User:SandyFerret/sandbox

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First generation electronic cigarette resembling a tobacco cigarette
Second generation types of electronic cigarettes

An electronic cigarette (e-cig or e-cigarette), personal vaporizer (PV) or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer which has the feel of tobacco smoking. They produce a mist rather than cigarette smoke.[1][2] In general a heating element vaporizes a liquid solution known as e-liquid. E-liquids usually contain a mixture of propylene glycol, glycerin, nicotine, and flavorings.[1] Others have similar ingredients but without nicotine.[3]

The benefits and risks of electronic cigarette use are uncertain.[4][5] Evidence suggests e-cigarettes may be safer than smoking tobacco products.[6][7] They may possibly be as safe as other nicotine replacement products, but there is not enough data to draw conclusions.[6][7] They may carry a risk of addiction in those who do not already smoke,[8] but there is no evidence of ongoing use among those who have never smoked.[9] They may promote delaying or deterring to quit smoking.[1] Emissions from e-cigarette contains flavors, aroma transporters, glycerol, propylene glycol, nicotine, carcinogens, tiny particles, heavy metals, and other chemicals.[1][9] The levels of contaminants do not warrant health concerns according to workplace safety standards.[10] E-cigarette mist has fewer toxicants than cigarette smoke.[1] They are likely to be less harmful to users and bystanders.[1][9] Less serious complaints from e-cigarette users include throat and mouth inflammation, vomiting, nausea, and cough.[1]

The frequency of use has increased with up to 10% of American high school students having ever used them as of 2012 and around 3.4% of American adults as of 2011.[11] In the UK the number of e-cigarette users has increased from 700,000 in 2012 to 2.1 million in 2013. About 60% are smokers and most of the rest are ex-smokers.[12] E-cigarette users most commonly continue to smoke traditional cigarettes.[1] Current e-cigarettes arose from an invention made in China in 2003[13] and devices are often manufactured in China.[1] E-cigarette brands have increased advertising with similar marketing to that used to sell cigarettes in the 1950s and 1960s.[1]

Because of the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation is being debated in many countries.[3][14] The European Parliament passed regulations in February 2014 requiring standardization of liquids and personal vaporizers, listing of ingredients, and child-proofing of liquid containers. The United States Food and Drug Administration published proposed regulations in April 2014 with some similar measures.[15]

Health effects[edit]

Safety[edit]

First hand[edit]

The risks of electronic cigarette use are uncertain.[4][5] This is due to there being little data regarding their health effects[16] and to the variability of vaporizers and variability in liquid ingredients and in their concentration and quality, and thus variability of the contents of mist delivered to the user.[1][4][17][16][18][19] However, some evidence suggests e-cigarettes may be safer than smoking tobacco products, and possibly as safe as other nicotine replacement products but there is insufficient data to draw conclusions.[1][17]

Chart showing various toxicants as measured in cigarette and e-cigarette smoke.[20]

A preliminary analysis of e-cigarette cartridges by the US Food and Drug Administration (FDA) in 2009 identified that some contain tobacco-specific nitrosamines (TSNAs), known cancer-causing agents.[21] The tobacco specific impurities suspected of being harmful to humans were anabasine, myosmine, and β-nicotyrine, they were detected in a majority of the samples.[22] The amounts of TSNAs present were on par with existing NRT products like nicotine gum and inhalers. The FDA's analysis also detected diethylene glycol, which is poisonous, in a single cartridge manufactured by Smoking Everywhere and nicotine in one cartridge claimed to be nicotine-free.[21][23] While diethylene glycol was found in a cartridge tested in 2009 by the FDA, in 2011 researchers reviewed the data and noted that 15 other studies had failed to find any evidence of this chemical in e-cigarettes.[24] The UK National Health Service noted that the toxic chemicals found by the FDA were at levels one-thousandth that of cigarette smoke, and that while there is no certainty that these small traces are harmless, initial test results are reassuring.[25] The risks, especially to the lungs, are not fully understood and are of concern to public health authorities and some reviewers.[6][16][26][27] Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device.[23]

The risk is probably low from the inhalation of propylene glycol and glycerol.[9] Some reviewers have noted that while there is variability in the ingredients and concentrations of ingredients in e-cigarette liquids, tobacco smoke contains thousands of chemicals, most of which are not understood and many of which are known to be harmful.[3][16]

