conclusion for smoking essay

Essay on Smoking

500 words essay on smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

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Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

Writing a Smoking Essay. Complete Actionable Guide

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
There is an endless number of environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them.

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper.

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

Home — Essay Samples — Nursing & Health — Nursing — Argumentative Essay On Smoking Cigarettes

Argumentative Essay on Smoking Cigarettes

Categories: Nursing

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Words: 507 |

Published: Mar 13, 2024

Words: 507 | Page: 1 | 3 min read

Health effects of smoking, economic implications, impact on non-smokers, the case for regulation, references:.

Centers for Disease Control and Prevention. (2020). Smoking & Tobacco Use. Retrieved from https://www.cdc.gov/tobacco/data_statistics/index.htm

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Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence (2010)

Chapter: 8 conclusions and recommendations, 8 conclusions and recommendations.

In this report, the committee has examined three relationships in response to its charge (see Box 8-1 for specific questions):

The association between secondhand-smoke exposure and cardiovascular disease, especially coronary heart disease and not stroke (Question 1).

The association between secondhand-smoke exposure and acute coronary events (Questions 2, 3, and 5).

The association between smoking bans and acute coronary events (Questions 4, 5, 6, 7, and 8).

This chapter summarizes the committee’s review of information relevant to those relationships; presents its findings, conclusions, and recommendations on the basis of the weight of evidence; and presents its responses to the specific questions that it was asked in its task.

SUMMARY OF REPORT

Exposure assessment.

To determine the effect of changes in exposure to secondhand smoke it is necessary to quantify changes in epidemiologic studies. Airborne measures and biomarkers of exposure to secondhand smoke are available; they are complementary and provide different information (see Chapter 2 ). Biomarkers (such as cotinine, the major proximate metabolite of nicotine) in-

tegrate all sources of exposure and inhalation rates, but cannot identify the place where secondhand-smoke exposure occurred and, because of a short half-life they reflect only recent exposures. Airborne measures of exposure can demonstrate the contribution of different sources or venues of exposure and can be used to measure changes in secondhand-smoke concentrations at individual venues, but they do not reflect the true dose. Airborne concentration of nicotine is a specific tracer for secondhand smoke. Particulate matter (PM) can also be used as an indicator of secondhand-smoke exposure, but because there are other sources of PM it is a less specific tracer than nicotine. The concentration of cotinine in serum, saliva, or urine is a specific indicator of integrated exposure to secondhand smoke.

Although in most of the smoking-ban studies the magnitude, frequency, and duration of exposures that occurred before a ban are not known, monitoring studies demonstrate that exposure to secondhand smoke is dramatically reduced in places that are covered by bans. Airborne nicotine

and PM concentrations in regulated venues such as workplaces, bars, and restaurants decreased by more than 80% in most studies; serum, salivary, or urinary cotinine concentrations decreased by 50% or more in most studies, probably reflecting continuing exposures in unregulated venues (for example, in homes and cars).

Pathophysiology

The pathophysiology of the induction of cardiovascular disease by cigarette-smoking and secondhand-smoke exposure is complex and undoubtedly involves multiple agents. Many chemicals in secondhand smoke have been shown to exert cardiovascular toxicity (see Table 3-1 ), and both acute and chronic effects of these chemicals have been identified. Experimental studies in humans, animals, and cell cultures have demonstrated effects of secondhand smoke, its components (such as PM, acrolein, polycyclic

aromatic hydrocarbons [PAHs], and metals), or both on the cardiovascular system (see Figure 3-1 for summary). Those studies have yielded sufficient evidence to support an inference that acute exposure to secondhand smoke induces endothelial dysfunction, increases thrombosis, causes inflammation, and potentially affects plaque stability adversely. Those effects appear at concentrations expected to be experienced by people exposed to secondhand smoke.

Data from animal studies also support a dose–response relationship between secondhand-smoke exposure and cardiovascular effects (see Chapter 3 ). The relationship is consistent with the understanding of the pathophysiology of coronary heart disease and the effects of secondhand smoke on humans, including chamber studies. The association comports with known associations between PM, a major constituent of secondhand smoke, and coronary heart disease.

Overall, the pathophysiologic data indicate that it is biologically plausible for secondhand-smoke exposure to have cardiovascular effects, such as effects that lead to cardiovascular disease and acute myocardial infarction (MI). The exact mechanisms by which such effects occur, however, remain to be elucidated.

Smoking-Ban Background

Characteristics of smoking bans can heavily influence their consequences. Interpretation of the results of epidemiologic studies that involve smoking bans must account for information on the bans and their enforcement.

Secondhand smoke should have been measured before and after implementation of a ban, and locations with and without bans should have been compared. Studies that include self-reported assessments of exposure to secondhand smoke cannot necessarily be compared with each other unless the survey instruments (such as interviews) were similar.

The comparability of the time and length of followup of the studies should be assessed. For example, the impact of a ban in one area may differ from the impact of a ban in another solely because the observation times were different and other activities may have occurred during the same periods. In comparing studies, it may be impossible to separate contextual factors associated with ban legislation—such as public comment periods, information announcing the ban, and notices about the impending changes—from the impact of the ban itself. The committee therefore included such contextual factors in drawing conclusions about the effects of a ban.

Interpretation needs to consider the timeframes in the epidemiologic evidence, for example, the time from onset of a smoking ban to the mea-

surement of incidence of a disease, the timing and nature of enforcement, and the time until changes in cardiovascular-event rates were observed in people who had various baseline risks. Interpretation should account for the extent to which studies assessed possible alternative causes of decreases in hospitalizations for coronary events, including changes in health-care availability and in the standard of practice in cardiac care, such as new diagnostic criteria for acute MI during the period of study. The latter is especially important in making before–after comparisons in the absence of a comparison geographic area in which no ban has been implemented.

When designing and analyzing future studies, researchers should examine the time between the implementation of a smoking ban and changes in rates of hospital admission or cardiac death. Future studies could evaluate whether decreases in admissions are transitory, sustained, or increasing, and ideally they would include information on individual subjects, including prior history of cardiac disease, to answer the questions posed to the committee.

Epidemiologic Studies

Cardiovascular disease is a major public-health concern. The results of dozens of epidemiologic studies of both case–control and cohort design carried out in multiple populations consistently indicate about a 25–30% increase in risk of coronary heart disease from exposure to secondhand smoke (see Chapter 4 ). Epidemiologic studies using serum cotinine concentration as a biomarker of overall exposure to secondhand smoke indicated that the relative risk (RR) of coronary heart disease associated with secondhand smoke is even greater than those estimates. The excess risk is unlikely to be explained by misclassification bias, uncontrolled-for confounding effects, or publication bias. Although few studies have addressed the risk of coronary heart disease posed by secondhand-smoke exposure in the workplace, there is no biologically plausible reason to suppose that the effect of secondhand-smoke exposure at work or in a public building differs from the effect of exposure in the home environment. Epidemiologic studies demonstrate a dose–response relationship between chronic secondhand-smoke exposure as assessed by self-reports of exposure (He et al., 1999) and as assessed by biomarkers (cotinine) and long-term risk of coronary heart disease (Whincup et al., 2004). Dose–response curves show a steep initial rise in risk when going from negligible to low exposure followed by a gradual increase with increasing exposure.

The INTERHEART study, a large case–control study of cases of first acute MI, showed that exposure to secondhand smoke increased the risk of nonfatal acute MI in a graded manner (Teo et al., 2006).

Eleven key epidemiologic studies evaluated the effects of eight smok-

ing bans on the incidence of acute coronary events (see Table 8-1 and Chapter 6 ). The results of those studies show remarkable consistency: all showed decreases in the rate of acute MIs after the implementation of smoking bans (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Pell et al., 2008; Sargent et al., 2004; Seo and Torabi, 2007; Vasselli et al., 2008). Two of the studies (Pell et al., 2008; Seo and Torabi, 2007) examined rates of hospitalization for acute coronary events after the implementation of smoking bans and provided direct evidence of the relationship of secondhand-smoke exposure to acute coronary events by presenting results in nonsmokers.

The decreases in acute MIs in the 11 studies ranged from about 6 to 47%, depending on characteristics of the study, including the method of statistical analysis. The consistency in the direction of change gave the committee confidence that smoking bans result in a decrease in the rate of acute MI. The studies took advantage of bans as “natural experiments” to look at questions about the effects of bans, and indirectly of a decrease in secondhand-smoke exposure, on the incidence of acute cardiac events. As discussed in Assessing the Health Impact of Air Quality Regulations: Concepts and Methods for Accountability Research (HEI Accountability Working Group, 2003) in the context of air-pollution regulations, studies of interventions constitute a more definitive approach than other epidemiologic studies to determining whether regulations result in health benefits. All the studies are relevant and informative with respect to the questions posed to the committee, and overall they support an association between smoking bans and a decrease in acute cardiovascular events. The studies have inherent limitations related to their nature, but they directly evaluated the effects of an intervention (a smoking ban, including any concomitant activities) on a health outcome of interest (acute coronary events).

The committee could not determine the magnitude of effect with any reasonable degree of certainty on the basis of those studies. The variability in study design, implementation, and analysis was so large that the committee concluded that it could not conduct a meta-analysis or combine the information from the studies to calculate a point estimate of the effect. In particular, the committee was unable to determine the overall portion of the effect attributable to decreased smoking by smokers as opposed to decreased exposure of nonsmokers to secondhand smoke because of a lack of information on smoking status in nine of the studies (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Seo and Torabi, 2007; Vasselli et al., 2008). The results of the studies are consistent with the findings of the pathophysiologic studies discussed in Chapter 3 and the data on PM discussed in Chapters 3 and 7 . At the population level,

results of the key intervention studies reviewed by the committee are for the most part consistent with a decrease in risk as early as a month following reductions in secondhand-smoke exposure; however, given the variability in the studies and the lack of data on the precise timing of interventions, the smoking-ban studies do not provide adequate information on the time it takes to see decreases in acute MIs.

Plausibility of Effect

The committee considered both the biologic plausibility of a causal relationship between a decrease in secondhand-smoke exposure and a decrease in the incidence of acute MI and the plausibility of the magnitude of the effect seen in the key epidemiologic studies after implementation of smoking bans.

The experimental data reviewed in Chapter 3 demonstrate that several components of secondhand smoke, as well as secondhand smoke itself, exert substantial cardiovascular toxicity. The toxic effects include the induction of endothelial dysfunction, an increase in thrombosis, increased inflammation, and possible reductions in plaque stability. The data provide evidence that it is biologically plausible for secondhand smoke to be a potential causative trigger of acute coronary events. The risk of acute coronary events is likely to be increased if a person has preexisting heart disease. The association comports with findings on air-pollution components, such as diesel exhaust (Mills et al., 2007) and PM (Bhatnagar, 2006).

As a “reality check” on the potential effects of changes in secondhand-smoke exposure, the committee estimated the decrease in risk of cardiovascular disease and specifically heart failure that would be expected on the basis of the risk effects of changes in airborne PM concentrations after implementation of smoking bans seen in the PM literature. The PM in cigarette smoke is not identical with that in air pollution, and the committee did not attempt to estimate the risk attributable to secondhand-smoke exposure through the PM risk estimates but rather found this a useful exercise to see whether the decreases seen in the epidemiologic literature are reasonable, given data on other air pollutants that have some common characteristics. The committee’s estimates on the basis of the PM literature support the possibility that changes in secondhand-smoke exposure after implementation of a smoking ban can have a substantial effect on hospital admissions for heart failure and cardiovascular disease.

SUMMARY OF OVERALL WEIGHT OF EVIDENCE

The committee examined three relationships—of secondhand-smoke exposure and cardiovascular disease, of secondhand-smoke exposure and

TABLE 8-1 Summary of Key Studies (Studies Listed by Smoking-Ban Region in Order of Publication)

acute coronary events, and of smoking bans and acute coronary events. The committee used the criteria of causation described in Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service (U.S. Public Health Service, 1964) in drawing conclusions regarding those relationships. The criteria are often referred to as the Bradford Hill criteria because they were, as stated by Hamill (1997), “later expanded and refined by A. B. Hill” (Hill, 1965). Table 8-2 summarizes the available evidence on secondhand-smoke exposure and coronary events in terms of the Bradford Hill criteria.

Secondhand-Smoke Exposure and Cardiovascular Disease

The results of both case–control and cohort studies carried out in multiple populations consistently indicate exposure to secondhand smoke causes about a 25–30% increase in the risk of coronary heart disease; results of some studies indicate a dose–response relationship. Data from animal studies support the dose–response relationship (see Chapter 3 ). Data from experimental studies of animals and cells and from intentional human-dosing studies indicate that a relationship between secondhand-smoke exposure and coronary heart disease is biologically plausible and consistent with understanding of the pathophysiology of coronary heart disease.

Taking all that evidence together, the committee concurs with the conclusions in the 2006 surgeon general’s report (HHS, 2006) that “the evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and increased risks of coronary heart disease morbidity and mortality among both men and women.” Although the committee found strong and consistent evidence of the existence of a positive association between chronic exposure to secondhand smoke and coronary heart disease, determining the magnitude of the risk (the number of cases that are attributable to secondhand-smoke exposure) proved challenging, and the committee has not done it.

Secondhand-Smoke Exposure and Acute Coronary Events

Two of the epidemiologic studies reviewed by the committee that examine rates of hospitalization for acute coronary events after implementation of smoking bans provide direct evidence related to secondhand smoke exposures. The studies either reported events in nonsmokers only (Monroe, Indiana) (Seo and Torabi, 2007) or analyzed nonsmokers and smokers separately on the basis of serum cotinine concentration (Scotland) (Pell et al., 2008). Both studies showed reductions in the RR of acute coronary events in nonsmokers when secondhand-smoke exposure was decreased after implementation of the bans; this indicates an association between a

decrease in exposure to secondhand smoke and a decrease in risk of acute coronary events. Because of differences between and limitations of the two studies (such as in population, population size, and analysis), they do not provide strong sufficient evidence to determine the magnitude of the decrease in RR.

The effect seen after implementation of smoking bans is consistent with data from the INTERHEART study, a case–control study of 15,152 cases of first acute MI in 262 centers in 52 countries (Teo et al., 2006). Increased exposure to secondhand smoke increased the risk of nonfatal acute MI in a graded manner, with adjusted odds ratios of 1.24 (95% confidence interval [CI], 1.17–1.32) and 1.62 (95% CI, 1.45–1.81) in the least exposed people (1–7 hours of exposure per week) and the most exposed (at least 22 hours of exposure per week), respectively. In contrast, a study using data from the Western New York Health Study collected from 1995 to 2001 found that secondhand smoke was not significantly associated with higher risk of MI (Stranges et al., 2007). That study, however, looked at lifetime cumulative exposure to secondhand smoke, a different exposure metric from that in the other studies and one that does not take into account how recent the exposure is.

The other key epidemiologic studies that looked at smoking bans provide indirect evidence of an association between secondhand-smoke exposure and acute coronary events (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Vasselli et al., 2008). Although it is not possible to separate the effect of smoking bans in reducing exposure to secondhand smoke and their effect in reducing active smoking in those studies, because they did not report individual smoking status or secondhand-smoke exposure concentrations, monitoring studies of airborne tracers 1 and biomarkers 2 of exposure to secondhand smoke have demonstrated that exposure to secondhand smoke is dramatically reduced after implementation of smoking bans. Those studies therefore provide indirect evidence that at least part of the decrease in acute coronary events seen after implementation of smoking bans could be mediated by a decrease in exposure to secondhand smoke. It is not possible to determine the differential magnitude of the effect that is attributable to changes in nonsmokers and smokers.

Experimental data show that an association between secondhand-

TABLE 8-2 Evaluation of Available Data in Terms of Bradford-Hill Criteria

smoke exposure and acute coronary events is biologically plausible (see Chapter 3 ). Experimental studies in humans, animals, and cell cultures have demonstrated short-term effects of secondhand smoke as a complex mixture or its components individually (such as oxidants, PM, acrolein, PAHs, benzene, and metals) on the cardiovascular system. There is sufficient evidence from such studies to infer that acute exposure to secondhand smoke at concentrations relevant to population exposures induces endothelial dysfunction, increases inflammation, increases thrombosis, and potentially adversely affects plaque stability. Those effects occur at magnitudes relevant to the pathogenesis of acute coronary events. Furthermore, indirect evidence obtained from studies of ambient PM supports the notion that exposure to PM present in secondhand smoke could trigger acute coronary events or induce arrhythmogenesis in a person with a vulnerable myocardium.

Taking all that evidence together, the committee concludes that there is sufficient evidence of a causal relationship between a decrease in secondhand-smoke exposure and a decrease in the risk of acute MI. Given the variability among studies and their limitations, the committee did not provide a quantitative estimate of the magnitude of the effect.

Smoking Bans and Acute Coronary Events

Nine key studies looked at the overall effect of smoking bans on the incidence of acute coronary events in the overall populations—smokers and nonsmokers—studied (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Vasselli et al., 2008). Those studies consistently show a decrease in acute MIs after implementation of smoking bans. The combination of experimental data on secondhand-smoke effects discussed above and exposure data that indicate that secondhand-smoke concentrations decrease substantially after implementation of a smoking ban provides evidence that it is biologically plausible for smoking bans to decrease the rate of acute MIs. The committee concludes that there is an association between smoking bans and a reduction in acute coronary events and, given the temporality and biologic plausibility of the effect, that the evidence is consistent with a causal relationship. Although all the studies demonstrated a positive effect of bans in reducing acute MIs, differences among the studies, including the components of the bans and other interventions that promote smoke-free environments that took place during the bans, limited the committee’s confidence in estimating the overall magnitude of the effect. There is little information on how long it would take for such an effect to be seen inasmuch as the studies have not evaluated periods shorter than a month.

DATA GAPS AND RESEARCH RECOMMENDATIONS

Studies of the effect of indoor smoking bans and secondhand-smoke exposure on acute coronary events should be designed to examine the time between an intervention and changes in the effect and to measure the magnitude of the effect. No time to effect can be postulated for individuals on the basis of the available data, and evaluation of population-based effectiveness of a smoking ban depends on societal actions that implement and enforce the ban and on actions that include smoke reduction in homes, cars, and elsewhere. The decrease in secondhand-smoke exposure does not necessarily occur suddenly—it might decline gradually or by steps. In a likely scenario, once a ban is put into place and enforced, a sharp drop in secondhand-smoke exposure might be seen immediately and followed by a slower decrease in exposure as the population becomes more educated about the health consequences of secondhand smoke and exposure becomes less socially acceptable. Future studies that examine the time from initiation of a ban to observation of an effect and that include followup after initiation of enforcement, taking the social aspects into account, would provide better information on how long it takes to see an effect of a ban. Statistical models should clearly articulate a set of assumptions and include sensitivity analyses. Studies that examine whether decreases in hospital admissions for acute coronary events are transitory or sustained would also be informative.

Many factors are likely to influence the effect of a smoking ban on the incidence and prevalence of acute coronary events in a population. They include age, sex, diet, background risk factors and environmental factors for cardiovascular disease, prevalence of smokers in the community, the underlying rate of heart disease in the community (for example, the rate in Italy versus the United States), and the social environment. Future studies should include direct observations on individuals—including their history of cardiac disease, exposure to other environmental agents, and other risk factors for cardiac events—to assess the impact of those factors on study results. Assessment of smoking status is also needed to distinguish between the effects of secondhand smoke in nonsmokers and the effects of a ban that decreases cigarette consumption or promotes smoking cessation in smokers.

Few constituents of secondhand smoke have been adequately studied for cardiotoxicity. Future research should examine the cardiotoxicity of environmental chemicals, including those in secondhand smoke, to define cardiovascular toxicity end points and establish consistent definitions and measurement standards for cardiotoxicity of environmental contaminants. Specifically, information is lacking on the cardiotoxicity of highly reactive smoke constituents, such as acrolein and other oxidants; on techniques for

quantitating those reactive components; and on the toxicity of low concentrations of benzo[ a ]pyrene, of PAHs other than benzo[a]pyrene, and of mixtures of tobacco-smoke toxicants.

