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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 which simulates the feeling of smoking, but without tobacco combustion. Their use is commonly called "vaping". The user automatically activates the e-cigarette by taking a puff; other devices turn on by pressing a button manually. They are often cylindrical, but come in many variations. Some e-cigarettes look like traditional cigarettes, but others do not. There are disposable "cigalikes" which are known as first generation cigalikes and there are reusable versions. Instead of cigarette smoke, the user inhales an aerosol, commonly called vapor. E-cigarettes typically have a heating element that atomizes a liquid solution known as e-liquid. E-liquids usually contain propylene glycol, glycerin, water, nicotine, and flavorings. E-liquids are also sold without propylene glycol, without nicotine, or without flavors.

The benefits to users and the health risks of e-cigarettes are uncertain. There is no evidence they are better than regulated medication for quitting smoking, but there is tentative evidence of benefit as a smoking cessation aid. Their usefulness in tobacco harm reduction is unclear, but in an effort to decrease tobacco related death and disease, they have a potential to be part of the strategy. Their safety risk to users is like that of smokeless tobacco. US Food and Drug Administration (FDA)-approved products, such as nicotine inhalers, are probably safer than e-cigarettes. E-cigarettes are probably safer than smoking. While later-generation and "hotter" e-cigarettes (e.g. 5.0 volts) may generate equal or higher levels of formaldehyde than smoking, reduced voltage e-cigarettes generate very low levels of formaldehyde. Nicotine is associated with cardiovascular disease, potential birth defects, and poisoning. There is inadequate research to demonstrate that nicotine is associated with cancer in humans.

Non-smokers who use them risk nicotine addiction. There is no evidence e-cigarettes are regularly used by those who have never smoked. E-cigarette use may delay or deter quitting smoking. E-cigarettes create vapor that consists of ultrafine particles. The vapor contains similar chemicals to the e-liquid, together with tiny amounts of toxicants and heavy metals. Exactly what comprises the vapor varies across and within manufacturers. E-cigarettes contain possibly harmful chemicals that are not found in tobacco. E-cigarette vapor contains fewer toxic substances than cigarette smoke. It also has lower concentrations of potential toxic substances than cigarette smoke, and is probably less harmful to users and bystanders. No serious adverse effects from e-cigarettes have been reported in trials. Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and cough. The long-term effects of e-cigarette use are unknown.

Since their introduction to the market in 2004, global usage has risen. As of 2012, up to 10% of American high school students had used them at least once, and around 3.4% of American adults as of 2011. In the UK user numbers have increased from 700,000 in 2012 to 2.1 million in 2013. About 60% of UK users are smokers and most others are ex-smokers. Most e-cigarette users still smoke traditional cigarettes. Most peoples' reason for using e-cigarettes is related to quitting, but a considerable proportion use them recreationally. The modern e-cigarette arose from a 2003 invention by Hon Lik in China and as of 2015 most devices are made there. Because of the potential relationship with tobacco laws and medical drug policies, electronic cigarette legislation is being debated in many countries. The European Parliament passed regulations in February 2014, to come into effect by 2016, standardizing liquids and personal vaporizers, listing ingredients, and child-proofing liquid containers. The US FDA published proposed regulations in April 2014 with some similar measures. Manufacturers have increased advertising, using marketing techniques like those used to sell cigarettes in the 1950s and 1960s. As of 2014, there were 466 brands with sale of around $7 billion.

Use

Frequency

Since their introduction to the market in 2004, global usage of e-cigarettes has risen exponentially. As of 2013, there are several million users globally. Awareness and use of e-cigarettes greatly increased over the few years to 2014, particularly among young people and women in some countries. In the US, vaping among young people exceeded smoking in 2014. As of 2014, it is projected that vaping will exceed smoking in about three decades. People with higher incomes are more likely to have heard of e-cigarettes, but those with lower incomes are more likely to have tried them. Trying e-cigarettes was common among less educated people. Whites are more likely to use them than non-whites. Most users have a history of smoking regular cigarettes. At least 52% of current or former smokers have used e-cigarettes. E-cigarette use in never-smokers is very low but is rising.

The majority of e-cigarette users use them every day. E-cigarette users mostly keep smoking traditional cigarettes. Many say e-cigarettes help them cut down or quit smoking. Adults often vape to replace tobacco, but not always to quit. Most e-cigarette users are middle-aged men who also smoke traditional cigarettes, either to help them quit or for recreational use. Among young adults e-cigarette use is not regularly associated with trying to quit smoking. Women who smoke who are poorer and did not finish high school, are more likely to have tried vaping at least once. E-cigarette use is also rising among women, including women of childbearing age, but the rate of use during pregnancy is unknown. Dual use of e-cigarettes and traditional tobacco is still a definite concern. Many worry that vaping may be a "gateway" to smoking. A 2014 review raised ethical concerns about minors' e-cigarette use and the potential to weaken cigarette smoking reduction efforts. There are serious concerns involving e-cigarettes and the possibility of misuse with cannabis and other psychoactive drugs by young people. E-cigarettes could be used with any kind of psychoactive drugs, including methamphetamine, cocaine, heroin, or bath salts.

In the US, the recent fall in smoking has accompanied a rapid growth in use of alternative nicotine products among young people and young adults. 56% of respondents to a small US 2013 survey answered that they had used e-cigarettes with the intention to quit or reduce smoking, and 26% of respondents used them in areas where smoking were banned. In the US, as of 2014, 12.6% of adults have used e-cigarette at least once and about 3.7% are still using them. Among grade 6 to 12 students in the US, those who have tried them rose from 3.3% in 2011 to 6.8% in 2012. Those still vaping over the last month rose from 1.1% to 2.1% and dual use was from 0.8% to 1.6%. Over the same period the proportion of grade 6 to 12 students who regularly smoke tobacco cigarettes fell from 7.5% to 6.7%. Use frequency has risen: as of 2012, up to 10% of American high school students have ever used them. In 2013 the Centers for Disease Control and Prevention (CDC) found around 160,000 students between 2011 to 2012 who had tried vaping had never smoked. Between 2013 and 2014, vaping among students tripled. The majority of young people who vape also smoke. E-cigarette use among never-smoking youth in the US correlates with elevated desires to use traditional cigarettes.

About one in 20 adults in the UK uses e-cigarettes. In the UK in 2014, 18% of regular smokers said they used e-cigarettes and 51% said they had used them in the past. Among those who had never smoked, 1.1% said they had tried them and 0.2% still use them. In 2013, among those under 18, 7% have used e-cigarettes at least once. Among non-smokers' children, 1% reported having tried e-cigarettes "once or twice", and there was no evidence of continued use. About 60% of all users are smokers and most of the rest are ex-smokers, with "negligible" numbers of never-smokers. In 2015 the latest figures showed that around 2% of under-18s used monthly, and 0.5% weekly, and despite experimentation, "nearly all those using EC regularly were cigarette smokers".

A February 2014 survey in France estimated that between 7.7 and 9.2 million people have tried e-cigarettes, with 1.1 to 1.9 million using them on a daily basis. 67% of smokers in the survey used e-cigarettes to reduce or quit 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.

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. Some young people who have never smoked normal cigarettes have tried e-cigarettes at least once. Most young people are not using e-cigarettes to help them quit tobacco. Teenagers who used an e-cigarette were more inclined than those who had not used them to become traditional cigarette users. Young people who vape are more likely to use hookah and blunts than smokers. 10-11-year-olds never-smokers are more likely to use e-cigarettes if a parent used e-cigarettes.

Motivation

There are varied reasons for e-cigarette use. Most users' motivation is related to quitting, but a fair proportion of use is recreational. Some users vape for relaxation. Many users vape because they believe it is healthier than smoking for themselves or bystanders although some are concerned about the possible adverse health effects. Users sometimes use e-cigarettes without nicotine around friends for the convenience. Non-smoking adults tried e-cigarettes due to curiosity, a relative was using them, or they were given an e-cigarette. College students often vape for experimentation. Millions of dollars spent on marketing aimed at smokers suggests e-cigarettes are "newer, healthier, cheaper and easier to use in smoke-free situations, all reasons that e-cigarette users claim motivate their use". Exposure to e-cigarette advertising influenced people to try them.

