An electronic cigarette (e-cig or e-cigarette), personal vaporizer (PV) or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer that feels similar to tobacco smoking. The user inhales an aerosol, commonly called vapor, rather than cigarette smoke. E-cigarettes typically have a heating element that atomizes a liquid solution known as e-liquid. E-cigarettes are generally cylindrical, with many variations. There are disposable or reusable versions. E-liquids usually contain propylene glycol, glycerin, nicotine, and flavorings. E-liquids are also sold without propylene glycol, without nicotine, or without flavors.
The benefits and health risks of electronic cigarettes are uncertain. One review found limited evidence of a benefit as a smoking cessation aid, but there is no evidence they are better than regulated medication for quitting smoking. Their usefulness in tobacco harm reduction is unclear. One review found their safety risk is similar to that of smokeless tobacco. Another found United States Food and Drug Administration (FDA)-approved products, such as nicotine inhalers, are probably safer than e-cigarettes.
Limited evidence suggests e-cigarettes are safer than traditional cigarettes. People who do not already smoke can become addicted to them. There is no evidence e-cigarettes are regularly used by those who have never smoked. E-cigarette use may delay or deter quitting smoking. E-cigarettes create vapor that consists of ultrafine particles. The vapor contains similar chemicals to the e-liquid, together with tiny amounts of toxicants and heavy metals. E-cigarette vapor contains fewer toxic substances than cigarette smoke, and is likely to be less harmful than traditional cigarettes to users and bystanders. No serious adverse effects from e-cigarettes have been reported in trials. Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and cough. The long-term effects of e-cigarette use are unknown.
Use has risen. As of 2012, up to 10% of American high school students had used them at least once, and around 3.4% of American adults as of 2011. In the United Kingdom user numbers have increased from 700,000 in 2012 to 2.1 million in 2013. About 60% of UK users are smokers and most of the rest are ex-smokers. Most e-cigarette users still smoke traditional cigarettes. Most peoples' reason for using e-cigarettes is related to quitting, but a considerable proportion use them recreationally. The modern e-cigarette arose from a 2003 invention by Hon Lik in China and as of 2014 most devices are made there. E-cigarette brands have increased their advertising, using marketing techniques like those used to sell cigarettes in the 1950s and 1960s. Because of the potential relationship with tobacco laws and medical drug policies, electronic cigarette legislation is being debated in many countries. The European Parliament passed regulations in February 2014 standardizing liquids and personal vaporizers, listing ingredients, and child-proofing liquid containers. The US FDA published proposed regulations in April 2014 with some similar measures.
As of 2013[update], there are several million e-cigarette users globally. Awareness and use of e-cigarettes greatly increased over the few years to 2014, particularly among young people and women in some countries. E-cigarette use among young people exceeds traditional cigarette use. People with higher incomes are more likely to have heard of e-cigarettes, but those with lower incomes are more likely to have tried them. Trying e-cigarettes was common among less educated people. Whites are more likely to use them than non-whites. Most users have a history of smoking normal cigarettes. Some young people who have never smoked normal cigarettes have tried e-cigarettes at least once.
The majority of e-cigarette users use them every day. E-cigarette users mostly keep smoking traditional cigarettes. Many say e-cigarettes help them cut down or quit smoking. Adults often use e-cigarettes to replace tobacco, but not always to quit. Dual use of e-cigarettes with traditional cigarettes is relatively common. Most e-cigarette users are middle-aged men who also smoke traditional cigarettes, either to help them quit or for recreational use. Among women, e-cigarette use is rising sharply. E-cigarette use is also rising among women of childbearing age, but the rate of use during pregnancy is unknown. Dual use of e-cigarettes and traditional tobacco is still a definite concern. Many worry that e-cigarettes may be a "gateway" to tobacco smoking. A 2014 review raised ethical concerns about minors' e-cigarette use and the potential to weaken cigarette smoking reduction efforts.
In the US, as of 2011, one in five adults who smoke have tried electronic cigarettes and 3.3% are still using them. Among grade 6 to 12 students in the United States, those who have used them at least once rose from 3.3% in 2011 to 6.8% in 2012 and those still using e-cigarettes rose 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%. Use frequency has risen: as of 2012, up to 10% of American high school students have ever used them. In 2013 the CDC found a threefold increase from 2011 in the number of youth who have used e-cigarettes but have never smoked. Between 2013 and 2014, use of e-cigarettes by US teenagers tripled. The limited data suggests e-cigarette use is rapidly growing among adolescents. The majority of young people who use e-cigarettes also smoke combustible cigarettes. E-cigarette use among never-smoking youth in the US correlates with an elevated wish to use traditional cigarettes.
In the UK in 2014, 18% of regular smokers said they used e-cigarettes and 51% said they had used them in the past. Among those who had never smoked, 1.1% said they had tried them and 0.2% still uses them. In 2013, among those under 18, 7% have used e-cigarettes at least once. Among non-smokers' children, 1% reported having tried e-cigarettes "once or twice", and there was no evidence of continued use. Sustained use was mostly confined to children who smoke or have smoked. 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%. About 60% are smokers and most of the rest are ex-smokers.
A February 2014 survey in France estimated that between 7.7 and 9.2 million people have tried e-cigarettes, with 1.1 to 1.9 million using them on a daily basis. 67% of tobacco smokers in the survey used e-cigarettes to reduce or quit tobacco smoking. 9% of those who tried e-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 e-cigarettes for stopping tobacco use.
Larger numbers of young people are starting to use e-cigarettes. Many young people who use e-cigarettes also smoke traditional cigarettes. Some youths who have tried an e-cigarette have never smoked a traditional cigarette; this indicates they can be a starting point for nicotine use. There are high levels of dual use with e-cigarettes and traditional cigarettes. Most young people are not using e-cigarettes to help them quit tobacco. Teenagers who used an e-cigarette were more inclined than those who had not used them to become traditional cigarette users.
There are varied reasons for e-cigarette use. Most users' motivation is related to quitting, but a fair proportion of use is recreational, for enjoyment, for relaxation, or to practice tricks like blowing smoke rings. The activity known in the vaping community as cloud-chasing to exhale the largest cloud of vapor is increasing in popularity. Many users assume vaping is healthier than smoking for personal use or for bystanders. Some are concerned about the possible adverse health effects or toxicity of e-cigarettes. People who think vaping is less toxic than smoking may be more likely to experiment with them. Marketing strategies directed at smokers frequently draw comparisons with regular cigarettes by suggesting e-cigarette devices are "newer, healthier, cheaper and easier to use in smoke-free situations, all reasons that e-cigarette users claim motivate their use". Exposure to e-cigarette advertising influenced people to try them.
A 2015 review said that if tobacco businesses persuade women that e-cigarettes are a small risk, non-smoking women of reproductive age might start using them and women smoking during pregnancy might switch to their use or use these devices to reduce smoking, instead of stopping using traditional cigarettes. Another 2015 review said that the belief that e-cigarettes are safer than traditional cigarettes could widen their use among pregnant women. Traditional cigarette users who have not used e-cigarettes had mixed ideas about their possible satisfaction and around a third thought that e-cigarettes might taste bad. They feel or taste similar to traditional cigarettes, and vapers disagreed about whether this was a benefit or a drawback. Some users liked that e-cigarettes resembled traditional cigarettes, but others did not. E-cigarettes users' views about saving money from using e-cigarettes compared to traditional cigarettes are inconsistent. The majority of committed e-cigarette users interviewed at an e-cigarette convention found them less costly than traditional cigarettes.
