Youth E-cigarette Use Remains Serious Public Health Concern Amid COVID-19 Pandemic

In addition, the research team delivered increasing concentrations of the nicotine over time, from 1% to 2.5%, to 5%. Another potential risk in studies of this type is the use of nonallocated products. As in previous studies, a much higher proportion of participants in the EC arm than in the other arms continued to use their product throughout the study period (63% vs 0%). The key question about long-term switching from smoking to EC use is whether this is a positive or a negative outcome.

Analyses from the Population Assessment for Tobacco and Health study show that the leading reason for youth and young adult e-cigarette use is “they come in flavors I like” — with 77.9% and 90.3% selecting this as a reason, respectively. In comparison, only 66.4% of adults aged 25 and over selected this as a reason. Preliminary data published in Nicotine & Tobacco Research showed that after just two weeks of using This is Quitting, more than half of participants — 60.8% — reported that they had reduced or stopped using e-cigarettes. In our fight to end smoking, vaping and nicotine addiction, we focus on the issues that matter most. We constantly monitor the latest topics and trends in tobacco and substance use.

As originally drafted, the bill would have imposed the first statewide tax on electronic cigarette products, as well as setting the minimum age for purchases to 21 from 19, the age currently in state law. However, the tax provisions were stripped out of the bill in the state House. The report was released as the Legislature was considering a bill intended to reduce youth use of electronic cigarettes. Nearly half – 46% — of Alaska high school students reported trying an electronic vapor product at least once, the report said. But use of electronic cigarettes rose from 18% in 2015 – the first year that metric was tracked — to 26% in 2019. The White House announced on April 26 that it would indefinitely delay the ban on menthol cigarette sales.

The most recent evidence suggests that e-cigarettes may pose their own unique health harms and that comparison to cigarettes may not be the only relevant question for determining their impact on individual health. Indeed, the growing evidence of potential health risks related to e-cigarette use has led some researchers to question whether e-cigarettes are safer than combustible cigarettes. Electronic cigarettes (e-cigarettes) is the name given to a group of battery-operated tobacco products that allow users to inhale aerosolized liquid (e-juice) containing nicotine and other substances. E-cigarettes, also known as electronic smoking devices (ESD) and vaporizer cigarettes, are battery-operated devices that emit doses of nicotine and non-nicotine vaporized solutions that are inhaled. While their manufacturers say they are an alternative for tobacco smokers who want to avoid inhaling smoke, critics say too little is known about the safety of ESDs because they are not regulated. E-cigarettes are sometimes called e-cigs, vapes, e-hookahs, vape pens and electronic nicotine delivery systems (ENDS).

E-cigarette use has increased 78 percent in one year for high schoolers and 48 percent in middle schoolers. Additionally, the CDC reports nearly 38 percent of all high schoolers and even 13 percent of middle schoolers have tried “vaping” at least once, and those statistics likely are underreported. Drawn to the fruity flavor cartridges, or trying to wean from traditional tobacco products, or even to curtail hunger, many people believe e-cigarettes or “vaping” is safer than smoking cigarettes and simply not addictive. As shown in Table 1, the majority of the 1624 respondents were males (61.2%), young adults between 25 and 34 years old (56.9%), Whites (59.4%), and had at least a bachelor’s degree (66.8%). The majority of respondents had used e-cigarettes between two and five years (69.6%) and 79.8% had moderate or strong intentions to quit. The percent of respondents saying they used e-cigarettes because of the added flavors or for quitting smoking cigarettes were 54.4% and 36.6%, respectively.

After 2021, there have not been any new applications for MRTP authorization in the pipeline. The 16 authorized MRTPs represent a fraction of a market with hundreds of commercial brands and many other forms of tobacco. A third bill requires the state Departments of Health and Education to develop and distribute anti-vaping materials to schools. The bills need to be passed by the full Assembly and the state Senate and signed by Murphy before they become law.

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. Some people believe e-cigarettes may help lower nicotine cravings in those who are trying to quit smoking. However, e-cigarettes are not an FDA-approved quit aid, and there is no conclusive scientific evidence on the effectiveness of vaping for long-term smoking cessation.

A 1.5-minute video that explains what e⁠-⁠cigarettes are and how they operate. A producer is anyone who manufactures or imports these products or who re-brands any product as their own.Retailers do not need to submit information for any products they sell unless they also qualify as a producer. “There’s still some hesitancy to prescribe this very safe – now generic – drug, and it really shouldn’t be that way,” Toll said. Alcohol and Drug Foundation’s services are here to support communities across all states and territories.

Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research. Vaping hasn’t been around that long, so its health risks aren’t all known. While flavors were nationally banned in 2019, this ban excludes mint and menthol flavors.

The intent behind this bill is to try to keep vape products out of the hands of children. Florence says that vapor stores cater to adults and that stores are either 21 and up or age-gated to prevent kids from accessing the products. Another research team collected weekly Google search rates related to online shopping for cigarettes and vaping products in California from January 2018 to May 2023. They found that shopping queries were 194% higher than expected for cigarettes and 162% higher than expected for e-cigarettes – which suggests consumers are searching on Google for vendors promoting banned products.

The city of Milwaukee last year changed its zoning regulations to prevent e-cigarette or tobacco retailers from opening within 500 feet of similar businesses or 1,000 feet of schools. The city of Monona has adopted a six-month ban on new vape shops, after three shops opened in recent years and the city rejected a fourth following the police chief’s concerns about its proximity to schools. Nguyen Anh Tri, former head of the National Institute of Hematology and Blood Transfusion, also agrees that e-cigarettes are an addictive substance and carcinogenic. Earlier last month, Minister of Health Dao Hong Lan said the ministry’s consistent stance is to ban e-cigarettes. That compares to adult rates for vaping, which at 6% in 2021 was little changed from the 7% reported in 2015. But the use of smokeless tobacco of all types remained constant statewide at 6% over the past 10 years.