A 2014 review stated the particles are of the ultrafine size similar to cigarettes, and go deep in the lungs and then into the systemic circulation.[1] A white pager by AIHA found that the concentration of particles was an order of magnitude greater in conventional cigarettes compared to e-cigarettes.[28] Fine particles can be chemically intricate, and the harmful elements and the importance of the size of the particle and what the particle is made of is mostly unknown, thus it is not clear whether the particles in e-cigarette emissions have health effects similar to those produced by conventional cigarettes.[1] The nature and chemical composition of particles in e-cigarette mist is entirely distinct from those in cigarette smoke, with one review concluding the effects of e-cigarette vapor to users and bystanders are minimal compared with conventional cigarettes.[29] E-cigarettes produce a mist that includes nicotine and tiny particles.[1]

A 2014 review found e-cigarettes emissions contain the heavy metals nickel, tin, and chromium.[1] These nanoparticles can deposit in the lung's alveolar sacs, potentially leading to local respiratory toxicity and entering the bloodstream.[1] A 2014 review concluded that there is no evidence of contamination of the aerosol with metals that would justify health concerns.[10] A 2014 review found that e-cigarettes used in the short-term on specified cardiovascular and respiratory functional results have demonstrated that even though some minor harmful effects of vaping are documented, these are appreciably milder in comparison to traditional cigarettes.[29]

The Centers for Disease Control and Prevention (CDC) stated the possible negative impact between nicotine and brain development in youth is a concern.[30]

A July 2014 WHO report cautioned about potential risks of using electronic cigarettes.[31] Complaints of less serious adverse effects of throat and mouth inflammation, vomiting, nausea, cough have resulted from e-cigarette use.[1] The US Food and Drug Administration Center for Tobacco Products reported between 2008 and the beginning of 2012, 47 cases of adverse effects associated with e-cigarettes, and eight were considered serious.[9]

Mist produced from an e-cigarette is frequently but inaccurately called vapor.[2] Technically, a vapor is a substance in the gas phase whereas a mist/aerosol is a suspension of tiny particles of liquid, solid or both within a gas.[2] A 2014 ASHRAE publication stated the word "vaping" is not technically accurate when applied to e-cigarettes and concluded that users of these devices are rather "aerosolizing."[32]

Second Hand[edit]

Passive exposure was also mentioned as a concern with the WHO 2014 report, indicating that current evidence is insufficient to determine whether the levels of exhaled mist are safe to involuntarily exposed bystanders.[31] Exhaled mist consists of nicotine and some other particles, primarily consisting of flavors, aroma transporters, glycerol and propylene glycol.[9]

E-cigarettes produce particles suspended in a gas, in the form of a mist.[33]

Since e-cigarettes do not burn (or contain) tobacco, no side-stream smoke or any cigarette smoke is produced.[34]

Only what is exhaled by electronic cigarettes users enters the surrounding air.[35] Exhaled mist consists of nicotine and some other particles, primarily consisting of flavors, aroma transporters, glycerol and propylene glycol.[35] Bystanders are exposed to these particles from exhaled e-cigarette mist.[34] A 2014 review of limited data concluded this mist can cause indoor air pollution and is not just "harmless water vapor".[34] As of 2014, the only clinical study currently published evaluating the respiratory effects of passive vaping found no adverse effects were detected.[36] A 2014 review concluded that their effects on bystanders are minimal in comparison to traditional cigarettes.[36] E-cigarette mist has notably fewer toxicants than cigarette smoke (other than particulates) and is likely to pose less harm to users or bystanders.[34][37][38][39] A 2014 review indicated that the levels of inhaled contaminants from the e-cigarette mist are not of significant health concern for human exposures by the standards used in workplaces to ensure safety.[40] Nonsmokers exposed to e-cigarette aerosol produced by a machine and pumped into a room were found to have detectable levels of the nicotine metabolite cotinine in their blood.[34] The same study stated that 80% of nicotine is normally absorbed by the user, so these results may be higher than in actual second hand exposure.[34] A 2014 review stated there are concerns about pregnant women exposure to e-cigarette mist through direct use or via exhaled mist.[41] As of 2014, there is no conclusions on the possible hazards of pregnant women using e-cigarettes, and there is a developing research on the possible effects of nicotine on prenatal brain development.[42] Since e-cigarettes have not been in use long, there has not been enough time for long term studies, the long-term health effects from the second-hand mist are not known.[41] A white paper published in 2014 by the American Industrial Hygiene Association concluded e-cigarettes emit airborne contaminants that may be inhaled by the user and those nearby. [43] Due to this possible risk, they urged restriction of their use indoors, similar to smoking bans, until research has shown the aerosol does not significantly harm others in the area.[43]