Some users stopped vaping due to issues with the devices. Not having odor from smoke on clothes on some occasions prompted interest in or use of e-cigarettes. Although some people want to quit smoking using e-cigarettes, others use them to circumvent smoke-free laws and policies, or to cut back on normal cigarette smoking. E-cigarette users have contradictory views about using them to get around smoking bans. Some surveys found that a small percentage of users' motives were to avoid the bans, but other surveys found that over 40% of users said they used the device for this reason. The extent to which traditional cigarette users vape to avoid smoking bans is unclear.
A 2014 review found "Health-related and lifestyle appeals may also encourage initiation among young non-smokers, as they may convey that trying e-cigarettes is less risky and more socially appealing, which may ameliorate negative beliefs or concerns about nicotine addiction." Adolescent experimenting with e-cigarettes may be related to sensation seeking behavior, and is not likely to be associated with tobacco reduction or quitting smoking. Young people and children are tempted by flavored e-cigarettes. The main reasons young people experimented with e-cigarettes were due to curiosity, flavors, and peer influences. E-cigarettes can appeal to youth because of their high-tech design, assortment of flavors, and accessibility online. E-cigarettes could be more appealing to non-smoking youths than traditional cigarettes. In the US, the North West of England and Paris, vaping by children may be due to experimentation. In North Wales, girls who use e-cigarettes consider them appealing. Infants and toddlers could ingest the e-liquid from an e-cigarette device out of curiosity.
Many users might begin by using a disposable e-cigarette. E-cigarette users often start with an e-cigarette resembling a normal cigarette and eventually most of them switch to a later-generation device. Most users of later-generation e-cigarettes shifted to their present model to get a "more satisfying hit". Many users enjoy adjusting their devices to provide more vapor for better throat hits.
An electronic cigarette is a battery-powered vaporizer which provides a flavor and feel similar to tobacco smoking, but there are differences. A noticeable difference between the traditional cigarette and the e-cigarette is sense of touch. The user inhales an aerosol, commonly called vapor, rather than cigarette smoke. Once the user inhales, the airflow activates the sensor, and then the heating element atomizes the liquid solution inside the cartridge into vapor. Other e-cigarettes have a manual push-button switch to turn on the device. E-cigarettes are generally cylindrical, with many variations. Some e-cigarettes look like traditional cigarettes, but others do not. There are three main categories of e-cigarettes: cigalikes, looking like cigarettes; eGos, bigger than cigalikes with refillable liquid tanks; and mods, assembled from basic parts or by altering existing products. There are disposable or reusable versions. E-cigarettes that resemble pens or USB memory sticks are also sold for those who may want to use the device unobtrusively.
First generation e-cigarettes tend to look like tobacco cigarettes and so are called "cigalikes". Second generation devices tend to be used by more experienced users. Third generation devices include mechanical mods and variable voltage devices. A fourth generation digital e-cigarette became available in the U.S. in 2014. As the e-cigarette industry is growing, new products are quickly developed and brought to market. The devices contain a rechargeable battery, which tends to be the largest component of an e-cigarette.
An atomizer comprises a small heating element that vaporizes e-liquid and a wicking material that draws liquid onto the coil. 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. Clearomizers or "clearos", not unlike cartotanks, use a clear tank in which an atomizer is inserted. 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 with off-the-shelf atomizer "heads".
The main ingredients in the e-liquid usually are propylene glycol, glycerin, water, nicotine, and flavorings. There is a vast array of e-liquids available. The liquid typically contains 95% propylene glycol and glycerin. E-liquids are also sold without propylene glycol, or without nicotine. Surveys demonstrate that 97% of e-cigarette users use products that contain nicotine. Some are sold without flavors. The flavorings may be natural or artificial.
Positions of medical organizations
As of 2014[update] electronic cigarettes had not been approved as a smoking cessation device by any government. In July 2014, a report produced by the World Health Organization (WHO) for the WHO Framework Convention on Tobacco Control, found there was not enough evidence to determine if electronic cigarettes can help people quit smoking. It suggested that smokers should be encouraged to use approved methods for help with quitting. But the same report also mentioned expert opinions in scientific papers that suggested e-cigarettes may have a role helping people quit who have failed using other methods. A previous WHO statement from July 2013 said that e-cigarettes have not been shown to help people quit smoking. 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. The World Lung Foundation applauded the WHO report's recommendation for tighter regulation of e-cigarettes due to concerns about the safety of e-cigarettes and the risk of increased nicotine or tobacco addiction among youth.
The UK National Health Service concluded that "While e-cigarettes may be safer than conventional cigarettes, we don't yet know the long-term effects of vaping on the body. There are clinical trials in progress to test the quality, safety and effectiveness of e-cigarettes, but until these are complete and the government can't give any advice on them or recommend their use."
In 2014, the US Food and Drug Administration (FDA) said "E-cigarettes have not been fully studied, so consumers currently don't know: the potential risks of e-cigarettes when used as intended, how much nicotine or other potentially harmful chemicals are being inhaled during use, or whether there are any benefits associated with using these products. Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death."
As of 2014[update], research on the safety and efficacy of e-cigarette use for smoking cessation is limited. They are unproven as quit-smoking aids. Their benefit for quitting smoking is uncertain. The evidence suggests that e-cigarettes can supply nicotine at concentrations that are, at least partially, enough to substitute for traditional cigarettes. While there are some reports of improved smoking cessation, especially with intensive e-cigarette users, there are also several studies showing a decline in cessation in dual users. A 2014 Cochrane review found limited evidence of a benefit as a smoking cessation aid from a small number of studies. A 2015 review found that e-cigarettes for quitting smoking were generally similar to a placebo. The same review concluded that while they may have a benefit for decreasing cigarette use in smokers, they have a limited benefit in quitting smoking. A 2014 review found e-cigarettes may have some potential for reducing smoking.
A 2015 review found variable quality evidence that e-cigarette users had higher cessation rates than users of nicotine replacement products. A 2014 review found limited quality evidence that e-cigarettes do not seem to improve cessation rates compared to regulated FDA nicotine replacement products. Two 2014 reviews found no evidence that e-cigarettes are more effective than existing nicotine replacement products for smoking cessation. They may be as effective, but not more, compared to nicotine patches for short-term smoking cessation. However, a randomized trial found 29% of e-cigarette users maintained e-cigarette use at 6 months while 8% for patch users, indicating the use of e-cigarettes could continue after other quit methods. Studies have not shown that e-cigarettes are better than regulated medication for smoking cessation. A 2014 review found four experimental studies and six cohort studies that indicated that electronic cigarettes reduced the desire to smoke and withdrawal symptoms. This review also noted that two cohort studies found that electronic cigarettes led to a reduction in the number of cigarettes smoked per day. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2014 review concluded that the adverse public health effects resulting from the widespread use of e-cigarettes could be significant, in part due to the possibility that they could undermine smoking cessation. This review therefore called for their use to be limited to smokers who are unwilling or unable to quit. A 2014 review found that the research suggested that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes could have a broad adverse effect for a population by expanding initiation and lowering cessation of smoking. A 2014 review found that the evidence suggests that "e-cigarettes are not associated with successful quitting in general population-based samples of smokers."