A 2015 review said that if tobacco businesses persuade women that e-cigarettes are a small risk, non-smoking women of reproductive age might start using them and women smoking during pregnancy might switch to their use or use these devices to reduce smoking, instead of quitting smoking altogether. Another 2015 review said that the belief that e-cigarettes are safer than traditional cigarettes could widen their use among pregnant women. Traditional cigarette users who have not used e-cigarettes had mixed ideas about their possible satisfaction and around a third thought that e-cigarettes might taste bad. They feel or taste similar to traditional cigarettes, and vapers disagreed about whether this was a benefit or a drawback. Some users liked that e-cigarettes resembled traditional cigarettes, but others did not. E-cigarettes users' views about saving money from using e-cigarettes compared to traditional cigarettes are inconsistent. The majority of committed e-cigarette users interviewed at an e-cigarette convention found them cheaper than traditional cigarettes.

Some users stopped vaping due to issues with the devices. Dissatisfaction and concerns over safety can discourage ongoing e-cigarette use. Not having odor from smoke on clothes on some occasions prompted interest in or use of e-cigarettes. Although some people want to quit smoking with e-cigarettes, others use them to circumvent smoke-free laws and policies, or to cut back on cigarette smoking. E-cigarette users have contradictory views about using them to get around smoking bans. Some surveys found that a small percentage of users' motives were to avoid the bans, but other surveys found that over 40% of users said they used the device for this reason. The extent to which traditional cigarette users vape to avoid smoking bans is unclear.

A 2014 review found "Health-related and lifestyle appeals may also encourage initiation among young non-smokers, as they may convey that trying e-cigarettes is less risky and more socially appealing, which may ameliorate negative beliefs or concerns about nicotine addiction." Marketing might appeal to young people as well as adults. E-cigarette websites regularly contain marketing claims that might appeal to a younger audience. Adolescent experimenting with e-cigarettes may be related to sensation seeking behavior, and is not likely to be associated with tobacco reduction or quitting smoking. Young people may view e-cigarettes as a symbol of rebellion. Young people and children are tempted by flavored e-cigarettes. The main reasons young people experimented with e-cigarettes were due to curiosity, flavors, and peer influences. E-cigarettes can appeal to youth because of their high-tech design, assortment of flavors, and accessibility online. Candy and fruit flavors e-cigarettes are designed to appeal to young people. Infants and toddlers could ingest the e-liquid from an e-cigarette device out of curiosity.

Users may begin by using a disposable e-cigarette, and it has been shown that e-cigarette users often start with e-cigarettes resembling normal cigarette, eventually moving to a later-generation device. Most later-generation e-cigarettes shifted to get a "more satisfying hit", and users may adjust their devices to provide more vapor for better "throat hits".

Construction

An electronic cigarette is a battery-powered vaporizer. The primary parts that make up an e-cigarette are a mouthpiece, a cartridge (tank), a heating element/atomizer, a microprocessor, a battery, and possibly a LED light on the end. An atomizer comprises a small heating element that vaporizes e-liquid and a wicking material that draws liquid onto the coil. When the user inhales a pressure sensor activates the heating element that atomizes the liquid solution; other devices are activated by a push-button manually. The e-liquid reaches a temperature of roughly 100–250 °C within a chamber to create an aerosolized vapor. The user inhales an aerosol, commonly called vapor, rather than cigarette smoke. The aerosol provides a flavor and feel similar to tobacco smoking. A traditional cigarette is smooth and light but an e-cigarette is rigid, cold and slightly heavier. The puffing experience is different than smoking. There is a learning curve to use e-cigarettes properly. E-cigarettes are generally cylindrical, with many variations. E-cigarettes that resemble pens or USB memory sticks are also sold for those who may want to use the device unobtrusively.

There are three main categories of e-cigarettes: cigalikes, looking like cigarettes, either disposable or with rechargeable batteries and replaceable nicotine cartridges; tank systems, bigger than cigalikes with refillable liquid tanks; and mods, assembled from basic parts or by altering existing products. A cigalike e-cigarette contains a cartomizer, which is connected to a battery. A "cartomizer" (a portmanteau of cartridge and atomizer) or "carto" consists of an atomizer surrounded by a liquid-soaked poly-foam that acts as an e-liquid holder. Clearomizers or "clearos", not unlike cartotanks, use a clear tank in which an atomizer is inserted. A rebuildable atomizer or an RBA is an atomizer that allows the user to assemble or "build" the wick and coil themselves instead of replacing them with off-the-shelf atomizer "heads". The devices can contain a rechargeable battery, which tends to be the largest component of an e-cigarette, but disposable cigalikes do not.

As the e-cigarette industry is growing, new products are quickly developed and brought to market. First generation e-cigarettes tend to look like tobacco cigarettes and so are called "cigalikes". Most cigalikes look like cigarettes but there is some variation in size. Second generation devices are larger overall and look less like tobacco cigarettes. Third generation devices include mechanical mods and variable voltage devices. The fourth generation includes Sub ohm tanks and temperature control devices. The voltage for first generation e-cigarettes is about 3.7 and second generation e-cigarettes can be adjusted from 3 volts to 6 volts, while more recent devices can go up to 8 volts.

The main ingredients in the e-liquid usually are propylene glycol, glycerin, water, nicotine, and flavorings. E-liquids are also sold without propylene glycol, or without nicotine. Some are sold without flavors. The liquid typically contains 95% propylene glycol and glycerin. Surveys demonstrate that 97% of e-cigarette users use products that contain nicotine. The flavorings may be natural or artificial. There is a vast array of e-liquids available. About 8,000 flavors exist as of 2014.

Health effects

Positions of medical organizations

As of 2014 electronic cigarettes had not been approved as a smoking cessation device by any government. In July 2014, a report produced by the World Health Organization (WHO) for the WHO Framework Convention on Tobacco Control, found there was not enough evidence to determine if electronic cigarettes can help people quit smoking. It suggested that smokers should be encouraged to use approved methods for help with quitting. But the same report also mentioned expert opinions in scientific papers that suggested e-cigarettes may have a role helping people quit who have failed using other methods. The report stated that "Smokers will obtain the maximum health benefit if they completely quit both tobacco and nicotine use." 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.

In a joint statement in 2015, Public Health England and other UK medical organizations stated that "e-cigarettes are significantly less harmful than smoking." In 2015, the Public Health England released a report stating that e-cigarettes are estimated to be 95% less harmful than smoking, and said that "PHE looks forward to the arrival on the market of a choice of medicinally regulated products that can be made available to smokers by the NHS on prescription." The UK National Health Service stated in 2015 that e-cigarettes have approximately 5% of the risk of tobacco cigarettes. They found that their safety won't be fully known for many years. The UK National Health Service concluded in 2014 that "While e-cigarettes may be safer than conventional cigarettes, we don't yet know the long-term effects of vaping on the body. There are clinical trials in progress to test the quality, safety and effectiveness of e-cigarettes, but until these are complete and the government can't give any advice on them or recommend their use."

In October 2015, the American Academy of Pediatrics recommends against e-cigarettes for quitting smoking and stated among adolescents, e-cigarette use is related with reduced quitting smoking. In August 2014, the American Heart Association released a policy statement in which they support "effective FDA regulation of e-cigarettes that addresses marketing, youth access, labeling, quality control over manufacturing, free sampling, and standards for contaminants." In 2015 the California Department of Public Health issued a report that stated the "aerosol has been found to contain at least ten chemicals that are on California’s Proposition 65 list of chemicals known to cause cancer, birth defects, or other reproductive harm." 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."