Components[edit]

Rare major injuries have occurred from battery malfunctions such as explosions and fires.[1] A causal relationship between e-cigarettes and the reported adverse effects was not established with the exception of two severe outcomes in the United States: a death when an infant choked on the cartridges and burns when one blew up.[9] The CDC stated with the spread of e-cigarette use, calls to poison control centers related to vomiting, nausea, and eye irritation have increased.[44] The study recorded 2,405 calls about e-cigarettes and 16,248 calls about traditional cigarettes from 2010 to 2014.[44] In the US, the number of calls to poison control centers associated with e-cigarette liquid rose from one per month in September 2010 to 215 per month in February 2014; the proportion related to e-cigarettes jumped from 0.3 percent in September 2010 to 41.7 percent in February 2014.[44] 51.1% of calls about e-cigarettes involved children under 5 years old but 94.9% calls about traditional cigarettes were for the same age group.[44] Liquids used with e-cigarettes also pose a risk if they are ingested or if the skin is exposed to them, especially for children.[44] The California Poison Control System reported from 2010 to 2012, 35 cases of e-cigarette contact.[29] 14 were from children and 25 were from accidental contact.[29] The majority of adverse effects reported were nausea, vomiting, dizziness and oral irritation.[29]

Harm reduction[edit]

Tobacco harm reduction has been controversial in the area of tobacco control, because health advocates do not trust the tobacco industry to bring to market reduced risk products.[45] It was found that e-cigarettes show tremendous promise in the fight against tobacco-related instance of death and disease.[45] There is no tobacco in e-cigarettes, but they can provide nicotine for recreational use.[45] Adults most often used electronic cigarettes as a replacement for tobacco, although not invariably to quit.[11] Although some people have a desire to quit smoking by using e-cigarettes, other common explanations for the use of these products are to reduce harm from smoking[46] and to cut back on traditional cigarettes.[1] Smoke from traditional tobacco products has 40 known carcinogens among the 10,000 chemicals it contains, none of which has been found in more than trace quantities in the cartridges or vapor of e-cigarettes.[45] While e-cigarettes can not be considered "safe" because there is no safe level for carcinogens, they are doubtless safer compared to tobacco cigarettes.[45] Switching from smoking tobacco to using e-cigarettes likely would result in reduced exposure to nicotine and reduced potential risk of disease from smoking.[47][18][48] Any residual risk of e-cigarette use should be weighed relative to the risk of continuing or returning to smoking, taking account of the low success rate of currently-approved smoking cessation medications.[29]

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.[47] In 2014 a report commissioned by Public Health England concluded that there is large potential for health benefits when switching from tobacco use to other nicotine delivery devices such as electronic cigarettes, but realizing their full potential requires regulation and monitoring to minimize possible risks.[6] The American Association of Public Health Physicians (AAPHP) suggests those who are unwilling to quit tobacco smoking or unable to quit with medical advice and pharmaceutical methods should consider other nicotine containing products such as electronic cigarettes and smokeless tobacco for long term use instead of smoking.[49] A 2014 review found electronic systems appear to generally deliver less nicotine than smoking, raising the question of whether they can effectively substitute for tobacco smoking over a long-term period.[50]

In an interview, the director of the Office on Smoking and Health for the U.S. federal agency Centers for Disease Control and Prevention (CDC) believes that there is enough evidence to say that using e-cigarettes is likely less harmful than smoking a pack of conventional cigarettes. However, due to the lack of regulation of the contents of the numerous different brands of electronic cigarettes and the presence of nicotine, which is not a benign substance, the CDC has issued warnings.[18] A 2014 systematic review concluded that the risks of e-cigarettes have been exaggerated by health authorities and stated that the risk of e-cigarette use is likely small compared to smoking tobacco.[29]

====
Smoking cessation ==== In July 2014, a report developed by the World Health Organization (WHO) found there was not enough evidence to determine if electronic cigarettes can help people quit smoking. This report noted that electronic cigarettes have not been approved, for helping people quit smoking, by any government. It suggested that smokers should be encouraged to use approved methods for help with quitting.[31] But the same report also mentioned expert opinions in scientific papers that suggested e-cigarette may have a role helping people quit that have failed using other methods.[31] A previous WHO statement from July 2013 stated that e-cigarettes have not been shown to be effective helping people quit smoking.[8] It also recommended that "consumers should be strongly advised not to use" e-cigarettes unless a reputable national regulatory body has found them safe and effective.[8] Smokefree.gov, a US government website on quitting smoking, stated that e-cigarettes have not been shown to be effective in helping people quit smoking so it did not recommend them.[51]

