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An electronic cigarette is an electronic device that simulates
tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...
. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of
smoke Smoke is a suspension of airborne particulates and gases emitted when a material undergoes combustion or pyrolysis, together with the quantity of air that is entrained or otherwise mixed into the mass. It is commonly an unwanted by-product ...
, the user inhales
vapor In physics, a vapor (American English) or vapour (British English and Canadian English; American and British English spelling differences#-our, -or, see spelling differences) is a substance in the gas phase at a temperature lower than its critic ...
. As such, using an e-cigarette is often called "vaping". The atomizer is a
heating element A heating element converts electrical energy into heat through the process of Joule heating. Electric current through the element encounters resistance, resulting in heating of the element. Unlike the Peltier effect, this process is independe ...
that vaporizes a
liquid solution In chemistry, a solution is a special type of homogeneous mixture composed of two or more substances. In such a mixture, a solute is a substance dissolved in another substance, known as a solvent. If the attractive forces between the solvent ...
called
e-liquid An electronic cigarette is a handheld battery-powered vaporizer that simulates smoking, but without tobacco combustion. E-cigarette components include a mouthpiece (drip tip), a cartridge (liquid storage area), a heating element/ atomizer, a mic ...
, which quickly cools into an aerosol of tiny droplets, vapor and air. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes, and most kinds are reusable. The vapor mainly comprises
propylene glycol Propylene glycol (IUPAC nomenclature, IUPAC name: propane-1,2-diol) is a viscous, colorless liquid, which is nearly odorless but possesses a faintly sweet taste. Its chemical formula is CH3CH(OH)CH2OH. Containing two Alcohol (chemistry), alcoho ...
and/or
glycerin Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids known ...
, usually with
nicotine Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
and
flavoring A flavoring (or flavouring), also known as flavor (or flavour) or flavorant, is a food additive used to improve the taste or smell of food. It changes the perceptual impression of food as determined primarily by the chemoreceptors of the gusta ...
. Its exact composition varies, and depends on several things including user behavior. Vaping is likely much less harmful than smoking. E-cigarette vapor contains fewer
toxin A toxin is a naturally occurring organic poison produced by metabolic activities of living cells or organisms. Toxins occur especially as a protein or conjugated protein. The term toxin was first used by organic chemist Ludwig Brieger (1849– ...
s than cigarette smoke. It contains traces of harmful substances not found in cigarette smoke. Nicotine is highly addictive. Users become physically and psychologically dependent. Scientists do not know whether e-cigarettes are harmful to humans long-term because it is hard to separate the effects of vaping from the effects of smoking when so many people both vape and smoke. E-cigarettes have not been used widely enough or for long enough to be sure. For people trying to
quit smoking Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes ...
, e-cigarette use alongside prescribed
nicotine replacement therapy Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
leads to a higher quit rate. For people trying to quit smoking without medical help, e-cigarettes have not been found to raise quit rates.


Construction

An electronic cigarette consists of an atomizer, a power source such as a battery, and a container for e-liquid such as a cartridge or tank. E-cigarettes have evolved over time, and the different designs are classified in generations. First-generation e-cigarettes tend to look like traditional cigarettes and are called "cigalikes". Second-generation devices are larger and look less like traditional cigarettes. Third-generation devices include mechanical mods and variable
voltage Voltage, also known as electric pressure, electric tension, or (electric) potential difference, is the difference in electric potential between two points. In a static electric field, it corresponds to the work needed per unit of charge to m ...
devices. The fourth-generation includes sub-ohm tanks (meaning they have electrical resistance of less than 1
ohm Ohm (symbol Ω) is a unit of electrical resistance named after Georg Ohm. Ohm or OHM may also refer to: People * Georg Ohm (1789–1854), German physicist and namesake of the term ''ohm'' * Germán Ohm (born 1936), Mexican boxer * Jörg Ohm (b ...
) and
temperature control Temperature control is a process in which change of temperature of a space (and objects collectively there within), or of a substance, is measured or otherwise detected, and the passage of heat energy into or out of the space or substance is ad ...
. There are also pod mod devices that use protonated nicotine, rather than free-base nicotine found in earlier generations, providing higher nicotine yields.


E-liquid

The mixture used in vapor products such as e-cigarettes is called e-liquid. E-liquid formulations vary widely. A typical e-liquid is composed of
propylene glycol Propylene glycol (IUPAC nomenclature, IUPAC name: propane-1,2-diol) is a viscous, colorless liquid, which is nearly odorless but possesses a faintly sweet taste. Its chemical formula is CH3CH(OH)CH2OH. Containing two Alcohol (chemistry), alcoho ...
and
glycerin Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids known ...
(95%) and a combination of
flavorings A flavoring (or flavouring), also known as flavor (or flavour) or flavorant, is a food additive used to improve the taste or smell of food. It changes the perceptual impression of food as determined primarily by the chemoreceptors of the gustat ...
,
nicotine Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
, and other additives (5%). The flavorings may be natural, artificial, or
organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ Chemistry * Organic matter, matter that has come from a once-living organism, is capable of decay or is the product ...
. Over 80 harmful chemicals such as formaldehyde and metallic nanoparticles have been found in e-liquids at trace quantities. There are many e-liquid manufacturers, and more than 15,000 flavors. Most countries regulate what e-liquids can contain. In the US, there are
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) compulsory manufacturing standards and American E-liquid Manufacturing Standards Association (AEMSA) recommended manufacturing standards. European Union standards are published in the EU
Tobacco Products Directive The Tobacco Products Directive (TPD) or European Tobacco Products Directive (EUTPD) (2014/40/EU) is a directive of the European Union which places limits on the sale and merchandising of tobacco and tobacco related products in the EU. The TPD aim ...
.


Use


Popularity

Since entering the market around 2003, e-cigarette use has risen rapidly. In 2011 there were about 7 million adult e-cigarette users globally, increasing to 68 million in 2020 compared with 1.1 billion cigarette smokers. There was a further rise to 82 million e-cigarette users in 2021. This increase has been attributed to targeted marketing, lower cost compared to conventional cigarettes, and the better safety profile of e-cigarettes compared to tobacco. E-cigarette use is highest in China, the US, and Europe, with China having the most users.


Motivation

There are varied reasons for e-cigarette use. Most users are trying to quit smoking, but a large proportion of use is recreational or as an attempt to get around
smoke-free laws Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor workpl ...
. Many people vape because they believe vaping is safer than smoking. The wide choice of flavors and lower price compared to cigarettes are also important factors. Other motivations include reduced odor and fewer stains. E-cigarettes also appeal to technophiles who enjoy customizing their devices.


Gateway theory

The gateway hypothesis is the idea that using less harmful drugs can lead to more harmful ones. Evidence shows that many users who begin by vaping will go onto also smoke traditional cigarettes. People with mental illnesses, who as a group are more susceptible to nicotine addiction, are at particularly high risk of dual use.


Young adult and teen use

Worldwide, increasing numbers of young people are vaping. With access to e-cigarettes, young people's tobacco use has dropped by about 75%. Most young e-cigarette users have never smoked, but there is a substantial minority who both vape and smoke. Young people who would not smoke are vaping. Young people who smoke tobacco or marijuana, or who drink alcohol, are much more likely to vape. Among young people who have tried vaping, most used a flavored product the first time. Vaping correlates with smoking among young people, even in those who would otherwise be unlikely to smoke. Experimenting with vaping encourages young people to continue smoking. A 2015 study found minors had little resistance to buying e-cigarettes online. Teenagers may not admit to using e-cigarettes, but use, for instance, a hookah pen. As a result, self-reporting may be lower in surveys. More recent studies show a trend of an increasing percentage of youths who use e-cigarettes. In 2018, 20% of high school students were using e-cigarettes. In 2020 however, this number increased to 50% of high school students reported to have used e-cigarettes. Similarly in Canada there has been trend showing 29% of youths reporting to have used e-cigarettes in 2017, increasing to 37% in 2018.


Health effects

The health effects of e-cigarettes include many unknowns. There are many chemicals used in electronic cigarettes that are either already known to already be toxic to humans or are completely unknown. However, the risk of
serious adverse event A serious adverse event (SAE) in human drug trials is defined as any untoward medical occurrence that at any dose #Results in death #Is life-threatening #Requires inpatient hospitalization or causes prolongation of existing hospitalization #Results ...
s is thought to be low, and e-cigarettes are likely safer than combusted
tobacco products Tobacco is the agricultural product of the leaves of plants in the genus ''Nicotiana'', commonly termed ''tobacco plants''. All species of ''Nicotiana'' contain the addictive drug nicotine—a psychostimulant alkaloid found in all parts of the ...
. According to the
National Academies of Sciences, Engineering, and Medicine The National Academies of Sciences, Engineering, and Medicine (also known as NASEM or the National Academies) are the collective scientific national academy of the United States. The name is used interchangeably in two senses: (1) as an umbrell ...
, "Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes." When provided alongside professional help and
nicotine replacement therapy Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
, e-cigarettes can help people quit smoking. Some of the most common but less serious
adverse effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...
s include abdominal pain, headache, blurry vision, throat and mouth irritation, vomiting, nausea, and coughing. Nicotine is addictive and harmful to fetuses, children, and young people. In 2019 and 2020, an outbreak of severe vaping lung illness in the US was strongly linked to
vitamin E acetate A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrien ...
by the
CDC The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency, under the United S ...
. While it is still widely debated which particular component of vape liquid is the cause of illness, vitamin E acetate, specifically, has been identified as a potential culprit in vape-related illnesses. There was likely more than one cause of the outbreak. E-cigarettes produce similar levels of
particulate Particulates – also known as atmospheric aerosol particles, atmospheric particulate matter, particulate matter (PM) or suspended particulate matter (SPM) – are microscopic particles of solid or liquid matter suspended in the air. The ter ...
s to tobacco cigarettes. There is "only limited evidence showing adverse respiratory and cardiovascular effects in humans", with the authors of a 2020 review calling for more long-term studies on the subject. E-cigarettes increase the risk of
asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...
by 40% and
chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
by 50% compared to not using nicotine at all. More serious adverse effects include chest pains, difficulty breathing, high blood pressure, elevated heart rate, and cognitive impairment. The regular usage of E-cigarettes have been linked with damage to the lungs, cardiovascular system as well as the brain. In a 2022 study, researchers found that frequent inhalation of the vapors in e-cigarettes have a positive correlation with the frequency and severity of asthma and obstructive lung disease. In the same study they also found a positive correlation between the usage of e-cigarettes and medical conditions such myocardial infarctions, coronary artery disease and strokes. In regards to the brain, the vapors in e-cigarettes can cause damage to the neurons in developing brains. This can impair the decision-making process leading to more frequent impulse decisions.


