BACKGROUND:

E-cigarettes(electronic-cigarettes), also known as vapes, mods, vape-pens (VYPE, JUUL,

BLU, MYLE), etc is a handheld battery-powered vaporizer that simulates smoking by producing
aerosols. They typically contain a heating element that atomizes a liquid solution called e-liquid. Some e-
cigarettes look like traditional cigarettes,[80] but they come in many variations.[3] Most versions are reusable,
though some are disposable. Using an e-cigarette is known as "vaping". E-liquids usually contain propylene
glycol, glycerin, nicotine, flavorings, additives, and differing amounts of contaminants.[86] E-liquids are also
sold without propylene glycol,[87] nicotine,[88] or flavors. They are considered to generate fewer toxic
chemicals when compared to the deadly mix of nearly 2000 chemicals in a regular cigarette.
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Bachon main
Use of electronic cigarettes (e-cigarettes) has increased rapidly among college students
and young adults over the past 5 years, exceeding that of conventional cigarettes.1-5 Some
argue that e-cigarettes provide an innovative harm reduction strategy for smokers6 and are a more
effective smoking quit-aid than other nicotine replacement therapy (NRT).7 Whereas e-cigarettes
contain many of the same chemicals as conventional cigarettes (eg, formaldehyde, acetaldehyde),
they expose users to far lower amounts of toxicants than cigarettes,8 and those who are able to
stop smoking completely would likely see health benefits from switching to e-cigarettes.9
However, increasing rates of e-cigarette initiation among young audiences that have not smoked
conventional cigarettes or used other tobacco products previously3,10-15 is concerning due to
nicotine’s effect on the cerebral cortex and hippocampus during development.16,17 Also, nicotine
is a vasoconstrictor, and prolonged exposure to nicotine can lead to increased heart rate, blood
pressure, and arterial stiffness.18,19 Initial research associates daily e-cigarette use with heart
diseases, such as ischemic heart disease and myocardial infarctions,20-22 and respiratory illnesses,
such as asthma.23,24 Moreover, one study found nicotine to induce DNA damage in human lung
and bladder epithelial cells, suggesting that e-cigarette use could increase one’s odds of
developing lung cancer and bladder cancer.25 Additionally, these products contain substances,
such as diacetyl, a flavoring chemical previously known to cause bronchiolitis obliterations
(commonly known as “popcorn lungs”),26 raising concern for use of e-cigarette products that do
not contain nicotine.
social
Some suggest that e-cigarettes’ may be more socially acceptable than conventional
cigarettes,27 which could promote the social renormalization of smoking,1,28 initiation among
never smokers,10-14 or re-engagement of former-smokers who believe e-cigarettes will allow them
to safely consume nicotine.29,30 Prior studies have employed the theory of reasoned action (TRA)
to explore college students’ use of e-cigarettes; findings suggested attitudes and social norms
predict intention to use e-cigarettes. 5,31-34 Strengths of the TRA include its ability to account for
evaluation of perceived outcomes (attitudes) as well as the willingness to comply with the wishes
of referent others (subjective norms).35 Studies suggest that college students have more favorable
attitudes toward e-cigarettes36 and believe e-cigarettes to be more socially acceptable among their
peers than conventional cigarettes;37 those with more favorable attitudes toward e-cigarettes and
accepting social environments of e-cigarette use report greater odds of trying these products.5,38
Dispite the obvious strengths of the TRA’s ability to explain e-cigarette use in young popuations,
no studies have developed a theory-driven measure for college student e-cigarette use using more
current iterations of this theory.