Tobacco harm reduction has been a controversial area of tobacco control. The health community has not endorsed e-cigarettes as a tobacco harm reduction strategy, in part in response to tobacco industry deception. A 2014 review concluded promotion of vaping as a harm reduction aid is premature. Another review found e-cigarettes would likely be less harmful than traditional cigarettes to users and bystanders. The authors warned against the potential harm of excessive regulation and advised health professionals to consider advising smokers who are reluctant to quit by other methods to switch to e-cigarettes as a safer alternative to smoking. A 2014 review argued that regulations for e-cigarettes should be similar to those for dietary supplements or cosmetic products to not limit their potential for harm reduction. Vaping may have potential in harm reduction compared to smoking. When used to quit smoking, they could reduce harm even more if the tobacco user quits but e-cigarettes are not harmless because nicotine has long-term adverse effects, may contain impurities, and nicotine is addictive, which may have serious side effects, particularly if users use unconventional ways to increase the doses of nicotine exposure. A 2012 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. A 2012 review found e-cigarettes could considerably reduce traditional cigarettes use and they likely could be used as a lower risk replacement for traditional cigarettes, but there is not enough data on the safety and efficacy to draw definite conclusions. E-cigarette use for risk reduction in high-risk groups such as people with mental disorders is unavailable.
Tobacco smoke has 40 known carcinogens among the many chemicals it contains. None of these has been found in more than trace quantities in the cartridges or aerosol of e-cigarettes. A 2011 review stated that while e-cigarettes cannot be considered "safe" because there is no safe level for carcinogens, they are doubtless safer compared to tobacco cigarettes. 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. Adults most frequently use electronic cigarettes as a replacement for tobacco, but not always to quit. Although some people have a desire to quit smoking by using e-cigarettes, another common explanation for the use of these products is to cut back on traditional cigarettes.
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. They found that the evidence suggests that a considerable number of smokers want to reduce harm from smoking by using these products. The British Medical Association encourages health professionals to recommend conventional nicotine replacement therapies, but for patients unwilling to use or continue using such methods, health professionals may present e-cigarettes as a lower-risk option than tobacco smoking. The American Association of Public Health Physicians (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. 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. A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both tobacco cigarettes and electronic cigarettes. This report found that such "dual use" of e-cigarettes and tobacco "will have much smaller beneficial effects on overall survival compared with quitting smoking completely."
The risks of electronic cigarette use are uncertain. There is little data about their health effects, and considerable variability between vaporizers and the contents of the aerosol delivered to the user. The limited evidence suggests that e-cigarettes are probably safer than traditional cigarettes. One review found, from limited data, their safety risk is similar to that of smokeless tobacco, which has about 1% of the mortality risk of traditional cigarettes. Another concluded that regulated FDA products such as a nicotine inhaler are probably a safer way to supply nicotine than e-cigarettes. E-cigarettes create vapor that consists of ultrafine particles. The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants and heavy metals, and other chemicals. E-cigarette vapor contains fewer toxic substances than cigarette smoke. Various methodological issues, conflicts of interest, and inconsistent research has been identified in the research regarding e-cigarettes. However, e-cigarettes cannot be regarded as simply harmless. As well as toxicity there are also risks from misuse or accidents (e.g., accidental fires caused by vaporizer malfunction, other vaporizer design issues, or accidental contact with liquid nicotine).
A July 2014 WHO report cautioned about potential risks of using e-cigarettes. The report concluded that "the existing evidence shows that ENDS aerosol is not merely "water vapour" as is often claimed in the marketing for these products. ENDS use poses serious threats to adolescents and fetuses." A 2014 systematic review concluded that the risks of e-cigarettes have been exaggerated by health authorities and stated that there may be some remaining risk, though the risk of e-cigarette use is likely small compared to smoking tobacco. A 2014 Cochrane review found no serious adverse effects reported in trials. Less serious adverse effects from e-cigarette use can include throat and mouth inflammation, vomiting, nausea, and cough. The long-term effects of e-cigarette use are unknown. The risk is probably low from the inhalation of propylene glycol and glycerin. E-cigarette users are exposed to potentially harmful nicotine. A 2014 review recommended that e-cigarettes should be regulated for consumer safety.
A number of organizations are concerned that e-cigarettes might increase addiction to and use of nicotine and tobacco products among young people. These include 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. The World Health Organization raised concern about addiction for non-smokers from their use in July 2013. The National Institute on Drug Abuse said they could maintain addiction to nicotine in those who are attempting to quit.
It is not clear whether using e-cigarettes will decrease or increase overall nicotine addiction. Information about the drug action of the nicotine in e-cigarettes is limited. The evidence suggests that the nicotine in e-cigarettes is adequate to sustain nicotine dependence. The limited data suggests that the likelihood of abuse from e-cigarettes could be smaller than traditional cigarettes. A 2014 systematic review found that the concerns that e-cigarettes could cause non-smokers to start smoking are unsubstantiated. No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction. Some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence. Like tobacco companies did in the last century, there is a chance that e-cigarettes could result in a new nicotine-dependent planet.
A 2014 review found no evidence that they are used regularly by those who have never smoked, while another 2014 review has found that in some populations nearly up to a third of youth who have ever used e-cigarettes have never smoked traditional cigarettes. The degree to which teens are using e-cigarettes in ways the manufacturers did not intend, such as increasing the nicotine delivery, is unknown. The extent to which e-cigarette use will lead to abuse in youth is unknown. The impact of e-cigarette use by children on substance dependence is unknown. Youthful experimentation with e-cigarettes could lead to a lifelong addiction.
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 a flavored solution that did not contain nicotine and produced steam. It was never commercialized.
Hon Lik, a Chinese pharmacist and inventor, who worked as a research pharmacist for a company producing ginseng products, is credited with the invention of the modern electronic cigarette. Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2003, he conceived of the idea of using a piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine. This design creates a smoke-like vapor and delivers nicotine once inhaled by the user.
Hon patented the modern e-cigarette design in 2003. Electronic cigarettes using different designs were first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. Many versions made their way to the U.S., sold mostly over the Internet by small marketing firms. 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 before receiving its first international patent in 2007.
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. This is a mechanism which integrates the heating coil into the liquid chamber. The new device was launched in the UK in 2007 under their Gamucci brand and the design 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. Since 2007, e-cigarette use in the US has risen.
International tobacco companies, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete, are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies. Blu, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. in 2012. 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. On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG. 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 with $20 million in incentive payments. Altria also markets its own e-cigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse product. As of March 2015, 74% of all e-cigarette sales in convenience stores in the U.S. were products made by tobacco companies.
Society and culture
Consumers of electronic cigarettes, sometimes referred to as "vapers", have shown evident and passionate support for the product that other nicotine replacement therapy did not receive. This suggests that electronic cigarettes have the potential mass appeal that could challenge the pre-eminence of combustible tobacco as the object of choice for nicotine users.
As the electronic cigarette industry grows, a subculture has emerged which calls itself "the vaping community". The online forum E-Cig-Reviews.com was one of the first major communities. Another online forum known as UKVaper.org was the origin of the hobby of modding. There are also groups on Facebook and Reddit. Members of this emerging subculture often view electronic cigarettes as a safer alternative to smoking and some even view it as a hobby. These groups tend to use highly customized devices that do not resemble the earlier "cig-a-likes", the electronic cigarettes that resemble real cigarettes. Online forums based around modding have grown in the vaping community. Vapers energetically embrace activities associated with the use of e-cigarettes and in some circumstances act as unpaid evangelicals according to a 2014 review. A 2014 Postgraduate Medical Journal editorial stated that e-cigarette companies have a substantial online presence, as well as many individual vapers who spend time blogging and tweeting about e-cigarette related products. The editorial stated that a few vapers "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". A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda. The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws. This is similar to tobacco industry activity going back to the 1980s. It was concluded that these approaches were used in Europe to minimize the EU Tobacco Product Directive in October 2013.
