Electronic cigarette

"Vape" redirects here. For the Argentine reconnaissance vehicle, see VAPE.

Not to be confused with Heated tobacco product or Vaporizer (inhalation device).

An electronic cigarette (e-cigarette), or vape,^{[note 1][1]} is a device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor,^[2] often called "vaping".^[3]

A first-generation e-cigarette that resembles a tobacco cigarette, with a battery portion that can be disconnected and recharged using the USB power charger

Various types of e-cigarettes from 2015, including a disposable e-cigarette, a rechargeable e-cigarette, a medium-size tank device, large-size tank devices, an e-cigar, and an e-pipe

The atomizer is a heating element that vaporizes a liquid solution called e-liquid^[4] that cools into an aerosol of tiny droplets, vapor and air.^[5] The vapor mainly comprises propylene glycol and/or glycerin, usually with nicotine and flavoring. Its exact composition varies, and depends on matters such as user behavior.^{[note 2]} E-cigarettes are activated by taking a puff or pressing a button.^[3][6] Some look like traditional cigarettes,^[3][7] and most kinds are reusable.^{[note 3]}

Vaping is less harmful than smoking,^[9] but still has health risks.^[10] Vaping affects asthma^[11] and chronic obstructive pulmonary disease.^[12][13][14] Nicotine is highly addictive.^[15] Limited evidence indicates that e-cigarettes are less addictive than smoking, with slower nicotine absorption rates.^[16][17]

E-cigarettes containing nicotine are more effective than nicotine replacement therapy (NRT) for smoking cessation,^[18] but have not been subject to the same rigorous testing that most nicotine replacement therapy products have.^[19]

Description

Main article: Construction of electronic cigarettes

An exploded view of a typical e-cigarette design with transparent atomizer (labeled clearomizer in diagram) and changeable dual-coil head.

An electronic cigarette consists of an atomizer, a power source such as a battery,^[20] 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".^[21][22] Second-generation devices are larger and look less like traditional cigarettes.^[23] Third-generation devices include mechanical mods and variable voltage devices.^[21] The fourth-generation includes sub-ohm tanks (meaning they have electrical resistance of less than 1 ohm) and temperature control.^[24] There are also pod mod devices that use protonated nicotine, rather than free-base nicotine found in earlier generations,^[25] providing higher nicotine yields.^[26][27]

E-liquid

The mixture used in vapor products such as e-cigarettes is called e-liquid.^[28] E-liquid formulations vary widely.^[22][29] A typical e-liquid is composed of propylene glycol and glycerin (95%) and a combination of flavorings, nicotine, and other additives (5%).^[30][31] The flavorings may be natural, artificial,^[29] or organic.^[32] There are many e-liquid manufacturers,^[33] and more than 15,000 flavors.^[34]

Many countries regulate what e-liquids can contain. In the US, there are Food and Drug Administration (FDA) compulsory manufacturing standards^[35] and American E-liquid Manufacturing Standards Association (AEMSA) recommended manufacturing standards.^[36] European Union standards are published in the EU Tobacco Products Directive.^[37]

Coils

Vaping cannabis usually involves higher temperatures than nicotine.^[38]

Use

Popularity

Estimated trends in the global number of vapers

Since entering the market around 2003, e-cigarette use has risen rapidly.^[39][40][41] 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.^[42] There was a further rise to 82 million e-cigarette users in 2021.^[43] This increase has been attributed to targeted marketing, and ecigs being cheaper and safer than combustible cigarettes.^[44] E-cigarette use is highest in China, the US, and Europe, with China having the most users.^[6][45]

Motivation

Reasons for initiating e-cigarette use in the European Union, in a 2018 Eurobarometer poll^[46]

There are varied reasons for e-cigarette use.^[6] Most users are trying to quit smoking,^{[47][obsolete source]}but a large proportion of use is recreational or as an attempt to get around smoke-free laws.^{[6][7][48][47]} Many people vape to relax,^[49] and some because vaping is safer than smoking.^[50][51][52] The wide choice of flavors and lower price compared to cigarettes are also important factors.^[53]

Other motivations include reduced odor and fewer stains.^[54] E-cigarettes also appeal to technophiles who enjoy customizing their devices.^[54]

Gateway theory

The gateway hypothesis is the idea that using less harmful drugs can lead to more harmful ones.^[55] Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes.^{[56][57][58][59][excessive citations][why?]} People with mental illnesses, who as a group are more susceptible to nicotine addiction, are at particularly high risk of dual use.^[60][61]

