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Pregnancy
Physicians for a Smoke-Free Canada (PSC) is a national health organization, founded in 1985 as a registered charity. We are a unique organization of Canadian physicians who share one goal: the reduction of tobacco-caused illness through reduced smoking and exposure to second-hand smoke. Over more than 4 decades, PSC has operated thanks to the contributions of time and volunteer effort of its members. In addition to donations from members, our sources of financing include contributions from health ministries and private foundations and earnings from consulting services.

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PSFC has a that states that "After 34 years, still working to reduce the toll of nicotine addiction in Canada!"

Blog
PSFC has a very active Blog. In a recent post entitled "" they stated that "A more truthful, blunter message to young people is warranted. Something like: Smoking kills, and vaping almost certainly kills too.

And for smokers who are trying to quit on their own? Health Canada should advise: using e-cigarettes will likely decrease the chances of success but will increase health risks in comparison with approved smoking cessation aids."

E-cigarette was also rising among women, including women of childbearing age, but the rate of use during pregnancy is unknown. Many woman still vape during pregnancy because of their perceived safety in comparison with tobacco. In one of the few studies identified, a 2015 survey of 316 pregnant women in a Maryland clinic found that the majority had heard of e-cigarettes, 13% had ever used them, and 0.6% were current daily users. These findings are of concern because the dose of nicotine delivered by e-cigarettes can be as high or higher than that delivered by traditional cigarettes. The rate of e-cigarette use among pregnant adolescents is unknown.

As of 2018, the health effects of Electronic Cigarette Use in Pregnancy for mother or fetus remain unknown. In its summary review the U.S. National Institute of medicine concluded that "Although the extensive research on tobacco and limited evidence on nicotine in isolation gives some focus to the questions regarding the potential effects of e-cigarettes, the need for direct evaluation is clear.", (Conclusion 13-1) "There is no available evidence whether or not e-cigarettes affect pregnancy outcomes.", and (Conclusion 13-2) "There is insufficient evidence whether or not maternal e-cigarette use affects fetal development."

Smoking cessation


The available research on the efficacy of e-cigarette use for smoking cessation is limited. Data regarding their use includes four randomized controlled trials and a number of user surveys, case reports, and cohort studies. There is tentative evidence they may help people quit smoking. Vaping does not greatly increase the odds of quitting smoking. Their use for quitting smoking is controversial. The evidence is conflicting to support or dismiss vaping for quit smoking. As a result of the data being confronted with methodological and study design limitations, no firm conclusions can be drawn in respect to their efficacy and safety. A 2016 review found that the combined abstinence rate among smokers using e-cigarettes in prospective studies was 29.1%. The same review noted that few clinical trials and prospective studies had yet been conducted on their effectiveness, and only one randomized clinical trial had included a group using other quit smoking methods. No long-term trials have been conducted for their use as a smoking cessation aid. It is still not evident as to whether vaping can adequately assist with quitting smoking at the population level. A 2015 PHE report recommends for smokers who cannot or do not want to quit to use e-cigarettes as one of the main steps to lower smoking-related disease, while a 2015 US PSTF statement found there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, pregnant women, and adolescents. , systematic reviews collectively agreed that there is insufficient evidence to unequivocally determine whether vaping helped people abstain from smoking.

Studies pertaining to their potential impact on smoking reduction are very limited. E-cigarette use may decrease the number of cigarettes smoked, but smoking just one to four cigarettes daily greatly increases the risk of cardiovascular disease compared to not smoking. The extent to which decreasing cigarette smoking with vaping leads to quitting is unknown. Randomized controlled trials have not shown that vaping is effective for quitting smoking. A 2016 meta-analysis based on 20 different studies found that smokers who used e-cigarettes were 28% less likely to quit than those who had not tried e-cigarettes. This finding persisted whether the smokers were initially interested in quitting or not. Tentative evidence indicates that health warnings on vaping products may influence users to give up vaping.

It is unclear whether e-cigarettes are only helpful for particular types of smokers. Vaping with nicotine may reduce tobacco use among daily smokers. Whether or not vaping is potentially effective for quitting smoking may rely upon whether it was used as part of making an effort to quit or not.

Vaping is not clearly more or less effective than regulated nicotine replacement products or 'usual care' for quitting smoking. The available research suggests e-cigarettes are likely equal or slightly better than nicotine patches for quitting smoking. People who vaped were not more likely to give up smoking than people who did not vape. Compared to many alternative quitting smoking medicines in early development in clinical trials including e-cigarettes, cytisine appears to be most encouraging in efﬁcacy and safety with an inexpensive price. E-cigarettes have not been proven to be more effective than smoking cessation medicine and regulated US FDA medicine. A 2014 review found they may be as effective, but not more, compared to nicotine patches for short-term quitting smoking. They also found that a randomized trial stated 29% of e-cigarette users were still vaping at 6 months, while only 8% of patch users still wore patches at 6 months. Some individuals who quit smoking with a vaping device are continuing to vape after a year. Vaping appears to be as effective as nicotine replacement products, though its potential adverse effects such as normalizing smoking have not been adequately studied. While some surveys reported improved quitting smoking, particularly with intensive e-cigarette users, several studies showed a decline in quitting smoking in dual users. A 2015 overview of systematic reviews indicates that e-cigarettes has no benefit for smokers trying to quit, and that the high rate of dual use indicates that e-cigarettes are used for supporting their nicotine addiction. Other kinds of nicotine replacement products are usually covered by health systems, but because e-cigarettes are not medically licensed they are not covered.

It is difficult to reach a general conclusion from e-cigarette use for smoking cessation because there are hundreds of brands and models of e-cigarettes sold that vary in the composition of the liquid. E-cigarettes have not been subjected to the same type of efficacy testing as nicotine replacement products. The similarity of e-cigarettes' vapor, looking like cigarette smoke, may prolong traditional cigarette use for people who could have quit instead, but the growing support of e-cigarettes could put extra pressure on smokers to stop cigarette smoking because smoking may be seen as socially unacceptable compared to a smokeless e-cigarette. The evidence indicates smokers are more frequently able to completely quit smoking using tank devices compared to cigalikes, which may be due to their more efficient nicotine delivery. There is low quality evidence that vaping assists smokers to quit smoking in the long-term compared with nicotine-free vaping. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2013 study in smokers who were not trying to quit, found that vaping, with or without nicotine decreased the number of cigarettes consumed. E-cigarettes without nicotine may reduce tobacco cravings because of the smoking-related physical stimuli. A 2015 meta-analysis on clinical trials found that e-cigarettes containing nicotine are more effective than nicotine-free ones for quitting smoking. They compared their finding that nicotine-containing e-cigarettes helped 20% of people quit with the results from other studies that found nicotine replacement products helps 10% of people quit. A 2016 review found low quality evidence of a trend towards benefit of e-cigarettes with nicotine for smoking cessation. In terms of whether flavored e-cigarettes assisted quitting smoking, the evidence is inconclusive.

The efficacy and safety of vaping for quitting smoking during pregnancy is unknown. No research is available to provide details on the efficacy of vaping for quitting smoking during pregnancy. There is robust evidence that vaping is not effective for quitting smoking among adolescents. In view of the shortage of evidence, vaping is not recommend for cancer patients. The effectiveness of vaping for quitting smoking among vulnerable groups is uncertain.