While inhaled nicotine is so addictive that half of adult smokers smoke themselves to death, is it rational to take substantial comfort in the fact that vaping e-cigarettes is almost certainly less destructive?

While reflecting on the fact that most smoking-induced diseases take decades to develop, ask yourself this. How long will it be before science is confident that it knows most of the long-term consequences upon the body's 37 trillion cells of inhaling thousands of flavored nicotine cocktails, vaporized by 200 to 1,000°F coils within hundreds of unique vaping devices?

To help demonstrate the breadth and complexity of e-cigarette risk analysis, here's a sampling of 2022 nicotine, c-cig, and vaped flavoring findings:

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1. "Our work provides evidence of an association between neurobehavioral changes and altered hippocampal VGLUT1 and VGAT expression in mice exposed to e-cigarette vapors containing nicotine. Such exposure was also associated with altered neurobehaviors, which might affect neurodegenerative diseases." Alasmari 2022
2. "Nicotine enhances proliferation, angiogenesis and metastasis and inhibits apoptosis/autophagy in [non-small cell lung cancer] cells by activating nicotinic acetylcholine receptors (nAChRs), especially the α7 subunit, and its downstream signaling pathways ..." Alsharairi 2022
3. "In utero nicotine exposure in pregnant rats showed deleterious impacts on fetus growth and weight, as well as placental size. These were accompanied by increased apoptosis within the placenta, as revealed by Bax gene upregulation." Alzu’bi 2022
4. "Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. Analysis showed 51.3% of current users ... and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85) ... compared to never e-cigarette users." Antwi 2022
5. "Varying strengths of nicotine concentration were examined for toxicity on head and neck cells. The use of electronic cigarettes (e-cigarettes) caused changes to cell size and shape and reduced cell viability and cell proliferation." Baniulyte 2022
6. "Animal studies investigating the effect of gestational nicotine exposure on fetal lung development demonstrated abnormal lung growth; including abnormal airway branching and alveolar development. Consequently, offspring display altered pulmonary mechanics, including both increased respiratory rate and airway resistance. These findings mirror respiratory pathology observed in infants born to smoking mothers." Bednarczuk 2022
7. "Dihydroxyacetone (DHA) is a major byproduct of e-cigarette combustion and is the active ingredient in sunless tanning products. Mounting evidence points to its damaging effects on cellular functions." Belfleur 2022
8. "The association of e-cigarette use with depressive symptoms strengthened significantly from 2019 to 2021." Cambron 2022
9. "E-cig vapor, regardless of nicotine content, induced DNA damage in oral epithelial cells, along with a decrease in proliferation and cell viability. While the initial immune response is dampened in the presence of e-cig aerosols, under chronic conditions, e-cig aerosols have the capacity to induce an inflammatory response and COX2-mediated signaling, which could lead to cancer initiation." Cátala-Valentín 2022
10. "Despite emerging evidence linking obsessive-compulsive disorder and symptoms (OCS) and nicotine dependence (ND), this comorbidity has received little research." "Findings from this study lend support for the OCS-ND comorbidity in clinical and non-clinical populations and suggests that the OCS-ND link may be obscured when obsessive-compulsive phenomena is modeled as a dichotomous diagnostic variable versus as a dimensional construct." Chasson 2022
11. "We found that the e-liquids may impair the development of rat ovarian follicles and reduce estrogen secretion through Hippo signaling pathway." Chen 2022
12. "DNA adducts are central in the mechanism of carcinogenesis by genotoxic agents." "The median value of this DNA adduct in the e-cigarette users was 179 fmol/µmol dGuo ... while that for non-users was 21.0 fmol/µmol dGuo." "These results demonstrate for the first time that e-cigarette users have elevated levels of a carcinogen-DNA adduct in their oral cells." Cheng 2022
13. "A total of 154,856 participants were included, of whom 5% were e-cigarette users, 31.4% were traditional smokers, and 63.6% were nonsmokers." "Our regression analysis showed that e-cigarette users have 2.2 times higher risk of having cancer compared to non-smokers." Chidharla 2022