Many questions remain with respect to the pathogenesis of cardiovascular disease and acute coronary events and how secondhand-smoke constituents perturb the pathophysiologic mechanisms and result in disease and death. For example, a better understanding of the factors that promote plaque rupture and how they are influenced by tobacco smoke and PM would provide insight into the mechanisms underlying the cardiovascular effects of secondhand smoke and might lead to better methods of detecting preclinical disease and preventing events.

The committee found only sparse data on the prevalence and incidence of cardiovascular disease and acute coronary events at the national level in general compared with other health end points for which there are central data registries and surveillance of all events, such as the Surveillance, Epidemiology, and End Results (SEER) Program for cancer. Although there are national databases that include acute MI patients—such as the National Registry of Myocardial Infarction (Morrow et al., 2001; Rogers et al., 1994), the Health Care Financing Administration database, and the Cooperative Cardiovascular Project (Ellerbeck et al., 1995)—and the Centers for Disease Control and Prevention’s annual National Hospital Discharge Survey and National Health Interview Survey provide some information on cardiovascular end points, these are not comprehensive or inclusive with respect to hospital participation, patient inclusion, or data capture. A national database that captures all cardiovascular end points would facilitate future epidemiologic studies by allowing the tracking of trends and identification of high-risk populations at a more granular level.

A large prospective cohort study could be very helpful in more accurately estimating the magnitude of the risk of cardiovascular disease and acute coronary events posed by secondhand-smoke exposure. It could be a new study specifically designed to assess effects of secondhand smoke or, as was done with the INTERHEART study, take advantage of existing studies—such as the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, the American Cancer Society’s Cancer Prevention Study-3, the European Prospective Investigation into Cancer and Nutrition study, and the Jackson Heart Study—provided that they have adequate information on individual smoking status and secondhand-smoke exposure (or the ability to measure it, for example, in adequate blood samples). If properly designed, such a study could identify subpopulations at highest risk for acute coronary events from secondhand-smoke exposure in relation to such characteristics as age and sex, and concomitant risk factors, such as obesity.

COMMITTEE RESPONSES TO SPECIFIC QUESTIONS

The committee was tasked with responding to eight specific questions. The questions and the committee’s responses are presented below.

What is the current scientific consensus on the relationship between exposure to secondhand smoke and cardiovascular disease? What is the pathophysiology? What is the strength of the relationship?

On the basis of the available studies of chronic exposure to secondhand smoke and cardiovascular disease, the committee concludes that there is scientific consensus that there is a causal relationship between secondhand-smoke exposure and cardiovascular disease. The results of a number of meta-analyses of the epidemiologic studies showed increases of 25–30% in the risk of cardiovascular disease caused by various exposures. The studies include some that use serum cotinine concentration as a biomarker of exposure and show a dose–response relationship. The pathophysiologic data are consistent with that relationship, as are the data from studies of air pollution and PM. The data in support of the relationship are consistent, but the committee could not calculate a point estimate of the magnitude of the effect (that is, the effect size) given the variable strength of the relationship, differences among studies, poor assessment of secondhand-smoke exposure, and variation in concomitant underlying risk factors.

Is there sufficient evidence to support the plausibility of a causal relation between secondhand smoke exposure and acute coronary events such as acute myocardial infarction and unstable angina? If yes, what is the pathophysiology? And what is the strength of the relationship?

The evidence reviewed by the committee is consistent with a causal relationship between secondhand-smoke exposure and acute coronary events, such as acute MI. It is unknown whether acute exposure, chronic exposure, or a combination of the two underlies the occurrence of acute coronary events, inasmuch as the duration or pattern of exposure in individuals is not known. The evidence includes the results of two key studies that have information on individual smoking status and that showed decreases in risks of acute coronary events in nonsmokers after implementation of a smoking ban. Those studies are supported by information from other smoking-ban studies (although these do not have information on individual smoking status, other exposure-assessment studies have demonstrated that secondhand-smoke exposure decreases after implementation of a smoking ban) and by the large body of literature on PM, especially PM 2.5 , a

constituent of secondhand smoke. The evidence is not yet comprehensive enough to determine a detailed mode of action for the relationship between secondhand-smoke exposure and a variety of intervening and preexisting conditions in predisposing to cardiac events. However, experimental studies have shown effects that are consistent with pathogenic factors in acute coronary events. Although the committee has confidence in the evidence of an association between chronic secondhand-smoke exposure and acute coronary events, the evidence on the magnitude of the association is less convincing, so the committee did not estimate that magnitude (that is, the effect size).

Is it biologically plausible that a relatively brief (e.g., under 1 hour) secondhand smoke exposure incident could precipitate an acute coronary event? If yes, what is known or suspected about how this risk may vary based upon absence or presence (and extent) of preexisting coronary artery disease?

There is no direct evidence that a relatively brief exposure to secondhand smoke can precipitate an acute coronary event; few published studies have addressed that question. The circumstantial evidence of such a relationship, however, is compelling. The strongest evidence comes from airpollution research, especially research on PM. Although the source of the PM can affect its toxicity, particle size in secondhand smoke is comparable with that in air pollution, and research has demonstrated a similarity between cardiovascular effects of PM and of secondhand smoke. Some studies have demonstrated rapid effects of brief secondhand-smoke exposure (for example, on platelet aggregation and endothelial function), but more research is necessary to delineate how secondhand smoke produces cardiovascular effects and the role of underlying preexisting coronary arterial disease in determining susceptibility to the effects. Given the data on PM, especially those from time-series studies, which indicate that a relatively brief exposure can precipitate an acute coronary event, and the fact that PM is a major component of secondhand smoke, the committee concludes that it is biologically plausible for a relatively brief exposure to secondhand smoke to precipitate an acute coronary event.

With respect to how the risk might vary in the presence or absence of preexisting coronary arterial disease, it is generally assumed that acute coronary events are more likely to occur in people who have some level of preexisting disease, although that underlying disease is often subclinical. There are not enough data on the presence of pre-existing coronary arterial disease in the populations studied to assess the extent to which the absence or presence of such preexisting disease affects the cardiovascular risk posed by secondhand-smoke exposure.

What is the strength of the evidence for a causal relationship between indoor smoking bans and decreased risk of acute myocardial infarction?

The key intervention studies that have evaluated the effects of indoor smoking bans consistently have shown a decreased risk of heart attack. Research has also indicated that secondhand-smoke exposure is causally related to heart attacks, that smoking bans decrease secondhand-smoke exposure, and that a relationship between secondhand-smoke exposure and acute coronary events is biologically plausible. All the relevant studies have shown an association in a direction consistent with a causal relationship (although the committee was unable to estimate the magnitude of the association), and the committee therefore concludes that the evidence is sufficient to infer a causal relationship.

What is a reasonable latency period between a decrease in secondhand smoke exposure and a decrease in risk of an acute myocardial infarction for an individual? What is a reasonable latency period between a decrease in population secondhand smoke exposure and a measurable decrease in acute myocardial infarction rates for a population?

No direct information is available on the time between a decrease in secondhand-smoke exposure and a decrease in the risk of a heart attack in an individual. Data on PM, however, have shown effects on the heart within 24 hours, and this supports a period of less than 24 hours. At the population level, results of the key intervention studies reviewed by the committee are for the most part consistent with a decrease in risk as early as a month following reductions in secondhand-smoke exposure; however, given the variability in the studies and the lack of data on the precise timing of interventions, the smoking-ban studies do not provide adequate information on the time it takes to see decreases in heart attacks.

What are the strengths and weaknesses of published population-based studies on the risk of acute myocardial infarction following the institution of comprehensive indoor smoking bans? In light of published studies’ strengths and weaknesses, how much confidence is warranted in reported effect size estimates?

Some of the weaknesses of the published population-based studies of the risk of MI after implementation of smoking bans are

Limitations associated with an open study population and, in some cases, with the use of a small sample.

Concurrent interventions that reduce the observed effect of a smoking ban.

Lack of exposure-assessment criteria and measurements.

Lack of information collected on the time between the cessation of exposure to secondhand smoke and changes in disease rates.

Differences between control and intervention groups.

Nonexperimental design of studies (by necessity).

Lack of assessment of the sensitivity of results to the assumptions made in the statistical analysis.

The different studies had different strengths and weaknesses in relation to the assessment of the effects of smoking bans. For example, the Scottish study had such strengths as prospective design and serum cotinine measurements. The Saskatoon study had the advantage of comprehensive hospital records, and the Monroe County study excluded smokers. The population-based studies of the risk of heart attack after the institution of comprehensive smoking bans were consistent in showing an association between the smoking bans and a decrease in the risk of acute coronary events, and this strengthened the committee’s confidence in the existence of the association. However, because of the weaknesses discussed above and the variability among the studies, the committee has little confidence in the magnitude of the effects and, therefore, thought it inappropriate to attempt to estimate an effect size from such disparate designs and measures.

What factors would be expected to influence the effect size? For example, population age distribution, baseline level of secondhand smoke protection among nonsmokers, and level of secondhand smoke protection provided by the smoke-free law .

A number of factors that vary among the key studies can influence effect size. Although some of the studies found different effects in different age groups, these were not consistently identified. One major factor is the size of the difference in secondhand-smoke exposure before and after implementation of a ban, which would vary and depends on: the magnitude of exposure before the ban, which is influenced by the baseline level of smoking and preexisting smoking bans or restrictions; and the magnitude of exposure after implementation of the ban, which is influenced by the extent of the ban, enforcement of and compliance with the ban, changes in social norms of smoking behaviors, and remaining exposure in areas not covered by the ban (for example, in private vehicles and homes). The baseline rate of acute coronary events or cardiovascular disease could influence the effect

size, as would the prevalence of other risk factors for acute coronary events, such as obesity, diabetes, and age.

What are the most critical research gaps that should be addressed to improve our understanding of the impact of indoor air policies on acute coronary events? What studies should be performed to address these gaps?

The committee identified the following gaps and research needs as those most critical for improving understanding of the effect of indoor-air policies on acute coronary events:

The committee found a relative paucity of data on environmental cardiotoxicity of secondhand smoke compared with other disease end points related to secondhand smoke, such as carcinogenicity and reproductive toxicity. Research should develop standard definitions of cardiotoxic end points in pathophysiologic studies (for example, specific results on standard assays) and a classification system for cardiotoxic agents (similar to the International Agency for Research on Cancer classification of carcinogens). Established cardiotoxicity assays for environmental exposures and consistent definitions of adverse outcomes of such tests would improve investigations of the cardiotoxicity of secondhand smoke and its components and identify potential end points for the investigation of the effects of indoor-air policies on acute coronary events.

The committee found a lack of a system for surveillance of the prevalence of cardiovascular disease and of the incidence of acute coronary events in the United States. Surveillance of incidence and prevalence trends would allow secular trends to be taken into account better and to be compared among different populations to establish the effects of indoor-air policies. Although some national databases and surveys include cardiovascular end points, a national database that tracks hospital admission rates and deaths from acute coronary events, similar to the SEER database for cancer, would improve epidemiologic studies.

The committee found a lack of understanding of a mechanism that leads to plaque rupture and from that to an acute coronary event and of how secondhand smoke affects that process. Additional research is necessary to develop reliable biomarkers of early effects on plaque vulnerability to rupture and to improve the design of pathophysiologic studies of secondhand smoke that examine effects of exposure on plaque stability.

All 11 key studies reviewed by the committee have strengths and limitations due to their study design, and none was designed to test the hypothesis that secondhand-smoke exposure causes cardiovascular disease or acute coronary events. Because of those limitations and the consequent variability in results, the committee did not have enough information to estimate the magnitude of the decrease in cardiovascular risk due to smoking bans or to a decrease in secondhand-smoke exposure. A large, well-designed study could permit estimation of the magnitude of the effect. An ideal study would be prospective; would have individual-level data on smoking status; would account for potential confounders, including other risk factors for cardiovascular events (such as obesity and age), would have biomarkers of mainstream and secondhand-smoke exposures (such as blood cotinine concentrations); and would have enough cases to allow separate analyses of smokers and nonsmokers or, ideally, stratification of cases by cotinine concentrations to examine the dose–response relationship. Such a study could be specifically designed for secondhand smoke or potentially could take advantage of existing cohort studies that might have data available or attainable for investigating secondhand-smoke exposure and its cardiovascular effects, such as was done with the INTERHEART study. Existing studies that could be explored to determine their utility and applicability to questions related to secondhand smoke include the Multi-Ethnic Study of Atherosclerosis (MESA) study, the American Cancer Society’s CPS-3, the European Prospective Investigation of Cancer (EPIC), the Framingham Heart Study, and the Jackson Heart Study. Researchers should clearly articulate the assumptions used in their statistical models and include analysis of the sensitivity of results to model choice and assumptions.

Barone-Adesi, F., L. Vizzini, F. Merletti, and L. Richiardi. 2006. Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. European Heart Journal 27(20):2468-2472.

Bartecchi, C., R. N. Alsever, C. Nevin-Woods, W. M. Thomas, R. O. Estacio, B. B. Bartelson, and M. J. Krantz. 2006. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation 114(14):1490-1496.

Bhatnagar, A. 2006. Environmental cardiology: Studying mechanistic links between pollution and heart disease. Circulation Research 99(7):692-705.

CDC (Centers for Disease Control and Prevention). 2009. Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance—city of Pueblo, Colorado, 2002–2006. MMWR—Morbidity & Mortality Weekly Report 57(51):1373-1377.

Cesaroni, G., F. Forastiere, N. Agabiti, P. Valente, P. Zuccaro, and C. A. Perucci. 2008. Effect of the Italian smoking ban on population rates of acute coronary events. Circulation 117(9):1183-1188.

Ellerbeck, E. F., S. F. Jencks, M. J. Radford, T. F. Kresowik, A. S. Craig, J. A. Gold, H. M. Krumholz, and R. A. Vogel. 1995. Quality of care for Medicare patients with acute myocardial infarction. A four-state pilot study from the cooperative cardiovascular project. JAMA 273(19):1509-1514.

Hamill, P. V. 1997. Re: “Invited commentary: Response to Science article, ‘Epidemiology faces its limits.’” American Journal of Epidemiology 146(6):527-528.

He, J., S. Vupputuri, K. Allen, M. R. Prerost, J. Hughes, and P. K. Whelton. 1999. Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. New England Journal of Medicine 340(12):920-926.

HEI (Health Effects Institute) Accountability Working Group. 2003. Assessing the health impact of air quality regulations: Concepts and methods for accountability research. Communication 11. Boston, MA: Health Effects Institute.

HHS (U.S. Department of Health and Human Services). 2006. The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

Hill, A. B. 1965. The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine 58:295-300.

Juster, H. R., B. R. Loomis, T. M. Hinman, M. C. Farrelly, A. Hyland, U. E. Bauer, and G. S. Birkhead. 2007. Declines in hospital admissions for acute myocardial infarction in New York state after implementation of a comprehensive smoking ban. American Journal of Public Health 97(11):2035-2039.

Khuder, S. A., S. Milz, T. Jordan, J. Price, K. Silvestri, and P. Butler. 2007. The impact of a smoking ban on hospital admissions for coronary heart disease. Preventive Medicine 45(1):3-8.

Lemstra, M., C. Neudorf, and J. Opondo. 2008. Implications of a public smoking ban. Canadian Journal of Public Health 99(1):62-65.

Mills, N. L., H. Tornqvist, M. C. Gonzalez, E. Vink, S. D. Robinson, S. Soderberg, N. A. Boon, K. Donaldson, T. Sandstrom, A. Blomberg, and D. E. Newby. 2007. Ischemic and thrombotic effects of dilute diesel-exhaust inhalation in men with coronary heart disease. New England Journal of Medicine 357(11):1075-1082.

Morrow, D. A., E. M. Antman, L. Parsons, J. A. de Lemos, C. P. Cannon, R. P. Giugliano, C. H. McCabe, H. V. Barron, and E. Braunwald. 2001. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA 286(11):1356-1359.

Pell, J. P., S. Haw, S. Cobbe, D. E. Newby, A. C. H. Pell, C. Fischbacher, A. McConnachie, S. Pringle, D. Murdoch, F. Dunn, K. Oldroyd, P. Macintyre, B. O’Rourke, and W. Borland. 2008. Smoke-free legislation and hospitalizations for acute coronary syndrome. New England Journal of Medicine 359(5):482-491.

Rogers, W. J., L. J. Bowlby, N. C. Chandra, W. J. French, J. M. Gore, C. T. Lambrew, R. M. Rubison, A. J. Tiefenbrunn, and W. D. Weaver. 1994. Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the National Registry of Myocardial Infarction. Circulation 90(4):2103-2114.

Sargent, R. P., R. M. Shepard, and S. A. Glantz. 2004. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: Before and after study. BMJ 328(7446):977-980.

Seo, D.-C., and M. R. Torabi. 2007. Reduced admissions for acute myocardial infarction associated with a public smoking ban: Matched controlled study. Journal of Drug Education 37(3):217-226.

Stranges, S., M. Cummings, F. P. Cappuccio, and M. Travisan. 2007. Secondhand smoke exposure and cardiovascular disease. Current Cardiovascular Risk Reports 1(5):373-378.

Teo, K. K., S. Ounpuu, S. Hawken, M. R. Pandey, V. Valentin, D. Hunt, R. Diaz, W. Rashed, R. Freeman, L. Jiang, X. Zhang, S. Yusuf, and I. S. Investigators. 2006. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: A case-control study. Lancet 368(9536):647-658.

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Vasselli, S., P. Papini, D. Gaelone, L. Spizzichino, E. De Campora, R. Gnavi, C. Saitto, N. Binkin, and G. Laurendi. 2008. Reduction incidence of myocardial infarction associated with a national legislative ban on smoking. Minerva Cardioangiologica 56(2):197-203.

Whincup, P. H., J. A. Gilg, J. R. Emberson, M. J. Jarvis, C. Feyerabend, A. Bryant, M. Walker, and D. G. Cook. 2004. Passive smoking and risk of coronary heart disease and stroke: Prospective study with cotinine measurement. BMJ 329(7459):200-205.

Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular health of nonsmoking adults, however, remains a question.

Secondhand Smoke Exposure and Cardiovascular Effects reviews available scientific literature to assess the relationship between secondhand smoke exposure and acute coronary events. The authors, experts in secondhand smoke exposure and toxicology, clinical cardiology, epidemiology, and statistics, find that there is about a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke. Their findings agree with the 2006 Surgeon General's Report conclusion that there are increased risks of coronary heart disease morbidity and mortality among men and women exposed to secondhand smoke. However, the authors note that the evidence for determining the magnitude of the relationship between chronic secondhand smoke exposure and coronary heart disease is not very strong.

Public health professionals will rely upon Secondhand Smoke Exposure and Cardiovascular Effects for its survey of critical epidemiological studies on the effects of smoking bans and evidence of links between secondhand smoke exposure and cardiovascular events, as well as its findings and recommendations.

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Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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Keep reading

Teenage Smoking Essay: Writing Guide & Smoking Essay Topics

Smoking can be viewed as one of the trendy habits. Numerous teenagers try it since they think that it is cool or can help them socialize. Often students start smoking due to stress or mental illnesses. But is it okay?

Educators tend to give different written assignments, which may disclose this topic. If you have to develop a teenage smoking essay, you should learn the effects and harm that this habit causes.

That’s when our Custom-writing.org writers can help you!In the article, you’ll see how to deal with writing about smoking students. We’ve gathered tips for different paper types and prompts that can inspire you to start. In the end, you’ll find some smoking essay topics as well.

🚬 Argumentative
📈 Cause and Effect
🚭 Persuasive
🔥 Topics & Prompts

🔗 References

✍️ how to write a teenage smoking essay.