Large gatherings of vapers, called vape meets, are happening around the United States. They focus on e-cig devices, accessories, and the lifestyle that accompanies them. Vapefest, which started in 2010, is an annual show hosted by different cities. People attending these meetings are usually enthusiasts that use specialized, community-made products that are not found in typical places like convenience stores or gas stations. 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. As of 2014[update], availability of e-cigarettes is increasing in retail stores in the U.S., especially in places with low taxed and smoking ban regulations.
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 with a resistance of less than 1 ohm. This practice is known as "cloud-chasing". By using a coil with very low resistance, the batteries used are stressed beyond the margins of what could be considered safe use. This could represent a risk of dangerous battery failures. As vaping comes under increased scrutiny, some members of the vaping community have voiced their concerns about cloud-chasing, claiming the practice gives vapers a bad reputation when doing it in public. The Oxford Dictionaries' word of the year for 2014 is 'vape'.
Because of the novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation is currently pending in many countries. As of 2015[update], around two thirds of major nations have regulated e-cigarettes in some way. Current regulations vary widely, from regions with no regulations to others banning the devices entirely. For example, some countries such as Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes. In Canada, they are legal to sell, however nicotine-containing e-fluid is not approved by Health Canada - making it technically illegal, although widely unenforced and commonly available for sale. As of December 2014, e-cigarettes are legal for minors to buy in ten states in the U.S. and since they do not contain tobacco, television advertising is not restricted. In the US, as of 2014 some states tax e-cigarettes as tobacco products, and some state and regional governments have broadened their indoor smoking bans to include e-cigarettes.
In August 2014, attorneys general from over two dozen states advised the FDA to enact restrictions on e-cigarettes, including banning flavors. E-cigarettes have been classified as "drug delivery devices" in several countries because they can contain nicotine, and their advertising has been restricted until safety and efficacy trials are conclusive. A 2014 review said these products should be considered for regulation in view of the "reported adverse health effects". In some countries, e-cigarettes are regulated as a medical product even though they are not approved as a smoking cessation aid. E-cigarettes are not approved by the FDA as a smoking cessation product.
In the fall of 2013, the electronic cigarette industry ran "a determined lobbying campaign" to defeat proposed European legislation to regulate e-cigarettes like medical devices. Pharmaceutical manufacturers GlaxoSmithKline and Johnson & Johnson have lobbied the US government, the FDA, and the EU parliament for stricter regulation of e-cigarettes which compete with their products Nicorette gum and nicotine patches. 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. In April 2014 the US FDA published proposed regulations for e-cigarettes along similar lines.
In October 2014 the UK's Advertising Standards Authority changed the regulations on e-cigarette advertising, allowing the devices to appear in television ads from 10 November. The first advert to take advantage of the change, promoting KiK Electronic Cigarettes, aired on the day it came into force.
Hon Lik, the inventor of the modern e-cigarette sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera." He has said: "My fame will follow the development of the e-cigarette industry. Maybe in 20 or 30 years I will be very famous." Many US and Chinese e-cig makers copied his designs illegally, so Hon Lik was not paid for his invention (although some US manufacturers have compensated him through out of court settlements). Europe's second largest tobacco manufacturer Imperial Tobacco bought Hon Lik's 2003 patents in 2013, for $75 million.
Worldwide e-cigarette sales in 2014 were around $7 billion. E-cigarette brands have been increasing advertising quickly; the aggressive marketing used is like that used to sell cigarettes in the 1950s and 1960s. While advertising of tobacco products was banned long ago, television and radio e-cigarette advertising in some countries may be indirectly encouraging traditional cigarette smoking. 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". E-cigarettes and nicotine are regularly promoted as safe and beneficial in the media and on brand websites. E-cigarette retail websites often make unscientific health claims to consumers in order to sell them products. The majority of advertisers also emphasize that the product can be used "anywhere" especially where smoking bans apply. A 2014 review found "only a small percentage of sites had an age restriction, which was only to click a box to state that the user is over a certain age. This easily-circumvented age verification leaves open room for youth access and marketing exposure."
Tobacco manufacturers dismissed e-cigarettes as a fad at first; but the purchase of the US brand blu eCigs by US tobacco manufacturer Lorillard for $135 million in April 2012 signaled their entry into the market. A national US advertising campaign starred Steven Dorff exhaling a "thick flume" of what the ad describes as 'vapor, not tobacco smoke', exhorting smokers with the message "We are all adults here, it's time to take our freedom back." Jason Healy, founder of blu, called the product "a lifestyle brand for smokers". The ads, occurring against the backdrop of longstanding prohibition of tobacco advertising on television, were criticized by organizations such as Campaign for Tobacco-Free Kids as undermining anti-tobacco efforts. Cynthia Hallett of Americans for Non-Smokers' Rights described the US advertising campaign as attempting to "re-establish a norm that smoking is okay, that smoking is glamorous and acceptable". The blu brand was purchased by Imperial Tobacco in July 2014. Big tobacco companies have purchased some e-cigarette businesses and greatly increased their marketing efforts. As of 2014[update] e-cigarette devices are mostly manufactured in China. US e-cigarette sales were forecast to increase to about 5 million units in 2012 compared to 50,000 in 2008. Sales in the U.S. were close to $2 billion in 2014. Big tobacco has a significant share of the e-cigarette market, and they are the major producers.
In the US there are more than a hundred small e-cigarette businesses, with about 70% of the market held by 10 businesses. A sizable share of the e-cigarette business is done on the internet. The majority of e-cigarette businesses have their own homepage and approximately 30–50% of total e-cigarettes sales are handled on the internet in respect to English-language websites. A 2014 review said e-cigarettes are aggressively promoted, mostly via the internet, as a healthy alternative to smoking in the US. According to Nielsen Holdings, convenience store e-cigarette sales in the US went down for the first time during the four-week period ending on 10 May 2014. This decline is attributed by Wells Fargo analyst Bonnie Herzog to a shift in consumers' behavior, buying more specialized devices or what she calls "vapor/tank/mods (VTMs)" that are not tracked by Neilsen. According to Herzog these products, produced and sold by stand alone makers are now (2014) growing twice as fast as traditional electronic cigarettes marketed by the major players (Lorillard, Logic Technology, NJOY etc...) and account for a third of the 2.2 billion dollar market in the US for vapor products.
The main e-cigarette businesses in the UK are British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid Vapours. British American Tobacco was the first tobacco business to sell e-cigarettes in the UK. They launched the e-cigarette Vype in July 2013. Philip Morris, the world’s largest tobacco manufacturer, purchased UK’s Nicocigs in June 2014. As of March 2014 the top selling e-cigarette brands in the UK at independent convenience stores are Nicolites and Vivid Vapours.
There are other technologies currently under development that seek to deliver nicotine for oral inhalation in an effort to mimic both the ritualistic and behavioral 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. In September 2014 a product based on this - named Voke - obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency.
Philip Morris International (PMI) bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University. The technology is based on the chemical reaction between nicotine acid and a base, which produces an inhalable nicotine pyruvate vapor.