However, an association between vaping and subsequent smoking does not necessarily imply a causal gateway effect.^[62] Instead, people may have underlying characteristics that predispose them to both activities.^[63][64] There is a genetic association between smoking, vaping, gambling, promiscuity and other risk-taking behaviors.^[65] Young people with poor executive functioning use e-cigarettes, cigarettes, and alcohol at higher rates than their peers.^[66] E-cigarette users are also more likely to use both cannabis and unprescribed Adderall or Ritalin.^[67] Longitudinal studies of e-cigarettes and smoking have been criticized for failing to adequately control for these and other confounding factors.^[68][69][70]

Smoking rates have continually declined as e-cigarettes have grown in popularity, especially among young people, suggesting that there is little evidence for a gateway effect at the population level.^[63][64] This observation has been criticized, however, for ignoring the effect of anti-smoking interventions.^[71]

Young adult and teen use

Worldwide, increasing numbers of young people are vaping.^[72][73][74] With access to e-cigarettes, young people's tobacco use has dropped by about 75%.^{[75][76][77][78][excessive citations]}

Most young e-cigarette users have never smoked,^[79] but there is a substantial minority who both vape and smoke.^[80] Many young people who would not smoke are vaping.^[81][48] Young people who smoke tobacco or marijuana, or who drink alcohol, are much more likely to vape.^[82][83] Among young people who have tried vaping, most used a flavored product the first time.^[82][84]

Vaping correlates with smoking among young people, even in those who would otherwise be unlikely to smoke.^[85] A 2015 study found minors had little resistance to buying e-cigarettes online.^{[86][obsolete source]}Teenagers may not admit to using e-cigarettes, but use, for instance, a hookah pen.^[87] As a result, self-reporting may be lower in surveys.^[87]

More recent studies show a trend of an increasing proportion of young people 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.^[88] Similarly, in Canada, there has been trend showing 29% of young people reporting to have used e-cigarettes in 2017, increasing to 37% in 2018.^[89]

Health effects

This section is an excerpt from Health effects of electronic cigarettes.[edit]

Electronic cigarettes (ecigs) are much less harmful than cigarettes which burn,^[90] but worse than not smoking at all. Ecigs increase the risk of asthma and chronic obstructive pulmonary disease (COPD) compared to not using nicotine at all.^[91] Pregnant women vaping may increase the risk of their children suffering asthma and COPD,^[92] but is still safer than smoking.^[93] Vaping is associated with heart failure.^[94] Unregulated or modified ecigs or liquids may be more dangerous.^[95]

The public health community is divided over the use of these devices to reduce/prevent smoking.^[96] As of 2017 they were not approved by the US Centers for Disease Control and Prevention (CDC) as a smoking cessation product,^[97] and in 2020 became regulated as a tobacco product (despite not containing tobacco). However, a 2019 study reported that 10% of participants given nicotine via gum, mouth spray, patches, etc., quit smoking, while 18% of those given vaping kits quit. Among participants still smoking, vapers smoked less.^[98] A 2021 review by Public Health England (PHE) reported vaping to be around 95% less harmful than smoking.^[90] E-cigarettes are estimated to have preserved 677,000 life–years in the US alone from 2011 to 2019.^[99]

E-cigarette use (vaping) carries some level of health risks.^[97][100] Reported risks (compared to not smoking) include exposure to toxic chemicals, increased likelihood of respiratory and cardiovascular diseases, reduced lung function, reduced cardiac muscle function, increased inflammation,^[101][102] increased drug dependency, and damage to the central nervous system.^[103] Misuse, accidents, and product malfunction issues increase risks^[104] such as nicotine poisoning,^[105][106] contact with liquid nicotine,^[107] and fires.^[108]

Adverse effects of vaping

Randomized controlled trials provide "high-certainty" evidence that e-cigarettes containing nicotine are more effective than nicotine replacement therapy for discontinuing tobacco smoking, and moderate‐certainty evidence that they are more effective than e-cigarettes free of nicotine.^{[109][note 4]}

Some of the most common but less serious adverse effects include abdominal pain, headache, blurry vision,^[110] throat and mouth irritation, vomiting, nausea, and coughing.^[111] Nicotine is addictive and harmful to fetuses, children, and young people.^[112]

History

It is commonly stated that the modern e-cigarette was invented in 2003 by Chinese pharmacist Hon Lik, but tobacco companies had been developing nicotine aerosol generation devices since as early as 1963.^[113]

