CHAPTER II - REVIEW OF RELATED LITERATURE AND STUDIES
The previous chapter discussed the problem and its breadth. Study that narrows down
to specific study questions is critical for achieving the desired outcomes. Earlier findings and
gaps in other research were discussed in this chapter. The purpose of this chapter was to give
relevant literature and studies in relation to the research subject of the effects of e-cigarettes on
the health of senior high school students. The following acts as a lending scheme to demonstrate
the basic aspects of the research that will be done.
Perceptions about e-cigarette harmfulness
Electronic cigarettes are thought to be less damaging to health than traditional cigarettes
and are a safer way to quit smoking (Zhao et al., 2021). The long-term effects of e-cigarette
usage on health and their use as smoking cessation aids, on the other hand, are uncertain.
Despite inconsistent results, their use has increased in China and around the world in recent
years. The population's understanding and perception of e-cigarette use is crucial for creating
preventive actions. Perceptions of risk, health advantages, and the effectiveness of e-cigarettes
in helping people stop smoking may all influence their use. E-cigarette awareness is highest
among smokers and is associated with being educated and younger. Female smokers and
smokers with a higher level of education are more likely to use e-cigarettes.
The study evaluated the harmfulness, advantages, and addictiveness of e-cigarettes to
regular cigarettes. It includes questions on their dangers, advantages, and addictiveness. The
findings revealed that e-cigarettes are less dangerous than traditional cigarettes, can help you
quit smoking, and are possibly addicting.
However, the majority of published studies were undertaken in high-income nations,
with only a few studies conducted in developing countries. According to the International
Tobacco Control Policy Evaluation Project, the number of smokers who are aware of and have
tried e-cigarettes is rapidly increasing in China. Understanding public attitudes can help inform
legislation, preventative messaging, and other public health initiatives for e-cigarette use in
China and other low- and middle-income countries.
Participants who believed e-cigarettes could help them stop smoking had higher
combined smoking and SHS exposure-related knowledge scores. Those who thought smoking
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caused lung cancer or heart disease were more inclined to think e-cigarettes were beneficial.
Participants who scored better on SHS exposure-related knowledge measures were also more
likely to feel e-cigarettes were beneficial.
Approximately half of rural homes with young kids are unaware of the dangers of e-
cigarettes and believe they can aid in the cessation of smoking. The majority of participants do
not believe that e-cigarettes are addictive. Public health initiatives should convey evidence-
based information and communicate facts concerning e-cigarette use. It is critical to tailor
campaigns to different rural groups and raise awareness about the health risks associated with
smoking and SHS exposure.
E-cigarettes as smoking cessation aids
Electronic cigarettes, often known as e-liquids, are battery-powered devices with
adjustable nicotine levels, Giovacchini et al. (2022). Developed initially as a less dangerous
alternative to traditional tobacco, they have grown in popularity because to their elegant
appearance, enticing flavors, and low nicotine contents. However, minimal long-term data
backs up claims that e-cigarettes are safe. The negative consequences of e-cigarette usage
exceed the potential advantages, particularly in terms of helping traditional smoking cessation
and addressing lung health issues in young adults.
Despite the lengthy history of smoking-related lung disorders, the study focuses on the
lung health impacts of e-cigarette use, emphasizing the limited data available due to a lack of
regular documentation and patient involvement in medical records.
According to epidemiologic studies, e-cigarettes are more effective than standard
nicotine replacement therapy (NRT) alone in achieving smoking cessation. According to a 2019
study, 18% of individuals who used e-cigarettes as smoking cessation aids quit smoking a year
later, compared to 9.9% of participants who used NRT to quit smoking. However, 80% of e-
cigarette users were still vaping a year later, compared to only 9% of NRT participants who
were still using NRT.
The Fagerstrom test for nicotine dependency was also used to assess the addictive
potential of e-cigarettes. Surprisingly, nicotine dependence was twice as high in e-cigarette
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users as it was in traditional cigarette smokers when tested using the Fagerstrom test for
nicotine dependence. The PATH cohort analysis discovered that adult former smokers who
reported using e-cigarettes after wave 1 but did not use traditional cigarettes during wave 1 of
the PATH experiment were more likely to relapse.
Adults who had never used e-cigarettes at baseline but reported ever trying them were
four times more likely to have transitioned to ever smoking combustible cigarettes than never
smokers who had not used e-cigarettes. While e-cigarette use may lead to short-term smoking
cessation, it is an inferior treatment approach when compared to well-proven smoking cessation
strategies. Their addictive nature, combined with the lack of documented damage reduction,
warns against using them to quit smoking.