14. "In conclusion, nicotine has an extremely strong toxicological profile, as demonstrated by the drastic reduction of cell viability and the induction of morphological changes and nuclear alterations associated with cellular apoptosis." Chioran 2022
15. "[W]e characterized the variability in mass concentration and particle size distribution associated with the aerosol generation of different devices and e-liquid compositions in an experimental setup. The findings of this study indicate a large inter-day variability in the experiments ..." Das 2022
16. "Several cross-sectional, national, population-based studies on large groups of adolescents have been carried out showing an association between vape exposure and self-reported asthma diagnosis and/or respiratory symptoms in this age group." Di Cicco 2022
17. "The unfavorable responses of sympathetic and arterial pressure to EC [electronic cigarette] smoking are similar to those elicited by TC [tobacco cigarette] in healthy habitual smokers." Dimitriadis 2022
18. "Alterations in cardiovascular homeostasis, inflammation, and molecular changes following vaping exposure demonstrate vaping-related health concerns." Echeagaray 2022
19. "We recently reported a mouse model of chronic electronic cigarette (e-cig) exposure-induced cardiovascular pathology, where long-term exposure to e-cig vape (ECV) induces cardiac abnormalities, impairment of endothelial function, and systemic hypertension. Here, we delineate the underlying mechanisms of ECV-induced vascular endothelial dysfunction (VED), a central trigger of cardiovascular disease." El-Mahdy 2022
20. "The use of ENDS [Electronic Nicotine Delivery Systems] seems to be associated with erectile dysfunction independent of age, cardiovascular disease, and other risk factors." El-Shahawy 2022
21. “Triple-negative breast cancer is more aggressive than other breast cancer subtypes ..." “We ... detected that nicotine significantly reduced the increase in cell apoptosis induced by paclitaxel treatment. Moreover, the presence of nicotine reduced the efficacy of paclitaxel treatment administered in three cycles to MDA-MB-231 tumor cells.” Español 2022
22. "This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems ..." Farrell 2022
23. "E-cigarette use is increasing at an alarming rate, particularly among adolescents and young adults. This is concerning given the lack of research into the effects of nicotine vapor exposure on the brain and behavior. The present study describes a viable rodent model of human e-cigarette use and suggests that exposure to nicotine vapor produces short-term increases in impulsive choice." Flores 2022
24. "A total of 71,940 women were included in our study. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, physical abuse during pregnancy, and complications during pregnancy, the odds of unfavorable birth outcomes increase by 62% among women who reported e-cigarette use during pregnancy versus women who did not." Galbo 2022
25. "Changes in blood pressure and arterial stiffness are similar after cigarette smoking and JUUL use. These changes may be associated with an increased cardiovascular risk compared with no product use." Gernun 2022
26. "This study investigated the differential adverse effects of heating-associated by-products versus the intact components of EC aerosol to the lungs and heart of mice." "EC aerosol exposure induced pulmonary and systemic inflammation." "Heating-associated by-products contributed to RV hypertrophy and dysfunction." "EC aerosol exposure without heating the e-liquid induced pulmonary fibrosis." Getiye 2022
27. "Flavor chemicals contribute to the appeal and toxicity of tobacco products, including electronic nicotine delivery systems (ENDS)." "A large library of 3012 unique flavor chemicals was compiled ..." "Computational analysis of the constructed flavor library flagged 638 chemicals with GHS classified respiratory health hazards, 1079 chemicals with at least one structural alert, and 2297 chemicals with substructural similarity to FDA's established and proposed list of HPHCs (Harmful and Potentially Harmful Constituents)." Goel 2022
28. "After excluding missing data, there were 1,173,646 participants. The adjusted odds ratio of visual impairment in current e-cigarette users compared with never e-cigarette users was 1.34 (95% confidence interval [CI] 1.20-1.48), and in former e-cigarette users was 1.14 (95% CI 1.06-1.22)." Golla 2022
