Electronic cigarette

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Electronic cigarette resembling a tobacco cigarette
Different types of electronic cigarettes

An electronic cigarette (e-cig or e-cigarette), electronic vaping device, personal vaporizer (PV), digital vapor device or electronic nicotine delivery system (ENDS) (not to be confused with smokeless cigarettes) is a battery-powered device which simulates tobacco smoking patented in 1963 by Herbert A. Gilbert.[1] It generally uses a heating element known as an atomizer, that vaporizes a liquid solution. Some solutions contain a mixture of nicotine and flavorings, while others release a flavored vapor without nicotine. Many are designed to simulate smoking implements, such as cigarettes or cigars, in their use and/or appearance, while others are considerably different in appearance.[2][3][4]

The benefits and risks of electronic cigarette use are uncertain.[5][6] They may carry a risk of developing nicotine addiction, and their regulation is the subject of ongoing debate.

Health[edit]

Smoking cessation[edit]

The World Health Organization (WHO) states that as of July 2013, the efficacy in using electronic cigarettes to aid in smoking cessation has not been demonstrated scientifically. They recommend that "consumers should be strongly advised not to use" electronic cigarettes until a reputable national regulatory body has found them safe and effective.[6]

A 2011 review states that electronic cigarettes may aid in smoking cessation and are likely to be more effective than traditional pharmacotherapy, as the physical stimuli of holding and puffing on the electronic cigarette may be better at improving short term craving.[7] The review found no studies that directly measured the effectiveness of electronic cigarettes in smoking cessation, and examined two published studies that indirectly considered the issue by measuring the effect of the product on cravings and other short-term indicators.[7]

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 chewing tobacco for long term use instead of smoking.[8]

The British Medical Association (BMA) reports there is a possibility for smoking cessation benefits, but has concerns that e-cigarettes are less regulated than nicotine replacement therapy (NRT), and that there is no peer reviewed evidence of their safety or efficacy. They recommend a "strong regulatory framework" for e-cigarette distribution in order to ensure their safety, quality, and that their marketing and sales are restricted to adults. The BMA encourages health professionals to recommend conventional nicotine replacement therapies, but for patients unwilling to use or continue those methods, they say health professionals may present e-cigarettes as a lower-risk option than tobacco smoking.[9]

One 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.[10]

A 2013 randomized controlled trial found no difference in smoking cessation rates between e-cigarettes with nicotine, e-cigarettes without nicotine and traditional NRT patches.[11][12] There are some non-controlled studies that reported possible benefit.[13]

Safety[edit]

Electronic cigarettes should have fewer toxic effects than traditional cigarettes,[10][14] and evidence suggests they are safer than real cigarettes, and possibly as safe as other nicotine replacement products.[7]

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 smoking electronic 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.[15]

One review raised concerns about the lack of regulatory oversight over the manufacturing process, marketing, as well as quality control. Also of concern were the purity of ingredients as well as the ease with which these devices can be modified.[10]

The BMA has noted literature finding electronic cigarettes as safer than tobacco smoking, but also is concerned by the lack of high quality peer-reviewed studies about safety. They have noted that the amount of nicotine delivered can be highly variable between devices due to differences in how well the nicotine is vaporized. They have also raised concerns that the delivered dose may be inconsistent or misleading compared to the nicotine level stated on the liquid container, with identically labelled cartridges emitting "markedly different" levels of nicotine. Issues around proper labeling, child-proof packaging, and electrical safety have also been raised.[9]

A preliminary analysis of e-cigarette cartridges by the US Food and Drug Administration (FDA) in 2009 identified that some contain tobacco-specific nitrosamines (TSNAs), known cancer-causing agents.[16][17] The amounts of TSNAs present were on par with existing NRT products like nicotine gum and inhalers. The FDA's analysis also detected diethylene glycol, a poisonous and hygroscopic liquid, in a single cartridge manufactured by Smoking Everywhere and nicotine in one[18] cartridge claimed to be nicotine-free.[16][17] Diethylene glycol was found in a cartridge tested in 2009 by the FDA, but in 2011 researchers reviewed the data and noted that 15 other studies had failed to find any evidence of this chemical in e-cigarettes.[19] Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device.[18] In some e-cigarettes, "Tobacco-specific impurities suspected of being harmful to humans – anabasine, myosmine, and β-nicotyrine – were detected in a majority of the samples tested." It is not clear if these chemicals were detectable in exhaled vapour.[20] The UK National Health Service noted that the toxic chemicals found by the FDA were at levels one-thousandth that of cigarette smoke, and that while there is no certainty that these small traces are harmless, initial test results are reassuring.[21]