A 2011 review article states how electronic cigarettes may aid in smoking cessation and may likely be more effective than traditional pharmacotherapy, as the physical stimuli of holding and puffing on the electronic cigarette may better reduce short-term cravings.[45] The review found no studies that directly measured the effectiveness of electronic cigarettes in smoking cessation, and examined two published studies that indirectly consider the issue by measuring the effect of the product on cravings and other short-term indicators.[45] A 2014 review asserted how electronic cigarettes may be a reasonable substitute for cigarette smoking.[3] The review also states that even individuals that did not intend to quit smoking before being introduced to e-cigarettes may subsequently do so.[3] Another 2014 review concluded that the benefit with respect to helping people quit smoking was uncertain.[5]

The British Medical Association (BMA) reported in 2013 that there was a possibility for smoking cessation benefits, but had concerns that e-cigarettes are less regulated than nicotine replacement therapy (NRT), and that there was no peer reviewed evidence concerning their safety or efficacy. Recommendations point to a "strong regulatory framework" for e-cigarette distribution in order to ensure the safety, quality, and that marketing and sales are restricted to adults. E-cigarettes may reinforce delaying or deterring to quit smoking.[1]

A 2013 randomized controlled trial found no difference in smoking cessation rates between e-cigarettes with nicotine, e-cigarettes without nicotine and traditional NRT patches.[52] There are some non-controlled studies which have reported possible benefit.[7] Electronic cigarettes were not regularly associated with trying to quit tobacco among young people.[11]

Addiction[edit]

It is not clear whether using e-cigarettes will decrease or increase overall nicotine addiction.[53] The National Institute on Drug Abuse stated that there is a possibility that they could promote continuation of addiction to nicotine in those who are attempting to quit.[54] A number of organizations have concerns that e-cigarettes might increase addiction to and use of nicotine and tobacco products in the young.[30][54][55] This including: the Centers for Disease Control and Prevention, the International Union Against Tuberculosis and Lung Disease, the American Academy of Pediatrics and the Food and Drug Administration.[18][27][56][57] The World Health Organization raised concern of addiction for nonsmokers from their use in July 2013.[8] A 2014 systematic review found these concerns that e-cigarettes could cause non-smokers to begin smoking are unsubstantiated.[29] A 2014 review found no evidence that they are used regularly by those who have never smoked,[9] while a 2014 review has found that in some populations nearly up to a third of youth who have ever used electronic cigarettes have never smoked traditional cigarettes.[1]

Construction[edit]

Disassembled cigarette-styled electronic cigarette.
A. LED light cover
B. battery (also houses circuitry)
C. atomizer (heating element)
D. cartridge (mouthpiece)

Most electronic cigarettes take an overall cylindrical shape although a wide array of shapes can be found: box, pipe styles etc. First generation electronic cigarettes were usually designed to simulate smoking implements, such as cigarettes or cigars, in their use and appearance.[50] New generation electronic cigarettes often called mods, PVs (personal vaporizer) or APVs (advanced personal vaporizer) have an increased nicotine-dispersal performance,[50] housing higher capacity batteries,[58] and come in various form factors, including metal tubes and boxes.[58][59][60] Many electronic cigarettes are composed of standardized replaceable parts that are interchangeable from one brand to the other,[61] while disposable devices combine all components into a single part that is discarded when its liquid is depleted.[62] Common components include a liquid delivery and container system like tanks or cartomizers, an atomizer, and a power source.[63]

Atomizer[edit]

An e-cigarette atomizer with the coil (heating element) in view.

An atomizer generally consists of a small heating element responsible for vaporizing e-liquid, as well as a wicking material that draws liquid in. Along with a battery, the atomizer is the central component of every personal vaporizer. Differences between atomizers cause differences in the ingredients and their concentrations delivered to users, even when the same liquid is used.[1]

A small length of resistance wire is coiled around the wicking material and then connected to the positive and negative poles of the device. When activated the resistance wire (or coil) quickly heats up thus creating a mist from the liquid, which is then inhaled by the user.[64]

The electrical resistance of the coil, the voltage output of the device, the airflow of the atomizer and the efficiency of the wick play important roles in the perceived quality of the mist coming from the atomizer. They also greatly affect the mist quantity or volume that will be produced by the atomizer.