Just like any other academic paper, a teen smoking essay should be organized according to its type. You are probably familiar with the following writing ones:

argumentative essay;
cause and effect essay;
persuasive essay.

Below, you can find insightful tips on how to compose a teenage smoking essay, fulfilling the requirements of each type.

🚬 Argumentative Essay on Smoking

An argumentative essay on teenage smoking should give the reader a rational discussion of a specific issue. The ideas are expected to be well-structured and solidified with valid evidence.

Below, you can find the most useful tips for writing an argumentative teen smoking essay. Don’t hesitate to use them!

Catch the reader’s attention. In the introduction, explain the significance and relatability of the chosen issue. Provide general background and make the reader continue exploring your essay through attention-grabbing elements (impressive statistics, personal stories, etc.).
Express your position clearly. Compose a concise thesis statement , so the reader can quickly get your position. Be as precise as possible! For example, your thesis might look like this: Teenage smoking leads to poor health, psychological and social issues.
The most vivid adverse ramification of teenage smoking is the development of health problems like heart or lung diseases and cancer.
Another disruptive effect of smoking at a young age is the risk of psychological disorders such as anxiety or depression.
The last negative consequence of teenage smoking is the conflict with social norms.
Support your arguments. Your ideas will become stronger if you support them with proof from other sources. But be careful here! Use only reliable sources (academic journals, scholarly articles, books, etc.).
Finish your essay dynamically. In your essay conclusion, restate your thesis statement and synthesize all of your arguments. Motivate your readers on further investigation of your topic. To make your paper even more impressive, finish it with the final memorable thought that would be stuck in your readers’ minds.

📈 Cause and Effect Essay on Smoking

A cause and effect of the teenage smoking essay should answer two questions:

Why do teenagers smoke? (Causes).
What are the consequences of teenage smoking? (Effects).

How to create an excellent cause and effect paper? You can start by checking successful teen smoking essay examples . Then, learn some useful tips here:

Get an idea. The first step of creating a causes effects of teenage smoking essay is brainstorming topics. Think of the common reasons for teens smoking and analyze the possible outcomes. Here are some ideas for you:
Outline your paper. This step helps structure your ideas properly. Create a well-organized plan and add there all the proof and examples. Make sure that everything is logical, and start writing your teenage smoking essay.
Form a clear thesis. In your thesis statement, state your position and introduce the chosen cause and effect of smoking. Here is an example of the thesis for this type of smoking among teenagers essay: Caused by peer pressure, smoking negatively affects teenagers’ health and appearance.
The key cause of teenage nicotine addiction is peer pressure and the fear of becoming an outsider among the friends-smokers.
One of the detrimental effects of cigarettes on teenagers is health problems.
Another adverse consequence of teenage smoking is negative changes in appearance .
Polish your piece of writing. After you finished your first draft, revise and edit your essay. Ensure the absence of grammar and punctuation mistakes and double-check if your paper is coherent.

🚭 Persuasive Essay on Smoking

A persuasive essay about teenage smoking resembles an argumentative one but has a different purpose. Here, you have to convince your reader in your opinion, using evidence and facts. Moreover, in some papers, you have to call your reader to action. For example, to quit or ban smoking . So, see how to do so:

Grab the reader’s attention. To do so, you should know your audience and their preferences. Start your smoking essay by proving to the reader your credibility and the significance of your topic. For example, if you are writing about smoking students, introduce the shocking statistics at the beginning of your paper and convince them to stop smoking.
Show your empathy. An emotional appeal is a powerful tool for gaining the readers’ trust and influencing their opinions. Demonstrate that you understand their emotions and, at the same time, convince them to change their beliefs. To make it more clear, see an example: Although smoking might help teenagers be on the same wavelength as their friends, nicotine has a detrimental effect on health and leads to cancer development.
Include rhetoric questions. This is a useful persuasive trick that makes readers change their minds. For instance, in your smoking essay, you may ask this question: Smoking helps me to relieve stress, but will I be able to overcome lung cancer later?
Highlight your position. In a persuasive essay, you should be incredibly convincing. So, don’t be afraid of exaggeration or even repeating yourself. These tricks may help you to deliver your message to the reader more quickly and effectively.

You have a lot of ways of creating fantastic teen smoking essays. You should just turn around and gather material. Sometimes it lies near your foot.

To smoke or not to smoke? – This is the question! You should decide what is for you: To be yourself or follow the fashion! It is not difficult to do!

🔥 Smoking Essay Topics

Do you know what the critical secret of a successful essay is? A well-chosen topic!

If you find something you are passionate about, your essay writing process will be much easier. So, take a look at our smoking essay topics. Select one of them or use some to come up with your idea.

Smoking among teenagers: an exaggerated problem or a real threat to the generation?
The influence of nicotine on teenagers’ brain activity.
How smoking parents develop smoking habits in their children.
Vaping : a healthier alternative to regular cigarettes or just another dangerous teenagers’ passion?
Is smoking still a problem among teenagers today – an essay to highlight the issue of cigarette addiction.
The danger of smoking for immature teenagers’ organisms.
If smoking in public places was banned, teenagers would be predisposed to cigarettes less.
Social problems caused by teenage smoking.
The role of parents in dealing with teenage cigarette addiction.
Useful tips to stop smoking .
Why teenagers are influenced by peer pressure , and how to overcome it.
Teenage smoking: a matter of real nicotine addiction or a case of psychological processes inside immature minds?
The danger of smoking and second-hand smoke.
Is e-cigarette a threat or solution?
Analyze the connection between vaping and dental health.
Is it necessary to ban cigarette manufacturers?
Is it possible to prevent teenagers from smoking using anti-smoking posters ?
What are the best ways to persuade young adults to stop smoking?
Discuss the possibility of the global ban on tobacco and its potential outcomes.
Pros and cons of anti-smoking adverts.
Explore the connection between smoking cessation and depression .
Describe the link between smoking and heart disease.
Explain how smoking cessation can improve teenagers’ life.
How to reduce smoking among youth.
What are the different types of cigarette smokers?
Analyze the challenges of each stage of smoking cessation and how to overcome them.
Is smoking an effective method of weight control?
Discuss the impact of smoke on health of primary and secondary smokers.
Do you support the idea of lowering the smoking age in the USA ?
Effect of tobacco use on our body.
Explore the efficiency of the acupuncture method for smoking cessation.
Will the complete prohibition of smoking in cities help to preserve teenagers’ health?
Examine how smoking in movies influences teenagers’ desire to start smoking.
Are nicotine replacement medications necessary for successful smoking cessation?
Reasons to prohibit tobacco products and cigarettes.
Describe the reasons that prevent teenagers from smoking cessation .
Analyze the public image of smoking in the USA.
Discuss the issues connected with the smoking ban.
Antismoking ads and their influence on youth smoking prevalence.
What factors determine the success of anti-smoking persuasive campaigns among teenagers?
Explore the impact of smoking on teenagers’ physical and mental health.
What can you do to motivate your teenage friend to quit smoking?
Why do teenagers start smoking?
Analyze the rates of tobacco smoking among adolescents.
Compare the peculiarities of smoking cessation methods and motivation for teenagers and adolescents.
Examine whether raising cigarette pricing is an effective way to lower smoking rates.

Teenage Smoking Essay Prompts

Here are some writing prompts that you can use for your smoking essay:

What does the data on smoking in different countries say? Compare the age limitations for smoking, attitude to smoking in America and Europe, for example. Where the situation is worst, whether the government tries to fight against this, etc.
The distribution of cigarettes and other types of tobacco. Is it okay that tobacco machines are available all over the world (especially in Europe)? Any child can buy a cigarette and start smoking. You could investigate this problem in your teen smoking essays.
Opinion essay: present your ideas and attitude to smoking. Explain whether you like to see people smoking around you, or you cannot stand when people are gazing at you while you are smoking.
How does media influence teens’ decision-making? When teenagers see their favorite characters getting pleasure from smoking, they may want to try it. Is it a reason to start? In what other ways does mass media affect the problem?

Effects of Teenage Smoking Essay Prompt

Smoking among teenagers is a serious problem that has long-term consequences for their physical and mental health. In your essay, you can dwell on the following ideas:

Analyze the health consequences of tobacco use among young people. In your paper, you can study how tobacco affects youths’ health. Focus on the most widespread problems, such as heart and lung diseases, cancer risk, and others.
Estimate the role of smoking in promoting antisocial behavior among teenagers . Does smoking really encourage aggression and vandalism among teenagers? Use psychological theories and recent research findings to prove your point.
Explain why teenage smoking is associated with an increased risk of suicidal thoughts and urges. To prove your point, you may discuss how nicotine causes depression and neurotransmitter imbalances. Make sure to illustrate your essay with relevant studies and statistical data.
Investigate the economic and social consequences of smoking among young people. Besides high cigarette prices, you can consider lost productivity and healthcare costs. Additionally, write about social issues, such as stigmatization and reduced life opportunities.

Smoking in School Essay Prompt

Despite the implementation of smoke-free policies, a large percentage of teenagers start smoking during their school years. You can write an essay advocating for more effective initiatives to address not only students’ access to cigarettes but also the core causes of teen smoking.

Check out some more ideas for your “Smoking in School” essay:

Explain why educators should prohibit smoking on school grounds. Smoking is a dangerous habit that damages students’ health and the overall school environment. Even secondhand smoke exposure has harmful consequences. Your essay could provide evidence that proves the effectiveness of smoke-free policies in reducing teenage smoking rates and improving general well-being.
Analyze the effectiveness of school smoking policies in your educational institution. What smoking policies are accepted in your school? Do students comply with them? What disciplinary measures are used? Use student surveys and disciplinary records to prove the effectiveness or ineffectiveness of current policies.
Describe the issue of smoking in schools in your country. Answer the questions: how widespread is this problem? How does it manifest itself? What causes smoking in schools, and how do schools fight it?
Investigate the role of schools in reducing youth smoking. How can schools prevent and reduce smoking among students? Are their programs and campaigns effective? What can families and communities do to support schools in their efforts? Study these questions in your essay.

Peer Pressure Smoking Essay Prompt

Peer pressure is a common reason why teenagers start smoking. Friends, romantic attachments, or other social circles — all have significant effects on teens’ smoking intentions and possible tobacco addiction.

Here are some practical ideas that can help you highlight the role of peer pressure in teenage smoking :

Analyze why adolescents tend to be powerful in influencing their friends to start smoking. Peer pressure often impacts teenagers’ decisions more than parents’ disapproval. To explain this phenomenon, you can examine theories like social contagion and recent studies on peer dynamics.
Provide your own experience of resisting peer pressure to smoke. Have you ever faced peer pressure inducing you to smoke? What helped you to withstand? Try to share some advice for students in a similar situation.
Investigate how social media can amplify peer pressure through online portrayals of smoking as glamorous. We recommend studying images, videos, advertisements, and influencers that depict smoking as stylish and sophisticated. What can be done to prevent smoking glamorization on social media?
Estimate the role of peers in normalizing smoking behavior. Peer influence is more than just direct pressure. Your essay could explain how factors like observational learning and group identity induce teenagers to smoke.

Causes of Smoking Essay Prompt

There are many reasons why people start smoking, ranging from simple curiosity to complicated social and psychological factors, including anxiety, low self-esteem, and domestic violence.

Check out several ideas for an essay about the causes of smoking:

Analyze tobacco or e-cigarette ads that emphasize weight control benefits and explain how these ads encourage teenagers to smoke. Your paper may discuss how tobacco and e-cigarette companies make use of teenagers’ insecurities and social norms regarding body image. Include studies that prove the impact of advertising on youths’ behavior.
Explore why the rising popularity of fashionable electronic “vaping” devices is one of the key causes of teen smoking. Why is vaping so popular among teenagers? How does it appeal to youths’ preferences and lifestyles? What role do sleek design and social media influence play in the devices’ popularity? Answer the questions in your paper.
Describe your or your friend’s experience that forced you to try cigarettes. Have you or your friend ever tried smoking? Share your story in your essay. Reflect on the circumstances and emotions involved. What conclusions did you make from the experience?

Smoking Is Bad for Health Essay Prompt

Cigarette smoking impacts nearly every organ in the body, causes a variety of diseases, and worsens smokers’ overall health.

In your essay, you can expand on the following ideas to show the severe consequences of smoking on human well-being:

Analyze why cigarette smoking is the leading cause of preventable death in the United States. Here, you can examine factors like addiction and chronic diseases cigarettes provoke. Add statistical data and emphasize the preventable nature of smoking-related illnesses and deaths.
Examine passive smoking as a serious threat to health, especially for children, pregnant women, and people with chronic diseases. Your essay could analyze research and case studies proving that secondhand smoke is as dangerous to human health as smoking itself. Underline its harm to vulnerable populations, such as children, pregnant women, and people with chronic diseases.
Investigate the impact of cigarettes on mental health, including their contribution to the development of depression and anxiety. In this paper, you can examine nicotine’s effect on neurotransmitters involved in mood regulation, such as dopamine and serotonin. Support your point with evidence from peer-reviewed studies.
Research the possible diseases that smoking can provoke, including cancer, cardiovascular diseases, and respiratory illnesses. How does smoking contribute to the development and progress of these diseases? Use epidemiological data and medical research to answer this question.

Is Smoking Still a Problem Among Teenagers: Argumentative Essay Prompt

According to the CDC, in 2023, 1 out of every 100 middle school students and nearly 2 out of every 100 high school students had smoked cigarettes in the past 30 days . Public health experts are especially concerned about e-cigarettes since flavorings in tobacco products can make cigarettes more appealing to teenagers.

To evaluate the current situation with smoking among teens, dwell on the following ideas in your essay:

Analyze your country’s or world’s statistics on teen smoking in recent decades. Do you see any changes? Why did they happen? What do these changes mean in terms of public health? Examine these questions in your essay.
Describe your own observations of teenagers’ smoking habits. Contrast what you witnessed in the past with the current situation. Do you think teenagers’ smoking habits changed? What makes you think so? Provide real-life examples to back up your opinion.
Examine data on e-cigarette use among teenagers. Your essay could compare ordinary cigarette smoking and e-cigarette use trends among teenagers. Which type prevails, and why? What impact does it have on teenagers’ health? What can be done to lower smoking and vaping rates among teenagers?

Thanks for reading till the end! Make sure to leave your opinion about the article below. Send it to your friends who may need our tips.

Essay on Teenage Smoking

Students are often asked to write an essay on Teenage Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Teenage Smoking

What is teenage smoking.

Teenage smoking means when young people, usually between 13 and 19 years old, start to smoke cigarettes. It is a big problem because it can harm their health very badly. Smoking can cause diseases like cancer and heart problems.

Why Do Teenagers Start Smoking?

Many teenagers start smoking because they see their friends doing it or they think it makes them look cool. Sometimes, they are under a lot of stress and think smoking will help them relax.

Effects of Smoking on Teenagers

Smoking can make teenagers sick. It can reduce their lung function and make it hard for them to breathe. It also increases the risk of getting sick with diseases like bronchitis and pneumonia.

Stopping Teenage Smoking

To stop teenagers from smoking, adults should talk to them about the dangers of smoking. Schools can also help by teaching students about the risks of smoking and how to say no to cigarettes.

250 Words Essay on Teenage Smoking

Teenage smoking refers to young people, usually between the ages of 13 and 19, who use cigarettes. This is a serious issue because smoking can harm their health. Many teenagers start smoking due to peer pressure or because they see adults in their lives doing it.

One main reason teenagers start smoking is peer pressure. They see their friends doing it and don’t want to feel left out. Some teenagers think smoking makes them look cool or grown-up. Others might start smoking because they are curious or because they see family members smoking.

Smoking is very harmful to anyone’s health, but it is especially bad for teenagers because their bodies are still growing. Smoking can lead to serious health problems like lung cancer, heart disease, and breathing problems. It also affects how they look, causing bad breath, yellow teeth, and a greater risk of getting sick.

Stopping teenage smoking is important. Parents, teachers, and communities can help by teaching teenagers about the dangers of smoking. They can also set a good example by not smoking themselves. Programs that encourage teenagers to stay away from cigarettes and offer support to those who want to quit are also very helpful.

In conclusion, teenage smoking is a problem that affects the health and future of young people. By understanding why teenagers start smoking and the effects it has, we can work together to help stop it.

500 Words Essay on Teenage Smoking

Teenage smoking: a grave threat to young lives.

Smoking among teenagers has become a pressing concern, posing significant risks to their health and overall well-being. It’s crucial to understand the harmful effects of smoking and take proactive measures to prevent and discourage teenagers from engaging in this dangerous habit.

Health Hazards of Teenage Smoking

Smoking cigarettes exposes teenagers to a multitude of health hazards. The chemicals present in cigarettes can damage the lungs, heart, and other vital organs. Smoking increases the risk of developing lung cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD). Additionally, it can lead to addiction, respiratory problems, and premature aging.

Negative Impact on Physical Development

Smoking interferes with the normal growth and development of teenagers. It can stunt their physical growth, delay puberty, and weaken their immune system, making them more susceptible to illnesses. Smoking also affects bone health, increasing the risk of osteoporosis in later life.

Social and Psychological Effects

Teenage smoking has detrimental social and psychological consequences. It can lead to isolation, peer pressure, and impaired social skills. Smokers are more likely to engage in risky behaviors, such as alcohol consumption and drug abuse. Moreover, smoking can negatively impact academic performance, concentration, and memory.

Preventing Teenage Smoking

Preventing teenage smoking requires a multifaceted approach involving parents, educators, healthcare providers, and policymakers. Parents should have open and honest conversations with their children about the dangers of smoking. Schools should implement comprehensive tobacco education programs to inform students about the health risks associated with smoking. Healthcare providers should counsel teenagers about the importance of avoiding tobacco use and offer support to those who want to quit. Additionally, policymakers should enact and enforce strict laws and regulations to restrict tobacco sales to minors and reduce youth access to cigarettes.

Teenage smoking is a serious public health issue that demands immediate attention. It’s essential to raise awareness about the harmful effects of smoking and empower teenagers with the knowledge and skills to resist tobacco use. By working together, we can create a smoke-free environment for our youth, ensuring their health and well-being for a brighter future.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

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Apart from these, you can look at all the essays by clicking here .

Happy studying!

E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General [Internet].

Chapter 1 introduction, conclusions, and historical background relative to e-cigarettes.

Introduction

Although conventional cigarette smoking has declined markedly over the past several decades among youth and young adults in the United States ( U.S. Department of Health and Human Services [USDHHS] 2012 ), there have been substantial increases in the use of emerging tobacco products among these populations in recent years ( Centers for Disease Control and Prevention [CDC] 2015c ). Among these increases has been a dramatic rise in electronic cigarette (e-cigarette) use among youth and young adults. It is crucial that the progress made in reducing cigarette smoking among youth and young adults not be compromised by the initiation and use of e-cigarettes. This Surgeon General’s report focuses on the history, epidemiology, and health effects of e-cigarette use among youth and young adults; the companies involved with marketing and promoting these products; and existing and proposed public health policies regarding the use of these products by youth and young adults.

E-cigarettes include a diverse group of devices that allow users to inhale an aerosol, which typically contains nicotine, flavorings, and other additives. E-cigarettes vary widely in design and appearance, but generally operate in a similar manner and are composed of similar components ( Figure 1.1 ). A key challenge for surveillance of the products and understanding their patterns of use is the diverse and nonstandard nomenclature for the devices ( Alexander et al. 2016 ). These devices are referred to, by the companies themselves, and by consumers, as “e-cigarettes,” “e-cigs,” “cigalikes,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.” In this report, the term “e-cigarette” is used to represent all of the various products in this rapidly diversifying product category. The terms may differ by geographic region or simply by the prevailing preferences among young users. For example, some refer to all cigarette-shaped products as “e-cigarettes” or as “cigalikes,” and some may refer to the pen-style e-cigarettes as “hookah pens” or “vape pens” ( Richtel 2014 ; Lempert et al. 2016 ).

