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  • Subject area(s): Marketing
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  • Published on: 14th September 2019
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This paper explores various published articles that inform on results from research conducted on the prevalence of electronic cigarette (e-cigarette) smoking. This paper describes an answer to the research question: How does prevalent electronic cigarette (e-cigarette) smoking expose potential health effects among the United States adolescents and college students aged from 18 to 25 years?

Methods: Using library search of the scientific literature and keywords such as “health effects” and “e-cigarette”. The author also used searching revealed other keywords such as “adolescents and e-cigarette effects”.

Results: The paper examines eleven scientific articles that reveal adequate information about the e-cigarette health effects, its nicotine addiction, and the needs of its regulation among the United States adolescents from 18 to 25. Scientists expose that e-cigarette carries some harmful aspects; it contains unhealthy issues as well as potentially toxic matters. E-cigarette use is likely to be an addition to other tobacco use, thus serving as another potential hazard for young people. Therefore, the significant e-cigarette regulations need to include rules on e-cigarette's products to youths.

Discussion and Conclusion: The vast majority of research studies examine the medical effects and risks of e-cigarette, and are undertaken by several institutions ranging from government agencies to universities-sponsored research. The tobacco industry aggressively markets e-cigarette to youth, glamorizing e-cigarette use in advertisements and offering e-cigarette in many flavors. It is important for the government such as FDA to begin restrictive administration of e-cigarettes, which would require warning labels and youth access restrictions.

Electronic cigarette, or e-cigarette (EC), is a popular new tobacco product that still has largely unknown public and individual health effects. Tobacco products are currently popular among U.S. adolescents and college students, especially e-cigarette smokers. Since e-cigarette has emerged publicly in recent years; experts have considered in the early stage of investigating what the health effects are for young people who use these products or who are exposed to it. The main component of an e-cigarette is the electronic-liquid contained in cartridges. To create an electronic-liquid, nicotine is obtained from tobacco and mixed with a base, and may also include artificial flavors, colors and other harmful chemicals. Since there is no government administration of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market without an official verification for their harms (Kristjansson, 2015; Littlefield, 2015; Primack, 2015). In fact, we should be concerned that e-cigarettes are totally uncontrolled by the U.S. Food and Drug Administration (FDA). Because of this, there are no safe instructions or minimal requirements for an e-cigarette. So there is no possible way for anyone such as healthcare professionals or smokers to perceive what chemicals are contained in e-liquids, or how e-cigarette smoking may affect health, whether in the short term or in the long term. Following by the results in their research, it showed use of e-cigarettes among US young adults increased from 3.3% to 6.2%, with 21.2% of current e-cigarette smokers during 2010-2013 (King, Patel, Nguyen, & Dube, 2015). This posed that the published data of use of e-cigarette increased significantly with a focus on the adolescents and college students' health effects.

This paper examines various academic and scientific journal articles that report on results from conducted studies on the prevalent smoking of electronic cigarette (e-cigarette). This paper aimed to examine prevalence and correlates of electronic cigarette use and its health hazards of young adult smokers in those journals .This paper illustrates an answer to the research question: How does prevalent electronic cigarette (e-cigarette) smoking expose potential health effects, nicotine addiction, and the needs for its regulation among the United States adolescents and college students aged from 18 to 25 years?

Methods

For investigating required information, I use appropriate library searching of the scientific literature and keywords such as “health effects” and “e-cigarette”. Also, I combined additional searching and revealed other keywords such as “adolescents and e-cigarette effects”. For the quality of the sources, I retrieved adequate information from many professional databases and journals in the medical field such as PubMed and JAMA. They were examined using a set of proper search terms used singly or in combination. Search terms included ‘electronic cigarette device' or ‘electronic nicotine device' or ‘electronic nicotine delivery systems' or ‘electronic cigarette' or ‘e-cig' or ‘e-cigs' and ‘health effects'. The article had to be published in a scientific peer-reviewed journal, and contained partially or entirely with e-cigarette exposure to health effects. Also, I conducted literature searches to identify studies related to e-cigarette and health effects such as other relevant peer-reviewed, refereed articles, and health science literature. These did not contain editorials or letters, must have abstract, and mostly within 10 years looked at electronic cigarette use. For the targeted audience, I limited the age range of young adults and college students from 18 to 25 years.