Get the latest facts and analyses on the most important issues related to smoking, vaping, nicotine and substance use. If, at the time of application, the applicant holds a valid cigarette, cigar and/or tobacco retailer permit for the same business location, use Permit Fee Table Two below to calculate the permit fee due. If, at the time of application, the applicant does not hold a valid cigarette, cigar and /or tobacco retailer permit for the same business location, use Permit Fee Table One below to calculate the permit fee due. It’s easy to renew your retail tobacco and e-cigarette permits online. Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others.

The researchers also raise concerns about risks of short- as well as long-term use of EVPs. That’s up to the e-cigarette companies, because the companies get to decide what kind of authorization they want to seek from FDA. There’s no reason why an e-cigarette company can’t say, “Thank you, Center for Tobacco Products, but we’d rather our product be regulated as a drug and we’re going to submit applications to the Center for Drug Evaluation and Research.” That’s their choice.

This conclusion was widely reported by Chinese media during the next year or so and discussed repeatedly at the WeChat forum, and we estimate that it led some 20% of participants in the EC arm to stop EC use. As a result, we estimate that some 15% of participants in the varenicline arm stopped using their product. These events may have reduced quit rates in the EC and varenicline arms, but this would dilute rather than amplify the difference between these 2 arms and the NRT arm. Another external event affecting the trial was the COVID-19 pandemic.

Compared with heterosexual individuals, persons who identified as bisexual had a higher prevalence of current e-cigarette use (12.2% [95% CI, 11.0%-13.7%] vs 6.8% [95% CI, 6.6%-7.1%]) and daily e-cigarette use (6.5% [95% CI, 5.4%-7.8%] vs 3.2% [95% CI, 3.0%-3.3%]). We summarized participant sociodemographics and chronic health conditions using proportions for the entire sample and for those reporting current and daily e-cigarette use. We calculated the age-standardized prevalence of current and daily e-cigarette use overall, within subgroups including combustible cigarette use categories (never, former, or current), and across age groups. Household income level was based on the 2021 federal poverty line.20 Weight and height were self-reported; body mass index was calculated as weight in kilograms divided by height in meters squared.

Nicotine exposure during this vital time can affect brain development in subtle and important ways. Their brains are still developing and forming the structure and connections necessary for the mature behavior of adulthood. Research published in 2017 found that the high temperatures needed to form the mist for vaping can create dozens of toxic chemicals, such as formaldehyde, which is thought to cause cancer. There are currently 78 licensed tobacco retailers in unincorporated Sonoma County, representing 23 percent of the total tobacco retailers throughout the county including cities. 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.

The Federal Trade Commission’s first-ever report on e-cigarette products paints a disturbing picture of surging e-cigarette sales and advertising that are likely to damage the health of America’s youth. “People can get to very high levels of nicotine exposure with these e-cigarette products, and they can use them near constantly throughout the day. So, the question we all have is, ‘Can any pharmacotherapy stand up to this challenge? Talk to your patients, including youth and young adults, about the dangers of tobacco use. Screen all patients, encourage them to quit, and refer patients to evidence-based services for help quitting.

A survey by the WHO and the health ministry on students in 11 localities revealed that the rate of using e-cigarettes among students has been consistently rising among certain age groups. They are addictive as they contain nicotine, can cause diseases like cancer, and affect one’s mental health. With the menthol cigarette ban uncertain, the path for low-risk tobacco product authorization needs to be reimagined to nationally increase MRTP availability, access, and appeal among people who use menthol cigarettes. For example, one study among people who smoke showed that hypothetical general claims about completely switching to a heated tobacco MRTP outperformed specific claims—such as switching from cigarettes will reduce the risk of lung cancer and exposure to arsenic.

And studies show that brands claiming to be “nicotine-free” may still have trace amounts. Developing teenage brains are especially sensitive to nicotine’s addictive properties. Surgeon General’s Report on e-cigarette use among youth and young adults became the first report issued by a federal agency that carefully reviewed the public health issue of e-cigarettes and their impact on our nation’s young people.

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. As with high school students, e-cigarette use was much more common than cigarette use. The Texas Tobacco Quitline offers free, confidential, and convenient cessation services to Texas residents ages 13 and older. This includes quit coaching, up to 2 weeks of nicotine replacement therapy, and a youth digital program for those ages 13-17. The AHA supports maintaining the Food and Drug Administration’s regulatory authority over e-cigarettes along with other tobacco products. Some e-cigarette brands and other nicotine products state they contain synthetic nicotine rather than nicotine made from or derived from tobacco.

That makes vaping them especially likely to cause negative side effects or long-term health problems. Rigotti noted that some studies indicate that as many as half of those who vape are attempting to quit every year but a lot of them are having trouble. While there is research suggesting the benefits of text messaging programs and behavioral support, as well as stories of the effectiveness of varenicline (Chantix) for vaping cessation, Rigotti noted there is no data to prove that these are effective. The word ‘vapor’ might sound like a harmless cloud of water, but e-cigarette liquid – even when nicotine-free – is full of chemicals, sometimes including toxic metals like arsenic, chromium, nickel, lead, and uranium. Sward points out that according to the FDA, there’s no evidence any e-cigarette is safe and effective at helping smokers quit. She suggests talking to your doctor about medications and other strategies that are proven stop-smoking tools.

A leaflet was provided with information on where the products could be bought. The study started recruitment in May 2021 and completed all follow-ups in December 2022. Ventilation, filtration and air cleaning techniques may reduce harmful substances released from e-cigarette use indoors but are not likely to eliminate them. E-cigarettes refers to the device and vaping is the use of the device.