Pregnancy

The British
Royal College of Midwives The Royal College of Midwives (RCM) is a British midwives organisation founded in 1881 by Louisa Hubbard and Zepherina Veitch. It has existed under its present name since 1947, and is the United Kingdom's only trade union or professional organis ...
states: "While vaping devices such as electronic cigarettes (e-cigs) do contain some toxins, they are at far lower levels than found in tobacco smoke. If a pregnant woman who has been smoking chooses to use an e-cig and it helps her to quit smoking and stay smokefree, she should be supported to do so." Based on the available evidence on e-cigarette safety, there was also "no reason to believe that use of an e-cig has any adverse effect on breastfeeding." The statement went on to say, "vaping should continue, if it is helpful to quitting smoking and staying smokefree". The UK
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
says: "If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke." Many women who vape continue to do so during pregnancy because of the perceived safety of e-cigarettes compared to tobacco.


United States

In one of the few studies identified, a 2015 survey of 316 pregnant women in a Maryland clinic found that the majority had heard of e-cigarettes, 13% had used them, and 0.6% were current daily users. These findings are of concern because the dose of nicotine delivered by e-cigarettes can be as high or higher than that delivered by traditional cigarettes. Data from two states in the Pregnancy Risk Assessment System (PRAMS) show that in 2015—roughly the mid-point of the study period—10.8% of the sample used e-cigarettes in the three months prior to the pregnancy while 7.0%, 5.8%, and 1.4% used these products at the time of the pregnancy, in the first trimester, and at birth respectively. According to National Health Interview Survey (NHIS) data from 2014 to 2017, 38.9% of pregnant smokers used e-cigarettes compared to only 13.5% of non-pregnant, reproductive age women smokers. A health economic study found that passing an e-cigarette minimum legal sale age law in the United States increased teenage prenatal smoking by 0.6 percentage points and had no effect on birth outcomes. Nevertheless, additional research needs to be done on the health effects of electronic cigarette use during pregnancy. According to the CDC, E-cigarettes are not safe during pregnancy. "Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby's brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby."


Harm reduction

Harm reduction Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to de ...
refers to any reduction in harm from a prior level. Harm minimization strives to reduce harms to the lowest achievable level. When a person does not want to quit nicotine, harm minimization means striving to eliminate tobacco exposure by replacing it with vaping. E-cigarettes can reduce smokers' exposure to carcinogens and other toxic chemicals found in tobacco.
Tobacco harm reduction Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of ...
has been a controversial area of
tobacco control Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use to ...
. Health advocates have been slow to support a harm reduction method out of concern that
tobacco companies The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
cannot be trusted to sell products that will lower the risks associated with tobacco use. A large number of smokers want to reduce harm from smoking by using e-cigarettes. The argument for harm reduction does not take into account the adverse effects of nicotine. There cannot be a defensible reason for harm reduction in children who are vaping with a base of nicotine. Quitting smoking is the most effective strategy to tobacco harm reduction. Tobacco smoke contains 100 known carcinogens and 900 potentially cancer-causing chemicals, but e-cigarette vapor contains less of the potential carcinogens than found in tobacco smoke. A study in 2015 using a third-generation device found levels of formaldehyde were greater than with cigarette smoke when adjusted to a maximum power setting. E-cigarettes cannot be considered safe because there is no safe level for carcinogens. Due to their similarity to traditional cigarettes, e-cigarettes could play a valuable role in tobacco harm reduction. However, the public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals. The core concern is that smokers who could have quit entirely will develop an alternative nicotine addiction. Dual use may be an increased risk to a smoker who continues to use even a minimal amount of traditional cigarettes, rather than quitting. Because of the convenience of e-cigarettes, it may further increase the risk of addiction. The promotion of vaping as a harm reduction aid is premature, while a 2011 review found they appear to have the potential to lower tobacco-related death and disease. Evidence to substantiate the potential of vaping to lower tobacco-related death and disease is unknown. The health benefits of reducing cigarette use while vaping is unclear. E-cigarettes could have an influential role in tobacco harm reduction. 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. 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. 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. There is no research available on vaping for reducing harm in high-risk groups such as people with
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s. A 2014 PHE report concluded that hazards associated with products currently on the market are probably low, and apparently much lower than smoking. However, harms could be reduced further through reasonable product standards. 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. The
American Association of Public Health Physicians The American Association of Public Health Physicians (AAPHP), is a professional association of public health physicians. Its motto is "the voice of Public Health Physicians / Guardians of the Public's Health". Brief history AAPHP was founded in 1 ...
(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 e-cigarettes and
smokeless tobacco Smokeless tobacco is a tobacco products, tobacco product that is used by means other than smoking. Their use involves chewing, sniffing, or placing the product between gum and the cheek or lip. Smokeless tobacco products are produced in various f ...
for long-term use instead of smoking. A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both. 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."


Smoking cessation

The use of e-cigarettes for quitting smoking is controversial. Limited evidence suggests that e-cigarettes probably do help people to
stop smoking Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes ...
when used in clinical settings. However, according to a review article by Hussein Traboulsi et al. in May 2020, a study by Dr Peter Hajek also resulted in more smokers becoming dual users than succeeded in complete abstinence; "Nonetheless, the continued use of and dependence on nicotine and the creation of dual users were issues in this trial...Additionally, while 18% of the e-cigarette users achieved complete abstinence, 25% (110/438) became dual users of e-cigarettes and conventional cigarettes." Data regarding their use includes at least 26
randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical te ...
s and a number of user surveys,
case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence ...
s, and
cohort studies A cohort study is a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation), performing ...
. At least once recent review (2019) found that vaping did not seem to greatly increase the odds of quitting smoking. As a result of the data being confronted with methodological and study design limitations, no firm conclusions can be drawn in respect to their efficacy and safety. A 2016 review found that the combined abstinence rate among smokers using e-cigarettes in prospective studies was 29.1%. The same review noted that few clinical trials and prospective studies had yet been conducted on their effectiveness, and only one randomized clinical trial had included a group using other quit smoking methods. No long-term trials have been conducted for their use as a smoking cessation aid. It is still not evident as to whether vaping can adequately assist with quitting smoking at the population level. A 2015 PHE report recommends for smokers who cannot or do not want to quit to use e-cigarettes as one of the main steps to lower smoking-related disease, while a 2015 US PSTF statement found there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, pregnant women, and adolescents. In 2021 the US PSTF concluded the evidence is still insufficient to recommend e-cigarettes for quitting smoking, finding that the balance of benefits and harms cannot be determined. ,
systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
s collectively agreed that there is insufficient evidence to unequivocally determine whether vaping helped people abstain from smoking. A 2020 systematic review and meta-analysis of 64 studies found that on the whole as consumer products e-cigarettes do not increase quitting smoking. A 2021 review came to the same conclusion. A recent 2022 study showed that E-cigarettes could actually lead people to smoke tobacco. Because the nicotine in e-cigarettes is addicting, it can cause new smokers to try tobacco and can cause current smokers to revert to using cigarettes One trial studied the medical effects that dual smoking had on a person's sleep. This trial was done to simulate a tobacco smoker using e-cigarettes to quit or reduce smoking. The results of this study showed that subjects who used e-cigarettes as well as ignitable tobacco had moderate to severe effects on their sleep. Patients reported irritability and trouble sleeping and restless sleep. The results indicated a positive correlation between increased dual smoking and sleeping troubles. A small number of studies have looked at whether using e-cigarettes reduces the number of cigarettes smokers consume. E-cigarette use may decrease the number of cigarettes smoked, but smoking just one to four cigarettes daily greatly increases the risk of cardiovascular disease compared to not smoking. The extent to which decreasing cigarette smoking with vaping leads to quitting is unknown. It is unclear whether e-cigarettes are only helpful for particular types of smokers. Vaping with nicotine may reduce tobacco use among daily smokers. Whether vaping is effective for quitting smoking may depend on whether it was used as part of an effort to quit. Comparing e-cigarettes to nicotine replacement therapy, a 2022 Cochrane review found "high-certainty evidence" that e-cigarettes with nicotine are more effective than
nicotine replacement therapy Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
(NRT) for quitting smoking (9 to 14 might successfully stop, compared to 6 of 100). However, some studies have people who vaped were not more likely to give up smoking than people who did not vape. and previous reviews have found that e-cigarettes were not been proven to be more effective than smoking cessation medicine and regulated US FDA medicine. A
randomized trial In science, randomized experiments are the experiments that allow the greatest reliability and validity of statistical estimates of treatment effects. Randomization-based inference is especially important in experimental design and in survey sampl ...
stated 29% of e-cigarette users were still vaping at 6 months, while only 8% of patch users still wore patches at 6 months, suggesting that some people are switching to cigarettes rather than fully quitting all tobacco use. The potential adverse effects such as normalizing smoking have not been adequately studied. While some surveys reported improved quitting smoking, particularly with intensive e-cigarette users, several studies showed a decline in quitting smoking in dual users of cigarettes and e-cigarettes. Compared to many alternative quitting smoking medicines in early development in clinical trials including e-cigarettes,
cytisine Cytisine, also known as baptitoxine, cytisinicline, or sophorine, is an alkaloid that occurs naturally in several plant genera, such as ''Laburnum'' and ''Cytisus'' of the family Fabaceae. It has been used medically to help with smoking cessati ...
may be the most encouraging in efficacy and safety with an inexpensive price. Other kinds of nicotine replacement products are usually covered by
health system Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
s, but because e-cigarettes are not medically licensed they are not covered. One of the challenges in studying e-cigarettes is that there are hundreds of brands and models of e-cigarettes sold that vary in the design and operation of the devices and composition of the liquid, and the technology continues to change. E-cigarettes have not been subjected to the same type of efficacy testing as
nicotine replacement products Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
. There are also social concerns - use of e-cigarettes may normalize tobacco use and prolong cigarette use for people who could have quit instead, or it could put extra pressure on smokers to stop cigarette smoking because e-cigarettes are a more socially acceptable alternative. The evidence indicates smokers are more frequently able to completely quit smoking using tank devices compared to cigalikes, which may be due to their more efficient nicotine delivery. There is low quality evidence that vaping assists smokers to quit smoking in the long-term compared with nicotine-free vaping. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2013 study in smokers who were not trying to quit, found that vaping, with or without nicotine decreased the number of cigarettes consumed. E-cigarettes without nicotine may reduce tobacco cravings because of the smoking-related physical stimuli. A 2015 meta-analysis on
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
s found that e-cigarettes containing nicotine are more effective than nicotine-free ones for quitting smoking. They compared their finding that nicotine-containing e-cigarettes helped 20% of people quit with the results from other studies that found nicotine replacement products helps 10% of people quit. A 2016 review found low quality evidence of a trend towards benefit of e-cigarettes with nicotine for smoking cessation. In terms of whether flavored e-cigarettes assisted quitting smoking, the evidence is inconclusive. Tentative evidence indicates that health warnings on vaping products may influence users to give up vaping. As of 2020, the efficacy and safety of vaping for quitting smoking during pregnancy was unknown. No research is available to provide details on the efficacy of vaping for quitting smoking during pregnancy. There is robust evidence that vaping is not effective for quitting smoking among adolescents. In view of the shortage of evidence, vaping is not recommend for cancer patients, although for all patients vaping is likely less dangerous than smoking cigarettes. The effectiveness of vaping for quitting smoking among vulnerable groups is uncertain.


