Electronic Cigarettes

Electronic cigarettes[note 1] are battery-powered vaporizers that simulate the feeling of
smoking, but without tobacco.[1] Their use is commonly called "vaping".[2] Instead of
cigarette smoke, the user inhales an aerosol, commonly called vapor,[3] typically
released by a heating element that atomizes a liquid solution known as e-liquid.[4] The
user activates the e-cigarette by taking a puff or pressing a button.[2][5] Some look like
traditional cigarettes, but they come in many variations.[6][7] Most are reusable but
there are also disposable versions called first-generation cigalikes;[8] there are also
second, third, and fourth-generation devices.[9][10][11]
The benefits and the health risks of e-cigarettes are uncertain,[12][13][14] and the longterm health effects are unknown.[2][5] Compared to smoking tobacco, e-cigarettes are
probably safer for both users and bystanders.[15][6][16] There is tentative evidence that
they can help people quit smoking,[17] although they have not been proven to work
better than regulated nicotine replacement products,[14] and the regulated medication is
safer.[18] Their usefulness in tobacco harm reduction is unclear,[18] but they could form
part of future strategies to decrease tobacco related death and disease.[19][20] Overall
their safety risk to users is similar to that of smokeless tobacco.[20] No serious adverse
effects from e-cigarettes have been reported in trials,[17] while less serious adverse
effects include throat and mouth inflammation, vomiting, nausea, and cough.[6] Nonsmokers who use e-cigarettes risk becoming addicted to nicotine,[21] a chemical with a
range of harmful effects.[22]
The e-liquids used in e-cigarettes usually contains a mix of propylene glycol, glycerin,
nicotine, and flavorings.[17][19][23][24] Some e-liquids may contain ingredients such as
cannabis, tobacco extract, or adulterants.[25][26] E-cigarettes create a vapor consisting of
ultrafine particles[6] whose composition varies across and within manufacturers.[3] The
vapor can contain small amounts of toxins, including traces of heavy metals detected
at levels permissible in inhalation medicines,[16][27][6] and some potentially harmful
chemicals not found in tobacco smoke[28] at levels permissible by workplace safety
standards.[27][29][30] However, chemicals may exceed the more stringent safety limits
which are relevant to the population as a whole.[6] Under certain settings, high power
e-cigarettes may generate more formaldehyde than tobacco does. However, human
research shows that e-cigarette users are repulsed by the acrid chemical taste and
"there is no indication that EC users are exposed to dangerous levels of aldehydes."[31]
The modern e-cigarette arose from a 2003 invention by Chinese pharmacist Hon Lik,
[32]
and as of 2015 most e-cigarettes are made in China.[33] Since their introduction to
the market in 2004, global usage has risen exponentially.[34] For instance, in the UK
user numbers have increased from 700,000 in 2012 to 2.6 million in 2015,[35] In the
United States e-cigarettes are used by a significant percentage of youth[36] and adults.
[37]
Most people's reason for using e-cigarettes is related to trying to quit smoking,
though many people use them recreationally.[5] A majority of e-cigarette users still
smoke traditional cigarettes, leading to concerns that dual use can "delay or deter
quitting".[6] About 60% of UK users are smokers and about 40% are ex-smokers,
while use among never-smokers remains "negligible".[35] Because of the potential
relationship with tobacco laws and medical drug policies, e-cigarette legislation is
being debated in many countries.[38][39] The European Parliament passed regulations in
February 2014, to come into effect by 2016, standardizing liquids and personal
vaporizers, listing ingredients, and child-proofing liquid containers.[40] The US FDA
published proposed regulations in April 2014 with some similar measures.[41] As of

2014, there were 466 brands of e-cigarette with sales of around $7 billion.[42][43]
Use
Frequency
Aerosol (vapor) exhaled by an e-cigarette user using a nicotine free e-cigarette.
Since their introduction to the market in 2004, global usage of e-cigarettes has risen
exponentially.[34] By 2013, there were several million users globally.[44] Awareness and
use of e-cigarettes greatly increased over the few years to 2014, particularly among
young people and women in some countries.[45] But in both the US and UK the growth
in usage seemed to have slowed in 2015.[46][47]
In the US, vaping among young people exceeded smoking in 2014.[28] In 2014, it was
projected that vaping would exceed smoking in about three decades.[26] People with
higher incomes are more likely to have heard of e-cigarettes, but those with lower
incomes are more likely to have tried them.[48] Trying e-cigarettes was common
among less educated people.[45] Whites are more likely to use them than non-whites.[48]
Most users have a history of smoking regular cigarettes.[48] At least 52% of current or
former smokers have used e-cigarettes.[33] Of smokers who use e-cigarettes, less than
15% turn into everyday e-cigarette users.[17] E-cigarette use in never-smokers is very
low but is rising.[49] A 2015 review suggests that 1% of e-cigarette users use liquid
without nicotine.[50] As of 2014, up to 13% of American high school students had used
them at least once in the last month,[36] and around 3.4% of American adults as of
2011.[48]
In the UK user numbers have increased from 700,000 in 2012 to 2.6 million in 2015,
but use by current smokers remained flat at 17.6% from 2014 into 2015 (in 2010 it
was 2.7%).[35] About 60% of UK users are smokers and about 40% are ex-smokers,
while use among never-smokers remains "negligible".[35]
The majority of e-cigarette users use them every day.[7] E-cigarette users mostly keep
smoking traditional cigarettes.[6] Many say e-cigarettes help them cut down or quit
smoking.[16] Adults often vape to replace tobacco, but not always to quit.[48] Most ecigarette users are middle-aged men who also smoke traditional cigarettes, either to
help them quit or for recreational use.[5] Among young adults e-cigarette use is not
regularly associated with trying to quit smoking.[48] E-cigarette use is also rising
among women.[51] Women smokers who are poorer and did not finish high school are
more likely to have tried vaping.[52] Dual use of e-cigarettes and traditional tobacco is
still a definite concern.[12] There is wide concern that vaping may be a "gateway" to
smoking.[53] On the other hand, Public Health England found no evidence e-cigarettes
increase teen tobacco smoking. They noted tentative evidence that e-cigarettes divert
youth away from cigarettes.[31] A 2014 review raised ethical concerns about minors' ecigarette use and the potential to weaken cigarette smoking reduction efforts.[53]
In the US, the recent fall in smoking has accompanied a rapid growth in the use of
alternative nicotine products among young people and young adults.[54] 56% of
respondents in a US 2013 survey admitted having used e-cigarettes to quit or reduce
their smoking, and 26% of respondents would use them in areas where smoking was
banned.[13] In the US, as of 2014, 12.6% of adults have used an e-cigarette at least
once and about 3.7% are still using them.[55] Among grade 6 to 12 students in the US,
the proportion who have tried them rose from 3.3% in 2011 to 6.8% in 2012.[48] Those
still vaping over the last month rose from 1.1% to 2.1% and dual use rose from 0.8%
to 1.6%.[48] Over the same period the proportion of grade 6 to 12 students who
regularly smoke tobacco fell from 7.5% to 6.7%.[56]
Use frequency has risen: as of 2012, up to 10% of American high school students
have used them.[48] In 2013 the Centers for Disease Control and Prevention (CDC)
estimated that around 160,000 students between 2011 to 2012 who had tried vaping
had never smoked.[54] Between 2013 and 2014, vaping among students tripled.[57] The
majority of young people who vape also smoke.[58] E-cigarette use among neversmoking youth in the US correlates with elevated desires to use traditional cigarettes.
[12]
About one in 20 adults in the UK uses e-cigarettes.[59] In the UK in 2015, 18% of