Early prototypes and barriers to entry: 1920s–1990s

In 1927, Joseph Robinson applied for a patent for an electronic vaporizer to be used with medicinal compounds.^[114] The patent was approved in 1930 but the device was never marketed.^[115] In 1930, the United States Patent and Trademark Office reported a patent stating, "for holding medicinal compounds which are electrically or otherwise heated to produce vapors for inhalation."^[116] In 1934 and 1936, further similar patents were applied for.^[116]

The earliest e-cigarette can be traced to American Herbert A. Gilbert.^[117] In 1963, Gilbert applied for a patent for "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air".^[118][119] This device produced flavored steam without nicotine.^[119] The patent was granted in 1965.^[120] Gilbert's invention was ahead of its time.^[121] However, it received little attention^[122] and was never commercialized^[119] because smoking was still fashionable at that time.^[123] Gilbert said in 2013 that today's electric cigarettes follow the basic design set forth in his original patent.^[120]

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.^[82] Favor was conceptualized by Phil Ray, one of the founders of Datapoint Corporation and inventors of the microprocessor. Development started in 1979 by Phil Ray and Norman Jacobson.^[124] 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."^[125]

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."^[126] In 1987, the FDA exercised jurisdiction over products analogous to E-Cigarettes.^[127] Advanced Tobacco Products never challenged the Warning Letter and ceased all distribution of Favor.^[128] Ray's wife Brenda Coffee coined the term vaping.^[129] Philip Morris' division NuMark, launched in 2013 the MarkTen e-cigarette that Philip Morris had been working on since 1990.^[113]

Modern electronic cigarette: 2000s

Despite these earlier efforts, Hon Lik, a Chinese pharmacist and inventor, who worked as a research pharmacist for a company producing ginseng products,^[130] is frequently credited with the invention of the modern e-cigarette.^[113] Hon quit smoking after his father, also a heavy smoker, died of lung cancer.^[130] In 2001, he thought of using a high frequency, piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine.^[131] This design creates a smoke-like vapor.^[130] Hon said that using resistance heating obtained better results and the difficulty was to scale down the device to a small enough size.^[131] Hon's invention was intended to be an alternative to smoking.^[131] Hon Lik sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera."^[132] Ultimately, Hon Lik did not quit smoking. He is now a dual user, both smoking and vaping.^[133]

The Ruyan e-cigar was first launched in China in 2004.^[134]

Hon Lik registered a patent for the modern e-cigarette design in 2003.^[131] Hon is credited with developing the first commercially successful electronic cigarette.^[135] The e-cigarette was first introduced to the Chinese domestic market in 2004.^[130] Many versions made their way to the US, sold mostly over the Internet by small marketing firms.^[130] E-cigarettes entered the European market and the US market in 2006 and 2007.^[136] The company that Hon worked for, Golden Dragon Holdings, registered an international patent in November 2007.^[137] The company changed its name to Ruyan (如烟, literally "like smoke"^[130]) later the same month,^[138] and started exporting its products.^[130]

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).^[132] Ruyan later changed its company name to Dragonite International Limited.^[138] As of 2014, most e-cigarettes used a battery-powered heating element rather than the earlier ultrasonic technology design.^[22]

Initially, their performance did not meet the expectations of users.^[139] The e-cigarette continued to evolve from the first-generation three-part device.^[22] In 2007, British entrepreneurs Umer and Tariq Sheikh invented the cartomizer.^[140] This is a mechanism that integrates the heating coil into the liquid chamber.^[140] They launched this new device in the UK in 2008 under their Gamucci brand^[141] and the design is now widely adopted by most "cigalike" brands.^[22] Other users tinkered with various parts to produce more satisfactory homemade devices, and the hobby of "modding" was born.^[142] 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^[142] in 2008.^[139] Other enthusiasts built their own mods to improve functionality or aesthetics.^[142] When pictures of mods appeared at online vaping forums many people wanted them, so some mod makers produced more for sale.^[142]

In 2008, a consumer created an e-cigarette called the screwdriver.^[139] The device generated a lot of interest back then, as it let the user to vape for hours at one time.^[142] The invention led to demand for customizable e-cigarettes, prompting manufacturers to produce devices with interchangeable components that could be selected by the user.^[139] In 2009, Joyetech developed the eGo series^[140] which offered the power of the screwdriver model and a user-activated switch to a wide market.^[139] The clearomizer was invented in 2009.^[140] Originating from the cartomizer design, it contained the wicking material, an e-liquid chamber, and an atomizer coil within a single clear component.^[140] The clearomizer allows the user to monitor the liquid level in the device.^[140] Soon after the clearomizer reached the market, replaceable atomizer coils and variable voltage batteries were introduced.^[140] Clearomizers and eGo batteries became the best-selling customizable e-cigarette components in early 2012.^[139]

