.

Vaping can cause eye, throat, and nose irritation, as well as irritation in the respiratory tract. The nicotine in e-cigarettes can cause dizziness and nausea, especially in new users. E-cigarettes contain many of the same toxins as regular cigarettes, but they may have smaller amounts. Some brands also have much less nicotine than regular cigarettes or no nicotine at all. Their brains are still developing and forming the structure and connections necessary for the mature behavior of adulthood.

The sales data came from ordinary brick-and-mortar establishments like gas stations, groceries, and convenience stores. Statistical analyses took into account a host of other factors that may affect tobacco product sales, such as concurrent restrictions on flavored cigar and menthol cigarette sales, tax rates, cannabis availability, and unemployment rates. We are also proud to announce a new cessation service from Quitline Iowa - My Life My Quit - a program designed especially for youth between 12 and 17 years of age to quit using tobacco and vape products.

Taken together, the studies provide strong evidence that an interactive, tailored text message program can help teens and their older peers break free from nicotine addiction. These findings are especially important given the recent youth mental health crisis documented by the U.S. Adolescents in this study were characterized by high severity of past-year problems with depression, sleep, anxiety, trauma, and substance use. In addition, moderate to high levels of nicotine dependence were observed across multiple measures, with more than three-quarters (76.2%) of teens vaping within 30 minutes of waking — a common way to measure addiction. Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses.

"From a public health perspective, we have always been concerned about dual-use of both traditional and e-cig products," said study lead author Marisa Bittoni, an oncology researcher at Ohio State University in Columbus. A second brand of e-cigarettes — marketed as Nixotine, Nixodine, Nixamide and Nic-Safe – contained a nicotine analog called nicotinamide, also at levels lower than the labels indicated, and combined with undisclosed amounts of 6-methyl nicotine. He emphasised that e-cigarettes are not an effective tobacco cessation tool, as they are not approved by food regulatory bodies. Additionally, they often lead to dual usage with people continuing to use traditional cigarettes along e-cigarettes.

They found that kids who used e-cigs were more likely than non-users to smoke cigarettes or other tobacco products over the next year. To study the short-term impacts of vaping, the researchers performed MRI exams on 31 healthy, non-smoking adults before and after vaping a nicotine-free e-cigarette. Comparing the pre- and post-MRI data, the single episode of vaping resulted in reduced blood flow and impaired endothelial function in the large (femoral) artery that supplies blood to the thigh and leg. The endothelium, which lines the inside surface of blood vessels, is essential to proper blood circulation. Once the endothelium is damaged, arteries thicken, and blood flow to the heart and the brain can be cut off, resulting in heart attack or stroke.

E-cigarettes can be used to smoke or "vape" marijuana products, herbs, waxes and oils. In the US, e-cigarettes are the most commonly used tobacco product among middle- and high-school students. In 2023, 2.1 million students (10% of high-school students and 4.6% of middle-school students) reported current e-cigarette use.

E-cigarettes are popular among teens and young adults, according to the Centers for Disease Control and Prevention (CDC). In 2019, nearly 28 percent of high-school students and 11 percent of middle-school students reported using e-cigarettes. About 8 percent of young adults ages 18 to 24 reported using e-cigarettes in 2018. In 2019, nearly 28% of high-school students and 11% of middle-school students reported using e-cigarettes. E-cigarettes are battery-powered devices that generate an inhalable aerosol that usually contains nicotine. Minnesota teens are using e-cigarettes and vapes at alarming rates, exposing themselves to the harms of nicotine and risking addiction.

Vaping works by heating liquid in a small device so you can breathe it into your lungs. The e-cigarette, vape pen or other vaping device heats the liquid in the device to create an aerosol. Mist from e-cigarettes contains particles of nicotine, flavoring and other substances suspended in air. You breathe these particles into your mouth from the mouthpiece, where they go down your throat and into your lungs. But, Blaha says, interpreting the data is tricky, since young people change their preferences often, and, when surveyed, may not consider using disposable products such as "puff bars" as vaping. The same CDC report says disposable e-cigarette use has increased 1,000% among high school students and 400% among middle school students since 2019.

