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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.^[1] The user inhales an aerosol, commonly called vapor, rather than cigarette smoke.^[2] E-cigarettes typically have a heating element that atomizes a liquid solution known as e-liquid.^[3] E-cigarettes are generally cylindrical, with many variations.^[4] There are disposable or reusable versions.^[5] E-liquids usually contain propylene glycol, glycerin, nicotine, and flavorings.^[4] E-liquids are also sold without propylene glycol, without nicotine, or without flavors.^[6]^[7]^[8]

The benefits and health risks of electronic cigarettes are uncertain.^[5]^[9] One review found limited evidence of a benefit as a smoking cessation aid,^[8] but there is no evidence they are better than regulated medication for quitting smoking.^[9] Their usefulness in tobacco harm reduction is unclear.^[10] One review found their safety risk is similar to that of smokeless tobacco.^[11] Another found United States Food and Drug Administration (FDA)-approved products, such as nicotine inhalers, are probably safer than e-cigarettes.^[10]

Limited evidence suggests e-cigarettes are safer than traditional cigarettes.^[12] People who do not already smoke can become addicted to them.^[13] There is no evidence e-cigarettes are regularly used by those who have never smoked.^[14] E-cigarette use may delay or deter quitting smoking.^[4] E-cigarettes create vapor that consists of ultrafine particles.^[4] The vapor contains similar chemicals to the e-liquid, together with tiny amounts of toxicants and heavy metals.^[4]^[14] E-cigarette vapor contains fewer toxic substances than cigarette smoke,^[4] and is likely to be less harmful than traditional cigarettes to users and bystanders.^[4]^[14] No serious adverse effects from e-cigarettes have been reported in trials.^[8] Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and cough.^[4] The long-term effects of e-cigarette use are unknown.^[15]^[16]

Use has risen.^[17] 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.^[17] 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.^[18] Most e-cigarette users still smoke traditional cigarettes.^[4] Most peoples' reason for using e-cigarettes is related to quitting, but a considerable proportion use them recreationally.^[16] The modern e-cigarette arose from a 2003 invention by Hon Lik in China^[19] and as of 2014 most devices are made there.^[4] E-cigarette brands have increased their advertising, using marketing techniques like those used to sell cigarettes in the 1950s and 1960s.^[4] Because of the potential relationship with tobacco laws and medical drug policies, electronic cigarette legislation is being debated in many countries.^[20]^[21] The European Parliament passed regulations in February 2014 standardizing liquids and personal vaporizers, listing ingredients, and child-proofing liquid containers.^[22] The US FDA published proposed regulations in April 2014 with some similar measures.^[23]

Use

Frequency

As of 2013^[update], there are several million e-cigarette users globally.^[24] Awareness and use of e-cigarettes greatly increased over the few years to 2014, particularly among young people and women in some countries.^[25] E-cigarette use among young people exceeds traditional cigarette use.^[26] People with higher incomes are more likely to have heard of e-cigarettes, but those with lower incomes are more likely to have tried them.^[17] Trying e-cigarettes was common among less educated people.^[25] Whites are more likely to use them than non-whites.^[17] Most users have a history of smoking normal cigarettes.^[17] Some young people who have never smoked normal cigarettes have tried e-cigarettes at least once.^[17]

The majority of e-cigarette users use them every day.^[27] E-cigarette users mostly keep smoking traditional cigarettes.^[4] Many say e-cigarettes help them cut down or quit smoking.^[14] Adults often use e-cigarettes to replace tobacco, but not always to quit.^[17] Dual use of e-cigarettes with traditional cigarettes is relatively common.^[27] Most e-cigarette users are middle-aged men who also smoke traditional cigarettes, either to help them quit or for recreational use.^[16] Among women, e-cigarette use is rising sharply.^[28] E-cigarette use is also rising among women of childbearing age, but the rate of use during pregnancy is unknown.^[28]^[29] Dual use of e-cigarettes and traditional tobacco is still a definite concern.^[5] Many worry that e-cigarettes may be a "gateway" to tobacco smoking.^[30] A 2014 review raised ethical concerns about minors' e-cigarette use and the potential to weaken cigarette smoking reduction efforts.^[30]

In the US, as of 2011, one in five adults who smoke have tried electronic cigarettes and 3.3% are still using them.^[17]^[31] 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^[17] 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%.^[32] Use frequency has risen: as of 2012, up to 10% of American high school students have ever used them.^[17] In 2013 the CDC found a threefold increase from 2011 in the number of youth who have used e-cigarettes but have never smoked.^[33] Between 2013 and 2014, use of e-cigarettes by US teenagers tripled.^[34] The limited data suggests e-cigarette use is rapidly growing among adolescents.^[35] The majority of young people who use e-cigarettes also smoke combustible cigarettes.^[36] E-cigarette use among never-smoking youth in the US correlates with an elevated wish to use traditional cigarettes.^[5]

In the UK in 2014, 18% of regular smokers said they used e-cigarettes and 51% said they had used them in the past.^[37] Among those who had never smoked, 1.1% said they had tried them and 0.2% still uses them.^[37] In 2013, among those under 18, 7% have used e-cigarettes at least once.^[37] Among non-smokers' children, 1% reported having tried e-cigarettes "once or twice", and there was no evidence of continued use.^[37] Sustained use was mostly confined to children who smoke or have smoked.^[37] 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%.^[38] About 60% are smokers and most of the rest are ex-smokers.^[18]

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.^[39]