This article focuses on public risk perceptions and knowledge about chemicals in SHV for a few
reasons. First, we focus on risk perceptions about
harmful effects of exposure to SHV because perceived
risk could influence e-cigarette use. We know
from prior research on perceptions about risks of
secondhand cigarette smoke exposure that those
who perceived secondhand smoke (SHS) risks as
lower were more likely to intend to smoke and
initiate smoking subsequently.(19–21) Second, inaccurate
knowledge about the presence of chemicals in
SHV may impact e-cigarette uptake in youth and
young adult populations. For instance, inaccurate
knowledge that SHV is free of any harmful chemicals
may encourage uptake of e-cigarette use among
youth who might otherwise abstain from tobacco use.
Third, risk perceptions may influence attitudes toward
regulating e-cigarette use in smoke-free places.
Drawing from research on combusted cigarette SHS,
perceiving SHS as harmful is associated with reduced
cigarette smoking behavior, increased enforcement
of household rules about smoking, and increased
support for public smoke-free policies.(19,20,22–24) Similarly,
a recent study found that lower perceptions
about health harms of breathing SHV are associated
with reduced support for banning e-cigarette use in
smoke-free places.(25)
Research in public risk perception suggests
that the public is particularly sensitive to risks
associated with chemicals in the environment.(26)
Compared to experts such as toxicologists, the lay
public has greater confidence in animal studies and
early research showing links between chemical exposure
and carcinogenic effects.(27,28) In addition, people
are prone to rely on their intuition(29) and on
representativeness heuristics(30) (e.g., extrapolating
what they know about the likelihood of harm from
SHS exposure to estimate risks associated with SHV)
to avoid toxic risks rather than factual evidence of the
presence and degree of environmental risks. These
trends have led to a growing challenge in educating
the public about actual health risks of technological
innovations as risks become less perceptible to the
basic human senses.(29) Based on the psychometric
paradigm described by Slovic et al.,(31) in the case of
SHV, risk perceptions are likely to be higher among
those who believe that such emissions contain chemicals
because e-cigarettes are novel products, evolving
rapidly in the marketplace, and may pose involuntary
risks to bystanders that are unobservable (invisible)
and relatively unknown to science.
While recent surveys have focused on beliefs
about e-cigarettes helping smokers quit and health
consequences of using e-cigarettes,(32–37) no study
has yet assessed people’s knowledge of chemicals
in SHV specifically. In one related study, Sanders-
Jackson et al. assessed knowledge about e-cigarette
constituents based on a national survey among young
adults (the survey items asked whether respondents
knew if e-cigarettes contained nicotine and any of
the toxic chemicals found in combustible cigarettes
but did not specify which chemicals). The study
found that 37% of respondents did not know whether
e-cigarettes contained nicotine and 48% were not
aware if e-cigarettes contained toxic chemicals found
in combustible cigarettes.(38) However, the study
did not measure people’s knowledge about specific
chemicals (e.g., formaldehyde) in e-cigarette
SHV.

Conceptual Framework
For the current study, we used the reasoned action
approach (RAA) as the theoretical framework,
due to its novel and updated approach to exploring
behavioral intention. The RAA is the most recent
version of the TRA, the theory of planned behavior
(TPB), and the integrated behavioral model.39 All
of these theories defined: (1) attitude as one’s beliefs
about the behavior and their evaluation of the
potential outcomes that may occur due to performing
this behavior; and (2) social norms as one’s perception
of referent others’ (who are important to
them) opinions about their behavior and their motivation
to comply with the wishes of these referents.
35 Ajzen40 expanded the TRA into the TPB by
adding the construct perceived behavioral control
(PBC), which measures perceived power to perform
the behavior within the given circumstances.
The most current version of this theory, the RAA,
expanded upon the TRA/TPB’s social norm construct
(defined above as injunctive norms) by also
including descriptive norms. Descriptive norms
are one’s perception of those who actually perform
the behavior and how closely the individual identifies
with these people.39,41 The RAA suggests that
attitudes, social norms (ie, injunctive norms and
descriptive norms), and PBCs influence a person’s
intention to perform a specific behavior, and intention
is the immediate predictor of actually performing
the given behavior. Previous studies have
used the RAA to improve understanding of behavioral
intentions to get an HPV vaccination,42,43 buy
and eat dark leafy vegetables,44 enroll in a tobacco
cessation program,45 and attend yoga classes;46
however, no studies have explored the RAA’s application
to intention to use e-cigarettes. Our study
investigates the construct validity of the RAA as it
applies to college students’ intention to use e-cigarettes
in the next 30 days for recreational purposes
(‘just because I want to do it’). The purposes of this
study were to: (1) develop a RAA-based measure,
assessing e-cigarette use; (2) evaluate and confirm
the factor structure of the measure; and (3) test the
theoretical application of the RAA to recreational
e-cigarette use.

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They have become very popular in no time among the smokers almost all over the
world.The E-cigarette, which was said to be a safer and economical alternative for the cigarettes
became much more addictive and lead to many harmful health issues. Though the original
propaganda by the companies was to taper the smoke consumption and have control over the
habit eventually quitting, but there was whole new scenario when launched.
However, recent surveys have shown an increased addiction towards the smoking and
increased the mortality rate of those using E-cigarettes. The rage of E-cigarettes has also
captured the attention of young people including the high school students owing to the influence
of cultureandadvertisements. It is at-most necessity to formulate and review the policies and
guidelines regarding the usage.
The CDC has released images of the lung scans related to those succumbed to E-cigarette
related fatal deaths.
 REFERENCE
https://www.ladbible.com/news/news-medical-scans-released-show-vape-related-damage-
20190912