International growth: 2010s

The market for electronic cigarettes rose rapidly during the early 2010s and it started gaining attention in mainstream media.^[143][144] In the United States, some of the most notable start-ups in the market were blu eCigs, NJOY, V2 Cigs, and Logic, as of 2013.^[145][146] International tobacco companies dismissed e-cigarettes as a fad at first.^[147] However, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete,^[148] they began to produce and market their own brands of e-cigarettes and acquire existing e-cigarette companies.^[149]

The large tobacco companies bought some of the established e-cigarette companies.^[150] blu eCigs, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc.^[151] for $135 million in April 2012.^[152] Japan Tobacco invested in Ploom. British American Tobacco was the first tobacco business to sell e-cigarettes in the UK^[153] and launched the e-cigarette Vype in July 2013.^[153] Imperial Tobacco's Fontem Ventures acquired the intellectual property owned by Hon Lik through Dragonite International Limited for $US 75 million in 2013 and launched Puritane in partnership with Boots UK.^[154] On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG.^[155] SKY was rebranded as blu.^[156]

Various e-cigarettes from 2018. From left to right: Phix, Juno, Von Erl, Juul

On 3 February 2014, Altria Group, Inc. acquired popular e-cigarette brand Green Smoke^{[157][note 5][158]} for $110 million.^[159] The deal was finalized in April 2014 for $110 million with $20 million in incentive payments.^[160] Altria also markets its own e-cigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse product.^[149] Philip Morris, the world's largest tobacco company, purchased UK's Nicocigs in June 2014.^[161] On 30 April 2015, Japan Tobacco bought the US Logic e-cigarette brand.^[162] Japan Tobacco also bought the UK E-Lites brand in June 2014.^[162][158] On 15 July 2014, Lorillard sold blu to Imperial Tobacco as part of a deal for $7.1 billion.^[163]

Following these changes, the main players in the e-cigarette market (at least in the US) were as follows (as of end 2015):^[164]

Company	Brand(s)
Reynolds American, Inc.	Vuse
Fontem (Imperial Brands)	Blu
Japan Tobacco International	Logic
Altria Group	MarkTen, Green Smoke
CB Distributors	21st Century Smoke
Njoy, Inc.	NJOY
Ballantyne Brands, Inc.	Mistic, NEO
VMR Products	V2, Vapor Couture
Nicotek	Metro
FIN Branding Group	FIN

Despite the acquisitions by big tobacco companies, some independent e-cigarette companies had more success, most notably Juul Labs, as of 2018.^[165]

As of 2018^[update], 95% of e-cigarettes were made in China.^[25] Despite international growth of e-cigarettes during the 2010s, not all regions around the world have yet embraced it as much. In 2018, Indonesia became only one of the first in Asia or the Global South to recognise e-cigarettes as a genuine alternative to smoking tobacco.^{[166][clarification needed]}

Established: 2020s

In the United States between 2020 and 2022, the number of e-cigarettes sold had climbed to 22.7 million units. Elf Bar/EBDESIGN, Vuse, JUUL, NJOY and Breeze Smoke were recognized as the five most popular brands as of December 2022.^[167] The surge was driven by non-tobacco flavors such as menthol (for prefilled cartridges) and fruit and candy (for disposables), according to the CDC's health economist Fatma Romeh Ali.^[167]

In the UK, where most vaping uses refillable sets and e-liquid, there is now support from the National Health Service,^[168] 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 estimated 3.6 million in 2019, 3.2 million in 2020, rising to 3.6 million in 2021.^[169] Current vapers being 2.2 million as of 2024.^[170]

Society and culture

"Vaper" redirects here and is not to be confused with Vapor.

Consumers have shown passionate support for e-cigarettes that other nicotine replacement products did not receive.^[171] They have a mass appeal that could challenge combustible tobacco's market position.^[171]

By 2013, a subculture had emerged calling itself "the vaping community".^[172][173] Members often see e-cigarettes as a safer alternative to smoking,^[174] and some view it as a hobby.^[175] The online forum E-Cig-Reviews.com was one of the first major communities.^[142] It and other online forums, such as UKVaper.org, were where the hobby of modding started.^[142] There are also groups on Facebook and Reddit.^[176] Online forums based around modding have grown in the vaping community.^[177]

Vapers embrace activities associated with e-cigarettes and sometimes evangelise for them.^[178] E-cigarette companies have a substantial online presence, and there are many individual vapers who blog and tweet about e-cigarette related products.^[179] A 2014 Postgraduate Medical Journal 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".^[179]