Safety

As of 2015, research had not yet provided a consensus on the risks of e-cigarette use. There is little data about their safety, and a considerable variety of liquids are used as carriers, and thus are present in the
aerosol An aerosol is a suspension (chemistry), suspension of fine solid particles or liquid Drop (liquid), droplets in air or another gas. Aerosols can be natural or Human impact on the environment, anthropogenic. Examples of natural aerosols are fog o ...
delivered to the user. Reviews of the safety of e-cigarettes have reached quite different conclusions. A 2014 WHO report cautioned about potential risks of using e-cigarettes. Regulated US FDA products such as nicotine inhalers may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted
tobacco products Tobacco is the agricultural product of the leaves of plants in the genus ''Nicotiana'', commonly termed ''tobacco plants''. All species of ''Nicotiana'' contain the addictive drug nicotine—a psychostimulant alkaloid found in all parts of the ...
such as cigarettes and cigars. The risk of early death is anticipated to be similar to that of
smokeless tobacco Smokeless tobacco is a tobacco products, tobacco product that is used by means other than smoking. Their use involves chewing, sniffing, or placing the product between gum and the cheek or lip. Smokeless tobacco products are produced in various f ...
. Since vapor does not contain tobacco and does not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke, such as
ash Ash or ashes are the solid remnants of fires. Specifically, ''ash'' refers to all non-aqueous, non- gaseous residues that remain after something burns. In analytical chemistry, to analyse the mineral and metal content of chemical samples, ash ...
,
tar Tar is a dark brown or black viscous liquid of hydrocarbons and free carbon, obtained from a wide variety of organic materials through destructive distillation. Tar can be produced from coal, wood, petroleum, or peat. "a dark brown or black bit ...
, and
carbon monoxide Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
. However, e-cigarette use with or without nicotine cannot be considered risk-free because the long-term effects of e-cigarette use are unknown. The
cytotoxicity Cytotoxicity is the quality of being toxic to cells. Examples of toxic agents are an immune cell or some types of venom, e.g. from the puff adder (''Bitis arietans'') or brown recluse spider (''Loxosceles reclusa''). Cell physiology Treating cells ...
of e-liquids varies, and contamination with various chemicals have been detected in the liquid. Metal parts of e-cigarettes in contact with the e-liquid can contaminate it with metal particles. Many chemicals including
carbonyl compounds In organic chemistry, a carbonyl group is a functional group composed of a carbon atom double-bonded to an oxygen atom: C=O. It is common to several classes of organic compounds, as part of many larger functional groups. A compound containing a ...
such as
formaldehyde Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section F ...
can inadvertently be produced when the
nichrome wire Nichrome (also known as NiCr, nickel-chromium or chromium-nickel) is a family of alloys of nickel, chromium, and often iron (and possibly other elements) commonly used as resistance wire, heating elements in devices like toasters, electrical kettl ...
(heating element) that touches the e-liquid is heated and chemically reacted with the liquid. Normal usage of e-cigarettes, and reduced voltage (3.0 V) devices generate very low levels of formaldehyde. The later-generation and "tank-style" e-cigarettes with a higher voltage (5.0 V) may generate equal or higher levels of formaldehyde compared to smoking. A 2015 report by Public Health England found that high levels of formaldehyde only occurred in overheated "dry-puffing". Users detect the "dry puff" (also known as a "dry hit") and avoid it, and they concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes." However, e-cigarette users may "learn" to overcome the unpleasant taste due to elevated
aldehyde In organic chemistry, an aldehyde () is an organic compound containing a functional group with the structure . The functional group itself (without the "R" side chain) can be referred to as an aldehyde but can also be classified as a formyl grou ...
formation, when the nicotine craving is high enough. Another common chemical found in e-cigarettes is ketene. When it enters the lungs after inhaled, this chemical causes damage to the cellular structure of lung tissue causing the cells to not function at maximum capacity and not absorb gasses as readily. This can cause shortness of breath which can lead to other health conditions such as tachycardia and respiratory failure. E-cigarette users who use devices that contain nicotine are exposed to its potentially harmful effects. Nicotine is associated with
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
, possible birth defects, and poisoning. ''
In vitro ''In vitro'' (meaning in glass, or ''in the glass'') studies are performed with microorganisms, cells, or biological molecules outside their normal biological context. Colloquially called "test-tube experiments", these studies in biology an ...
'' studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated ''
in vivo Studies that are ''in vivo'' (Latin for "within the living"; often not italicized in English) are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and ...
''. There is inadequate research to show that nicotine is associated with cancer in humans. The risk is probably low from the inhalation of propylene glycol and glycerin. No information is available on the long-term effects of the inhalation of flavors. In October 2021, researchers at Johns Hopkins University reported over 2,000 unknown chemicals in the vape clouds that they tested from Vuse, Juul, Blu and Mi-Salt vape devices. In 2019–2020, there was an outbreak of vaping-related lung illness in the US and Canada, primarily related to vaping
THC Tetrahydrocannabinol (THC) is the principal psychoactive constituent of cannabis and one of at least 113 total cannabinoids identified on the plant. Although the chemical formula for THC (C21H30O2) describes multiple isomers, the term ''THC'' ...
with
vitamin E acetate A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrien ...
. E-cigarettes create vapor that consists of fine and
ultrafine particle Ultrafine particles (UFPs) are particulate matter of nanoscale size (less than 0.1 μm or 100 nm in diameter). Regulations do not exist for this size class of ambient air pollution particles, which are far smaller than the regulated PM10 and ...
s of
particulate matter Particulates – also known as atmospheric aerosol particles, atmospheric particulate matter, particulate matter (PM) or suspended particulate matter (SPM) – are microscopic particles of solid or liquid matter suspended in the air. The ter ...
, with the majority of particles in the ultrafine range. The vapor have been found to contain propylene glycol, glycerin, nicotine, flavors, small amounts of
toxicant A toxicant is any toxic substance, whether man-made or naturally occurring. By contrast, a toxin is a poison produced naturally by an organism (e.g. plant, animal, insect). The different types of toxicants can be found in the air, soil, water, or ...
s,
carcinogen A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
s, and
heavy metals upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead Heavy metals are generally defined as ...
, as well as metal
nanoparticle A nanoparticle or ultrafine particle is usually defined as a particle of matter that is between 1 and 100 nanometres (nm) in diameter. The term is sometimes used for larger particles, up to 500 nm, or fibers and tubes that are less than 1 ...
s, and other substances. Many carcinogenic compounds have been detected in e-cigarettes, such as N-Nitrosonornicotine (NNN), N-Nitrosoanatabine (NAT), etc., all of which have been proven to be harmful to human health. Exactly what the vapor consists of varies in composition and concentration 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. The majority of toxic chemicals found in cigarette smoke are absent in e-cigarette vapor. E-cigarette vapor contains lower concentrations of potentially toxic chemicals than with cigarette smoke. Those which are present, are mostly below 1% of the corresponding levels permissible by
workplace safety standards Workplace safety standards are sets of standards, aimed at safety at workplaces and to reduce occupational risk from occupational illnesses. History The Russian scientist Mikhail Lomonosov in 1763 first describes the dangers of mining in his ...
. But workplace safety standards do not recognize exposure to certain vulnerable groups such as people with medical ailments, children, and infants who may be exposed to second-hand vapor. Concern exists that some of the mainstream vapor exhaled by e-cigarette users may be inhaled by bystanders, particularly indoors, although e-cigarette pollutant levels are much lower than for cigarettes and likely to pose a much lower risk, if any, compared to cigarettes. E-cigarette use by a parent might lead to inadvertent health risks to offspring. A 2014 review recommended that e-cigarettes should be regulated for
consumer safety Consumer protection is the practice of safeguarding buyers of goods and services, and the public, against unfair practices in the marketplace. Consumer protection measures are often established by law. Such laws are intended to prevent business ...
. There is limited information available on the
environmental issue Environmental issues are effects of human activity on the biophysical environment, most often of which are harmful effects that cause environmental degradation. Environmental protection is the practice of protecting the natural environment on th ...
s around production, use, and disposal of e-cigarettes that use cartridges. E-cigarettes that are not reusable may contribute to the problem of
electronic waste Electronic waste or e-waste describes discarded electrical or electronic devices. Used electronics which are destined for refurbishment, reuse, resale, salvage recycling through material recovery, or disposal are also considered e-waste. Informa ...
.