29. "In the present study, the effects of maternal nicotine exposure (MNE) during pregnancy on fetal heart morphogenesis were studied." "In conclusion, MNE induces congenital heart defects and coronary artery malformation in mice." Greco 2022
30. "4th generation e-cigarette users had significantly more bronchial epithelial cells in sputum, suggestive of airway injury." Hickman 2022
31. "Comparing aorta segments from nicotine-treated mice relative to an equal number of control counterparts, stiffness in the circumferential direction was nearly twofold higher (377 kPa ± 165 kPa versus 191 kPa ± 65 kPa, n = 5, p = 0.03) at 50% strain." Ho 2022
32. "In rodent models, nicotine administration nearly doubles the amount of opioids taken in intravenous self-administration paradigms." "In conclusion, acute nicotine administration in adult male rats significantly enhances compulsive-like responding for [synthetic opioid remifentanil] that persists despite contingent punishment of drug-directed responding." Honeycutt 2022
33. "E-cigarette vendors started marketing synthetic cooling agents as additives that impart a cooling effect but lack a characteristic minty odor. Knowledge about content of synthetic coolants in US-marketed E-cigarette products and associated health risks is limited." "Synthetic cooling agents (WS-3/WS-23) were present in US-marketed E-cigarettes, at levels that may result in consumer exposures exceeding safety thresholds set by regulatory agencies." Jabba 2022
34. "Suicide attempts were significantly higher among e-cigarette users compared to non-users. E-cigarette use was associated with depression, suicidal ideation and suicide attempt." Javed 2022
35. "Adolescents and young people" ... "who used e-cigarettes had 1.5 times higher odds of reporting oral lesions." Alade 2022
36. "Tobacco-specific nitrosamines (TSNAs) ... NNN and NNK are known carcinogens." "To understand the drivers behind the potential formation of TSNAs in electronic cigarette (e-cigarette) aerosols and e-liquids, model e-liquid systems were generated in the lab to demonstrate that nitrite can react with nicotine and minor alkaloids to form TSNAs in e-liquids." Jin 2022
37. "[W]e assessed the mass of metals as a function of EC flavoring, nicotine concentration, device power, puff duration, and aging of the devices. The masses of Cr, Cu, Mn, Ni, Cu, and Zn were consistently high across all brands in the primary and secondhand aerosols, some of which were above the regulated maximum daily intake amount ..." Kapiamba 2022
38. "E-cigarette vapers practiced exclusive nasal exhalation at far higher rates than did cigarette smokers (19.5% vs 4.9%)." "It is therefore plausible that ATP-specific [alternative tobacco product] consumer behaviors may foster unique upper respiratory health consequences that have not been observed in smokers." Karey 2022
39. "Nicotine induces kinetic tremor, which resembles pharmacological features of essential tremors, via activating the inferior olive (IO) neurons." "The present study suggests that dopamine D3 and D1/5 receptors regulate the induction of nicotine tremor in an opposite way, D3 receptors facilitately and D1/5 receptors inhibitorily." Kato 2022
40. "Some of the most concentrated and prevalent flavorants in e-liquids include trans-cinnamaldehyde, vanillin, and benzaldehyde. Aldehyde flavorants have been shown to react with PG and GL to form flavorant-PG and -GL acetals that have unique toxicity properties in e-liquids before aerosolization." Kerber 2022
41. “Nicotine … promotes angiogenesis, proliferation, and epithelial-mesenchymal transition while promoting growth and metastasis of tumors." "Nicotine contributes to the pathogenesis of a wide range of cancers including breast cancer through its carcinogens such as NNK and NNN." Khodabandeh 2022
42. "Many electronic cigarette manufacturers have offered different types of 'high-end mods' that allow for controlled heating of the e-liquid. However, the controlled heating condition can drastically alter the inhaled aerosols’ physical properties and chemical substances, causing potential health risks." Ko 2022
43. "E-cigarette liquid (e-liquid) is mainly composed of propylene glycol (PG) and glycerol (Gly), and the aerosol generated by these devices primarily contains these two components." "PG damaged SAECs [small airway epithelial cells] more than Gly. In addition, COPD-SAECs were more susceptible to PG than SAECs without COPD. Usage of e-cigarettes may be harmful to the respiratory system, especially in patients with COPD." Komura 2022