For example, in a previous large trial comparing EC and NRT conducted within the stop-smoking services in the UK,13 75% of the participants had tried treatment with NRT in the past. This raises a concern that the results of EC comparisons with other treatments may apply only to smokers who did not experience results with the alternative treatments in the past. This study replicated the previous findings of ECs being more effective than NRT despite only 3% of participants having had tried treatment with NRT before. There is no good evidence that second-hand vapour from e-cigarettes is harmful. As vaping is still relatively new, we can’t be sure there aren’t any long-term effects to people who breathe in someone else’s vapour. E-cigarettes should only be used to help you stop smoking, or to stop you going back to tobacco.

Descriptive statistics and multinomial logistic regression models were applied. The retailers sold or distributed e-cigarette products in the U.S. that were not authorized by the FDA, putting them in violation of the Federal Food, Drug, and Cosmetic Act, the agency indicates. The warning letters also identified other brands that are popular with teens, according to retail sales data and internal FDA data from a survey among teen users.

Nicotine exposure damages adolescent brain development (learning, attention, impulse control), which does not end until one’s mid-20s. It also contributes to the hardening of the arterial walls, which in turn, may lead to a cardiac event. The aerosol, or “vapor,” produced by e-cigarettes is not a harmless, flavorful water vapor.

After this time, the footrest was abruptly lowered, and they were asked to stand up and remain still, an action known to increase cardiac sympathetic nerve activity. This action has been shown to unmask abnormal ventricular repolarization. CDC recommends you not use e-cigarettes or vapor products, especially those with THC. Fewer Pierce County youth are smoking cigarettes in recent years, but more are vaping. Vape pen and e-cigarette explosions from overheated, defective and/or modified device batteries have occurred, causing injury and serious health problems to users.

Numerous in vivo and in vitro studies have been performed to better understand the impact of these new inhalable compounds on human health. Results of toxicological analyses suggest that e-cigarettes can be safer than conventional cigarettes, although harmful effects from short-term e-cigarette use have been described. Worryingly, the potential long-term effects of e-cigarette consumption have been scarcely investigated. In this review, we take stock of the main findings in this field and their consequences for human health including coronavirus disease 2019 (COVID-19). The prevalence of e-cigarette use by adults in the United States continues to rise.

Over the years, we’ve learned that vapers like you want products fast – and delivered for free where possible.Our warehouse team works from 8am to 6pm, 6 days a week, to ensure that your orders get to you fast.Even better oxva xlim pro nz, you get FREE delivery on all orders over £20. The data collected show a dramatic increase in e-cigarette sales in general between 2015 and 2018 (from $304.2 million to $2.06 billion, respectively), as well as a similarly dramatic increase in the sales of cartridge e-cigarette systems such as Juul’s. The companies sold $260 million worth of such cartridge systems in 2015, with sales growing to $1.969 billion in just three years. Consumer advice and details of how to report problems with e-cigarettes with guidance on how to place an e-cigarette on the market in Great Britain and Northern Ireland, including the notification scheme. If a first try at quitting smoking doesn’t work, should the same method be tried again?

It is estimated that 4.5% among all adults in the United States and 11% among adults aged used e-cigarettes in 2021. While adults who switch from smoking combustible cigarettes to using nicotine e-cigarettes reduce their tobacco-related health risks, e-cigarettes products are not harmless and sustain nicotine dependence. In surveys, more than half of adults who vape nicotine plan to quit. Cytisinicline, if approved, could be the first prescription drug to help people who are ready to address their addiction to e-cigarettes. Achieve plans to conduct an End-of-Phase 2 Meeting with the FDA later this year to discuss future clinical trial requirements to pursue an indication for vaping cessation.

You will not get the full benefit from vaping unless you stop smoking cigarettes completely. Many thousands of people in the UK have already stopped smoking with the help of an e-cigarette. In absence of federal law, states are acting to remove flavored nicotine products from the shelves. Some people use vaping to curb their appetite, but there’s no proof that vaping helps with weight loss. If you think this is why your child vapes, talk to them about healthier ways to stay at a healthy weight or lose weight. Start by asking your child in a nonjudgmental, concerned way if they have tried vaping.

Over the years, Evans tried to quit by using the nicotine patch, gum, and even hypnosis. A 2015 expert review from Public Health England estimated e-cigs are 95% less harmful than the real thing. When you stop using it, you can go into withdrawal and feel depressed and crabby. This study was the first to use endothelial cells derived from iPS cells to directly investigate the effect of e-liquids with and without nicotine on their viability and function.

Since e-cigarettes often contain the same chemicals as traditional cigarettes, smoke produced by vaping may be toxic to people nearby. Manufacturers claim that e-cigarettes bypass many of the health risks of tobacco smoking, providing a healthful alternative. Manufacturers claim e-cigarettes are a safe alternative to smoking regular cigarettes.

The Ministry of Finance would instruct customs to manage the transportation of e-cigarettes through the border, and to tackle smuggling. The data about high school students in the new report is from the 2019 Alaska Youth Risk Behavior Survey, a system of anonymous questionnaires sponsored by the U.S. Of the three bills approved by the committee Monday, two deal directly with enforcement and penalties. One bill, A2388, would require vape retailers to be inspected at least twice every year to see if they are selling illegal products.

One of the most popular vaping devices, JUUL, has a sleek, modern design that resembles a USB drive. Other compounds that have been detected in aerosols include acetamide, a potential human carcinogen [5], and some aldehydes [69], although their levels were minimal. Interestingly, the existence of harmful concentrations of diethylene glycol, a known cytotoxic agent, in e-liquid aerosols is contentious with some studies detecting its presence [4, 68, 70,71,72], and others finding low subtoxic concentrations [73, 74].

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. Our blog has an easy-to-read guide on the latest vaping regulations and the changes to how you vape.