Addiction

Nicotine, a key ingredient in most e-liquids, is well-recognized as one of the most
addictive Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use oft ...
substances, as addictive as
heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brow ...
and
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...
. Addiction is believed to be a disorder of experience-dependent
brain plasticity A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
. The reinforcing effects of nicotine play a significant role in the beginning and continuing use of the drug. First-time nicotine users develop a dependence about 32% of the time. Chronic nicotine use involves both
psychological Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
and
physical dependence Physical dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms. Physical dependence can develop from low-dose therapeutic use of certai ...
. Nicotine-containing e-cigarette vapor induces addiction-related neurochemical, physiological and behavioral changes. Nicotine affects neurological, neuromuscular, cardiovascular, respiratory, immunological and gastrointestinal systems.
Neuroplasticity Neuroplasticity, also known as neural plasticity, or brain plasticity, is the ability of Neural circuit, neural networks in the brain to change through growth and reorganization. It is when the brain is rewired to function in some way that diffe ...
within the brain's
reward system The reward system (the mesocorticolimbic circuit) is a group of neural structures responsible for incentive salience (i.e., "wanting"; desire or craving for a reward and motivation), associative learning (primarily positive reinforcement and class ...
occurs as a result of long-term nicotine use, leading to
nicotine dependence Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of with ...
. The neurophysiological activities that are the basis of nicotine dependence are intricate. It includes genetic components, age, gender, and the environment. Nicotine addiction is a disorder which alters different neural systems such as dopaminergic, glutamatergic, GABAergic, serotoninergic, that take part in reacting to nicotine. Long-term nicotine use affects a broad range of genes associated with neurotransmission, signal transduction, and synaptic architecture. The ability to quitting smoking is affected by genetic factors, including genetically based differences in the way nicotine is metabolized. Nicotine is a
parasympathomimetic A parasympathomimetic drug, sometimes called a cholinomimetic drug or cholinergic receptor stimulating agent, is a substance that stimulates the parasympathetic nervous system (PSNS). These chemicals are also called cholinergic drugs because acet ...
stimulant Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...
that binds to and activates
nicotinic acetylcholine receptor Nicotinic acetylcholine receptors, or nAChRs, are receptor polypeptides that respond to the neurotransmitter acetylcholine. Nicotinic receptors also respond to drugs such as the agonist nicotine. They are found in the central and peripheral ne ...
s in the brain, which subsequently causes the release of
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
and other
neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell. Neuro ...
s, such as
norepinephrine Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as both a hormone and neurotransmitter. The name "noradrenaline" (from Latin '' ad'', ...
,
acetylcholine Acetylcholine (ACh) is an organic chemical that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Part ...
,
serotonin Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
, gamma-aminobutyric acid,
glutamate Glutamic acid (symbol Glu or E; the ionic form is known as glutamate) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is a non-essential nutrient for humans, meaning that the human body can syn ...
,
endorphin Endorphins (contracted from endogenous morphine) are chemical signals in the brain that block the perception of pain and increase feelings of wellbeing. They are produced and stored in an area of the brain known as the pituitary gland. Hist ...
s, and several
neuropeptide Neuropeptides are chemical messengers made up of small chains of amino acids that are synthesized and released by neurons. Neuropeptides typically bind to G protein-coupled receptors (GPCRs) to modulate neural activity and other tissues like the ...
s, including
proopiomelanocortin Pro-opiomelanocortin (POMC) is a precursor polypeptide with 241 amino acid residues. POMC is synthesized in corticotrophs of the anterior pituitary from the 267-amino-acid-long polypeptide precursor pre-pro-opiomelanocortin (pre-POMC), by the r ...
-derived
α-MSH α-Melanocyte-stimulating hormone (α-MSH) is an endogenous peptide hormone and neuropeptide of the melanocortin family, with a tridecapeptide structure and the amino acid sequence Ac-Ser-Tyr-Ser-Met-Glu-His-Phe-Arg-Trp-Gly-Lys-Pro-Val-NH2. I ...
and
adrenocorticotropic hormone Adrenocorticotropic hormone (ACTH; also adrenocorticotropin, corticotropin) is a polypeptide tropic hormone produced by and secreted by the anterior pituitary gland. It is also used as a medication and diagnostic agent. ACTH is an important c ...
. Corticotropin-releasing factor, Neuropeptide Y, orexins, and norepinephrine are involved in nicotine addiction. Continuous exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor desensitization and subsequent receptor
upregulation In the biological context of organisms' production of gene products, downregulation is the process by which a cell decreases the quantity of a cellular component, such as RNA or protein, in response to an external stimulus. The complementary proce ...
. Long-term exposure to nicotine can also result in downregulation of glutamate transporter 1. Long-term nicotine exposure upregulates cortical nicotinic receptors, but it also lowers the activity of the nicotinic receptors in the cortical vasodilation region. These effects are not easily understood. With constant use of nicotine,
tolerance Tolerance or toleration is the state of tolerating, or putting up with, conditionally. Economics, business, and politics * Toleration Party, a historic political party active in Connecticut * Tolerant Systems, the former name of Veritas Software ...
occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain. After several months of nicotine abstinence, the number of receptors go back to normal. The extent to which alterations in the brain caused by nicotine use are reversible is not fully understood. Nicotine also stimulates nicotinic acetylcholine receptors in the
adrenal medulla The adrenal medulla ( la, medulla glandulae suprarenalis) is part of the adrenal gland. It is located at the center of the gland, being surrounded by the adrenal cortex. It is the innermost part of the adrenal gland, consisting of chromaffin cel ...
, resulting in increased levels of
epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
and
beta-endorphin ''beta''-Endorphin (β-endorphin) is an endogenous opioid neuropeptide and peptide hormone that is produced in certain neurons within the central nervous system and peripheral nervous system. It is one of three endorphins that are produced in ...
. Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the
central Central is an adjective usually referring to being in the center of some place or (mathematical) object. Central may also refer to: Directions and generalised locations * Central Africa, a region in the centre of Africa continent, also known as ...
and
peripheral nervous system The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain ...
s. When nicotine intake stops, the upregulated nicotinic acetylcholine receptors induce
withdrawal symptoms Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs. In order for the symptoms of with ...
. These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating. When trying to quit smoking with vaping a base containing nicotine, symptoms of withdrawal can include irritability, restlessness, poor concentration, anxiety, depression, and hunger. The changes in the brain cause a nicotine user to feel abnormal when not using nicotine. In order to feel normal, the user has to keep his or her body supplied with nicotine. E-cigarettes may reduce cigarette craving and withdrawal symptoms. It is not clear whether e-cigarette use will decrease or increase overall
nicotine addiction Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
, but the nicotine content in e-cigarettes is adequate to sustain nicotine dependence. Chronic nicotine use causes a broad range of neuroplastic adaptations, making quitting hard to accomplish. A 2015 study found that users vaping non-nicotine e-liquid exhibited signs of dependence. Experienced users tend to take longer puffs which may result in higher nicotine intake. It is difficult to assess the impact of nicotine dependence from e-cigarette use because of the wide range of e-cigarette products. The addiction potential of e-cigarettes may have risen because as they have progressed, they have delivered nicotine better. A 2015 American Academy of Pediatrics (AAP) policy statement stressed "the potential for these products to addict a new generation of youth to nicotine and reverse more than 50 years of public health gains in tobacco control." The World Health Organization (WHO) is concerned about starting nicotine use among non-smokers, and the
National Institute on Drug Abuse The National Institute on Drug Abuse (NIDA) is a United States federal government research institute whose mission is to "advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual a ...
said e-cigarettes could maintain nicotine addiction in those who are attempting to quit. The limited available data suggests that the likelihood of excessive use of e-cigarettes is smaller than traditional cigarettes. No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction, but some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence. There is concern that children may progress from vaping to smoking. Adolescents are likely to underestimate nicotine's addictiveness. Vulnerability to the brain-modifying effects of nicotine, along with youthful experimentation with e-cigarettes, could lead to a lifelong addiction. A long-term nicotine addiction from using a vape may result in using other tobacco products. The majority of addiction to nicotine starts during youth and young adulthood. Adolescents are more likely to become nicotine dependent than adults. The adolescent brain seems to be particularly sensitive to neuroplasticity as a result of nicotine. Minimal exposure could be enough to produce neuroplastic alterations in the very sensitive adolescent brain. A 2014 review found that in studies up to a third of youth who have not tried a traditional cigarette have used e-cigarettes. The degree to which teens are using e-cigarettes in ways the manufacturers did not intend, such as increasing the nicotine delivery, is unknown, as is the extent to which e-cigarette use may lead to addiction or
substance dependence Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has develope ...
in youth.


Positions

Because of overlap with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries. The revised EU
Tobacco Products Directive The Tobacco Products Directive (TPD) or European Tobacco Products Directive (EUTPD) (2014/40/EU) is a directive of the European Union which places limits on the sale and merchandising of tobacco and tobacco related products in the EU. The TPD aim ...
came into effect in May 2016, providing stricter regulations for e-cigarettes. In February 2010 the
US District Court The United States district courts are the trial courts of the U.S. federal judiciary. There is one district court for each federal judicial district, which each cover one U.S. state or, in some cases, a portion of a state. Each district cou ...
ruled against the
FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...
's seizure of E-Cigarettes as a "drug-device" and in December 2010 the
US Court of Appeals The United States courts of appeals are the intermediate appellate courts of the United States federal judiciary. The courts of appeals are divided into 11 numbered circuits that cover geographic areas of the United States and hear appeals fro ...
confirmed them to be tobacco products which were by then subject to regulation under the 2009 FSPTC Act. In August 2016, the US FDA extended its regulatory power to include e-cigarettes, cigars, and "all other tobacco products". Large tobacco companies have greatly increased their marketing efforts. The
scientific community The scientific community is a diverse network of interacting scientists. It includes many " sub-communities" working on particular scientific fields, and within particular institutions; interdisciplinary and cross-institutional activities are als ...
in US and Europe are primarily concerned with their possible effect on
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for
quitting smoking Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...
is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things. Medical organizations differ in their views about the health implications of vaping. There is general agreement that e-cigarettes expose users to fewer
toxicant A toxicant is any toxic substance, whether man-made or naturally occurring. By contrast, a toxin is a poison produced naturally by an organism (e.g. plant, animal, insect). The different types of toxicants can be found in the air, soil, water, or ...
s than tobacco cigarettes. Some healthcare groups and policy makers have hesitated to recommend e-cigarettes for quitting smoking, because of limited evidence of effectiveness and safety. Some have advocated bans on e-cigarette sales and others have suggested that e-cigarettes may be regulated as
tobacco products Tobacco is the agricultural product of the leaves of plants in the genus ''Nicotiana'', commonly termed ''tobacco plants''. All species of ''Nicotiana'' contain the addictive drug nicotine—a psychostimulant alkaloid found in all parts of the ...
but with less nicotine content or be regulated as a
medicinal product A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
. A 2019
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) report found that the
scientific evidence Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...
"does not support the tobacco industry's claim that these products are less harmful relative to conventional tobacco products" and that there is insufficient evidence to support vaping as a smoking cessation tool.World Health Organization
WHO report on the global tobacco epidemic
(2019).
Healthcare organizations in the UK (including the
Royal College of Physicians The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
and
Public Health England Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
) have encouraged smokers to switch to e-cigarettes or other nicotine replacements if they cannot quit, as this would potentially save millions of lives. The
American Cancer Society The American Cancer Society (ACS) is a nationwide voluntary health organization dedicated to eliminating cancer. Established in 1913, the society is organized into six geographical regions of both medical and lay volunteers operating in more than ...
,
American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
, and the
surgeon general of the United States The surgeon general of the United States is the operational head of the United States Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. Th ...
have cautioned that accumulating evidence indicates e-cigarettes may have negative effects on the heart and lungs and should not be used to quit smoking without sufficient evidence that they are safe and effective.U.S. Department of Health and Human Services
E-Cigarette Use Among Youth and Young Adults
A Report of the
Surgeon General of the United States The surgeon general of the United States is the operational head of the United States Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. Th ...
. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
In 2016, the US
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(US FDA) stated that "Although ENDS lectronic nicotine delivery systemsmay potentially provide cessation benefits to individual smokers, no ENDS have been approved as effective cessation aids." In 2019 the
European Respiratory Society The European Respiratory Society, or ERS, is a non-profit organization with offices in Lausanne, Brussels and Sheffield. It was founded in 1990 in the field of respiratory medicine. The organization was formed with the merger of the Societas Euro ...
stated that "The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term" and that " e tobacco harm reduction strategy is based on well-meaning but incorrect or undocumented claims or assumptions." Following hundreds of possible cases of severe lung illness and five confirmed deaths associated with vaping in the US, the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
stated on 6 September 2019 that people should consider not using vaping products while their investigation is ongoing.