Atomizer resistances usually vary from 1.5Ω (ohms) to 3.0Ω from one atomizer to the next but can go as low as 0.1Ω in the most extreme cases of DIY coil building. Coils of lower ohms have increased mist production but could present a fire hazard and other dangerous battery failures if the user is not knowledgeable enough about basic electrical principles and how they relate to battery safety.[65]

Wicking materials vary greatly from one atomizer to another but silica fibers are the most commonly used in manufactured atomizers. "Rebuildable" or "do it yourself" atomizers can use silica, cotton, rayon, porous ceramic, hemp, bamboo yarn, oxidized stainless steel mesh and even wire rope cables as wicking materials.[66]

A wide array of atomizers and e-liquid container combinations are available:[67]

Cartomizers[edit]

A 45mm length, extra-long cartomizer

A "cartomizer" (a portmanteau of cartridge and atomizer) or "carto" consists of an atomizer surrounded by a liquid-soaked poly-foam that acts as an e-liquid holder. It is usually disposed of once the e-liquid acquires a burnt taste, which is usually due to an activation when the coil is dry or when the cartomizer gets consistently flooded (gurgling) because of sedimentation of the wick. Most cartomizers are refillable even if not advertised as such.[68]

Cartomizers can be used on their own or in conjunction with a tank that allows more e-liquid capacity. In this case the portmanteau word of "cartotank" has been coined. When used in a tank, the cartomizer is inserted in a plastic, glass or metal tube and holes or slots have to be punched on the sides of the cartomizer to allow liquid to reach the coil.

Clearomizers[edit]

eGo style e-cigarette with a top-coil clearomizer. Silica fibers are hanging down freely inside of the tank, drawing e-liquid by capillary action to the coil that is located directly under the mouthpiece.

Clearomizers or "clearos", not unlike cartotanks, use a clear tank in which an atomizer is inserted.[69] Unlike cartotanks, however, no poly-foam material can be found in them. There are a lot of different wicking systems employed inside of clearomizers to ensure good moistening of the wick without flooding the coil. Some rely on gravity to bring the e-liquid to the wick and coil assembly (bottom coil clearomizers for example) whereas others rely on capillary action and to some degree the user agitating the e-liquid while handling the clearomizer (top coil clearomizers).[70] The coil and wicks are typically inside a prefabricated assembly or "head" that is replaceable by the user and can contain either single or duel coils.[71] Present day clearomizers commonly have adjustable air flow control.[71]

Rebuildable atomizers[edit]

A rebuildable atomizer or an RBA is an atomizer that allows the user to assemble or "build" the wick and coil themselves instead of replacing them by an off-the-shelf atomizer "head". They also allow the user to build atomizers at any desired electrical resistance. The materials needed to "rebuild" the atomizers are usually much cheaper than the usual prefabricated replaceable wick and coil assemblies destined to clearomizers.

These atomizers are divided into three main categories; rebuildable tank atomizers (RTAs), rebuildable dripping atomizers (RDAs), and rebuildable dripping tank atomizers (RDTAs).

Rebuildable tank atomizers (RTAs) are similar to clearomizers in that they use a tank or container to hold and bring liquid to the coil. They usually hold significantly more e-liquid than their RDA counterparts.

Rebuildable dripping atomizers (RDAs) on the other hand lack the container section and hold very little liquid compared to RTAs, but are usually a lot smaller. They typically consist only of an atomizer "building deck" which can accept one or more coils and a "top cap" to cover the coils where a mouth piece can be attached. The user needs to manually keep the atomizer wet by dripping liquid on the bare wick and coil assembly, hence their name.

Rebuildable dripping tank atomizers (RDTAs) combine features of both RTAs and RDAs. They usually consist of a RDA build deck with a tank over the deck held up by a spring. The user pushes down on the mouth piece and liquid is then dripped onto the coils.This is unlike a RTA that continuously feeds liquid to the wicks.