Drugwatch.com’s trusted legal partners support the organization’s mission to keep people safe from dangerous drugs and medical devices. Vaping may be safer than smoking for adults past their mid-20s who already smoke. But e-cigarettes are not safe for nonsmokers, teens, young adults or pregnant women, according to the CDC. However, the next day, Juul filed an emergency appeal that allowed it to continue selling its products until the FDA finishes a second review of safety data. In September 2022, the e-cigarette maker sued the FDA for refusing to disclose documents that led to the ban. The term “vaping” comes from the act of inhaling and exhaling e-cigarette vapor (which is actually an aerosol).

E-cigarettes have been strongly linked to continued tobacco use and are not recommended for young people. 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.

Beginning smoking, switching to smoking, or reverting to smoking exposes the user to potentially devastating health effects. E-cigarette, battery-operated device modeled after regular cigarettes. The e-cigarette was invented in 2003 by Chinese pharmacist Hon Lik, who initially developed the device to serve as an alternative to conventional smoking. In addition to the battery component, an e-cigarette comprises an atomizer and a cartridge containing either a nicotine or a non-nicotine liquid solution. When the device is operated, the battery heats the liquid in the cartridge, and the atomizer vaporizes the liquid, emitting it as a mist that the user inhales.

Since we stopped our attempted online purchases with placing items in an electronic shopping cart, this precluded our ability to examine whether age would have been verified at delivery and to calculate the actual purchase rate. However, only four websites in our study stated that age verification would actually occur at delivery. It remains unclear as to why flavored e-cigarettes are still available from online retailers in California.

The most recent data from the CDC’s 2019 National Youth Tobacco Survey confirms JUUL’s grip on America’s kids. More than 59% of high school e-cigarette users reported that JUUL was their “usual brand.” Among middle school e-cigarette users, the number was more than 54%. This equates to more than 3 million children reporting regular use of JUUL. Investigative reporting by Reuters shows that even early in its operations, JUUL was aware that its products were attracting unprecedented youth use, yet, in the face of enormous revenue growth smok vape pen 2, the company failed to take effective action to stem that trends. This work is part of a growing body of research on the potential toxicity and health impacts of e-cigarettes reported by the American Heart Association Tobacco Regulation and Addiction Center, for which UofL serves as the flagship institute. In the study, published in Nicotine and Tobacco Research, researchers compared heart rate and heart rate variability in mice exposed to vape aerosols containing different types of nicotine.

Small and sleek, these products can look a lot like a computer flash drive or pen. This makes it tricky for adults to recognize them right away as vaping tools. Pod-based e-cigarette devices are easy to hide in a fist or a pocket. The CDC’s Office on Smoking and Health (OSH) developed this presentation to educate youth on e-cigarettes, including the health risks, the factors that lead to e-cigarette use, and what youth can do to avoid all tobacco products, including e-cigarettes.

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. Vaping can cause breathing problems, organ damage, addiction and other conditions. Additionally, a study of adult smokers in Europe found those who vaped nicotine were less like to have stopped smoking than those who did not.

E-cigarettes are battery-powered devices that generate an inhalable aerosol that usually contains nicotine. With a 399.73% increase in retail e-cigarette sales (excluding internet sales and tobacco-specialty stores) from 2015 through 2020, the environmental consequences of e-cigarette waste are enormous. Dr. Baldassarri says that e-cigarettes do help some people quit smoking, which is a good thing tpms معنى, but points out that there is no long-term data on the safety of e-cigarette use itself.

Electronic smoking devices (ESDs) do not just emit “harmless water vapor.” Secondhand aerosol (incorrectly called vapor by the industry) from ESDs contains nicotine, ultrafine particles and low levels of toxins that are known to cause cancer. In May 2015, Oregon expanded the Oregon Indoor Clean Air Act (ICAA) to include the use of “inhalant delivery systems,” which include e-cigarettes, vape pens, e-hookah and other devices. Under the law, Oregonians may not use e-cigarettes and other inhalant delivery systems in workplaces, restaurants, bars and other indoor public places in Oregon. Instead of smoke from burning tobacco, e-cigarette users inhale aerosol, or vapor, consisting of nicotine, flavor additives and other chemicals. We have validated a simple, cheap and effective system for condensing vaped ECL vapour to enable in vitro work.

The FDA reports an alarming 900% rise in e-cigarette use among high school students from 2011 to 2015 and the number of high school students using them increased 78% in 2018 alone. Some individuals who smoke combustible tobacco products, such as cigarettes, cigars, and pipes, have been turning to electronic cigarettes (e-cigarettes) as an alternative to combustibles and as a smoking cessation tool. E-cigarettes are also commonly referred to as electronic nicotine devices, alternate nicotine devices, hookahs, vape pens, or e-cigs. Use of e-cigarettes and inhalation of their contents is known as vaping (American Cancer Society, 2022). Moreover, while the basic technology behind e-cigarettes is consistent, there is enormous variability within the product category and there is no typical e-cigarette. The products include different ingredients, different hardware and deliver highly variable amounts of nicotine and potentially toxic chemicals, including heavy metals such as cadmium, lead, nickel, tin and copper.

For example, tobacco-flavored e-cigarette cartridges sales dropped from 47.2% of those sold or given away in 2015 to 21% in 2018, while the sale of “other” flavored cartridges tripled in that time, increasing from 13.8% in 2015 to 42.1% in 2018. This was significant because Chantix, at one point, had a “black box warning” after reports linking the drug to psychiatric side effects. That warning was dropped in 2016 after a very large study showed the drug to be safe, but Toll and Fucito said the stigma of the warning remains in the minds of both health care providers and the general public. The American Association of Poison Control Centers, reports as of May 31, 2022, poison control centers have managed 2,451 exposure cases about e-cigarette devices and liquid nicotne in 2022. For more information about how poison control center data is collected click here.

