Cigarrillos electrónicos: una breve actualización sobre su consumo por adolescentes y sus efectos sobre la salud

[Electronic cigarettes: a brief update on their consumption by adolescents and their effects on health]
DOI: 10.37980/im.journal.rspp.20242392
Publicado
2024-08-31

Descargas

Autores/as

  • Virginia Díaz Atencio Servicio de Neumología, Hospital del Niño Dr. José Renán Esquivel, Panamá, Rep. de Panamá

Palabras clave:

cigarillos electrónicos, adolescentes, efectos en la salud

Keywords:

electronic cigarettes, adolescents, health effects

Resumen

La mayoría del consumo de productos de tabaco comienza durante la adolescencia y los productos de tabaco han evolucionado para incluir varios productos como los cigarrillos electrónicos.

Los cigarrillos electrónicos resultan muy atractivos entre los jóvenes principalmente por la disponibilidad de sabores, la exposición a la comercialización de productos de tabaco, la curiosidad y las percepciones erróneas sobre su seguridad u poca repercusión en la salud en comparación con el daño causado por el uso de cigarrillos convencionales.

Se ha encontrado asociaciones entre el uso de cigarrillos electrónicos y el uso posterior de cigarrillos convencionales en adolescentes y también se describe una fuerte asociación entre estos dispositivos y la utilización subsecuente de alcohol, marihuana, y otras drogas.

La regulación de los sistemas electrónicos de administración de nicotina varía significativamente entre países. La Organización Mundial de la Salud (OMS) recomienda a los gobiernos crear reglamentaciones para evitar que los no fumadores empiecen a consumir estos productos, impedir que el hábito de fumar vuelva a normalizarse en la sociedad y proteger a las generaciones futuras.


Abstract

Most tobacco product use begins during adolescence and tobacco products have evolved to include various products such as e-cigarettes.
E-cigarettes are very attractive among youth mainly because of the availability of flavors, exposure to tobacco product marketing, curiosity, and misperceptions about their safety or low health impact compared to the harm caused by conventional cigarette use.
Associations have been found between e-cigarette use and subsequent use of conventional cigarettes in adolescents, and a strong association between these devices and subsequent use of alcohol, marijuana, and other drugs is also described.
Regulation of electronic nicotine delivery systems varies significantly among countries. The World Health Organization (WHO) recommends that governments create regulations to prevent non-smokers from starting to use these products, to prevent smoking from becoming normalized again in society, and to protect future generations.

Citas

Britton J. Death, disease, and tobacco. Lancet. 2017 May 13;389(10082):1861-1862. doi: 10.1016/S0140-6736(17)30867-X. Epub 2017 Apr 5. PMID: 28390696.

Srivastava P, Currie GP, Britton J. Smoking cessation. BMJ. 2006 Jun 3;332(7553):1324-6. doi: 10.1136/bmj.332.7553.1324. PMID: 16740563; PMCID: PMC1473103.

Lindson N, Butler AR, McRobbie H, et al. Electronic cigarretess for smoking cessation. Cochrane Database Syst Rev. 2024 Jan 8;1(1):CD010216. doi: 10.1002/14651858.CD010216.pub8.

Simonavicius E, McNeill A, Arnott D, Brose LS. What factors are associated with current smokers using or stopping e-cigarette use? Drug Alcohol Depend. 2017 Apr 1; 173:139-143. doi: 10.1016/j.drugalcdep.2017.01.002. Epub 2017 Feb 14. PMID: 28246049; PMCID: PMC5380653.

Hajek P. Electronic cigarettes have a potential for huge public health benefit. BMC Med 2014; 12: 225. doi: 10.1186/s12916-014-0225-z.

Pisinger C. Why public health people are more worried than excited over e-cigarettes. BMC Med 2014; 12: 226.doi: 10.1186/s12916-014-0226-y.

Fairchild AL, Bayer R, Colgrove J. The renormalization of smoking? E-cigarettes and the tobacco "endgame". N Engl J Med. 2014 Jan 23;370(4):293-5. doi: 10.1056/NEJMp1313940. Epub 2013 Dec 18. Erratum in: N Engl J Med. 2014 Jun 12;370(24):2354. PMID: 24350902.