Contempt for Big Tobacco is part of vaping culture.^[180][181] A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda.^[80] The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws.^[80] This is similar to tobacco industry activity going back to the 1980s.^[80] These approaches were used in Europe to minimize the EU Tobacco Products Directive in October 2013.^[80] Grassroots lobbying also influenced the Tobacco Products Directive decision.^[182] 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.^[183]

E-cigarette user blowing a cloud of aerosol (vapor). The activity is known as cloud-chasing.^[184]

Large gatherings of vapers, called vape meets, take place around the US.^[172] They focus on e-cigarette devices, accessories, and the lifestyle that accompanies them.^[172] Vapefest, which started in 2010, is an annual show hosted by different cities.^[176] People attending these meetings are usually enthusiasts that use specialized, community-made products not found in convenience stores or gas stations.^[172] 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.^[185] Some vape shops have a vape bar where patrons can test out different e-liquids and socialize.^[186] The Electronic Cigarette Convention in North America which started in 2013, is an annual show where companies and consumers meet up.^[187]

A subclass of vapers configure their atomizers to produce large amounts of vapor by using low-resistance heating coils.^[188] This practice is called "cloud-chasing".^[189] By using a coil with very low resistance, the batteries are stressed to a potentially unsafe extent.^[190] This could present a risk of dangerous battery failures.^[190] 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.^[191] The Oxford Dictionaries' word of the year for 2014 was "vape".^[192]

Regulation

Main articles: Regulation of electronic cigarettes and List of vaping bans in the United States

Regulation of e-cigarettes varies across countries and states, ranging from no regulation to banning them entirely.^[193] For instance, e-cigarettes containing nicotine are illegal in Japan, forcing the market to use heated tobacco products for cigarette alternatives.^[194] Others have introduced strict restrictions and some have licensed devices as medicines such as in the UK.^[195] However, as of February 2018^[update], there is no e-cigarette device that has been given a medical license that is commercially sold or available by prescription in the UK.^[196] As of 2015^[update], around two thirds of major nations have regulated e-cigarettes in some way.^[197]

Because of the potential relationship with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries.^[198] The companies that make e-cigarettes have been pushing for laws that support their interests.^[199] In 2016 the US Department of Transportation banned the use of e-cigarettes on commercial flights.^[200] This regulation applies to all flights to and from the US.^[200] 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.^[201]

The legal status of e-cigarettes is currently pending in many countries.^[80] Many countries such as Brazil, Singapore, Uruguay,^[195] and India have banned e-cigarettes.^[202] Canada-wide in 2014, they were technically illegal to sell, as no nicotine-containing e-cigarettes are not regulated by Health Canada, but this is generally unenforced and they are commonly available for sale Canada-wide.^[203] In 2016, Health Canada announced plans to regulate vaping products.^[204] In the US and the UK, the use and sale to adults of e-cigarettes are legal.^{[205]: US [206]: UK} The revised EU Tobacco Products Directive came into effect in May 2016, providing stricter regulations for e-cigarettes.^[207] 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.^[208] It does not ban vaping in public places.^[209] 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.^[210] The updated Tobacco Products Directive has been disputed by tobacco lobbyists whose businesses could be impacted by these revisions.^[211]

The US FDA regulates e-cigarettes, e-liquid and all related products.^[212] It evaluates ingredients, product features and health risks, as well their appeal to minors and non-users.^[213] The FDA rule also bans access to minors.^[213] A photo ID is now required to buy e-cigarettes,^[214] and their sale in all-ages vending machines is not permitted in the US.^[213]

In 2016, the US FDA used its authority under the Family Smoking Prevention and Tobacco Control Act 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 regulation.^[215] E-cigarette and tobacco companies recruited lobbyists in an effort to prevent the US FDA from evaluating e-cigarette products or banning existing products already on the market.^[216]

In February 2014, the European Parliament passed regulations requiring standardization and quality control for liquids and vaporizers, disclosure of ingredients in liquids, and child-proofing and tamper-proofing for liquid packaging.^[217] In April 2014 the US FDA published proposed regulations for e-cigarettes.^[218][219] 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.^[220] As of April 2017^[update], 12 US states and 615 localities had prohibited the use of e-cigarettes in venues in which traditional cigarette smoking was prohibited.^[48] In 2015, at least 48 states and 2 territories had banned e-cigarette sales to minors.^[221]

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.^[222]