Cig-a-likes may also contain low levels of cadmium, a toxic metal also found in cigarette smoke that can cause breathing problems and disease.11 More research is needed on the health consequences of repeated exposure to these chemicals. There are also reports of lung illnesses and deaths related to inhalation of certain vaping oils into the lungs, which have no way to filter out toxic ingredients. As the menthol ban hangs in limbo, people who cannot quit smoking those products altogether could be advised to shift to less harmful alternatives. These so-called modified risk tobacco products (MRTPs) are less dangerous than traditional cigarettes, according to the Food and Drug Administration (FDA). But they have generated limited sales датчик tpms замена батарейки, in part because they use ineffective advertising and must undergo an onerous authorization process.

Vitamin E acetate is a chemical added to some vaping products that contain THC, the main psychoactive compound found in marijuana. A 1.5-minute video that explains how teens first get hooked on e⁠-⁠cigarettes and what this means for their future relationship with nicotine. The FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories For more information about this ruling, visit the FDA’s webpage, Regulation and Enforcement of Non-Tobacco Nicotine (NTN) Products.

In 2008, just after e-cigarettes showed up in the U.S. and Europe, the World Health Organization urged marketers to remove claims that e-cigarettes are a safe and effective way to quit smoking because no scientific evidence was available to support those claims. “These electronic cigarettes are also marketed for their flavors that are more appealing than the musty, odorous tobacco cigarettes have been and are targeted to a different generation,” Mansour said. Stay up to date on the adverse health effects of smoking and vaping tobacco while gaining important guidance on how to counsel patients on the risks and quitting. Be aware that some e-cigarettes that claim to be nicotine-free have been found to contain nicotine. Companies that make or sell e-cigarettes must follow certain Food and Drug Administration (FDA) regulations. For example, only people age 21 and over are allowed to buy e-cigarettes.

“My reading of the evidence is that it is quite convincing that e-cigarettes are helping some people quit smoking.” E-cigarettes are battery-operated devices that can look like a real cigarette or pen. There are hundreds of brands, and they’re sometimes marketed as a way to get your nicotine fix without the danger of cigarettes. They found that while several of the liquids were moderately toxic to the endothelial cells, the cinnamon- and menthol-flavored e-liquids significantly decreased the viability of the cells in culture even in the absence of nicotine.

Before and after the passage of SB 793, our researchers – all posing online as minors under the age of 21 – attempted to buy flavored e-cigarette products from 26 websites that sold them in California. Despite the known risks, vaping has seen a dramatic increase among U.S. adolescents. Researchers from Florida Atlantic University’s Schmidt College of Medicine conducted a study using data from the Youth Risk Behavior Survey which included participants from ninth to 12th grade. E-cigarettes are electronic devices that heat a liquid and produce an aerosol or mix of small particles in the air. Here are facts about vaping that you should consider before taking it up. The measure, Senate Bill 89, is sponsored by Senate President Gary Stevens, R-Kodiak.

Vapes are often viewed and marketed as a safe alternative to smoking. A 2015 study in the Journal of the American Medical Association found that teens who took up vaping were three times more likely to start smoking within six months compared to teens who didn’t vape. A Yale University study in 2018 found the switch from vaping to tobacco cigarettes could happen in as little as one month.

For example, some Juul pods contain more nicotine than many other e-cigarettes. Research is mixed on whether vaping is safer than smoking, and e-cigs like Juul are so new that not a lot of research has been done. In November 2018, the FDA announced restrictions on the sale of flavored e-cigarette vape fluids. In September 2019, the Wall Street Journal reported that the FDA had opened a criminal investigation into Juul Labs to determine whether the company used deceptive advertising and targeted minors.

Because of this and other studies, vitamin E acetate is considered the main cause of EVALI. Other chemicals found in nicotine- and THC-containing vaping products may also play a role in the condition. Below are answers to common questions about e-cigarettes, including health consequences, risks of secondhand emissions, kids and e-cigarettes and FDA oversight. Respondents reported several features of their e-cigarette use for the past 30 days (for post-ban) and in the month before the state flavor ban (for pre-ban).

But levels are usually low and generally far lower than in tobacco cigarettes. Some of the harmful substances emitted in secondhand e-cigarette aerosols are similar to those in secondhand tobacco smoke. However uwell e cigi, more research is needed to fully understand emissions from e-cigarettes and their impact on human health.

Findings  In this randomized clinical trial including 1068 smokers, ECs were as effective as varenicline and more effective than nicotine chewing gum when all 3 treatments were provided with minimal behavioral support. 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 over three times as much as vaping. If you or someone you know has had a safety issue with an electronic cigarette (e-cigarette or vape), please report the problem to the Food and Drug Administration (FDA) at the FDA Safety Reporting Portal (hhs.gov).

E-cigarettes are nicotine-based products, and no nicotine use is safe. Until we know more, it is probably best to avoid these products whenever possible, including secondhand smoke. However, vaping early on may increase the chances of smoking ordinary cigarettes later in life.

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. Findings show alarming statistically significant and clinically important increases of the daily use of electronic vapor products in U.S. adolescents. E-cigarette manufacturers introduced a new tobacco product that soared in popularity with little thought on how to responsibly dispose of the resulting tons of e-cigarette waste. Even though the majority of survey participants knew about the dangers to the environment presented by e-cigarettes, those who had vaped at least once were significantly less informed about the environmental impact of littering e-cigarettes than those who had never vaped.

The person then inhales the resulting aerosol or vapor (called vaping). Get regular updates on the health effects of tobacco, public health educational resources, and highlights on current tobacco issues and regulations. “This is Our Watch” is a voluntary education program with resources to help tobacco retailers better understand and comply with FDA tobacco regulations.

In e-cigarettes, tobacco combustion is replaced by e-liquid heating, leading some manufacturers to propose that e-cigarettes have less harmful respiratory effects than tobacco consumption. Other innovative features such as the adjustment of nicotine content and the choice of pleasant flavours have won over many users. Nevertheless, the safety of e-cigarette consumption and its potential as a smoking cessation method remain controversial due to limited evidence. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity.