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.^[4] Most young people are not using e-cigarettes to help them quit tobacco.^[17]

Motivation

File:Bangor bilingual station no smoking sign.jpg

Common reasons people use the e-cigarette is a desire to quit smoking cigarettes, cut down on their smoking habit or for use where smoking is prohibited by law.^[4]

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.^[16]^[27]^[40] The activity known in the vaping community as cloud-chasing to exhale the largest cloud of vapor is increasing in popularity.^[41] Many users assume vaping is healthier than smoking for personal use or for bystanders.^[27] Some are concerned about the possible adverse health effects or toxicity of e-cigarettes.^[27] People who think vaping is less toxic than smoking may be more likely to experiment with them.^[42] 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".^[43]

File:Electronic Cigarette Cloud Chasing.jpg

E-cigarette user blowing a cloud of aerosol (vapor).^[44]

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.^[28] Another 2015 review said that the belief that e-cigarettes are safer than traditional cigarettes could widen their use among pregnant women.^[5] 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.^[27] They feel or taste similar to traditional cigarettes, and vapers disagreed about whether this was a benefit or a drawback.^[27] Some users liked that e-cigarettes resembled traditional cigarettes, but others did not.^[27] E-cigarettes users' views about saving money from using e-cigarettes compared to traditional cigarettes are inconsistent.^[27] The majority of committed e-cigarette users interviewed at an e-cigarette convention found them less costly than traditional cigarettes.^[27]

Some users stopped vaping due to issues with the devices.^[27] Not having odor from smoke on clothes on some occasions prompted interest in or use of e-cigarettes.^[27] 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.^[4] E-cigarette users have contradictory views about using them to get around smoking bans.^[27] 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.^[27] The extent to which traditional cigarette users vape to avoid smoking bans is unclear.^[27]

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."^[45] 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.^[5] Young people and children are tempted by flavored e-cigarettes.^[46] The main reasons young people experimented with e-cigarettes were due to curiosity, flavors, and peer influences.^[47] E-cigarettes can appeal to youth because of their high-tech design, assortment of flavors, and accessibility online.^[48] E-cigarettes could be more appealing to non-smoking youths than traditional cigarettes.^[49] In the US, the North West of England and Paris, vaping by children may be due to experimentation.^[50]^[51]^[52] In North Wales, girls who use e-cigarettes consider them appealing.^[53] Infants and toddlers could ingest the e-liquid from an e-cigarette device out of curiosity.^[54]

Many users might begin by using a disposable e-cigarette.^[7] E-cigarette users often start with an e-cigarette resembling a normal cigarette and eventually most of them switch to a later-generation device.^[55] Most users of later-generation e-cigarettes shifted to their present model to get a "more satisfying hit".^[55] Many users enjoy adjusting their devices to provide more vapor for better throat hits.^[56]

Construction

An electronic cigarette is a battery-powered vaporizer which provides a flavor and feel similar to tobacco smoking, but there are differences.^[1] A noticeable difference between the traditional cigarette and the e-cigarette is sense of touch.^[1] The user inhales an aerosol, commonly called vapor, rather than cigarette smoke.^[2] E-cigarettes typically have a heating element that atomizes a liquid solution known as e-liquid.^[3] E-cigarettes are generally cylindrical, with many variations.^[4] Some e-cigarettes look like traditional cigarettes, but others do not.^[27] 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.^[5] There are disposable or reusable versions.^[5] E-cigarettes that resemble pens or USB memory sticks are also sold for those who may want to use the device unobtrusively.^[25]

First generation e-cigarettes tend to look like tobacco cigarettes and so are called "cigalikes".^[57] Second generation devices tend to be used by more experienced users.^[58] Third generation devices include mechanical mods and variable voltage devices.^[57] A fourth generation digital e-cigarette became available in the U.S. in 2014.^[7] The devices contain a rechargeable battery, which tends to be the largest component of an e-cigarette.^[58]

An atomizer comprises a small heating element that vaporizes e-liquid and a wicking material that draws liquid onto the coil.^[59] 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.^[59] Clearomizers or "clearos", not unlike cartotanks, use a clear tank in which an atomizer is inserted.^[60] 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".^[57]

The main ingredients in the e-liquid usually are propylene glycol, glycerin, water, nicotine, and flavorings.^[11] There is a vast array of e-liquids available.^[61] The liquid typically contains 95% propylene glycol and glycerin.^[62] E-liquids are also sold without propylene glycol, or without nicotine.^[6]^[7] Surveys demonstrate that 97% of e-cigarette users use products that contain nicotine.^[7] Some are sold without flavors.^[8] The flavorings may be natural or artificial.^[63]

Health effects

Positions of medical organizations

As of 2014^[update] electronic cigarettes had not been approved as a smoking cessation device by any government.^[64] 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.^[64] It suggested that smokers should be encouraged to use approved methods for help with quitting.^[64] 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.^[64] A previous WHO statement from July 2013 said that e-cigarettes have not been shown to help people quit smoking.^[13] 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.^[13] 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.^[65]

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."^[66]

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."^[67]

Smoking cessation

As of 2014^[update], research on the safety and efficacy of e-cigarette use for smoking cessation is limited.^[30]^[68] They are unproven as quit-smoking aids.^[28] Their benefit for quitting smoking is uncertain.^[9] The evidence suggests that e-cigarettes can supply nicotine at concentrations that are, at least partially, enough to substitute for traditional cigarettes.^[69] 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.^[15] A 2014 Cochrane review found limited evidence of a benefit as a smoking cessation aid from a small number of studies.^[8] A 2015 review concluded that while they may have a benefit for decreasing cigarette use in smokers, they have a limited benefit in quitting smoking.^[70] A 2014 review found e-cigarettes may have some potential for reducing smoking.^[16]