Addiction[edit]

A number of organizations including the Centers for Disease Control and Prevention,[15] the International Union Against Tuberculosis and Lung Disease,[22] the American Academy of Pediatrics[23] and the Food and Drug Administration[24] have concerns that e-cigs might increase addiction to and use of nicotine and tobacco products in children.[25][26] The World Health Organization raises the concern of addiction from their use.[27] A 2013 report by the CDC analysing the 2012 National Youth Tobacco Survey (NYTS), a survey including 24,658 US students, found that while electronic cigarette use among middle and high school students almost doubled from 2011 to 2012, use of certain tobacco products (bidis and kreteks) were shown to have fallen over the same period.[28]

Construction[edit]

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

Most electronic cigarettes take an overall cylindrical shape although a wide array of shapes can be found: box, pipe styles etc. Many are made to look like tobacco cigarettes. Common components include a liquid delivery and container system, an atomizer, and a power source.[29] Many electronic cigarettes are composed of streamlined replaceable parts, while disposable devices combine all components into a single part that is discarded when its liquid is depleted.[30]

Atomizer[edit]

Along with the battery, the atomizer is the central component of every personal vaporizer. Although many kinds of atomizers are in use, they generally consist of a small heating element responsible for vaporizing liquid, as well as a wicking material that draws liquid in.

A small length of resistance wire is wrapped around the wicking material and then connected to the positive and negative poles of the device. When activated the resistance wire (or coil) quickly heats up thus turning the liquid into a vapor, which is then inhaled by the user.[31]

The electrical resistance of the coil and the voltage output of a device play important roles in the perceived quality of the vapor that is produced by an atomizer. Atomizer resistances usually vary from 1.5Ω (ohms) to 3.0Ω from one atomizer to the next but can go as low as 0.1Ω in the most extreme cases of DIY coil building which produce large amounts of vapor but could present a fire hazard and other dangerous battery failures if the user is not knowledgeable enough about basic electrical principles and how they relate to battery safety.[32][33]

Wicking materials vary greatly from one atomizer to another but silica fibers are the most commonly used in manufactured atomizers. "Rebuildable" or "do it yourself" atomizers can use silica, cotton, porous ceramic, hemp, bamboo yarn, oxidized stainless steel mesh and even wire rope cables as wicking materials.[34]

A wide array of atomizers and e-liquid container combinations are available:[35]

Most of the devices that imitate the cigarette form factor use a "cartomizer" (a portmanteau of cartridge and atomizer) or "carto" as an e-liquid delivery system. The piece consists of a heating element surrounded by a liquid-soaked poly-foam that acts as an e-liquid holder. It is usually disposed of once the e-liquid acquires a burnt taste, which is usually due to an activation when the coil is dry or when the cartomizer gets consistently flooded (gurgling) because of sedimentation of the wick. Most cartomizers are refillable even if not advertised as such.[36]

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

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

Clearomizers or "clearos", not unlike cartotanks, use a clear tank in which an atomizer is inserted.[37] Unlike cartotanks, however, no poly-foam material can be found in them. There are a lot of different wicking systems employed inside of clearomizers to ensure good moistening of the wick without flooding the coil. Some rely on gravity to bring the e-liquid to the wick and coil assembly (bottom coil clearomizers for example) whereas others rely on capillary action and to some degree the user agitating the e-liquid while handling the clearomizer (top coil clearomizers).[38]

A rebuildable atomizer is an atomizer that allows the user to assemble or "build" the wick and coil themselves.

