In a regarding development that underscores the continuing public well being challenges posed by vaping, analysis introduced at The American School of Chest Physicians’ Annual Assembly in October 2023 has revealed a shift within the demographics and severity of e-cigarette or vaping-associated lung harm (EVALI) instances. This examine, performed throughout 14 Utah hospitals, highlights that, regardless of the decline within the EVALI epidemic first recognized in late 2019, instances proceed to emerge, albeit with notable variations from these noticed on the epidemic’s peak.
The analysis aimed to characterize the variations amongst sufferers identified with EVALI earlier than and after the onset of the COVID-19 pandemic, a interval that not solely sophisticated the identification of EVALI instances on account of overlapping signs but additionally probably altered e-cigarette consumer traits. With a meticulous method, together with a prerequisite of a adverse SARS-CoV-2 take a look at for EVALI analysis post-March 2020, the examine presents a complete look into the altering panorama of EVALI.
The findings are stark: in comparison with the early days of the EVALI outbreak (June 2019-February 2020), sufferers identified between March 2020 and April 2022 had been youthful, with a median age lower from 32 to twenty-eight years. Moreover, these newer sufferers had been much less prone to require intensive care, evidenced by a major drop in ICU admissions from 52% to 26%, and exhibited decrease mortality charges. Moreover, the size of hospital stays decreased, and there was a noticeable improve in sufferers requiring solely nasal cannula oxygen for help.
Apparently, the examine additionally famous a psychological dimension, with late EVALI sufferers extra prone to have a historical past of hysteria. Regardless of comparable smoking histories between the 2 teams, late EVALI instances had been extra incessantly related to THC use. The decreased probability of present process spirometry amongst latest sufferers suggests potential modifications in medical approaches to EVALI.
These findings point out not solely a shift within the medical presentation of EVALI but additionally trace at completely different underlying mechanisms of illness, diverging from the Vitamin E Acetate-associated accidents seen in early instances. The context of the COVID-19 pandemic, alongside doable ascertainment biases, might have influenced the milder illness shows noticed in recent times.
The medical implications of this examine are vital. Physicians are urged to stay vigilant for EVALI, which persists with a youthful demographic and altered medical traits. This evolving problem emphasizes the necessity for ongoing consciousness and adaptation within the medical neighborhood’s method to diagnosing and managing vaping-associated diseases.
As EVALI continues to have an effect on youthful people with much less extreme, but nonetheless vital, medical shows, the examine underscores the important significance of public well being efforts to fight the vaping epidemic. With vaping’s recognition remaining excessive amongst youthful populations, this analysis highlights the important want for focused prevention and schooling methods to deal with the dangers related to e-cigarette use.
You’ll be able to learn extra concerning the examine and its findings on the following hyperlinks:
What’s EVALI?
E-cigarette or Vaping product use-Related Lung Harm (EVALI) is a medical situation related to using vaping merchandise, which embrace digital cigarettes (e-cigarettes) and vape pens. This situation got here to prominence in 2019 when the USA skilled a nationwide outbreak of extreme lung illness linked to vaping. The Facilities for Illness Management and Prevention (CDC) and different well being authorities launched investigations that recognized EVALI as a brand new, distinct lung illness related to inhaling substances present in vaping merchandise.
EVALI signs can mimic these of different respiratory situations and might vary from gentle to extreme, together with:
- Shortness of breath
- Cough
- Chest ache
- Fever
- Fatigue
- Gastrointestinal signs (nausea, vomiting, diarrhea)
- Weight reduction
Extreme instances of EVALI can result in acute respiratory misery syndrome (ARDS), a life-threatening situation that requires hospitalization and might necessitate mechanical air flow.
The precise explanation for EVALI has been linked to the inhalation of sure substances present in vaping merchandise. Vitamin E acetate, a thickening agent utilized in THC-containing e-cigarette, or vaping merchandise, has been recognized as a major chemical of concern related to EVALI. Nevertheless, researchers and well being authorities have famous that different substances and components in vape liquids may additionally contribute to the event of the situation.
In response to the EVALI outbreak, public well being officers have really helpful warning with using e-cigarette and vaping merchandise, notably these containing THC or obtained from casual sources like associates, household, or on-line sellers. The outbreak led to elevated scrutiny of vaping merchandise, regulatory actions geared toward controlling using sure substances in these merchandise, and heightened public consciousness of the potential dangers related to vaping.