A 2015 review found variable quality evidence that e-cigarette users had higher cessation rates than users of nicotine replacement products.^[71] A 2014 review found limited quality evidence that e-cigarettes do not seem to improve cessation rates compared to regulated FDA nicotine replacement products.^[68] Two 2014 reviews found no evidence that e-cigarettes are more effective than existing nicotine replacement products for smoking cessation.^[8]^[10] They may be as effective, but not more, compared to nicotine patches for short-term smoking cessation.^[17] 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.^[17] Studies have not shown that e-cigarettes are better than regulated medication for smoking cessation.^[9] A 2014 review found four experimental studies and six cohort studies that indicated that electronic cigarettes reduced the desire to smoke and withdrawal symptoms.^[72] This review also noted that two cohort studies found that electronic cigarettes led to a reduction in the number of cigarettes smoked per day.^[72] Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine.^[71] 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.^[73] This review therefore called for their use to be limited to smokers who are unwilling or unable to quit.^[73] A 2014 review found that the research suggested that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes.^[58] However, e-cigarettes could have a broad adverse effect for a population by expanding initiation and lowering cessation of smoking.^[58] A 2014 review found that the evidence suggests that "e-cigarettes are not associated with successful quitting in general population-based samples of smokers."^[4]

Harm reduction

Tobacco harm reduction has been a controversial area of tobacco control.^[74] The health community has not endorsed e-cigarettes as a tobacco harm reduction strategy, in part in response to tobacco industry deception.^[74] A 2014 review concluded promotion of vaping as a harm reduction aid is premature.^[10] Another review found e-cigarettes would likely be less harmful than traditional cigarettes to users and bystanders.^[14] 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.^[14] 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.^[20] Vaping may have potential in harm reduction compared to smoking.^[3] 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.^[3] 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.^[12] 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.^[1] E-cigarette use for risk reduction in high-risk groups such as people with mental disorders is unavailable.^[75]

Tobacco smoke has 40 known carcinogens among the many chemicals it contains.^[74] None of these has been found in more than trace quantities in the cartridges or aerosol of e-cigarettes.^[74] 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.^[74] 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.^[76] Adults most frequently use electronic cigarettes as a replacement for tobacco, but not always to quit.^[17] 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.^[4]

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.^[77] They found that the evidence suggests that a considerable number of smokers want to reduce harm from smoking by using these products.^[77] 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.^[78] 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.^[79] 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.^[80] 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."^[64]

Safety

The risks of electronic cigarette use are uncertain.^[5]^[9] There is little data about their health effects,^[81] and considerable variability between vaporizers and the contents of the aerosol delivered to the user.^[4]^[12]^[82] The limited evidence suggests that e-cigarettes are probably safer than traditional cigarettes.^[12] 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.^[11] Another concluded that regulated FDA products such as a nicotine inhaler are probably a safer way to supply nicotine than e-cigarettes.^[10] E-cigarettes create vapor that consists of ultrafine particles.^[4] The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants and heavy metals, and other chemicals.^[4]^[14] E-cigarette vapor contains fewer toxic substances than cigarette smoke.^[4] Various methodological issues, conflicts of interest, and inconsistent research has been identified in the research regarding e-cigarettes.^[73] However, e-cigarettes cannot be regarded as simply harmless.^[73] 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).^[4]^[76]^[83]

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."^[64] 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.^[76] A 2014 Cochrane review found no serious adverse effects reported in trials.^[8] Less serious adverse effects from e-cigarette use can include throat and mouth inflammation, vomiting, nausea, and cough.^[4] The long-term effects of e-cigarette use are unknown.^[15]^[16] The risk is probably low from the inhalation of propylene glycol and glycerin.^[14] E-cigarette users are exposed to potentially harmful nicotine.^[2] A 2014 review recommended that e-cigarettes should be regulated for consumer safety.^[20]

Addiction

A number of organizations are concerned that e-cigarettes might increase addiction to and use of nicotine and tobacco products among young people.^[84]^[85]^[86] 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.^[80]^[87]^[88]^[89] The World Health Organization raised concern about addiction for non-smokers from their use in July 2013.^[13] The National Institute on Drug Abuse said they could maintain addiction to nicotine in those who are attempting to quit.^[85]

It is not clear whether using e-cigarettes will decrease or increase overall nicotine addiction.^[81] Information about the drug action of the nicotine in e-cigarettes is limited.^[69] The evidence suggests that the nicotine in e-cigarettes is adequate to sustain nicotine dependence.^[69] The limited data suggests that the likelihood of abuse from e-cigarettes could be smaller than traditional cigarettes.^[90] A 2014 systematic review found that the concerns that e-cigarettes could cause non-smokers to start smoking are unsubstantiated.^[76] A 2014 review found no evidence that they are used regularly by those who have never smoked,^[14] 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.^[4] No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction.^[10] The degree to which teens are using e-cigarettes in ways the manufacturers did not intend, such as increasing the nicotine delivery, is unknown.^[83] The extent to which e-cigarette use will lead to abuse in youth is unknown.^[83] The impact of e-cigarette use by children on substance dependence is unknown.^[83] Some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence.^[15]

History

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.^[91]^[92]