The ACS encourages young people currently using any of these products to ask for help in quitting and to quit as soon as possible. E-cigarettes can be especially harmful for young people because nicotine affects them in different ways than adults. People who use e-cigarettes should make sure they do not vape around children and ensure they always store e-cigarettes and e-liquids out of reach of children when not in use.

Upon entering the blood, nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with most addictive substances, nicotine activates the brain’s reward circuits and also increases levels of a chemical messenger in the brain called dopamine, which reinforces rewarding behaviors. Pleasure caused by nicotine’s interaction with the reward circuit motivates some people to use nicotine again and again, despite risks to their health and well-being. First PuffsThe current iteration of e-cigarettes was invented and popularized by Chinese pharmacist Hon Lik in 2003 and entered the U.S. market some seven years ago. A federal appeals court ruled in December 2010 that the agency lacked authority over e-cigs because they offer only the recreational benefits of a regular cigarette.

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.

The data shows that in 2021, 69.2 percent of e-cigarette cartridges either sold or given away contained menthol-flavored e-liquids, and the rest were tobacco-flavored. E-cigarette companies also spent $90.6 million more advertising and promoting their products in 2021 than in 2020. Flavored e-cigarettes are very popular, especially among young people.

In addition, the VITA only heats its vape liquid to about 240 degrees Fahrenheit. That's much lower than many other kinds of vapes, so it won't be as rough on your lungs. LUVV also says their products are tested to "safeguard against" harmful byproducts of heating metal and vape fluid. They don't provide much detail to support this claim, though, so take it with a grain of salt. Like HELO, LUVV vapes are free of diacetyl, vitamin E acetate, and nicotine.

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.

Choose from the most popular bar salts like MaryLiq, ElfLiq by Elf Bar, Elux Legend Nic Salts and Crystal Bar E-liquid. If you need more than 10ml bottles, we have an incredibly diverse range of shortfill e-liquids. They offer great value for money and are available in 50ml-150ml options. Or, if you prefer, you can add a nic shot to create your blend of nicotine e-liquid. We stock a fantastic range of vape liquids to cater to any vaper and vaping style.

During the Vietnam War, cigarettes were included with C-ration meals. In 1975, the U.S. government stopped putting cigarettes in military rations. During the second half of the 20th century, the adverse health effects of tobacco smoking started to become widely known and printed health warnings became common on cigarette packets. This health advisory is being issued by the State Health Officer to inform the public about the alarming statistics on current e-cigarette use among youth in Wisconsin. In Wisconsin, current e-cigarette use among Wisconsin high school students increased 154% between 2014 and 2018.

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.

Smoking is the leading cause of lung cancer, and people who smoke are 20 times more likely than nonsmokers to be diagnosed with lung cancer. Tobacco products contain unsafe substances, from acetone and tar to nicotine and carbon monoxide. The inhaled substances can affect your lungs and the other organs in your body.

However, no rigorous scientific studies have shown that they are safe for use. Some people who smoke choose to try e-cigarettes to help them stop smoking. But switching to e-cigarettes still exposes users to potentially serious ongoing health risks. It’s important to stop using all tobacco products, including e-cigarettes, as soon as possible both to reduce health risks and to avoid staying addicted to nicotine.

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.

Poisoning from nicotine and e-cigarette liquid can occur by drinking it, spilling it on the skin, and breathing too much vapor. Cases of accidental eye exposure have also been reported as refill bottles are similar to commercially available eye dropper bottles used for therapeutic eye drops. Prohibiting e-cigarette use inside or near buildings, vehicles and other enclosed spaces is the only way to eliminate exposure to secondhand e-cigarette aerosol and health risks that may come with it. Other electronic vapor products that use e-liquids include e-cigars, e-pipes, and hookah pens (e-hookah).

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.

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 (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.

We want to make a difference in the lives of our users, and create products that can fit all levels and styles of vapers, to help as many as possible. Stanford Medicine Tobacco Prevention ToolkitTheory-based and evidence-informed resources created by educators, parents, and researchers aimed at preventing middle and high school students' use of tobacco and nicotine. There are several resources available to assist with learning more about e-cigarettes and educating youth about the risks. Resources are available for parents, educators, and health care providers. According to the 2017 Behavior Risk Factor Survey (BRFS) conducted by DHSS, 4.8 percent of Delaware adults currently use e-cigarettes, roughly the same percentage reported in the 2016 survey.