44. "Ruthenium-bispyridine (RuBi) complexes are photolyzed by biologically harmless visible light. In the present study, we show that RuBi-caged nicotine can be used as a source of free nicotine to induce proliferation of A549 nonsmall-cell lung cancer (NSCLC) cells by acting on nicotinic acetylcholine receptors expressed in these cells." Kravchuk 2022
45. "Mice exposed to PG/VG, Apple, Cherry, and Wintergreen increased MMP2 levels. Our results revealed flavor- and sex-based e-cigarette effects in female mice exposed to cherry-flavored e-liquids and male mice exposed to tobacco-flavored e-liquids, namely, increased lung inflammation." Lamb 2022
46. "Diacetyl (DA) is an α-diketone that is used to flavor microwave popcorn, coffee, and e-cigarettes." "In this study ... [t]ranscriptomic analysis demonstrated cilia dysregulation, an increase in hypoxia and sterile inflammation associated pathways, and decreased expression of interferon-stimulated genes after DA exposure." Langel 2022
47. "There are sparse data on the specific effects of electronic cigarettes and smokeless tobacco in pregnancy." Layoun 2022
48. "Taken together, this study shows that the glycerol contained in vaping liquids can affect the liver as well as the aspects of glucose and glycerol homeostasis." Lechasseur 2022
49. "Nicotine, a psychoactive alkaloid found in tobacco, is associated with the development of gastric cancer." Li 2022
50. Among 483,948 middle- and high-school students, the "median prevalence of ever E-cigarette use was 11.2% ... and current use was 7.5% .... Overall, E-cigarette use was associated with significantly higher odds of having asthma (pooled OR=1.31, 95% CI=1.22, 1.42) than nonuse, and both current use (OR=1.36, 95% CI=1.26, 1.48) and ever use (OR=1.20, 95% CI=1.12, 1.28) showed similar associations." Li 2022
51. "Nicotine, a major alkaloid found in tobacco, is a significant risk factor for gastric cancer." "In this study, we found that nicotine induces IL-8 expression via ROS/NF-κB and ROS/MAPK (Erk1/2, p38)/AP-1 axis in gastric cancer cells, thus stimulating endothelial cell proliferation and angiogenesis in the tumor microenvironment." Lian 2022
52. "We found that e-cigarette aerosol contains certain harmful organic chemicals and metals documented to result in respiratory problems. Estimated respiratory cancer risks corresponding to chromium from both ENDS [electronic nicotine delivery systems] products and nickel from Air Bar (Watermelon Ice) were substantially above the conventionally acceptable risk." Lin 2022
53. "In the population, 1,447 (17.4%) were reported to be binge drinkers. Significant factors associated with binge drinking in the final model included ... smoking/e-cigarette use (Cigarette user only aOR = 2.11 (1.69-2.65); E-cigarette user only aOR = 2.67 (1.62-3.17); dual cigarette and e-cigarette user = 3.43 (2.21-5.33)." Lines 2022
54. "Taken together, our data demonstrate for the first time that flavored and nicotine-containing e-cigarettes induce endothelial dysfunction through excessive ROS production, resulting in decreased NO bioavailability, increased endothelial cell apoptosis, and impairment in angiogenesis and wound healing, especially under diabetic condition." Liu 2020
55. "We report a case of three seizures provoked by e-cigarette use (vaping) within the time span of five years from youth to young adult." "Each seizure occurred within minutes of vaping, thereby suggesting a temporal association and a possible causal relationship between e-cigarettes and seizures." Liu-Zarzuela 2022
56. "Despite the increasing popularity of e-cigarettes, their long-term health effects remain unknown." "Our stable isotope tracing experiments provide further evidence that thermal decomposition of vegetable glycerin in the e-cigarette solvent leads to generation of acrolein and glycidol. This suggests that the adverse health effects of e-cigarettes may be attributable in part to these reactive compounds formed through the process of aerosolizing nicotine." Lorkiewicz 2022
57. "Vaping has been reported to cause acute epiglottitis, a life-threatening airway obstruction induced by direct epithelial injury and subsequent inflammatory reaction. Here, we show that we were able to recapitulate this phenomenon in vitro." Lungova 2022
58. "Most vapers in the United Kingdom and the United States want to stop vaping (62% vs 61%) but US respondents plan to quit significantly sooner..." Machado 2022