A total of 11 articles qualified the criteria. Article titles and abstracts were screened for potential relevance. This promoted all articles for full-text review and proper reference citations. The validity and efficacy of selected articles were determined to fulfill the study's objectives.

One of the concerns is electronic cigarette's health hazards towards to the U.S. adolescents and college students' smoking. In fact, adolescents' use of electronic cigarette is a growing public health issue. Adolescents' use of e-cigarettes, which are also called vaping, has increased impressively since their introduction in the U.S. marketplace in 2007 (King et al., 2015). E-cigarette use tripled among adolescents and college students from 2013 to 2014, and many students reported using e-cigarettes in the last 30 days than conventional cigarettes (Cooke, 2015; King, 2015). Besides, e-cigarette contains harmful chemical substances, such as formaldehyde, acetaldehyde, tobacco-specific nitrosamines, and potential allergens; other potentially harmful substances, including a variety of toxins such as diethylene glycol, formaldehyde, acetaldehyde, and acrolein, were included in some EC brands (Callahan-Lyon, 2014; Wasowicz, 2015). The health hazards of EC use might also be linked to the various substances found in EC refill cartridges. Researchers stated that one such substance is propylene glycol, in which nicotine is suspended and which is used in order to induce the e-cigarette aerosol. Aerosols, the most toxic element, can deposit into the body's respiratory system, which are vital to moving air into the body. In addition, in their studies, many medical experts discovered that the conception of e-cigarette smoking is related to other combustible tobacco products usage. It may therefore make an initiation of combustible tobacco use to increase the risk of alcohol use among young adults, and serve to increase the overall prevalence of tobacco use (Kristjansson, 2015; Littlefield, 2015; Primack, 2015). Therefore, e-cigarette poses a risk to adolescent and college student's health for multiple reasons.

Nicotine addiction is also another concern of electronic cigarette to the U.S. adolescents and college students' health condition. Nicotine is an addictive factor, and almost all e-cigarettes contain nicotine. Even some products that demand to be nicotine-free still may contain the nicotine. For instance, a lot of scientific tests found that cartridges labeled as nicotine-free had traceable levels of nicotine (Littlefield, 2015; Primack, 2015). Callahan-Lyon (2014) stated that nicotine is easily absorbed through the airway, skin, mucous membranes and gastrointestinal tract. Also, a 2015 study found considerable consistency in the amount of nicotine delivered by e-cigarette of different brands (Rigotti, 2015). Similarly, another study found that the amount of nicotine inside an e-cigarette refilling usually is substantially different from the amount listed on the package (Yuan, Cross, Loughlin, & Leslie, 2015). Experienced users learn how to use e-cigarette in a way that increases their exposure to nicotine. Newest e-cigarette devices, especially “container” styles with higher voltage, also deliver a greater concentration of nicotine. This makes a concern because the more nicotine used, the greater possibility for addiction.

Moreover, nicotine is not safe; when smokeless tobacco such as EC is used, nicotine is absorbed through the mouth tissues directly into the blood, where it proceeds to the brain. Even if the tobacco is withdrew from the mouth, nicotine remains to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for smokeless tobacco users than for regular smokers. In their study, Hildick-Smith et al. (2015) reported that the U.S. Surgeon General has found exposure to nicotine during pregnancy harms the developing fetus, and causes serious damages for brain development and lung function in babies. Nicotine exposure also affects maternal and fetal health during pregnancy, and can affect in low birth weights, preterm delivery and stillbirth. Nicotine still negatively influences adolescent brain development. Human brain development continues far longer than was previously known, and nicotine use during adolescence and young adulthood has been resulted in lasting cognitive and behavioral impairments, including effects on working memory and attention. Exposure to nicotine can modify the structure and function of the developing brains of adolescents and harm fetal development during pregnancy. Thus, e-cigarette harms young users by exposing them directly to adverse nicotine effects and also by inducing nicotine addiction.