Smoking cessation

As of 2014, research on the safety and efficacy of e-cigarette use for smoking cessation is limited. The benefit of e-cigarettes for quitting smoking is uncertain and unproven, and they have not been subject to the type of efficacy testing as nicotine replacement products. The evidence suggests that e-cigarettes can supply nicotine at concentrations that are enough to substitute for traditional cigarettes. A 2014 Cochrane review found limited evidence of a benefit as a smoking cessation aid from a small number of studies, which included two randomized controlled trials (RCT). A third RCT in 2014 found that smokers who were not interested in quitting, after eight weeks of e-cigarette use 34% who used e-cigarettes had quit smoking in comparison with 0% of users who did not use e-cigarettes, with considerable reductions from smoking in the e-cigarette group. A 2014 UK cross-sectional population survey of smokers who tried to stop without professional assistance, found that those who used e-cigarettes were more likely to stop smoking than those who used nicotine replacement products. 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. The US Preventive Services Task Force found there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, including pregnant women. A 2015 review found that e-cigarettes for quitting smoking were generally similar to a placebo. The same review concluded that while they may have a benefit for decreasing cigarette use in smokers, they have a limited benefit in quitting smoking. A 2014 review found e-cigarettes may have some potential for reducing smoking. A 2015 review found that vaping was not associated with successful quitting, but there are reports of quitting smoking or reduction. Since smoking reduction may just be dual use, smoking reduction may not be a positive public health result.

A 2015 review found variable evidence that e-cigarette users had higher cessation rates than users of nicotine replacement products. A 2014 review found limited evidence that e-cigarettes do not seem to improve cessation rates compared to regulated FDA nicotine replacement products. Two 2014 reviews found no evidence that e-cigarettes are more effective than existing nicotine replacement products for smoking cessation. They may be as effective, but not more, compared to nicotine patches for short-term smoking cessation. However, a randomized trial found 29% of e-cigarette users maintained e-cigarette use at 6 months while 8% for patch users, indicating that vaping may continue after other quit methods. Studies have not shown that e-cigarettes are better than regulated medication for smoking cessation. A 2014 review found four experimental studies and six cohort studies that indicated that electronic cigarettes reduced the desire to smoke and withdrawal symptoms. This review also noted that two cohort studies found that electronic cigarettes led to a reduction in the number of cigarettes smoked per day. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2014 review concluded that the adverse public health effects resulting from the widespread use of e-cigarettes could be significant, in part due to the possibility that they could undermine smoking cessation. This review therefore called for their use to be limited to smokers who are unwilling or unable to quit. A 2014 review found that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes could have a broad adverse effect for a population by expanding initiation and lowering cessation of smoking.

Harm reduction

Tobacco harm reduction has been a controversial area of tobacco control. The core concern is that smokers who could have quit smoking entirely, will alternatively develop an addiction to another harmful device. As of 2014 promotion of vaping as a harm reduction aid is premature, but in an effort to decrease tobacco related death and disease, e-cigarettes have a potential to be part of the harm reduction strategy. Another review found e-cigarettes would likely be less harmful than traditional cigarettes to users and bystanders. The authors warned against the potential harm of excessive regulation and advised health professionals to consider advising smokers who are reluctant to quit by other methods to switch to e-cigarettes as a safer alternative to smoking. In 2015 a report commissioned by Public Health England concluded that e-cigarettes "release negligible levels of nicotine into ambient air with no identified health risks to bystanders".

A 2014 review recommended that regulations for e-cigarettes could be similar to those for dietary supplements or cosmetic products to not limit their potential for harm reduction. Vaping may have potential in harm reduction compared to smoking. When used to quit smoking, they could reduce harm even more if the tobacco user quits but e-cigarettes are not harmless because nicotine has long-term adverse effects, may contain impurities, and nicotine is addictive, which may have serious side effects, particularly with unconventional ways to increase the doses of nicotine exposure. 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 their safety and efficacy to draw definite conclusions. E-cigarette use for risk reduction in high-risk groups such as people with mental disorders is unavailable.

While e-cigarettes with higher voltage batteries can produce carcinogens including formaldehyde at levels found in cigarette smoke, reduced voltage e-cigarettes produce vapor with levels of formaldehyde and acetaldehyde roughly 13 and 807-fold less than indicated in cigarette smoke. A 2015 review found vaping e-cigarettes at a high voltage (5.0V) may generate formaldehyde-forming chemicals at a greater level than smoking, which has been determined to be a lifetime cancer risk of about 5 to 15 times greater than smoking. A Public Health England report looking at the same study found that a "puffing machine" was used to detect the high levels. The report also included a small study with people using similar devices and settings. The users could not use the devices because of dry-puffs at the high settings, which "poses no danger to either experienced or novice vapers, because dry puffs are aversive and are avoided rather than inhaled" and "At normal settings, there was no or negligible formaldehyde release." They concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes." While tobacco smoke contains 100 known carcinogens, none of these has been found in more than trace quantities in the cartridges or aerosol of e-cigarettes. According to a 2011 review, while e-cigarettes cannot be considered "safe" because there is no safe level for carcinogens, they are doubtless safer than tobacco cigarettes. Any residual risk of vaping should be weighed against the risk of continuing or returning to smoking, taking account of the low success rate of currently-approved smoking cessation medications.

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 e-cigarettes, but realizing their full potential requires regulation and monitoring to minimize possible risks. They found that a considerable number of smokers want to reduce harm from smoking by using these products. The British Medical Association encourages health professionals to recommend conventional nicotine replacement therapies, but for patients unwilling to use or continue using such methods, health professionals may present e-cigarettes as a lower-risk option than tobacco smoking. The American Association of Public Health Physicians (AAPHP) suggests those who are unwilling to quit tobacco smoking or unable to quit with medical advice and pharmaceutical methods should consider other nicotine containing products such as electronic cigarettes and smokeless tobacco for long term use instead of smoking. In an interview, the director of the Office on Smoking and Health for the U.S. federal agency Centers for Disease Control and Prevention (CDC) believes that there is enough evidence to say that using e-cigarettes is likely less harmful than smoking a pack of conventional cigarettes. However, due to the lack of regulation of the contents of e-cigarettes and the presence of nicotine, the CDC has issued warnings. A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both. 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."

Safety

The safety of e-cigarettes is unclear, but the evidence suggests they cause less harmful effects than tobacco. The risks involved are uncertain. There is little data about their health effects, and considerable variability between vaporizers and in quality of their liquid ingredients and thus the contents of the aerosol delivered to the user. Vaping is probably safer than smoking. One review found, from limited data, their safety risk is similar to that of smokeless tobacco, which has about 1% of the mortality risk of traditional cigarettes. Another concluded that regulated FDA products such as nicotine inhalers are probably safer than e-cigarettes.

The e-liquid has a low level of toxicity, and contamination with various chemicals has been identified in the product. A few metal parts in e-cigarettes can contact the e-liquid and contaminate it with metals. Many chemicals including carbonyl compounds such as formaldehyde can inadvertently be produced when the nichrome wire that touches the e-liquid is heated and chemically reacts with the liquid. E-cigarettes create vapor that consists of ultrafine particles, with the majority of particles in the ultrafine range. The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other chemicals. Exactly what comprises the vapor varies in composition and concentration across and within manufacturers. Due to various methodological issues, severe conflicts of interest, and inconsistent research, no definite conclusions can be determined regarding the safety of e-cigarettes. However, e-cigarettes cannot be regarded as simply harmless. Aside from toxicity, there are also risks from misuse or accidents such as accidental contact with liquid nicotine, accidental fires caused by vaporizer malfunction, and explosions resulting from extended charging, use of unsuitable chargers, or vaporizer design flaws. There is a small risk of battery explosion in devices modified to increase battery power. Battery explosions are caused by an increase in internal battery temperature and some have resulted in severe skin burns.

A July 2014 WHO report cautioned about potential risks of using e-cigarettes. The report concluded that "the existing evidence shows that ENDS aerosol is not merely "water vapour" as is often claimed in the marketing for these products. ENDS use poses serious threats to adolescents and fetuses." A 2014 systematic review concluded that the risks of e-cigarettes have been exaggerated by health authorities and stated that while there may be some remaining risk, the risk of e-cigarette use is likely small compared to smoking tobacco. E-cigarette vapor contains fewer toxic substances than cigarette smoke. It also has lower concentrations of potential toxic substances than cigarette smoke. There is a concern that some of the mainstream vapor exhaled by e-cigarette users can be inhaled by bystanders, particularly indoors.