As of January 7, 2020, a complete of two,558 hospitalized sufferers with nonfatal instances and 60 sufferers with deadly instances of EVALI had been reported to the Facilities for Illness Management and Prevention (CDC). Since that point, the numbers have decreased barely, however EVALI continues to be a big difficulty.
Different dangers for youths from vape pens
On October 19, 2023, Ohio Division of Well being Director Bruce Vanderhoff, M.D., MBA, issued a warning concerning the rising variety of accidents associated to e-cigarettes, notably amongst kids aged 5 and beneath in Ohio. Throughout a digital press convention, he highlighted the risks posed by the liquids utilized in vaping gadgets, which can comprise nicotine, THC, CBD, flavors, or a mixture of these substances. Dr. Vanderhoff expressed concern over kids being poisoned by ingesting these liquids, inhaling them, or absorbing them via pores and skin or eye contact.
The Ohio Poison Facilities have reported a major improve in vape liquid exposures, with numbers practically tripling from 130 instances in 2015 to 360 instances in 2022, and 328 exposures already reported by September 2023. Out of the 1,762 complete exposures reported since 2015, 1,301 instances concerned kids 5 years outdated and youthful, representing over 70% of incidents. Signs of publicity can vary from nausea and vomiting to extra extreme results similar to modifications in coronary heart charge, blood stress, and seizures, probably requiring emergency medical care.
Dr. Vanderhoff emphasised the inherent risks of nicotine, no matter its type, and its potential to trigger dependancy. He additionally identified that whereas Ohio’s grownup smoking charge has seen some enchancment, it stays above the nationwide common, and accidents from vaping liquids are a brand new problem within the ongoing public well being battle. He urged Ohioans to be extra conscious of the dangers vaping gadgets pose to kids and really helpful calling the Poison Management Hotline at 800-222-1222 in case of publicity. It’s probably this difficulty is going on in all 50 states amongst kids in properties the place vapes or vape provides may be accessed.
North Dakota man who vaped required a double lung transplant
A 22-year-old man obtained a double lung transplant in January 2024 after being on life assist for 70 days. Jackson Allard, a North Dakota resident, went to the emergency room for a abdomen ache in October 2023, however was as a substitute admitted to the hospital as a result of his oxygen ranges had dipped too low. The information was first reported by Valley Information Reside based mostly on a GoFundMe page arrange by an Allard’s household pal.
Medical doctors in North Dakota identified Allard with parainfluenza, a virus that may trigger respiratory infections, which spiraled into pneumonia, then acute respiratory misery syndrome — a life-threatening harm brought on by fluid buildup within the lungs. “After they did X-rays, you couldn’t even see his coronary heart. It was all white. So meaning the entire lung was stuffed with fluid,” stated Doreen Hurlburt, Allard’s grandmother.
Hurlburt stated Allard had used e-cigarettes since he was 16 or 17, however not too long ago began vaping extra closely. “He had no concept how dangerous it was for him,” she stated. “The day earlier than he was intubated, he stated, ‘I had no concept I may get this sick.’”
Scientists nonetheless don’t absolutely perceive the affiliation between vaping and lung illness, so it’s unclear what position vaping might have performed in Allard’s case. Some research counsel that utilizing e-cigarettes may make folks extra prone to respiratory tract infections.
Dr. Brian Keller, medical director of the Massachusetts Normal Hospital Lung Transplantation Program, stated research involving animals and human cells have proven that e-cigarette use can injury blood vessels and cells that line the lungs. However scientists are nonetheless attempting to slim in on which compounds in e-cigarettes are the worst for human well being.
“There’s really a number of that may trigger injury,” Keller stated. “This contains the nicotine itself, but additionally the burning of a provider fluid like propylene glycol or glycerol, in addition to the flavoring that lots of people add to their vaping system.” Hurlburt stated her grandson’s docs suspected that his use of e-cigarettes prevented him from recovering from his preliminary viral an infection. “As he was not getting higher, they’re like, ‘Effectively, he vaped and vaping hurts your lungs,’” she stated.