History

It is commonly stated that the modern e-cigarette was invented in 2003 by Chinese pharmacist
Hon Lik Han Li or Hon Lik () is a Chinese people, Chinese pharmacist who invented the modern electronic cigarette. Early life Hon Lik (or Han Li) was born in Shenyang, Shenyang, China in 1956. He started smoking at age 18. He attended Liaoning Univers ...
, but tobacco companies had been developing nicotine aerosol generation devices since as early as 1963.


Early prototypes & barriers to entry: 1920s – 90s

In 1927, Joseph Robinson applied for a patent for an electronic vaporizer to be used with medicinal compounds. The patent was approved in 1930 but the device was never marketed. In 1930, the
United States Patent and Trademark Office The United States Patent and Trademark Office (USPTO) is an agency in the U.S. Department of Commerce that serves as the national patent office and trademark registration authority for the United States. The USPTO's headquarters are in Alexa ...
reported a patent stating, "for holding medicinal compounds which are electrically or otherwise heated to produce vapors for inhalation." In 1934 and 1936, further similar patents were applied for. The earliest e-cigarette can be traced to American Herbert A. Gilbert, who in 1963 applied for a patent for "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air". This device produced flavored steam without nicotine. The patent was granted in 1965. Gilbert's invention was ahead of its time and received little attention and was never commercialized because smoking was still fashionable at that time. Gilbert said in 2013 that today's electric cigarettes follow the basic design set forth in his original patent. The Favor cigarette, introduced in 1986 by public company Advanced Tobacco Products, was another early noncombustible product promoted as an alternative nicotine-containing tobacco product. Favor was conceptualized by Phil Ray, one of the founders of
Datapoint Corporation Datapoint Corporation, originally known as Computer Terminal Corporation (CTC), was a computer company based in San Antonio, Texas, United States. Founded in July 1968 by Phil Ray and Gus Roche, its first products were, as the company's initial ...
and inventors of the microprocessor. Development started in 1979 by Phil Ray and Norman Jacobson. Favor was a "plastic, smoke-free product shaped and colored like a conventional cigarette that contained a filter paper soaked with liquid nicotine so users could draw a small dose by inhaling. There was no electricity, combustion, or smoke; it delivered only nicotine." Favor cigarettes were sold in California and several Southwestern states, marketed as "an alternative to smokers, and only to smokers, to use where smoking is unacceptable or prohibited." In 1987 the
FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...
exercised jurisdiction over products analogous to E-Cigarettes. Advanced Tobacco Products never challenged the Warning Letter and ceased all distribution of Favor. Rays's wife Brenda Coffee coined the term ''vaping''. Philip Morris' division NuMark, launched in 2013 the MarkTen e-cigarette that Philip Morris had been working on since 1990.


Modern electronic cigarette: 2000s

Despite these earlier efforts,
Hon Lik Han Li or Hon Lik () is a Chinese people, Chinese pharmacist who invented the modern electronic cigarette. Early life Hon Lik (or Han Li) was born in Shenyang, Shenyang, China in 1956. He started smoking at age 18. He attended Liaoning Univers ...
, a Chinese pharmacist and inventor, who worked as a research pharmacist for a company producing
ginseng Ginseng () is the root of plants in the genus ''Panax'', such as Korean ginseng ('' P. ginseng''), South China ginseng ('' P. notoginseng''), and American ginseng ('' P. quinquefolius''), typically characterized by the presence of ginsenosides an ...
products, is frequently credited with the invention of the modern e-cigarette. Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2001, he thought of using a
high frequency High frequency (HF) is the ITU designation for the range of radio frequency electromagnetic waves (radio waves) between 3 and 30 megahertz (MHz). It is also known as the decameter band or decameter wave as its wavelengths range from one to ten ...
,
piezoelectric Piezoelectricity (, ) is the electric charge that accumulates in certain solid materials—such as crystals, certain ceramics, and biological matter such as bone, DNA, and various proteins—in response to applied Stress (mechanics), mechanical s ...
ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
-emitting element to vaporize a pressurized jet of liquid containing nicotine. This design creates a smoke-like vapor. Hon said that using resistance heating obtained better results and the difficulty was to scale down the device to a small enough size. Hon's invention was intended to be an alternative to smoking. Hon Lik sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera." Ultimately, Hon Lik did not quit smoking. He is now a dual user, both smoking and vaping. Hon Lik registered a patent for the modern e-cigarette design in 2003. Hon is credited with developing the first commercially successful electronic cigarette. The e-cigarette was first introduced to the Chinese domestic market in 2004. Many versions made their way to the US, sold mostly over the Internet by small marketing firms. E-cigarettes entered the European market and the US market in 2006 and 2007. The company that Hon worked for, Golden Dragon Holdings, registered an international patent in November 2007. The company changed its name to Ruyan (如烟, literally "like smoke") later the same month, and started exporting its products. Many US and Chinese e-cigarette makers copied his designs illegally, so Hon has not received much financial reward for his invention (although some US manufacturers have compensated him through out-of-court settlements). Ruyan later changed its company name to
Dragonite International Limited Dragonite International Limited, formerly known as Ruyan Group (Holdings) Limited (Simplified Chinese:如烟集团有限公司; Traditional Chinese: 如煙集團有限公司; Pinyin: rúyān Jítuán Yǒuxiàn Gōngsī), and initially, Golden Drag ...
. As of 2014, most e-cigarettes used a battery-powered heating element rather than the earlier ultrasonic technology design. Initially, their performance did not meet the expectations of users. The e-cigarette continued to evolve from the first-generation three-part device. In 2007 British entrepreneurs Umer and Tariq Sheikh invented the cartomizer. This is a mechanism that integrates the heating coil into the liquid chamber. They launched this new device in the UK in 2008 under their Gamucci brand and the design is now widely adopted by most "cigalike" brands. Other users tinkered with various parts to produce more satisfactory homemade devices, and the hobby of "modding" was born. The first mod to replace the e-cigarette's case to accommodate a longer-lasting battery, dubbed the "screwdriver", was developed by Ted and Matt Rogers in 2008. Other enthusiasts built their own mods to improve functionality or aesthetics. When pictures of mods appeared at online vaping forums many people wanted them, so some mod makers produced more for sale. In 2008, a consumer-created an e-cigarette called the screwdriver. The device generated a lot of interest back then, as it let the user to vape for hours at one time. The invention led to demand for customizable e-cigarettes, prompting manufacturers to produce devices with interchangeable components that could be selected by the user. In 2009, Joyetech developed the eGo series which offered the power of the screwdriver model and a user-activated switch to a wide market. The clearomizer was invented in 2009. Originating from the cartomizer design, it contained the wicking material, an e-liquid chamber, and an atomizer coil within a single clear component. The clearomizer allows the user to monitor the liquid level in the device. Soon after the clearomizer reached the market, replaceable atomizer coils and variable voltage batteries were introduced. Clearomizers and eGo batteries became the best-selling customizable e-cigarette components in early 2012.


International growth: 2010s – present

International tobacco companies dismissed e-cigarettes as a fad at first. However, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete, they began to produce and market their own brands of e-cigarettes and acquire existing e-cigarette companies. They bought the largest e-cigarette companies.
blu eCigs blu is an electronic cigarette brand, produced by Fontem Ventures and owned by Imperial Brands. The brand blu sells various types of rechargeable and disposable e-cigarettes with a wide selection of flavored and unflavored liquids. Its products a ...
, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. for $135 million in April 2012.
British American Tobacco British American Tobacco plc (BAT) is a British multinational company that manufactures and sells cigarettes, tobacco and other nicotine products. The company, established in 1902, is headquartered in London, England. As of 2019, it is the large ...
was the first tobacco business to sell e-cigarettes in the UK. They launched the e-cigarette Vype in July 2013, while
Imperial Tobacco Imperial Brands plc (formerly Imperial Tobacco Group plc), is a British multinational tobacco company headquartered in Bristol, England. It is the world's fourth-largest international cigarette company measured by market share after Philip Mor ...
'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 Boots UK Limited (formerly Boots the Chemists), trading as Boots, is a British health and beauty retailer and pharmacy chain in the United Kingdom and other countries and territories including Ireland, Italy, Norway, the Netherlands, Thailand an ...
. On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG. SKY was rebranded as blu. On 3 February 2014, Altria Group, Inc. acquired popular e-cigarette brand Green Smoke for $110 million. The deal was finalized in April 2014 for $110 million with $20 million in incentive payments. Altria also markets its own e-cigarette, the MarkTen, while
Reynolds American Reynolds American, Inc. is an American tobacco company which is a subsidiary of British American Tobacco and is the second-largest tobacco company in the United States. Its holdings include R. J. Reynolds Tobacco Company, American Snuff Company ( ...
has entered the sector with its
Vuse Vuse is an electronic cigarette produced by R. J. Reynolds Vapor Company, a subsidiary of the Reynolds American tobacco company. In 2015, it was the most popular e-cigarette in the United States with 33% market share in Nielsen-tracked channels ...
product. Philip Morris, the world's largest tobacco company, purchased UK's Nicocigs in June 2014. On 30 April 2015,
Japan Tobacco Hepburn: ''Nippon Senbai Kōsha'' , type = 1985-: Public (''kabushiki gaisha'') 1949-1985: Statutory corporation , traded_as = , industry = FoodTobacco , foundation = 1898 (as Imperial Japanese Tobacco Company)1 June 1949 (as Japan Tobacco ...
bought the US
Logic Logic is the study of correct reasoning. It includes both formal and informal logic. Formal logic is the science of deductively valid inferences or of logical truths. It is a formal science investigating how conclusions follow from premises ...
e-cigarette brand. Japan Tobacco also bought the UK E-Lites brand in June 2014. On 15 July 2014, Lorillard sold blu to Imperial Tobacco as part of a deal for $7.1 billion. , 95% of e-cigarettes were made in China. In the UK, where most vaping uses refillable sets and e-liquid, there is now support from the
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
, and other medical bodies now embrace the use of e-cigarettes as a viable way to quit smoking. This has contributed to record numbers of people vaping, with current vapers over 3.6 million as of June 2021.