Power[edit]

Most portable devices contain a rechargeable battery, which tends to be the largest component of an electronic cigarette. The battery may contain an electronic airflow sensor whereby activation is triggered simply by drawing breath through the device, while other models employ a power button that must be held during operation. An LED to indicate activation may also be employed. Some manufacturers also offer a cigarette pack-shaped portable charging case (PCC), which contains a larger battery capable of charging e-cigarettes. Devices aimed at more experienced users may sport additional features, such as variable power output and support of a wide range of internal batteries and atomizer configurations and tend to stray away from the cigarette form factor. Some cheaper devices use a microphone to activate.[72] Other batteries, like Ego type batteries, can use a custom IC to indicate battery status on the included LCD and a button to activate.[73]

Variable power and voltage devices[edit]

PV with variable and regulated power offering battery protection

Variable power and or voltage are personal vaporizers devices that contain a built in electronic chip that allows the user to adjust the power that goes through the heating element. They are often rectangular in shape but can also be cylindrical. They usually incorporate a LED screen to display various information. Variable Voltage PVs eliminate the need to replace an atomizer with another one of lower or higher electrical resistance to control the intensity of the mist or change it. Variable Wattage devices automatically adjust the voltage based on the resistance of the coil. They also feature a voltage regulation mode and some have battery protection to prevent damage to the control board if the battery is put in wrong.[74][75]

Some of these devices offer additional features through their menu system such as: atomizer resistance checker, remaining battery voltage, puff counter, activation cut-off etc.[76]

On 9/2/2014 Evolv vapor received a patent on variable wattage. Evolve was the company that introduced variable wattage to the industry. The technology goes all the way back to the Darwin, the companies first variable wattage device.[77]

The DNA 40 is a control board can be used in devices that control variable wattage and voltage was released in October 2014. The DNA 40 is the first control board to monitor and control the temperature of the heating coil. Controlling temperature is important to limit charing of the wicking material and reduce the breakdown of flavoring and base liquid ingredients.[78]

Mechanical personal vaporizers[edit]

Mechanical PV with a rebuildable atomizer

Mechanical PVs or mechanical "mods", often called "mechs" are devices without electronic components and battery protection (apart from vent holes drilled in some mechanical devices) or voltage regulation. Because there is neither protection nor regulation, they will work either way the battery is inserted. They are activated by spring loaded or opposing magnetic mechanical switches, hence their name. They rely on the natural voltage output of a battery and the material that the mod is made of.[79]

The term "mod" was originally used instead of modification.[80] Users would modify existing hardware to get better performance, and as an alternative to the e-cigarettes that looked like traditional cigarettes.[80] Users would also modify other items like flashlights as battery compartments to power atomizers.[81] Today the word mod is used to describe most personal vaporizers either bought in a store or created by the user.

They are commonly used with "low resistance" (1.0Ω ~ 0.2Ω) rebuildable atomizers. Seeing that most e-cigarettes containing electronic battery protection will interpret sub ohm resistance coils as a short circuit, thus prohibiting the device from being activated, mechanical mods are among the only devices that will accept such atomizer resistances although more recent (2013) electronic devices offers this possibility as well.[citation needed]

Since mechanical PVs have no power regulation and are unprotected, they require special attention on the user's part that other regulated and protected PVs do not need. Making sure that the battery does not over-discharge and that the atomizer will not require more amperage than what the battery can safely allow are the user's responsibilities.[79]

E-liquid[edit]

E-liquid, e-juice or simply "juice", refers to a liquid solution that when heated by an atomizer produces mist. The main ingredients of e-liquids are usually a mix of propylene glycol (PG), glycerin (G), and/or polyethylene glycol 400 (PEG400), sometimes with differing levels of alcohol mixed with concentrated or extracted flavorings; and optionally, a variable concentration of tobacco-derived nicotine.[7][82] Most e-cigarette liquids contain nicotine, but the level of nicotine is chosen by the consumer.[10] The consumer can even purchase e-liquid that has no nicotine.[10]

The solution is often sold in bottles or pre-filled disposable cartridges, or as a kit for consumers to make their own eJuices. Components are also available individually and consumers may choose to modify or boost their flavor, nicotine strength, or concentration with various offerings. Pre-made e-liquids are manufactured with various tobacco, fruit, and other flavors,[1] as well as variable nicotine concentrations (including nicotine-free versions). The standard notation "mg/ml" is often used in labeling for denoting nicotine concentration, and is sometimes shortened to a simple "mg".[83] In surveys of regular e-cigarette users the most liked e-liquids had a nicotine content of 18 mg/ml, and largely the favorite flavors were tobacco, mint and fruit.[9]

Usage[edit]

