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Claims up in smoke?

I've been seeing ads for electronic cigarettes (e-cigarettes) that suggest they're a safer alternative to traditional tobacco cigarettes and can help smokers quit. What's the evidence say about this newer way to "smoke"?-S.T., ALASKA


E-cigarettes are devices produced to deliver nicotine or other substances to the user as a vapor. Most consist of a rechargeable, battery-operated heating element, a replaceable cartridge that may contain nicotine or other chemicals, and an atomizer that uses heat to convert the cartridge's contents into a vapor that the user inhales. They may resemble cigarettes, cigars, or pipes; some devices look like pens or USB memory sticks so that users can use them more discretely.1


Although the FDA hasn't evaluated the safety or effectiveness of any e-cigarettes, some limited lab studies it did conduct revealed significant quality control issues. For instance, some cartridges that were labeled as not containing nicotine did contain this substance, and three e-cigarette cartridges labeled the same way provided very different amounts of inhaled nicotine.1


Current evidence shows that more young people are starting to smoke by first trying e-cigarettes. In the United States, youth who'd ever used e-cigarettes increased from 3.3% to 6.8% from 2011 to 2012.2 Nicotine is highly addictive and harmful to brain development, which is particularly a concern in adolescents. Limited data show that e-cigarette vapors are a source of indoor air pollution.2


Many people use both traditional cigarettes and e-cigarettes, sometimes to circumvent no-smoking policies. Rather than aiding smoking cessation, e-cigarettes may reinforce the smoking habit and present an obstacle to smokers trying to quit.2 Recommend that smokers wanting to quit try FDA-approved smoking cessation aids such as gum, skin patches, lozenges, oral inhaled products, or nasal sprays containing nicotine to lessen their nicotine dependence. Smokers can get free help with quitting by calling 1-800-QUIT-NOW or visiting



1. FDA. For Consumers. E-Cigarettes. Questions and answers. 2014. [Context Link]


2. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129(19):1972-1986. [Context Link]



Encouraging words

My neighbor's teenage daughter came over recently to talk with me about her career options. She explained that she's always wanted to be a nurse but has heard "horror" stories from others and is now reconsidering her career choice.


I want to encourage her without being unrealistic about the challenges of nursing. What should I tell her?-N.A., MISS.


You're in a position to shape the future of this potential nurse. First, thank her for letting you speak to her about your chosen career. Remind her that all professional groups have unhappy members, but that most nurses are dedicated patient advocates who actively participate in the profession.


Ask her to explain why she's considering becoming a nurse, and share the reasons you became one. Suggest she learn more about nursing, such as by visiting the "Why be a Nurse" site:


Besides talking about the value and benefits of a nursing career, describe the challenging realities of the profession and how they compare with your own original impressions.


Here are some great reasons to choose a nursing career:


* the ability to teach others about health and make a significant difference in their lives


* opportunities to witness the miracles of life


* the privilege of helping a patient experience a good death


* respect and appreciation from patients, families, and communities


* the chance to interact with people from all cultures and age-groups


* a wide range of specialties, job environments, and travel locations


* flexible schedules


* life-long learning in a career that's never stagnant or boring


* various levels of achievement to meet each nurse's needs, wishes, and abilities


* job security and good benefits.



Finally, consider seeking permission from your employer to let her shadow you at work. You can also encourage her to seek part-time healthcare employment or volunteer work. With some real-world experience, she can make an informed decision about her future.