Effects of e-cigarette use on the pulmonary system
Chemicals in e-cigarette aerosols initially contact the airways before being absorbed
into the bloodstream, Tsai et al. (2020). These substances then interact with vascular endothelial
cells before spreading to other organ systems such as the heart. The majority of research on the
effects of e-cigarettes on lung function is based on acute or subacute exposures, with a heavy
reliance on animal studies. Many e-cigarette users, particularly adolescents and young people,
are never smokers, making comparing the impact of vaping against traditional tobacco smoking
problematic. This is because, with the exception of nicotine, the chemical profiles of e-cigarette
aerosols differ from those of tobacco smoke. Limiting study to recognized effects in smoking
environments may limit our understanding of the health impacts of vaping.
Ultimately, these human investigations of acute and subacute e-cigarette exposure and
use demonstrate that vaping worsens asthma and chronic obstructive pulmonary disease
(COPD), induces pathological alterations in the small airways, and dysregulates innate
immunity in the lung. These clinical and physiological effects of vaping may be less severe
than those seen with conventional tobacco, but because we have only acute and sub-acute
studies to draw conclusions from, it is clear that more studies, particularly longitudinal studies,
are required to better understand the effects of e-cigarette use on pulmonary physiology. If e-
cigarettes follow in the path of traditional tobacco smoking, it could take years or decades for
significant physiological changes to emerge with use. Still, the fact that physiological
alterations are obvious with acute and sub-acute exposures indicates that e-cigarettes will
produce significant physiological changes with chronic exposures. Plus, it is uncertain what
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effects other compounds in e-cigarette aerosols, such as those employed as flavorings and
carriers, would have on the airways. Animal studies will be critical in identifying physiological
effects of chronic inhalation of these chemicals and others on the lungs before epidemiological
studies in humans over decades of use, due to their capacity to replicate long-term, chronic
inhalant exposures.
E-cigarettes have been demonstrated in studies to have an immediate influence on
cardiac physiology, including heart rate and blood pressure. In four separate acute exposure
experiments, smokers who were given e-cigarettes containing at least 18 mg ml1 of nicotine
experienced an increase in heart rate. However, diastolic blood pressure (DBP) was not
significantly higher following e-cigarette use, which is linked to an elevated risk of
cardiovascular disease and mortality, especially in women. A study discovered that after 30
minutes of vaping an e-cigarette, carotid-femoral pulse-wave velocity (PWV) rose, similar to
traditional cigarette smoking but with a longer vaping effect. The study's use of a 30-minute
vaping session, on the other hand, may have exaggerated the effects on PWV in the e-cigarette
sample.
Effects of E-cigarettes to the Mental Health
As E-cigarettes gain more popularity among youth and adolescents, they are more likely
to begin using this device. Starting from the introduction of E-cigarettes, trying it from a
smoker friend, buying their own, and eventually being a user that has become dependent on
smoking, is a cycle that happens to most of the starters which result in aggressive consumption.
Consuming and doing something without proper education results in poor decisions and
mishandling of the situation.
Along with a lot that is affected by excessive nicotine consumption, Mental Health is
affected as well. According to (Becker et al., 2020), people with mental illness are more prone
to using e-cigarettes than those who are mentally healthy. Their reasons for consuming nicotine
are because of its psychological effects. Nicotine reaches the brain and improves the mood of
the consumer as a short term effect. As stated by (Smoking and mental health. n.d.), long term
consumption of nicotine results in the interference of dopamine production in the brain,
resulting in more aggressive smoking.
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Using an Electric Cigarette as a coping mechanism is a negative way resulting in
negative reactions to the body and the mind. Numerous people believe that using e-cigarettes
contributes to the relief of mood and coping for depression, but it is actually the opposite.
According to (Machaalani, R., & Chen, H. 2018), brain development is affected as well
as how it functions. Nicotine disrupts the process of how the brain usually works, particularly
mood and behavior related resulting in cases where the Mental health is affected.
Effects of E-cigarettes to the Physical Health
As E-cigarettes have impacts to Mental Health, it brings effects to physical health as
well. The potential of E-cigarettes to damage physical health has been blindly ignored by many.
As mental health is being harmed from the consumption of nicotine from the e-cigarette, there
lies the physical health being harmed simultaneously as well.