regular smokers said they used e-cigarettes and 59% said they had used them in the
past.[35] Among those who had never smoked, 1.1% said they had tried them and 0.2%
still use them.[60] In 2013, among those under 18, 7% have used e-cigarettes at least
once.[60] Among non-smokers' children, 1% reported having tried e-cigarettes "once or
twice", and there was no evidence of continued use.[60] About 60% of all users are
smokers and most of the rest are ex-smokers, with "negligible" numbers of neversmokers.[61] In 2015 figures showed around 2% monthly EC-usage among under-18s,
and 0.5% weekly, and despite experimentation, "nearly all those using EC regularly
were cigarette smokers".[62] 10-11-year-old Welsh never-smokers are more likely to
use e-cigarettes if a parent used e-cigarettes.[63]
Play media
National Institute on Drug Abuse director Nora Volkow discussing a National
Institutes of Health-funded study showing teens using e-cigarettes are more likely to
start smoking tobacco.[64]
In France, a 2014 survey estimated between 7.7 and 9.2 million people had tried ecigarettes and 1.1 to 1.9 million use them on a daily basis.[65] The same survey also
found 67% of smokers used e-cigarettes to reduce or quit smoking. Of respondents
who indicated they tried e-cigarettes, 9% said they had never smoked tobacco.[65] Of
the 1.2% who had recently stopped tobacco smoking at the time of the survey, 84%
(or 1% of the population surveyed) credited e-cigarettes as essential in quitting.[65]
Many young people who use e-cigarettes also smoke tobacco.[6] Some young people
who have tried an e-cigarette have never smoked tobacco, so ECs can be a starting
point for nicotine use.[6] There are high levels of dual use with e-cigarettes and
traditional cigarettes.[28] Some young people who have never smoked have tried ecigarettes at least once.[48] Most young people are not using e-cigarettes to help them
quit tobacco.[48] Teenagers who had used an e-cigarette were more inclined to become
smokers than those who had not.[66] Young people who vape are more likely to use
hookah and blunts than smokers.[23]
Motivation
There are concerns that colorful electronic cigarettes may appeal especially to
younger users.[67]
Candy, fruit and coffee flavored e-liquid may appeal to younger users of electronic
cigarettes.[68][69]
Reasons for e-cigarette usage often relate to quitting cigarettes, relaxation, and
recreation.[5][7] While many vapers believe usage is healthier than smoking for
themselves and bystanders, some are concerned about the possible adverse health
effects.[7] Others use them to circumvent smoke-free laws and policies, or to cut back
on cigarette smoking.[6] Not having odor from smoke on clothes on some occasions
prompted interest in or use of e-cigarettes.[7] E-cigarette users have contradictory
views about using them to get around smoking bans.[7]
Users sometimes use e-cigarettes without nicotine around friends for the convenience.
[70]
Non-smoking adults tried e-cigarettes due to curiosity, because a relative was using
them, or because they were given an e-cigarette.[23] College students often vape for
experimentation.[2] Expensive marketing aimed at smokers suggests e-cigarettes are
"newer, healthier, cheaper and easier to use in smoke-free situations, all reasons that
e-cigarette users claim motivate their use".[71] Exposure to e-cigarette advertising
influenced people to try them.[66]
If tobacco businesses persuade women that e-cigarettes are a small risk, women might
vape while pregnant.[72] The belief that e-cigarettes are safer than traditional cigarettes
could widen their use among pregnant women.[12] E-cigarettes feel or taste similar to
traditional cigarettes, and vapers disagreed about whether this was a benefit or a
drawback.[7] The majority of committed e-cigarette users interviewed at an e-cigarette

convention found them cheaper than traditional cigarettes.[7]
Some users stopped vaping due to issues with the devices.[7] Dissatisfaction and
concerns over safety can discourage ongoing e-cigarette use.[59] Some surveys found
that a small percentage of users' motives were to avoid smoking bans, but other
surveys found that over 40% of users said they used the device for this reason.[7] The
extent to which traditional cigarette users vape to avoid smoking bans is unclear.[7]
The health and lifestyle appeal may also encourage young non-smokers to use ecigarettes, as they may perceive that trying e-cigarettes is less risky and more socially
appealing. This may ameliorate negative beliefs or concerns about nicotine addiction.
[73]
Marketing might appeal to young people as well as adults.[74] Adolescent
experimenting with e-cigarettes may be sensation seeking behavior, and is not likely
to be associated with tobacco reduction or quitting smoking.[12] Young people may
view e-cigarettes as a symbol of rebellion.[49] The main reasons young people
experimented with e-cigarettes were due to curiosity, flavors, and peer influences.[75]
Some advocates say there is concern that e-cigarettes could be appealing to youth
because of their high-tech design, assortment of flavors, and accessibility online.[67] At
least one advocacy group claims that candy and fruit flavors e-cigarettes are designed
to appeal to young people.[76] Infants and toddlers could ingest the e-liquid from an ecigarette device out of curiosity.[77]
Users may begin by using a disposable e-cigarette,[24] and e-cigarette users often start
with e-cigarettes resembling normal cigarettes, eventually moving to a latergeneration device.[78] Most later-generation e-cigarette users shifted to their present
device to get a "more satisfying hit",[78] and users may adjust their devices to provide
more vapor for better "throat hits".[52]
Other uses
Electronic cigarettes may be used with other substances and cartridges can potentially
be filled with e-liquid containing substances other than nicotine, thus serving as a new
and potentially dangerous way to deliver other drugs,[79] for example psychoactive or
psychotropic drugs such as THC.[80]
The emergence of e-cigs has given cannabis smokers a new method of inhaling
cannabinoids.[80] E-cigs differ from traditional marijuana cigarettes in several respects.
[80]
It is assumed that vaporizing cannabinoids at lower temperatures is safer because it
produces smaller amounts of toxic substances than the hot combustion of a marijuana
cigarette.[80] Recreational cannabis users can discretely vape deodorized cannabis
extracts with minimal annoyance to the people around them and less chance of
detection, known as "stealth vaping".[80] While cannabis is not readily soluble in the
liquid used for e-cigs; recipes containing synthetic cannabinoids which are soluble
may be found on the Internet.[80]
Cannabinoid-enriched e-liquids require lengthy, complex processing, some being
readily present on the Internet despite lack of quality control, expiry date, conditions
of preservation, or any toxicological and clinical assessment.[80]
The health consequences specific to vaping these cannabis preparations remain

