Introduced to the United States in 2007, the sales revenues of e-cigarettes have surged worldwide.

Invented in China in 2003, e-cigarettes were introduced as nicotine delivery devices and developed with the intent of providing smokers the satisfaction of conventional tobacco cigarettes without deleterious health effects ( 10). The popularity of e-cigarettes continues to outpace our medical knowledge about their safety, and contradictory scientific evidence has sparked a debate among tobacco control advocates, policy makers, and regulatory agencies. These trends are worldwide and demonstrate the emergence and potential threat of a new tobacco epidemic ( 7– 9). More concerning still are estimates of adolescent vapers: 22% of high school and 9.4% of middle school students report daily e-cigarette use ( 6). In 2019, more than 10 million US adults reported using an e-cigarette (approximately one-third of the number of adult smokers) ( 5). Conversely, the use of alternative tobacco products (ATPs)-including electronic cigarettes (e-cigarettes)-has increased at an alarming pace ( 1, 4). For many years, US consumption of conventional cigarettes has steadily declined ( 2, 3).

The rapidly diversifying number of commercially available tobacco products on the global market has dramatically influenced tobacco use patterns ( 1). However, the evolving e-cigarette landscape continues to impede timely toxicological studies and hinder progress made toward our understanding of the long-term health consequence of e-cigarettes. Federal, state, and local regulations have attempted to govern e-cigarette flavors, manufacturing, distribution, and availability, particularly to underaged youths. Adverse health effects related to e-cigarette aerosols are influenced by several factors, including e-liquid components, physical device factors, chemical changes related to heating, and health of the e-cigarette user (e.g., asthmatic). This review describes the experimental and clinical evidence of e-cigarette toxicity and deleterious health effects. Within the evolving alternative tobacco product space, electronic cigarette (e-cigarette) vaping has surpassed conventional cigarette smoking among adolescents and young adults in the United States and beyond. Since the spread of tobacco from the Americas hundreds of years ago, tobacco cigarettes and, more recently, alternative tobacco products have become global products of nicotine addiction.

Sims 4 smoking cigarette mod