The long-term effects of e-cigarette use are unknown. A 2014 Cochrane review found no serious adverse effects reported in trials. Less serious adverse effects from e-cigarette use include throat and mouth inflammation, vomiting, nausea, and cough. The risk is probably low from the inhalation of propylene glycol and glycerin. No information is available on the long-term effects of the inhalation of flavors. E-cigarette users are exposed to potentially harmful nicotine. Nicotine is associated with cardiovascular disease, potential birth defects, and poisoning. In vitro studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated in vivo. There is inadequate research to demonstrate that nicotine is associated with cancer in humans. A 2014 review recommended that e-cigarettes should be regulated for consumer safety. There is limited information available on the environmental issues around production, use, and disposal of e-cigarettes that use cartridges.

Addiction

Nicotine is very addictive, comparable to heroin or cocaine. Nicotine induces strong effects on the brain, which lead to considerable changes in the brain’s physiology such as stimulation in regions of the cortex associated with reward, pleasure and reducing anxiety. When nicotine intake stops, there are withdrawal symptoms.

Various organizations are concerned that vaping might increase nicotine addiction and use among young people. These include the Centers for Disease Control and Prevention, the International Union Against Tuberculosis and Lung Disease, the American Academy of Pediatrics and the Food and Drug Administration. The World Health Organization raised concern about addiction for non-smokers from their use in July 2014. The National Institute on Drug Abuse said they could maintain nicotine addiction in those who are attempting to quit.

It is not clear whether vaping will decrease or increase overall nicotine addiction. Information about the drug action of the nicotine in e-cigarettes is limited, but the nicotine in e-cigarettes is adequate to sustain nicotine dependence. The limited data suggests that the likelihood of abuse from e-cigarettes could be smaller than traditional cigarettes. A 2014 systematic review found that the concerns that e-cigarettes could cause non-smokers to start smoking are unsubstantiated. No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction. Some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence.

A 2014 review found no evidence that they are used regularly by those who have never smoked, while another 2014 review has found that in studies up to a third of young people who have ever vaped have never smoked tobacco. The degree to which teens are using e-cigarettes in ways the manufacturers did not intend, such as increasing the nicotine delivery, is unknown. The extent to which e-cigarette use will lead to addiction or substance dependence in youth is unknown. Youthful experimentation with e-cigarettes could lead to a lifelong addiction.

History

The earliest e-cigarette can be traced to American Herbert A. Gilbert, who in 1963 patented "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air". This device produced flavored steam without nicotine. The patent was granted in 1965. Gilbert’s invention was ahead of its time. There were prototypes, but it received little attention and was never commercialized because smoking was still fashionable at that time. Gilbert said in 2013 that today's electric cigarettes follow the basic design set forth in his original patent.

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 e-cigarette. Lik quit smoking after his father, also a heavy smoker, died of lung cancer. In 2003, he thought of using a high frequency, piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine. This design creates a smoke-like vapor. Lik said that using resistance heating obtained better results and he said the difficulty was to scale down the device to a small enough size. Lik’s invention was intended to be an alternative to smoking.

Hon Lik patented the modern e-cigarette design in 2003. Lik is credited with developing the first commercially successful electronic cigarette. The e-cigarette was first introduced to the Chinese domestic market in 2004. Many versions made their way to the U.S., sold mostly over the Internet by small marketing firms. The company that Lik worked for, Golden Dragon Holdings, changed its name to Ruyan (如烟, literally "Resembling smoking"), and started exporting its products in 2005–2006 before receiving its first international patent in 2007. Ruyan changed its company name to Dragonite International Limited. Lik said in 2013 that "I really hope that the large international pharmaceutical groups get into manufacturing electronic cigarettes and that authorities like the FDA in the United States will continue to impose stricter and stricter standards so that the product will be as safe as possible." Most e-cigarettes today use a battery-powered heating element rather than the ultrasonic technology patented design from 2003.

Hon Lik sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera." He has said "My fame will follow the development of the e-cigarette industry. Maybe in 20 or 30 years I will be very famous." Many US and Chinese e-cig makers copied his designs illegally, so Lik was not paid for his invention (although some US manufacturers have compensated him through out of court settlements). The company had sold e-cigarettes and e-cigars.

The e-cigarette continued to evolve from the first generation three-part device. In 2007 British entrepreneurs Umer and Tariq Sheikh invented the cartomizer. This is a mechanism that integrates the heating coil into the liquid chamber. They launched this new device in the UK in 2008 under their Gamucci brand and the design is now widely adopted by most "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. The clearomizer was invented in 2009 that originated from the cartomizer design. It contained the wicking material, an e-liquid chamber, and an atomizer coil within a single clear component. The clearomizer allows the user to monitor the liquid level in the device. E-cigarettes entered the European market and the US market in 2006 and 2007.

International tobacco companies, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete, are increasingly involved in the production and marketing of their own brands of e-cigarettes and in acquiring existing e-cigarette companies. blu eCigs, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc. in 2012. British American Tobacco launched Vype in 2013, while Imperial Tobacco's Fontem Ventures acquired the intellectual property owned by Hon Lik through Dragonite International Limited for $US 75 million in 2013 and launched Puritane in partnership with Boots UK. On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG. SKY was rebranded as blu. On 3 February 2014, Altria Group, Inc. acquired popular electronic cigarette brand Green Smoke for $110 million. The deal was finalized in April 2014 for $110 million with $20 million in incentive payments. Altria also markets its own e-cigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse product. On 30 April 30, 2015, Japan Tobacco bought the US Logic e-cigarette brand. Japan Tobacco also bought the UK E-Lites brand in June 2014. On 15 July 15, 2014, Lorillard sold blu to Imperial Tobacco as part of a deal for $7.1 billion. As of March 2015, 74% of all e-cigarette sales in convenience stores in the U.S. were products made by tobacco companies. As of May 2015, 80% were products made by tobacco companies.

In the UK in 2015 the "most prominent brands of cigalikes" were owned by tobacco companies, but except for one model all the tank types came from "non-tobacco industry companies". However some tobacco industry products, while using prefilled cartridges, resemble tank models.

Society and culture

Consumers of e-cigarettes, sometimes called "vapers", have shown passionate support for the device that other nicotine replacement therapy did not receive. This suggests e-cigarettes have potential mass appeal that could challenge combustible tobacco's market position.

As the electronic cigarette industry grows, a subculture has emerged which calls itself "the vaping community". The online forum E-Cig-Reviews.com was one of the first major communities. Another online forum known as UKVaper.org was the origin of the hobby of modding. There are also groups on Facebook and Reddit. Members of this emerging subculture often see e-cigarettes as a safer alternative to smoking and some view it as a hobby. These groups tend to use highly customized devices that do not resemble the earlier "cig-a-likes". Online forums based around modding have grown in the vaping community. Vapers energetically embrace activities associated with e-cigarettes and sometimes act as unpaid evangelicals according to a 2014 review. A 2014 Postgraduate Medical Journal editorial stated that e-cigarette companies have a substantial online presence, as well as many individual vapers who blog and tweet about e-cigarette related products. The editorial stated that vapers "also engage in grossly offensive online attacks on anyone who has the temerity to suggest that ENDS are anything other than an innovation that can save thousands of lives with no risks". 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. These approaches were used in Europe to minimize the EU Tobacco Product Directive in October 2013.