largely unknown.[80]
Construction
Exploded view of electronic cigarette with transparent clearomizer and changable

dual-coil head. This model allows for a wide range of settings.[81]
Electronic cigarettes can come in very different formssuch as this hand-grenadeshaped variant.
Main article: Construction of electronic cigarettes
The primary parts that make up an e-cigarette are a mouthpiece, a cartridge (tank), a
heating element/atomizer, a microprocessor, a battery, and possibly a LED light on the
end.[82] The only exception to this are mechanical e-cigarettes (mods) which contain
no electronics and the circuit is closed by using a mechanical action switch.[83] An
atomizer comprises a small heating element that vaporizes e-liquid and wicking
material that draws liquid onto the coil.[84] When the user pushes a button,[2] or (in
some variations) activates a pressure sensor by inhaling, the heating element that
atomizes the liquid solution;[5] The e-liquid reaches a temperature of roughly 100250 C within a chamber to create an aerosolized vapor.[85] The user inhales the
aerosol, commonly called vapor, rather than cigarette smoke.[3] The aerosol provides a
flavor and feel similar to tobacco smoking.[1]
There are three main types of e-cigarettes: cigalikes, looking like cigarettes; eGos,
bigger than cigalikes with refillable liquid tanks; and mods, assembled from basic
parts or by altering existing products.[12] As the e-cigarette industry is growing, new
products are quickly developed and brought to market.[86] First generation e-cigarettes
tend to look like tobacco cigarettes and so are called "cigalikes".[10] Most cigalikes
look like cigarettes but there is some variation in size.[87] A traditional cigarette is
smooth and light while a cigalike is rigid and slightly heavier.[1] Second generation
devices are larger overall and look less like tobacco cigarettes.[9] Third generation
devices include mechanical mods and variable voltage devices.[10] The fourth
generation includes Sub ohm tanks and temperature control devices.[11] The power
source is the biggest component of an e-cigarette,[34] which is frequently a
rechargeable lithium-ion battery.[88]
Health effects
Positions of medical organizations
Main article: Positions of medical organizations on electronic cigarettes
2014 Centers for Disease Control (CDC) press release concerning e-cigarettes.[89]
Physicians and public health officials have been concerned about the health
implications of e-cigarette use. Numerous medical organizations have made
statements about their health and safety. All agree that more research is needed. Some
healthcare groups have hesitated to recommend e-cigarettes for quitting smoking,
because of limited evidence of effectiveness and safety.[17] In July 2014, a report
produced by the World Health Organization (WHO) found there was not enough
evidence to determine if electronic cigarettes could help people quit smoking,[21]
suggesting smokers be encouraged to use approved methods for help with quitting.[21]
The same report also notes expert opinion which suggests e-cigarettes have a role in
helping those who have failed to quit by other means.[21] Smokers will get the
maximum health benefit if they completely quit all nicotine use.[21] The World Lung
Foundation has applauded the WHO report's recommendation of tighter regulation
due to safety concerns and the risk of increased nicotine or tobacco addiction among
youth.[90]
In a 2015 joint statement, Public Health England and twelve other UK medical bodies
concluded "e-cigarettes are significantly less harmful than smoking."[91] PHE also
stated that e-cigarettes are estimated to be 95% less harmful than smoking,[92] and that
"...[it] looks forward to the arrival on the market of a choice of medicinally regulated
products that can be made available to smokers by the NHS on prescription."[93] The
UK National Health Service followed with the statement that e-cigarettes have
approximately 5% of the risk of tobacco cigarettes,[94] while also concluding that there
won't be a complete understanding of their safety for many years.[94] As of 2014 there
are clinical trials in progress to test the quality, safety and effectiveness of ecigarettes, but until these are complete the NHS maintains that the government could
not give any advice on them or to recommend their use.[95]
The United States Centers for Disease Control and Prevention released a 2016 report
titled E-cigarette Ads and Youth which concerned marketing towards adolescents.[96]
In 2015 the American Academy of Pediatrics strongly recommended against using ecigarettes to quit smoking, stating that for adolescents e-cigarettes are not effective in
treating tobacco dependence.[97] In August 2014, the American Heart Association
released a policy statement in which they support "effective FDA regulation of ecigarettes that addresses marketing, youth access, labeling, quality control over
manufacturing, free sampling, and standards for contaminants."[8] In 2015 the
California Department of Public Health issued a report that stated the "aerosol has
been found to contain at least ten chemicals that are on Californias Proposition 65 list
of chemicals known to cause cancer, birth defects, or other reproductive harm."[98] In
2014, the US FDA said "E-cigarettes have not been fully studied, so consumers
currently don't know: the potential risks of e-cigarettes when used as intended, how
much nicotine or other potentially harmful chemicals are being inhaled during use, or
whether there are any benefits associated with using these products. Additionally, it is
not known whether e-cigarettes may lead young people to try other tobacco products,
including conventional cigarettes, which are known to cause disease and lead to
premature death."[99]
Smoking cessation
Play media
CDC launches "Tips From Former Smokers" ad campaign in 2015. The main
information on e-cigarettes begins at 24:45.[100]
The available research on the safety and efficacy of e-cigarette use for smoking
cessation is limited and the evidence is contradictory. Some medical authorities
recommend that e-cigarettes have a role in smoking cessation, and others disagree.
Views of e-cigarettes' role range from on the one hand Public Health England, who
recommend that stop-smoking practitioners should:- (1) advise people who want to
quit to try e-cigarettes if they are not succeeding with conventional nicotine
replacement therapy (NRT); and (2) advise people who cannot or do not want to quit
to switch to e-cigarettes to reduce smoking-related disease[91] to, on the other hand, the
United States Preventive Services Task Force that advised only use of conventional
NRT products in smoking cessation and found insufficient evidence to recommend ecigarettes for this purpose.[13]
There is tentative evidence that they can help people quit smoking.[17] A 2016 metaanalysis based on 20 different studies found that those smokers who had used
electronic cigarettes were 28% less likely to quit than those who had not tried
electronic cigarettes.[101] This finding persisted whether not the smokers where initially
interested in quitting or not.[101] A 2015 meta-analysis on clinical trials of e-cigarettes
for smoking cessation found that e-cigarettes containing nicotine are more effective
than those that do not. They compared their finding that nicotine-containing ecigarettes helped 20% of people quit with the results from other studies that found
conventional NRT helps 10% of people quit.[102] There has only been one study
directly comparing first generation e-cigarettes to conventional NRT as smoking
cessation tools so the comparative effectiveness is not known.[102]
However, e-cigarettes have not been subject to the same efficacy testing as nicotine
replacement products. Several authorities, including the World Health Organisation,
take the view that there is not enough evidence to recommend e-cigarettes for quitting
smoking in adults,[13] and there are studies showing a decline in smoking cessation
among dual users.[101] A 2014 review found that e-cigarettes do not seem to improve
cessation rates compared to regulated nicotine replacement products, and a trial found
29% of e-cigarette users were still vaping at 6 months, but only 8% of patch users still
wore patches at 6 months.[48]
Harm reduction
Tobacco harm reduction (THR) is the replacement of tobacco cigarettes with lower
risk products to reduce tobacco related death and disease.[103] THR has been
controversial out of fear that tobacco companies cannot be trusted to produce and
market products that will reduce the risks associated with tobacco use.[104] E-cigarettes
can reduce smokers' exposure to carcinogens and other toxic substances found in
tobacco.[4][104] Tobacco smoke contains 100 known carcinogens, and 900 potentially
cancer causing chemicals,[19] none of which has been found in more than trace
quantities in the cartridges or aerosol of e-cigarettes.[104] According to a 2011 review,
while e-cigarettes cannot be considered "safe" because there is no safe level for
carcinogens, they are doubtless safer than tobacco cigarettes.[104]
However, some reviews have concluded that the benefits and the health risks of ecigarettes are uncertain,[12][13][14] and the long-term health effects are unknown.[2][5]
A core concern is that smokers who could have quit completely will develop an
alternative nicotine addiction instead.[104] A 2014 review stated that promotion of
vaping as a harm reduction aid is premature,[18] but in an effort to decrease tobacco
related death and disease, e-cigarettes have a potential to be part of the harm reduction
strategy.[19][20] Another review found e-cigarettes would likely be less harmful than
traditional cigarettes to users and bystanders.[16] The authors warned against the
potential harm of excessive regulation and advised health professionals to consider
advising smokers who are reluctant to quit by other methods to switch to e-cigarettes
as a safer alternative to smoking.[16] A 2015 Public Health England report concluded
that e-cigarettes "release negligible levels of nicotine into ambient air with no
identified health risks to bystanders".[105] A 2014 review recommended that regulations
for e-cigarettes could be similar to those for dietary supplements or cosmetic products
to not limit their potential for harm reduction.[38] A 2012 review found e-cigarettes
could considerably reduce traditional cigarettes use and they likely could be used as a
lower risk replacement for traditional cigarettes, but there is not enough data on their
safety and efficacy to draw definite conclusions.[1] E-cigarette use for risk reduction in
high-risk groups such as people with mental disorders is unavailable.[106]
A 2014 Public Health England report concluded that there is large potential for health
benefits when switching from tobacco use to other nicotine delivery devices such as
e-cigarettes, but realizing their full potential requires regulation and monitoring to
minimize possible risks.[30] They found that a considerable number of smokers want to
reduce harm from smoking by using these products.[30] The British Medical
Association encourages health professionals to recommend conventional nicotine
replacement therapies, but for patients unwilling to use or continue using such
methods, health professionals may present e-cigarettes as a lower-risk option than
tobacco smoking.[107] The American Association of Public Health Physicians
(AAPHP) suggests those who are unwilling to quit tobacco smoking or unable to quit
with medical advice and pharmaceutical methods should consider other nicotine
containing products such as electronic cigarettes and smokeless tobacco for long term
use instead of smoking.[108] In an interview, the director of the Office on Smoking and
Health for the U.S. federal agency Centers for Disease Control and Prevention (CDC)
believes that there is enough evidence to say that using e-cigarettes is likely less
harmful than smoking a pack of conventional cigarettes.[109] However, due to the lack
of regulation of the contents of e-cigarettes and the presence of nicotine, the CDC has
issued warnings.[109] A 2014 WHO report concluded that some smokers will switch
completely to e-cigarettes from traditional tobacco but a "sizeable" number will use
both.[21] This report found that such "dual use" of e-cigarettes and tobacco "will have
much smaller beneficial effects on overall survival compared with quitting smoking
completely."[21]
Safety
Main articles: Safety of electronic cigarettes and Electronic cigarette aerosol and eliquid
Adverse effects of vaping.[110]