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.^[19]^[93] Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2003,^[94] he came up with the idea of using a piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.^[95] This design uses a battery that atomizes a liquid containing nicotine which produces a smoke-like vapor inhaled by the user.^[19]

Hon patented the modern e-cigarette design in 2003.^[1] 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.^[19] 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^[19] before receiving its first international patent in 2007.^[96]

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.^[97] 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.^[98] Since 2007, e-cigarette use in the US has risen.^[45]

International tobacco companies, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete,^[99] are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies.^[100] Blu, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. in 2012.^[101] 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.^[102] On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the 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 with $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.^[100] As of March 2015, 74% of all e-cigarette sales in convenience stores in the U.S. were products made by tobacco companies.^[105]

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.^[106]^[77] 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.^[77]

As the electronic cigarette industry grows, a subculture has emerged which calls itself "the vaping community".^[106]^[107] The online forum E-Cig-Reviews.com was one of the first major communities.^[108] Another online forum known as UKVaper.org was the origin of the hobby of modding.^[108] There are also groups on Facebook and Reddit.^[109] Members of this emerging subculture often view electronic cigarettes as a safer alternative to smoking^[14] and some even view it as a hobby.^[110] These groups tend to use highly customized devices that do not resemble the earlier "cig-a-likes", the electronic cigarettes that resemble real cigarettes.^[111] Online forums based around modding have grown in the vaping community.^[112] 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.^[113] 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".^[113] 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.^[4]

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.^[106] Vapefest, which started in 2010, is an annual show hosted by different cities.^[109] 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.^[106] 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.^[114] 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.^[115]

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.^[116] This practice is known as "cloud-chasing".^[117] 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.^[117] 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.^[118] The Oxford Dictionaries' word of the year for 2014 is 'vape'.^[119]

Legal status

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.^[21] As of 2015^[update], around two thirds of major nations have regulated e-cigarettes in some way.^[120] Current regulations vary widely, from regions with no regulations to others banning the devices entirely.^[21] For example, some countries such as Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes.^[4] 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.^[121] As of 2015^[update], e-cigarettes are legal for minors to buy in a few states in the U.S.^[28] and since they do not contain tobacco, television advertising is not restricted.^[122] 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.^[43]

In August 2014, attorneys general from over two dozen states advised the FDA to enact restrictions on e-cigarettes, including banning flavors.^[123] 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.^[124] A 2014 review said these products should be considered for regulation in view of the "reported adverse health effects".^[61] In some countries, e-cigarettes are regulated as a medical product even though they are not approved as a smoking cessation aid.^[61] E-cigarettes are not approved by the FDA as a smoking cessation product.^[69]^[125]

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.^[126] 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.^[127] 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.^[22]^[128] In April 2014 the US FDA published proposed regulations for e-cigarettes along similar lines.^[129]^[130]

In March 2014 Western Australia banned sale of electronic cigarettes.^[131]

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.^[132] The first advert to take advantage of the change, promoting KiK Electronic Cigarettes, aired on the day it came into force.^[133]

Economics

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."^[134] 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).^[134] Europe's second largest tobacco manufacturer Imperial Tobacco bought Hon Lik's 2003 patents in 2013, for $75 million.^[134]

Worldwide e-cigarette sales in 2014 were around $7 billion.^[135] 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".^[4] E-cigarettes and nicotine are regularly promoted as safe and beneficial in the media and on brand websites.^[28] E-cigarette retail websites often make unscientific health claims to consumers in order to sell them products.^[45] The majority of advertisers also emphasize that the product can be used "anywhere" especially where smoking bans apply.^[45] 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."^[45]

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.^[136] 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."^[136] Jason Healy, founder of blu, called the product "a lifestyle brand for smokers".^[136] 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.^[136] 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".^[136] The blu brand was purchased by Imperial Tobacco in July 2014.^[137] Big tobacco companies have purchased some e-cigarette businesses and greatly increased their marketing efforts.^[10] As of 2014^[update] e-cigarette devices are mostly manufactured in China.^[4] US e-cigarette sales were forecast to increase to about 5 million units in 2012 compared to 50,000 in 2008.^[138] Sales in the U.S. were close to $2 billion in 2014.^[43] Big tobacco has a significant share of the e-cigarette market.^[139]

In the US there are more than a hundred small e-cigarette businesses, with about 70% of the market held by 10 businesses.^[15] A sizable share of the e-cigarette business is done on the internet.^[58] 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.^[58] A 2014 review said e-cigarettes are aggressively promoted, mostly via the internet, as a healthy alternative to smoking in the US.^[58] 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.^[140] 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.^[141]

The main e-cigarette businesses in the UK are British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid Vapours.^[142] British American Tobacco was the first tobacco business to sell e-cigarettes in the UK.^[143] They launched the e-cigarette Vype in July 2013.^[143] Philip Morris, the world’s largest tobacco manufacturer, purchased UK’s Nicocigs in June 2014.^[144] As of March 2014 the top selling e-cigarette brands in the UK at independent convenience stores are Nicolites and Vivid Vapours.^[145]

France is a growing market for e-cigarettes,^[146] which is said to be about €100 million (£85 million) in sales as of 2013.^[147] There are about 150 e-cigarette retail shops in France.^[147]

Related technologies

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.^[148] In September 2014 a product based on this - named Voke - obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency.^[149]

Philip Morris International (PMI) bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University.^[150] The technology is based on the chemical reaction between nicotine acid and a base, which produces an inhalable nicotine pyruvate vapor.^[151]

HeatSticks is a heated tobacco product marketed under the brand Marlboro by PMI.^[152]

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External links

Media related to Electronic cigarettes at Wikimedia Commons

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[Cheng2014-2] 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.