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.^[223] Since they do not contain tobacco, television advertising in the US is not restricted.^[224] Some countries have regulated e-cigarettes as a medical product even though they have not approved them as a smoking cessation aid.^[225] 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.^[226] It added, "heavy regulation by restricting access to e-cigarettes would just encourage continuing use of much unhealthier tobacco smoking."^[226] A 2014 review said regulation of the e-cigarette should be considered on the basis of reported adverse health effects.^[225]

Criticism of vaping bans

Vaping is much safer than smoking, and critics of vaping bans say that they incentivize people to return to smoking.^[227][228] Additionally, San Francisco's chief economist, Ted Egan, when discussing the San Francisco vaping ban said that the city's ban on e-cigarette sales would increase smoking as vapers switch to combustible cigarettes.^{[229][needs update]} 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^{[clarification needed]} either, but rather allowing consumers to have the choice to choose whatever products they desire.^[227]

In 2022, after two years of review, the Food and Drug Administration (FDA) denied Juul's application to keep its tobacco and menthol flavored vaping products on the market.^[230] 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.^[231] 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 conclude that electronic cigarettes have been combusting and injuring people and surrounding areas.^[232][233] 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.^[22] A research report by the U.S. Fire Administration supports this, stating that, "Unlike mobile phones, some e-cigarette lithium-ion batteries within e-cigarettes offer no protection to stop the coil overheating".^[233]

In 2015, the U.S. Fire Administration noted in their report that electronic cigarettes are not created by Big Tobacco or other tobacco companies, but by independent factories that have little quality control.^{[233][needs update]}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.^[233][232]

Marketing

Main article: Electronic cigarette and e-cigarette liquid marketing

They are marketed to men, women, and children^{[better source needed]} as being safer than traditional cigarettes.^[234] They are also marketed to non-smokers.^[45] E-cigarette marketing is common.^[235] There are growing concerns that e-cigarette advertising campaigns unjustifiably focus on young adults, adolescents, and women.^[236] Large tobacco companies have greatly increased their marketing efforts.^[183] This marketing trend may expand the use of e-cigarettes and contribute to re-glamorizing smoking.^[237] Some companies may use e-cigarette advertising to advocate smoking, deliberately, or inadvertently, is an area of concern.^[238] 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."^[80]

E-cigarette companies are using methods that were once used by the tobacco industry to persuade young people to start using cigarettes.^[239] E-cigarettes are promoted to a certain extent to forge a vaping culture that entices non-smokers.^[239] Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that are appealing to young people and young adults in traditional cigarette advertising and promotion.^[82] A 2017 review found "The tobacco industry sees a future where ENDS accompany and perpetuate, rather than supplant, tobacco use, especially targeting the youth."^[238] 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.^[30]

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.^{[80][better source needed]} E-cigarette advertisements are also in magazines, newspapers, online, and in retail stores.^[240] Between 2010 and 2014, e-cigarettes were second only to cigarettes as the top advertised product in magazines.^[241] 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.^[150] This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry.^[150] 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".^[80] 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.^[242]

In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013.^[243] In the US and Canada, over $2 million is spent yearly on promoting e-cigarettes online.^[239] E-cigarette websites often made unscientific health statements in 2012.^[244] The ease to get past the age verification system at e-cigarette company websites allows underage individuals to access and be exposed to marketing.^[244] Around half of e-cigarette company websites have a minimum age notice that prohibited underage individuals from entering.^[45]

Celebrity endorsements are used to encourage e-cigarette use.^[245] 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.^[152]

From 2011 to 2014, e-cigarette use among young people in the US was rising as e-cigarette advertising increased.^[246]

Since at least 2007, e-cigarettes have been heavily promoted across media outlets globally.^[85] They are vigorously advertised, mostly through the Internet, as a safe substitute to traditional cigarettes, among other things.^[39] E-cigarette companies promote their e-cigarette products on Facebook, Instagram,^[240] YouTube, and Twitter.^[247] They are promoted on YouTube by movies with sexual material and music icons, who encourage minors to "take their freedom back."^[238] They have partnered with a number of sports and music icons to promote their products.^[248] Tobacco companies intensely market e-cigarettes to young people,^[249] with industry strategies including cartoon characters and candy flavors.^[250] Fruit flavored e-liquid is the most commonly marketed e-liquid flavor on social media.^[251]

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.^[86] 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 compounds, in addition to particulate matter.^[252] Massive advertising included the assertion that they would present little risk to non-users.^[253] 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",^[253] and evidence indicates that use of e-cigarettes degrades indoor air quality.^[254]