The safety of electronic cigarettes is uncertain.[12][13][14] There is little data about their
health effects,[111] and considerable variability between vaporizers and in quality of
their liquid ingredients and thus the contents of the aerosol delivered to the user.[6][112]
[113]
Reviews on the safety of electronic cigarettes have reached different conclusions.
[114]
In July 2014 the World Health Organization (WHO) report cautioned about
potential risks of using e-cigarettes.[21] Regulated US Food and Drug Administration
(FDA) products such as nicotine inhalers are probably safer than e-cigarettes.[18] In
2015, Public Health England stated that e-cigarettes are estimated to be 95% less
harmful than smoking,[92] A 2014 systematic review concluded that the risks of ecigarettes have been exaggerated by health authorities and stated that while there may
be some remaining risk, the risk of e-cigarette use is likely small compared to
smoking tobacco.[27]
The long-term effects of e-cigarette use are unknown.[2][5] A 2014 Cochrane review
found no serious adverse effects reported in trials.[17] Less serious adverse effects from
e-cigarette use include throat and mouth inflammation, vomiting, nausea, and cough.
[6]
The evidence suggests they produce less harmful effects than tobacco.[115] A 2014
WHO report said, "ENDS use poses serious threats to adolescents and fetuses."[21]
Aside from toxicity, there are also risks from misuse or accidents[27] such as contact
with liquid nicotine,[116] fires caused by vaporizer malfunction,[6] and explosions as
result from extended charging, unsuitable chargers, or design flaws.[27] Battery
explosions are caused by an increase in internal battery temperature and some have
resulted in severe skin burns.[12] There is a small risk of battery explosion in devices
modified to increase battery power.[85]
The e-liquid has a low level of toxicity, and contamination with various chemicals has
been identified in the product.[117] E-cigarette vapor contains fewer toxic substances,[6]
and lower concentrations of potential toxic substances than cigarette smoke.[118] Metal
parts of e-cigarettes in contact with the e-liquid can contaminate it with metals.[27]
Normal usage of e-cigarettes generates very low levels of formaldehyde.[119] A 2015
review found that later-generation e-cigarettes set at higher power may generate equal
or higher levels of formaldehyde compared to smoking.[120][121] A 2015 review found
that these levels were the result of overheating under test conditions that bear little
resemblance to common usage.[119] The 2015 Public Health England report looking at
the research concluded that by applying maximum power and increasing the time the
device is used on a puffing machine, e-liquids can thermally degrade and produce
high levels of formaldehyde.[31] Users detect the "dry puff" and avoid it, and the report
concluded that "There is no indication that EC users are exposed to dangerous levels
of aldehydes."[31] E-cigarette users are exposed to potentially harmful nicotine.[3]
Nicotine is associated with cardiovascular disease, potential birth defects, and
poisoning.[22] In vitro studies of nicotine have associated it with cancer, but
carcinogenicity has not been demonstrated in vivo.[22] There is inadequate research to
demonstrate that nicotine is associated with cancer in humans.[122] The risk is probably
low from the inhalation of propylene glycol and glycerin.[16] No information is
available on the long-term effects of the inhalation of flavors.[117]
E-cigarettes create vapor that consists of ultrafine particles, with the majority of
particles in the ultrafine range.[6] The vapor has been found to contain flavors,
propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy
metals, and metal nanoparticles, and other chemicals.[6][16] Exactly what comprises the
vapor varies in composition and concentration across and within manufacturers.[3]
However, e-cigarettes cannot be regarded as simply harmless.[26] There is a concern
that some of the mainstream vapor exhaled by e-cigarette users can be inhaled by
bystanders, particularly indoors.[34] E-cigarette use by a parent might lead to
inadvertent health risks to offspring.[72] A 2014 review recommended that e-cigarettes