Diversity of e-cigarette products. Source: Photo by Mandie Mills, CDC.

This report focuses on research conducted among youth and young adults because of the implications of e-cigarette use in this population, particularly the potential for future public health problems. Understanding e-cigarette use among young persons is critical because previous research suggests that about 9 in 10 adult smokers first try conventional cigarettes during adolescence ( USDHHS 2012 ). Similarly, youth e-cigarette experimentation and use could also extend into adulthood; however, e-cigarette use in this population has not been examined in previous reports of the Surgeon General. The first Surgeon General’s report on the health consequences of smoking was published in 1964; of the subsequent reports, those published in 1994 and 2012 focused solely on youth and young adults ( USDHHS 1994 , 2012 ). More recently, the 2012 report documented the evidence regarding tobacco use among youth and young adults, concluding that declines in cigarette smoking had slowed and that decreases in the use of smokeless tobacco had stalled. That report also found that the tobacco industry’s advertising and promotional activities are causal to the onset of smoking in youth and young adults and the continuation of such use as adults ( USDHHS 2012 ). However, the 2012 report was prepared before e-cigarettes were as widely promoted and used in the United States as they are now. Therefore, this 2016 report documents the scientific literature on these new products and their marketing, within the context of youth and young adults. This report also looks to the future by examining the potential impact of e-cigarette use among youth and young adults, while also summarizing the research on current use, health consequences, and marketing as it applies to youth and young adults.

Evidence for this report was gathered from studies that included one or more of three age groups. We defined these age groups to be young adolescents (11–13 years of age), adolescents (14–17 years of age), and young adults (18–24 years of age). Some studies refer to the younger groups more generally as youth. Despite important issues related to e-cigarette use in adult populations, clinical and otherwise (e. g ., their potential for use in conventional smoking cessation), that literature will generally not be included in this report unless it also discusses youth and young adults ( Farsalinos and Polosa 2014 ; Franck et al. 2014 ; Grana et al. 2014 ).

Given the recency of the research that pertains to e-cigarettes, compared with the decades of research on cigarette smoking, the “precautionary principle” is used to guide actions to address e-cigarette use among youth and young adults. This principle supports intervention to avoid possible health risks when the potential risks remain uncertain and have been as yet partially undefined ( Bialous and Sarma 2014 ; Saitta et al. 2014 ; Hagopian et al. 2015 ). Still, the report underscores and draws its conclusions from the known health risks of e-cigarette use in this age group.

Organization of the Report

This chapter presents a brief introduction to this report and includes its major conclusions followed by the conclusions of the chapters, the historical background of e-cigarettes, descriptions of the products, a review of the marketing and promotional activities of e-cigarette companies, and the current status of regulations from the U.S. Food and Drug Administration ( FDA ). Chapter 2 (“Patterns of E-Cigarette Use Among U.S. Youth and Young Adults”) describes the epidemiology of e-cigarette use, including current use (i.e., past 30 day); ever use; co-occurrence of using e-cigarettes with other tobacco products, like cigarettes; and psychosocial factors associated with using e-cigarettes, relying on data from the most recent nationally representative studies available at the time this report was prepared. Chapter 3 (“Health Effects of E-Cigarette Use Among U.S. Youth and Young Adults”) documents the evidence related to the health effects of e-cigarette use, including those that are associated with direct aerosol inhalation by users, the indirect health effects of e-cigarette use, other non-aerosol health effects of e-cigarette use, and secondhand exposure to constituents of the aerosol. Chapter 4 (“Activities of the E-Cigarette Companies”) describes e-cigarette companies’ influences on e-cigarette use and considers manufacturing and price; the impact of price on sales and use; the rapid changes in the industry, particularly the e-cigarette companies; and the marketing and promotion of e-cigarettes. Chapter 5 (“E-Cigarette Policy and Practice Implications”) discusses the implications for policy and practice at the national, state, and local levels. The report ends with a Call to Action to stakeholders—including policymakers, public health practitioners and clinicians, researchers, and the public—to work to prevent harms from e-cigarette use and secondhand aerosol exposure among youth and young adults.

Preparation of this Report

This Surgeon General’s report was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC , which is part of USDHHS . The initial drafts of the chapters were written by 27 experts who were selected for their knowledge of the topics addressed. These contributions are summarized in five chapters that were evaluated by approximately 30 peer reviewers. After peer review, the entire manuscript was sent to more than 20 scientists and other experts, who examined it for its scientific integrity. After each review cycle, the drafts were revised by the report’s scientific editors on the basis of reviewers’ comments. Subsequently, the report was reviewed by various institutes and agencies within USDHHS.

Scientific Basis of the Report

The statements and conclusions throughout this report are documented by the citation of studies published in the scientific literature. Publication lags have prevented an up-to-the-minute inclusion of all recently published articles and data. This overall report primarily cites peer-reviewed journal articles, including reviews that integrate findings from numerous studies and books that were published through December 2015. However, selected studies from 2016 have been added during the review process that provide further support for the conclusions in this report. When a cited study has been accepted for publication, but the publication has not yet occurred because of the delay between acceptance and final publication, the study is referred to as “in press.” This report also refers, on occasion, to unpublished research, such as presentations at a professional meeting, personal communications from a researcher, or information available in various media. These references are employed when acknowledged by the editors and reviewers as being from reliable sources, which add to the emerging literature on a topic.

Major Conclusions
E-cigarettes are a rapidly emerging and diversified product class. These devices typically deliver nicotine, flavorings, and other additives to users via an inhaled aerosol. These devices are referred to by a variety of names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.”
E-cigarette use among youth and young adults has become a public health concern. In 2014, current use of e-cigarettes by young adults 18–24 years of age surpassed that of adults 25 years of age and older.
E-cigarettes are now the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, including combustible tobacco products.
The use of products containing nicotine poses dangers to youth, pregnant women, and fetuses. The use of products containing nicotine in any form among youth, including in e-cigarettes, is unsafe.
E-cigarette aerosol is not harmless. It can contain harmful and potentially harmful constituents, including nicotine. Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.
E-cigarettes are marketed by promoting flavors and using a wide variety of media channels and approaches that have been used in the past for marketing conventional tobacco products to youth and young adults.
Action can be taken at the national, state, local, tribal, and territorial levels to address e-cigarette use among youth and young adults. Actions could include incorporating e-cigarettes into smokefree policies, preventing access to e-cigarettes by youth, price and tax policies, retail licensure, regulation of e-cigarette marketing likely to attract youth, and educational initiatives targeting youth and young adults.
Chapter Conclusions

Chapter 1. Introduction, Conclusions, and Historical Background Relative to E-Cigarettes

E-cigarettes are devices that typically deliver nicotine, flavorings, and other additives to users via an inhaled aerosol. These devices are referred to by a variety of names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.”
E-cigarettes represent an evolution in a long history of tobacco products in the United States, including conventional cigarettes.
In May 2016, the Food and Drug Administration issued the deeming rule, exercising its regulatory authority over e-cigarettes as a tobacco product.

Chapter 2. Patterns of E-Cigarette Use Among U.S. Youth and Young Adults

Among middle and high school students, both ever and past-30-day e-cigarette use have more than tripled since 2011. Among young adults 18–24 years of age, ever e-cigarette use more than doubled from 2013 to 2014 following a period of relative stability from 2011 to 2013.
The most recent data available show that the prevalence of past-30-day use of e-cigarettes is similar among high school students (16% in 2015, 13.4% in 2014) and young adults 18–24 years of age (13.6% in 2013–2014) compared to middle school students (5.3% in 2015, 3.9% in 2014) and adults 25 years of age and older (5.7% in 2013–2014).
Exclusive, past-30-day use of e-cigarettes among 8th-, 10th-, and 12th-grade students (6.8%, 10.4%, and 10.4%, respectively) exceeded exclusive, past-30-day use of conventional cigarettes in 2015 (1.4%, 2.2%, and 5.3%, respectively). In contrast—in 2013–2014 among young adults 18–24 years of age—exclusive, past-30-day use of conventional cigarettes (9.6%) exceeded exclusive, past-30-day use of e-cigarettes (6.1%). For both age groups, dual use of these products is common.
E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, particularly the use of combustible tobacco products. For example, in 2015, 58.8% of high school students who were current users of combustible tobacco products were also current users of e-cigarettes.
Among youth—older students, Hispanics, and Whites are more likely to use e-cigarettes than younger students and Blacks. Among young adults—males, Hispanics, Whites, and those with lower levels of education are more likely to use e-cigarettes than females, Blacks, and those with higher levels of education.
The most commonly cited reasons for using e-cigarettes among both youth and young adults are curiosity, flavoring/taste, and low perceived harm compared to other tobacco products. The use of e-cigarettes as an aid to quit conventional cigarettes is not reported as a primary reason for use among youth and young adults.
Flavored e-cigarette use among young adult current users (18–24 years of age) exceeds that of older adult current users (25 years of age and older). Moreover, among youth who have ever tried an e-cigarette, a majority used a flavored product the first time they tried an e-cigarette.
E-cigarette products can be used as a delivery system for cannabinoids and potentially for other illicit drugs. More specific surveillance measures are needed to assess the use of drugs other than nicotine in e-cigarettes.

Chapter 3. Health Effects of E-Cigarette Use Among U.S. Youth and Young Adults

Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.
Nicotine can cross the placenta and has known effects on fetal and postnatal development. Therefore, nicotine delivered by e-cigarettes during pregnancy can result in multiple adverse consequences, including sudden infant death syndrome, and could result in altered corpus callosum, deficits in auditory processing, and obesity.
E-cigarettes can expose users to several chemicals, including nicotine, carbonyl compounds, and volatile organic compounds, known to have adverse health effects. The health effects and potentially harmful doses of heated and aerosolized constituents of e-cigarette liquids, including solvents, flavorants, and toxicants, are not completely understood.
E-cigarette aerosol is not harmless “water vapor,” although it generally contains fewer toxicants than combustible tobacco products.
Ingestion of e-cigarette liquids containing nicotine can cause acute toxicity and possibly death if the contents of refill cartridges or bottles containing nicotine are consumed.

Chapter 4. Activities of the E-Cigarette Companies

The e-cigarette market has grown and changed rapidly, with notable increases in total sales of e-cigarette products, types of products, consolidation of companies, marketing expenses, and sales channels.
Prices of e-cigarette products are inversely related to sales volume: as prices have declined, sales have sharply increased.
E-cigarette products are marketed in a wide variety of channels that have broad reach among youth and young adults, including television, point-of-sale, magazines, promotional activities, radio, and the Internet.
Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that have been found to be appealing to youth and young adults in conventional cigarette advertising and promotion.

Chapter 5. E-Cigarette Policy and Practice Implications

The dynamic nature of the e-cigarette landscape calls for expansion and enhancement of tobacco-related surveillance to include (a) tracking patterns of use in priority populations; (b) monitoring the characteristics of the retail market; (c) examining policies at the national, state, local, tribal, and territorial levels; (d) examining the channels and messaging for marketing e-cigarettes in order to more fully understand the impact future regulations could have; and (e) searching for sentinel health events in youth and young adult e-cigarette users, while longer-term health consequences are tracked.
Strategic, comprehensive research is critical to identify and characterize the potential health risks from e-cigarette use, particularly among youth and young adults.
The adoption of public health strategies that are precautionary to protect youth and young adults from adverse effects related to e-cigarettes is justified.
A broad program of behavioral, communications, and educational research is crucial to assess how youth perceive e-cigarettes and associated marketing messages, and to determine what kinds of tobacco control communication strategies and channels are most effective.
Health professionals represent an important channel for education about e-cigarettes, particularly for youth and young adults.
Diverse actions, modeled after evidence-based tobacco control strategies, can be taken at the state, local, tribal, and territorial levels to address e-cigarette use among youth and young adults, including incorporating e-cigarettes into smoke-free policies; preventing the access of youth to e-cigarettes; price and tax policies; retail licensure; regulation of e-cigarette marketing that is likely to attract youth and young adults, to the extent feasible under the law; and educational initiatives targeting youth and young adults. Among others, research focused on policy, economics, and the e-cigarette industry will aid in the development and implementation of evidence-based strategies and best practices.
Historical Background

Understanding the role of e-cigarettes requires understanding the long history of tobacco use in the United States, including the role of nicotine delivery, the multiple examples of “reduced-harm” products and associated health claims, and the impact of using tobacco products on the public’s health. Since the late nineteenth century, when the “modern” cigarette came into use, scientists and public health officials have linked cigarette smoking to a remarkable number of adverse effects, and it is now recognized as the primary cause of premature death in the United States ( USDHHS 2014 ). Correspondingly, for a century, manufacturers, scientists, entrepreneurs, and public health leaders have promoted or recommended product changes that might remove some of the harmful elements in cigarette smoke. E-cigarettes are among the latest products.

E-cigarettes are designed for users to inhale nicotine, flavorings, and other additives through an aerosol. The claims and marketing strategies employed by the e-cigarette companies, and the efforts made by others to develop scientific and regulatory tools to deal with these new products, both contribute to the current discourse on e-cigarettes. Many lessons for assessing the potential (and future) consequences of these products can be learned from examining the relevant experiences of the past century, especially the introduction of novel products (including e-cigarettes as well as other tobacco and nicotine products) and the claims of reduced exposure to toxins made by the industry and elsewhere.

Early Efforts to Modify Cigarettes

In the 1880s and 1890s, entrepreneurs promoted novel products that allegedly blocked nicotine and other constituents of conventional cigarettes believed to be poisonous. Dr. Scott’s Electric Cigarettes, advertised in Harper’s Weekly, claimed not only to light without matches but also to contain a cotton filter that “strains and eliminates the injurious qualities from the smoke,” including nicotine ( Harper’s Weekly 1887 ). Nicotine delivery was essential to the development of the modern cigarette in the twentieth century; early on, this substance was thought to be addicting and thus vital to retaining customers. In 1913, the Camel brand was a new kind of cigarette that introduced high-nicotine content by using burley tobacco, which was generally too harsh to inhale into the lungs, but was made more inhalable through the addition of casings (e. g ., sugars, licorice) ( Tindall 1992 ; Proctor 2011 ). In 1916, American Tobacco introduced its Lucky Strike blended cigarette, and in 1918 Liggett & Myers ( L &M) reformulated its Chesterfield brand to make it more palatable to users. As the market grew, advertisements for major brands routinely included health-related statements and testimonials from physicians. During the 1930s and 1940s, prominent advertising campaigns included claims like “Not a cough in a carload” (Old Gold) ( Federal Trade Commission [FTC] 1964 , p. LBA-5); “We removed from the tobacco harmful corrosive ACRIDS (pungent irritants) present in cigarettes manufactured in the old-fashioned way” (Lucky Strike) ( FTC 1964 , p. LBA-2); and “Smoking Camels stimulates the natural flow of digestive fluids … increases alkalinity” (Camel) ( FTC 1964 , p. LBA-1a). Thus, early modifications to the cigarette were made so that it was more palatable, had a higher nicotine delivery and uptake, and could be marketed as “safe” ( FTC 1964 ; Calfee 1985 ).

Filters, Tar Reduction, and Light and Low-Tar Cigarettes

The landmark 1964 Surgeon General’s report on smoking and health concluded that cigarette smoking contributed substantially to mortality from certain specific diseases, including lung cancer ( U.S. Department of Health, Education, and Welfare 1964 ). Although the 1964 report considered the topic, it found the evidence insufficient to assess the potential health benefits of cigarette filters. Cigarettes with filters became the norm by the 1960s, and marketing them with an overt message about harm reduction became the standard ( National Cancer Institute [NCI] 1996 ). However, the Surgeon General convened another group of experts on June 1, 1966, to review the evidence on the role played by the tar and nicotine content in health. The group concluded that “[t]he preponderance of scientific evidence strongly suggests that the lower the ‘tar’ and nicotine content of cigarette smoke, the less harmful are the effects” ( Horn 1966 , p. 16,168). Subsequent studies have repeatedly failed to demonstrate health benefits of smoking light and low-tar cigarettes versus full-flavor cigarettes ( Herning et al. 1981 ; Russell et al. 1982 ; Benowitz et al. 1983 , NCI 2001 ).

Over the years, the tobacco industry used multiple methods to reduce the machine-tested yields of tar and nicotine in cigarettes as a way to claim “healthier” cigarettes. Beginning in the 1970s, tobacco companies advertised the tar and nicotine levels for their cigarettes, which encouraged smokers to believe, without substantiation, they could reduce their risk of exposure to these constituents ( Cummings et al. 2002 ; Pollay and Dewhirst 2002 ). In 1996, the FTC issued a statement that it would allow cigarette companies to include statements about tar and nicotine content in their advertising as long as they used a standardized machine-testing method ( Peeler 1996 ).

The Role of Nicotine and Nicotine Delivery

Although the public health community understood early on that nicotine was the primary psycho-active ingredient in cigarette smoke, before the 1980s, little was known about the importance of nicotine in the addiction process beyond what the cigarette manufacturers had learned from their own research. Some scientists warned that due to nicotine addiction, a reduction in nicotine yields, along with decreases in tar, could lead smokers to change their smoking behavior, such as by smoking a greater number of cigarettes to maintain their nicotine intake or changing their behavior in more subtle ways, such as varying the depth of inhalation or smoking more of the cigarette ( Jarvis et al. 2001 ; National Cancer Institute 2001 ; Thun and Burns 2001 ). Not until the 1970s and 1980s, as researchers studying other forms of drug abuse began to apply their research methods to cigarette smoking, did it become apparent that nicotine was similar in its addictive capability to other drugs of abuse, such as heroin and cocaine ( USDHHS 1981 , 1988 ). As described in the 1988 Surgeon General’s report and in subsequent research, symptoms associated with nicotine addiction include craving, withdrawal, and unconscious behaviors to ensure consistent intake of nicotine ( USDHHS 1988 ; al’Absi et al. 2002 ; Hughes 2007 ).

Although the tobacco industry has long understood the importance of nicotine to maintain long-term cigarette smokers through addiction, public health officials did not fully appreciate this in a broad sense until the 1988 Surgeon General’s report, The Health Consequences of Smoking: Nicotine Addiction ( USDHHS 1988 ).

FDA and Nicotine Regulation

In 1988 (and again in 1994), the Coalition on Smoking OR Health and other public-interest organizations petitioned FDA to classify low-tar and nicotine products as drugs and to classify Premier, the short-lived “smokeless cigarette product” from R.J. Reynolds, as an alternative nicotine-delivery system ( Stratton et al. 2001 ). The Coalition on Smoking OR Health cited indirect claims made through advertising and marketing as evidence of R. J. Reynolds’s intent to have the product used for the mitigation or prevention of disease ( Slade and Ballin 1993 ). Meanwhile, FDA launched an investigation into the practices of the tobacco industry, including the manipulation of nicotine delivery. FDA asserted its jurisdiction over cigarettes and smokeless tobacco and issued certain rules governing access to and promotion of these products ( Federal Register 1996 ). On March 21, 2000, the U.S. Supreme Court ruled 5-4 that Congress had not yet given FDA the necessary statutory authority to issue any rules pertaining to tobacco products ( Gottleib 2000 ; FDA v. Brown & Williamson Tobacco Corp. 2000 ). The subsequent debate over control of nicotine products, including their potential impact on youth, ultimately led to the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, which gave FDA authority to regulate tobacco products. Thus, discussions about the introduction of novel nicotine-containing tobacco products in the market during the 1980s and 1990s helped shape the current regulation of tobacco and nicotine products.