[Weaver2014-3] 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.

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[EbbertAgunwamba2015-5] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ 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.

[Kacker2014-6] 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.

[Brandon2015-7] 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". Clinical Cancer Research. 21: 514–525. doi:10.1158/1078-0432.CCR-14-2544. ISSN 1078-0432. PMID 25557889.

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[Suter2015-29] 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.

[Franck2014-30] 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.

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[CDCNYTS2013-36] 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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[121] "Public health officers tackle hazy issue of e-cigarettes". The Globe and Mail. 29 September 2014. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)

[MaloneyCappella2015-122] 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.

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[Cervellin2013-124] 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.

[Callahan2014-125] 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.

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[142] 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.

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@@ Line 63: / Line 63: @@
 ===Positions of medical organizations===
 {{Main|Positions of medical organizations regarding electronic cigarettes}}
-{{Asof|2014}} electronic cigarettes had not been approved as a smoking cessation device by any government.<ref name=WHOPosition2014/> 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.<!-- <ref name=WHOPosition2014/> --> It suggested that smokers should be encouraged to use approved methods for help with quitting.<ref name=WHOPosition2014/> 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.<ref name=WHOPosition2014>{{cite web|last1=WHO|title=Electronic nicotine delivery systems|url=http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf|accessdate=28 August 2014}}</ref> A previous WHO statement from July 2013 said that e-cigarettes have not been shown to help people quit smoking.<ref name=WHOJuly2013/> 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.<ref name=WHOJuly2013/>  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.<ref>{{cite web|title=WHO Right to Call for E-Cigarette Regulation|url=http://www.worldlungfoundation.org/ht/d/ReleaseDetails/i/32757|publisher=World Lung Federation|accessdate=6 November 2014}}</ref>
+{{Asof|2014}} electronic cigarettes had not been approved as a smoking cessation device by any government.<ref name=WHOPosition2014/> 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.<ref name=WHOPosition2014/> It suggested that smokers should be encouraged to use approved methods for help with quitting.<ref name=WHOPosition2014/> 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.<ref name=WHOPosition2014>{{cite web|last1=WHO|title=Electronic nicotine delivery systems|url=http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf|accessdate=28 August 2014}}</ref> A previous WHO statement from July 2013 said that e-cigarettes have not been shown to help people quit smoking.<ref name=WHOJuly2013/> 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.<ref name=WHOJuly2013/>  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.<ref>{{cite web|title=WHO Right to Call for E-Cigarette Regulation|url=http://www.worldlungfoundation.org/ht/d/ReleaseDetails/i/32757|publisher=World Lung Federation|accessdate=6 November 2014}}</ref>
 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."<ref>{{cite web|title=Stop smoking treatments|url=http://www.nhs.uk/Conditions/Smoking-%28quitting%29/Pages/Treatment.aspx|publisher=UK National Health Service|accessdate=6 November 2014}}</ref>
@@ Line 95: / Line 95: @@
 ==History==
-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.<ref>James Dunworth for the Ashtray Blog. 3 May 2012 [https://www.ecigarettedirect.co.uk/ashtray-blog/2012/05/history-electronic-cigarette.html The History of the Electronic Cigarette]</ref><ref>{{cite web|url=http://www.google.com/patents?id=RjlUAAAAEBAJ&printsec=abstract&zoom=4&source=gbs_overview_r&cad=0#v=onepage&q&f=false |title=US Patent 3200819. Smokeless non-tobacco cigarette|accessdate=29 February 2012}}</ref>
+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.<ref>{{cite web|url=https://www.ecigarettedirect.co.uk/ashtray-blog/2012/05/history-electronic-cigarette.html |title=The History of the Electronic Cigarette |publisher=Ashtray blog: An Electronic Cigarette Blog |author=James Dunworth |date=3 May 2012}}</ref><ref>{{cite web|url=http://www.google.com/patents?id=RjlUAAAAEBAJ&printsec=abstract&zoom=4&source=gbs_overview_r&cad=0#v=onepage&q&f=false |title=US Patent 3200819. Smokeless non-tobacco cigarette|accessdate=29 February 2012}}</ref>
