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Nearly 70% of counselors regarded ENDS as ineffective quitting aids. Slightly more than one-third (36%) of the physicians endorsed a harm-reduction approach when justifying ENDS use, and consistent with previous results, 17 30% of the physicians recommended ENDS in lieu of combustible cigarettes.Ĭummins et al 20 surveyed 418 quit line counselors in the United States and Canada about counselors’ perceptions of ENDS and what information they typically share with callers regarding the safety and use guidelines for these products. Similarly, Steinberg et al 15 made use of an e-mailed link to a Web-based survey to enroll 150 physician specialists and ask about physician-patient communication regarding ENDS. Indeed, 35% of the physicians recommended ENDS, especially if individual patients asked about them. The researchers found that over half of the physicians in the sample (67.2%) believed that ENDS are helpful for smoking cessation and only slightly less (64.8%) thought that ENDS lower the risk of cancer for patients who use them instead of traditional cigarettes.
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Recruitment strategies made use of e-mail canvassing and a series of close-ended survey questions. Kandra et al 18 investigated a diverse sample of 122 physician specialists, all treating tobacco-related disease in North Carolina. These studies have involved e-mail and online surveys with patients and quit line staff 15 an analysis of free-text tobacco use comments in electronic health record (EHR) documentation 16, 17 and qualitative and survey-based research focusing on physicians’ views of ENDS products. Several different types of studies exist to explore the question of how patients are currently advised on this topic.
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Given the absence of FDA regulatory recommendations and the existence of inconsistent professional health organizations’ guidelines for ENDS use, medical professionals are left to develop their own empirical and clinical perspectives to inform and manage patients who use ENDS.
6 This heterogeneous international regulatory response reflects the lack of consensus among regulators, medical associations, and health professionals on whether ENDS represent an exciting new smoking cessation opportunity 7 – 10 or are an untested, potential unsafe technology that risks undermining existing public health successes in “denormalizing” smoking. This situation changed in August 2016, when the Food and Drug Administration “deemed” that ENDS should be regulated as tobacco products, with new restrictions including a ban on under-18s purchasing ENDS, and the inclusion of mandatory warning labels on ENDS products. 5 In the US context, prior to 2016, there was no federal (ie, national) regulation regarding the sale or use of ENDS.
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For example, in the United Kingdom, it is possible to license ENDS as medicines, 4 whereas in Switzerland, the sale of nicotine-containing ENDS is prohibited. 3Īt present, there is no clear international consensus on the appropriate regulation of ENDS, with jurisdictions adopting a range of regulatory responses to the product. 2 This growth in ENDS users has occurred in the context of a general reduction in the proportion of current, daily smokers of combustible cigarettes in the US population 15.1% of adults were current daily smokers in 2015, compared with 20.9% in 2005. 1 In 2014, the proportion of the US adult population to have tried ENDS at least once was estimated to be 12.6%, with 3.6% of adults currently using the products.
Since their introduction, e-cigarettes (Electronic Nicotine Delivery Systems-ENDS) have quickly grown to become a US $2.5 billion dollar industry.
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