Large gatherings of vapers, called vape meets, take place around the US. They focus on e-cig devices, accessories, and the lifestyle that accompanies them. Vapefest, which started in 2010, is an annual show hosted by different cities. People attending these meetings are usually enthusiasts that use specialized, community-made products not found in convenience stores or gas stations. These products are mostly available online or in dedicated "vape" storefronts where mainstream e-cigarettes brands from the tobacco industry and larger e-cig manufacturers are not as popular. Some vape shops have a vape bar where patrons can test out different e-liquids and socialize. Vape shop owners generally believe vaping is a habit. The Electronic Cigarette Convention in North America which started in 2013, is an annual show where companies and consumers meet up. As of 2014, e-cigarette availability in US stores is increasing, especially in places with low taxes and smoking bans. In the US they are more likely available in places with a higher median family income.

A growing subclass of vapers called "cloud-chasers" configure their atomizers to produce large amounts of vapor by using low-resistance heating coils. This practice is called "cloud-chasing" and is growing more popular. By using a coil with very low resistance, the batteries are stressed to a potentially unsafe extent. This could present a risk of dangerous battery failures. As vaping comes under increased scrutiny, some members of the vaping community have voiced their concerns about cloud-chasing, claiming the practice gives vapers a bad reputation when doing it in public. The Oxford Dictionaries' word of the year for 2014 is "vape".

Legal status

Because of the novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation is pending in many countries. As of 2015, around two thirds of major nations have regulated e-cigarettes in some way. Regulations vary from regions with no regulation to others banning them entirely. For example, Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes. In Canada, they are technically illegal to sell, as no nicotine-containing e-fluid is approved by Health Canada, but this is generally unenforced and they are commonly available for sale Canada-wide. As of July 2014, with an absence of federal regulations in the US, 44 states have adopted their own e-cigarette regulations. As of December 2014, e-cigarettes are legal for minors to buy in ten states in the U.S. and since they do not contain tobacco, television advertising is not restricted. In the US, as of 2014 some states tax e-cigarettes as tobacco products, and some state and regional governments have broadened their indoor smoking bans to include e-cigarettes.

In August 2014, attorneys general from over two dozen states advised the FDA to enact restrictions on e-cigarettes, including banning flavors. E-cigarettes have been classified as "drug delivery devices" in several countries because they can contain nicotine, and their advertising has been restricted until safety and efficacy trials are conclusive. A 2014 review said these products should be considered for regulation in view of the "reported adverse health effects". In some countries, e-cigarettes are regulated as a medical product even though they are not approved as a smoking cessation aid. E-cigarettes are not approved by the FDA as a smoking cessation product.

In autumn 2013, the e-cigarette industry ran "a determined lobbying campaign" to defeat proposed European legislation to regulate e-cigarettes like medical devices. Pharmaceutical manufacturers GlaxoSmithKline and Johnson & Johnson have lobbied the US government, the FDA, and the EU parliament for stricter regulation of e-cigarettes which compete with their products Nicorette gum and nicotine patches. In February 2014 the European Parliament passed regulations requiring standardization and quality control for liquids and vaporizers, disclosure of ingredients in liquids, and child-proofing and tamper-proofing for liquid packaging. In April 2014 the US FDA published proposed regulations for e-cigarettes along similar lines.

In March 2014 Western Australia banned sale of e-cigarettes.

In October 2014 the UK's Advertising Standards Authority changed the regulations on e-cigarette advertising, allowing the devices to appear in TV ads from 10 November. The first advert to take advantage of the change, promoting KiK Electronic Cigarettes, aired on the day it came into force.

Marketing

E-cigarette makers have been increasing advertising quickly; the aggressive marketing is similar to that used to sell cigarettes in the 1950s and 1960s. E-cigarettes and nicotine are regularly promoted as safe and beneficial in the media and on brand websites. E-cigarette retail websites often make unscientific health claims to consumers in order to sell them products. While advertising of tobacco products is banned in most countries, 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". In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013. The majority of advertisers also emphasize that the product can be used "anywhere" especially where smoking bans apply. A 2014 review found "only a small percentage of sites had an age restriction, which was only to click a box to state that the user is over a certain age. This easily-circumvented age verification leaves open room for youth access and marketing exposure."

A national US advertising campaign starred Steven Dorff exhaling a "thick flume" of what the ad describes as "vapor, not tobacco smoke", exhorting smokers with the message "We are all adults here, it's time to take our freedom back." Jason Healy, founder of blu, called the product "a lifestyle brand for smokers". The ads, in a context of longstanding prohibition of tobacco advertising on TV, were criticized by organizations such as Campaign for Tobacco-Free Kids as undermining anti-tobacco efforts. Cynthia Hallett of Americans for Non-Smokers' Rights described the US advertising campaign as attempting to "re-establish a norm that smoking is okay, that smoking is glamorous and acceptable". University of Pennsylvania communications professor Joseph Cappella stated that the setting of the ad near an ocean was meant to suggest an association of clean air with the nicotine product. Nielsen data find e-cigarette companies advertising reaches 24 million youth in the U.S. The top channels for e-cigarette advertising reaching youth were AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1.

A 2014 review said e-cigarettes are aggressively promoted, mostly via the internet, as a healthy alternative to smoking in the US. Celebrity endorsements are used to encourage e-cigarette use. Big tobacco markets e-cigarettes to young people. Industry strategies include cartoon characters and candy flavors to sell e-cigarettes. E-cigarette companies commonly promote that their products contain only water, nicotine, glycerin, propylene glycol, and flavoring but this assertion is misleading as scientists have found differing amounts of heavy metals in the vapor, including chromium, nickel, tin, silver, cadmium, mercury, and aluminum. The popular assertion that e-cigarette emit "only water vapor" is false because the evidence indicates e-cigarette vapor contains possibly harmful chemicals such as nicotine, carbonyls, metals, and organic volatile compounds, in addition to particulates.

Economics

As of 2014 the number of e-cigarettes sold has increased every year. As of 2014 there were at least 466 e-cigarette companies. Worldwide e-cigarette sales in 2014 were around US$7 billion. US e-cigarette sales were forecast to increase to about 5 million units in 2012 compared to 50,000 in 2008. Big tobacco has a significant share of the e-cigarette market, and they are the major producers.

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. Big tobacco companies have bought some e-cigarette businesses and greatly increased their marketing efforts. As of 2015 e-cigarette devices are mostly made in China. In the US there are more than a hundred small e-cigarette businesses, with about 70% of the market held by 10 businesses. A sizable share of the e-cigarette business is done on the internet. The majority of e-cigarette businesses have their own homepage and approximately 30–50% of total e-cigarettes sales are handled on the internet in respect to English-language websites.

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. Wells Fargo analyst Bonnie Herzog attributes this decline to a shift in consumers' behavior, buying more specialized devices or what she calls "vapor/tank/mods (VTMs)" that are not tracked by Nielsen. 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. There are around a thousand e-cigarette retail shops in California.

Canada is an expanding market for e-cigarettes. There are numerous e-cigarette retail shops in Canada. The company Smoke NV is the leading seller of e-cigarette products in Canada.

The UK is a growing market for e-cigarettes. The main e-cigarette businesses in the UK are British American Tobacco, Imperial Tobacco, Nicocigs, and Vivid Vapours. British American Tobacco was the first tobacco business to sell e-cigarettes in the UK. They launched the e-cigarette Vype in July 2013. Philip Morris, the world’s largest tobacco firm, purchased UK’s Nicocigs in June 2014. As of March 2014 the top selling e-cigarette brands in the UK at independent convenience stores are Nicolites and Vivid Vapours.

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

Related technologies and alternatives

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

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

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

HeatSticks is a heated tobacco product marketed under the brand Marlboro by PMI. PAX Labs (formally known as Ploom) developed a vaporizer called Pax that heats the leaves of tobacco or cannabis. In 2015 the company launched Pax 2. On June 1, 2015, they introduced Juul a different type of e-cigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to an actual cigarette puff.

BLOW started selling e-hookahs, an electronic version of the hookah, in 2014.

Medical Cannabis Management introduced an e-cigarette containing THC rather than nicotine. KanaVape is an e-cigarette containing cannabidiol (CBD) and no THC. Several companies including Canada's Eagle Energy Vapor are selling caffeine-based e-cigarettes instead of nicotine.