Many e-cigarette companies market their products as a smoking cessation aid without evidence of effectiveness.^[255] 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.^[53] E-cigarette marketing advocate weight control and emphasize use of nicotine with many flavors.^[256] These marketing angles could particularly entice overweight people, young people, and vulnerable groups.^[256] Some e-cigarette companies state that their products are green without supporting evidence which may be purely to increase their sales.^[198]

Economics

The number of e-cigarettes sold increased every year from 2003 to 2014.^[22] As of 2014^[update], there were at least 466 e-cigarette brands.^[257] Worldwide e-cigarette sales in 2014 were around US$7 billion.^[258] Worldwide e-cigarette sales in 2019 were about $19.3 billion.^[259] E-cigarette sales could exceed traditional cigarette sales by 2023.^[260] Approximately 30–50% of total e-cigarettes sales are handled on the internet.^[39] Established tobacco companies have a significant share of the e-cigarette market.^[87][261]

As of 2018^[update], 95% of e-cigarette devices were made in China,^[25] mainly in Shenzhen.^[262][263] Chinese companies' market share of e-liquid is low.^[264] In 2014, online and offline sales started to increase.^[265] Since combustible cigarettes are relatively inexpensive in China a lower price may not be a large factor in marketing vaping products over there.^[265]

Large tobacco retailers are leading the cigalike market.^[266] "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's Jim Cramer stated April 2018.^[267] "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.^[267] 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 around the US.^[268]

The leading seller in the e-cigarette market in the US is the Juul e-cigarette,^[269] which was introduced in June 2015.^[270] As of August 2018^[update], Juul accounts for over 72% of the US e-cigarette market monitored by Nielsen, and its closest competitor—RJ Reynolds' Vuse—makes up less than 10% of the market.^[271] Juul rose to popularity quickly, growing by 700% in 2016 alone.^[272] On 17 July 2018 Reynolds announced it will debut in August 2018 a pod mod type device similar Juul.^[271] The popularity of the Juul pod system has led to a flood of other pod devices hitting the market.^[273]

In Canada, e-cigarettes had an estimated value of 140 million CAD in 2015.^[274] There are numerous e-cigarette retail shops in Canada.^[275] 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.^[276]

By 2015, the e-cigarette market had only reached a twentieth of the size of the tobacco market in the UK.^[277] 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".^[278] Yet some tobacco industry products, while using prefilled cartridges, resemble tank models.^[278]

France's e-cigarette market was estimated by Groupe Xerfi to be €130 million in 2015.^[279] Additionally, France's e-liquid market was estimated at €265 million.^[279] In December 2015, there were 2,400 vape shops in France, 400 fewer than in March of the same year.^[279] Industry organization Fivape said the reduction was due to consolidation, not to reduced demand.^[279]

In Vietnam, the e-cigarette market is growing rapidly, with the use rate increasing 18 times from 2015 to 2020.^[280][281] The use rate of e-cigarettes in adolescents aged 13–15 is 3.5%, up 1.6% from 2019.^{[282][283][284]} According to estimates by the World Health Organization (WHO), the global economic losses caused by tobacco each year are $1.4 trillion.^[285] Economic losses caused by tobacco are estimated to account for 1% of GDP.^[286][287] The Vietnamese government is making efforts to control the e-cigarette market.^{[288][289][290]} However, here are still many challenges to be addressed, such as consumer's lack of understanding of the harm of e-cigarettes, unclear legal regulations, and fierce competition from imported e-cigarette products.^[291][292]

Environmental impact

Main article: Environmental impact of electronic cigarettes

A discarded e-cigarette next to a traditional cigarette in a car park

Compared to traditional cigarettes, reusable e-cigarettes do not create waste and potential litter from every use in the form of discarded cigarette butts.^[293] Traditional cigarettes tend to end up in the ocean where they cause pollution,^[293] though once discarded they undergo biodegradation and photodegradation.

E-cigarettes that are not reusable contribute to the problem of electronic waste, which can create a hazard for people and other organisms.^[294] If improperly disposed of, they can release heavy metals, nicotine, and other chemicals from batteries and unused e-liquid.^[198][236] 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.^[295]

Councils in England and Wales are pushing for a 2024 ban on single-use vapes due to environmental and health risks, as 1.3 million are thrown away weekly. Recycling challenges, waste issues, and fire hazards are cited. Concerns about youth vaping are also raised. The UK Vaping Industry Association defends disposables as quitting aids and warns of potential black market products if banned.^[296] Although some brands have begun recycling services for their e-cigarette cartridges and batteries, the prevalence of recycling is unknown.^[297]

