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Forey, B., Hamling, J

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in contrast, the potent amount of nicotine in e-cigarettes liquids may be toxic if it is accidentally ingested or absorbed via the skin.[13] The health effects of nicotine in infants and children are unclear.[131] E-cigarettes provide nicotine to the blood quicker than nicotine inhalers.[38] The levels were above that of nicotine replacement product users.[13] E-cigarettes seem to have a pharmacokinetic nicotine profile closer to nicotine replacement products than with traditional cigarettes.[133] How efficiently different e-cigarettes give nicotine is unclear.[13] Serum cotinine levels are comparable to that of traditional cigarettes,[134] but are inharmonious and rely upon the user and the device.[135] Blood nicotine levels raised more gradually and took more time to get to peak concentration with e-cigarettes than with traditional cigarettes.[136] Vaping was found to have comparable levels of nicotine urinary metabolites to those who were tobacco and smokeless tobacco product users.[46] Though, the oxidative nicotine metabolites were less in those who were vaping.[46] Evidence indicates that some vaping products may deliver the same amount of nicotine as traditional cigarettes.[44] There is fair evidence that chance and degree of dependence are less for e-cigarettes than traditional cigarettes, according to a 2018 National Academies of Sciences, Engineering, and Medicine report.[137] It not clear the level of addictiveness of e-cigarettes, compared with traditional cigarettes, according to a 2018 PHE report.[138] The report also stated "nicotine addictiveness depends on a number of factors including presence of other chemicals, speed of delivery, pH, rate of absorption, the dose, and other aspects of the nicotine delivery system, environment and behaviour."[139] Users vaping without using nicotine exhibited symptoms of dependence, according to a 2015 study.[140] E-cigarette packages and advertisements require health warnings under US law, stating "WARNING: This product contains nicotine

Tellini R, et al