should be regulated for consumer safety.[38] There is limited information available on
the environmental issues around production, use, and disposal of e-cigarettes that use
cartridges.[123] A 2014 review found "disposable e-cigarettes might cause an electrical
waste problem."[106]
E-liquid
E-liquid is the mixture used in vapor products such as e-cigarettes[19] and generally
consists of propylene glycol, glycerin, water, nicotine, and flavorings.[20] While the
ingredients vary[17][19][24] the liquid typically contains 95% propylene glycol and
glycerin.[124] There are many e-liquids manufacturers in the USA and worldwide,[125]
and upwards of 8,000 flavors.[43] While there are currently no US Food and Drug
Administration (FDA) manufacturing standards for e-liquid, the FDA has proposed
regulations that are expected to be finalized in late 2015.[125] Industry standards have
been created and published by the American E-liquid Manufacturing Standards
Association (AEMSA).[126]
Addiction
Nicotine, a key ingredient in e-liquids, is a highly addictive substance, on a level
comparable to heroin and cocaine.[98] Nicotine induces strong effects on the brain,
which lead to considerable changes in the brains physiology such as stimulation in
regions of the cortex associated with reward, pleasure and reducing anxiety.[85] When
nicotine intake stops, withdrawal symptoms include cravings for nicotine,
anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness,
hunger or weight gain, and difficulty concentrating.[49][127] It is not clear whether ecigarette use will decrease or increase overall nicotine addiction,[111] but the nicotine
content in e-cigarettes is adequate to sustain nicotine dependence.[128]
The World Health Organization has raised concern about addiction for non-smokers,
[21]
and the National Institute on Drug Abuse said e-cigarettes could maintain nicotine
addiction in those who are attempting to quit.[129] The limited available data suggests
that the likelihood of abuse from e-cigarettes is smaller than traditional cigarettes.[130]
A 2014 systematic review found that the concerns that e-cigarettes could lead nonsmokers to start smoking are unsubstantiated.[27] No long-term studies have been done
on the effectiveness of e-cigarettes in treating tobacco addiction,[18] but some evidence
suggests that dual use of e-cigarettes and traditional cigarettes may be associated with
greater nicotine dependence.[2]
Many studies have focused on young people in particular, since youthful
experimentation with e-cigarettes could lead to lifelong addiction.[66] Various
organizations, including the UATLD, the AAP and the FDA, have expressed concern
that e-cigarette use could increase nicotine addiction in youth.[109][129][131][132][133][134][135]
Although regular use of e-cigarettes is generally very low by people who have never
smoked,[16] significant numbers of teenagers who have never smoked tobacco have
experimented with e-cigarettes.[6] The degree to which teens are using e-cigarettes in
ways the manufacturers did not intend, such as increasing the nicotine delivery, is
unknown,[116] as is the extent to which e-cigarette use will lead to addiction or
substance dependence in youth.[116]
Nicotine yield
Smoking a traditional cigarette yields between 0.5 and 1.5 mg of nicotine,[128] but the
nicotine content of the cigarette is only weakly correlated with the levels of nicotine
in the smoker's bloodstream.[136] The amount of nicotine in the e-cigarette aerosol
varies widely either from puff-to-puff or among products of the same company.[3] In
practice e-cigarette users tend to reach lower blood nicotine concentrations than
smokers, particularly when the users are inexperienced or using earlier-generation
devices.[10] Nicotine in tobacco smoke is absorbed into the bloodstream rapidly, and ecigarette vapor is relatively slow in this regard.[10] The concentration of nicotine in eliquid ranges up to 36 mg/mL.[30] New EU regulations cap this at a maximum of 2%
(20 mg/mL), but this is an arbitrary ceiling based on limited data.[12] In practice the
nicotine concentration in an e-liquid is not a reliable guide to the amount of nicotine
that reaches the bloodstream.[30]
History
The earliest e-cigarette can be traced to American Herbert A. Gilbert,[137] who in 1963
patented "a smokeless non-tobacco cigarette" that involved "replacing burning
tobacco and paper with heated, moist, flavored air".[138][139] This device produced
flavored steam without nicotine.[139] The patent was granted in 1965.[140] Gilberts
invention was ahead of its time.[141] There were prototypes, but it received little
attention[142] and was never commercialized[139] because smoking was still fashionable
at that time.[143] Gilbert said in 2013 that today's electric cigarettes follow the basic
design set forth in his original patent.[140]
Hon Lik, a Chinese pharmacist and inventor who worked as a research pharmacist for
a company producing ginseng products, is credited with the invention of the modern
e-cigarette.[32] Lik quit smoking after his father, also a heavy smoker, died of lung
cancer.[32] In 2001, he thought of using a high frequency, piezoelectric ultrasoundemitting element to vaporize a pressurized jet of liquid containing nicotine.[144] This
design creates a smoke-like vapor.[32] Lik said that using resistance heating obtained
better results and the difficulty was to scale down the device to a small enough size.
[144]
Liks invention was intended to be an alternative to smoking.[144]
The Ruyan e-cigar was first launched in China in 2004.