Allard’s mom, Jaime Foertsch, stated her son was positioned on a life-support system known as extracorporeal membrane oxygenation, or ECMO, then airlifted to M Well being Fairview in Minnesota on the finish of October. Foertsch stated Allard was the longest affected person that M Well being Fairview had ever stored on an ECMO machine, which provides oxygen to the blood and sends it again to the physique. A hospital consultant declined to touch upon Monday, citing the Well being Insurance coverage Portability and Accountability Act, which safeguards affected person privateness.
To be thought-about for a transplant, Allard wanted to return off sedation and be capable to stroll. However on the finish of final yr, he was struggling to outlive: Medical doctors needed to exchange components of his ECMO system twice on account of blood clots forming, which may have been deadly. Then on Dec. 12, he went into cardiac arrest and needed to be resuscitated. “In a number of household conferences the [Surgical Intensive Care Unit] crew stated there was a 1% likelihood of survival,” Foertsch stated in an electronic mail. “We by no means gave up and stored advocating for Jackson.”
By the top of the month, Allard had improved and was in a position to stand and take just a few steps, his household stated.
“Unexpectedly, it simply rotated,” Hurlburt stated. “It was similar to day and night time.” On New 12 months’s Eve, Foertsch acquired the decision that docs had allotted a pair of latest lungs to her son. Allard obtained a transplant the subsequent day. By Jan. 5, he now not required life assist.
Allard continues to be on a ventilator within the ICU, his mom stated, however he’s in a position to get out and in of mattress with some assist and stroll about 5 ft with a walker. “The nurses are calling him a legend and a miracle,” Foertsch stated. “He’s getting stronger day-after-day and hopes he will likely be moved to rehab quickly.” Hurbult stated her grandson nonetheless must re-learn the way to speak, however he’s in a position to talk. “He thanked the nurses for all the assistance,” she stated. “He simply stated, ‘Thanks for working so onerous to avoid wasting me.’ He’s a candy child.”
Lung transplants are comparatively uncommon, and even rarer for folks beneath age 50. Out of two,569 lung transplants carried out within the U.S. in 2021, simply 440 had been in recipients ages 18 to 49. Most vaping-related lung accidents don’t require a transplant, however sufferers sometimes want some kind of respiratory assist like supplemental oxygen or mechanical air flow. “I’ve solely been in a position to come throughout a few experiences of sufferers requiring lung transplant after vaping,” Keller stated.
A 17-year-old boy in Michigan who received a transplant in 2019 is believed to be the primary case. In 2023, a 34-year-old man in Missouri additionally received a double lung transplant after growing a life-threatening lung an infection that was immune to antibiotics. The person had a historical past of smoking cigarettes and likewise vaped for 9 years. Round 54% of those that obtain a lung transplant survive for at the least 5 years after surgical procedure.
Hurbult stated Allard might want to spend round six months in Minneapolis so docs can monitor his progress and ensure he’s tolerating the transplant. However his household anticipates a full restoration. “He’s going to get his life again,” Hurbult stated. “We’re going to get our Jackson again.” (source)
Two college students hospitalized after vaping marijuana at Colorado Springs center college
Two college students had been taken to the hospital Thursday, October 19, 2023, after allegedly vaping highly-concentrated marijuana at a Colorado Springs center college. In accordance with a District 11 spokesperson, eight college students at Sabin Center Faculty had vaped the highly-concentrated substance.
Two of these college students had been taken to the hospital with elevated coronary heart charges for therapy, whereas the others had been handled on scene. Presently, it’s unknown if the scholars had been vaping earlier than or after college had already begun for the day. (source)
North Carolina lady warns of vaping risks after teen stepson’s sudden demise: ‘We had no clue’
A North Carolina lady is sounding the alarm concerning the potential risks of vaping after her 15-year-old stepson’s surprising demise. Solomon Wynn’s household took him off a ventilator in mid-June, simply months after the teenage soccer participant developed a nasty cough.
“We went to the first care physician as a result of he had a nasty cough. They identified him with what they thought was bronchitis,” his stepmother, Charlene Zorn of Wilmington, instructed Fox Information Digital in an interview.
Medical doctors prescribed Solomon antibiotics, steroids and inhalers, however nothing appeared to assist enhance his situation, in order that they referred him to a pulmonologist. The pulmonologist did allergy testing and take a look at X-rays on Solomon, figuring out in April he had been vaping.