Use of microporous ceramic as a wicking material improves heating efficiency, but how it affects the chemical emissions of these devices is unclear. We assessed the emissions of a pod e-cigarette with innovative ceramic wick-based technology and two flavoured e-liquids containing nicotine lactate and nicotine benzoate (57 and 18 mg mL−1 nicotine, respectively). Among the studied harmful and potentially harmful constituents (HPHCs) listed by the US FDA and/or WHO TobReg, only 5 (acetone, acetaldehyde, formaldehyde, naphthalene and nornicotine) were quantified at levels of 0.14 to 100 ng puff−1. In the combustible cigarette (Kentucky reference 1R6F), levels were from 0.131 to 168 µg puff−1.

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.

Replacing your cigarette with a cigar, pipe, e-cigarette, or hookah won’t help you avoid the health risks. The U.S. government has taken steps to restrict most flavored vaping products, effective in 2020. While this should reduce the number of flavored cartridges available in the United States, the guidelines are limited to products submitted for market authorization and don’t include those made at home or purchased online from other countries. Other studies suggest that while using e-cigarettes sends pollutants into the air, the concentration of these toxins drops quickly after someone stops vaping (much faster than cigarette smoke), but that doesn’t mean that the risk has gone away. Some, for example, will settle on surfaces, such as carpets or furniture, where small children might touch them or inadvertently ingest them when placing contaminated objects in their mouths.

"Popcorn lung" is another name for bronchiolitis obliterans (BO), a rare condition that results from damage of the lungs’ small airways. BO was originally discovered when popcorn factory workers started getting sick. The culprit was diacetyl, a food additive used to simulate butter flavor in microwave popcorn.

In the United States, the mortality rate for smokers is three times that of people who never smoked. In fact, the Centers for Disease Control and Prevention (CDC) note that smoking is the most common preventable cause of death in the United States. Join our rewards program today to start earning rewards with your in-store and online purchases. With 180 Rewards, you can earn back what you spend and shop smarter to get the most out of your purchases. Nicotine also can affect concentration and brain development, according to information and data from a new report from the surgeon general.

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.

Overall, comparisons of the particle-size distribution in aerosols from e-cigarettes found that the substances tested had particle distributions similar to the traditional e-liquids containing nicotine. "Our finding indicates that health care expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn’t use any tobacco products," said lead author Yingning Wang, PhD, of the UCSF Institute for Health & Aging. Use of electronic cigarettes costs the United States $15 billion annually in health care expenditures – more than $2,000 per person a year – according to a study by researchers at the UC San Francisco School of Nursing. Between 2016 and 2022–2023, the proportion of people who both smoked regular (combustible) tobacco cigarettes and used e‑cigarettes increased, as did the proportion who currently used e‑cigarettes but did not use regular cigarettes.

A note from Cleveland ClinicNicotine poisoning is on the rise, mostly due to the availability of some of the newer forms of nicotine that are now popular. Children eat cigarettes and can be accidentally poisoned by touching, tasting or swallowing liquid nicotine or liquid nicotine-containing products used in e-cigarettes. To keep you and your family and pets safe from nicotine poisoning, the most effective approach would be to eliminate or ban tobacco-containing or nicotine-containing products in your home. If you're interested in quitting smoking, your healthcare team is here, ready and looking forward to helping you. All tobacco products contain nicotine and are harmful to your health. All are technically capable of causing poisoning if taken in large enough quantities.

"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.

In Cumberland County, Chalmers McClain and Graham said the growing number of vape shops opening near schools with their colorful and bright lights to attract students is also part of the problem. For example, Ramsey Street Alternative High School has two vape shops within a six-minute walk from the school. Teacher concerns around increasing the suspension rates of students caught vaping on school property prompted the initial pilot and current implementation of CATCH My Breath into county schools, said Graham.

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