References

1. ^ Caponnetto, Pasquale; Campagna, Davide; Papale, Gabriella; Russo, Cristina; Polosa, Riccardo (2012). "The emerging phenomenon of electronic cigarettes". Expert Review of Respiratory Medicine. 6 (1): 63–74. doi:10.1586/ers.11.92. ISSN 1747-6348. PMID 22283580.
2. ^ Orellana-Barrios, Menfil A.; Payne, Drew; Mulkey, Zachary; Nugent, Kenneth (2015). "Electronic cigarettes-a narrative review for clinicians". The American Journal of Medicine. doi:10.1016/j.amjmed.2015.01.033. ISSN 0002-9343. PMID 25731134.
3. ^ "Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues". Tob Induc Dis. 12 (1): 21. 2014. doi:10.1186/1617-9625-12-21. PMC 4350653. PMID 25745382. {{cite journal}}: Unknown parameter |authors= ignored (help)CS1 maint: unflagged free DOI (link)
4. ^ Grana, R; Benowitz, N; Glantz, SA (13 May 2014). "E-cigarettes: a scientific review". Circulation. 129 (19): 1972–86. doi:10.1161/circulationaha.114.007667. PMC 4018182. PMID 24821826.
5. ^ Pepper, J. K.; Brewer, N. T. (2013). "Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review". Tobacco Control. 23 (5): 375–384. doi:10.1136/tobaccocontrol-2013-051122. ISSN 0964-4563. PMID 24259045.
6. ^ Bhatnagar, A.; Whitsel, L. P.; Ribisl, K. M.; Bullen, C.; Chaloupka, F.; Piano, M. R.; Robertson, R. M.; McAuley, T.; Goff, D.; Benowitz, N. (24 August 2014). "Electronic Cigarettes: A Policy Statement From the American Heart Association". Circulation. 130 (16): 1418–1436. doi:10.1161/CIR.0000000000000107. PMID 25156991.
7. ^ 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.
8. ^ 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.
9. ^ Cooke, Andrew; Fergeson, Jennifer; Bulkhi, Adeeb; Casale, Thomas B. (2015). "The Electronic Cigarette: The Good, the Bad, and the Ugly". The Journal of Allergy and Clinical Immunology: In Practice. 3 (4): 498–505. doi:10.1016/j.jaip.2015.05.022. ISSN 2213-2198. PMID 26164573.
10. ^ 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.
11. ^ 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.
12. ^ McRobbie, Hayden; Bullen, Chris; Hartmann-Boyce, Jamie; Hajek, Peter; McRobbie, Hayden (2014). "Electronic cigarettes for smoking cessation and reduction". The Cochrane Library. 12: CD010216. doi:10.1002/14651858.CD010216.pub2. PMID 25515689.
13. ^ 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.
14. ^ Harrell, PT; Simmons, VN; Correa, JB; Padhya, TA; Brandon, TH (4 June 2014). "Electronic Nicotine Delivery Systems ("E-cigarettes"): Review of Safety and Smoking Cessation Efficacy". Otolaryngology—head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 151: 381–393. doi:10.1177/0194599814536847. PMID 24898072.
15. ^ Siu, AL (22 September 2015). "Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement". Annals of internal medicine. PMID 26389730.
16. ^ Drummond, MB; Upson, D (February 2014). "Electronic cigarettes. Potential harms and benefits". Annals of the American Thoracic Society. 11 (2): 236–42. doi:10.1513/annalsats.201311-391fr. PMID 24575993.
17. ^ M., Z.; Siegel, M (February 2011). "Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?". Journal of public health policy. 32 (1): 16–31. doi:10.1057/jphp.2010.41. PMID 21150942.
18. ^ Caponnetto P; Russo C; Bruno CM; Alamo A; Amaradio MD; Polosa R. (March 2013). "Electronic cigarette: a possible substitute for cigarette dependence". Monaldi archives for chest disease. 79 (1): 12–19. PMID 23741941.
19. ^ Golub, Justin S.; Samy, Ravi N. (2015). "Preventing or reducing smoking-related complications in otologic and neurotologic surgery". Current Opinion in Otolaryngology & Head and Neck Surgery. 23 (5): 334–340. doi:10.1097/MOO.0000000000000184. ISSN 1068-9508. PMID 26339963.
20. ^ Bekki, Kanae; Uchiyama, Shigehisa; Ohta, Kazushi; Inaba, Yohei; Nakagome, Hideki; Kunugita, Naoki (2014). "Carbonyl Compounds Generated from Electronic Cigarettes". International Journal of Environmental Research and Public Health. 11 (11): 11192–11200. doi:10.3390/ijerph111111192. ISSN 1660-4601. PMID 25353061.{{cite journal}}: CS1 maint: unflagged free DOI (link)
21. ^ "E-cigarettes: Safe to recommend to patients?". Cleve Clin J Med. 82 (8): 521–6. 2015. doi:10.3949/ccjm.82a.14054. PMID 26270431. {{cite journal}}: Unknown parameter |authors= ignored (help)
22. ^ "Chapter 5 - Nicotine" (PDF). Surgeon General of the United States. 2014. pp. 107–138.
23. ^ WHO. "Electronic nicotine delivery systems" (PDF). pp. 1–13. Retrieved 28 August 2014.
24. ^ Hajek, P; Etter, JF; Benowitz, N; Eissenberg, T; McRobbie, H (31 July 2014). "Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit" (PDF). Addiction (Abingdon, England). 109 (11): 1801–10. doi:10.1111/add.12659. PMID 25078252.
25. ^ Hildick-Smith, Gordon J.; Pesko, Michael F.; Shearer, Lee; Hughes, Jenna M.; Chang, Jane; Loughlin, Gerald M.; Ipp, Lisa S. (2015). "A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population". Journal of Adolescent Health. doi:10.1016/j.jadohealth.2015.07.020. ISSN 1054-139X. PMID 26422289.
26. ^ Fernández, Esteve; Ballbè, Montse; Sureda, Xisca; Fu, Marcela; Saltó, Esteve; Martínez-Sánchez, Jose M. (2015). "Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study". Current Environmental Health Reports. doi:10.1007/s40572-015-0072-x. ISSN 2196-5412. PMID 26452675.
27. ^ Rom, Oren; Pecorelli, Alessandra; Valacchi, Giuseppe; Reznick, Abraham Z. (2014). "Are E-cigarettes a safe and good alternative to cigarette smoking?". Annals of the New York Academy of Sciences. 1340 (1): 65–74. doi:10.1111/nyas.12609. ISSN 0077-8923. PMID 25557889.
28. ^ Carroll Chapman, SL; Wu, LT (18 March 2014). "E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison". Journal of Psychiatric Research. 54: 43–54. doi:10.1016/j.jpsychires.2014.03.005. PMID 24680203.
29. ^ "Over 2 million Britons now regularly use electronic cigarettes". ASH UK. 28 April 2014. Retrieved 30 May 2014.
30. ^ Barbara Demick (25 April 2009). "A high-tech approach to getting a nicotine fix". Los Angeles Times.
31. ^ Alawsi, F.; Nour, R.; Prabhu, S. (2015). "Are e-cigarettes a gateway to smoking or a pathway to quitting?". BDJ. 219 (3): 111–115. doi:10.1038/sj.bdj.2015.591. ISSN 0007-0610. PMID 26271862.
32. ^ Saitta, D; Ferro, GA; Polosa, R (March 2014). "Achieving appropriate regulations for electronic cigarettes". Therapeutic advances in chronic disease. 5 (2): 50–61. doi:10.1177/2040622314521271. PMC 3926346. PMID 24587890.
33. ^ Etter, J. F.; Bullen, C.; Flouris, A. D.; Laugesen, M.; Eissenberg, T. (May 2011). "Electronic nicotine delivery systems: a research agenda". Tobacco control. 20 (3): 243–8. doi:10.1136/tc.2010.042168. PMC 3215262. PMID 21415064.
34. ^ "Questions & Answers: New rules for tobacco products". European Commission. 26 February 2014.
35. "Electronic Cigarettes (e-Cigarettes)". FDA. 11 August 2014. Retrieved 18 October 2014.
36. ^ Peter Evans (20 February 2015). "E-Cigarette Makers Face Rise of Counterfeits". The Wall Street Journal. {{cite web}}: Italic or bold markup not allowed in: |publisher= (help)