Society and culture

Consumers have shown passionate support for e-cigarettes that other nicotine replacement products did not receive. They have a mass appeal that could challenge combustible tobacco's market position. By 2013, a
subculture A subculture is a group of people within a culture that differentiates itself from the parent culture to which it belongs, often maintaining some of its founding principles. Subcultures develop their own norms and values regarding cultural, poli ...
had emerged calling itself "the vaping community". Members often see e-cigarettes as a safer alternative to smoking, and some view it as a
hobby A hobby is considered to be a regular activity that is done for enjoyment, typically during one's leisure time. Hobbies include collecting themed items and objects, engaging in creative and artistic pursuits, playing Sport, sports, or pursu ...
. The online forum E-Cig-Reviews.com was one of the first major communities. It and other online forums, such as UKVaper.org, were where the hobby of modding started. There are also groups on
Facebook Facebook is an online social media and social networking service owned by American company Meta Platforms. Founded in 2004 by Mark Zuckerberg with fellow Harvard College students and roommates Eduardo Saverin, Andrew McCollum, Dustin M ...
and
Reddit Reddit (; stylized in all lowercase as reddit) is an American social news aggregation, content rating, and discussion website. Registered users (commonly referred to as "Redditors") submit content to the site such as links, text posts, images ...
. Online forums based around modding have grown in the vaping community. Vapers embrace activities associated with e-cigarettes and sometimes evangelise for them. E-cigarette companies have a substantial online presence, and there are many individual vapers who blog and tweet about e-cigarette related products. A 2014 ''
Postgraduate Medical Journal The ''Postgraduate Medical Journal'' is a monthly peer-reviewed medical journal that was established in 1925 by the Fellowship of Postgraduate Medicine, of which it is the official journal. It is currently published on behalf of the Fellowship by ...
'' editorial said 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". Contempt for
Big Tobacco Big Tobacco is a name used to refer to the largest companies in the tobacco industry. According to the World Medical Journal, the five largest tobacco companies are: Philip Morris International, British American Tobacco, Imperial Brands, Japan To ...
is part of vaping culture. A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda. The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws. This is similar to
tobacco industry The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
activity going back to the 1980s. These approaches were used in Europe to minimize the EU Tobacco Products Directive in October 2013.
Grassroots A grassroots movement is one that uses the people in a given district, region or community as the basis for a political or economic movement. Grassroots movements and organizations use collective action from the local level to effect change at t ...
lobbying also influenced the Tobacco Products Directive decision. Tobacco companies have worked with organizations conceived to promote e-cigarette use, and these organizations have worked to hamper legislation intended at restricting e-cigarette use. A popular vaporizer used by American youth is
Juul Juul Labs, Inc. (, stylized as JUUL Labs) is an American electronic cigarette company that spun off from Pax Labs in 2017. Juul Labs makes the Juul electronic cigarette, which atomizes nicotine salts derived from tobacco supplied by one-time ...
. Close to 80% of respondents in a 2017
Truth Initiative Truth Initiative (formerly the American Legacy Foundation or Legacy) is a nonprofit tobacco control organization "dedicated to achieving a culture where all youth and young adults reject tobacco." It was established in March 1999 as a result of ...
study aged 15–24 reported using Juul also used the device in the last 30 days. Teenagers use the verb "Juuling" to describe their use of Juul, and Juuling is the subject of many
memes A meme ( ) is an idea, behavior, or style that spreads by means of imitation from person to person within a culture and often carries symbolic meaning representing a particular phenomenon or theme. A meme acts as a unit for carrying cultural i ...
on social media. Students have commented on
Twitter Twitter is an online social media and social networking service owned and operated by American company Twitter, Inc., on which users post and interact with 280-character-long messages known as "tweets". Registered users can post, like, and ...
about using Juul in class. Large gatherings of vapers, called vape meets, take place around the US. They focus on e-cigarette devices, accessories, and the lifestyle that accompanies them. Vapefest, which started in 2010, is an annual show hosted by different cities. People attending these meetings are usually enthusiasts that use specialized, community-made products not found in
convenience store A convenience store, convenience shop, corner store or corner shop is a small retail business that stocks a range of everyday items such as coffee, groceries, snack foods, confectionery, soft drinks, ice creams, tobacco products, lottery ticket ...
s or
gas stations A filling station, also known as a gas station () or petrol station (), is a facility that sells fuel and engine lubricants for motor vehicles. The most common fuels sold in the 2010s were gasoline (or petrol) and diesel fuel. Gasoline ...
. 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. Some
vape shop A vape shop is a Retail#Retailing in the modern era, retail outlet specializing in the selling of electronic cigarette products. There are also online shopping, online vape shops. A vape shop offers a range of e-cigarette products. The majority ...
s have a vape bar where patrons can test out different e-liquids and socialize. The Electronic Cigarette Convention in North America which started in 2013, is an annual show where companies and consumers meet up. A subclass of vapers configure their atomizers to produce large amounts of vapor by using low-resistance heating coils. This practice is called "
cloud-chasing Cloud-chasing is the activity of blowing large clouds of vapor using an electronic cigarette. Using the devices for "cloud-chasing" began in the West Coast of the US. The exact origins of the activity are unclear, but most competitive e-cigaret ...
". By using a coil with very low resistance, the batteries are stressed to a potentially unsafe extent. This could present a risk of dangerous battery failures. As vaping comes under increased scrutiny, some members of the vaping community have voiced their concerns about cloud-chasing, stating the practice gives vapers a bad reputation when doing it in public. The Oxford Dictionaries'
word of the year The word(s) of the year, sometimes capitalized as "Word(s) of the Year" and abbreviated "WOTY" (or "WotY"), refers to any of various assessments as to the most important word(s) or expression(s) in the public sphere during a specific year. The Ge ...
for 2014 was "vape".


Regulation

Regulation of e-cigarettes varies across countries and states, ranging from no regulation to banning them entirely. For instance, e-cigarettes containing nicotine are illegal in Japan, forcing the market to use
heated tobacco product A heated tobacco product (HTP) is a tobacco product that heats the tobacco at a lower temperature than conventional cigarettes. These products contain nicotine, which is a highly addictive chemical. The heat generates an aerosol or smoke to be ...
s for cigarette alternatives. Others have introduced strict restrictions and some have licensed devices as medicines such as in the UK. However, , there is no e-cigarette device that has been given a medical license that is commercially sold or available by prescription in the UK. , around two thirds of major nations have regulated e-cigarettes in some way. Because of the potential relationship with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries. The companies that make e-cigarettes have been pushing for laws that support their interests. In 2016 the
US Department of Transportation The United States Department of Transportation (USDOT or DOT) is one of the executive departments of the U.S. federal government. It is headed by the secretary of transportation, who reports directly to the President of the United States and ...
banned the use of e-cigarettes on commercial flights. This regulation applies to all flights to and from the US. In 2018, the Royal College of Physicians asked that a balance is found in regulations over e-cigarettes that ensure product safety while encouraging smokers to use them instead of tobacco, as well as keep an eye on any effects contrary to the control agencies for tobacco. The legal status of e-cigarettes is currently pending in many countries. Many countries such as Brazil, Singapore, Uruguay, and India have banned e-cigarettes. Canada-wide in 2014, they were technically illegal to sell, as no nicotine-containing e-cigarettes are not regulated by
Health Canada Health Canada (HC; french: Santé Canada, SC)Health Canada is the applied title under the Federal Identity Program; the legal title is Department of Health (). is the Structure of the Canadian federal government#Departments, with subsidiary unit ...
, but this is generally unenforced and they are commonly available for sale Canada-wide. In 2016, Health Canada announced plans to regulate vaping products. In the US and the UK, the use and sale to adults of e-cigarettes are legal. The revised EU Tobacco Products Directive came into effect in May 2016, providing stricter regulations for e-cigarettes. It limits e-cigarette advertising in print, on television and radio, along with reducing the level of nicotine in liquids and reducing the flavors used. It does not ban vaping in public places. It requires the purchaser for e-cigarettes to be at least 18 and does not permit buying them for anyone less than 18 years of age. The updated Tobacco Products Directive has been disputed by
tobacco lobbyists Tobacco politics refers to the politics surrounding the use and distribution of tobacco. In the United States, from the 1950s until the 1990s, tobacco industries wielded great influence in shaping public opinion on the health risks of tobacco. ...
whose businesses could be impacted by these revisions. As of 8 August 2016, the US FDA extended its regulatory power to include e-cigarettes, e-liquid and all related products. Under this ruling the FDA will evaluate certain issues, including ingredients, product features and health risks, as well their appeal to minors and non-users. The FDA rule also bans access to minors. A photo ID is now required to buy e-cigarettes, and their sale in all-ages vending machines is not permitted in the US. As of August 2017, regulatory compliance deadlines relating to premarket review requirements for most e-cigarette and e-liquid products have been extended from November 2017 to 8 August 2022, which attracted a lawsuit filed by the American Heart Association, American Academy of Pediatrics, the
Campaign for Tobacco-Free Kids The Campaign for Tobacco-Free Kids is an American non-profit membership organization that advocates in favor of reducing tobacco consumption. It has been called "a leading anti-tobacco organization" by ''the New York Times''. History It was estab ...
, and other plaintiffs. In May 2016 the US FDA used its authority under the
Family Smoking Prevention and Tobacco Control Act Family (from la, familia) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). The purpose of the family is to maintain the well-being of its members and of society. Ideall ...
to deem e-cigarette devices and e-liquids to be tobacco products, which meant it intended to regulate the marketing, labelling, and manufacture of devices and liquids; vape shops that mix e-liquids or make or modify devices were considered manufacturing sites that needed to register with US FDA and comply with
good manufacturing practice Current good manufacturing practices (cGMP) are those conforming to the guidelines recommended by relevant agencies. Those agencies control the authorization and licensing of the manufacture and sale of food and beverages, cosmetics, pharmaceutica ...
regulation. E-cigarette and tobacco companies have recruited lobbyists in an effort to prevent the US FDA from evaluating e-cigarette products or banning existing products already on the market. In February 2014 the
European Parliament The European Parliament (EP) is one of the legislative bodies of the European Union and one of its seven institutions. Together with the Council of the European Union (known as the Council and informally as the Council of Ministers), it adopts ...
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. In April 2014 the US FDA published proposed regulations for e-cigarettes. 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. , 12 US states and 615 localities had prohibited the use of e-cigarettes in venues in which traditional cigarette smoking was prohibited. In 2015, at least 48 states and 2 territories had banned e-cigarette sales to minors. In November 2020, the New Zealand government passed a vaping regulation that requires vape stores to register as specialist vape retailers before they can sell e-cigarettes, the wider range of flavoured e-liquids, and other related vaping products. Vaping products are required to be notified by the government before they can be sold to ensure that the products are following safety requirements and ingredients in liquids do not contain prohibited substances. E-cigarettes containing nicotine have been listed as drug delivery devices in a number of countries, and the marketing of such products has been restricted or put on hold until safety and efficacy clinical trials are conclusive. Since they do not contain tobacco, television advertising in the US is not restricted. Some countries have regulated e-cigarettes as a
medical product Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
even though they have not approved them as a smoking cessation aid. 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. It added, "heavy regulation by restricting access to e-cigarettes would just encourage continuing use of much unhealthier tobacco smoking." A 2014 review said regulation of the e-cigarette should be considered on the basis of reported adverse health effects.