59. "The study found that higher depressive and anxiety symptoms and higher impulsivity were significantly associated with current cigarette and e-cigarette use. For example, one unit increases in depression, anxiety, and impulsivity were associated with 34%, 17%, and 38% increased odds of e-cigarette use versus non-use, respectively." Masaki 2022
60. "Collectively, these findings indicate that paternal nicotine taking produces heritable sex-specific molecular changes that promote addiction-like phenotypes and memory impairments in male offspring." Maurer 2022
61. "Young adults involuntarily exposed to vapor from ENDS express elevated whole salivary cotinine and IL-1β levels. Long-term exposure to ENDS vapor may potentially predispose vulnerable populations to oral and systemic inflammatory diseases." AlMubarak 2022
62. "Finally, research using the preclinical models has demonstrated synergistic interactions between developmental nicotine exposure and repetitive mild traumatic brain injury that contribute to "worse" outcomes from the injury in individuals with attention deficit hyperactivity disorder associated with developmental nicotine exposure." McCarthy 2022
63. "Temporal influences of electronic cigarettes (Ecigs) on blood vessels are poorly understood." "These data show that exposure to cigarettes and Ecigs triggers a similar level/duration of cerebrovascular dysfunction after a single exposure." Mills 2022
64. "In conclusion, the results of the present study suggested that nicotine exposure suppressed the proliferation and promoted the death of 16HBE cells ... These findings indicated that nicotine treatment induced pyroptosis in 16HBE cells, which may be associated with the progression of COPD." Mo 2022
65. "Ethyl ester flavor additives are used in e-liquids to produce a citrus flavor. Although these compounds are considered safe as flavor additives, this only applies to oral consumption and not vaping operations, where they can decompose into potentially harmful compounds including carboxylic acids." Narimani 2022
66. "Combined with previous evidence of lower e-cigarette use following the minimum legal age law, our findings indicate that youth e-cigarette use increases risks of mood and anxiety disorders." Nguyen 2022
67. "Compared to control animals with no smoke exposure, there were significant decreases in the numbers of goblet cells within the ET [eustachian tube] mucosa of mice exposed to tobacco smoke and e-cigarette vapor." Nicholas 2022
68. Osteoblasts are cells within bone that develop new bone. E-cigarette vapour "can significantly reduce osteoblast viability and impair osteoblast function." Nicholson 2022
69. "This review identified six EVDS-induced [electronic vapor delivery systems] pulmonary implications warranting anesthetic consideration: alterations in pulmonary function tests, disrupted ventilation, impaired mucociliary clearance, tissue destruction, a disrupted immune response, and oxidative stress with DNA fragmentation." Novelli 2022
70. "Our study demonstrates that disposable Puff ECs have high levels of cytotoxic chemicals." Omaiye 2022
71. "[S]moking is a major cause of pulmonary disease due to pulmonary/lung inflammation." "Our data indicate that certain e-liquids induce an inflammatory response in our zebrafish model and that e-liquid exposure alone results in pro-inflammatory lung responses in our C57BL/6J model, data collected from lung staining and ELISA analysis, respectively, in the mouse." Onyenwoke 2022
72. "[E]xposure to e-cig aerosols during pregnancy raises concern for maternal and fetal health." "Morphologic assessment of distal airspaces in neonatal lungs display an emphysematic phenotype. Respiratory mechanics of neonates display signs of increased respiratory workload, with increased resistance and decreased compliance. These data are novel and provide evidence that prenatal e-cig exposure may result in altered lung function or development of disease." Orzabal 2022
73. "Stroke was more prevalent among traditional smokers than among e-cigarette smokers. (6.75% vs. 1.09%)" "E-cigarette smokers had early onset of stroke in comparison with traditional smokers (median age: 48 vs. 59 years)." Patel 2022
74. “From the present study, it could be concluded that nicotine significantly induced rectal cancer in the mice model by modulating gut microflora and increasing COX-2 and prostaglandin E2 levels.” Peng 2022