37. ^ "Backgrounder on WHO report on regulation of e-cigarettes and similar products". 26 August 2014. Retrieved 2 June 2015.
38. Michael Felberbaum (11 June 2013). "Marlboro Maker To Launch New Electronic Cigarette". The Huffington Post. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
39. ^ Schraufnagel, Dean E.; Blasi, Francesco; Drummond, M. Bradley; Lam, David C. L.; Latif, Ehsan; Rosen, Mark J.; Sansores, Raul; Van Zyl-Smit, Richard (2014). "Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies". American Journal of Respiratory and Critical Care Medicine. 190 (6): 611–618. doi:10.1164/rccm.201407-1198PP. ISSN 1073-449X. PMID 25006874.
40. ^ Pisinger, Charlotta; Døssing, Martin (December 2014). "A systematic review of health effects of electronic cigarettes". Preventive Medicine. 69: 248–260. doi:10.1016/j.ypmed.2014.10.009. PMID 25456810.
41. ^ Bullen, Christopher (2014). "Electronic Cigarettes for Smoking Cessation". Current Cardiology Reports. 16 (11). doi:10.1007/s11886-014-0538-8. ISSN 1523-3782. PMID 25303892.
42. ^ "E-cigarettes: an up to date review and discussion of the controversy". W V Med J. 110 (4): 10–5. 2014. PMID 25322582. {{cite journal}}: Unknown parameter |authors= ignored (help)
43. 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.
44. ^ England, Lucinda J.; Bunnell, Rebecca E.; Pechacek, Terry F.; Tong, Van T.; McAfee, Tim A. (2015). "Nicotine and the Developing Human". American Journal of Preventive Medicine. doi:10.1016/j.amepre.2015.01.015. ISSN 0749-3797. PMID 25794473.
45. ^ 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.
46. ^ Giroud, Christian; de Cesare, Mariangela; Berthet, Aurélie; Varlet, Vincent; Concha-Lozano, Nicolas; Favrat, Bernard (2015). "E-Cigarettes: A Review of New Trends in Cannabis Use". International Journal of Environmental Research and Public Health. 12 (8): 9988–10008. doi:10.3390/ijerph120809988. ISSN 1660-4601. PMID 26308021.{{cite journal}}: CS1 maint: unflagged free DOI (link)
47. ^ Lauterstein, Dana; Hoshino, Risa; Gordon, Terry; Watkins, Beverly-Xaviera; Weitzman, Michael; Zelikoff, Judith (2014). "The Changing Face of Tobacco Use Among United States Youth". Current Drug Abuse Reviews. 7 (1): 29–43. doi:10.2174/1874473707666141015220110. ISSN 1874-4737. PMID 25323124.
48. "Electronic Cigarette Use Among Adults: United States, 2014" (PDF). Centers for Disease Control and Prevention. October 2015. pp. 1–8. {{cite web}}: Unknown parameter |authors= ignored (help)
49. Centers for Disease Control and Prevention (CDC) (November 2013). "Tobacco product use among middle and high school students—United States, 2011 and 2012". MMWR Morb. Mortal. Wkly. Rep. 62 (45): 893–7. PMID 24226625.
50. Sabrina Tavernise (17 April 2015). "Use of e-cigarettes rising sharply among teenagers". The Boston Globe.
51. 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)
52. ^ McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. Retrieved 19 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
53. ^ "Use of electronic cigarettes in Great Britain" (PDF). ASH. ASH. July 2014. Retrieved 18 September 2014.
54. McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. pp. 31–34. Retrieved 25 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
55. Volkow, Nora (August 2015). "Teens Using E-cigarettes More Likely to Start Smoking Tobacco". National Institute on Drug Abuse.
56. ^ "Prévalence, comportements d'achat et d'usage, motivations des utilisateurs de la cigarette électronique" (PDF). Observatoire Français des Drogues et des Toxicomanies. 12 February 2014. Retrieved 28 March 2014.
57. ^ Schraufnagel, Dean E. (2015). "Electronic Cigarettes: Vulnerability of Youth". Pediatric Allergy, Immunology, and Pulmonology. 28 (1): 2–6. doi:10.1089/ped.2015.0490. ISSN 2151-321X. PMID 25830075.
58. Moore, G. F.; Littlecott, H. J.; Moore, L.; Ahmed, N.; Holliday, J. (2014). "E-cigarette use and intentions to smoke among 10-11-year-old never-smokers in Wales". Tobacco Control. doi:10.1136/tobaccocontrol-2014-052011. ISSN 0964-4563. PMID 25535293.
59. "Are e-cigarettes safe to puff?". CBC News. 19 June 2013.
60. ^ Crowley, Ryan A. (2015). "Electronic Nicotine Delivery Systems: Executive Summary of a Policy Position Paper From the American College of Physicians". Annals of Internal Medicine. 162 (8): 583. doi:10.7326/M14-2481. ISSN 0003-4819. PMID 25894027.
61. ^ ""Smoking revolution": a content analysis of electronic cigarette retail websites". Am J Prev Med. 46 (4): 395–403. 2014. doi:10.1016/j.amepre.2013.12.010. PMID 24650842. {{cite journal}}: Unknown parameter |authors= ignored (help)
62. ^ Linda Bauld, Kathryn Angus, Marisa de Andrade (May 2014). "E-cigarette uptake and marketing" (PDF). Public Health England. pp. 1–19.{{cite web}}: CS1 maint: multiple names: authors list (link)
63. Samantha Payne (20 June 2014). "Harvard Study: E-Cigarettes Not 'Gateway' to Smoking". International Business Times.
64. Kong, G.; Morean, M. E.; Cavallo, D. A.; Camenga, D. R.; Krishnan-Sarin, S. (2014). "Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults". Nicotine & Tobacco Research. doi:10.1093/ntr/ntu257. ISSN 1462-2203. PMID 25481917.
65. "Regulation of Electronic Cigarettes ("E-Cigarettes")" (PDF). National Association of County and City Health Officials.
66. "Heart and Stroke Foundation: E-cigarettes in Canada". Heart and Stroke Foundation.
67. Kevin Chatham-Stephens (20 October 2014). "Young Children and e-Cigarette Poisoning". Medscape.
68. ^ Yingst, J. M.; Veldheer, S.; Hrabovsky, S.; Nichols, T. T.; Wilson, S. J.; Foulds, J. (2015). "Factors associated with electronic cigarette users' device preferences and transition from first generation to advanced generation devices". Nicotine Tob Res. doi:10.1093/ntr/ntv052. ISSN 1462-2203. PMID 25744966.
69. "Electronic Cigarette Fires and Explosions" (PDF). U.S. Fire Administration. 2014. pp. 1–11.
70. ^ "Vaper Talk – The Vaper's Glossary". Spinfuel eMagazine. 5 July 2013. Retrieved 18 November 2014.
71. ^ Rowell, Temperance R; Tarran, Robert (2015). "Will Chronic E-Cigarette Use Cause Lung Disease?". American Journal of Physiology – Lung Cellular and Molecular Physiology: ajplung.00272.2015. doi:10.1152/ajplung.00272.2015. ISSN 1040-0605. PMID 26408554.
72. ^ McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. p. 15. Retrieved 24 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
73. ^ Bhatnagar, A.; Whitsel, L. P.; Ribisl, K. M.; Bullen, C.; Chaloupka, F.; Piano, M. R.; Robertson, R. M.; McAuley, T.; Goff, D.; Benowitz, N. (24 August 2014). "AHA Policy Statement – Electronic Cigarettes". Circulation. 130 (16): 1418–1436.
74. Greg Olson (29 January 2014). "Smoking going electronic". Civistas Media. Journal-Courier.
75. ^ Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V (2014). "Nicotine absorption from electronic cigarette use: Comparison between first and new-generation devices". Scientific Reports. 4: 4133. doi:10.1038/srep04133. PMC 3935206. PMID 24569565.{{cite journal}}: CS1 maint: multiple names: authors list (link)
