FAQ – IBIZA CLUB KNOWLEDGE BASE

SAFEVAPEUK – NICOTINE FACTS

Nicotine is an alkaloid found in the nightshade family of plants (Solanaceae) and, while it is found in other foods, it is predominantly found in tobacco.

Nicotine is highly addictive and most commonly found in combustible tobacco products such as cigarettes and cigars, vapour products (including open and closed vaping systems) and nicotine replacement therapy (NRT) smoking cessation aids. At present, cigarettes are the most common delivery mechanism.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

This symbol appears on the packaging of all e-liquids which contain 18mg/ml of Nicotine or more. Nicotine is classified as a toxic substance. But, its impact on health depends very much on how it is ingested/inhaled.

If swallowed in its pure/neat liquid form, it is highly toxic. The ingestion of relatively small amounts of liquid nicotine can result in severe poisoning, and sometimes death.

Nicotine poisoning via inhalation is rare in this country. However, if swallowed it can result in life threatening toxicity, particularly for small children.

Smoking, and its associated health hazards, have been researched in depth over many years. It’s not surprising that nicotine has been subjected to many careful (and long-term) studies.

One 2-year study of the long-term effects of inhaled nicotine found that when inhaled, does not indicate any harmful effects (particularly in relation to cardiovascular disease and cancer – particularly lung cancer).

To clarify: nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

Although the metabolism of nicotine varies considerably between individuals, nicotine has a short-half life, approximately two hours which, together with the repeat dosing of nicotine resulting from puffing on tobacco cigarettes, enables users to regulate their nicotine intake.

Nicotine is a stimulant drug, but can produce effects of both stimulation and relaxation. It is highly addictive, and its effect is linked to its capacity to trigger the release of dopamine – a chemical in the brain that is associated with feelings of pleasure. As with any addiction, smokers experience cravings when trying to quit1, making it very difficult to ‘kick the habit.’ When you start down the road of quitting, your body goes into ‘withdrawal’ which essentially means that the ‘reward’ of the drug has been taken away and can lead to irritability, anxiety, depression, restlessness, difficulty concentrating, increased appetite, insomnia and craving.  All or any of which can lead to relapse.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

Nicotine is classed as a toxin, but its toxicity depends very much on the method of ingestion/inhalation. When swallowed it is highly toxic, but when inhaled it is addictive but not harmful to long-term lung health.

Nicotine is not a harmful substance when inhaled, and used as part of a Nicotine Replacement Treatment (NRT), or in less harmful delivery devices such as e-cigarettes, the smoker avoids roughly 4,000 other toxic substances that are inhaled via tobacco smoke. Four in ten smokers, and ex-smokers, incorrectly think that nicotine is the cause of most of the smoking-related cancer6 when in fact, it is the deadly cocktail of other toxins that are found in cigarette smoke. Regulated nicotine-containing products are an effective way of reducing the amount people smoke, helping them to quit without the hazards of smoking tobacco.

Using NRT, and other stop smoking cessation tools, can double your chances of quitting successfully compared with willpower alone. However over 58% of smokers still try to quit without using an aid and going ‘cold turkey’.

Cravings happen because your body misses its regular hits of nicotine. According to the NHS the most effective way to tackle cravings is by adopting a combination of stop smoking medicine and behavioural changes. Behavioural changes are essential as many smokers are accustomed to following a set pattern of smoking which trigger cravings.  Everything from the time of day, to an association with food or drink, and even the company we keep.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

Young people should avoid nicotine in any form. While it isn’t a harmful substance when inhaled, it affects the adolescent brain differently and can potentially harm the developing adolescent brain.

Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.

Each time a new memory is created, or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

No. Nicotine is addictive. Depending on the volume of nicotine in the e-liquid you vape you will be more, or less, prone to being addicted to it.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

The delivery method (and the way you inhale) and strength of the nicotine determines how much nicotine you are exposed to. That is true of both vaping and smoking. Traditional tobacco products tend to have more nicotine in them as much of it is burned off and, to ensure consistent levels of nicotine ingestion, more is added at the outset.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

Asking if it is ‘better for you’ is not the right way to look at it. E-liquids/vaping is 95% less harmful than smoking. Nicotine is addictive, so if you don’t want to be addicted to Nicotine, then yes, zero Nicotine is ‘better.’ Nicotine is not harmful when inhaled. The health issues surrounding smoking relate primarily to the toxins created by the burning of tobacco, not the nicotine content.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

Nicotine is not harmful to your health when inhaled. Other than being addictive, nicotine does not present any significant risks to health.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)

It depends on the strength of the e-liquid you use and how you vape. Are you using a sub-ohm, pod or e-cigarette device? How deeply do you inhale?

The important point to understand is that it isn’t the nicotine that causes so many health issues. Nicotine is addictive and as such the stronger the concentration the more likely it is to be addictive. As with cigarettes, how you vape also determines how much of the nicotine is absorbed.

Nicotine is highly toxic when swallowed but is proven to have minimal impact on health when inhaled – other than it being highly addictive.

References

  1. British Heart Foundation, Health at work. 2015. Available from: https://www.bhf.org.uk/informationsupport/publications/health-at-work/health-at-work—quit-smoking-booklet [Accessed January 2019]
  2. ASH Fact Sheet. Nicotine and Addiction. August 2018. Available from: http://ash.org.uk/category/information-and-resources/fact-sheets/ [Accessed January 2019]
  3. Foundation for a Smoke-Free World GLOBAL TRENDS IN NICOTINE. Available from https://www.smokefreeworld.org/sites/default/files/fsfw-report-trends-in-nicotine-1005201811.pdf [Accessed January 2019]
  4. British Medical Journal. Nicotine and health 2014. Available from https://www.bmj.com/content/349/bmj.2014.7.0264rep.full [Accessed January 2019]
  5. UK. Four in 10 smokers incorrectly think nicotine causes cancer. March 2018. Available from https://www.gov.uk/government/news/four-in-10-smokers-incorrectly-think-nicotine-caUSes-cancer [Accessed January 2019]
  6. ASH – What’s in a cigarette? September 2018. Available from http://ash.org.uk/information-and-resources/fact-sheets/whats-in-a-cigarette/
  7. NHS Quit Smoking. Available from: https://www.nhs.uk/live-well/quit-smoking/stop-smoking-coping-with-cravings/ [Accessed January 2019]
  8. Adriani W, Macri S, Pacifici R, Laviola G. Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology 2002;27(2):212–24.
  9. Long-term effects of inhaled nicotine. Waldum HL (et al), study for Department of Medicine, University Hospital, Tronheim, Norway. (1996)
  10. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. Worku D, Worku E. Review commissioned by the University Hospital of Wales, Cardiff, UK. & the Royal Brisbane and Women’s Hospital Foundation, Herston, QLD, Australia. (2019)