found they appear to have the potential to lower tobacco-related death and disease. Regulated US Food and Drug Administration nicotine replacement products may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products. It is estimated their safety risk to users is similar to that of smokeless tobacco. The long-term effects of e-cigarette use are unknown. The risk from serious adverse events was reported in 2016 to be low. Less serious adverse effects include abdominal pain, headache, blurry vision, throat and mouth irritation, vomiting, nausea, and coughing. Nicotine itself is associated with some health harms. In 2019 and 2020, an outbreak of severe lung illness throughout the US was linked to the use of vaping products E-cigarettes create vapor made of fine and ultrafine particles of particulate matter, which have been found to contain propylene glycol, glycerin, nicotine, flavors, small amounts of toxicants, carcinogens, and heavy metals, as well as metal nanoparticles, and other substances. Its exact composition varies across and within manufacturers, and depends on the contents of the liquid, the physical and electrical design of the device, and user behavior, among other factors. E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke. E-cigarette vapor contains fewer toxic chemicals, and lower concentrations of potential toxic chemicals than cigarette smoke. The vapor is probably much less harmful to users and bystanders than cigarette smoke, although concern exists that the exhaled vapor may be inhaled by non-users, particularly indoors. Health effects Smokers The harm from smoking comes from the many toxic chemicals in the natural tobacco leaf and those formed in smoke from burning tobacco. People keep smoking because the nicotine, the primary psychoactive chemical in cigarettes, is highly addictive. Cigarettes, like narcotics, have been described as "strategically addictive", with the addictive properties being a core component of the business strategy. About half of smokers die from a smoking-related cause. Smoking harms nearly every organ of the body. Smoking leads most commonly to diseases affecting the heart, liver, and lungs, being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. Children born to women who smoke during pregnancy are at higher risk of congenital disorders, cancer, respiratory disease, and sudden death. On average,