-[[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.<ref name=Demick2009>{{cite news|url=http://articles.latimes.com/2009/apr/25/world/fg-china-cigarettes25|author=Barbara Demick|title=A high-tech approach to getting a nicotine fix|publisher=''Los Angeles Times''|date=25 April 2009}}</ref><ref>[http://www.npr.org/templates/story/story.php?storyId=111578997 E-Cigarettes: The New Frontier In War On Smoking], [[NPR]]</ref> Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2003,<ref>{{cite web|url=http://inventors.about.com/od/estartinventions/a/Electronic-Cigarettes.htm |title=Who Invented Electronic Cigarettes? |publisher=Inventors.about.com |accessdate=20 November 2013}}</ref> he came up with the idea of using a [[piezoelectric]] [[ultrasound]]-emitting element to vaporize a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.<ref name=wiki>{{cite web|url=http://www.wikipatents.com/CA-Patent-2518174/a-non-smokable-electronic-spray-cigarette|title=CA Patent 2518174 – A Non-Smokable Electronic Spray Cigarette|publisher=WikiPatents|accessdate=15 August 2012}}</ref> This design produces a smoke-like vapor 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 utilizing a disposable plastic cartridge to serve as a liquid reservoir and mouthpiece.
+[[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.<ref name=Demick2009>{{cite news|url=http://articles.latimes.com/2009/apr/25/world/fg-china-cigarettes25|author=Barbara Demick|title=A high-tech approach to getting a nicotine fix|publisher=''Los Angeles Times''|date=25 April 2009}}</ref><ref>{{cite web|url=http://www.npr.org/templates/story/story.php?storyId=111578997 |title=E-Cigarettes: The New Frontier In War On Smoking |publisher=[[NPR]] |author=Debbie Elliott |date=5 August 2009}}</ref> Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2003,<ref>{{cite web|url=http://inventors.about.com/od/estartinventions/a/Electronic-Cigarettes.htm |title=Who Invented Electronic Cigarettes? |publisher=Inventors.about.com |accessdate=20 November 2013}}</ref> he came up with the idea of using a [[piezoelectric]] [[ultrasound]]-emitting element to vaporize a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.<ref name=wiki>{{cite web|url=http://www.wikipatents.com/CA-Patent-2518174/a-non-smokable-electronic-spray-cigarette|title=CA Patent 2518174 – A Non-Smokable Electronic Spray Cigarette|publisher=WikiPatents|accessdate=15 August 2012}}</ref> This design uses a battery that atomizes a liquid containing nicotine which produces a smoke-like vapor inhaled by the user.<ref name=Demick2009/>
 Hon patented the modern e-cigarette design in 2003.<ref name=Caponnetto2012/> 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.<ref name=Demick2009/> 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<ref name=Demick2009/> before receiving its first international patent in 2007.<ref>{{cite web|url=http://worldwide.espacenet.com/publicationDetails/biblio?CC=US&NR=2007267031&KC=&FT=E&locale=en_EP|title=Electronic Atomizer Cigarette European patent |publisher=Worldwide.espacenet.com |date=22 November 2007|accessdate=29 February 2012}}</ref>
@@ Line 103: / Line 103: @@
 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.<ref>{{cite web|url=http://www.cityam.com/article/brothers-who-took-punt-new-market/ |title=Brothers who took a punt on a new market |publisher=CityAM |accessdate=4 April 2014}}</ref> 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.<ref>{{cite web|url=http://www.ipo.gov.uk/p-ipsum/Case/PublicationNumber/GB2465247 |title=Patent document and information service (Ipsum) |publisher=[[Intellectual Property Office (United Kingdom)|Intellectual Property Office]] |accessdate=20 November 2013}}</ref> Since 2007, e-cigarette use in the US has risen.<ref name=GranaLing2014/>
-International tobacco companies, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete,<ref>The Economist, 28 Sep 2013, [http://www.economist.com/news/business/21586867-regulators-wrestle-e-smokes-tobacco-industry-changing-fast-kodak-moment Kodak Moment], retrieved 11 March 2014</ref> are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies.<ref name=Esterl2014>{{cite web|url=http://online.wsj.com/news/articles/SB10001424052702304626804579360552508696542 |title=Altria Expands in E-Cigarettes With Green Smoke |publisher=Wall Street Journal |author=Mike Esterl|date=3 February 2014 |accessdate=7 March 2014}}</ref> Blu, a prominent US e-cigarette manufacturer, was acquired by [[Lorillard|Lorillard Inc.]] in 2012.<ref>CBS News, 11 June 1023, [http://www.cbsnews.com/8301-201_162-57588583/tobacco-companies-bet-on-electronic-cigarettes/ Tobacco companies bet on electronic cigarettes], retrieved 16 August 2013.</ref> [[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]].<ref>{{cite web|last=Gustafsson |first=Katarina |url=http://www.bloomberg.com/news/2013-09-02/imperial-tobacco-agrees-to-acquire-dragonite-s-e-cigarette-unit.html |title=Imperial Tobacco Agrees to Acquire Dragonite's E-Cigarette Unit |publisher=Bloomberg |date=2 September 2013 |accessdate=20 November 2013}}</ref><ref>{{cite web|url=http://www.puritane.co.uk/our-story |title=Our Story Puritane |accessdate=4 April 2014}}</ref> On 1 October 2013 [[Lorillard|Lorillard Inc.]] acquired another e-cigarette company, this time the UK based company SKYCIG.<ref>{{cite web|url=http://finance.yahoo.com/news/lorillard-inc-acquires-british-based-120000550.html |title=Lorillard, Inc. Acquires British-based SKYCIG, Expanding its Electronic Cigarette Business |accessdate=1 October 2013}}</ref> On 3 February 2014, [[Altria|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.<ref>{{cite web | url=http://www.bloomberg.com/article/2014-04-01/ayIkoAxs1y8Y.html | title=Altria Completes Acquisition of Green Smoke | work=BusinessWire | date=1 April 2014 | accessdate=21 November 2014}}</ref> Altria also markets its own e-cigarette, the MarkTen, while [[Reynolds American]] has entered the sector with its Vuse product.<ref name=Esterl2014/> As of March 2015, 74% of all e-cigarette sales in convenience stores in the U.S. were products made by tobacco companies.<ref name=cspnet2015>{{cite web|url=http://www.cspnet.com/category-news/tobacco/articles/electronic-cigarette-growth-re-accelerates |title=Electronic Cigarette Growth Re-Accelerates |publisher=CSPnet.com |author=Melissa Vonder Haar|date=April 1, 2015 |accessdate=May 1, 2015}}</ref>