Criticism of vaping bans

Critics of vaping bans state that vaping is a much safer alternative to smoking tobacco products and that vaping bans incentivize people to return to smoking cigarettes. For example, critics cite the British Journal of Family Medicine in August 2015 which stated, "E-cigarettes are 95% safer than traditional smoking." Additionally, San Francisco's chief economist, Ted Egan, when discussing the San Francisco vaping ban stated the city's ban on e-cigarette sales will increase smoking as vapers switch to combustible cigarettes. Critics of smoking bans stress the absurdity of criminalizing the sale of a safer alternative to tobacco while tobacco continues to be legal. Prominent proponents of smoking bans are not in favor of criminalizing tobacco either, but rather allowing consumers to have the choice to choose whatever products they desire. In 2022, after two years of review, the
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) denied Juul's application to keep its tobacco and menthol flavored vaping products on the market. Critics of this denial note that research published in Nicotine and Tobacco Research found that smokers who transitioned to Juuls in North America were significantly more likely to switch to vaping than those in the United Kingdom who only had access to lower-strength nicotine products. This happens as the Biden Administration seeks to mandate low-nicotine cigarettes which, critics note, is not what makes cigarettes dangerous. They also note that vaping does not contain many of the components that make smoking dangerous such as the combustion process and certain chemicals that are present in cigarettes that are not present in vape products.


Product liability

Multiple reports from the
U.S. Fire Administration The United States Fire Administration (USFA) is a division of the Federal Emergency Management Agency (FEMA) located in unincorporated Frederick County, Maryland, near Emmitsburg. Per the official website, "the mission of the U.S. Fire Administr ...
conclude that electronic cigarettes have been combusting and injuring people and surrounding areas. The composition of a cigarette is the cause of this, as the cartridges that are meant to contain the liquid mixture are in such close proximity to the battery. A research report by the
U.S. Fire Administration The United States Fire Administration (USFA) is a division of the Federal Emergency Management Agency (FEMA) located in unincorporated Frederick County, Maryland, near Emmitsburg. Per the official website, "the mission of the U.S. Fire Administr ...
supports this, stating that, "Unlike mobile phones, some e-cigarette lithium-ion batteries within e-cigarettes offer no protection to stop the coil overheating" . In 2015 the
U.S. Fire Administration The United States Fire Administration (USFA) is a division of the Federal Emergency Management Agency (FEMA) located in unincorporated Frederick County, Maryland, near Emmitsburg. Per the official website, "the mission of the U.S. Fire Administr ...
noted in their report that electronic cigarettes are not created by
Big Tobacco Big Tobacco is a name used to refer to the largest companies in the tobacco industry. According to the World Medical Journal, the five largest tobacco companies are: Philip Morris International, British American Tobacco, Imperial Brands, Japan To ...
or other tobacco companies, but by independent factories that have little quality control. Because of this low quality control when made, electronic cigarettes have led to incidents in which people are hurt, or in which the surrounding area is damaged.


Marketing

They are marketed to men, women, and children as being safer than traditional cigarettes. They are also marketed to non-smokers. E-cigarette marketing is common. There are growing concerns that e-cigarette
advertising campaign An advertising campaign is a series of advertisement messages that share a single idea and theme which make up an integrated marketing communication (IMC). An IMC is a platform in which a group of people can group their ideas, beliefs, and conc ...
s unjustifiably focus on young adults, adolescents, and women. Large tobacco companies have greatly increased their marketing efforts. This marketing trend may expand the use of e-cigarettes and contribute to re-glamorizing smoking. Some companies may use e-cigarette advertising to advocate smoking, deliberately, or inadvertently, is an area of concern. 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." E-cigarette companies are using methods that were once used by the tobacco industry to persuade young people to start using cigarettes. E-cigarettes are promoted to a certain extent to forge a vaping culture that entices non-smokers. Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that are appealing to youth and young adults in traditional cigarette advertising and promotion. A 2017 review found "The tobacco industry sees a future where ENDS accompany and perpetuate, rather than supplant, tobacco use, especially targeting the youth." E-cigarettes and nicotine are regularly promoted as safe and even healthy in the media and on brand websites, which is an area of concern. While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in several countries may be indirectly encouraging traditional cigarette use. E-cigarette advertisements are also in magazines, newspapers, online, and in retail stores. Between 2010 and 2014, e-cigarettes were second only to cigarettes as the top advertised product in magazines. As cigarette companies have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction. This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry. There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some stating to want to cooperate in "harm reduction". E-cigarette advertising for using e-cigarettes as a quitting tool have been seen in the US, UK, and China, which have not been supported by regulatory bodies. In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013. In the US and Canada, over $2 million is spent yearly on promoting e-cigarettes online. E-cigarette websites often made unscientific health statements in 2012. The ease to get past the
age verification An age verification system, also known as an age gate, is a technical protection measure used to restrict access to digital content from those who are not appropriately-aged. These systems are used primarily to restrict access to content classifie ...
system at e-cigarette company websites allows underage individuals to access and be exposed to marketing. Around half of e-cigarette company websites have a minimum age notice that prohibited underage individuals from entering.
Celebrity endorsements Celebrity branding or celebrity endorsement is a form of advertising campaign or marketing strategy which uses a celebrity's fame or social status to promote a product, brand or service, or to raise awareness about an issue. Marketers use celebr ...
are used to encourage e-cigarette use. A 2012 national US television advertising campaign for e-cigarettes starred
Stephen Dorff Stephen Hartley Dorff Jr. (born July 29, 1973) is an American actor. He is known for portraying Roland West in the third season of HBO's crime drama anthology series ''True Detective'', PK in '' The Power of One'', Stuart Sutcliffe in ''Backbe ...
exhaling a "thick flume" of what the advertisement describes as "vapor, not tobacco smoke", exhorting smokers with the message "We are all adults here, it's time to take our freedom back." Opponents of the tobacco industry state that the Blu advertisement, in a context of longstanding prohibition of tobacco advertising on television, seems to have resorted to advertising tactics that got former generations of people in the US addicted to traditional cigarettes. 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". University of Pennsylvania communications professor Joseph Cappella stated that the setting of the advertisement near an ocean was meant to suggest an association of clean air with the nicotine product. In 2012 and 2013, e-cigarette companies advertised to a large television audience in the US which included 24 million youth. The channels to which e-cigarette advertising reached the largest numbers of youth (ages 12–17) were AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1. Since at least 2007, e-cigarettes have been heavily promoted across media outlets globally. They are vigorously advertised, mostly through the Internet, as a safe substitute to traditional cigarettes, among other things. E-cigarette companies promote their e-cigarette products on
Facebook Facebook is an online social media and social networking service owned by American company Meta Platforms. Founded in 2004 by Mark Zuckerberg with fellow Harvard College students and roommates Eduardo Saverin, Andrew McCollum, Dustin M ...
,
Instagram Instagram is a photo and video sharing social networking service owned by American company Meta Platforms. The app allows users to upload media that can be edited with filters and organized by hashtags and geographical tagging. Posts can ...
,
YouTube YouTube is a global online video platform, online video sharing and social media, social media platform headquartered in San Bruno, California. It was launched on February 14, 2005, by Steve Chen, Chad Hurley, and Jawed Karim. It is owned by ...
, and
Twitter Twitter is an online social media and social networking service owned and operated by American company Twitter, Inc., on which users post and interact with 280-character-long messages known as "tweets". Registered users can post, like, and ...
. They are promoted on YouTube by movies with sexual material and music icons, who encourage minors to "take their freedom back." They have partnered with a number of sports and music icons to promote their products. Tobacco companies intensely market e-cigarettes to youth, with industry strategies including cartoon characters and candy flavors. Fruit flavored e-liquid is the most commonly marketed e-liquid flavor on social media. E-cigarette companies commonly promote that their products contain only water, nicotine, glycerin, propylene glycol, and flavoring but this assertion is misleading as researchers have found differing amounts of heavy metals in the vapor, including chromium, nickel, tin, silver, cadmium, mercury, and aluminum. The widespread assertion that e-cigarettes emit "only water vapor" is not true because the evidence demonstrates e-cigarette vapor contains possibly harmful chemicals such as nicotine, carbonyls, metals, and
volatile organic compound Volatile organic compounds (VOCs) are organic compounds that have a high vapour pressure at room temperature. High vapor pressure correlates with a low boiling point, which relates to the number of the sample's molecules in the surrounding air, a ...
s, in addition to particulate matter. Massive advertising included the assertion that they would present little risk to non-users. However, "disadvantages and side effects have been reported in many articles, and the unfavorable effects of its secondhand vapor have been demonstrated in many studies", and evidence indicates that use of e-cigarettes degrades indoor air quality. Many e-cigarette companies market their products as a smoking cessation aid without evidence of effectiveness. E-cigarette marketing has been found to make unsubstantiated health statements (e.g., that they help one quit smoking) including statements about improving psychiatric symptoms, which may be particularly appealing to smokers with mental illness. E-cigarette marketing advocate weight control and emphasize use of nicotine with many flavors. These marketing angles could particularly entice overweight people, youth, and vulnerable groups. Some e-cigarette companies state that their products are
green Green is the color between cyan and yellow on the visible spectrum. It is evoked by light which has a dominant wavelength of roughly 495570 Nanometre, nm. In subtractive color systems, used in painting and color printing, it is created by ...
without supporting evidence which may be purely to increase their sales.