According to (Münzel et al., 2020), any type of E-cigarettes is not considered as an
alternative to tobacco. It is not proven to be a harm-free smoking device. Any smoking device
is an acute health consequences holder as it emits a toxic substance to the body. As stated by
(American Lung Association. n.d.-a), E-cigarettes can cause lung and cardiovascular diseases.
In addition to that, according to (Sissons, B. 2023), the side effects of consuming Nicotine are
dizziness, change in blood flow, risk of blood clot, changes in heart rhythm and more, yet
excessive intake results in long term effects.
Nicotine Addiction along with its Benefits and Risks
Nicotine, found usually in products of tobacco and e-cigarettes is an addictive
substance that when excessively consumed, leads to long term risks. As stated by (20116
Nicotine dependence. n.d.), it is addictive for the reason that it enhances the mood, leaving a
temporary good mood.
E-cigarettes have both the benefit and risks hence it is only beneficial depending on the
situation. According to (Balfour et al., 2021), it is known to be beneficial as it helps in reducing
the intake of an actual tobacco user to withdraw from smoking. However, as introduced to be
helpful in setting the mood and behavior, Electronic cigarettes have gained more popularity.
Despite knowing the risks, people only had the view of the benefits. No cigarette devices are
not harmful to the body.
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Risks of using e-cigarettes that contain nicotine involve worsening of asthma, coughs,
and bronchitis according to (Balfour et al., 2021). Too much usage of electronic cigarettes will
result in severity of risk in blood clot and stroke. All organs are at risk, especially the lungs and
the heart.
SYNTHESIS
Nicotine-containing e-cigarettes pose severe health concerns to both mental and
physical health. According to research, vaping can cause chronic lung illness, asthma, and
cardiovascular disease. Nicotine, the major active ingredient in e-cigarettes, is extremely
addictive and can impair the brain development of adolescents and young adults, as well as
fetuses. E-cigarette vapor includes varying levels of nicotine as well as potentially dangerous
chemicals, which can be harmful to one's health. The American Lung Association is concerned
about the effect of e-cigarettes on lung health since they can emit harmful chemicals that cause
lung illness and irreparable damage. The Surgeon General of the United States advises that e-
cigarettes contain hazardous substances that endanger the respiratory system and overall health.
Nicotine's addictive nature is well-documented, and its intake, whether through
traditional tobacco products or e-cigarettes, can lead to long-term dangers and negative health
impacts. While e-cigarettes were marketed as a "healthier alternative" to traditional cigarettes,
there is still much to learn about their long-term health impacts, and they are not regarded a
harm-free smoking device. It is critical to evaluate the potential consequences of using e-
cigarettes, specifically its impact on both mental and physical health.
E-cigarettes have been linked to a variety of pulmonary and cardiovascular
consequences, including increased airway reactivity, blockage, inflammation, and emphysema.
E-cigarette use can aggravate asthma and chronic obstructive pulmonary disease (COPD),
cause pathological changes in tiny airways, and disrupt innate immunity in the lung. While the
clinical and physiological effects of vaping may be less severe than those of traditional tobacco,
additional long-term research are required to better understand the impact of e-cigarette usage
on pulmonary physiology. E-cigarettes have also been demonstrated to have a direct impact on
cardiac physiology, such as heart rate and blood pressure. The long-term implications of e-
cigarette usage on lung function are yet unknown, and further research is needed to properly
understand the effects of e-cigarettes on lung function.
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Despite e-cigarettes have been proposed as a viable smoking cessation tool, there are
worries regarding their long-term safety and addiction potential. According to some research,
e-cigarettes may be more effective than regular nicotine replacement therapy (NRT) alone in
helping people quit smoking. However, 80% of e-cigarette users continue to vape a year later,
while just 9% of NRT participants do.
Nicotine dependency is twice as high in e-cigarette users as it is in conventional
cigarette smokers, and adult former smokers who reported using e-cigarettes after wave 1 but
did not use traditional cigarettes during wave 1 were more likely to relapse. Furthermore,
persons who had never used e-cigarettes at baseline but reported ever attempting them were
four times more likely to convert to ever smoking combustible cigarettes than never smokers
who had not tried e-cigarettes.
There is a lack of long-term research on the safety and effectiveness of vaping as a
smoking cessation aid. While some studies show that e-cigarettes can aid in the cessation of
smoking in certain people, further study is needed to assess their overall benefit and long-term
safety. In conclusion, further study is required to properly comprehend the ramifications of
utilizing e-cigarettes as smoking cessation aids.
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