Thrasher JF, Abad-Vivero EN, Barrientos-Gutíerrez I, et al. Prevalence and Correlates of E-Cigarette Perceptions and Trial Among Early Adolescents in Mexico. J Adolesc Health. 2016 Mar;58(3):358-65. doi: 10.1016/j.jadohealth.2015.11.008. PMID: 26903433; PMCID: PMC4765736.

Lozano P, Barrientos-Gutierrez I, Arillo-Santillan E, et al. A longitudinal study of electronic cigarette use and onset of conventional cigarette smoking and marijuana use among Mexican adolescents. Drug Alcohol Depend. 2017 Nov 1; 180:427-430. doi: 10.1016/j.drugalcdep.2017.09.001. Epub 2017 Sep 28. PMID: 28988005; PMCID: PMC5771440.

Overbeek DL, Kass AP, Chiel LE, Boyer EW, Casey AMH. A review of toxic effects of electronic cigarettes/vaping in adolescents and young adults. Crit Rev Toxicol. 2020 Jul;50(6):531-538. doi: 10.1080/10408444.2020.1794443.

Singh T, Agaku IT, Arrazola RA, et al. Exposure to Advertisements and Electronic Cigarette Use Among US Middle and High School Students. Pediatrics. 2016 May;137(5): e20154155. doi: 10.1542/peds.2015-4155. PMID: 27244815; PMCID: PMC11317357.

Vasiljevic M, Petrescu DC, Marteau TM. Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study. Tob Control. 2016 Dec;25(e2): e107-e112. doi: 10.1136/tobaccocontrol-2015-052593. Epub 2016 Jan 17. PMID: 26781305; PMCID: PMC5284337.

East K, Hitchman SC, Bakolis I, et al. The Association Between Smoking and Electronic Cigarette Use in a Cohort of Young People. J Adolesc Health. 2018 May;62(5):539-547. doi: 10.1016/j.jadohealth.2017.11.301. Epub 2018 Mar 2. PMID: 29499983; PMCID: PMC5938086.

Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA Pediatr. 2015 Nov;169(11):1018-23. doi: 10.1001/jamapediatrics.2015.1742. PMID: 26348249; PMCID: PMC4800740.

Bold KW, Kong G, Camenga DR, Simon P, Cavallo DA, Morean ME, Krishnan-Sarin S. Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth. Pediatrics. 2018 Jan;141(1):e20171832. doi: 10.1542/peds.2017-1832. Epub 2017 Dec 4. PMID: 29203523; PMCID: PMC5744268.

Montreuil A, Macdonald M, Asbridge M, et al. Prevalence and correlates of electronic cigarette use among Canadian students: cross-sectional findings from the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey. CMAJ Open. 2017;5(2): E460-E467. doi:10.9778/cmajo.20160167

Milicic S, DeCicca P, Pierard E, Leatherdale S. An evaluation of school-based e-cigarette control policies’impact on the use of vaping products. Tob.Induc Dis.2018;16:35 https://doi.org/10.18332/tid/93594

Czoli CD, Hammond D, Reid JL, Cole AG, Leatherdale ST. Use of conventional and alternative tobacco and nicotine products among a sample of Canadian youth. J Adolesc Heal. 2015;57(1):123-125. doi:10.1016/j.jadohealth.2015.03.006

Vardavas CI, Filippidis FT, Agaku IT. Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries. Tob Control. 2015 Sep;24(5):442-8. doi: 10.1136/tobaccocontrol-2013-051394. Epub 2014 Jun 16. PMID: 24935441.

Anand V, McGinty KL, O'Brien K, Guenthner G, Hahn E, Martin CA. E-cigarette Use and Beliefs Among Urban Public High School Students in North Carolina. J Adolesc Health. 2015 Jul;57(1):46-51. doi: 10.1016/j.jadohealth.2015.03.018. PMID: 26095408.

[]

Amrock SM, Zakhar J, Zhou S, Weitzman M. Perception of e-cigarette harm and its correlation with use among U.S. adolescents. Nicotine Tob Res. 2015 Mar;17(3):330-6. doi: 10.1093/ntr/ntu156. Epub 2014 Aug 14. PMID: 25125321; PMCID: PMC5479512.