Electronic cigarette sales increased from 50,000 in 2008 to 3.5 million in 2012.[82] Most people who use electronic cigarettes have a history of smoking cigarettes while some young people who have never smoked cigarettes have tried electronic cigarettes at least once.[11] E-cigarette users most commonly continue to smoke traditional cigarettes.[1] Many users report that electronic cigarettes help them either quit smoking or reduce the number of cigarettes smoked.[9] Adults most often used electronic cigarettes as a replacement for tobacco, although not invariably to quit.[11] Although some people have a desire to quit smoking by using e-cigarettes, other common explanations for the use of these products are to evade smoke-free laws,[1] to reduce harm from smoking[46] and to cut back on traditional cigarettes.[1]

In the United States, as of 2011, one in five adults who smoke have tried electronic cigarettes and 3.3% are currently using them.[11][84] Among grade 6 to 12 students in the United States, those who have at least once used the product increased from 3.3% in 2011 to 6.8% in 2012.[11] and those currently using electronic cigarettes increased from 0.6% to 1.1%. Over the same period the percentage of grade 6 to 12 students who regularly smoke tobacco cigarettes fell from 7.5% to 6.7%.[85] The frequency of use has increased with up to 10% of American high school students having ever used them as of 2012.[11] In 2013 the CDC found a threefold increase from 2011 in the number of youth who have used electronic cigarettes who have never smoked.[86]

In the UK in 2014, 18% of regular smokers identified themselves as using electronic cigarettes and 51% stated that they had used them in the past.[87] Among those who had never smoked, 1.1% said they had tried them and 0.2% continue to use them.[87] In 2013, among those under 18, 7% have used e-cigarettes at least once.[87] Among non-smokers children, 1% reported having tried e-cigarettes "once or twice," and there was no evidence of continued use.[87] Sustained was mostly confined to children who smoke or have smoked.[87] In 2014 child regular users was at 1.8%, children who have ever used e-cigarettes was at 10%, and occasional or greater use among never smoking children was at 0.18%.[88]

A February 2014 survey in France estimated that between 7.7 and 9.2 million individuals have experimented with using electronic cigarettes, with between 1.1 and 1.9 million using on a daily basis. 67% of tobacco smokers in the survey used electronic cigarettes to reduce or quit tobacco smoking. 9% of those who experimented with electronic cigarettes had never smoked tobacco. Of the 1.2% that had recently stopped tobacco smoking at the time of the survey, 84% (or 1% of the population surveyed) credited electronic cigarettes for stopping tobacco use.[89]

Larger numbers of young people are starting to use e-cigarettes.[1] There is a high number of youth who use e-cigarettes also smoking traditional cigarettes.[1] Some youth who have tried an e-cigarette have never smoked a traditional cigarette, this shows that they can be a starting point for nicotine use for some youth and nicotine is an addictive drug.[1] There is a high levels of use of both e-cigarettes and traditional cigarettes, no proven help with stopping smoking.[1]

History[edit]

The earliest electronic cigarette can be traced to Herbert A. Gilbert, who in 1963 patented a device described as "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air". This device heated the nicotine solution and produced steam. It was never commercialized.[90][91]

Hon Lik, a Chinese pharmacist, is credited with the invention of the electronic cigarette.[13][92] In 2003,[93] he came up with the idea of using a piezoelectric ultrasound-emitting element to vaporise a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.[94] This design produces a smoke-like vapour that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs. He also proposed using propylene glycol to dilute nicotine and placing it in a disposable plastic cartridge which serves as a liquid reservoir and mouthpiece.

Electronic cigarettes using a different design were first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. The company that Hon Lik worked for, Golden Dragon Holdings, changed its name to Ruyan (如烟, literally "Resembling smoking"), and started exporting its products in 2005–2006[13] before receiving its first international patent in 2007.[95] E-cigarette devices are predominately manufactured in China.[1] E-cigarette brands have been increasing advertising at a fast rate, the aggressive marketing used is similar to that used to sell cigarettes in the 1950s and 1960s.[1] While advertising of tobacco products was banned long ago, television and radio e-cigarette advertising in a number of countries may be indirectly creating a desire for traditional cigarette smoking.[1]

The electronic cigarette continued to evolve from the first generation three-part device. In 2006 the "cartomizer" was invented by British entrepreneurs Umer and Tariq Sheikh of XL Distributors.[96] This is a mechanism which integrates the heating coil into the liquid chamber. The new device was launched in the UK in 2007 in their Gamucci brand and is now widely adopted by the majority of 'cigalike' brands. The grant of the UK patent for the "cartomizer" was made to XL Distributors in February 2013 and published by the UK Intellectual Property Office.[97]