Economics

The number of e-cigarettes sold increased every year from 2003 to 2014. In 2015 a slowdown in the growth in usage occurred in the US. As of January 2018, the growth in usage in the UK has slowed down since 2013. there were at least 466 e-cigarette brands. Worldwide e-cigarette sales in 2014 were around US$7 billion. Worldwide e-cigarette sales in 2019 were about $19.3 billion. E-cigarette sales could exceed traditional cigarette sales by 2023. Approximately 30–50% of total e-cigarettes sales are handled on the internet. Established tobacco companies have a significant share of the e-cigarette market. , 95% of e-cigarette devices were made in China, mainly in
Shenzhen Shenzhen (; ; ; ), also historically known as Sham Chun, is a major sub-provincial city and one of the special economic zones of China. The city is located on the east bank of the Pearl River estuary on the central coast of southern province ...
. Chinese companies' market share of e-liquid is low. In 2014, online and offline sales starting increases. Since combustible cigarettes are relatively inexpensive in China a lower price may not be large factor in marketing vaping products over there. In 2015, 80% of all e-cigarette sales in convenience stores in the US were products made by tobacco companies. According to
Nielsen Holdings Nielsen Holdings plc is an American information, data and market measurement firm. Nielsen operates in over 100 countries and employs approximately 44,000 people worldwide. The company was listed on the New York Stock Exchange (NYSE) and use ...
, convenience store e-cigarette sales in the US went down for the first time during the four-week period ending on 10 May 2014. Wells Fargo analyst Bonnie Herzog attributes this decline to a shift in consumers' behavior, buying more specialized devices or what she calls "vapors-tanks-mods (VTMs)" that are not tracked by Nielsen. Wells Fargo estimated that VTMs accounted for 57% of the 3.5 billion dollar market in the US for vapor products in 2015. In 2014, dollar sales of customizable e-cigarettes and e-liquid surpassed sales of cigalikes in the US, even though, overall, customizables are a less expensive vaping option. 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. However the 2015 slowdown in market growth affected VTMs as well. Large tobacco retailers are leading the cigalike market. "We saw the market's sudden recognition that the cigarette industry seems to be in serious trouble, disrupted by the rise of vaping," ''
Mad Money ''Mad Money'' is an American finance television program hosted by Jim Cramer that began airing on CNBC on March 14, 2005. Its main focus is investment and speculation, particularly in public company stocks. Cramer defines "mad money" as th ...
s
Jim Cramer James Joseph Cramer (born February 10, 1955) is an American television personality and author. He is the host of ''Mad Money'' on CNBC and an anchor on ''Squawk on the Street''. A former hedge fund manager, founder, and senior partner of Cramer ...
stated April 2018. "Over the course of three short days, the tobacco stocks were bent, they were spindled and they were mutilated by the realization that electronic cigarettes have become a serious threat to the old-school cigarette makers," he added. In 2019, a vaping industry organization released a report stating that a possible US ban on e-cigarettes flavors can potentially effect greater than 150,000
jobs Jobs may refer to: * Job, an activity that people do for regular income gain People * Steve Jobs (1955–2011), co-founder and former CEO of Apple Inc ** Steve Jobs (disambiguation) * Laurene Powell Jobs (born 1963), widow of Steve Jobs * Lisa ...
around the US. The leading seller in the e-cigarette market in the US is the Juul e-cigarette, which was introduced in June 2015. , Juul accounts for over 72% of the US e-cigarette market monitored by Nielsen, and its closest competitor—
RJ Reynolds Richard Joshua Reynolds (July 20, 1850 – July 29, 1918) was an American businessman and founder of the R. J. Reynolds Tobacco Company. The son of a tobacco farmer, he worked for his father and attended Emory & Henry College from 1868 to 1870, ...
'
Vuse Vuse is an electronic cigarette produced by R. J. Reynolds Vapor Company, a subsidiary of the Reynolds American tobacco company. In 2015, it was the most popular e-cigarette in the United States with 33% market share in Nielsen-tracked channels ...
—makes up less than 10% of the market. Juul rose to popularity quickly, growing by 700% in 2016 alone. On 17 July 2018 Reynolds announced it will debut in August 2018 a pod mod type device similar Juul. The popularity of the Juul pod system has led to a flood of other pod devices hitting the market. In Canada, e-cigarettes had an estimated value of 140 million CAD in 2015. There are numerous e-cigarette retail shops in Canada. A 2014 audit of retailers in four Canadian cities found that 94% of grocery stores, convenience stores, and tobacconist shops which sold e-cigarettes sold nicotine-free varieties only, while all vape shops stocked at least one nicotine-containing product. By 2015 the e-cigarette market had only reached a twentieth of the size of the tobacco market in the UK. In the UK in 2015 the "most prominent brands of cigalikes" were owned by tobacco companies, however, with the exception of one model, all the tank types came from "non-tobacco industry companies". Yet some tobacco industry products, while using prefilled cartridges, resemble tank models. France's e-cigarette market was estimated by Groupe Xerfi to be
The euro sign () is the currency sign used for the euro, the official currency of the eurozone and unilaterally adopted by Kosovo and Montenegro. The design was presented to the public by the European Commission on 12 December 1996. It consists o ...
130 million in 2015. Additionally, France's e-liquid market was estimated at €265 million. In December 2015, there were 2,400 vape shops in France, 400 fewer than in March of the same year. Industry organization Fivape said the reduction was due to consolidation, not to reduced demand.


Environmental impact

Compared to traditional cigarettes, reusable e-cigarettes do not create waste and potential litter from every use in the form of discarded cigarette butts. Traditional cigarettes tend to end up in the ocean where they cause pollution, though once discarded they undergo
biodegradation Biodegradation is the breakdown of organic matter by microorganisms, such as bacteria and fungi. It is generally assumed to be a natural process, which differentiates it from composting. Composting is a human-driven process in which biodegrada ...
and
photodegradation Photodegradation is the alteration of materials by light. Commonly, the term is used loosely to refer to the combined action of sunlight and air, which cause oxidation and hydrolysis. Often photodegradation is intentionally avoided, since it destroy ...
. Although some brands have begun recycling services for their e-cigarette cartridges and batteries, the prevalence of recycling is unknown. E-cigarettes that are not reusable contribute to the problem of
electronic waste Electronic waste or e-waste describes discarded electrical or electronic devices. Used electronics which are destined for refurbishment, reuse, resale, salvage recycling through material recovery, or disposal are also considered e-waste. Informa ...
, which can create a hazard for people and other organisms. If improperly disposed of, they can release
heavy metals upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead Heavy metals are generally defined as ...
, nicotine, and other chemicals from batteries and unused e-liquid. A July 2018–April 2019 garbology study found e-cigarette products composed 19% of the waste from all traditional and electronic tobacco and cannabis products collected at 12 public high schools in Northern California.


Related technologies

Other devices to deliver inhaled nicotine have been developed. They aim to mimic the ritual and behavioral aspects of traditional cigarettes. British American Tobacco, through their subsidiary Nicoventures, licensed a nicotine delivery system based on existing asthma
inhaler An inhaler (also known as a puffer, pump or allergy spray) is a medical device used for delivering medicines into the lungs through the work of a person's breathing. This allows medicines to be delivered to and absorbed in the lungs, which prov ...
technology from UK-based healthcare company
Kind Consumer Kind Consumer Limited was a UK-based company that developed Voke, a nicotine inhaler intended to address tobacco harm reduction. The company was founded in 2006 by Alex Hearn, a British inventor and entrepreneur based in London. The company coll ...
. In September 2014 a product based on this named Voke obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency. In 2011
Philip Morris International Philip Morris International Inc. (PMI) is an American Multinational corporation, multinational tobacco company, with products sold in over 180 countries. The most recognized and best selling product of the company is Marlboro. Philip Morris I ...
bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University. The technology is based on the chemical reaction between
pyruvic acid Pyruvic acid (CH3COCOOH) is the simplest of the alpha-keto acids, with a carboxylic acid and a ketone functional group. Pyruvate, the conjugate base, CH3COCOO−, is an intermediate in several metabolic pathways throughout the cell. Pyruvic aci ...
and nicotine, which produces an inhalable nicotine pyruvate vapor. Philip Morris Products S.A. created a different kind e-cigarette named P3L. The device is supplied with a cartridge that contains nicotine and lactic acid in different cavities. When turned on and heated, the nicotine salt called nicotine lactate forms an aerosol. The IQOS is a heated tobacco product marketed by Philip Morris International. It heats tobacco at a lower temperature than traditional cigarettes. The tobacco sticks reach a temperature up to 350 °C. It sold first in Japan since November 2014. On 2 December 2016, the United Tobacco Vapor Group's (UTVG) stated that they have been given a patent for their vaporizing component system. qmos from UTVG does not contain a wick or sponge and the number of components is 5 compared to 20 for traditional e-cigarettes.
Pax Labs Pax Labs (formerly Ploom and stylized as PAX Labs) is an American vaporizer (inhalation device), electronic vaporizer company founded in 2007 that markets the Pax vaporizers. The company developed the Juul (pronounced jewel) e-cigarette; Juul L ...
has developed vaporizers that heats the leaves of tobacco to deliver nicotine in a vapor. On 1 June 2015, they introduced
Juul Juul Labs, Inc. (, stylized as JUUL Labs) is an American electronic cigarette company that spun off from Pax Labs in 2017. Juul Labs makes the Juul electronic cigarette, which atomizes nicotine salts derived from tobacco supplied by one-time ...
a type of e-cigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to an actual cigarette puff. Juul was spun off from Pax Labs in June 2017 and is now available by the independent company Juul Labs. The eTron 3T from Vapor Tobacco Manufacturing, launched in December 2014, employs a patented, aqueous system whereby the tobacco is extracted into water. The e-liquid contains
organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ Chemistry * Organic matter, matter that has come from a once-living organism, is capable of decay or is the product ...
tobacco, organic glycerin, and water. In December 2013
Japan Tobacco Hepburn: ''Nippon Senbai Kōsha'' , type = 1985-: Public (''kabushiki gaisha'') 1949-1985: Statutory corporation , traded_as = , industry = FoodTobacco , foundation = 1898 (as Imperial Japanese Tobacco Company)1 June 1949 (as Japan Tobacco ...
launched Ploom in Japan. In January 2016 they launched Ploom TECH that produces a vapor from a heated liquid that moves through a capsule of granulated tobacco leaves. In 2016 British American Tobacco (BAT) released its own version of the heat but not burn technology called glo in Japan and Switzerland. It uses tobacco sticks rather than nicotine liquid, and does not directly heat or burn tobacco. Heated tobacco products were first introduced in 1988, but were not a commercial success. BLOW started selling e-hookahs, an electronic version of the
hookah A hookah (Hindustani language, Hindustani: (Nastaleeq), (Devanagari), IPA: ; also see #Names and etymology, other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco ...
, in 2014. The handle of each hose for the e-hookah contains a heating element and a liquid, which produces vapor.
Gopal Bhatnagar Gopal Bhatnagar is a Canadian cardiac surgeon based in Toronto, Canada. Bhatnagar headed the cardiovascular surgery unit at Trillium Health Centre and served as chief of staff at Trillium Hospital from 2005 to March 2013. He is a practitioner of ...
, based in Toronto, Canada, invented a 3D printed adapter to turn a traditional hookah into an e-hookah. It is used instead of the ceramic bowl that contains shisha tobacco. Rather than the tobacco, users can insert e-cigarettes. KanaVape is an e-cigarette containing
cannabidiol Cannabidiol (CBD) is a phytocannabinoid discovered in 1940. It is one of 113 identified cannabinoids in cannabis plants, along with tetrahydrocannabinol (THC), and accounts for up to 40% of the plant's extract. , clinical research on CBD incl ...
(CBD) and no
THC Tetrahydrocannabinol (THC) is the principal psychoactive constituent of cannabis and one of at least 113 total cannabinoids identified on the plant. Although the chemical formula for THC (C21H30O2) describes multiple isomers, the term ''THC'' ...
. Several companies including Canada's Eagle Energy Vapor are selling
caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...
-based e-cigarettes instead of containing nicotine.


Notes


Bibliography

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References


External links

* {{Authority control Cigarette types Chinese inventions Smoking cessation Substance-related disorders Non-tobacco nicotine products 2003 introductions 21st-century inventions Articles containing video clips