Jenssen BP, Walley SC, AAP Section on Tobacco Control. E-Cigarettes and similar devices. Pediatrics. 2019;143(2): e20183652. doi: 10.1542/peds.2018-3652.

Wang TW, Gentzke AS, Creamer MR, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - United States, 2019. MMWR Surveill Summ 2019; 68(No.SS-12.doi: http://dx.doi.org/10.15585/mmwr.ss6812a1externalicon.

Biyani S, Derkay CS. E-cigarettes: Considerations for the otolaryngologist. Int J Pediatr Otorhinolaryngol. 2015 Aug;79(8):1180-3. doi: 10.1016/j.ijporl.2015.04.032. Epub 2015 Apr 28. PMID: 25998217.

Worku D, Worku E. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE Open Med. 2019 Aug 18;7:2050312119871405. doi: 10.1177/2050312119871405. PMID: 31452888; PMCID: PMC6700846.

Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ. 2022 Mar 11;71(5):1-29. doi: 10.15585/mmwr. ss7105a1. PMID: 35271557; PMCID: PMC8923300.

Instituto Nacional de Salud Pública, Comisión Nacional Contra las Adicciones, Secretaría de Salud Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco ENCODAT 2016-2017: Reporte de Tabaco. Ciudad de México, México: INPRFM; 2017. https://www.gob.mx/salud%7Cconadic/acciones-y-programas/encuesta-nacional-de-consumo-de-drogas-alcohol-y-tabaco-encodat-2016-2017-136758

David A Barrera-Núñez DA, López-Olmedo N, Luis Zavala-Arciniega L, Barrientos-Gutiérrez I, Myriam Reynales-Shigematsu L. Consumo de tabaco y Uso de cigarro electrónico en adolescentes y adultos mexicanos. Ensanut Continua 2022, Salud Pública VOL. 65 (2023): SUPLEMENTO 1. ENCUESTA NACIONAL DE SALUD Y NUTRICIÓN CONTINUA 2022. RESULTADOS NACIONALES https://doi.org/10.21149/14830

Thrasher JF, Abad-Vivero EN, Barrientos-Gutíerrez I, et al. Prevalence and Correlates of E-Cigarette Perceptions and Trial Among Early Adolescents in Mexico. J Adolesc Health. 2016 Mar;58(3):358-65. doi: 10.1016/j.jadohealth.2015.11.008. PMID: 26903433; PMCID: PMC4765736.

Encuesta Mundial sobre Tabaquismo en Jóvenes. Organización Mundial de la Salud. https://www.paho.org/es

IV Encuesta Mundial de Tabaquismo en Jóvenes.Panamá, 2018. Oficina Regional para las Américas de la Organización Mundial de la Salud. Organización Panamericana de la Salud https://www.who.int/publications/m/item/2018-gshs-fact-sheet-panama

Barrington-Trimis JL, Urman R, Berhane K, et al. E-cigarettes and future cigarette use. Pediatrics 2016; 138(1): e20160379.doi: 10.1542/peds.2016-0379.

Barrington-Trimis, J.L., Kong, G., Leventhal, A.M., Liu, F., Mayer, M., Cruz, T.B., Krishnan-Sarin, S., McConnell, R. E-cigarette use and subsequent smoking frequency among adolescents. Pediatrics.2018; 142(6):e20180486. doi: 10.1542/peds.2018-0486.

Leventhal AM, Strong DR, Kirkpatrick MG, et al. Association of Electronic Cigarette use with Initiation of Combustible Tobacco product smoking in early adolescence.JAMA. 2015 Aug 18;314(7):700-7. doi: 10.1001/jama.2015.8950.

Cruz TB, McConnell R, Low BW, et al.Tobacco marketing and subsequent use of cigarettes, E-Cigarettes, and Hookah in Adolescents. Nicotine Tob Res. 2019 Jun 21;21(7):926-932. doi: 10.1093/ntr/nty107. PMID: 29846704; PMCID: PMC6588392.

Soneji S, Barrington-Trimis JL, Wills TA, et al. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017 Aug 1;171(8):788-797. doi: 10.1001/jamapediatrics.2017.1488.

Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored Tobacco Product Use Among Middle and High School Students--United States, 2014. MMWR Morb Mortal Wkly Rep. 2015 Oct 2;64(38):1066-70. doi: 10.15585/mmwr.mm6438a2. PMID: 26421418.

Dai H, Hao J. Flavored Electronic Cigarette Use and Smoking Among Youth. Pediatrics. 2016 Dec;138(6): e20162513. doi: 10.1542/peds.2016-2513. Epub 2016 Nov 7. PMID: 27940718.

Chadi R, Schroeder R, Jensen J et al. Association Between Electronic Cigarette Use and Marijuana Use Among Adolescents and Young Adults A Systematic Review and Meta-analysis. JAMA Pediatr. 2019; e192574. doi: 10.1001/jamapediatrics.2019.2574.

Agrawal A, Madden PA, Martin NG, Lynskey MT. Do early experiences with cannabis vary in cigarette smokers? Drug Alcohol Depend. 2013 Mar 1;128(3):255-9. doi: 10.1016/j.drugalcdep.2012.09.002. Epub 2012 Sep 23. PMID: 23010290; PMCID: PMC3614406.

Azagba S. E-cigarette use, dual use of e-cigarettes and tobacco cigarettes, and frequency of cannabis use among high school students. Addict Behav. 2018 Apr; 79:166-170. doi: 10.1016/j.addbeh.2017.12.028. Epub 2017 Dec 23. PMID: 29291507.

Eggers ME, Lee YO, Jackson K, Wiley JL, Porter L, Nonnemaker JM. Youth use of electronic vapor products and blunts for administering cannabis. Addict Behav. 2017 Jul; 70:79-82. doi: 10.1016/j.addbeh.2017.02.020. Epub 2017 Feb 10. PMID: 28214740.

Kenne DR, Fischbein RL, Tan AS, Banks M. The Use of Substances Other Than Nicotine in Electronic Cigarettes Among College Students. Subst Abuse. 2017 Sep 25;11:1178221817733736. doi: 10.1177/1178221817733736. PMID: 28979131; PMCID: PMC5617088.

Giroud C, de Cesare M, Berthet A, Varlet V, Concha-Lozano N, Favrat B. E-Cigarettes: A Review of New Trends in Cannabis Use. Int J Environ Res Public Health. 2015 Aug 21;12(8):9988-10008. doi: 10.3390/ijerph120809988. PMID: 26308021; PMCID: PMC4555324.

Mathur A, Dempsey OJ. Electronic cigarettes: a brief update. J R Coll Physicians Edinb. 2018 Dec;48(4):346-351. doi: 10.4997/JRCPE.2018.415. PMID: 30488894.

Rom O, Pecorelli A, Valacchi G, Reznick AZ. Are E-cigarettes a safe and good alternative to cigarette smoking? Ann N Y Acad Sci. 2015 Mar; 1340:65-74. doi: 10.1111/nyas.12609. Epub 2014 Dec 31. PMID: 25557889.

Thirión-Romero I, Pérez-Padilla R, Zabert G, Barrientos-Gutiérrez I. Respiratory impact of electronic cigarettes and "low-risk" tobacco. Rev Invest Clin. 2019;71(1):17-27. doi: 10.24875/RIC.18002616. PMID: 30810544.

Glantz SA, Bareham DW. E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annu Rev Public Health. 2018 Apr 1; 39:215-235. doi: 10.1146/annurev-publhealth-040617-013757. Epub 2018 Jan 11. PMID: 29323609; PMCID: PMC6251310.

Kosmider L, Sobczak A, Fik M, et al. Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res. 2014 Oct;16(10):1319-26. doi: 10.1093/ntr/ntu078. Epub 2014 May 15. PMID: 24832759; PMCID: PMC4838028.

Radding B. 2015. Pax Juul New E-Cigarette: The iPhone of e-cigs. Accesado 22 /10/23. https://www.mensjournal.com/gear/pax-juul-iphone-e-cigs/.

Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tob Control. 2019 Mar;28(2):146-151. doi: 10.1136/tobaccocontrol-2018-054382. Epub 2018 May 31. PMID: 29853561; PMCID: PMC6274629.