Although evidence is lacking, e-cigarettes for inhalation of nicotine may be beneficial in reducing adverse health effects related to the use of combustible tobacco products. However, e-cigarettes are not FDA approved as a smoking cessation tool and the amount of nicotine and other substances a person inhales from each nicotine cartridge remains unclear. When FDA “deemed” e-cigarettes as part of its jurisdiction in 2016, it gave e-cigarettes that were currently on the market two years to prepare premarket applications (known as PMTAs). These applications are what FDA uses to to determine whether new tobacco products are “appropriate for the protection of public health” before they are allowed on the market.

E-cigarettes usually contain nicotine and may have other harmful substances too. When the liquid is used up or the battery dies, the user throws the device away. Others can be refilled with liquid датчик давления в шинах пежо 5008, recharged, and used over and over. If you prefer to stop vaping in one step, you can ask your pharmacist or stop smoking adviser about switching to a suitable nicotine replacement therapy (NRT) product. This is an alternative way of cutting down your nicotine use until you are ready to stop completely. They also cause other serious illnesses, including lung disease, heart disease and stroke.

The main component of e-cigarettes is the e-liquid contained in cartridges or tanks. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals (such as formaldehyde and acrolein, which can cause irreversible lung damage). The American Lung Association is very concerned that we are at risk of losing another generation to tobacco-caused diseases as the result of e-cigarettes. The Lung Association remains extremely troubled about the rapid increase of youth using these products and has repeatedly called upon the Food and Drug Administration (FDA) to increase their oversight and scrutiny of these products to protect kids. At this time, we still don’t know the full potential health effects of e-cigarettes.

The health protection agency reports that 2.8 percent of American adults used e-cigarettes in 2017. Among adult e-cig users, 58.8 percent also continued to smoke tobacco cigarettes while 29.8 percent were former tobacco smokers. Another 11.4 percent of e-cig users had never been regular tobacco smokers. As of December 2022, Juul faces 4,908 e-cigarette lawsuits combined in a mass litigation in a San Francisco federal court.

By 2021, the percentage of EVP use was higher in girls (5.6%) than boys (4.5%), a one-and-one-quarter increase. An employer, manager or other person in charge cannot fire, refuse to hire, penalize, discriminate or retaliate against an employee, applicant or customer who exercises any right to a smoke-free environment provided under the MCIAA. “Indoor Area” means a space between a floor and a ceiling that is at least 50% enclosed by walls, doorways or windows (open or closed) around the perimeter. A wall includes retractable dividers, garage doors, plastic sheeting or any other temporary or permanent physical barrier. The Minnesota Clean Indoor Air Act (MCIAA) is a state law that describes where smoking is prohibited, outlines the responsibilities of employers, managers, and other persons in charge and lists exemptions that affect their workplaces and facilities.

But more importantly, I do not want any other child to have to deal with what my son, Jacob dealt with and is still dealing with. His story is an important one because…People need to understand how quickly the addiction can happen. People need to understand how severe the negative effects of vaping are, both mentally and physically. I do not want any parent to have to hear his/her child have a panic attack on the phone like I did as Jacob sat locked in a bathroom stall at school because he couldn’t leave for fear he might vape with the other kids. Tony Florence, the owner of 723 Vapor and a Kentucky Hemp Association board member, has concerns with HB 11.

“We still do not understand the consequences of chronic e-cigarette vaping,” he says. In 2018, the FDA warned of an epidemic of teens who were becoming addicted to nicotine through these products. More than 2 million middle and high school students use e-cigarettes, and almost 85% of them use flavored products, according to the 2021 National Youth Tobacco Survey from the FDA and the Centers for Disease Control and Prevention (CDC). “Even with the current relatively low use of e-cigarettes among adults – 3.7 percent – health care costs are already substantial, and likely to increase in the future if youth continue to use this product,” said Max. In addition, the FTC found that there was a large shift in sales from tobacco-flavored e-cigarette products to fruit, candy, and dessert flavors.

The agency has taken a multitude of actions to keep ENDS out of the hands of youth, from policy making to enforcement to education. The Surgeon General reports e-cigarette use among youth is a significant public health concern and steps must be taken by parents, educators and especially policymakers to discourage use of e-cigarettes. Learn more about e-cigarettes lung health risks and get downloadable resources for parents, schools and teens. E-cigarettes are devices that heat a liquid into an aerosol that the user inhales. The liquid usually has nicotine and flavoring in it, and other additives.

The FDA has never approved an e-cigarette as a smoking cessation device. Studies into whether the devices help people quit smoking have yielded mixed results. When Juul first hit the market in 2015, its vape liquid contained much higher levels of nicotine than e-cigs that had already been on the market. Each Juul pod contains as much nicotine as 20 regular cigarettes, according to the Centers for Disease Control and Prevention.

That’s why the Surgeon General’s Report calls on parents, teachers, health providers, the government, and communities to educate young people about and discourage the use of e-cigarettes. For those wishing to argue that “vaping” is safer than smoking and an effective way to quit, the Center for Disease Control (CDC), the surgeon general’s office, public health groups, and others point to the evidence disputing such a claim. Respondents who perceived a lower level of local retailers’ compliance to the ban were more likely to obtain e-cigarettes from illegal sellers and mixed flavored e-liquids on their own, compared with those who perceived a higher level of local retailer compliance. A possible explanation is the neighborhood effect, that is, in neighborhoods where law enforcement is relatively weak, local retailers are less likely to follow the ban and illegal sellers are more active.

The nicotine content of the liquid can range from “very high” to zero. Refills come in flavors such as cool cucumber, mango, and mint, which may seem natural and harmless, but a single JUUL refill contains as much nicotine as a pack of 20 cigarettes. Some of the ingredients in e-cigarettes could also be harmful to the lungs in the long-term.