New products introduced in the 1990s or later included modified tobacco cigarettes (e. g ., Advance, Omni); cigarette-like products, also called cigalikes (e.g., Eclipse, Accord); and smokeless tobacco products (e.g., Ariva, Exalt, Revel, snus). Advance, made by Brown and Williamson, was test-marketed with the slogan “All of the taste … Less of the toxins.” Vector launched a national advertising campaign for its Omni cigarette with the slogan “Reduced carcinogens. Premium taste.” In addition to the question of whether the claims were supported by sufficient evidence, scientists and tobacco control leaders raised concerns about the potential for adverse consequences associated with novel nicotine and tobacco products marketed for harm reduction, such as a reduction in cessation rates or increased experimentation by children ( Warner and Martin 2003 ; Joseph et al. 2004 ; Caraballo et al. 2006 ). Studies have shown that smokers are interested in trying novel “reduced-exposure” products and perceive them to have lower health risks, even when advertising messages do not make explicit health claims ( Hamilton et al. 2004 ; O’Connor et al. 2005 ; Caraballo et al. 2006 ; Choi et al. 2012 ; Pearson et al. 2012 ).

At FDA ’s request, the Institute of Medicine ( IOM [now the National Academy of Medicine]) convened a committee of experts to formulate scientific methods and standards by which potentially reduced-exposure products (PREPs), whether the purported reduction was pharmaceutical or tobacco related, could be assessed. The committee concluded that “[f]or many diseases attributable to tobacco use, reducing risk of disease by reducing exposure to tobacco toxicants is feasible” ( Stratton et al. 2001 , p. 232). However, it also cautioned that “PREPs have not yet been evaluated comprehensively enough (including for a sufficient time) to provide a scientific basis for concluding that they are associated with a reduced risk of dis ease compared to conventional tobacco use” ( Stratton et al. 2001 , p. 232). The committee added that “the major concern for public health is that tobacco users who might otherwise quit will use PREPs instead, or others may initiate smoking, feeling that PREPs are safe. That will lead to less harm reduction for a population (as well as less risk reduction for that individual) than would occur without the PREP , and possibly to an adverse effect on the population” ( Stratton et al. 2001 , p. 235). Subsequently, in 2006, Judge Kessler cited these findings in her decision which demanded the removal of light and low-tar labeling due to the misleading nature of these claims ( United States v. Philip Morris 2006 ).

The E-Cigarette

Invention of the E-Cigarette

An early approximation of the current e-cigarette appeared in a U.S. patent application submitted in 1963 by Herbert A. Gilbert and was patented in August 1965 (U.S. Patent No. 3,200,819) ( Gilbert 1965 ). The application was for a “smokeless nontobacco cigarette,” with the aim of providing “a safe and harmless means for and method of smoking” by replacing burning tobacco and paper with heated, moist, flavored air. A battery-powered heating element would heat the flavor elements without combustion ( Gilbert 1965 ). The Favor cigarette, introduced in 1986, was another early noncombustible product promoted as an alternative nicotine-containing tobacco product ( United Press International 1986 ; Ling and Glantz 2005 ).

The first device in the recent innovation in e-cigarettes was developed in 2003 by the Chinese pharmacist Hon Lik, a former deputy director of the Institute of Chinese Medicine in Liaoning Province. Lik’s patent application described a kind of electronic atomizing cigarette ( Hon 2013 ). With support from Chinese investors, in 2004 the product was introduced on the Chinese market under the company name Ruyan ( Sanford and Goebel 2014 ). The product gained some attention among Chinese smokers early on as a potential cessation device or an alternative cigarette product.

The e-cigarette was part of the U.S. market by the mid-2000s, and by 2010 additional brands started to appear in the nation’s marketplace, including Ruyan and Janty ( Regan et al. 2013 ). Ruyan gained a U.S. patent for its product with the application stating that the product is “an electronic atomization cigarette that functions as substitutes (sic) for quitting smoking and cigarette substitutes.” (U.S. Patent No. 8,490,628 B2, 2013). In August 2013, Imperial Tobacco Group purchased the intellectual property behind the Ruyan e-cigarette for $75 million. As of 2014 an estimated 90% of the world’s production of e-cigarette technology and products came from mainland China, mainly Guangdong Province and Zhejiang Province ( Barboza 2014 ).

Sales of e-cigarettes in the United States have risen rapidly since 2007. Widespread advertising via television commercials and through print advertisements for popular brands, often featuring celebrities, has contributed to a large increase in e-cigarette use by both adults and youth since 2010 ( Felberbaum 2013 ; King et al. 2013 ; Regan et al. 2013 ). Additionally, marketing through social media, as well as other forms of Internet marketing, has been employed to market these devices ( Huang et al. 2014 ; Kim et al. 2014 ).

In 2013, an estimated 13.1 million middle school and high school students were aware of e-cigarettes ( Wang et al. 2014 ). According to data from the National Youth Tobacco Survey, in 2011 the prevalence of current e-cigarette use (defined as use during at least 1 day in the past 30 days) among high school students was 1.5%; prevalence increased dramatically, however, to 16% by 2015, surpassing the rate of conventional-cigarette use among high school students ( CDC 2016b ; see Chapter 2 ). This equates to 2.4 million high school students and 620,000 middle school students having used an e-cigarette at least one time in the past 30 days in 2015 ( CDC 2016b ).

These trends have led to substantial concern and discussion within public health communities, including state and national public health agencies, professional organizations, and school administrators and teachers. A primary concern is the potential for nicotine addiction among nonsmokers, especially youth and young adults, and that this exposure to nicotine among youth and young adults is harmful. The diversity and novelty of e-cigarette products on the market and ongoing product innovations make assessments of the biological effects of current e-cigarettes under actual conditions of use—such as their long-term harmfulness—difficult to measure. Unanswered questions remain about the risk profile of these devices, their potential use by young people as a first step to other nicotine products, and their total impact on public health. There are diverging opinions about the potential public health impact of these new products. Some public health scientists have highlighted the potential for alternative nicotine products to serve as a substitute for conventional cigarettes and thus a harm reduction tool ( Henningfield et al. 2003 ; Abrams 2014 ). Others have cautioned that the use of alternative nicotine products might become a bridge that may lead to greater tobacco product use—including dual- or multiple-product use—or initiate nicotine addiction among nonsmokers, especially youth ( Cobb et al. 2010 ; Wagener et al. 2012 ; Benowitz and Goniewicz 2013 ; Britton 2013 ; Chapman 2013 ; Etter 2013 ; USDHHS 2014 ). Current evidence is insufficient to reject either of these hypotheses.

E-Cigarette Products

Components and devices.

E-cigarette devices are composed of a battery, a reservoir for holding a solution that typically contains nicotine, a heating element or an atomizer, and a mouthpiece through which the user puffs ( Figure 1.2 ). The device heats a liquid solution (often called e-liquid or e-juice) into an aerosol that is inhaled by the user. E-liquid typically uses propylene glycol and/or glycerin as a solvent for the nicotine and flavoring chemicals

Parts of an e-cigarette device. Source: Photo by Mandie Mills, CDC.

Flavors and E-Cigarettes

The e-liquids in e-cigarettes are most often flavored; a study estimated that 7,700 unique flavors exist ( Zhu et al. 2014 ) and that most of them are fruit or candy flavors ( Figure 1.3 ). A content analysis of the products available via online retail websites documented that tobacco, mint, coffee, and fruit flavors were most common, followed by candy (e. g ., bubble gum), unique flavors (e.g., Belgian waffle), and alcoholic drink flavors (e.g., strawberry daiquiri) ( Grana and Ling 2014 ). Some retail stores are also manufacturers that create custom flavors, which increases the variety of flavors available.

Examples of e-liquid flavors. Source: Photo by Mandie Mills, CDC.

The widespread availability and popularity of flavored e-cigarettes is a key concern regarding the potential public health implications of the products. The concern, among youth, is that the availability of e-cigarettes with sweet flavors will facilitate nicotine addiction and simulated smoking behavior—which will lead to the use of conventional tobacco products ( Kong et al. 2015 ; Krishnan-Sarin et al. 2015 ). Flavors have been used for decades to attract youth to tobacco products and to mask the flavor and harshness of tobacco ( USDHHS 2012 ). Industry documents show that tobacco companies marketed flavored little cigars and cigarillos to youth and to African Americans to facilitate their uptake of cigarettes ( Kostygina et al. 2014 ). Companies also intended flavored smokeless tobacco products to facilitate “graduation” to unflavored products that more easily deliver more nicotine to the user ( USDHHS 2012 ). Various studies have shown that youth are more likely than adults to choose flavored cigarettes and cigars ( CDC 2015b ). Concern over these findings led Congress to include a ban on characterizing flavors for cigarettes, other than tobacco or menthol, in the Tobacco Control Act. A similar concern exists about e-cigarettes, and this concern is supported by studies indicating that youth and young adults who have ever used e-cigarettes begin their use with sweet flavors rather than tobacco flavors ( Kong et al. 2015 ; Krishnan-Sarin et al. 2015 ). Notably, 81.5% of current youth e-cigarette users said they used e-cigarettes “because they come in flavors I like” ( Ambrose et al. 2015 ).

E-Cigarette Devices

First-generation e-cigarettes were often similar in size and shape to conventional cigarettes, with a design that also simulated a traditional cigarette in terms of the colors used (e. g ., a white body with tan mouthpiece). These devices were often called cigalikes, but there were other products designed to simulate a cigar or pipe. Other cigalikes were slightly longer or narrower than a cigarette; they may combine white with tan or may be black or colored brightly. These newer models use a cartridge design for the part of the device that holds the e-liquid, which is either prefilled with the liquid or empty and ready to be filled. The user then squeezes drops of the e-liquid onto a wick (or bit of cotton or polyfil) connected to the heating element and atomizer ( Figure 1.4 ). As e-cigarettes have become more popular, their designs have become more diverse, as have the types of venues where they are sold ( Noel et al. 2011 ; Zhu et al. 2014 ).

E-liquids being poured into an e-cigarette device. Source: Photo by Mandie Mills, CDC.

Second-generation devices include products that are shaped like pens, are comparatively larger and cylindrical, and are often referred to as “tank systems” in a nod to the transparent reservoir that holds larger amounts of e-liquid than previous cartridge-containing models. Third- and fourth-generation devices represent a diverse set of products and, aesthetically, constitute the greatest departure from the traditional cigarette shape, as many are square or rectangular and feature customizable and rebuildable atomizers and batteries. In addition, since the beginning of the availability of e-cigarettes and their component parts, users have been modifying the devices or building their own devices, which are often referred to as “mods.” The differences in design and engineering of the products are key factors in the size, distribution, and amount of aerosol particles and the variability in levels of chemicals and nicotine present in the e-liquid/aerosol and delivered to the user ( Brown and Cheng 2014 ).

E-Cigarette Product Components and Risks

One of the primary features of the more recent generation of devices is that they contain larger batteries and are capable of heating the liquid to a higher temperature, potentially releasing more nicotine, forming additional toxicants, and creating larger clouds of particulate matter ( Bhatnagar et al. 2014 ; Kosmider et al. 2014 ). For instance, one study demonstrated that, at high temperatures (150°C), exceedingly high levels of formaldehyde—a carcinogen (found to be 10 times higher than at ambient temperatures)—are present that are formed through the heating of the e-liquid solvents (propylene glycol and glycerin), although the level of tolerance of actual users to the taste of the aerosol heated to this temperature is debated ( Kosmider et al. 2014 ; CDC 2015a ; Flavor and Extract Manufacturers Association of the United States 2015 ; Pankow et al. 2015 ). There is also concern regarding the safety of inhaling e-cigarette flavorings. Although some manufacturers have claimed their flavorants are generally recognized as safe for food additives (i.e., to be used in preparing foods for eating), little is known about the long-term health effects of inhaling these substances into the lungs ( CDC 2015a ).

Many devices can be readily customized by their users, which is also leading to the concern that these devices are often being used to deliver drugs other than nicotine ( Brown and Cheng 2014 ). Most commonly reported in the news media, on blogs, and by user anecdote is the use of certain types of e-cigarette-related products for delivering different forms of marijuana ( Morean et al. 2015 ; Schauer et al. 2016 ). The tank systems, for example, have been used with liquid tetrahydrocannabinol ( THC ) or hash oil. Some personal vaporizer devices can be used with marijuana plant material or a concentrated resin form of marijuana called “wax.” One study describes the use, in Europe, of e-cigarette devices to smoke marijuana ( Etter 2015 ).

The various e-cigarette products, viewed as a group, lack standardization in terms of design, capacity for safely holding e-liquid, packaging of the e-liquid, and features designed to minimize hazards with use ( Yang et al. 2014 ). All of these design features may have implications for the health impact of e-cigarette use. Notably, from 2010 to 2014, calls to poison control centers in the United States about exposures related to e-cigarettes increased dramatically. According to the American Association of Poison Control Centers (2015) , 271 cases were reported in 2011, but 3,783 calls were reported in 2014. Among all calls, 51% involved exposure among children younger than 5 years of age ( CDC 2014 ). Most poisonings appear to have been caused by exposure to nicotine-containing liquid ( CDC 2014 ). The lack of a requirement for child-resistant packaging for e-liquid containers may have contributed to these poisonings. Since these data were released, one death in the United States has been confirmed in a child who drank e-liquid containing nicotine ( Mohney 2014 ). Additionally, serious adverse reactions, including at least two deaths, have been reported to FDA in cases that could be attributed to the use of e-cigarettes ( FDA 2013 ). This increase in poisonings prompted the Child Nicotine Poisoning Prevention Act of 2015 (2016) , which was enacted in January 2016. This law requires any container of liquid nicotine that is sold, manufactured, distributed, or imported into the United States to be placed in packaging that is difficult to open by children under 5 years of age.

Secondary risks are also of concern regarding e-cigarettes, including passive exposure to nicotine and other chemicals, and adverse events due to device malfunction. Nicotine is a neuroteratogen, and its use by pregnant women exposes a developing fetus to risks that are well documented in the 50th-anniversary Surgeon General’s report on smoking ( USDHHS 2014 ) and include impaired brain development ( England et al. 2015 ) and other serious consequences. Finally, another consequence of the lack of device regulation is the occurrence of battery failures and subsequent explosions. Explosions have typically occurred during charging, resulting in house and car fires, and sometimes causing injuries to those involved. From 2009 to late 2014, 25 incidents of explosions and fires involving e-cigarettes occurred in the United States ( Chen 2013 ; U.S. Fire Administration 2014 ; FDA 2013 ).

E-Cigarette Companies

E-cigarette companies include manufacturers, wholesalers, importers, retailers, distributors, and some other groups that overlap with these entities ( Barboza 2014 ; Whelan 2015 ). Currently, most of the products are manufactured in Shenzhen, Guangdong Province, China ( Cobb et al. 2010 ; Grana et al. 2014 ; Zhu et al. 2014 ). One study placed the number of brands at 466 in January 2014 and found a net increase of 10.5 brands per month ( Zhu et al. 2014 ). All the major tobacco companies (e. g ., Reynolds American, Altria; Table 1.1 ) and many smaller, independent companies are now in the business. When e-cigarettes first entered the U.S. market, they were sold primarily by independent companies via the Internet and in shopping malls at kiosks where those interested could sample the products. A unique feature of the e-cigarette industry, compared to other tobacco and nicotine products, is the recruitment of visitors to their websites as “affiliates” or distributors to help market the products and, in turn, receive commissions on sales ( Grana and Ling 2014 ; Cobb et al. 2015 ). For example, some companies offer a way for users to earn a commission by advertising the products (e.g., a banner ad is placed on one’s website, and when someone clicks on the link and subsequently purchases a product, the website owner gets a percentage commission). Some companies also offer rewards programs for recruiting new customers or for brand loyalty, with web-site users earning points for free or reduced-price products ( Richardson et al. 2015 ).

Multinational tobacco companies with e-cigarette brands.

E-cigarettes are now in widespread national distribution through convenience stores, tobacco stores, pharmacies, “big box” retail chains such as Costco, online retailers, and shops devoted to e-cigarette products (often called “vape shops”) ( Giovenco et al. 2015 ; Public Health Law Center 2015 ). The “vape shops” offer a place to buy customizable devices and e-liquid solutions in many flavors and sometimes include a café or other elements that promote socializing, essentially making such places like a lounge. With the rapid increase in distribution and marketing in the industry, sales have increased rapidly and were projected to reach $2.5 billion in 2014 and $3.5 billion in 2015, including projections for retail and online channels, as well as “vape shops” ( Wells Fargo Securities 2015 ).

The advertising and marketing of e-cigarette products has engendered skepticism among public health professionals and legislators, who have noted many similarities to the advertising claims and promotional tactics used for decades by the tobacco industry to sell conventional tobacco products ( Campaign for Tobacco-Free Kids 2013 ; CDC 2016a ). Indeed, several of the e-cigarette marketing themes have been reprised from the most memorable cigarette advertising, including those focused on freedom, rebellion, and glamor ( Grana and Ling 2014 ). E-cigarette products are marketed with a variety of unsubstantiated health and cessation messages, with some websites featuring videos of endorsements by physicians (another reprisal of old tobacco industry advertising) ( Grana and Ling 2014 ; Zhu et al. 2014 ). Unlike conventional cigarettes, for which advertising has been prohibited from radio and television since 1971, e-cigarette products are advertised on both radio and television, with many ads featuring celebrities. E-cigarettes also are promoted through sports and music festival sponsorships, in contrast to conventional cigarettes and smokeless tobacco products, which have been prohibited from such sponsorships since the Master Settlement Agreement in 1998. E-cigarettes also appear as product placements in television shows and movies ( Grana et al. 2011 ; Grana and Ling 2014 ).

Another key avenue for e-cigarette promotion is social media, such as Twitter, Facebook, YouTube, and Instagram. As is true in the tobacco industry, the e-cigarette industry organizes users through advocacy groups ( Noel et al. 2011 ; Harris et al. 2014 ; Saitta et al. 2014 ; Caponnetto et al. 2015 ). The extensive marketing and advocacy through various channels broadens exposure to e-cigarette marketing messages and products; such activity may encourage nonsmokers, particularly youth and young adults, to perceive e-cigarette use as socially normative. The plethora of unregulated advertising is of particular concern, as exposure to advertising for tobacco products among youth is associated with cigarette smoking in a dose-response fashion ( USDHHS 2012 ).

Federal Regulation of E-Cigarettes

A “Two-Pronged” Approach to Comprehensive Tobacco Control

Since the passage of the Tobacco Control Act in 2009, FDA has had the authority to regulate the manufacturing, distribution, and marketing of tobacco products sold in the United States. FDA had immediate jurisdiction over cigarettes, roll-your-own cigarette tobacco, and smokeless tobacco. In May 2016, FDA asserted jurisdiction over products that meet the statutory definition of a tobacco product, including e-cigarettes, except accessories of these products ( Federal Register 2016 ). That regulation is currently under litigation.

The IOM ’s 2007 report, Ending the Tobacco Problem: A Blueprint for the Nation, established a “two-pronged” strategy for comprehensive tobacco control: (1) full implementation of proven, traditional tobacco control measures such as clean indoor air laws, taxation, and countermarketing campaigns; and (2) “strong federal regulation of tobacco products and their marketing and distribution” ( Bonnie et al. 2007 , p. 1).

Included in FDA ’s broad authority are the restriction of marketing and sales to youth, requiring disclosure of ingredients and harmful and potentially harmful constituents, setting product standards (e. g ., requiring the reduction or elimination of ingredients or constituents), requiring premarket approval of new tobacco products and review of modified-risk tobacco products, and requiring health warnings. The standard for FDA to use many of its regulatory authorities is whether such an action is appropriate for the protection of public health ( Federal Food, Drug, and Cosmetic Act , § 907(a)(3)(A)). The public health standard in the Tobacco Control Act also requires FDA to consider the health impact of certain regulatory actions at both the individual and population levels, including their impact on nonusers, and on initiation and cessation ( Federal Food, Drug, and Cosmetic Act , § 907(a)(3)(B)).