“By trying on the take a look at X-rays, she knew,” Zorn stated. Previous to his sudden cough, Solomon had been a wholesome teenager. He “beloved” soccer, his stepmother stated. As soon as he started going to the gymnasium together with his dad, Zorn stated, it grew to become a routine. Solomon went to the gymnasium “each morning.”
“He brazenly admitted it to the physician. He didn’t try to deny it,” Zorn stated of the second Solomon’s physician stated he had been vaping. “As dad and mom, we had no clue. We had no indication that he had been vaping. Neither his father nor myself smoke, so there have been no merchandise in our home that he may get. It wasn’t that it was one thing accessible to him. It was one thing he acquired via his associates.” He additionally admitted that his associates offered him with vapes and “confirmed him the way to do it,” Zorn stated, including that she doesn’t know the model of the vape or vapes Solomon was utilizing.
However as soon as the cough started, Solomon’s power steadily declined to the purpose he couldn’t stroll for 5 minutes, Zorn stated. “After a few minute and a half, he needed to cease as a result of his respiratory had turn out to be labored.”
“The CAT scan confirmed that there was fluid in three locations on his lungs and surrounding his coronary heart. He was presupposed to see the heart specialist that following Monday as a result of, clearly, they’d considerations as a result of it was affecting his coronary heart. After which on that Friday, on June 16, he collapsed after which ended up within the hospital on a ventilator,” Zorn recalled.
He collapsed on June 16 and died the subsequent day, stunning his household, associates and soccer crew at college. Zorn implored Solomon’s teammates at his funeral to surrender vaping.
“All this stuff that we thought Solomon was going to do — we thought he would play soccer all through highschool. He talked on and off concerning the navy. He talked about jobs that he wished to have,” Zorn stated. “We even joked about him even having a household sometime. None of these issues are going to occur now. … We have now recollections. That’s all we now have now.”
Simply earlier than the COVID-19 pandemic unfold throughout the USA, the Facilities for Illness Management and Prevention stated that, as of February 2020, greater than 2,800 folks in 50 states and two U.S. territories had been hospitalized or died on account of a vaping- and THC-related lung sickness known as e-cigarette, or vaping, product use-associated lung harm, or EVALI.
“The vapes have all types of metals in them. They’ve robust nicotine in them that it impacts the lungs, it turns them into — they name it popcorn lungs,” Zorn stated. The CDC has since stopped monitoring EVALI deaths as a result of they’ve turn out to be much less frequent.
Signs of EVALI embrace “respiratory signs, together with cough, shortness of breath or chest ache; gastrointestinal signs, together with nausea, vomiting, abdomen ache, or diarrhea; and nonspecific constitutional signs, like fever, chills, or weight reduction,” in line with the CDC.
The CDC additionally notes that vapes or e-cigarettes comprise nicotine, which “is very addictive and might hurt adolescent mind growth,” persevering with into the “early to mid-20s.” Tobacco stays the No. 1 main explanation for preventable demise within the U.S., killing practically 480,000 folks yearly, in line with the anti-tobacco marketing campaign Tobacco-Free Children.
Zorn famous, nonetheless, that vaping and e-cigarette tradition is completely different from smoking tradition for American kids. Whereas few American kids and youngsters smoke, vaping is frequent, and youngsters share vaping merchandise with one another at school.
A stunning 2022 CDC examine famous that greater than 2.5 million American teenagers vape. About 85% of teenagers surveyed stated they used flavored e-cigarette merchandise. The Meals and Drug Administration (FDA) banned all flavors, together with candy and fruity flavors well-liked amongst youngsters, besides tobacco and menthol in an effort to curb youth vaping, however sure flavored vape merchandise are nonetheless making their manner into the market.
“Folks suppose that we’re exaggerating or, ‘Oh, this may’t occur to my child.’ … The demise charge amongst youngsters vaping could be very low, sure, however the charge of youngsters ending up within the hospital and the youngsters getting sick is on the rise, not the lower,” Zorn stated.
Zorn has one piece of recommendation for folks: “Discuss to your youngsters.” She says dad and mom ought to focus on vaping in the identical manner they might speak to their kids about secure intercourse, smoking and ingesting. (source)
Texas 15-year-old’s demise is youngest vaping lung harm fatality in the USA
As of January 7, 2020, vaping-related lung accidents had induced 57 deaths in 27 states and the District of Columbia, together with the youngest sufferer at 15 years outdated, the US Facilities for Illness Management and Prevention stated. The numbers embrace a complete of two,602 folks hospitalized for lung harm linked to vaping in all 50 states, the District of Columbia, Puerto Rico and the US Virgin Islands.