+International tobacco companies, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete,<ref>{{cite web|url=http://www.economist.com/news/business/21586867-regulators-wrestle-e-smokes-tobacco-industry-changing-fast-kodak-moment |title=Kodak moment |publisher=The Economist |author= |date=28 September 2013|accessdate=11 March 2014}}</ref> are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies.<ref name=Esterl2014>{{cite web|url=http://online.wsj.com/news/articles/SB10001424052702304626804579360552508696542 |title=Altria Expands in E-Cigarettes With Green Smoke |publisher=Wall Street Journal |author=Mike Esterl|date=3 February 2014 |accessdate=7 March 2014}}</ref> Blu, a prominent US e-cigarette manufacturer, was acquired by [[Lorillard|Lorillard Inc.]] in 2012.<ref>{{cite web|url=http://www.cbsnews.com/8301-201_162-57588583/tobacco-companies-bet-on-electronic-cigarettes/ |title=Tobacco companies bet on electronic cigarettes |author=Brian Montopoli |publisher=CBS News |date=11 June 2013 |accessdate=16 August 2013}}</ref> [[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]].<ref>{{cite web|last=Gustafsson |first=Katarina |url=http://www.bloomberg.com/news/2013-09-02/imperial-tobacco-agrees-to-acquire-dragonite-s-e-cigarette-unit.html |title=Imperial Tobacco Agrees to Acquire Dragonite's E-Cigarette Unit |publisher=Bloomberg |date=2 September 2013 |accessdate=20 November 2013}}</ref> On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG.<ref>{{cite web|url=http://finance.yahoo.com/news/lorillard-inc-acquires-british-based-120000550.html |title=Lorillard, Inc. Acquires British-based SKYCIG, Expanding its Electronic Cigarette Business |accessdate=1 October 2013}}</ref> On 3 February 2014, [[Altria|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.<ref>{{cite web | url=http://www.bloomberg.com/article/2014-04-01/ayIkoAxs1y8Y.html | title=Altria Completes Acquisition of Green Smoke | work=BusinessWire | date=1 April 2014 | accessdate=21 November 2014}}</ref> Altria also markets its own e-cigarette, the MarkTen, while [[Reynolds American]] has entered the sector with its Vuse product.<ref name=Esterl2014/> As of March 2015, 74% of all e-cigarette sales in convenience stores in the U.S. were products made by tobacco companies.<ref name=cspnet2015>{{cite web|url=http://www.cspnet.com/category-news/tobacco/articles/electronic-cigarette-growth-re-accelerates |title=Electronic Cigarette Growth Re-Accelerates |publisher=CSPnet.com |author=Melissa Vonder Haar|date=April 1, 2015 |accessdate=May 1, 2015}}</ref>
 ==Society and culture==
@@ Line 122: / Line 122: @@
 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.<ref name=Higgins2013>{{cite news|author=Andrew Higgins|title=Aided by Army of 'Vapers', E-Cigarette Industry Woos and Wins Europe|url=http://www.nytimes.com/2013/11/10/world/europe/aided-by-army-of-vapers-e-cigarette-industry-woos-and-wins-europe.html|accessdate=22 November 2014|publisher=The New York Times|date=9 November 2013}}</ref> 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 patch|nicotine patches]].<ref name=Kitamura2014>{{cite news|author1=Makiko Kitamura|title=Glaxo Memo Shows Drug Industry Lobbying on E-Cigarettes|url=http://www.bloomberg.com/news/2014-02-19/glaxo-memo-shows-drug-industry-lobbying-on-e-cigarettes.html|accessdate=22 November 2014|publisher=Bloomberg News|date=19 February 2014}}</ref> 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.<ref name=EURegs2014>{{cite web | url=http://europa.eu/rapid/press-release_MEMO-14-134_en.htm Memo/14/134 | title=Questions & Answers: New rules for tobacco products| publisher=European Commission | date=26 February 2014}}</ref><ref>{{cite news | url=http://time.com/10290/europe-sets-new-rules-for-e-cigs-while-the-u-s-drags-its-feet/ | title=Europe Sets New Rules for E-Cigs While the U.S. Drags Its Feet | author=Eliza Gray | publisher=''Time'' (magazine) | date=27 February 2014}}</ref> In April 2014 the US FDA published proposed regulations for e-cigarettes along similar lines.<ref name=FederalRegister2014>{{cite web|url=https://www.federalregister.gov/articles/2014/04/25/2014-09491/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the|title=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|publisher=US FDA Federal Register: A Proposed Rule by the Food and Drug Administration on 04/25/2014}}</ref><ref name=Tavernise2014>{{cite news|url=http://www.nytimes.com/2014/04/24/health/fda-will-propose-new-regulations-for-e-cigarettes.html?_r=0 |title=F.D.A. Will Propose New Regulations for E-Cigarettes |author=Sabrina Tavernise |publisher=The New York Times |date=24 April 2014}}</ref>
-In March 2014 Western Australia banned sale of electronic cigarettes.<ref>{{cite web|url=http://www.watoday.com.au/wa-news/ecigarette-message-goes-up-in-smoke-20140626-zsljx.html|title=E-cigarette message goes up in smoke}}</ref>