Importantly, the Tobacco Control Act preserves the authority of state, local, tribal, and territorial governments to enact any policy “in addition to, or more stringent than” requirements established under the Tobacco Control Act “relating to or prohibiting the sale, distribution, possession, exposure to, access to, advertising and promotion of, or use of tobacco products by individuals of any age” ( Federal Food, Drug, and Cosmetic Act , § 916(a)(1)). This preservation of state and local authority ensures the continuation of more local-level, comprehensive tobacco control. However, the statute expressly preempts states and localities from establishing or continuing requirements that are different from or in addition to FDA requirements regarding standards for tobacco products, premarket review, adulteration, misbranding, labeling, registration, good manufacturing practices, or modified-risk tobacco products ( Federal Food, Drug, and Cosmetic Act , § 916(a)(2)(A)). But this express preemption provision does not apply to state and local authority to impose requirements relating to the “sale, distribution, possession, information reporting to the State, exposure to, access to, the advertising and promotion of, or use of, tobacco products by individuals of any age …” ( Federal Food, Drug, and Cosmetic Act , § 916(a)(2)(b)). The interaction of these complex provisions related to federal preemption of state law has been the subject of challenges by the tobacco industry to state and local laws. Thus far, courts have upheld certain local ordinances restricting the sale of flavored tobacco products ( National Association of Tobacco Outlets, Inc. v. City of Providence 2013 ; U.S. Smokeless Tobacco Manufacturing Co. v. City of New York 2013 ).

Legal Basis for Regulating E-Cigarettes as Tobacco Products

In the United States, e-cigarettes can be regulated either as products marketed for therapeutic purposes or as tobacco products. Since the advent of e-cigarettes in the United States around 2007, manufacturers have had the option to apply to FDA ’s Center for Drug Evaluation and Research ( CDER ) or Center for Devices and Radiological Health (CDRH) for approval to market e-cigarettes for therapeutic purposes; as of August 2016, no e-cigarette manufacturers have received approval through this avenue.

In 2008 and early 2009, FDA detained multiple shipments of e-cigarettes from overseas manufacturers and denied them entry into the United States on the grounds that e-cigarettes were unapproved drug-device combination products ( FDA 2011 ). Sottera, Inc., which now does business as NJOY, challenged that determination ( Smoking Everywhere, Inc. and Sottera, Inc., d/b/a NJOY v. U.S. Food and Drug Administration, et al. 2010 ; Bloomberg Business 2015 ). Between the filing of the lawsuit and a decision on the motion for preliminary injunction, Congress passed the Tobacco Control Act and the President signed it into law. The Tobacco Control Act defines the term “tobacco product,” in part, as any product, including component parts or accessories, “made or derived from tobacco” that is not a “drug,” “device,” or “combination product” as defined by the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(rr)) ( Family Smoking Prevention and Tobacco Control Act 2009 , § 101(a)). The District Court subsequently granted a preliminary injunction relying on the Supreme Court’s decision in Brown and Williamson (1996) and the recently enacted Tobacco Control Act. FDA appealed the decision and the U.S. Court of Appeals for the D.C. Circuit held that e-cigarettes and, therefore, other products “made or derived from tobacco” are not drug/device combinations unless they are marketed for therapeutic purposes, but can be regulated by FDA as tobacco products under the Tobacco Control Act ( Sottera, Inc. v. Food & Drug Administration 2010 ).

On September 25, 2015, FDA proposed regulations to describe the circumstances in which a product made or derived from tobacco that is intended for human consumption will be subject to regulation as a drug, device, or a combination product. The comment period for this proposed regulation closed on November 24, 2015.

Most e-cigarettes marketed and sold in the United States today contain nicotine made or derived from tobacco. Although some e-cigarettes claim that they contain nicotine not derived from tobacco, or that they contain no nicotine at all ( Lempert et al. 2016 ), there may be reason to doubt some of these claims. Currently, synthetic nicotine and nicotine derived from genetically modified, nontobacco plants are cost-prohibitive for e-cigarette manufacturers, although technological advances could eventually increase the cost-effectiveness of using nicotine that was not derived from tobacco ( Lempert et al. 2016 ). The health effects of passive exposure to e-cigarettes with no nicotine, as well as their actual use and the extent of exposure to these products, have just begun to be studied ( Hall et al. 2014 ; Marini et al. 2014 ; Schweitzer et al. 2015 ) and some states and localities are taking steps to regulate e-cigarettes that do not contain nicotine or tobacco ( Lempert et al. 2016 ).

Deeming Rule

The Tobacco Control Act added a new chapter to the Federal Food, Drug, and Cosmetic Act , which provides FDA with authority over tobacco products. The new chapter applied immediately to all cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco; and the law included “any other tobacco products that the Secretary of Health and Human Services by regulation deems to be subject to this chapter” ( Federal Food, Drug, and Cosmetic Act , §901 (b)). Therefore, to regulate e-cigarettes as tobacco products, FDA was required to undertake a rulemaking process to extend its regulatory authority to include e-cigarettes.

Prohibitions on adulterated and misbranded products;
Required disclosure of existing health information, including lists of ingredients and documents on health effects;
Required registration of manufacturers;
Required disclosure of a list of all tobacco products, including information related to labeling and advertising;
Premarket review of new tobacco products (i.e., those not on the market on February 15, 2007);
Restrictions on products marketed with claims about modified risk.
Minimum age restrictions to prevent sales to minors;
Requirements to include a nicotine warning; and
Prohibitions on vending machine sales, unless in a facility that never admits youth.

Future Regulatory Options

Product standards, including restrictions on flavors;
Restrictions on promotion, marketing, and advertising, and prohibitions on brand-name sponsorship of events;
Minimum package sizes;
Prohibitions on self-service displays;
Child-resistant packaging and the inclusion of health warnings; and
Regulation of nicotine levels in products.

Despite this broad authority, FDA is prohibited from certain regulatory actions, even if those actions may be appropriate for the protection of public health. Specifically, FDA generally cannot restrict tobacco use in public places, levy taxes on tobacco products, prohibit sales by a specific category of retail outlet (e. g ., pharmacies), completely eliminate nicotine in tobacco products, require prescriptions for tobacco products unless it is marketed for therapeutic purposes, or establish a federal minimum age of sale for tobacco products above 18 years of age. Thus, even if FDA fully exercises all of its existing authority over e-cigarettes, regulation will still need to be complemented at the state and local levels, including efforts previously shown to be effective for conventional tobacco products, such as comprehensive smokefree laws at the state and local levels, pricing strategies, raising the minimum age of sales to minors to 21, and high-impact countermarketing campaigns. In the current context of rising rates of use by youth, localities and states can also implement policies and programs that minimize the individual- and population-level harms of e-cigarettes (see Chapter 5 ).

This chapter presents the major conclusions of this Surgeon General’s report and the conclusions of each chapter. E-cigarettes are presented within their historical context, with an overview of the components of these devices and the types of products. In 2016, FDA announced its final rule to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act. The chapter outlines options for the regulation of e-cigarettes, particularly as they relate to youth and young adults, based on successful smoking policies. The need to protect youth and young adults from initiating or continuing the use of nicotine-containing products forms a strong basis for the need to regulate e-cigarettes at the local, state, and national levels in the future.

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Yang L, Rudy SF, Cheng JM, Durmowicz EL. Electronic cigarettes: incorporating human factors engineering into risk assessments. Tobacco Control 2014;23:(Suppl 2):ii47–ii53. [ PMC free article : PMC3995290 ] [ PubMed : 24732164 ]
Zhu SH, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, Lee M. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tobacco Control 2014;23:(Suppl 3):iii3–iii9. [ PMC free article : PMC4078673 ] [ PubMed : 24935895 ]
Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2016. Chapter 1, Introduction, Conclusions, and Historical Background Relative to E-Cigarettes.
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Conclusions about the effects of electronic cigarettes remain the same

Conclusions about effects of electronic cigarettes remain unchanged

An updated Cochrane Review provides an independent, rigorous assessment of the best available evidence to date about electronic cigarettes for quitting smoking.

Scroll to the bottom of this article for a round-up of media coverage

The conclusions of this updated Review are unchanged since the last review was published two years ago: electronic cigarettes may help smokers stop their smoking, and the included studies did not find any serious side effects associated with their use for up to two years.

Many studies are now underway which may help us understand more about their effects in the future.

The first Cochrane Review, published in the Cochrane Library in December 2014, showed that electronic cigarettes may be an aid to smokers in stopping their smoking. The updated Review did not find any new randomized controlled trials (RCTs) with long-term outcomes looking at the effectiveness of electronic cigarettes in helping people to stop smoking. However, this is an active area of research, with a large number of ongoing studies that will add to the evidence in the next few years.

Smoking is a significant global health problem. Despite many smokers wanting to stop, they often find it difficult to succeed in the long term. One of the most effective and widely used strategies to help combat the cravings associated with nicotine addiction is to deliver nicotine by patches and chewing gum.

Electronic cigarettes have been around in some form for a number of years, but over the past few years their popularity has increased significantly, and they have begun to look and feel less like conventional cigarettes. Unlike chewing gum and patches, they mimic the experience of cigarette smoking because they are hand-held and generate a smoke-like vapour when used. They help to recreate similar sensations of smoking without exposing users or others to the smoke from conventional cigarettes, and can be used to provide smokers with nicotine. Though they are used by many smokers, little is still known about how effective they are at helping people stop smoking.

This version of the updated Cochrane Review includes no new RCTs. The original Review included two RCTs involving more than 600 participants, and found that electronic cigarettes containing nicotine may increase the chances of stopping smoking within six to 12 months, compared to using an electronic cigarette without nicotine. The researchers could not determine whether using electronic cigarettes was better than a nicotine patch in helping people stop smoking, because there were not enough people taking part in the study.

This updated Review now includes observational data from an additional 11 studies. Of the studies which measured side effects, none found any serious side effects of using electronic cigarettes for up to two years. The studies showed that throat and mouth irritation are the most commonly reported side effects in the short to medium term (up to two years).

The lead author of this Cochrane Review, Jamie Hartmann-Boyce from the Cochrane Tobacco Addiction Group, said, “The randomized evidence on smoking cessation is unchanged since the last version of the Review. We are encouraged to find many studies are now underway, particularly as electronic cigarettes are an evolving technology. Since the last version of the Review, 11 new observational and uncontrolled studies have been published. In terms of quitting, these can’t provide the same information we get from randomized controlled trials, but they contribute further information on the side effects of using electronic cigarettes to quit smoking. None detected any serious side effects, but longer term data are needed.”

Read this Press Release in French, Spanish or Polish .

Editor’s notes Full citation: Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation . Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3.

Cochrane Review Author contact details : [email protected]

For all media enquiries, please contact:

Jo Anthony Senior Media and Communications Officer, Cochrane M +44(0) 7582 726 634 E [email protected] or [email protected]

About Cochrane Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for-profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org | Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: [email protected]

About Wiley Wiley is a global provider of knowledge and knowledge-enabled services that improve outcomes in areas of research, professional practice, and education. Through the Research segment, the Company provides digital and print scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising. The Professional Development segment provides digital and print books, online assessment and training services, and test prep and certification. In Education, Wiley provides education solutions including online program management services for higher education institutions and course management tools for instructors and students, as well as print and digital content. The Company's website can be accessed at http://www.wiley.com .

Selected Media Coverage:

E-cigarettes can help smokers quit, says study in The Guardian . Why can't scientists agree on e-cigarettes? blog post in The Guardian . E-Cigs Might Help Some Quit Smoking, New Study Reveals on Consumer Reports .

How to Write a Conclusion for an Essay

By the time you get to the final paragraph of your paper, you have already done so much work on your essay, so all you want to do is to wrap it up as quickly as possible. You’ve already made a stunning introduction, proven your argument, and structured the whole piece as supposed – who cares about making a good conclusion paragraph?

The only thing you need to remember is that the conclusion of an essay is not just the last paragraph of an academic paper where you restate your thesis and key arguments. A concluding paragraph is also your opportunity to have a final impact on your audience.

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How to write a conclusion paragraph that leaves a lasting impression – In this guide, the team at EssayPro is going to walk you through the process of writing a perfect conclusion step by step. Additionally, we will share valuable tips and tricks to help students of all ages impress their readers at the last moment.

Instead of Intro: What Is a Conclusion?

Before we can move on, let’s take a moment here to define the conclusion itself. According to the standard conclusion definition, it is pretty much the last part of something, its result, or end. However, this term is rather broad and superficial.

When it comes to writing academic papers, a concluding statement refers to an opinion, judgment, suggestion, or position arrived at by logical reasoning (through the arguments provided in the body of the text). Therefore, if you are wondering “what is a good closing sentence like?” – keep on reading.

What Does a Good Conclusion Mean?

Writing a good conclusion for a paper isn’t easy. However, we are going to walk you through this process step by step. Although there are generally no strict rules on how to formulate one, there are some basic principles that everyone should keep in mind. In this section, we will share some core ideas for writing a good conclusion, and, later in the article, we will also provide you with more practical advice and examples.

How to Write a Conclusion for an Essay _ 4 MAJOR OBJECTIVES THAT CONCLUSION MUST ACCOMPLISH

Here are the core goals a good conclusion should complete:

“Wrap up” the entire paper;
Demonstrate to readers that the author accomplished what he/she set out to do;
Show how you the author has proved their thesis statement;
Give a sense of completeness and closure on the topic;
Leave something extra for your reader to think about;
Leave a powerful final impact on a reader.

Another key thing to remember is that you should not introduce any new ideas or arguments to your paper's conclusion. It should only sum up what you have already written, revisit your thesis statement, and end with a powerful final impression.

When considering how to write a conclusion that works, here are the key points to keep in mind:

A concluding sentence should only revisit the thesis statement, not restate it;
It should summarize the main ideas from the body of the paper;
It should demonstrate the significance and relevance of your work;
An essay’s conclusion should include a call for action and leave space for further study or development of the topic (if necessary).

How Long Should a Conclusion Be?

Although there are no strict universal rules regarding the length of an essay’s final clause, both teachers and experienced writers recommend keeping it clear, concise, and straight to the point. There is an unspoken rule that the introduction and conclusion of an academic paper should both be about 10% of the overall paper’s volume. For example, if you were assigned a 1500 word essay, both the introductory and final clauses should be approximately 150 words long (300 together).

Why You Need to Know How to End an Essay:

A conclusion is what drives a paper to its logical end. It also drives the main points of your piece one last time. It is your last opportunity to impact and impress your audience. And, most importantly, it is your chance to demonstrate to readers why your work matters. Simply put, the final paragraph of your essay should answer the last important question a reader will have – “So what?”

If you do a concluding paragraph right, it can give your readers a sense of logical completeness. On the other hand, if you do not make it powerful enough, it can leave them hanging, and diminish the effect of the entire piece.

Strategies to Crafting a Proper Conclusion

Although there are no strict rules for what style to use to write your conclusion, there are several strategies that have been proven to be effective. In the list below, you can find some of the most effective strategies with some good conclusion paragraph examples to help you grasp the idea.

One effective way to emphasize the significance of your essay and give the audience some thought to ponder about is by taking a look into the future. The “When and If” technique is quite powerful when it comes to supporting your points in the essay’s conclusion.

Prediction essay conclusion example: “Taking care of a pet is quite hard, which is the reason why most parents refuse their children’s requests to get a pet. However, the refusal should be the last choice of parents. If we want to inculcate a deep sense of responsibility and organization in our kids, and, at the same time, sprout compassion in them, we must let our children take care of pets.”

Another effective strategy is to link your conclusion to your introductory paragraph. This will create a full-circle narration for your readers, create a better understanding of your topic, and emphasize your key point.

Echo conclusion paragraph example: Introduction: “I believe that all children should grow up with a pet. I still remember the exact day my parents brought my first puppy to our house. This was one of the happiest moments in my life and, at the same time, one of the most life-changing ones. Growing up with a pet taught me a lot, and most importantly, it taught me to be responsible.” Conclusion:. “I remember when I picked up my first puppy and how happy I was at that time. Growing up with a pet, I learned what it means to take care of someone, make sure that he always has water and food, teach him, and constantly keep an eye on my little companion. Having a child grow up with a pet teaches them responsibility and helps them acquire a variety of other life skills like leadership, love, compassion, and empathy. This is why I believe that every kid should grow up with a pet!”

Finally, one more trick that will help you create a flawless conclusion is to amplify your main idea or to present it in another perspective of a larger context. This technique will help your readers to look at the problem discussed from a different angle.

Step-up argumentative essay conclusion example: “Despite the obvious advantages of owning a pet in childhood, I feel that we cannot generalize whether all children should have a pet. Whereas some kids may benefit from such experiences, namely, by becoming more compassionate, organized, and responsible, it really depends on the situation, motivation, and enthusiasm of a particular child for owning a pet.”

What is a clincher in an essay? – The final part of an essay’s conclusion is often referred to as a clincher sentence. According to the clincher definition, it is a final sentence that reinforces the main idea or leaves the audience with an intriguing thought to ponder upon. In a nutshell, the clincher is very similar to the hook you would use in an introductory paragraph. Its core mission is to seize the audience’s attention until the end of the paper. At the same time, this statement is what creates a sense of completeness and helps the author leave a lasting impression on the reader.

Now, since you now know what a clincher is, you are probably wondering how to use one in your own paper. First of all, keep in mind that a good clincher should be intriguing, memorable, smooth, and straightforward.

Generally, there are several different tricks you can use for your clincher statement; it can be:

A short, but memorable and attention-grabbing conclusion;
A relevant and memorable quote (only if it brings actual value);
A call to action;
A rhetorical question;
An illustrative story or provocative example;
A warning against a possibility or suggestion about the consequences of a discussed problem;
A joke (however, be careful with this as it may not always be deemed appropriate).

Regardless of the technique you choose, make sure that your clincher is memorable and aligns with your introduction and thesis.

Clincher examples: - While New York may not be the only place with the breathtaking views, it is definitely among my personal to 3… and that’s what definitely makes it worth visiting. - “Thence we came forth to rebehold the stars”, Divine Comedy - Don’t you think all these advantages sound like almost life-saving benefits of owning a pet? “So we beat on, boats against the current, borne back ceaselessly into the past.”, The Great Gatsby

Conclusion Writing Don'ts

Now, when you know what tricks and techniques you should use to create a perfect conclusion, let’s look at some of the things you should not do with our online paper writing service :

Starting with some cliché concluding sentence starters. Many students find common phrases like “In conclusion,” “Therefore,” “In summary,” or similar statements to be pretty good conclusion starters. However, though such conclusion sentence starters may work in certain cases – for example, in speeches – they are overused, so it is recommended not to use them in writing to introduce your conclusion.
Putting the first mention of your thesis statement in the conclusion – it has to be presented in your introduction first.
Providing new arguments, subtopics, or ideas in the conclusion paragraph.
Including a slightly changed or unchanged thesis statement.
Providing arguments and evidence that belong in the body of the work.
Writing too long, hard to read, or confusing sentences.

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Conclusion Paragraph Outline

The total number of sentences in your final paragraph may vary depending on the number of points you discussed in your essay, as well as on the overall word count of your paper. However, the overall conclusion paragraph outline will remain the same and consists of the following elements:

A conclusion starter:

The first part of your paragraph should drive readers back to your thesis statement. Thus, if you were wondering how to start a conclusion, the best way to do it is by rephrasing your thesis statement.

Summary of the body paragraphs:

Right after revisiting your thesis, you should include several sentences that wrap up the key highlights and points from your body paragraphs. This part of your conclusion can consist of 2-3 sentences—depending on the number of arguments you’ve made. If necessary, you can also explain to the readers how your main points fit together.

A concluding sentence:

Finally, you should end your paragraph with a last, powerful sentence that leaves a lasting impression, gives a sense of logical completeness, and connects readers back to the introduction of the paper.