Hon Lik registered a patent for the modern e-cigarette design in 2003.[144] The ecigarette was first introduced to the Chinese domestic market in 2004.[32] Many
versions made their way to the U.S., sold mostly over the Internet by small marketing
firms.[32] E-cigarettes entered the European market and the US market in 2006 and
2007.[7] The company that Lik worked for, Golden Dragon Holdings, registered an
international patent in November 2007.[145] The company changed its name to Ruyan
(, literally "Resembling smoking") later the same month[146] and started exporting
its products.[32] Many US and Chinese e-cig makers copied his designs illegally, so Lik
has not received much financial reward for his invention (although some US
manufacturers have compensated him through out of court settlements).[147] Ruyan
later changed its company name to Dragonite International Limited.[146] Most ecigarettes today use a battery-powered heating element rather than the earlier
ultrasonic technology design.[8]
When e-cigarettes entered the international market, some users were dissatisfied with
their performance,[148][149] and the e-cigarette continued to evolve from the first
generation three-part device.[87] In 2007 British entrepreneurs Umer and Tariq Sheikh
invented the cartomizer.[150] This is a mechanism that integrates the heating coil into
the liquid chamber.[150] They launched this new device in the UK in 2008 under their
Gamucci brand,[149] and the design is now widely adopted by most "cigalike" brands.
[87]
Other users tinkered with various parts to produce more satisfactory homemade
devices, and the hobby of "modding" was born.[148] The first mod to replace the ecigarette's case to accommodate a longer-lasting battery, dubbed the "screwdriver",
was developed by Ted and Matt Rogers[148] in 2008.[88] Other enthusiasts built their
own mods to improve functionality or aesthetics.[148] When pictures of mods appeared
at online vaping forums many people wanted them, so some mod makers produced
more for sale.[148]
The demand for customizable e-cigarettes prompted some manufacturers to produce
devices with interchangeable components that could be selected by the user.[88] In
2009, Joyetech developed the eGo series[150] which offered the power of the
screwdriver model and a user-activated switch to a wide market.[88] The clearomizer
was invented in 2009.[150] Originating from the cartomizer design, it contained the
wicking material, an e-liquid chamber, and an atomizer coil within a single clear
component.[150] The clearomizer allows the user to monitor the liquid level in the
device.[150] Soon after the clearomizer reached the market, replaceable atomizer coils
and variable voltage batteries were introduced.[150] Clearomizers and eGo batteries
became the best-selling customizable e-cigarette components in early 2012.[88]
Tobacco company
Imperial Tobacco
British American Tobacco
R. J. Reynolds Tobacco
Company
Altria[note 2]
Japan Tobacco International
Subsidiary company
Fontem Ventures and
Dragonite
CN Creative and
Nicoventures
R. J. Reynolds Vapor
Company
Nu Mark, LLC
Ploom
Electronic cigarette
Puritane[23] blu
eCigs[151]
Vype[23]
Vuse[23]
MarkTen[23]
E-lites[23] LOGIC[152]
International tobacco companies dismissed e-cigarettes as a fad at first.[153] However,

recognizing the development of a potential new market sector that could render
traditional tobacco products obsolete,[154] they began to produce and market their own
brands of e-cigarettes and acquire existing e-cigarette companies.[155] blu eCigs, a
prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. in 2012.[156]

British American Tobacco launched Vype in 2013, while Imperial Tobacco's Fontem
Ventures acquired the intellectual property owned by Hon Lik through Dragonite
International Limited for $US 75 million in 2013 and launched Puritane in partnership
with Boots UK.[157] On 1 October 2013 Lorillard Inc. acquired another e-cigarette
company, this time the UK based company SKYCIG.[158] SKY was rebranded as blu.
[159]
On 3 February 2014, Altria Group, Inc. acquired popular electronic cigarette
brand Green Smoke for $110 million.[160] The deal was finalized in April 2014 for
$110 million with $20 million in incentive payments.[160] Altria also markets its own ecigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse
product.[155] On 30 April 2015, Japan Tobacco bought the US Logic e-cigarette brand.
[152]
Japan Tobacco also bought the UK E-Lites brand in June 2014.[152] On 15 July
2014, Lorillard sold blu to Imperial Tobacco as part of a deal for $7.1 billion.[151]
Society and culture

Consumers of e-cigarettes, sometimes called "vapers", have shown passionate support
for the device that other nicotine replacement therapy did not receive.[30][161] This
suggests e-cigarettes have potential mass appeal that could challenge combustible
tobacco's market position.[30]
As the electronic cigarette industry grows, a subculture has emerged which calls itself
"the vaping community".[161][162] The online forum E-Cig-Reviews.com was one of the
first major communities.[148] Another online forum known as UKVaper.org was the
origin of the hobby of modding.[148] There are also groups on Facebook and Reddit.[163]
Members of this emerging subculture often see e-cigarettes as a safer alternative to
smoking[16] and some view it as a hobby.[164] These groups tend to use highly
customized devices that do not resemble the earlier "cig-a-likes".[165] Online forums
based around modding have grown in the vaping community.[166] Vapers energetically
embrace activities associated with e-cigarettes and sometimes act as unpaid
evangelicals according to a 2014 review.[52] A 2014 Postgraduate Medical Journal
editorial stated that e-cigarette companies have a substantial online presence, as well
as many individual vapers who blog and tweet about e-cigarette related products.[167]
The editorial stated that vapers "also engage in grossly offensive online attacks on
anyone who has the temerity to suggest that ENDS are anything other than an
innovation that can save thousands of lives with no risks".[167] A 2014 review stated
that tobacco and e-cigarette companies interact with consumers for their policy
agenda.[6] The companies use websites, social media, and marketing to get consumers
involved in opposing bills that include e-cigarettes in smoke-free laws.[6] The same
review said this is similar to tobacco industry activity going back to the 1980s.[6]
These approaches were used in Europe to minimize the EU Tobacco Product
Directive in October 2013.[6] True grassroots lobbying also influenced the TPD
decision.[168] Rebecca Taylor, a member of the European Parliament, stated, "to say its
an orchestrated campaign is absolute rubbish."[168]
E-cigarette user blowing a cloud of aerosol (vapor). The activity is known as cloudchasing.[169]
Large gatherings of vapers, called vape meets, take place around the US.[161] They
focus on e-cig devices, accessories, and the lifestyle that accompanies them.[161]
Vapefest, which started in 2010, is an annual show hosted by different cities.[163]
People attending these meetings are usually enthusiasts that use specialized,
community-made products not found in convenience stores or gas stations.[161] These
products are mostly available online or in dedicated "vape" storefronts where
mainstream e-cigarettes brands from the tobacco industry and larger e-cig
manufacturers are not as popular.[170] Some vape shops have a vape bar where patrons
can test out different e-liquids and socialize.[171] The Electronic Cigarette Convention
in North America which started in 2013, is an annual show where companies and
consumers meet up.[172] As of 2014, e-cigarette availability in US stores is increasing,
especially in places with low taxes and smoking bans.[173] In the US they are more
likely available in places with a higher median family income.[8]
A growing subclass of vapers called "cloud-chasers" configure their atomizers to
produce large amounts of vapor by using low-resistance heating coils.[174] This
practice is called "cloud-chasing"[175] and is growing more popular.[176] By using a coil
with very low resistance, the batteries are stressed to a potentially unsafe extent.[175]
This could present a risk of dangerous battery failures.[175] As vaping comes under
increased scrutiny, some members of the vaping community have voiced their
concerns about cloud-chasing, claiming the practice gives vapers a bad reputation
when doing it in public.[177] The Oxford Dictionaries' word of the year for 2014 is
"vape".[178]
Regulation
Main articles: Regulation of electronic cigarettes and List of vaping bans in the
United States
A no smoking or vaping sign from the US.
Regulation of e-cigarettes varies across countries and states, ranging from no