75. "There is currently insufficient information available regarding the perioperative implications of electronic cigarettes ... These substances affect the cardiovascular, respiratory and immune systems, and can interact with multiple drugs, which can affect the anesthetic management." Pereira 2022
76. "Our results indicate that nicotine exposure through breastfeeding leads to long-lasting behavioral effects and synaptic protein changes" Pereira-Junior 2022
77. "E-liquid exposure induces bladder cancer cells to release extracellular vesicles that promote non-malignant urothelial cell transformation." "Strikingly, menthol E-liquid-induced BCEVs significantly increased rates of malignant urothelial cell transformation." Molony 2023
78. "In this study, we provide evidence that nicotine induces Nox5-mediated pro-calcific processes as novel mechanism of increased atherosclerotic calcification." Petsophonsakul 2022
79. "This review aims to discuss the significant effect that E-cig use has on the BC [breast cancer] tumor microenvironment, which ultimately leads to enhanced tumor malignancy and metastasis ..." Pham 2022
80. "This study demonstrates that e-cigs, at high-power setting, should be considered, contrary to popular belief, as hazardous products in terms of genotoxicity in mouse model." Platel 2022
81. "Prenatal exposure to nicotine, tobacco's major addictive constituent, has been shown to reduce birth weight and increases apoptosis, oxidative stress, and mitochondrial dysfunction in the postnatal pancreas." Raez-Villanueva 2022
82. "A wide range of ENDS, including multiple types of e-cigarettes with and without nicotine, a heated tobacco product, and an ultrasonic vaping device devoid of heating coil, all impair FMD [arterial flow-mediated dilation] after a single vaping session comparably to combusted cigarettes." Rao 2022
83. "The use of electronic cigarettes is documented to increase the risk of myocardial infarction and stroke." "Spontaneous intracerebral hemorrhage (sICH) is a deadly stroke subtype, and tobacco use increases sICH risk." "Our data in the present study show that nicotine exposure increases hematoma expansion and neurological impairment post-sICH in both male and female rats." Rehni 2022
84. "EC use is significantly associated with a high prevalence of CRS [chronic rhinosinusitis] and AR [allergic rhinitis] in the adult population. These results indicate that the use of ECs may increase the risk of upper airway disease." Rha 2022
85. "Oral squamous cell carcinoma (OSSC) is a common malignancy affecting 30,000 people in the United States each year. Our objective was to determine the impact of eCig and nicotine on gingival OSSC invasion and their secretion of pro-inflammatory molecules." "These results support the already established data showing that nicotine promotes oral carcinogenesis." Robin 2022
86. "Nicotine, the most abundant smoke component, deposits on indoor surfaces during smoking and reacts with pollutants in the indoor environment to form a mix containing toxic and carcinogenic chemicals. More specifically, surface-bound nicotine reacts with nitrous acid (HONO), a common atmospheric species that is emitted from indoor combustion appliances and smoking, to produce tobacco-specific nitrosamines (TSNAs) including NNA, NNK and NNN." Sarker 2022
87. "Cases of intentional or accidental intoxication following ingestion of the refill solution are also a growing concern. Most of these cases were fatal and related to cardiac arrest and hypoxic brain injury." Sellner 2022
88. "While e-cigarettes have the potential to promote smoking cessation, their real-world impact is uncertain. In this cohort, dual users were more likely to quit smoking than cigarette-only users, but the overall impact was small because most dual users returned to cigarette-only use." Shafie-Khorassani 2022
89. Myocardial infarction (MI) is a heart attack. "Those using e-cigarettes have higher odds of suffering from an MI in comparison to not using e-cigarettes." Sharma A 2022
90. "Nicotine binding to nAChR promotes proliferation, migration, invasion, chemoresistance, radioresistance, and metastasis of oral cancer cells." "Since nAChRs dictate both addictive and carcinogenic effects of nicotine, it seems counterintuitive to designate nicotine just as an addictive agent devoid of any carcinogenicity." Sharma M 2022
91. "The short and long-term health effects of JUUL electronic cigarette (e-Cig) are largely unknown and warrant extensive research." "We exposed male C57 mice to TS/JUUL vapor for 14 days." "Post-ischemic brain injury following tMCAO [transient middle cerebral artery occlusion] was significantly worsened by JUUL/TS pre-exposure." Sifat 2022