These three key elements make up a perfect essay conclusion. Now, to give you an even better idea of how to create a perfect conclusion, let us give you a sample conclusion paragraph outline with examples from an argumentative essay on the topic of “Every Child Should Own a Pet:

Sentence 1: Starter
~ Thesis: "Though taking care of a pet may be a bit challenging for small children. Parents should not restrict their kids from having a pet as it helps them grow into more responsible and compassionate people."
~ Restated thesis for a conclusion: "I can say that taking care of a pet is good for every child."
Sentences 2-4: Summary
~ "Studies have shown that pet owners generally have fewer health problems."
~ "Owning a pet teaches a child to be more responsible."
~ "Spending time with a pet reduces stress, feelings of loneliness, and anxiety."
Sentence 5: A concluding sentence
~ "Pets can really change a child life for the better, so don't hesitate to endorse your kid's desire to own a pet."

This is a clear example of how you can shape your conclusion paragraph.

How to Conclude Various Types of Essays

Depending on the type of academic essay you are working on, your concluding paragraph's style, tone, and length may vary. In this part of our guide, we will tell you how to end different types of essays and other works.

How to End an Argumentative Essay

Persuasive or argumentative essays always have the single goal of convincing readers of something (an idea, stance, or viewpoint) by appealing to arguments, facts, logic, and even emotions. The conclusion for such an essay has to be persuasive as well. A good trick you can use is to illustrate a real-life scenario that proves your stance or encourages readers to take action. More about persuasive essay outline you can read in our article.

Here are a few more tips for making a perfect conclusion for an argumentative essay:

Carefully read the whole essay before you begin;
Re-emphasize your ideas;
Discuss possible implications;
Don’t be afraid to appeal to the reader’s emotions.

How to End a Compare and Contrast Essay

The purpose of a compare and contrast essay is to emphasize the differences or similarities between two or more objects, people, phenomena, etc. Therefore, a logical conclusion should highlight how the reviewed objects are different or similar. Basically, in such a paper, your conclusion should recall all of the key common and distinctive features discussed in the body of your essay and also give readers some food for thought after they finish reading it.

How to Conclude a Descriptive Essay

The key idea of a descriptive essay is to showcase your creativity and writing skills by painting a vivid picture with the help of words. This is one of the most creative types of essays as it requires you to show a story, not tell it. This kind of essay implies using a lot of vivid details. Respectively, the conclusion of such a paper should also use descriptive imagery and, at the same time, sum up the main ideas. A good strategy for ending a descriptive essay would be to begin with a short explanation of why you wrote the essay. Then, you should reflect on how your topic affects you. In the middle of the conclusion, you should cover the most critical moments of the story to smoothly lead the reader into a logical closing statement. The “clincher”, in this case, should be a thought-provoking final sentence that leaves a good and lasting impression on the audience. Do not lead the reader into the essay and then leave them with dwindling memories of it.

How to Conclude an Essay About Yourself

If you find yourself writing an essay about yourself, you need to tell a personal story. As a rule, such essays talk about the author’s experiences, which is why a conclusion should create a feeling of narrative closure. A good strategy is to end your story with a logical finale and the lessons you have learned, while, at the same time, linking it to the introductory paragraph and recalling key moments from the story.

How to End an Informative Essay

Unlike other types of papers, informative or expository essays load readers with a lot of information and facts. In this case, “Synthesize, don’t summarize” is the best technique you can use to end your paper. Simply put, instead of recalling all of the major facts, you should approach your conclusion from the “So what?” position by highlighting the significance of the information provided.

How to Conclude a Narrative Essay

In a nutshell, a narrative essay is based on simple storytelling. The purpose of this paper is to share a particular story in detail. Therefore, the conclusion for such a paper should wrap up the story and avoid finishing on an abrupt cliffhanger. It is vital to include the key takeaways and the lessons learned from the story.

How to Write a Conclusion for a Lab Report

Unlike an essay, a lab report is based on an experiment. This type of paper describes the flow of a particular experiment conducted by a student and its conclusion should reflect on the outcomes of this experiment.

In thinking of how to write a conclusion for a lab, here are the key things you should do to get it right:

Restate the goals of your experiment
Describe the methods you used
Include the results of the experiment and analyze the final data
End your conclusion with a clear statement on whether or not the experiment was successful (Did you reach the expected results?)

How to Write a Conclusion for a Research Paper

Writing a paper is probably the hardest task of all, even for experienced dissertation writer . Unlike an essay or even a lab report, a research paper is a much longer piece of work that requires a deeper investigation of the problem. Therefore, a conclusion for such a paper should be even more sophisticated and powerful. If you're feeling difficulty writing an essay, you can buy essay on our service.

However, given that a research paper is the second most popular kind of academic paper (after an essay), it is important to know how to conclude a research paper. Even if you have not yet been assigned to do this task, be sure that you will face it soon. So, here are the steps you should follow to create a great conclusion for a research paper:

Restate the Topic

Start your final paragraph with a quick reminder of what the topic of the piece is about. Keep it one sentence long.

Revisit the Thesis

Next, you should remind your readers what your thesis statement was. However, do not just copy and paste it from the introductory clause: paraphrase your thesis so that you deliver the same idea but with different words. Keep your paraphrased thesis narrow, specific, and topic-oriented.

Summarise Your Key Ideas

Just like the case of a regular essay’s conclusion, a research paper’s final paragraph should also include a short summary of all of the key points stated in the body sections. We recommend reading the entire body part a few times to define all of your main arguments and ideas.

Showcase the Significance of Your Work

In the research paper conclusion, it is vital to highlight the significance of your research problem and state how your solution could be helpful.

Make Suggestions for Future Studies

Finally, at the end of your conclusion, you should define how your findings will contribute to the development of its particular field of science. Outline the perspectives of further research and, if necessary, explain what is yet to be discovered on the topic.

Then, end your conclusion with a powerful concluding sentence – it can be a rhetorical question, call to action, or another hook that will help you have a strong impact on the audience.

Answer the Right Questions

To create a top-notch research paper conclusion, be sure to answer the following questions:

What is the goal of a research paper?
What are the possible solutions to the research question(s)?
How can your results be implemented in real life? (Is your research paper helpful to the community?)
Why is this study important and relevant?

Additionally, here are a few more handy tips to follow:

Provide clear examples from real life to help readers better understand the further implementation of the stated solutions;
Keep your conclusion fresh, original, and creative.

Address to our term paper writers if you need to proofread or rewrite essay.

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So, What Is a Good Closing Sentence? See The Difference

One of the best ways to learn how to write a good conclusion is to look at several professional essay conclusion examples. In this section of our guide, we are going to look at two different final paragraphs shaped on the basis of the same template, but even so, they are very different – where one is weak and the other is strong. Below, we are going to compare them to help you understand the difference between a good and a bad conclusion.

Here is the template we used: College degrees are in decline. The price of receiving an education does not correlate with the quality of the education received. As a result, graduated students face underemployment, and the worth of college degrees appears to be in serious doubt. However, the potential social and economic benefits of educated students balance out the equation.

Strong Conclusion ‍

People either see college as an opportunity or an inconvenience; therefore, a degree can only hold as much value as its owner’s skillset. The underemployment of graduate students puts the worth of college degrees in serious doubt. Yet, with the multitude of benefits that educated students bring to society and the economy, the equation remains in balance. Perhaps the ordinary person should consider college as a wise financial investment, but only if they stay determined to study and do the hard work.

Why is this example good? There are several key points that prove its effectiveness:

There is a bold opening statement that encompasses the two contrasting types of students we can see today.
There are two sentences that recall the thesis statement and cover the key arguments from the body of the essay.
Finally, the last sentence sums up the key message of the essay and leaves readers with something to think about.

Weak Conclusion

In conclusion, with the poor preparation of students in college and the subsequent underemployment after graduation from college, the worth associated with the college degree appears to be in serious doubt. However, these issues alone may not reasonably conclude beyond a doubt that investing in a college degree is a rewarding venture. When the full benefits that come with education are carefully put into consideration and evaluated, college education for children in any country still has good advantages, and society should continue to advocate for a college education. The ordinary person should consider this a wise financial decision that holds rewards in the end. Apart from the monetary gains associated with a college education, society will greatly benefit from students when they finish college. Their minds are going to be expanded, and their reasoning and decision making will be enhanced.

What makes this example bad? Here are a few points to consider:

Unlike the first example, this paragraph is long and not specific enough. The author provides plenty of generalized phrases that are not backed up by actual arguments.
This piece is hard to read and understand and sentences have a confusing structure. Also, there are lots of repetitions and too many uses of the word “college”.
There is no summary of the key benefits.
The last two sentences that highlight the value of education contradict with the initial statement.
Finally, the last sentence doesn’t offer a strong conclusion and gives no thought to ponder upon.
In the body of your essay, you have hopefully already provided your reader(s) with plenty of information. Therefore, it is not wise to present new arguments or ideas in your conclusion.
To end your final paragraph right, find a clear and straightforward message that will have the most powerful impact on your audience.
Don’t use more than one quote in the final clause of your paper – the information from external sources (including quotes) belongs in the body of a paper.
Be authoritative when writing a conclusion. You should sound confident and convincing to leave a good impression. Sentences like “I’m not an expert, but…” will most likely make you seem less knowledgeable and/or credible.

Good Conclusion Examples

Now that we've learned what a conclusion is and how to write one let's take a look at some essay conclusion examples to strengthen our knowledge.

The ending ironically reveals that all was for nothing. (A short explanation of the thematic effect of the book’s end) Tom says that Miss Watson freed Jim in her final will.Jim told Huck that the dead man on the Island was pap. The entire adventure seemingly evaporated into nothingness. (How this effect was manifested into the minds of thereaders).

All in all, international schools hold the key to building a full future that students can achieve. (Thesis statement simplified) They help students develop their own character by learning from their mistakes, without having to face a dreadful penalty for failure. (Thesis statement elaborated)Although some say that kids emerged “spoiled” with this mentality, the results prove the contrary. (Possible counter-arguments are noted)

In conclusion, public workers should be allowed to strike since it will give them a chance to air their grievances. (Thesis statement) Public workers should be allowed to strike when their rights, safety, and regulations are compromised. The workers will get motivated when they strike, and their demands are met.

In summary, studies reveal some similarities in the nutrient contents between the organic and non-organic food substances. (Starts with similarities) However, others have revealed many considerable differences in the amounts of antioxidants as well as other minerals present in organic and non-organic foods. Generally, organic foods have higher levels of antioxidants than non-organic foods and therefore are more important in the prevention of chronic illnesses.

As time went by, my obsession grew into something bigger than art; (‘As time went by’ signals maturation) it grew into a dream of developing myself for the world. (Showing student’s interest of developing himself for the community) It is a dream of not only seeing the world from a different perspective but also changing the perspective of people who see my work. (Showing student’s determination to create moving pieces of art)

In conclusion, it is evident that technology is an integral part of our lives and without it, we become “lost” since we have increasingly become dependent on its use. (Thesis with main point)

You might also be interested in reading nursing essay examples from our service.

How To Write A Conclusion For An Essay?

How to write a good conclusion, how to write a conclusion for a college essay.

Daniel Parker

is a seasoned educational writer focusing on scholarship guidance, research papers, and various forms of academic essays including reflective and narrative essays. His expertise also extends to detailed case studies. A scholar with a background in English Literature and Education, Daniel’s work on EssayPro blog aims to support students in achieving academic excellence and securing scholarships. His hobbies include reading classic literature and participating in academic forums.

is an expert in nursing and healthcare, with a strong background in history, law, and literature. Holding advanced degrees in nursing and public health, his analytical approach and comprehensive knowledge help students navigate complex topics. On EssayPro blog, Adam provides insightful articles on everything from historical analysis to the intricacies of healthcare policies. In his downtime, he enjoys historical documentaries and volunteering at local clinics.

Conclusion of Smoking Should Be Banned on College Campuses Essay

To find inspiration for your paper and overcome writer’s block
As a source of information (ensure proper referencing)
As a template for you assignment

Introduction

Arguments in favor of smoking in campus, arguments against smoking in campus, reconciliation of the two positions, campus smoking: conclusion of the essay, works cited.

The idea of smoking in colleges and campuses has developed a mixed reaction in the USA and in many other parts of the world such that it has posed a very hot and contentious universal debate.

Several campuses and colleges have tried to impose a total ban on smoking within their environs, some of them succeeding while others failing to do so. For instance, colleges like Santa Ana and Fullerton have managed to ban smoking completely within their environs, while others such as Huntington Beach and Golden West College still allow smoking in prescribed places such as in parking lots.

Fullerton College was the first to successfully impose a smoking ban in the year 2007 (Bates 57). Nevertheless, many colleges and campuses have not managed to follow suit because of some state laws which assert that smoking is only proscribed inside buildings and within 20 feet from entry points of buildings in all campuses. These laws continue to give students the right to smoke within certain areas of their campuses.

As aforementioned, section 7595 of the government code affirms that smoking is proscribed only in public buildings and within 20 feet from entry points of buildings in all campuses (Merrill 36).Therefore, the opponents of this subject believe that since it is the right of every citizen to do anything that is recognized as legal, it is very wrong to impose a total ban on smoking, especially in campuses.

The most important thing is to ensure that students follow the laid down rules and regulations such as the strict use of the recommended areas of smoking. In deed, it is very unfair to send students off campus to smoke.

In addition, the opponents of this argument believe that smoking should not be banned because it helps students to relax whenever they are in stressful situations. Concerning the health risks that are brought about by smoking, they assert that every mature citizen should be in a position to separate good behavior from wrong behavior.

They say that since there has been an integration of cigarette smoking topics in schools for several decades, by the time a student reaches campus, he/she must be in a position to understand the risks that cigarette smoking poses to their health and therefore they should be able to make informed decisions about smoking. They also argue that it is very unfair to impose an immediate ban on cigarette smoking in campus yet it is clearly understood that smoking is an additive activity which can not be stopped at once.

Even though campus students have the right to smoke within some prescribed areas whenever they wish to do so, as mandated by some state laws, they ought to realize the fact that cigarette smoking has got very serious and detrimental effects on human health. Smoking of cigarettes can bring about lung infections to both first-hand and second-hand smokers. Therefore, smokers need to recognize that their right to smoke may greatly infringe on the rights of their non-smoking counterparts.

It is obvious that students know the negative effects of smoking cigarettes. For instance, it is expensive for them and it may also reduce their lifetime. Generally speaking, cigarette smoking is just bad. Currently, at least forty three colleges in the USA have imposed a total ban on cigarette smoking in their campuses and this trend is increasing especially among commuter schools and community colleges (Merrill 40).

However, it is hard to impose such a ban in some colleges because of the mixed reactions that are held by different stakeholders about the issue of smoking, and the existing campus policies which give the smokers the right to smoke in prescribed areas. According to the research that was carried out by the U.S. Department of Health and Human services, 31% of college students smoke cigarettes. This figure exceeds the national general average of 25% (Longmire 15).

It is also worth to note that even though there has been an integration of cigarette smoking topics in schools for several decades, cigarette smoking has continued to attract many youths and this continues to raise a lot of alarm about their future. This is because cigarette smoking is the major contributor of the cases of lung cancer in the entire world.

Research indicates that close to eighty percent of men who die from lung cancer, and seventy five percent of women who die from the same disease do so because of smoking tobacco. Research also indicates that the risk of lung cancer increases when a person starts smoking at an early age, and with an increase in the number of cigarettes that a person smokes in a day (Robicsek 56).

Scientific research has proved that cigarette smoking is harmful to the body. The smoke that comes out of a burning cigarette is a compound mixture of several chemicals which are produced when tobacco is burned.

This smoke contains a deadly compound called tar, which consists of more than four thousand chemicals which are very poisonous, and a majority of them have been clearly identified to be the main cause of cancer. Most of these chemicals are also known to cause lung diseases and heart problems. Some of these chemicals include cyanide, benzene, methanol, ammonia, formaldehyde and acetylene (Merrill 45).

Other deadly substances that are found in cigarettes include carbon monoxide and nitrogen oxide gases which are very poisonous. The most active component of a cigarette is nicotine. Nicotine is a very addictive compound. Cigarette smoking can cause several problems such as cancer, lung damage and heart infections among many other diseases.

Research also indicates that more than thirty percent of the deaths that result in the United States occur due to the use of tobacco. Cigarette smoking also causes eighty seven percent of the deaths that result due to lung cancer. Other types of tobacco-related cancers include mouth cancer, cancer of the larynx, cancer of the throat and esophagus and cancer of the bladder. There is also a very close connection between cigarette smoking and the occurrence of the cancers of the kidney, pancreas, stomach and the cervix.

Cigarette smoking can also cause lung damage which begins at the early stages of smoking. Cigarette smokers encounter many problems with their lungs as compared to non-smokers and this situation gets worse when an individual increases his/her capacity to smoke. Smoking is linked to many dangerous lung infections which are just as perilous as lung cancer. These infections include emphysema and chronic bronchitis which cause difficulties in breathing and may even cause death.

Cigarette smoking also augments the risk of heart infections which stand out as the major causes of deaths in the U.S. Out of all the risk factors of heart infections, i.e. excess cholesterol, diabetes, obesity, cigarette smoking, physical lethargy and high blood pressure, cigarette smoking remains the leading risk factor for impulsive deaths that result from heart attacks (Bates 78).

In addition, low levels of cigarette smoking which may not be able to cause lung infections are capable of damaging the heart. Therefore, second-hand smokers also stand a very high chance of getting heart infections.

As stated earlier, Section 7595 of the government code affirms that smoking is proscribed in all public buildings and within 20 feet from entry points of buildings in all campuses (Merrill 36). Even though this ruling is good, it is not sufficient because it seems to discriminate the innocent second-hand smokers who continue to suffer from cigarette smoke which pollutes the air around them.

Cigarette smoking has also very detrimental effects to the real smokers and therefore they should be able to accept this ban because it is meant for their own good. Though it is very hard to ban citizens from doing something which is legally right, smoking should be gradually banned in campuses so as to protect the non-smokers. This is because campuses are public places which consist of both smokers and non-smokers.

My stand on this issue differs significantly from my opponents who believe that smoking should be allowed in some prescribed areas in campuses. My stand is that cigarette smoking should be banned in campuses because it impacts negatively on the non-smokers. Banning of cigarette smoking in campuses would enable the non-smoking citizens to enjoy the delight of breathing unpolluted air.

Nevertheless, my stand does not include cigarette smoking in private places such as in homes. At the same time, cigarette smokers should understand that the non-smokers are not trying to be intolerant when they keep on complaining about them. Rather, they are doing it for the sake of their own health.

In conclusion, smoking should be totally banned in campuses and colleges because of its severe health risks to both smokers and non-smokers. The health risks are much more to non-smokers because they may double up especially to those who already suffer from other ailments such as heart and lung problems.

In addition, a very short exposure by a non-smoker to secondhand smoke may have abrupt severe effects on his/her cardiovascular system thus escalating the risk for lung and heart infections. This makes the non-smoker to have a higher risk of catching infections from cigarette smoke than the real smoker yet he/she is very innocent. A more effective way of reducing smoking in campuses would be to provide tobacco termination counseling programs in the campuses.

Bates, Tim & Gordon Mangan. Smoking and Raven IQ. New York: Pocket Books, 2007.

Longmire, Wilkinson, & Torok Edgar. Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press, 2006.

Melo, Maurice. Cigarette Smoking and Reproductive Function. Oxford: Oxford University Press, 2009.

Merrill, David. How Cigarettes are made. London: Oxford University Press, 2000.

Robicsek, Francis. Ritual Smoking in Central America. Cambridge: Cambridge University Press, 2008.

Understanding Advertising: Second-Hand Smoking
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How to Write a Good Conclusion (With Examples)

Smodin Editorial Team
Published: May 31, 2024

Students often spend a great deal of time crafting essay introductions while leaving the conclusion as an afterthought. While the introduction is one of the most vital aspects of an essay, a good conclusion can have just as much of an impact on its effectiveness. Knowing how to write a good conclusion is crucial, as it encapsulates your main points and leaves a lasting impression on the reader.

A well-crafted conclusion should serve as the final pitch for your arguments. Your reader should walk away with a clear understanding of what they just read and how it applies to the core of your thesis. With the right approach, your conclusion can transform a good essay into a great one, making it both memorable and impactful.