Fadus MC, Smith TT, Squeglia LM.The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend. 2019 Aug 1:201: 85-93.doi: 10.1016/j.drugalcdep.2019.04.011.

Allem JP, Dharmapuri L, Unger JB, Cruz TB. Characterizing JUUL-related posts on Twitter. Drug Alcohol Depend. 2018 Sep 1; 190:1-5. doi: 10.1016/j.drugalcdep.2018.05.018. Epub 2018 Jun 23. PMID: 29958115; PMCID: PMC6693487.

Kavuluru R, Han S, Hahn EJ. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tob Control. 2019 Jan;28(1):110-112. doi: 10.1136/tobaccocontrol-2018-054259. Epub 2018 Apr 13. PMID: 29654121; PMCID: PMC6186192.

Kinouani, S., Pereira, E., Tzourio, C. Electronic cigarette use in students and its relation with tobacco-smoking: a cross-sectional analysis of the i-share study. Int. J. Environ. Res. Public Health. 2017 Nov 5;14(11): 1345.doi: 10.3390/ijerph14111345

McKeganey N, Barnard M, Russell C. Vapers and vaping: E-cigarettes users views of vaping and smoking. Drugs: Education, Prevention and Policy, 25(1), 13–20. https://doi.org/10.1080/09687637.2017.1296933

Pepper JK, Ribisl KM, Brewer NT. Adolescents' interest in trying flavoured e-cigarettes. Tob Control. 2016 Nov;25(Suppl 2):ii62-ii66. doi: 10.1136/tobaccocontrol-2016-053174. Epub 2016 Sep 15. PMID: 27633762; PMCID: PMC5125087.

Ramamurthi D, Chau C, Jackler RK. JUUL and other stealth vaporisers: hiding the habit from parents and teachers. Tob Control. 2018 Sep 15: tobacco control-2018-054455. doi: 10.1136/tobaccocontrol-2018-054455. Epub ahead of print. PMID: 30219794.

Yingst J, Lester C, Veldheer S, Allen S, Du P. Foulds. E-cigarette users commonly stealth vape in places where e-cigarette use is prohibited. Tob Control. 2019 Sep;28(5):493-497. doi: 10.1136/tobaccocontrol-2018-054432.

Barrington-Trimis JL, Leventhal AM. Adolescents' Use of "Pod Mod" E-Cigarettes - Urgent Concerns. N Engl J Med. 2018 Sep 20;379(12):1099-1102. doi: 10.1056/NEJMp1805758. Epub 2018 Aug 22. PMID: 30134127; PMCID: PMC7489756.

Kong G, Morean ME, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults. Nicotine Tob Res. 2015 Jul;17(7):847-54. doi: 10.1093/ntr/ntu257. Epub 2014 Dec 6. PMID: 25481917; PMCID: PMC4674436.

Harvanko AM, Havel CM, Jacob P, Benowitz NL. Characterization of Nicotine Salts in 23 Electronic Cigarette Refill Liquids. Nicotine Tob Res. 2020 Jun 12;22(7):1239-1243. doi: 10.1093/ntr/ntz232. PMID: 31821492; PMCID: PMC7291795.

Paterson D, Nordberg A. Neuronal nicotinic receptors in the human brain. Prog Neurobiol. 2000 May;61(1):75-111. doi: 10.1016/s0301-0082(99)00045-3. PMID: 10759066.

Benowitz NL. Nicotine addiction. N Engl J Med. 2010 Jun 17;362(24):2295-303. doi: 10.1056/NEJMra0809890. PMID: 20554984; PMCID: PMC2928221.

Kandel ER, Kandel DB. Shattuck Lecture. A molecular basis for nicotine as a gateway drug. N Engl J Med. 2014 Sep 4;371(10):932-43. doi: 10.1056/NEJMsa1405092. PMID: 25184865; PMCID: PMC4353486.

McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014;(12):CD010216. doi: 10.1002/14651858.CD010216.pub2. Epub 2014 Dec 17. PMID: 25515689.

Hartmann-Boyce J, Lindson N, Butler AR, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2022 Nov 17;11(11):CD010216. doi: 10.1002/14651858.CD010216.pub7

Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011 Oct 11; 11:786. doi: 10.1186/1471-2458-11-786. PMID: 21989407; PMCID: PMC3203079.