Related technologies

Other devices to deliver inhaled nicotine have been developed.^[298] They aim to mimic the ritual and behavioral aspects of traditional cigarettes.^[298]

British American Tobacco, through their subsidiary Nicoventures, licensed a nicotine delivery system based on existing asthma inhaler technology from UK-based healthcare company Kind Consumer.^[299] In September 2014 a product based on this named Voke obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency.^[300]

In 2011, Philip Morris International bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University.^[301] The technology is based on the chemical reaction between pyruvic acid and nicotine, which produces an inhalable nicotine pyruvate vapor.^[302] Philip Morris Products S.A. created a different kind e-cigarette named P3L.^[303] The device is supplied with a cartridge that contains nicotine and lactic acid in different cavities.^[303] When turned on and heated, the nicotine salt called nicotine lactate forms an aerosol.^[303]

Philip Morris International's IQOS device with charger and tobacco stick

The IQOS is a heated tobacco product marketed by Philip Morris International.^[304] It heats tobacco at a lower temperature than traditional cigarettes.^[305] The tobacco sticks reach a temperature up to 350 °C.^[306] It sold first in Japan since November 2014.^[307] In December 2016, the United Tobacco Vapor Group's (UTVG) stated that they have been given a patent for their vaporizing component system.^[308] qmos from UTVG does not contain a wick or sponge and the number of components is 5 compared to 20 for traditional e-cigarettes.^[308]

Pax Labs has developed vaporizers that heats the leaves of tobacco to deliver nicotine in a vapor.^[309][310] In June 2015, they introduced Juul, a type of e-cigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to an actual cigarette puff.^[270] Juul was spun off from Pax Labs in June 2017 and is now available by the independent company Juul Labs.^[311] The eTron 3T from Vapor Tobacco Manufacturing, launched in December 2014,^[312] employs a patented, aqueous system whereby the tobacco is extracted into water.^[313] The e-liquid contains organic tobacco, organic glycerin, and water.^[312]

In December 2013, Japan Tobacco launched Ploom in Japan.^[314] In January 2016, they launched Ploom TECH^[315] that produces a vapor from a heated liquid that moves through a capsule of granulated tobacco leaves.^[316] In 2016, British American Tobacco (BAT) released its own version of the heat but not burn technology called glo in Japan^[317] and Switzerland.^[318] It uses tobacco sticks rather than nicotine liquid,^[319] and does not directly heat or burn tobacco.^[320] Heated tobacco products were first introduced in 1988, but were not a commercial success.^[321]

BLOW started selling e-hookahs, an electronic version of the hookah in 2014.^[322] The handle of each hose for the e-hookah contains a heating element and a liquid, which produces vapor.^[323] Gopal Bhatnagar, based in Toronto, Canada, invented a 3D printed adapter to turn a traditional hookah into an e-hookah.^[324] It is used instead of the ceramic bowl that contains shisha tobacco.^[325] Rather than the tobacco, users can insert e-cigarettes.^[325]

Cannabis vaping

Further information: CBD cigarette

Some vape pens, generally not referred to as "e-cigarettes", contain cannabis derivatives instead of nicotine and tobacco derivatives. Some cannabis pens, known as "dab pens", contain cannabis extracted using butane as solvent ("butane hash oil"). Other vaporizers contain e-liquid made with pure THC, and they generally resemble conventional e-cigarettes. A 2020 study shows that one third of teenagers engaged in conventional, tobacco vaping also engage in THC vaping.^[326]

KanaVape is an e-cigarette containing cannabidiol (CBD) and no THC.^[327] Several companies including Canada's Eagle Energy Vapor are selling caffeine-based e-cigarettes instead of containing nicotine.^[328]

See also

• Vaping cessation

Notes

1. Also known as an e-cig, vaporizer, vape pen, hookah pen, e-pipe, nic stick, razz or, formally, electronic nicotine delivery system (ENDS).^[1]
2. A 2014 review found "In addition to the uniqueness of the liquid compositions in each brand, inconsistency of both the device performance properties and the data collection methodologies used by researchers contribute to the observed variation in constituent levels and to the range of particle size distributions among products."^[2]
3. "Most ENDS consist of a rechargeable, battery-operated heating element and a replaceable or refillable cartridge for the e-liquid. An atomizer heats the liquid in the cartridge to convert it into an aerosol, which is then inhaled by the user. Most of these products are rechargeable, but some are disposable."^[8]
4. Two of the authors of this study received funding from Pfizer, which manufactures nicotine replacement therapy products.
5. Altria no longer sells e-cigarettes.^[157]