Power[edit]

Most portable devices contain a rechargeable battery, which tends to be the largest component of an electronic cigarette. The battery may contain an electronic airflow sensor whereby activation is triggered simply by drawing breath through the device, while other models employ a power button that must be held during operation. An LED to indicate activation may also be employed. Some manufacturers also offer a cigarette pack-shaped portable charging case (PCC), which contains a larger battery capable of charging e-cigarettes. Devices aimed at more experienced users may sport additional features, such as variable power output and support of a wide range of internal batteries and atomizers configurations and tend to stray away from the cigarette form factor. Some cheaper recent devices use an electret microphone with a custom IC to detect airflow and indicate battery status on the included blue LED.[39]

Variable power and voltage devices[edit]

PV with variable and regulated power offering battery protection

Variable voltage or power personal vaporizers are devices that contain a built in electronic chip that allows the user to adjust the power that goes through the heating element. They usually incorporate a LED screen to display various information. Variable PV's eliminate the need of having to replace an atomizer with another one of lower or higher electrical resistance to change the intensity of the vapor.[40] They also feature voltage regulation and some battery protection.[41][42]

Some of these device offer additional features through their menu system such as: atomizer resistance checker, remaining battery voltage, puff counter, activation cut-off etc.[43]

Mechanical personal vaporizers[edit]

Mechanical PV with a rebuildable atomizer

Mechanical PVs or mechanical "mods", often called "mechs" are devices without electronic components, electrical wires and battery protection (apart from vent holes drilled in some mechanical devices). They are activated by spring loaded or opposing magnetic mechanical switches, hence their name. Since no wires are found in them, they are usually solder free. They rely entirely on the natural voltage output of a battery.[citation needed]

They are commonly used with "low resistance" (1.0Ω ~ 0.5Ω) rebuildable atomizers. Seeing that most e-cigarettes containing electronic battery protection will interpret sub ohm resistance coils as a short circuit, thus prohibiting the device from being activated, mechanical mods are among the only devices that will accept such atomizer resistances.[citation needed]

Since mechanical PVs are unregulated and unprotected, they require special attention on the users part that other regulated and protected PVs do not need. Making sure that the battery does not over-discharge and that the atomizer will not require more amperage than what the battery can safely allow are the user's responsibilities.[citation needed]

Liquid[edit]

Liquid for producing vapor in electronic cigarettes, commonly known as e-juice or e-liquid, is a solution of propylene glycol (PG), vegetable glycerin (VG), and/or polyethylene glycol 400 (PEG400) mixed with concentrated flavors; and optionally, a variable concentration of nicotine.[44]

The solution is often sold in a bottle or in pre-filled disposable cartridges. They are manufactured with various tobacco, fruit, and other flavors, as well as variable nicotine concentrations (including nicotine-free versions). The standard notation "mg/ml" is often used in labeling for denoting nicotine concentration, and is sometimes shortened to a simple "mg".[45]

Use[edit]

Electronic cigarette sales increased from 50,000 in 2008 to 3.5 million in 2012.[44] As of 2011, in the United States, one in five adults who smoke have tried electronic cigarettes.[46] In a UK survey conducted in 2013 of more than 12,000 adults, 11% of regular smokers in the sample identified themselves as using electronic cigarettes and 24% stated that they had used them in the past. Amongst non-smokers in the same sample, 1% said they had tried them and 0% stated that they were currently using them.[47]

Among grade 6 to 12 students in the United States, those who have ever used the product increased from 3.3% in 2011 to 6.8% in 2012.[48] Those currently using electronic cigarettes increased from 0.6% to 1.1%. Over the same period the percentage of grade 6 to 12 students who regularly smoke tobacco cigarettes fell from 7.5% to 6.7%.[28] 10% of students who have used e-cigs have never smoked.[48] A 2013 UK survey by Action on Smoking and Health found that among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future. ASH concluded that among children who have heard of e-cigarettes, sustained use is rare and confined to children who smoke or have smoked.[47]

As the electronic cigarette industry grows, a subculture has emerged which calls itself "the vaping community".[35][49][50] Members of this emerging subculture often view electronic cigarettes as a safer alternative to smoking and some even view it as a hobby. They tend to use highly customized devices that do not resemble what are known, by some, as "cig-a-likes," or electronic cigarettes that resemble real cigarettes.[51]

History[edit]

The earliest electronic cigarette can be traced to Herbert A. Gilbert,[52] 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. In 1967, Gilbert was approached by several companies interested in manufacturing it, but it was never commercialized and disappeared from the public record after 1967.[53][54][55][56][57][58]

Hon Lik, a Chinese pharmacist, is widely credited[59][60][61] with the invention of the first generation electronic cigarette. In 2003,[62] he came up with the idea of using a piezoelectric ultrasound-emitting element to vaporise a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.[63] This design produces a smoke-like vapour that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs. He also proposed using propylene glycol to dilute nicotine and placing it in a disposable plastic cartridge which serves as a liquid reservoir and mouthpiece.