+In March 2014 [[Western Australia]] banned sale of electronic cigarettes.<ref>{{cite web|url=http://www.watoday.com.au/wa-news/ecigarette-message-goes-up-in-smoke-20140626-zsljx.html|title=E-cigarette message goes up in smoke|publisher=[[WAtoday]]}}</ref>
-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.<ref>{{cite news | url=http://www.bbc.com/news/uk-29553288 | title=E-cigarettes can appear in TV adverts, watchdog rules | publisher=[[BBC News Online]] | date=9 October 2014}}</ref> The first advert to take advantage of the change, promoting KiK Electronic Cigarettes, aired on the day it came into force.<ref>{{cite news | url=http://www.manchestereveningnews.co.uk/business/business-news/e-cigarette-firm-kik-make-tv-8076005 | title=E-cigarette firm KiK to make TV history | author=Alex Bell | publisher=''[[Manchester Evening News]]'' | date=10 November 2014}}</ref>
+In October 2014 the UK's [[Advertising Standards Authority (United Kingdom)|Advertising Standards Authority]] changed the regulations on e-cigarette advertising, allowing the devices to appear in television ads from 10 November.<ref>{{cite news | url=http://www.bbc.com/news/uk-29553288 | title=E-cigarettes can appear in TV adverts, watchdog rules | publisher=[[BBC News Online]] | date=9 October 2014}}</ref> The first advert to take advantage of the change, promoting KiK Electronic Cigarettes, aired on the day it came into force.<ref>{{cite news | url=http://www.manchestereveningnews.co.uk/business/business-news/e-cigarette-firm-kik-make-tv-8076005 | title=E-cigarette firm KiK to make TV history | author=Alex Bell | publisher=''[[Manchester Evening News]]'' | date=10 November 2014}}</ref>
 ===Economics===
@@ Line 138: / Line 138: @@
 <!-- UK -->
-The main e-cigarette businesses in the UK are British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid Vapours.<ref>{{cite news | url=http://finance.yahoo.com/news/research-markets-uk-e-cigarette-184200085.html;_ylt=A86.J3VqBiZVrjsASccnnIlQ;_ylu=X3oDMTByc25qcnVyBHNlYwNzcgRwb3MDNARjb2xvA2dxMQR2dGlkAw-- | title=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 | author=Laura Wood | work=Research and Markets | publisher=Yahoo! Finance | date=14 May 2014}}</ref> British American Tobacco was the first tobacco business to sell e-cigarettes in the UK.<ref name=Manning2013/> They launched the e-cigarette Vype in July 2013.<ref name=Manning2013>{{cite news | url=http://www.independent.co.uk/news/uk/home-news/british-american-tobacco-enters-electronic-cigarette-market-in-britain-with-the-vype-8737286.html | author=Sanchez Manning | title=British American Tobacco enters electronic cigarette market in Britain with the 'Vype' |publisher=''The Independent'' | date=29 July 2013}}</ref> Philip Morris, the world’s largest tobacco manufacturer, purchased UK’s Nicocigs in June 2014.<ref>{{cite news | url=http://www.independent.co.uk/news/business/news/philip-morris-buys-ecigarette-maker-nicocigs-as-it-warns-of-falling-profits-9565087.html | author=Gideon Spanier | title=Philip Morris buys e-cigarette maker Nicocigs as it warns of falling profits |publisher=''The Independent'' | date=26 June 2014}}</ref> As of March 2014 the top selling e-cigarette brands in the UK at independent convenience stores are Nicolites and Vivid Vapours.<ref>{{cite news | url=https://www.nfrnonline.com/News/Nicolites-and-Vivid-Vapours-Brands-Dominate-Sector | author=Joe Lenane | title=Nicolites and Vivid Dominate E-cigarette Market | publisher=National Federation of Retail Newsagents  | date=24 March 2014}}</ref>
+The main e-cigarette businesses in the UK are British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid Vapours.<ref>{{cite news | url=http://finance.yahoo.com/news/research-markets-uk-e-cigarette-184200085.html;_ylt=A86.J3VqBiZVrjsASccnnIlQ;_ylu=X3oDMTByc25qcnVyBHNlYwNzcgRwb3MDNARjb2xvA2dxMQR2dGlkAw-- | title=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 | author=Laura Wood | work=Research and Markets | publisher=Yahoo! Finance | date=14 May 2014}}</ref> British American Tobacco was the first tobacco business to sell e-cigarettes in the UK.<ref name=Manning2013/> They launched the e-cigarette Vype in July 2013.<ref name=Manning2013>{{cite news | url=http://www.independent.co.uk/news/uk/home-news/british-american-tobacco-enters-electronic-cigarette-market-in-britain-with-the-vype-8737286.html | author=Sanchez Manning | title=British American Tobacco enters electronic cigarette market in Britain with the 'Vype' |publisher=''The Independent'' | date=29 July 2013}}</ref> Philip Morris, the world’s largest tobacco manufacturer, purchased UK’s Nicocigs in June 2014.<ref>{{cite news | url=http://www.independent.co.uk/news/business/news/philip-morris-buys-ecigarette-maker-nicocigs-as-it-warns-of-falling-profits-9565087.html | author=Gideon Spanier | title=Philip Morris buys e-cigarette maker Nicocigs as it warns of falling profits |publisher=''The Independent'' | date=26 June 2014}}</ref> As of March 2014 the top selling e-cigarette brands in the UK at independent convenience stores are Nicolites and Vivid Vapours.<ref>{{cite news | url=https://www.nfrnonline.com/News/Nicolites-and-Vivid-Vapours-Brands-Dominate-Sector | author=Joe Lenane | title=Nicolites and Vivid Dominate E-cigarette Market | publisher=National Federation of Retail Newsagents | date=24 March 2014}}</ref>
 <!-- France -->