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E-cigarettes: an evidence update <br /> <br />16 <br />Studies have validated the ability of EC to deliver nicotine to the user. Blood plasma <br />nicotine concentrations increase after inhalation of EC aerosol [6, 7], and cotinine, a <br />biomarker for nicotine, has been detected in the saliva of EC users [8, 9]. Information <br />about the overall and relative risks of EC in comparison with smoking has also been <br />developing. Using a multi-criteria decision analysis (MCDA) model, the Independent <br />Scientific Committee on Drugs selected experts from several different countries to <br />compare a variety of nicotine products on variables of harm identified by the UK <br />Advisory Council on the Misuse of Drugs [10]. EC were identified as having 4% of the <br />relative harm of cigarettes overall (including social harm) and 5% of the harm to users, <br />although it was acknowledged that there was a lack of hard evidence for the harms of <br />most of the nicotine products on most of the criteria. <br /> <br />Structure of report <br />Following Chapter 2 on methodology, Chapter 3 assesses the current and future policy <br />framework for EC. Chapters 4 and 5 assess trial and usage in England among adults <br />and youth as well as different socioeconomic groups where evidence permits. Chapter 6 <br />examines the evidence for the impact of EC on smoking behaviour including the use of <br />EC in quit attempts as well as alongside smoking. Chapter 7 assesses reasons for <br />trying and discontinuing EC and Chapter 8 perceptions of relative harms of EC and <br />smoking. Chapter 9 discusses nicotine content and emissions of EC as well as nicotine <br />uptake in users. Chapters 10 and 11 assess different aspects of safety drawing on <br />recent published studies as well as national statistics. Chapter 12 examines <br />international perspectives of EC policies and usage. <br /> <br /> <br /> <br />