Electronic cigarettes using a different design were first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. The company that Hon Lik worked for, Golden Dragon Holdings, changed its name to Ruyan (如烟, literally "Resembling smoking"), and started exporting its products in 2005–2006[64] before receiving its first international patent in 2007.[65]

The electronic cigarette continued to evolve from the first generation three-part device. In 2006 the "cartomizer" was invented by Umer and Tariq Sheikh.[66] This is a mechanism which integrates the heating coil into the liquid chamber. The new device was launched in the UK in 2007 in the Gamucci brand and it is now widely adopted by the majority of 'cigalike' brands. The grant of the UK patent for the "cartomizer" was published by the UK Intellectual Property Office in February 2013.[67]

Blu, a prominent US e-cigarette producer, was acquired by Lorillard Inc. in 2012.[68] Other major tobacco companies announced that they were set to launch brands during 2013 including British American Tobacco with Vype, while Imperial Tobacco acquired the intellectual property owned by Hon Lik through Dragonite for $US 75 million.[69] On 3 February 2014, Altria Group, Inc. acquired popular electronic cigarette brand Green Smoke for $110 million. The deal is expected to be finalized during the second quarter of 2014.[70]

Legal status[edit]

Because of the relative novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation and public health investigations are currently pending in many countries. Current regulations vary widely, from regions with no regulations to others banning the devices entirely.[71]

Europe[edit]

On 19 December 2012 the European Commission adopted its proposal to revise the European Union Tobacco Products Directive 2001/37/EC which included proposals to introduce restrictions on the use and sales of e-cigarettes.[72][73][74] On 8 October 2013 the European Parliament in Strasbourg voted down the Commission's proposal to introduce medical regulation for electronic cigarettes, but proposed that cross-border marketing of e-cigarettes be regulated similarly to tobacco products, meaning that sales of e-cigarettes to under 18s would be prohibited in the European Union, along with most cross-border advertising. Warning labels also would be required. The Parliament and Member States are involved in trilogue discussions to reach a common conclusion. [75]

United States[edit]

Federal regulation[edit]

The FDA classified electronic cigarettes as drug delivery devices and subject to regulation under the Food, Drug, and Cosmetic Act (FDCA) before importation and sale in the United States. The classification was challenged in court, and overruled in January 2010 by Federal District Court Judge Richard J. Leon, citing that "the devices should be regulated as tobacco products rather than drug or medical products."[89][90]

In March 2010, the U.S. Court of Appeals for the District of Columbia stayed the injunction pending an appeal, during which the FDA argued the right to regulate electronic cigarettes based on their previous ability to regulate nicotine replacement therapies such as nicotine gum or patches. Further, the agency argued that tobacco legislation enacted the previous year "expressly excludes from the definition of 'tobacco product' any article that is a drug, device or combination product under the FDCA, and provides that such articles shall be subject to regulation under the pre-existing FDCA provisions."[91] On 7 December 2010, the appeals court ruled against the FDA in a 3–0 unanimous decision, ruling the FDA can only regulate electronic cigarettes as tobacco products, and thus cannot block their import.[92] The judges ruled that such devices would only be subject to drug legislation if they are marketed for therapeutic use – E-cigarette manufacturers had successfully proven that their products were targeted at smokers and not at those seeking to quit. The District of Columbia Circuit appeals court, on 24 January 2011, declined to review the decision en banc, blocking the products from FDA regulation as medical devices.[93]

State regulation[edit]

With an absence of federal regulations, many states and cities have adopted their own e-cigarette regulations, most commonly to prohibit sales to minors, including Maryland, Kentucky, Minnesota, New Jersey, New Hampshire, Tennessee, Utah, Wisconsin, and Colorado. Other states are considering similar legislation.[94]

Other countries[edit]

Related nicotine inhalation technologies[edit]

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

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