Dallas County well being officers reported on New 12 months’s Eve of 2020 {that a} Dallas County teenager with a “continual underlying medical situation” had turn out to be the county’s first demise linked to the lung harm outbreak. On Thursday, Dallas County Well being and Human Companies confirmed to CNN that the particular person was 15. “Reporting a demise in a teen on account of EVALI is so tragic,” DCHHS Director Dr. Philip Huang stated in an announcement final week. The time period EVALI is used amongst well being officers as shorthand for “e-cigarette, or vaping, product use-associated lung harm.”
“We’re seeing that extreme lung injury, and even demise, can happen with simply brief time period use of those merchandise,” Huang added. The CDC has not specified particulars on the identities of those that have died. The company did say, nonetheless, that the median age of deceased sufferers was 51 years, with deaths starting from age 15 via age 75. Extra deaths are nonetheless beneath investigation, the company stated.
Information counsel the outbreak could be on the decline after peaking in September 2019, the CDC stated, however states proceed to report new instances and deaths to the company on a weekly foundation. The CDC recommends that individuals not use e-cigarette merchandise that comprise THC. Whereas it seems that vitamin E acetate, a thickener utilized in some vaping merchandise, is related to lung harm instances, the company can’t rule out different chemical substances, it stated. Furthermore, no single product or model has been recognized as a sole perpetrator. (source)
Teen hospitalized with collapsed lungs apparently brought on by vaping
A youngster was hospitalized Thursday, April 14, 2023, on account of collapsed lungs that had been apparently induced through the use of digital cigarettes. The 16-year-old boy was being handled on the Schneider Kids’s Medical Middle of Israel, the place he was listed in severe situation. The hospital stated he was being handled within the intensive care unit with an extracorporeal membrane oxygenation (ECMO) machine, which offers cardiac and respiratory help.
The boy’s mom requested Israelis to wish for his well being and urged different dad and mom to not let their kids use digital cigarettes, sometimes called vapes. The Israeli Affiliation of Public Well being Physicians known as for larger preventive measures to dam the sale of tobacco merchandise to kids and urged a ban on digital cigarettes.
“Utilizing digital cigarettes endangers lives,” Hagai Levine, a number one public well being official, tweeted in response. In 2019, the Well being Ministry thought-about a complete ban on digital cigarettes on account of experiences relating to digital cigarette-related deaths within the US amid a surge in vape utilization, notably amongst younger folks.
In June, the US Meals and Drug Administration banned the sale of vape merchandise produced by Juul Labs Inc., because of the excessive ranges of nicotine discovered within the flavored oils produced by the corporate. Israel already positioned a ban on importing Juul merchandise containing greater than 20 milligrams of nicotine in 2018. Digital cigarette utilization stays authorized. (source)
My spouse’s vaping behavior killed her — now I’m warning others of risks
After the devastating lack of her spouse, one lady is issuing a stark warning concerning the well being dangers of vaping. Amanda Lee Corridor was a smoker, turning to e-cigarettes in an try and kick the dangerous behavior for good, however her lungs ultimately “shut down,” leading to her demise in 2021.
“We misplaced the guts of our household and it’s a loss that we’ll by no means get well from,” Hensley instructed NeedToKnow.On-line. “Since shedding her, life has been depressing and I really feel adrift – day-after-day is a wrestle simply to perform and her absence is felt to the core.” When she and her spouse Kristen Hensley wed in 2014, the pair had been unaware of what tragedies had been forward.
Corridor, 44, had begun smoking cigarettes at 14 till breaking the 22-year behavior by turning to vapes in 2013, assuming it was more healthy than conventional cigarettes. However when she started vomiting and experiencing extreme weight reduction – dropping practically 60 kilos in simply 5 months – she knew one thing was flawed.
In September 2019, she was rushed to the hospital the place clinicians identified her with bronchitis, and gave her antibiotics. However simply 4 days later, the docs found that her lungs had been shutting down and positioned Corridor on high-flow oxygen, then a ventilator and a medically-induced coma a month later. Ultimately, she was placed on life assist earlier than being discharged in November.