92. Among 5,207 matched youth (school engagement, thrill-seeking, delinquency, peer & parent smoking, parental education), youth using e-cigarettes by age 14 were 2.7 times more likely to use cocaine by age 17 than nicotine naïve youth (7.6% vs. 3.1%) Silva 2022
93. "E-cigarette aerosols induced moderate cellular toxicity in bronchial epithelial cells." Sinha 2022
94. "Coil-less ENDS offer the promise of delivering fewer toxicants due to the absence of heating coils, but initial studies show that these products exhibit similar toxicological profiles compared with JUULs." Strongin 2022
95. "Our study showed differences in the analyzed personality traits between e-cigarette users and never smokers. The study group had significantly higher levels of neuroticism and lower levels of extraversion and conscientiousness than the control group." Suchanecka 2022
96. "Nicotine dependence plays a vital role in an individual's anxiety and depression level. Higher the nicotine dependence, higher their anxiety and depression level." Sushanthi 2022
97. "We propose that E-cig nicotine can be nitrosated in mouse and human cells becoming nitrosamines, thereby causing two carcinogenic effects, induction of DNA damage and inhibition of DNA repair, and that e-cigarette aerosol is carcinogenic in mice." Tang 2022
98. "E-cig aerosols contain unique chemicals which alter the oral microbiome and promote dysbiosis in ways we are just beginning to investigate." "Yet there is little evidence of the effects of long-term use of e-cigs on oral health." Thomas 2022
99. "The odds ratios of "inflammatory arthritis diseases were 1.31 and 1.55 among sole e-cigarette and dual users compared with never e-cigarette users, respectively." Tian 2022
100. "Brain metastasis is the most common malignancy of the central nervous system, occurring in up to 50% of lung cancer patients with a median survival of less than a year and at a rate twice to ten times higher than that of primary neural neoplasms." "Here, we showed that nicotine skews neutrophil polarization within the pre-metastatic brain niche and promotes metastatic colonization of lung cancer cells by regulating their stemness and energy metabolism." Tyagi 2022
101. "Here it will be shown how exposure to e-cigarette aerosol induces stress/mitochondrial toxicity, DNA breaks/fragmentation following the same pathological pathways triggered by tobacco smoke, including the deregulation of molecular signalling axis associated with cancer progression and cell migration." Vivarelli 2022
102. "As extracellular vesicles (EVs) are involved in intercellular communication in atherosclerosis, we investigated whether their influence on arterial pathophysiology under nicotine stimulation." "Nicotine exacerbates endothelial dysfunction and drives atherosclerosis via extracellular vesicle-miRNA." Wang C 2022
103. "[W]e and others have developed animal models to demonstrate that childhood asthma induced by perinatal exposure to nicotine in F0 dams can persist for at least three generations in the absence of continuous perinatal exposure to nicotine in F1-F3." "Our data revealed that perinatal exposure to nicotine leads to alterations in the profiles of sperm-borne RNAs, including mRNAs and small RNAs ..." Wang H 2022
104. "It was revealed that the toxicity mechanism and related signal pathways of e-cigarettes were similar to those of cigarettes, such as inflammation response, oxidative stress, and DNA damage. Additionally, since e-cigarettes have been on the market for less than 20 years, most studies have assessed the short-term effects of e-cigarettes based on acute exposure. Little is known about chronic effects, especially in humans." Wang L 2022
105. "From the present study, it could be concluded that nicotine significantly induced rectal cancer in the mice model by modulating gut microflora and increasing COX-2 and prostaglandin E2 levels." Wang P 2022
106. "Collectively, our results depicted a novel and clinically important mechanism of chemoresistance in small cell lung cancer (SCLC) treatment: nicotine exposure significantly compromises the efficacy of platinum-based chemotherapies in SCLC treatment by reducing therapy-induced DNA damage and accelerating chemoresistance acquisition." Wang Y 2022
107. "Children who have prenatally been exposed to nicotine tend to have lower birth weights, with an elevated risk of becoming overweight throughout development and into their adolescent and adult life." White 2022