Vapes can also be used with marijuana or tetrahydrocannabinol (THC). New ‘pod-mod’ style vape products are similar in shape and size to JUUL® and other vape sticks but are disposable. It is generally accepted that e-cigarettes produce fewer of the toxins found in cigarette smoke. However, it is becoming increasingly apparent that this frame is not adequate to tell the entire story regarding individual health impacts.

With the rise in electronic cigarettes (e-cigarette, e-cigs or vapes) and vaping use among youth, teens and young adults, the Health Department and our team are working to prevent initiation and reduce vaping of all substances in Vermont. As of 2021, 16% of Vermont high school students said they used e-cigarettes at least once in the past 30 days. Students who smoke cigarettes, tried flavored tobacco before age 13, binge drink or use cannabis vape at the highest rates.

These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults. We know nicotine and other ingredients in e-liquids can hurt your body and we still don’t know what long-term health problems vaping could cause. There are online resources, texting and phone services and apps that connect you with real people to help you on your journey to kick the habit. People usually think vaping isn’t as bad as cigarette smoking, but the mist you breathe in still has nicotine and other harmful chemicals in it. Vaping isn’t safe and can cause health problems, including life-threatening lung injuries.

In fact, they are widely used as alimentary and pharmaceutical products [2]. In an analysis of 54 commercially available e-liquids, PG and glycerol were detected in almost all samples at concentrations ranging from 0.4% to 98% (average 57%) and from 0.3% to 95% (average 37%), respectively [35]. 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].

E-cigarettes are the most commonly used tobacco product among middle- and high-school students. 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. Quitting smoking is one of the best things you can do for your health — smoking harms nearly every organ in your body, including your heart. Nearly one-third of deaths from heart disease are the result of smoking and secondhand smoke.

On April 22, the Plan Commission denied the proposal, based on inadequate parking. Some members expressed concerns about the proximity to schools and the growing number of vape shops. “This business would in essence serve as a tobacco billboard advertisement to those young persons passing by every day on the way to and from school,” Police Chief Brian Chaney wrote in a letter to city staff. The Milwaukee ordinance and the Monona moratorium apply to stores where vaping supplies make up at least 10% of stock or floor space. That is meant to avoid gas stations or other stores that sell some e-cigarettes.

We also have a selection of cheap disposable vapes, featuring top brands at great value prices. If you are not sure whether disposables are for you, these kits would be a great place to start. FDA Real Cost Campaign”The Real Cost” campaign website and social media channels are intended for the campaign target audience only — youth ages 12-17. Findings also show that in 2015, the percentage of EVP use was significantly higher in boys (2.8%) than girls (1.1%).

There are other proven, safe, and effective methods for quitting smoking. One way to start is to talk with your doctor, nurse, or a trained quitline counselor to figure out the best strategies for you. The liquids used in e-cigarettes do not contain tobacco, but they do contain nicotine derived from tobacco, and thus the U.S. Food and Drug Administration (FDA) classifies them as a tobacco product. FDA regulates the manufacture dekktrykksensorer, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes that meet the definition of a tobacco product. E-cigarettes may also be used to aerosolize other substances for inhalation, including cannabinoid products.

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. I never kidded myself into thinking that this habit was harmless, but my conviction that they were less harmful than cigarettes made the endeavor seem worthwhile, even praiseworthy. (THE CONVERSATION) This article was originally published on Dec. 21, 2023 Californians – including minors – are still able to buy flavored electronic cigarettes online, even after the state’s much-publicized ban went into effect. That’s the key finding of my team’s 2023 study, published in JAMA Network Open. Initially marketed as a safer alternative to traditional cigarettes for adults looking to quit smoking, these products quickly caught the attention of younger demographics. A survey of more than 4,000 New Jersey adolescents found that 25% were vaping — far outpacing cigarette smoking, according to a 2020 study.

While these devices may help some people quit smoking, there is growing evidence that e-cigarettes can pose serious health risks, especially to people who do not smoke traditional cigarettes. The composition of e-liquids requires stricter regulation, as they can be easily bought online and many incidences of mislabelling have been detected, which can seriously affect consumers’ health. Beyond their unknown long-term effects on human health, the extended list of appealing flavours available seems to attract new “never-smokers”, which is especially worrying among young users. Additionally, there is still a lack of evidence of e-cigarette consumption as a smoking cessation method. Indeed, e-cigarettes containing nicotine may relieve the craving for smoking, but not the conventional cigarette smoking habit.

Randomization was conducted via a central randomization system for clinical research. Randomization sequences were generated using Proc Plan in SAS, version 9.3 (SAS Institute), with trial sites as the stratification factor and a block length of 5. After logging into the website, staff entered participants’ sex, age, and Fagerstrom Test for Cigarette Dependence (FTCD) score, and the system generated each participant’s identification number and treatment allocation via stratified block randomization. The study statistician was masked to treatment codes until the analysis of primary outcome was completed.

A US National Youth Tobacco Survey in 2023 found that 10 percent of high school students currently used e-cigarettes, with nearly 40 percent of those reporting vaping on at least 20 days in the previous month. Ninety percent of e-cigarette users said they used flavored products. There are currently more than 7,000 varieties of flavored e-cigarettes and e-juice (liquid containing nicotine that is used in refillable devices) on the market. Although the popularity and use of e-cigarettes continues to increase, there is a lack of data on their potential health effects. Food and Drug Administration (FDA) has issued a proposed rule to include e-cigarettes under its authority to regulate certain tobacco and nicotine-containing products. E-cigarettes have a battery-operated component that heats liquid containing nicotine, flavorings, and other chemicals.

The devices, also known as vapes, can cause serious health implications, including contributing to detrimental inhalation patterns and heightened risks for youth’s developing brains, according to medical researchers. The changes to the county regulations are in response to public health data that show the increased use of e-cigarettes by Sonoma teenagers in high school. In 2022, tobacco conglomerate Philip Morris International bet big on Zyn, acquiring its parent company Swedish Match as part of its push into smokeless products.

