A double-edged sword: E-cigarettes, and other electronic nicotine delivery systems (ENDS)
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CE - LETTER TO THE EDITOR
A double‑edged sword: E‑cigarettes, and other electronic nicotine delivery systems (ENDS) Kamal Kant Sahu1 · Ajay Kumar Mishra1 · Amos Lal2 · George Abraham1 Received: 4 September 2019 / Accepted: 27 September 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Dear Editor,
Behavioral and social impact
With interest we read the article by Polosa et al. published in your esteemed journal [1]. While we congratulate them for the excellent writeup, we believe that discussion on the “ill-effects” of E-cigarettes and other vaporizers need more elaboration, so that readers are well aware of both the sides of the coin. Our letter aims to discuss the latest literature available on the impact of ENDS on mental and physical health of consumers. Since the time vaporizers, E-cigarettes, and other electronic nicotine delivery systems (ENDS) came into existence, they always remained surrounded by the smoke of controversies with regard to their ill effects on physical health as well as the mental wellbeing of the E-consumers. As also said by Polosa et al., ENDS were introduced to the market with the intent of reducing toxicants in population, reducing the ill effects of second‐hand smoke and also to assist the motivated smoke quitters during their craving period. With time, the usage of E-cigarettes went off its intended trajectory and has increasingly becoming a nuisance for the society. Many recent studies prospective, retrospective or survey based have shown convincing results to suggest the same.
Behavioral studies conducted by researchers have shown some alarming and concerning results. Bold et al. in their prospective study conducted over 3 years found that E-cigarette usage led to future conventional cigarette addiction at the end of the 3rd year (OR 3.87, 95% CI 1.86–8.06) [2]. Population assessment of Tobacco and Health (PATH) study by Nicksic et al. included 5156 nationally representative youth (12–17 years) who never smoked tobacco, marijuana, and alcohol [3]. They found that E-cigarette usage predicted initiation of E-cigarettes, marijuana, and alcohol. Another interesting fact reported was lesser odds of cigarette and marijuana initiation amongst youth (OR 0.16–0.62) with highly educated parents (bachelor’s degree or higher). Also, there is always a curiosity amongst youths to experience new things. There is enough evidence that the flavoring agents in E-fluids are also responsible to attract youth to experiment with ENDS. A study based on 2014 National Youth Tobacco Survey extrapolates the behavior of 18,392 youth non-smokers with regard to current E-cigarette use (non-use, flavored and plain E-cigarette use) and smoking susceptibility at follow-up. They found that flavored E-cigarette users when compared to plain E-cigarette users (AOR 1.7, p
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