Gulland A. E-cigarettes help smokers quit. Cochrane review confirms. BMJ. 2016 Sep 13;354: i4993. doi: 10.1136/bmj. i4993. PMID: 27629778.

Chun LF, Moazed F, Calfee CS, Matthay MA, Gotts JE. Pulmonary toxicity of e-cigarettes. Am J Physiol Lung Cell Mol Physiol. 2017 Aug 1;313(2): L193-L206. doi: 10.1152/ajplung.00071.2017. Epub 2017 May 18. PMID: 28522559; PMCID: PMC5582932.

Shields PG, Berman M, Brasky TM, et al. A Review of Pulmonary Toxicity of Electronic Cigarettes in the Context of Smoking: A Focus on Inflammation. Cancer Epidemiol Biomarkers Prev. 2017 Aug;26(8):1175-1191. doi: 10.1158/1055-9965.EPI-17-0358. Epub 2017 Jun 22. PMID: 28642230; PMCID: PMC5614602.

Polosa R, Cibella F, Caponnetto P, Maglia M, Prosperini U, Russo C, Tashkin D. Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked. Sci Rep. 2017 Nov 17;7(1):13825. doi: 10.1038/s41598-017-14043-2. PMID: 29150612; PMCID: PMC5693960.

Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Secondhand exposure to vapors from electronic cigarettes. Nicotine Tob Res. 2014 Jun;16(6):655-62. doi: 10.1093/ntr/ntt203. Epub 2013 Dec 11. PMID: 24336346; PMCID: PMC4565991.

Lerner CA, Sundar IK, Yao H, et al. Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory respon se in lung epithelial cells and in mouse lung. PLoS One. 2015; Feb 6;10(2): e0116732.doi: 10.1371/journal.pone.0116732. eCollection 2015.

Higham A, Bostock D, Booth G, Dungwa JV, Singh D. The effect of electronic cigarette and tobacco smoke exposure on COPD bronchial epithelial cell inflammatory responses. Int J Chron Obstruct Pulmon Dis. 2018 Mar 23; 13:989-1000. doi: 10.2147/COPD.S157728. PMID: 29615835; PMCID: PMC5870631.

Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016 Feb;4(2):116-28. doi: 10.1016/S2213-2600(15)00521-4. Epub 2016 Jan 14. PMID: 26776875; PMCID: PMC4752870.

Herrington JS, Myers C. Electronic cigarette solutions and resultant aerosol profiles. J Chromatogr A. 2015 Oct 30; 1418:192-199. doi: 10.1016/j.chroma.2015.09.034. Epub 2015 Sep 15. PMID: 26422308.

Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci. 2017 Apr;1394(1):5-30. doi: 10.1111/nyas.12977. Epub 2016 Jan 15. PMID: 26774031; PMCID: PMC4947026.

Biyani S, Derkay CS. E-cigarettes: Considerations for the otolaryngologist. Int J Pediatr Otorhinolaryngol. 2015 Aug;79(8):1180-3. doi: 10.1016/j.ijporl.2015.04.032. Epub 2015 Apr 28. PMID: 25998217.

Kaur G, Pinkston R, Mclemore B, Dorsey WC, Batra S. Immunological and toxicological risk assessment of e-cigarettes. Eur Respir Rev. 2018 Feb 28;27(147):170119. doi: 10.1183/16000617.0119-2017. PMID: 29491036; PMCID: PMC9489161.

Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology. 2016 Jul 15;365:67-75. doi: 10.1016/j.tox.2016.07.020. Epub 2016 Jul 28. PMID: 27477296; PMCID: PMC4993660.

Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electron-ic cigarette cartomizer fluid and aerosol. PLoS One. 2013; 8:e57987. doi: 10.1371/journal.pone.0057987.

Worku D, Worku E. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE Open Med. 2019 Aug 18;7:2050312119871405. doi: 10.1177/2050312119871405. PMID: 31452888; PMCID: PMC6700846.

Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems, Board on Population Health and Public Health Practice, Health and Medi-cine Division, National Academies of Sciences, Engineering, and Medicine. Stratton K, Kwan LY, Eaton DL. Eds. Public Health Consequences of E-Cigarettes. Washington, D.C. National Academies Press; 2018. DOI: 10.17226/24952

Clapp PW, Jaspers I. Electronic cigarettes: their constituents and potential links to asthma. Curr Allergy Asthma Rep. 2017;17:79. doi: 10.1007/s11882-017-0747-5

Mead EL, Duffy V, Oncken C, Litt MD. E-cigarette palatability in smokers as a function of flavorings, nicotine content and propylthiouracil (PROP) taster phenotype. Addict Behav. 2019 Apr;91:37-44. doi: 10.1016/j.addbeh.2018.11.014. Epub 2018 Nov 15. PMID: 30470456; PMCID: PMC6358501.

Gerloff J, Sundar IK, Freter R, et al. Inflammatory Response and Barrier Dysfunction by Different e-Cigarette Flavoring Chemicals Identified by Gas Chromatography-Mass Spectrometry in e-Liquids and e-Vapors on Human Lung Epithelial Cells and Fibroblasts. Appl In Vitro Toxicol. 2017 Mar 1;3(1):28-40. doi: 10.1089/aivt.2016.0030. PMID: 28337465; PMCID: PMC5338075.

Tierney PA, Karpinski CD, Brown JE, Luo W, Pankow JF. Flavour chemicals in electronic cigarette fluids. Tob Control. 2016 Apr;25(e1):e10-5. doi: 10.1136/tobaccocontrol-2014-052175. Epub 2015 Apr 15. PMID: 25877377; PMCID: PMC4853541.

Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009 Oct;30(10):515-27. doi: 10.1016/j.tips.2009.07.006. Epub 2009 Sep 2. Erratum in: Trends Pharmacol Sci. 2009 Dec;30(12):609. PMID: 19729208.

Giroud C, de Cesare M, Berthet A, Varlet V, Concha-Lozano N, Favrat B. E-Cigarettes: A Review of New Trends in Cannabis Use. Int J Environ Res Public Health. 2015 Aug 21;12(8):9988-10008. doi: 10.3390/ijerph120809988. PMID: 26308021; PMCID: PMC4555324.

Milicic S, Leatherdale ST. The Associations Between E-Cigarettes and Binge Drinking, Marijuana Use, and Energy Drinks Mixed with Alcohol. J Adolesc Health. 2017 Mar;60(3):320-327. doi: 10.1016/j.jadohealth.2016.10.011. Epub 2016 Dec 21. PMID: 28012834.

Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014 Jun 5;370(23):2219-27. doi: 10.1056/NEJMra1402309. PMID: 24897085; PMCID: PMC4827335.

Blundell MS, Dargan PI, Wood DM. The dark cloud of recreational drugs and vaping. QJM. 2018 Mar 1;111(3):145-148. doi: 10.1093/qjmed/hcx049. PMID: 28339800.

Tait RJ, Caldicott D, Mountain D, Hill SL, Lenton S. A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment. Clin Toxicol (Phila). 2016;54(1):1-13. doi: 10.3109/15563650.2015.1110590. Epub 2015 Nov 15. PMID: 26567470.

Convenio Marco de la Organización Mundial de la salud para el Control del Tabaco https://www.paho.org/es/documentos/convenio-marco-oms-para-control-tabaco.

Ley 40 de 7 de julio de 2004. Gaceta Oficial 25097 del 20 de julio de 2004.

Resolución 660 de 11 de agosto de 2009. Gaceta Oficial Digital 26356-B del 28 de agosto de 2009.

Decreto Ejecutivo 1838 de 5 de diciembre de 2014. Gaceta Oficial Digital 27678-A del 11 de diciembre de 2014.

Asamblea Nacional. Secretaria General. Trámite legislativo 2019-2020. Anteproyecto de Ley 278. Proyecto de Ley 178. 28 de octubre de 2019 https://www.panacamara.com/wpcontent/uploads/2020/08/ActualidadLegislativa3-agosto.pdf.

Gaceta Oficial Digital número 29568-B de 30 de junio de 2022. https://www.gacetaoficial.gob.pa/pdfTemp/29568_B/GacetaNo_29568b_20220630.pdf