This article will guide you through four simple steps of writing compelling conclusions. Each step is designed to help you reinforce your thesis and articulate your final thoughts in a way that will resonate with your teacher or professor. With a bit of practice, you can learn how to stick the landing and give every essay the finale it deserves.

What Is the Purpose of the Conclusion Paragraph?

Understanding the purpose of the conclusion paragraph is essential for effective essay writing. The conclusion paragraph should be more than just a summary of your essay. It should consolidate all your arguments and tie them back to your thesis.

Remember, all good writing inspires emotion. Whether to inspire, provoke, or engage is up to you, but the conclusion should always leave a lasting impression.

If in doubt, Smodin’s AI Chat tool can be handy for gauging the emotional impact of your conclusion.

By mastering the art of writing a powerful conclusion, you equip yourself with the tools to ensure your essays stand out. Whether it’s the first or last essay you’re writing for the class, it’s your chance to leave a definitive mark on your reader.

How to Write a Good Conclusion

This approach ensures your conclusion adds value and reinforces your arguments’ coherence. Here are three simple and effective practices to help you craft a solid conclusion.

Restating Your Thesis

Restating your thesis in the conclusion is a common practice in essay writing, and for good reason. It helps underscore how your understanding has deepened or shifted based on the evidence you provided.

Just understand that a restatement of your original thesis doesn’t mean a complete word-for-word repeat. You should rephrase your original thesis so that it elucidates the insights you touched on throughout the essay. Smodin’s AI Rewriter can help refine your restatement to ensure it is fresh and impactful.

Here are a few tips to effectively restate your thesis

Show Complexity : If your essay added layers or nuances to the original statement, be sure to articulate that clearly.
Integrate Key Findings : Incorporate the main findings of your essay to reinforce how they supported or refined your thesis.
Keep It Fresh : Again, you want to avoid repeating the same things twice. Use different wording that reflects a nuanced perspective.

Finally, always ensure that the restated thesis connects seamlessly with the rest of your essay. Always try to showcase the coherence of your writing to provide the reader with a strong sense of closure.

Using AI tools like Smodin’s Outliner and Essay Writer can ensure your writing flows smoothly and is easy to follow.

Providing an Effective Synthesis

Providing an effective synthesis should enhance your original thesis. All good arguments should evolve and shift throughout the essay. Rather than simply summarizing these findings, you should integrate critical insights and evidence to demonstrate a deeper or more nuanced understanding.

Draw connections between the main points discussed and show how they collectively support your thesis. Also, reflect on the implications of these insights for the broader context of your subject. And once again, always use fresh and engaging language to maintain the reader’s interest.

The last thing you want is for your reader to view your essay as a collection of individual points. A good essay should read as a unified whole, with all the pieces tying together naturally. You affirm your argument’s significance when you tie all the pieces together in your conclusion.

Providing New Insights

provide insights when writing conclusion paragraph

Also, think of this step as your opportunity to propose future research directions based on your findings. What could a student or researcher study next? What unanswered questions remain? If you’re having trouble answering these questions, consider using Smodin’s research tools to expand your knowledge of the topic.

That isn’t to say you can leave open-ended or unanswered questions about your own thesis. On the contrary, your conclusion should firmly establish the validity of your argument. That said, any deep and insightful analysis naturally leads to further exploration. Draw attention to these potential areas of inquiry.

(Optional) Form a Personal Connection With the Reader

Forming a connection with the reader in the conclusion can personalize and strengthen the impact of your essay. This technique can be powerful if implemented correctly, making your writing more relatable, human, and memorable.

That said, slime academics discourage using “I” in formal essays. It’s always best to clarify your teacher’s or professor’s stance before submitting your final draft.

If it is allowed, consider sharing a brief personal reflection or anecdote that ties back to the main themes of your essay. A personal touch can go a long way toward humanizing your arguments and creating a connection with the reader.

Whatever you choose, remember that your conclusion should always complement the analytical findings of your essay. Never say anything that detracts from your thesis or the findings you presented.

Examples of Good Conclusions

Let’s explore some examples to illustrate what a well-crafted conclusion looks and sounds like. The following are two hypothetical thesis essays from the fields of science and literature.

Thesis Topic: The Impact of Climate Change on Coral Reefs
Introduction: “Coral reefs act as the guardians of the ocean’s biodiversity. These underwater ecosystems are among the most vibrant and essential on the entire planet. However, the escalating impact of climate change poses a severe threat to their health and survival. This essay aims to dissect specific environmental changes contributing to coral degradation while proposing measures for mitigation.”
Conclusion: “This investigation into the impact of climate change on coral reefs has revealed a disturbing acceleration of coral bleaching events and a significant decline of reef biodiversity. The findings presented in this study establish a clear link between increased sea temperatures and coral reef mortality. Future research should focus on the resilience mechanisms of coral species that could influence conservation strategies. The fate of the coral reefs depends on humanity’s immediate and concentrated action to curb global emissions and preserve these vital ecosystems for future generations.”

Notice how the conclusion doesn’t simply restate the thesis. Instead, it highlights the definitive connection between climate change and coral health. It also reiterates the issue’s urgency and extends a call of action for ongoing intervention. The last sentence is direct, to the point, and leaves a lasting impression on the reader.

If you’re struggling with your closing sentence (or any sentence, for that matter), Smodin’s Rewriter can create hundreds of different sentences in seconds. Then, choose the sentences and phrases that resonate the most and use them to craft a compelling conclusion.

Thesis Topic: The Evolution of the American Dream in 20th-Century American Literature
Introduction: “The American Dream was once defined by prosperity and success. However, throughout the 20th century, the representation of the American Dream in popular literature has undergone significant changes. Are these representations indicative of a far-reaching sentiment that lay dormant among the American public? Or were these works simply the result of disillusioned writers responding to the evolving challenges of the times?”
Conclusion: “Works by F. Scott Fitzgerald, John Steinbeck, and Toni Morrison illustrate the American Dream’s evolution from unbridled optimism to a more critical examination of the American ethos. Throughout modernist and post-modernist literature, the American Dream is often at odds with core American values. These novels reflect broader societal shifts that continue to shape the national consciousness. Further research into contemporary literature could provide greater insight into the complexities of this concept.”

You will know exactly what this essay covers by reading the introduction and conclusion alone. It summarizes the evolution of the American Dream by examining the works of three unique authors. It then analyzes these works to demonstrate how they reflect broader societal shifts. The conclusion works as both a capstone and a bridge to set the stage for future inquiries.

Write Better Conclusions With Smodin

Always remember the human element behind the grading process when crafting your essay. Your teachers or professors are human and have likely spent countless hours reviewing essays on similar topics. The grading process can be long and exhaustive. Your conclusion should aim to make their task easier, not harder.

A well-crafted conclusion serves as the final piece to your argument. It should recap the critical insights discussed above while shedding new light on the topic. By including innovative elements and insightful observations, your conclusion will help your essay stand out from the crowd.

Make sure your essay ends on a high note to maximize your chances of getting a better grade now and in the future. Smodin’s comprehensive suite of AI tools can help you enhance every aspect of your essay writing. From initial research to structuring, these tools can streamline the process and improve the quality of your essays.

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Guest Essay

The Dizzying Rise and Damp, Deflated End of Prime Minister Rishi Sunak

A man walking through a doorway. He’s wearing a suit that is soaked through.

By Sam Freedman

Mr. Freedman is a former Conservative Party adviser and the author of the forthcoming “ Failed State: Why Nothing Works and How We Fix It .” He is a co-writer of the newsletter Comment Is Freed.

Last week a visibly cold Rishi Sunak stood in front of No. 10 Downing Street in a downpour to announce the date of the general election — July 4 , months earlier than expected — to an indifferent nation. “Now is the moment for Britain to choose its future,” Mr. Sunak said , as water soaked into his suit.

That it doesn’t seem to have occurred to his team to hold the event inside, or even give him an umbrella, does rather symbolize the state his Conservative Party finds itself in. Perhaps Mr. Sunak, his party now routinely polling more than 20 points behind the opposition Labour Party, has given up and wants to get it over with. Or maybe it was because another expected round of election-bribe tax cuts in September looked less plausible, given recent financial forecasts , and so the thought of grimly hanging on until the fall suddenly seemed much less attractive.

Either way, by bringing the election forward, Mr. Sunak has played his last card. This damp and deflated moment will probably be the beginning of the end for Mr. Sunak's career in British politics, after a swift, almost dizzying rise to the top. And his legacy may be the reminder that it can be a very bad idea to get everything you want too soon.

Mr. Sunak became a member of Parliament in 2015 after a successful career in finance and publicly backed Leave in the Brexit referendum when many of the party’s up-and-comers had stayed loyal to the party leadership and backed Remain. That proved to be a smart career decision. By 2018 he had his first ministerial position, and by 2019 — after co-writing a sycophantic newspaper article for The Times of London, “ The Tories Are in Deep Peril. Only Boris Johnson Can Save Us ” — he was chief secretary to the Treasury in Mr. Johnson’s government. After Mr. Johnson had an explosive row with his chancellor of the Exchequer, Mr. Sunak was installed as a compliant and numerate alternative.

During the pandemic, Mr. Sunak’s dapper suits and apparent calm offered a stark contrast to Mr. Johnson’s shambolic bluster. By the time Mr. Johnson became entangled in several scandals, Mr. Sunak looked like a potential successor. That he managed to lose the leadership contest to Liz Truss should have been an early clue to his weaknesses. But then Ms. Truss set fire to her own premiership , and Mr. Sunak was quickly appointed to replace her — when his only opponent withdrew — in October 2022. At age 42, he was the youngest prime minister in more than 200 years.

The problems with this rapid rise have been apparent during his time at Downing Street. Mr. Sunak has never run a department like health or education, and he just doesn’t understand how public sector institutions work. This may explain his decision to promise to cut record-level waiting lists in the National Health Service while refusing to negotiate with striking doctors, rendering the pledge impossible. It may also shed light on his plan to deport thousands of asylum seekers to Rwanda regardless of where they came from, which has baffled anyone with government experience. Whatever one thinks about the ethics of the policy, it was just never going to work.

As the election begins in earnest, his lack of experience running a national campaign is also becoming obvious. He has struggled to rally Conservative lawmakers, particularly when so many were blindsided by the earlier date. One who had a holiday to Greece planned decided to go anyway — for a “much needed break,” he’s reported to have said .

He projects neither charm nor charisma and can come across as defensive and petulant in interviews. In response to an impassioned question about poverty on a popular daytime television show, he started speaking insistently about making it harder for children to have access to social media.

Mr. Sunak also hasn’t made it easy for voters to get a clear sense of what he stands for. One of the great ironies of this Parliament is that Mr. Sunak is ideologically to the right of Mr. Johnson, though he is often seen by the former prime minister’s fans as a centrist technocrat. Perhaps because his interests are so eclectic — he bounces around between tech utopianism about the future of A.I., tax cuts, smoking bans and reforming high school education.

This combination of a confusing agenda, inexperience and lack of basic political acumen would have been toxic at any time. But at what appears to be the end of a chaotic 14 years of Conservative rule, it has put his party in a genuinely existential position : The Tories are on track for the worst beating in their history.

This is going to be a dispiriting few weeks for Britons. The National Health Service is in a state of near collapse, several local authorities have declared municipal bankruptcy (and more are expected to follow ), and British prisons are running out of space . Economic growth is sluggish . Britain needs a real conversation about its future that neither party is going to want to have.

Labour, already so far ahead , will prefer to avoid major errors and point to the failures of more than a decade of Conservative government, rather than anything significant it will do to improve voters’ lives. And the Conservatives won’t want to talk about it because, well, these are the failures of more than a decade of Conservative government. Instead they are promising, if re-elected, to revive national service for 18-year-olds and a $3 billion tax break for pensioners — straightforward pitches to older voters who might be contemplating voting for the upstart, right-wing Reform party. (And both designed to stem losses, rather than win an election.)

Brexit, which a majority of Britons now consider a failure , will also barely be mentioned. It is too unpopular for the Conservatives to claim as a success, and not yet unpopular enough for Labour to attack it without alienating Leave voters.

How Labour deals with the challenges of governing will be determined in part by the size of its majority and the space that gives it to maneuver. Mr. Sunak has, if nothing else, given it some handy lessons in what not to do. If the rumors , which he denies , are to be believed, he will leave politics after the election and return to finance, possibly in America. One suspects he’d be a lot happier.

Sam Freedman is a former Conservative policy adviser and the author of the forthcoming “ Failed State : Why Nothing Works and How We Fix It.” He is a co-writer of the newsletter Comment Is Freed .

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Trump’s Smoking Gun Is a Dream That Will Never Die

Is there a tape of Trump saying a racial slur? If so, what would it actually reveal? What could it?

Donald Trump sits with his hands splayed and touching

Listen to this article

Produced by ElevenLabs and News Over Audio (NOA) using AI narration.

In 2018, Omarosa Manigault Newman turned a long-standing rumor into a piece of news: Donald Trump, she alleged, had used racist epithets on the set of The Apprentice . And the slurs, she claimed, had been caught on tape. Her claim led to a frenzy of speculation: Would the Apprentice recordings do what the Access Hollywood tapes had not? Would the show that had bolstered Trump’s rise in politics be, in the end, his undoing? What becomes of a public figure who has been caught, in such a literal way, saying the quiet part out loud?

The promised recordings never materialized, though, and so neither did the promised consequences. Without the evidence to back them up, Manigault Newman’s accusations languished in the space that divides the things that are known from the things that merely might be. Her claims took on the ironic distance of the genre that had bound her to Trump in the first place: Their dramas now came with asterisks. “Reality,” in their rendering, required scare quotes .

But lordy, many still hoped there’d be tapes. And this week—on the same day, as it happened, that a Manhattan jury turned Donald Trump, the alleged felon, into Donald Trump, the convicted one —the specter of recordings was raised again, this time as part of a Slate essay written by the former Apprentice producer Bill Pruitt. “The Donald Trump I Saw on The Apprentice ” is long, thoughtful, and detailed. It offers new stories to support the old idea that Trump’s most powerful enablers, as he launched his bid for the presidency, were not politicians but entertainers: the behind-the-scenes workers who took a failing businessman and edited him, frame by soft-lit frame, into competence. Pruitt is sharing those stories now, he writes, because he can: The nondisclosure agreement he signed to join the show—-a document whose restrictions lasted for 20 years—recently expired. The essay reflects his catharsis. But it is sober too—akin, in that way, to the many other essays written by former Trump aides who indulged his truthful hyperbole before realizing the depth of the lie. Pruitt’s essay is openly confessional. It is implicitly apologetic. Its revelations read, in moments, as pleas for forgiveness: journalism as an act of atonement.

Adam Serwer: Did the media learn nothing from 2016?

The tapes—or more specifically, the spectral versions of them—come several paragraphs into Pruitt’s story, as he relates a discussion Trump had with Apprentice producers about whether a high-performing Black contestant, Kwame Jackson, should be named the season’s victor: “‘Yeah,’ [Trump] says to no one in particular, ‘but, I mean, would America buy a n— winning?’”

Pruitt’s allegation echoes the one that Manigault Newman made in 2018. And it is similarly difficult to verify. (“Those tapes, I’ve come to believe, will never be found,” Pruitt writes.) Pruitt has effectively given readers Schrödinger’s slur: a word at once uttered and not, a piece of proof and a defiance of it—news that is, at this point, no news at all. Trump might have said it. Or Pruitt’s allegation might be, as a Trump-campaign spokesperson put it yesterday, “fabricated and bullshit.”

But all of the things that the claim is not, at the moment, also highlight what it could be: an opportunity. The tapes, failing to give helpful answers, might instead offer helpful questions. Among them: What would such tapes, if they’re ever found, actually reveal? What could they, really? (Why would Trump be exempt from the truism that actions speak louder than words?) Trump has treated racism as a campaign message and a marketing ploy. He keeps finding new ways to insist that some Americans are more American than others. Epithets, for him, are a way of life. What could words convey that his actions haven’t? What, precisely, remains to be proved?

David A. Graham: Trump goes all in on racism

In 2018, in response to Manigault Newman’s claim, the Atlantic writer Matt Thompson considered what would happen—and what wouldn’t—if the rumored tapes materialized. The answer, he suggested , would have very little to do with Trump, and very much to do with everyone else. Six years later, that insight looks ever more prescient—and ever more urgent. Trump himself is a smoking gun. He has been there all along, strutting on stages and slumping in courtrooms and making his plans to restore the country to his particular version of greatness. He has shown us who he is. Why is it so hard to believe him?

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Get an idea. The first step of creating a causes effects of teenage smoking essay is brainstorming topics. Think of the common reasons for teens smoking and analyze the possible outcomes. Here are some ideas for you: Causes. Effects. peer pressure (a desire to be as "cool" as friends); to relieve stress;
The Harmful Effects of Smoking
Human body is very vulnerable to harmful effects of smoking, and it can harm our heart, lungs, blood circulation, bones, stomach, mouth, eyes, skin, reproduction and fertility. Smoking effect on heart and lung in very serious manner, in case of heart nicotine raises blood pressure and blood gets clot easily. Carbon monoxide raids the blood of ...
Smoking: Causes and Effects
Smoking: Causes and Effects Essay. Among numerous bad habits of modern society smoking seems to be of the greatest importance. Not only does it affect the person who smokes, but also those who are around him. Many people argue about the appropriate definition of smoking, whether it is a disease or just a bad habit.
Essay on Teenage Smoking
In conclusion, teenage smoking is a problem that affects the health and future of young people. By understanding why teenagers start smoking and the effects it has, we can work together to help stop it. 500 Words Essay on Teenage Smoking Teenage Smoking: A Grave Threat to Young Lives.
How to Conclude an Essay
Step 1: Return to your thesis. To begin your conclusion, signal that the essay is coming to an end by returning to your overall argument. Don't just repeat your thesis statement —instead, try to rephrase your argument in a way that shows how it has been developed since the introduction. Example: Returning to the thesis.
Introduction, Conclusions, and Historical Background Relative to E
Introduction. Although conventional cigarette smoking has declined markedly over the past several decades among youth and young adults in the United States (U.S. Department of Health and Human Services [USDHHS] 2012), there have been substantial increases in the use of emerging tobacco products among these populations in recent years (Centers for Disease Control and Prevention [CDC] 2015c).
Conclusions about the effects of electronic cigarettes ...
An updated Cochrane Review provides an independent, rigorous assessment of the best available evidence to date about electronic cigarettes for quitting smoking.. Scroll to the bottom of this article for a round-up of media coverage. The conclusions of this updated Review are unchanged since the last review was published two years ago: electronic cigarettes may help smokers stop their smoking ...
How to Write a Conclusion: Full Writing Guide with Examples
These three key elements make up a perfect essay conclusion. Now, to give you an even better idea of how to create a perfect conclusion, let us give you a sample conclusion paragraph outline with examples from an argumentative essay on the topic of "Every Child Should Own a Pet: Sentence 1: Starter.
Conclusion of Smoking Should Be Banned
Campus Smoking: Conclusion of the Essay. In conclusion, smoking should be totally banned in campuses and colleges because of its severe health risks to both smokers and non-smokers. The health risks are much more to non-smokers because they may double up especially to those who already suffer from other ailments such as heart and lung problems.
How to Write a Good Conclusion (With Examples)
The conclusion paragraph should be more than just a summary of your essay. It should consolidate all your arguments and tie them back to your thesis. Remember, all good writing inspires emotion. Whether to inspire, provoke, or engage is up to you, but the conclusion should always leave a lasting impression.
Opinion
Or maybe it was because another expected round of election-bribe tax cuts in September looked less plausible, given recent financial forecasts, and so the thought of grimly hanging on until the ...
Trump's Smoking Gun Is a Dream That Will Never Die
The essay reflects his catharsis. But it is sober too—akin, in that way, to the many other essays written by former Trump aides who indulged his truthful hyperbole before realizing the depth of ...