Talk to your kids about e-cigarettes while they’re still willing to listen. In a recently published randomised trial of 886 subjects who were willing to quit smoking [100], the abstinence rate was found to be twice as high in the e-cigarette group than in the nicotine-replacement group (18.0% vs. 9.9%) after 1 year. Of note, the abstinence rate found in the nicotine-replacement group was lower than what is usually expected with this therapy. Nevertheless voopoo vape coil eesti, the incidence of throat and mouth irritation was higher in the e-cigarette group than in the nicotine-replacement group (65.3% vs. 51.2%, respectively). Also, the participant adherence to the treatment after 1-year abstinence was significantly higher in the e-cigarette group (80%) than in nicotine-replacement products group (9%) [100]. Of note, another study indicated that although RANTES/CCL5 and CCR1 mRNA were upregulated in flavour/nicotine-containing e-cigarette users, vaping flavour and nicotine-less e-cigarettes did not significantly dysregulate cytokine and inflammasome activation [43].

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-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. E-cigarettes also are controversial because of various regulatory issues. In January 2010, following a lawsuit by an e-cigarette distributor, the U.S.

They also have a good practice of retaining older designs that vapers wish to continue using, such as their popular Nautilus Coil range, which boasts an impressive number of resistance options for different vaping styles. Aspire vape kits have a certain steel & glass sophistication to their designs, with high-performance functionality hidden beneath the glossy exteriors. Aspire are an established and well-respected vape brand known for pairing sleek builds with widely-compatible coils for all ohmage preferences. OXVA are a relative newcomer, founded in 2019 by Justin Lai, but in only five years, their devices have become some of the most sought-after MTL kits around. There will be many of you reading this whose first vape kit was made by Innokin, one of the top vape brands, and there’s an excellent reason for that. Since its founding in 2011, Innokin’s primary focus has been producing simple vape kits that even an absolute beginner can master immediately.

This means that e-cigarettes (vapes) cannot be used in areas where smoking is banned, cannot be displayed at retailer outlets, and cannot be sold to people under 18 years of age, as well as being subject to other restrictions. The FDA’s tobacco center was created by Congress in 2009 and granted sweeping powers to remake the industry, including banning harmful ingredients from traditional products and authorizing new, less-harmful alternatives. Not everyone is aware that there is nicotine in most e-cigarettes in varying amounts.

Scientists are still learning about the long-term health effects of e-cigarettes. CDC continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers. In summary, it seems that either smoking or nicotine vaping may adversely impact on COVID-19 outcome.

However, the leading causes of nicotine poisoning are smokeless tobacco products (chew and snuff) and liquid nicotine that’s used in e-cigarettes. Chewing and snorting tobacco releases more nicotine into the body than smoking. 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.

In 2019, IQOS — produced by Philip Morris International — became the first tobacco heating system authorized by the FDA to be marketed and sold in the U.S. Although manufacturers claim that heating tobacco is less harmful than traditional cigarettes, current data on health effects of these devices are sparse and most of what has been published has been by tobacco industry scientists. Without urgent and effective public health action, e-cigarettes will lead to a new generation of nicotine-addicted individuals. The smoke also caused damage to the lungs and bladders of mice, indicating that it may increase the risks of developing lung and bladder cancer. E-cigarettes are electronic devices that produce an aerosol by heating a liquid that usually contains nicotine (the addictive drug in regular cigarettes, cigars, and other tobacco products), flavorings, and other chemicals to help make the aerosol. In this line, a study compared the acute impact of CS vs. e-cigarette vaping with equivalent nicotine content in healthy smokers and non-smokers.

Getting expert help from your local Stop Smoking Service gives you the best chance of quitting smoking for good. To get the best out of it, make sure you’re using it as much as you need to and with the right strength of nicotine in your e-liquid. E-cigarettes do not burn tobacco and do not produce tar or carbon monoxide uwell einweg vape, two of the most damaging elements in tobacco smoke. An e-cigarette is a device that allows you to inhale nicotine in a vapour rather than smoke.

As of July 2020, the sale of flavored e-cigarettes is prohibited in NYC. Vaping can cause lung injury and may affect lung health in other ways. Since COVID-19 can also affect your lungs, vaping may put your lungs at increased risk. E-cigarettes produce an aerosolized liquid (vapor) that usually contains nicotine and other chemicals inhaled by the user.

Because the liquid solution is converted into an aerosol vapor, e-cigarette use is often referred to as “vaping,” rather than smoking. 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. Nicotine is a highly addictive substance found in tobacco products, including cigarettes, cigars, chewing tobacco, e-cigarettes, and pouches.

Unsurprisingly, the FDA has only granted authorization to 4 big tobacco companies, while rejecting the millions of devices and liquids submitted by the vape industry. This includes our brand Custom Clouds and every other brand on our shelves. The Electronic Cigarette Company is one of the original online vape stores in the UK, founded in 2008.

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. 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. Most e-cigarettes have a battery, a heating element, and place to hold a liquid (such as a cartridge or pod). The e-liquid usually contains nicotine, flavorings, and other chemicals.

Clearly the dangers extend beyond what is being done to the lungs and heart. Adults who used e-cigarettes at least once a week before the flavor bans were recruited online. Respondents reported their e-cigarette use, primarily used flavor, and ways of obtaining e-cigarettes before and after the bans.

Validated 7-day point prevalence abstinence rates were affected less, and effect sizes for all outcomes were close to those predicted, but the lower quit rates have reduced the statistical power for the primary outcome. Another key limitation of open-label trials is that participants’ expectations can affect outcomes. In smoking cessation studies, the results can be biased if participants randomized to what they perceive as an inferior option are less likely to use their treatment or are more likely to drop out of the trial.