108. "Our study demonstrates that nicotine inhalation alters the gut microbiome in a sex-specific manner, which may contribute to the adverse health consequences of inhaled nicotine." Whitehead 2022
109. "Nicotine addiction remains one of the easiest addictions to fall into, can develop rapidly and one of the toughest addictions to get rid of. Once addicted, people take tobacco products to deliver the desired dose of nicotine as body demands and there is individual variation regarding the intervals between the dose and the rate of delivery." Widysanto 2022
110. "Aberrant morphology, cytotoxicity, oxidative stress, reduced viability, delayed fibroblast migration, and genotoxicity were statistically significant when the head, neck, and oral cells were exposed to e-cigarettes."Wilson 2022
111. "In this nationally representative cohort of young adults, former and current e-cigarette use was associated with higher odds of developing wheezing-related respiratory symptoms, after accounting for cigarette smoking and other combustible tobacco product use." Xie W 2022
112. "By comparison, never users and ex-smokers had the best overall self-reported mental health, with 2.49 days and 2.76 days (out of 30 days) of having bad mental health. Relatively, exclusive vapers and current vapers who were ex-smokers had worse self-reported mental health, with 5.45 and 5.16 days of having bad mental health." Xie Z 2022
113. "Several states have included e-cigarettes in their comprehensive smoke-free indoor air laws (i.e., aerosol-free policies), prohibiting the use of e-cigarettes--in addition to combustible tobacco products--in workplaces, restaurants, and bars." Yang 2022
114. "Our findings indicate people carrying an ALDH2*2 genetic variant may be more susceptible to increases in cardiovascular oxidative stress from e-cigarette aerosol exposure." Yu 2022
115. "Nicotine ... promotes activation of pancreatic stellate cells (PSCs) and exacerbates pancreatic fibrosis in previous studies." "Nicotine induces mitochondrial oxidative stress (OS) in hPSCs." Yuan 2022
116. "The results of the present study demonstrated that nicotine upregulated miR-21-3p in lung cancer cells, leading to suppression of the proapoptotic protein FOXO3a and subsequent proliferation of tumor cells, therefore resulting in chemoresistance." Zhang 2022
117. "Metallic parts of electronic cigarette cartridges and devices can result in exposure of users to various metals including (but not limited to) chromium (Cr), lead (Pb), nickel (Ni), and tin (Sn), all of which can be found in e-cigarette hardware such as heating coils and solder joints." "Overall, e-cigarettes are a source of exposure to a wide variety of toxic metals." Zhao 2022

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While true that nicotine is a highly addictive natural insecticide and that once hooked it's as permanent as alcoholism, during and after recovery it's impossible to fail so long as all nicotine remains on the outside.

Nicotine's 2-hour elimination half-life guarantees that with 72 hours of ending nicotine use, your body will become 100% nicotine-free and your brain will have no choice but to begin the process of restoring natural sensitivities, as you sense moving beyond peak withdrawal. The worst behind you, within 21 days you'll begin feeling normal again as your brain completes the process of down-regulating receptor counts to levels seen in non-smokers.

There was always only one rule. On comfortable probation for the balance of life, for us, one puff will always be too many, while thousands won't be enough. Yes, just one rule ... no nicotine today ... to Never Take Another Puff!

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John R. Polito received his JD from the University of South Carolina School of Law in 1985, where he graduated Wig & Robe. He is a former 3-pack-a-day thirty-year smoker and the 1999 founder of WhyQuit. A nicotine cessation educator since 2000, John mentored under Joel Spitzer for two decades, presenting more than 100 live nicotine dependency recovery programs modeled after Joel's programs. He is the author of "Freedom from Nicotine - The Journey Home," "Smart Turkey," and 6 peer-reviewed journal articles. John is the founder and director of Turkeyville, a 15,000-member Facebook support group exclusively for cold turkey quitters. Email: johnpolito54@gmail.com

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