- Caponnetto, Pasquale; Campagna, Davide; Papale, Gabriella; Russo, Cristina; Polosa, Riccardo (2012). "The emerging phenomenon of electronic cigarettes". Expert Review of Respiratory Medicine 6 (1): 63–74. doi:10.1586/ers.11.92. ISSN 1747-6348. PMID 22283580.
- Cheng, T. (2014). "Chemical evaluation of electronic cigarettes". Tobacco Control 23 (Supplement 2): ii11–ii17. doi:10.1136/tobaccocontrol-2013-051482. ISSN 0964-4563. PMC 3995255. PMID 24732157.
- Weaver, Michael; Breland, Alison; Spindle, Tory; Eissenberg, Thomas (2014). "Electronic Cigarettes". Journal of Addiction Medicine 8 (4): 234–240. doi:10.1097/ADM.0000000000000043. ISSN 1932-0620. PMID 25089953.
- Grana, R; Benowitz, N; Glantz, SA (13 May 2014). "E-cigarettes: a scientific review.". Circulation 129 (19): 1972–86. doi:10.1161/circulationaha.114.007667. PMC 4018182. PMID 24821826.
- Ebbert, Jon O.; Agunwamba, Amenah A.; Rutten, Lila J. (2015). "Counseling Patients on the Use of Electronic Cigarettes". Mayo Clinic Proceedings 90 (1): 128–134. doi:10.1016/j.mayocp.2014.11.004. ISSN 0025-6196. PMID 25572196.
- Oh, Anne Y.; Kacker, Ashutosh (December 2014). "Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke". The Laryngoscope 124 (12): 2702–2706. doi:10.1002/lary.24750. PMID 25302452.
- Brandon, T. H.; Goniewicz, M. L.; Hanna, N. H.; Hatsukami, D. K.; Herbst, R. S.; Hobin, J. A.; Ostroff, J. S.; Shields, P. G.; Toll, B. A.; Tyne, C. A.; Viswanath, K.; Warren, G. W. (2015). "Electronic Nicotine Delivery Systems: A Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology" (PDF). Clinical Cancer Research 21: 514–525. doi:10.1158/1078-0432.CCR-14-2544. ISSN 1078-0432. PMID 25557889.
- McRobbie, Hayden; Bullen, Chris; Hartmann-Boyce, Jamie; Hajek, Peter; McRobbie, Hayden (2014). "Electronic cigarettes for smoking cessation and reduction". The Cochrane Library 12: CD010216. doi:10.1002/14651858.CD010216.pub2. PMID 25515689.
- Harrell, PT; Simmons, VN; Correa, JB; Padhya, TA; Brandon, TH (4 June 2014). "Electronic Nicotine Delivery Systems ("E-cigarettes"): Review of Safety and Smoking Cessation Efficacy.". Otolaryngology—head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 151: 381–393. doi:10.1177/0194599814536847. PMID 24898072.
These devices are unregulated, of unknown safety, and of uncertain benefit in quitting smoking.
- Drummond, MB; Upson, D (February 2014). "Electronic cigarettes. Potential harms and benefits.". Annals of the American Thoracic Society 11 (2): 236–42. doi:10.1513/annalsats.201311-391fr. PMID 24575993.
- Caponnetto P; Russo C; Bruno CM; Alamo A; Amaradio MD; Polosa R. (Mar 2013). "Electronic cigarette: a possible substitute for cigarette dependence.". Monaldi archives for chest disease 79 (1): 12–19. PMID 23741941.
- O'Connor, RJ (March 2012). "Non-cigarette tobacco products: what have we learnt and where are we headed?". Tobacco control 21 (2): 181–90. doi:10.1136/tobaccocontrol-2011-050281. PMC 3716250. PMID 22345243.
- "Tobacco Free Initiative (TFI)". World Health Organization. 9 July 2013.
- Hajek, P; Etter, JF; Benowitz, N; Eissenberg, T; McRobbie, H (31 July 2014). "Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit." (PDF). Addiction (Abingdon, England) 109 (11): 1801–10. doi:10.1111/add.12659. PMID 25078252.
- Orellana-Barrios, Menfil A.; Payne, Drew; Mulkey, Zachary; Nugent, Kenneth (2015). "Electronic cigarettes-a narrative review for clinicians". The American Journal of Medicine. doi:10.1016/j.amjmed.2015.01.033. ISSN 0002-9343. PMID 25731134.
- Rahman MA, Hann N, Wilson A, Worrall-Carter L (2014). "Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues". Tob Induc Dis 12 (1): 21. doi:10.1186/1617-9625-12-21. PMC 4350653. PMID 25745382.
- Carroll Chapman, SL; Wu, LT (18 Mar 2014). "E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison.". Journal of Psychiatric Research 54: 43–54. doi:10.1016/j.jpsychires.2014.03.005. PMID 24680203.
- ASH UK (28 April 2014). "Over 2 million Britons now regularly use electronic cigarettes". Retrieved 30 May 2014.
- Barbara Demick (25 April 2009). "A high-tech approach to getting a nicotine fix". Los Angeles Times.
- Saitta, D; Ferro, GA; Polosa, R (Mar 2014). "Achieving appropriate regulations for electronic cigarettes.". Therapeutic advances in chronic disease 5 (2): 50–61. doi:10.1177/2040622314521271. PMC 3926346. PMID 24587890.
- Etter, J. F.; Bullen, C.; Flouris, A. D.; Laugesen, M.; Eissenberg, T. (May 2011). "Electronic nicotine delivery systems: a research agenda". Tobacco control 20 (3): 243–8. doi:10.1136/tc.2010.042168. PMC 3215262. PMID 21415064.
- Memo/14/134 "Questions & Answers: New rules for tobacco products". European Commission. 26 February 2014.
- "Electronic Cigarettes (e-Cigarettes)". FDA. 11 August 2014. Retrieved 18 October 2014.
- "Marlboro Maker To Launch New Electronic Cigarette". The Huntington Post. 11 June 2013.
- Schraufnagel, Dean E.; Blasi, Francesco; Drummond, M. Bradley; Lam, David C. L.; Latif, Ehsan; Rosen, Mark J.; Sansores, Raul; Van Zyl-Smit, Richard (2014). "Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies". American Journal of Respiratory and Critical Care Medicine 190 (6): 611–618. doi:10.1164/rccm.201407-1198PP. ISSN 1073-449X. PMID 25006874.
- Jesse Rifkin (16 April 2015). "E-Cigarettes Are Now More Popular With Young People Than Regular Cigarettes". The Huffington Post.
- Pepper, J. K.; Brewer, N. T. (2013). "Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review". Tobacco Control 23 (5): 375–384. doi:10.1136/tobaccocontrol-2013-051122. ISSN 0964-4563. PMID 24259045.
- England, Lucinda J.; Bunnell, Rebecca E.; Pechacek, Terry F.; Tong, Van T.; McAfee, Tim A. (2015). "Nicotine and the Developing Human". American Journal of Preventive Medicine. doi:10.1016/j.amepre.2015.01.015. ISSN 0749-3797. PMID 25794473.
- Suter, Melissa A.; Mastrobattista, Joan; Sachs, Maike; Aagaard, Kjersti (2015). "Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy?". Birth Defects Research Part A: Clinical and Molecular Teratology 103 (3): 186–195. doi:10.1002/bdra.23333. ISSN 1542-0752. PMID 25366492.