“I used to be so scared, particularly as I had no concept how sick she was as a result of she had been bravely performing prefer it was only a chilly,” Hensley, from North Carolina, recalled. “I utterly believed her lungs would heal from the vaping harm and he or she could be wholesome once more – however I used to be flawed.” In February 2020, Corridor contracted pneumonia in each lungs and was admitted to the hospital once more, and in December suffered a fourth setback earlier than her passing in February 2021.
In a year-and-a-half, Corridor and Hensley’s lives modified drastically. “I used to be instructed there was no significant likelihood of enchancment and that it was unlikely she would ever be capable to survive with out the ventilator, particularly as her stats wouldn’t enhance – the place they instructed me to say my goodbyes,” stated Hensley, who was left to cope with the immense grief and mounting medical payments. “I used to be in a position to speak to her and maintain her hand whereas she was dying till she closed her eyes and took her final breath.”
Whereas Corridor’s data don’t explicitly blame her vaping behavior for the lung harm, Hensley stated the docs urged it might be. The US Meals and Drug Administration estimates that one in 10 – or greater than 2.5 million – US center or excessive schoolers vaped final yr, whereas greater than 5 million adults are estimated to be vape customers, per a examine printed within the JAMA Community Open.
“Amanda wished others to pay attention to the risks of vaping and the chance to share her story, even when it solely helps one particular person, could be superb,” Hensley stated. “Individuals are dying from this behavior.”
Corridor isn’t the one e-cigarette consumer duped into believing vapes are a lung-conscious various to tobacco darts. Final yr, 23-year-old Grace Brassel shared her horrifying ordeal with a collapsed lung on TikTok, which she believed may have been aggravated by her vaping behavior. The FDA even tried to ban the sale of Juuls, a well-liked e-cigarette model, final yr on account of security considerations. “With smoking, at the least docs know what the long-term results are however that is new and unregulated,” Hensley stated, referring to vapes. “Nobody is aware of what it’s actually doing to folks.”
John Hopkins Drugs warns e-cigarette customers that whereas vaping could be much less dangerous than conventional cigarettes, it doesn’t come with out danger. Lung harm and deaths have been reported, whereas researchers found undisclosed chemical substances current within the vape juice that might pose well being dangers.
Prior research have additionally linked vaping to an elevated danger of consuming problems, diabetes and psychological well being points. Hensley has now developed post-traumatic stress dysfunction on account of Corridor’s demise, saying she doesn’t “sleep effectively on account of nightmares” or wakes herself up crying.
“She was the primary lady I went out with and I used to be terrified at first, however I had a lot enjoyable together with her,” she stated. “She put me comfy, made me chuckle and was simply so cute.” Now, Hensley has a GoFundMe page, which started when Corridor was first identified, to boost cash for medical payments. She’s raised simply over $2,000 to this point.
“Life isn’t the identical with out her, however my love for Amanda will all the time keep alive – she was my all the things and a lot extra,” Hensley stated. “I hope my spouse’s story will assist others who’re attempting to discourage this lethal behavior and hopefully keep away from the identical devastating destiny we’ve all suffered.”
Name a California vape harm lawyer immediately
As we replicate on the difficult yr of 2023, which marked an unprecedented improve within the variety of younger people hospitalized on account of E-cigarette or Vaping Product Use-Related Lung Harm (EVALI), the urgency to deal with and mitigate the dangers related to vaping has by no means been clearer. The rise in EVALI instances, notably among the many youth, underscores the important want for consciousness, schooling, and authorized assist for these affected by these dangerous merchandise.
For those who or a beloved one has been injured by a vape or has suffered from EVALI, know that you’re not alone. The J&Y Legislation Agency in Los Angeles, CA, is devoted to offering the assist and authorized experience essential to navigate these difficult occasions. With a dedication to justice and a ardour for advocating for victims, our skilled crew presents a free session that will help you perceive your rights and potential avenues for compensation. You’ll be able to attain us at (323) 202-2305 to be taught extra about how we are able to help you on this troublesome journey in direction of restoration and justice.
As we transfer ahead, allow us to all decide to selling safer environments and more healthy selections for our youth, making certain that the alarming developments of 2023 don’t proceed into the longer term. Collectively, with the suitable assist and assets, we are able to overcome the challenges posed by EVALI and work in direction of a safer, more healthy tomorrow.