The last concern is that electronic cigarette proposes to the needs of governmental regulations and effective actions to protect adolescents and college students' health beneficence. E-cigarette is not publicly regulated by the FDA and is not subject to tobacco laws. E-cigarette has been shown to be a possible source of secondary exposure to nicotine addiction. Also, marketing strategies have contributed extremely to the rapid growth in e-cigarette use among adolescents. According to the National Adult Tobacco Survey, marketing of e-cigarette products continued to increase in young adults, with 5.8% of U.S. adults reporting ever use of electronic cigarettes (Cooke, Fergeson, Bulkhi, & Casale, 2015). Adolescents and college students are the most vulnerable group to approach use of e-cigarettes. The innovation of the e-cigarette, perceptions about the harmlessness of the product, a broad variety of flavors (fruit, chocolate, menthol, bubble gum, and other), and peer-influence are just a few examples of elements contributing to the e-cigarette popularity among youth. The most issues related to e-cigarette use by adolescents are massive marketing campaigns and easy access to the product. E-cigarette companies have tremendously boosted marketing spending, more than doubling expenditures between 2012 and 2013 (Wasowicz, 2015). For instance, in the U.S., a lot of e-cigarette companies spent $59.3 million in 2013 to promote e-cigarettes to young adults (Wasowicz, 2015). Currently, there is not much restriction on the marketing of e-cigarettes. This allows for companies to exploit correspondent marketing programs to those previously used by tobacco industry to inspire young people to endeavor the product. (Saitta, 2014; Wasowicz, 2015). Other issues are wide availability, easy access to the product, and lack of age restrictions on purchasing the e-cigarettes. Youths can purchase e-cigarettes easily via the Internet and other online retailers due to lack of age-confirmation. Therefore, the rapid increasing in adolescent e-cigarette use should advocate implementation and enforcement of regulations to control their prevalence among young people. Both of these potential regulations include laws on marketing, safety of recently introduced products (nicotine dose, or labelling requirements to consumers), marketing limitations, and banning the sales of e-cigarettes to young people. It is important for the new rules to be implemented as soon as possible and restricted properly in adolescents and college students' smoking. Therefore, the FDA discourages applying e-cigarette advertisements and promotes solid restrictions on its products, and encourages adolescents and college students to limit their use and preventing nicotine addiction.

Discussion

This paper is unique in three ways. First, the goal of this article is to present a review of the scientific evidence-based primary literature concerning electronic cigarettes and its potential health effects among the U.S. college students and adolescents aged from 18 to 25 years. This review will systematically synthesize studies related across a broad range of study designs and outcomes on an e-cigarette and its health hazards basis. Second, the review has reported that e-cigarette cartridges and solutions actually contain toxic substances such as nitrosamines, diethylene glycol, and other contaminants potentially harmful to young users. E-cigarette is also a second exposure to nicotine addiction and other combustible tobacco products use. Third, this review also highlights gaps in the federal control to recommend regulated areas for future research in pace with the rapidly involving e-cigarette and adolescents and college students use.

Limitations of the review include the restriction of eligible studies to those that are peer-reviewed, indexed in PubMed and available in English language. The review is based on the accessible volume of studies in the literature base; the search is limited to one database (PubMed searching engine), and a single author conducts the title and abstract review for a given search. The author did not have much authorization to access other concrete analyzed studies. Most of the resources are available through the UNR library database. While an individual author conducts data extraction for a given various of studies, the author still has developed a process for identifying studies that should be categorized under multiple outcomes and future approaches to in-class discussion in order to reduce bias in data extraction.

Conclusion

This study examines the existing evidence-based literature, and explores analyzing prevalent numbers of adolescents and college students aged from 18 to 25 years in the United States who are using increasingly electronic cigarette in recent years. This current issue should be the most concern to the health community because of the potential health harms posed by increased use of these products and the potential for increased exposure to nicotine and nicotine addiction. Researchers have provided evidence how new and improved products, such as e-cigarette and other smokeless tobacco, might affect tobacco product use patterns among adolescents and college students. Those working in the interests of public health should be concerned with the relationship between other tobacco products and e-cigarette use patterns among youth to understand the potential harms pose to the youth's health. The medical community advises on the side of caution, indicating that very little scientific evidence is available to show, one way or the other, that e-cigarettes are safe to use, or that they help in the smoking cessation process. Policy makers also have yet to regulate tobacco control policies for e-cigarette, such as the ban on characterizing flavors and the age of purchasers. Effective actions are needed to protect youth and reduce the demand for e-cigarette by nonsmokers of all ages, including restrictions on cigarette smoking in public places and workplaces.

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