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However, 87% of people who reported using e‑cigarettes with nicotine had obtained them without prescriptions. “This relatively small study showed that e-cigarettes have the potential to decrease heart muscle blood supply, not just under the stress of exercise like traditional cigarettes but even at rest,” he says. The authors of a 2019 review point out that e-liquid aerosols contain particulates, oxidizing agents, aldehydes, and nicotine. When inhaled, these aerosols most likely affect the heart and circulatory system. 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].

Krishnan-Sarin points to progress that has been made—finally—in recent years to reduce regular cigarette smoking rates among young adults. In her opinion, the significant decline is due to the success of large-scale public health campaigns and a general awareness among youth that cigarettes are harmful to health. The liquid they contain also has many monikers—it might be called e-juice, e-liquid, cartridges, pods, or oil.

The survey also found that Minnesota youth are ill-informed about the health risks of e-cigarettes with 76.1% of 11th graders saying there is either no, slight, or a moderate risk to using e-cigarettes. 11th grade students responding to the student survey said that the top ways they got e-cigarettes included getting products from friends (72.3%), getting products at a vape shop (14.0%), and on the Internet (9.6%). Among 8th grade students, e-cigarette use nearly doubled from 2016 to 2019, and one in four 11th graders now use e-cigarettes. Students in all grades surveyed now use e-cigarettes and vapes at five times the rate of conventional cigarettes. In Australia, during the survey period, it was not legal to obtain e‑cigarettes containing nicotine without a prescription (TGA 2020).

The vapor produced by e-cigarettes usually contains nicotine, heavy metals, volatile organic compounds, carcinogens (cancer causing chemicals), and in some cases, flavoring linked to serious lung disease. These and other harmful substances present in e-cigarette&nbsp