- Franck, C.; Budlovsky, T.; Windle, S. B.; Filion, K. B.; Eisenberg, M. J. (2014). "Electronic Cigarettes in North America: History, Use, and Implications for Smoking Cessation". Circulation 129 (19): 1945–1952. doi:10.1161/CIRCULATIONAHA.113.006416. ISSN 0009-7322. PMID 24821825.
- "CDC Electronic Cigarette Statistics". CDC Newsroom. 28 February 2013. Retrieved 4 March 2013.
- Centers for Disease Control and Prevention (CDC) (November 2013). "Tobacco product use among middle and high school students--United States, 2011 and 2012". MMWR Morb. Mortal. Wkly. Rep. 62 (45): 893–7. PMID 24226625.
- "More than a quarter-million youth have used e-cigarettes who have never smoked.". 25 August 2014. Retrieved 30 August 2014.
- Tavernise, Sabrina (16 April 2015). "Use of E-Cigarettes Rises Sharply Among Teenagers, Report Says". New York Times. Retrieved 17 April 2015.
- Lauterstein, Dana; Hoshino, Risa; Gordon, Terry; Watkins, Beverly-Xaviera; Weitzman, Michael; Zelikoff, Judith (2014). "The Changing Face of Tobacco Use Among United States Youth". Current Drug Abuse Reviews 7 (1): 29–43. doi:10.2174/1874473707666141015220110. ISSN 1874-4737. PMID 25323124.
- Arrazola, RA; Neff, LJ; Kennedy, SM; Holder-Hayes, E; Jones, CD (14 November 2014). "Tobacco Use Among Middle and High School Students — United States, 2013". MMWR Morb. Mortal. Wkly. Rep. 63 (45): 1021–1026. PMID 24699766.
- "Use of electronic cigarettes in Great Britain" (PDF). ASH. ASH. July 2014. Retrieved 18 September 2014.
- "New survey finds regular use by children still rare". ASH-UK. Retrieved 17 September 2014.
- "Prévalence, comportements d'achat et d'usage, motivations des utilisateurs de la cigarette électronique" (PDF). Observatoire Français des Drogues et des Toxicomanies. Retrieved 28 March 2014.
- Schraufnagel, Dean E. (2015). "Electronic Cigarettes: Vulnerability of Youth". Pediatric Allergy, Immunology, and Pulmonology 28 (1): 2–6. doi:10.1089/ped.2015.0490. ISSN 2151-321X. PMID 25830075.
- Jilian Mincer (1 May 2015). "As youth vaping rises, teens cite the allure of tricks". Reuters.
- Dominique Mosbergen (5 August 2014). "This Man Is An Athlete In The Sport Of 'Cloud Chasing'". The Huffington Post.
- Choi, Kelvin; Forster, Jean L. (2014). "Beliefs and Experimentation with Electronic Cigarettes". American Journal of Preventive Medicine 46 (2): 175–178. doi:10.1016/j.amepre.2013.10.007. ISSN 0749-3797. PMID 24439352.
- Crowley, Ryan A. (2015). "Electronic Nicotine Delivery Systems: Executive Summary of a Policy Position Paper From the American College of Physicians". Annals of Internal Medicine 162 (8): 583. doi:10.7326/M14-2481. ISSN 0003-4819. PMID 25894027.
- Gavin Haynes (22 April 2015). "Daft vapers: the competitive world of e-cigarette smoking". The Guardian.
- Grana RA, Ling PM (2014). ""Smoking revolution": a content analysis of electronic cigarette retail websites". Am J Prev Med 46 (4): 395–403. doi:10.1016/j.amepre.2013.12.010. PMID 24650842.
- Samantha Payne (20 June 2014). "Harvard Study: E-Cigarettes Not 'Gateway' to Smoking". International Business Times.
- Kong, G.; Morean, M. E.; Cavallo, D. A.; Camenga, D. R.; Krishnan-Sarin, S. (2014). "Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults". Nicotine & Tobacco Research. doi:10.1093/ntr/ntu257. ISSN 1462-2203. PMID 25481917.
- "Regulation of Electronic Cigarettes ("E-Cigarettes")" (PDF). National Association of County and City Health Officials.
- "E-Cigarettes May Be Tempting Non-Smoking Youths To Smoke". The Huntington Post. 25 August 2014.
- Mike Stobbe (6 September 2013). "U.S. children's use of e-cigarettes increasing, study finds". CTV News.
- Ian Sample (30 March 2015). "Scientists issue call for urgent controls on e-cigarette sales to children". The Guardian.
- Liz Alderman (12 June 2013). "E-Cigarettes Are in Vogue and at a Crossroads". The New York Times.
- Wayne Davies (19 June 2014). "Girls as young as 11 tempted by 'gummy bear' e-cigarettes, Welsh researchers warn". Wales Online.
- Kevin Chatham-Stephens (20 October 2014). "Young Children and e-Cigarette Poisoning". Medscape.
- Yingst, J. M.; Veldheer, S.; Hrabovsky, S.; Nichols, T. T.; Wilson, S. J.; Foulds, J. (2015). "Factors associated with electronic cigarette users' device preferences and transition from first generation to advanced generation devices.". Nicotine Tob Res. doi:10.1093/ntr/ntv052. ISSN 1462-2203. PMID 25744966.
- Sanford Z, Goebel L (2014). "E-cigarettes: an up to date review and discussion of the controversy". W V Med J 110 (4): 10–5. PMID 25322582.
- McQueen, Amy; Tower, Stephanie; Sumner, Walton (2011). "Interviews with "vapers": implications for future research with electronic cigarettes" (PDF). Nicotine & Tobacco Research 13 (9): 860–7. doi:10.1093/ntr/ntr088. PMID 21571692.
- Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V (2014). "Nicotine absorption from electronic cigarette use: Comparison between first and new-generation devices". Scientific Reports 4: 4133. doi:10.1038/srep04133. PMC 3935206. PMID 24569565.
- Rom, Oren; Pecorelli, Alessandra; Valacchi, Giuseppe; Reznick, Abraham Z. (2014). "Are E-cigarettes a safe and good alternative to cigarette smoking?". Annals of the New York Academy of Sciences: n/a–n/a. doi:10.1111/nyas.12609. ISSN 0077-8923. PMID 25557889.
- Glasser, A. M.; Cobb, C. O.; Teplitskaya, L.; Ganz, O.; Katz, L.; Rose, S. W.; Feirman, S.; Villanti, A. C. (2015). "Electronic nicotine delivery devices, and their impact on health and patterns of tobacco use: a systematic review protocol". BMJ Open 5 (4): e007688–e007688. doi:10.1136/bmjopen-2015-007688. ISSN 2044-6055. PMID 25926149.
- "Vaper Talk – The Vaper's Glossary". Spinfuel Magizine. 5 July 2013. Retrieved 18 November 2014.
- Greg Olson (29 January 2014). "Smoking going electronic". Thetelegraph.com. Retrieved 6 February 2014.
- Bekki, Kanae; Uchiyama, Shigehisa; Ohta, Kazushi; Inaba, Yohei; Nakagome, Hideki; Kunugita, Naoki (2014). "Carbonyl Compounds Generated from Electronic Cigarettes". International Journal of Environmental Research and Public Health 11 (11): 11192–11200. doi:10.3390/ijerph111111192. ISSN 1660-4601. PMID 25353061.
- Jimenez Ruiz, CA; Solano Reina, S; de Granda Orive, JI; Signes-Costa Minaya, J; de Higes Martinez, E; Riesco Miranda, JA; Altet Gómez, N; Lorza Blasco, JJ; Barrueco Ferrero, M; de Lucas Ramos, P (August 2014). "The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes.". Archivos de bronconeumologia 50 (8): 362–7. doi:10.1016/j.arbr.2014.06.007. PMID 24684764.
- Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (2013). "Electronic Cigarettes: A Short Review". Respiration 86: 433–8. doi:10.1159/000353253. ISSN 1423-0356. PMID 24080743.
- WHO. "Electronic nicotine delivery systems" (PDF). Retrieved 28 August 2014.
- "WHO Right to Call for E-Cigarette Regulation". World Lung Federation. Retrieved 6 November 2014.
- "Stop smoking treatments". UK National Health Service. Retrieved 6 November 2014.
- "Electronic Cigarettes (e-Cigarettes)". US Food and Drug Administration. Retrieved 6 November 2014.
- Orr, KK; Asal, NJ (November 2014). "Efficacy of electronic cigarettes for smoking cessation.". The Annals of pharmacotherapy 48 (11): 1502–6. doi:10.1177/1060028014547076. PMID 25136064.
- Schroeder, M. J.; Hoffman, A. C. (2014). "Electronic cigarettes and nicotine clinical pharmacology". Tobacco Control 23 (Supplement 2): ii30–ii35. doi:10.1136/tobaccocontrol-2013-051469. ISSN 0964-4563. PMID 24732160.
- Rahman, Muhammad Aziz (30 March 2015). "E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis.". PLOS ONE 10: e0122544. doi:10.1371/journal.pone.0122544. PMID 25822251.
- Gualano, M. R.; Passi, S.; Bert, F.; La Torre, G.; Scaioli, G.; Siliquini, R. (9 August 2014). "Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies". Journal of Public Health. doi:10.1093/pubmed/fdu055. PMID 25108741.
- Pisinger, Charlotta; Døssing, Martin (December 2014). "A systematic review of health effects of electronic cigarettes". Preventive Medicine 69: 248–260. doi:10.1016/j.ypmed.2014.10.009. PMID 25456810.
- M., Z.; Siegel, M (February 2011). "Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?". Journal of public health policy 32 (1): 16–31. doi:10.1057/jphp.2010.41. PMID 21150942.
- Nowak D, Jörres RA, Rüther T (2014). "E-cigarettes--prevention, pulmonary health, and addiction". Dtsch Arztebl Int 111 (20): 349–55. doi:10.3238/arztebl.2014.0349. PMC 4047602. PMID 24882626.
- Farsalinos, K. E.; Polosa, R. (2014). "Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review". Therapeutic Advances in Drug Safety 5 (2): 67–86. doi:10.1177/2042098614524430. ISSN 2042-0986. PMC 4110871. PMID 25083263.
- Britton, John; Bogdanovica, Ilze (15 May 2014). "Electronic cigarettes – A report commissioned by Public Health England" (PDF). Public Health England.
- "BMA calls for stronger regulation of e-cigarettes" (PDF). British Medical Association. Retrieved 18 November 2013.
- "Principles to Guide AAPHP Tobacco Policy". American Association of Public Health Physicians. Retrieved 31 July 2013.
- Edgar, Julie. "E-Cigarettes: Expert Q&A With the CDC". WebMD. Retrieved 17 November 2013.
- Palazzolo, Dominic L. (Nov 2013). "Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review.". Frontiers in Public Health 1 (56). doi:10.3389/fpubh.2013.00056. PMC 3859972. PMID 24350225.
- Odum, L. E.; O'Dell, K. A.; Schepers, J. S. (December 2012). "Electronic cigarettes: do they have a role in smoking cessation?". Journal of pharmacy practice 25 (6): 611–4. doi:10.1177/0897190012451909. PMID 22797832.
- Durmowicz, E. L. (2014). "The impact of electronic cigarettes on the paediatric population". Tobacco Control 23 (Supplement 2): ii41–ii46. doi:10.1136/tobaccocontrol-2013-051468. ISSN 0964-4563. PMID 24732163.
- Centers for Disease Control and Prevention, (CDC) (6 September 2013). "Notes from the field: electronic cigarette use among middle and high school students – United States, 2011–2012". MMWR. Morbidity and mortality weekly report 62 (35): 729–30. PMID 24005229.
- "DrugFacts: Electronic Cigarettes (e-Cigarettes)". National Institute on Drug Abuse. September 2014. Retrieved 15 October 2014.
There is also the possibility that they could perpetuate the nicotine addiction and thus interfere with quitting.
- "Citing Health Concerns the American Cancer Society Calls for Action". American Cancer Society. Retrieved 12 November 2013.
Government agencies and medical organizations, such as the FDA, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics have also expressed concern that electronic cigarettes could increase nicotine addiction and tobacco use in young people.
- "Position Statement on Electronic Cigarettes [ECs] or Electronic Nicotine Delivery Systems [ENDS]" (PDF). The International Union against Tuberculosis and Lung Disease. October 2013.
- Korioth, Trisha. "E-cigarettes easy to buy, can hook kids on nicotine". The American Academy of Pediatrics. Retrieved 17 November 2013.
- "FDA Warns of Health Risks Posed by E-Cigarettes". FDA. 23 July 2009. Retrieved 17 November 2013—Reviewed 17 September 2013
- Evans, S. E.; Hoffman, A. C. (2014). "Electronic cigarettes: abuse liability, topography and subjective effects". Tobacco Control 23 (Supplement 2): ii23–ii29. doi:10.1136/tobaccocontrol-2013-051489. ISSN 0964-4563. PMID 24732159.
- "US Patent 3200819. Smokeless non-tobacco cigarette". Retrieved 29 February 2012.
- Mary Bellis (2015). "Who Invented Electronic Cigarettes?". About.com.
- Debbie Elliott (5 August 2009). "E-Cigarettes: The New Frontier In War On Smoking". NPR.
- "Who Invented Electronic Cigarettes?". Inventors.about.com. Retrieved 20 November 2013.
- "Bibliographic data". Worldwide.espacenet.com.
- "Electronic Atomizer Cigarette European patent". Worldwide.espacenet.com. 22 November 2007. Retrieved 29 February 2012.
- "Brothers who took a punt on a new market". CityAM. Retrieved 4 April 2014.
- "Patent document and information service (Ipsum)". Intellectual Property Office. Retrieved 20 November 2013.
- "Kodak moment". The Economist. 28 September 2013. Retrieved 11 March 2014.
- Mike Esterl (3 February 2014). "Altria Expands in E-Cigarettes With Green Smoke". Wall Street Journal. Retrieved 7 March 2014.
- Brian Montopoli (11 June 2013). "Tobacco companies bet on electronic cigarettes". CBS News. Retrieved 16 August 2013.
- Gustafsson, Katarina (2 September 2013). "Imperial Tobacco Agrees to Acquire Dragonite's E-Cigarette Unit". Bloomberg. Retrieved 20 November 2013.
- "Lorillard, Inc. Acquires British-based SKYCIG, Expanding its Electronic Cigarette Business". Retrieved 1 October 2013.
- "Altria Completes Acquisition of Green Smoke". BusinessWire. 1 April 2014. Retrieved 21 November 2014.
- Melissa Vonder Haar (April 1, 2015). "Electronic Cigarette Growth Re-Accelerates". CSPnet.com. Retrieved May 1, 2015.
- Couts, Andrew (13 May 2013). "Inside the world of vapers, the subculture that might save smokers' lives". Digital Trends. Retrieved 20 November 2013.