The international tobacco companies, recognising the development of a potential new market sector that could render traditional tobacco products obsolete,[98] are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies.[99] Blu, a prominent US e-cigarette producer, was acquired by Lorillard Inc. in 2012.[100] British American Tobacco launched Vype in 2013, while Imperial Tobacco's Fontem Ventures acquired the intellectual property owned by Hon Lik through Dragonite for $US 75 million in 2013 and launched Puritane in partnership with Boots UK.[101][102] On October 1, 2013 Lorillard Inc. acquired another e-cigarette company, this time a UK based company SKYCIG.[103] On 3 February 2014, Altria Group, Inc. acquired popular electronic cigarette brand Green Smoke for $110 million. The deal was finalized in April 2014 for $110 million and $20 million in incentive payments.[104] Altria also markets its own e-cigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse product.[99]

Society and culture[edit]

Consumers of electronic cigarettes or "vapers" as some call them have shown evident and passionate support for the product that other nicotine replacement therapy did not receive.[46][67] This suggests that electronic cigarettes have the potential mass appeal that could challenge the preeminence of combustible tobacco as the object of choice for nicotine users.[46]

As the electronic cigarette industry grows, a subculture has emerged which calls itself "the vaping community".[67][105][106] Members of this emerging subculture often view electronic cigarettes as a safer alternative to smoking[9] and some even view it as a hobby. They tend to use highly customized devices that do not resemble what are known, by some, as "cig-a-likes," or electronic cigarettes that resemble real cigarettes.[107]

Large gatherings of vapers, called vape meets, are happening around the United States which focus around e-cig devices, accessories, and the life style that accompanies them.[67] People attending these meetings are usually enthusiasts that use specialized, community-made products that are not found in typical places like convenience stores or gas stations.[67] 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 available.[108]

A growing subclass of vapers called "cloud-chasers" assemble their atomizers in such a way that can produce extremely large amounts of vapor by using heating coils of less than 1 ohm.[109] This practice is known as "cloud-chasing". By using a coil at less that 1 ohm the batteries of PVs are stressed considerably more than what could be considered regular use and could represent a risk of dangerous battery failures.[110] As vaping comes under more and more scrutiny, some members of the vaping community have voiced their concerns about cloud-chasing claiming the practice gives vapers a bad reputation when doing it in public.[111]

Legal status[edit]

Main article: Legal status of electronic cigarettes

The emerging phenomenon of electronic cigarettes has raised concerns among the health community, pharmaceutical industry, health regulators and state governments.[3] Some jurisdictions are now prohibiting or regulating the use of e-cigarettes in public spaces.

Because of the relative novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation and public health investigations are currently pending in many countries.[14] Current regulations vary widely, from regions with no regulations to others banning the devices entirely.[14]

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.[112][113] In April 2014 the US FDA published proposed regulations for e-cigarettes along similar lines.[114][115]

In March 2014 Western Australia banned sale of electronics cigarettes.[116]

Economics[edit]

According to Nielsen Holdings, convenience store e-cigarette sales went down for the first time during the four-week period ending on 10 May 2014. This decline is attributed by Wells Fargo analyst Bonnie Herzog to a shift in consumers behavior, buying more specialized devices or what she refers to as "vapor/tank/mods (VTMs)" that are not tracked by Neilsen.[117] According to Herzog these products, produced and sold by stand alone makers are now (2014) growing 2 times faster than traditional electronic cigarettes marketed by the major players (Lorillard, Logic Technology, NJOY etc...) and account for a third of the 2.2 billion dollar market for vapor products.[118] There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some claiming to want to cooperate in "harm reduction."[1]

There is concern with some financial analysts that the rapid growth of the e-cigarette market is accelerating the decline of $87 billion outstanding in tobacco bonds.[119][120] States with large populations, such as New York and California, are affected to a greater degree than others.[120]

Related technologies[edit]

There are other technologies currently under development that seek to deliver nicotine for oral inhalation in an effort to mimic both the ritualistic and behavioural aspects of traditional cigarettes.

  • British American Tobacco, through their subsidiary Nicoventures Limited, licensed a nicotine delivery system based on existing asthma inhaler technology from UK-based healthcare company Kind Consumer Limited.[121][122] In September 2014 a product based on this - named Voke - obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency.[123]
  • Philip Morris International bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University.[124] The technology is based on the chemical reaction between nicotine acid and a base, which produces an inhalable nicotine pyruvate mist.[125]
  • HeatSticks which heats tobacco.

References[edit]

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External links[edit]

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