regulation to banning them entirely.[39] As of 2015, around two thirds of major nations
have regulated e-cigarettes in some way.[179] Because of the potential relationship with
tobacco laws and medical drug policies, e-cigarette legislation is being debated in
many countries.[38]
The legal status of e-cigarettes is currently pending in many countries.[6] Some
countries such Brazil, Singapore, the Seychelles, and Uruguay have banned ecigarettes.[6] In Canada, they are technically illegal to sell, as no nicotine-containing efluid is approved by Health Canada, but this is generally unenforced and they are
commonly available for sale Canada-wide.[180] In the US and the UK, the use and sale
of e-cigarettes are legal.[181][182]
In February 2014 the European Parliament passed regulations requiring
standardization and quality control for liquids and vaporizers, disclosure of
ingredients in liquids, and child-proofing and tamper-proofing for liquid packaging.[40]
[183]
In April 2014 the US FDA published proposed regulations for e-cigarettes along
similar lines.[184][185] In the US some states tax e-cigarettes as tobacco products, and
some state and regional governments have broadened their indoor smoking bans to
include e-cigarettes.[71] As of 9 October 2015, at least 48 states and 2 territories
banned e-cigarette sales to minors.[186]
E-cigarettes have been listed as drug delivery devices in several countries because
they contain nicotine, and their advertising has been restricted until safety and
efficacy clinical trials are conclusive.[187] Since they do not contain tobacco, television
advertising in the US is not restricted.[188] Some countries have regulated e-cigarettes
as a medical product even though they have not approved them as a smoking
cessation aid.[189] As of 2014 electronic cigarettes had not been approved as a smoking
cessation device by any government.[21] A 2014 review stated the emerging
phenomenon of e-cigarettes has raised concerns in the health community,
governments, and the general public and recommended that e-cigarettes should be
regulated to protect consumers.[38] It added, "heavy regulation by restricting access to
e-cigarettes would just encourage continuing use of much unhealthier tobacco
smoking." [38] A 2014 review said these products should be considered for regulation
in view of the "reported adverse health effects".[189]
Marketing
Adolescents are exposed to electronic cigarette marketing in a number of ways, many

of which are not available to traditional cigarettes.[96]
A 2014 review said, "the e-cigarette companies have been rapidly expanding using
aggressive marketing messages similar to those used to promote cigarettes in the
1950s and 1960s."[6] E-cigarettes and nicotine are regularly promoted as safe and
beneficial in the media and on brand websites.[72] While advertising of tobacco
products is banned in most countries, television and radio e-cigarette advertising in
some countries may be indirectly encouraging traditional cigarette smoking.[6] There
is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to
phase out traditional cigarettes, despite some claiming to want to cooperate in "harm
reduction".[6] In the US, six large e-cigarette businesses spent $59.3 million on
promoting e-cigarettes in 2013.[190] Easily circumvented age verification at company
websites enables young people to access and be exposed to marketing for e-cigarettes.
[73]
A national US television advertising campaign starred Steven Dorff exhaling a "thick

flume" of what the ad describes as "vapor, not tobacco smoke", exhorting smokers
with the message "We are all adults here, it's time to take our freedom back."[191] The
ads, in a context of longstanding prohibition of tobacco advertising on TV, were
criticized by organizations such as Campaign for Tobacco-Free Kids as undermining
anti-tobacco efforts.[191] Cynthia Hallett of Americans for Non-Smokers' Rights
described the US advertising campaign as attempting to "re-establish a norm that
smoking is okay, that smoking is glamorous and acceptable".[191] University of
Pennsylvania communications professor Joseph Cappella stated that the setting of the
ad near an ocean was meant to suggest an association of clean air with the nicotine
product.[191] In 2012 and 2013, e-cigarette companies advertised to a large television
audience in the US which included 24 million youth.[192] The channels on which ecigarette advertising reached the largest numbers of youth (ages 1217) were AMC,
Country Music Television, Comedy Central, WGN America, TV Land, and VH1.[192]
A 2014 review said e-cigarettes are aggressively promoted, mostly via the internet, as
a healthy alternative to smoking in the US.[34] Celebrity endorsements are used to
encourage e-cigarette use.[74] "Big tobacco" markets e-cigarettes to young people,[193]
with industry strategies including cartoon characters and candy flavors to sell ecigarettes.[194] E-cigarette companies commonly promote that their products contain
only water, nicotine, glycerin, propylene glycol, and flavoring but this assertion is
misleading as scientists have found differing amounts of heavy metals in the vapor,
including chromium, nickel, tin, silver, cadmium, mercury, and aluminum.[28] The
assertion that e-cigarette emit "only water vapor" is false because the evidence
indicates e-cigarette vapor contains possibly harmful chemicals such as nicotine,
carbonyls, metals, and organic volatile compounds, in addition to particulates.[118]
Economics
Vaping stand, London shopping centre.