- Park, Andy (26 August 2013). "The Feed: The subculture around e-cigarettes". SBS World News. Retrieved 20 November 2013.
- Michael Grothaus (1 October 2014). "Trading addictions: the inside story of the e-cig modding scene". Engadget.
- Eric Larson (25 January 2014). "Pimp My Vape: The Rise of E-Cigarette Hackers". Mashable. Retrieved 22 November 2014.
- Barbeau, Amanda M; Burda, Jennifer; Siegel, Michael (2013). "Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach". Addiction Science & Clinical Practice 8 (1): 5. doi:10.1186/1940-0640-8-5. ISSN 1940-0640. PMID 23497603.
- "Crutch or cure: issues surround use of e-cigarettes". Fremont Tribune. 9 November 2013.
- Molly Osberg (25 February 2014). "CVape life: welcome to the weird world of e-cig evangelists". The Verge.
- McKee, M. (2014). "Electronic cigarettes: peering through the smokescreen" (PDF). Postgraduate Medical Journal 90 (1069): 607–609. doi:10.1136/postgradmedj-2014-133029. ISSN 0032-5473. PMID 25294933.
- Mike Esterl (29 May 2014). "'Vaporizers' Are the New Draw in E-Cigarettes". The Wall Street Journal.
- Rose, S. W.; Barker, D. C.; D'Angelo, H.; Khan, T.; Huang, J.; Chaloupka, F. J.; Ribisl, K. M. (2014). "The availability of electronic cigarettes in US retail outlets, 2012: results of two national studies". Tobacco Control 23 (Supplement 3): iii10–iii16. doi:10.1136/tobaccocontrol-2013-051461. ISSN 0964-4563. PMID 24935892.
- "The Cloud Chasers". 29 January 2014.
- Sean Cooper (23 May 2014). "What you need to know about vaporizers". Engadget.
- Victoria Bekiempis (1 April 2015). "Veteran E-Cigarette Users Fret 'Cloud Chasers' Give Them a Bad Name". Newsweek.
- Fallon, Claire (19 November 2014). "'Vape' Is Oxford Dictionaries' Word Of The Year". The Huffington Post.
- Barnaby Page (5 March 2015). "World’s law-makers favour basing e-cig rules on tobacco". ECigIntelligence (Tamarind Media Limited).
- "Public health officers tackle hazy issue of e-cigarettes". The Globe and Mail. 29 September 2014.
- Biyani, S; Derkay, CS (28 April 2015). "E-cigarettes: Considerations for the otolaryngologist.". International journal of pediatric otorhinolaryngology. doi:10.1016/j.ijporl.2015.04.032. PMID 25998217.
- Maloney, Erin K.; Cappella, Joseph N. (2015). "Does Vaping in E-Cigarette Advertisements Affect Tobacco Smoking Urge, Intentions, and Perceptions in Daily, Intermittent, and Former Smokers?". Health Communication: 1–10. doi:10.1080/10410236.2014.993496. ISSN 1041-0236. PMID 25758192.
- "Heart group: E-cigarettes might help smokers quit". WHEC-TV (A Hubbard Broadcasting Company). 25 August 2014.
- Cervellin, Gianfranco; Borghi, Loris; Mattiuzzi, Camilla; Meschi, Tiziana; Favaloro, Emmanuel; Lippi, Giuseppe (2013). "E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism". Seminars in Thrombosis and Hemostasis 40 (01): 060–065. doi:10.1055/s-0033-1363468. ISSN 0094-6176. PMID 24343348.
- Callahan-Lyon, P. (2014). "Electronic cigarettes: human health effects". Tobacco Control 23 (Supplement 2): ii36–ii40. doi:10.1136/tobaccocontrol-2013-051470. ISSN 0964-4563. PMID 24732161.
- Andrew Higgins (9 November 2013). "Aided by Army of 'Vapers', E-Cigarette Industry Woos and Wins Europe". The New York Times. Retrieved 22 November 2014.
- Makiko Kitamura (19 February 2014). "Glaxo Memo Shows Drug Industry Lobbying on E-Cigarettes". Bloomberg News. Retrieved 22 November 2014.
- Eliza Gray (27 February 2014). "Europe Sets New Rules for E-Cigs While the U.S. Drags Its Feet". Time (magazine).
- "Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products". US FDA Federal Register: A Proposed Rule by the Food and Drug Administration on 04/25/2014.
- Sabrina Tavernise (24 April 2014). "F.D.A. Will Propose New Regulations for E-Cigarettes". The New York Times.
- Aleisha Orr (26 June 2014). "E-cigarette message goes up in smoke". WAtoday.
- "E-cigarettes can appear in TV adverts, watchdog rules". BBC News Online. 9 October 2014.
- Alex Bell (10 November 2014). "E-cigarette firm KiK to make TV history". Manchester Evening News.
- Tom Hancock (1 October 2013). "China's e-cigarette inventor fights for financial rewards". Fox News Channel.
- "E-Cigarette Makers Face Rise of Counterfeits". Dow Jones Business News.
- Daniel Nasaw (2012-12-05). "Electronic cigarettes challenge anti-smoking efforts". BBC.
- Mangan, Dan (15 July 2014). "Feeling blu? E-cig company spun off in major tobacco deal". CNBC.
- "E-cigarettes: No smoke, but fiery debate over safety". USA Today. Retrieved 20 July 2013.
- Meera Senthilingam (23 March 2015). "E-cigarettes: Helping smokers quit, or fueling a new addiction?". CNN.
- Melissa Vonder Haar (28 May 2014). "Nielsen: Electronic Cigarette Dollar Sales Decline". CSP Magazine.
- Tom Gara (14 April 2014). "Are E-Cigarettes Losing Ground in the Vapor Market?". The Wall Street Journal.
- Laura Wood (14 May 2014). "Research and Markets: UK E-cigarette Market 2014-2018: British American Tobacco plc, Lorillard Inc., Nicocigs Ltd. & Vivid Vapours Ltd. Dominate this New Lucrative Market". Research and Markets (Yahoo! Finance).
- Sanchez Manning (29 July 2013). "British American Tobacco enters electronic cigarette market in Britain with the 'Vype'". The Independent.
- Gideon Spanier (26 June 2014). "Philip Morris buys e-cigarette maker Nicocigs as it warns of falling profits". The Independent.
- Joe Lenane (24 March 2014). "Nicolites and Vivid Dominate E-cigarette Market". National Federation of Retail Newsagents.
- Celestine Bohlen (21 October 2013). "In France, an E-Cigarette Bubble?". The New York Times.
- Angelique Chrisafis (28 May 2013). "France considers electronic cigarette ban in public places". The Guardian.
- "BAT unit to market nicotine inhaler". Tobacco Journal International. 2011.
- Financial Times. "British American Tobacco nicotine inhaler wins regulatory approval". Retrieved 18 September 2014.
- "News Release: Philip Morris International (PMI) Enters into a Patent Purchase Agreement of New Technology with the Potential to Reduce the Harm of Smoking". Philip Morris International. 26 May 2011. Retrieved 27 August 2013.
- "New smoking cessation therapy proves promising". Esciencenews.com. 27 February 2010. Retrieved 27 August 2013.
- Harriet Hernando (26 June 2014). "Now it's the Marlboro HeatStick: Cigarette maker Philip Morris to sell new product that heats tobacco rather than burning it". Mail Online.
- Media related to Electronic cigarettes at Wikimedia Commons