As of 2014 the number of e-cigarettes sold has increased every year.[8] In 2015, a
slowdown in the growth in usage occurred in both the US and the UK[46][47] As of 2014
there were at least 466 e-cigarette companies.[50] Worldwide e-cigarette sales in 2014
were around US$7 billion.,[42] yet it is expected to continue to rise, and even exceed
traditional cigarette sales by 2047.[195] In the US, tobacco producers have a significant
share of the e-cigarette market,[196] and they are the major producers.[66]
The purchase of the US brand blu eCigs by US tobacco manufacturer Lorillard for
$135 million in April 2012 signaled the entry of tobacco companies into the market.
[191]
Tobacco companies have bought some e-cigarette businesses and greatly increased
their marketing efforts.[18] As of 2015 e-cigarette devices are mostly made in China.[33]
A 2015 review said there are more than a hundred small e-cigarette businesses in the
US, with about 70% of the market held by 10 businesses.[2] As of March 2015, 74% of
all e-cigarette sales in convenience stores in the U.S. were products made by tobacco
companies.[197] As of May 2015, 80% were products made by tobacco companies.[198]
A sizable share of the e-cigarette business is done on the internet.[34] The majority of ecigarette businesses have their own homepage and approximately 3050% of total ecigarettes sales are handled on the internet in respect to English-language websites.[34]
Canada is an expanding market for e-cigarettes.[199] There are numerous e-cigarette
retail shops in Canada.[200] In 2013, the company Smoke NV was the leading seller of
e-cigarette products in Canada.[201] Smoke NV does not sell vapor products containing
nicotine.[201]
The UK is a growing market for e-cigarettes.[74] Key e-cigarette businesses in the UK
in 2014 were British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid
Vapours.[202] British American Tobacco was the first tobacco business to sell ecigarettes in the UK.[203] They launched the e-cigarette Vype in July 2013.[203] Philip
Morris, the worlds largest tobacco firm, purchased UKs Nicocigs in June 2014.[204] In
the UK in 2015 the "most prominent brands of cigalikes" were owned by tobacco
companies, but except for one model all the tank types came from "non-tobacco
industry companies".[205] However some tobacco industry products, while using
prefilled cartridges, resemble tank models.[205] In March 2014 the top selling ecigarette brands in the UK at independent convenience stores were Nicolites and
Vivid Vapours.[206]
France is a growing market for e-cigarettes,[207] which is said to be about 100 million
(85 million) in sales as of 2013.[208] In 2013, there were about 150 e-cigarette retail
shops there.[208]
According to Nielsen Holdings, convenience store e-cigarette sales in the US went

down for the first time during the four-week period ending on 10 May 2014.[209] Wells
Fargo analyst Bonnie Herzog attributes this decline to a shift in consumers' behavior,
buying more specialized devices or what she calls "vapor/tank/mods (VTMs)" that are
not tracked by Nielsen.[209] According to Herzog these products, produced and sold by
stand alone makers are now (2014) growing twice as fast as traditional electronic
cigarettes marketed by the major players (Lorillard, Logic Technology, NJOY, etc.)[210]
Wells Fargo estimated that VTMs accounted for 57% of the 3.5 billion dollar market
in the US for vapor products in 2015.[211] In 2014, the Smoke-Free Alternatives Trade
Association estimated that there were 35,000 vape shops in the US, more than triple
the number a year earlier.[212]
Related technologies and alternatives

Other devices to deliver inhaled nicotine have been developed.[25] They aim to mimic
the ritual and behavioral aspects of traditional cigarettes.[25]
British American Tobacco, through their subsidiary Nicoventures Limited, licensed a
nicotine delivery system based on existing asthma inhaler technology from UK-based
healthcare company Kind Consumer Limited.[213] In September 2014 a product based
on this named Voke obtained approval from the United Kingdom's Medicines and
Healthcare Products Regulatory Agency.[214]
Philip Morris International (PMI) bought the rights to a nicotine pyruvate technology
developed by Jed Rose at Duke University.[215] The technology is based on the
chemical reaction between pyruvic acid and nicotine, which produces an inhalable
nicotine pyruvate vapor.[216]
PAX Labs has developed vaporizers that heats the leaves of tobacco to deliver
nicotine in a vapor.[217][218] On 1 June 2015, they introduced Juul a different type of ecigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to
an actual cigarette puff.[219]
BLOW started selling e-hookahs, an electronic version of the hookah, in 2014.[220]
Several companies including Canada's Eagle Energy Vapor are selling caffeine-based
e-cigarettes instead of nicotine.[221]
References
Footnotes
1.
Variously also known as ECs, e-cigs, e-cigarettes, personal vaporizers (PVs), or
electronic nicotine delivery systems (ENDS)
2.
Philip Morris International sells Altria's vaping products outside of
the US, while Altria only sells two e-cigarette brands in the US.
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External links
Media related to Electronic cigarettes at Wikimedia Commons
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Electronic cigarettes[note 1] are battery-powered vaporizers that simulate the feeling of

published proposed regulations in April 2014 with some similar measures.[41] As of

About one in 20 adults in the UK uses e-cigarettes.[59] In the UK in 2015, 18% of

drawback.[7] The majority of committed e-cigarette users interviewed at an e-cigarette

The health consequences specific to vaping these cannabis preparations remain

Exploded view of electronic cigarette with transparent clearomizer and changable

Adverse effects of vaping.[110]

inadvertent health risks to offspring.[72] A 2014 review recommended that e-cigarettes

The Ruyan e-cigar was first launched in China in 2004.

International tobacco companies dismissed e-cigarettes as a fad at first.[153] However,

prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. in 2012.[156]

Society and culture

A no smoking or vaping sign from the US.

Regulation of e-cigarettes varies across countries and states, ranging from no

Adolescents are exposed to electronic cigarette marketing in a number of ways, many

A national US television advertising campaign starred Steven Dorff exhaling a "thick

Vaping stand, London shopping centre.

According to Nielsen Holdings, convenience store e-cigarette sales in the US went

Related technologies and alternatives

and Smoking Cessation Efficacy.". Otolaryngologyhead and neck surgery : official

Farsalinos, K.E.; Polosa, R. (2014). "Safety evaluation and risk assessment of

(2014). "Electronic Cigarettes. A Position Statement of the Forum of International

"Stop smoking treatments". UK National Health Service. Retrieved 6

O'Connor, R.J. (March 2012). "Non-cigarette tobacco products: what have we

E-Liquid Manufacturing Standards (PDF). US: AMERICAN E-LIQUID

Michael Grothaus (1 October 2014). "Trading addictions: the inside story of

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Cite this page

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