76. Glasser, A. M.; Cobb, C. O.; Teplitskaya, L.; Ganz, O.; Katz, L.; Rose, S. W.; Feirman, S.; Villanti, A. C. (2015). "Electronic nicotine delivery devices, and their impact on health and patterns of tobacco use: a systematic review protocol". BMJ Open. 5 (4): e007688–e007688. doi:10.1136/bmjopen-2015-007688. ISSN 2044-6055. PMID 25926149.
77. Hayden McRobbie (2014). "Electronic cigarettes" (PDF). National Centre for Smoking Cessation and Training. pp. 1–16.
78. Konstantinos Farsalinos. "Electronic cigarette evolution from the first to fourth generation and beyond" (PDF). gfn.net.co. Global Forum on Nicotine. Retrieved 23 September 2015.
79. ^ "Electronic cigarettes: the new face of nicotine delivery and addiction". J Thorac Dis. 7 (8): E248–51. 2015. doi:10.3978/j.issn.2072-1439.2015.07.37. PMC 4561260. PMID 26380791. {{cite journal}}: Unknown parameter |authors= ignored (help)
80. Tom McBride (11 February 2013). "Vaping Basics – VAPE GEAR". Spinfuel.com. Retrieved 28 September 2015.
81. Jimenez Ruiz, CA; Solano Reina, S; de Granda Orive, JI; Signes-Costa Minaya, J; de Higes Martinez, E; Riesco Miranda, JA; Altet Gómez, N; Lorza Blasco, JJ; Barrueco Ferrero, M; de Lucas Ramos, P (August 2014). "The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes". Archivos de bronconeumologia. 50 (8): 362–7. doi:10.1016/j.arbr.2014.06.007. PMID 24684764.
82. ^ Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (2013). "Electronic Cigarettes: A Short Review". Respiration. 86: 433–8. doi:10.1159/000353253. ISSN 1423-0356. PMID 24080743.
83. "More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013". Centers for Disease Control and Prevention. Retrieved 8 July 2015.
84. "WHO Right to Call for E-Cigarette Regulation". World Lung Federation. Retrieved 6 November 2014.
85. "E-cigarettes: an emerging public health consensus". UK: Public Health England. 2015.
86. McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. p. 76. Retrieved 19 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
87. "E – cigarettes: a new foundation for evidence – based policy and practice" (PDF). Public Health England. 19 August 2015. p. 5. Retrieved 22 August 2015.
88. ^ "Electronic cigarettes". Smokefree NHS. Are e-cigarettes safe to use?. Retrieved 28 October 2015.
89. "Stop smoking treatments". UK National Health Service. Retrieved 6 November 2014.
90. "Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke" (PDF). PEDIATRICS. 136 (5): 1008–1017. 2015. doi:10.1542/peds.2015-3108. ISSN 0031-4005. PMID 26504137.
91. ^ "State Health Officer's Report on E-Cigarettes: A Community Health Threat" (PDF). California Department of Public Health, California Tobacco Control Program. January 2015.
92. "Electronic Cigarettes (e-Cigarettes)". US Food and Drug Administration. Retrieved 6 November 2014.
93. "CDC launches powerful new ads in "Tips From Former Smokers" campaign". Centers for Disease Control and Prevention. 26 March 2015.
94. ^ Orr, KK; Asal, NJ (November 2014). "Efficacy of electronic cigarettes for smoking cessation". The Annals of pharmacotherapy. 48 (11): 1502–6. doi:10.1177/1060028014547076. PMID 25136064.
95. ^ Schroeder, M. J.; Hoffman, A. C. (2014). "Electronic cigarettes and nicotine clinical pharmacology". Tobacco Control. 23 (Supplement 2): ii30–ii35. doi:10.1136/tobaccocontrol-2013-051469. ISSN 0964-4563. PMID 24732160.
96. ^ McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. p. 47–48. Retrieved 25 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
97. ^ Lee, Andrew H. Y.; Stater, Brian J.; Close, Lanny; Rahmati, Rahmatullah (2015). "Are e-cigarettes effective in smoking cessation?". The Laryngoscope. 125 (4): 785–787. doi:10.1002/lary.24954l. ISSN 0023-852X. PMID 25387447.
98. ^ Rahman, Muhammad Aziz (30 March 2015). "E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis". PLOS ONE. 10: e0122544. doi:10.1371/journal.pone.0122544. PMID 25822251.{{cite journal}}: CS1 maint: unflagged free DOI (link)
99. ^ Gualano, M. R.; Passi, S.; Bert, F.; La Torre, G.; Scaioli, G.; Siliquini, R. (9 August 2014). "Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies". Journal of Public Health. doi:10.1093/pubmed/fdu055. PMID 25108741.
100. Dagaonkar RS, R.S.; Udwadi, Z.F. (2014). "Water pipes and E-cigarettes: new faces of an ancient enemy" (PDF). Journal of the Association of Physicians of India. 62 (4): 324–328. PMID 25327035.
101. McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. p. 65. Retrieved 20 August 2015.{{cite web}}: CS1 maint: multiple names: authors list (link)
102. "E-cigarettes—prevention, pulmonary health, and addiction". Dtsch Arztebl Int. 111 (20): 349–55. 2014. doi:10.3238/arztebl.2014.0349. PMC 4047602. PMID 24882626. {{cite journal}}: Unknown parameter |authors= ignored (help)
103. Collaco, Joseph M. (2015). "Electronic Use and Exposure in the Pediatric Population". JAMA Pediatrics. 169 (2): 177–182. doi:10.1001/jamapediatrics.2014.2898. PMID 25546699.
104. ^ McNeill, A, SC (2015). "E – cigarettes: an evidence update A report commissioned by Public Health England" (PDF). www.gov.uk. UK: Public Health England. pp. 77–78.{{cite web}}: CS1 maint: multiple names: authors list (link)
105. ^ Farsalinos, K. E.; Polosa, R. (2014). "Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review". Therapeutic Advances in Drug Safety. 5 (2): 67–86. doi:10.1177/2042098614524430. ISSN 2042-0986. PMC 4110871. PMID 25083263.
106. ^ Britton, John; Bogdanovica, Ilze (15 May 2014). "Electronic cigarettes – A report commissioned by Public Health England" (PDF). Public Health England.
107. "BMA calls for stronger regulation of e-cigarettes" (PDF). British Medical Association. Retrieved 18 November 2013.
108. "Principles to Guide AAPHP Tobacco Policy". American Association of Public Health Physicians. Retrieved 31 July 2013.
109. ^ Edgar, Julie. "E-Cigarettes: Expert Q&A With the CDC". WebMD. Retrieved 17 November 2013.
110. Detailed reference list is located on a separate image page.
111. "The Potential Adverse Health Consequences of Exposure to Electronic Cigarettes and Electronic Nicotine Delivery Systems". Oncology Nursing Forum. 42 (5): 445–446. 2015. doi:10.1188/15.ONF.445-446. ISSN 0190-535X. PMID 26302273.
112. ^ Palazzolo, Dominic L. (November 2013). "Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review". Frontiers in Public Health. 1 (56). doi:10.3389/fpubh.2013.00056. PMC 3859972. PMID 24350225.{{cite journal}}: CS1 maint: unflagged free DOI (link)
113. O'Connor, RJ (March 2012). "Non-cigarette tobacco products: what have we learnt and where are we headed?". Tobacco control. 21 (2): 181–90. doi:10.1136/tobaccocontrol-2011-050281. PMC 3716250. PMID 22345243.
114. Odum, L. E.; O'Dell, K. A.; Schepers, J. S. (December 2012). "Electronic cigarettes: do they have a role in smoking cessation?". Journal of pharmacy practice. 25 (6): 611–4. doi:10.1177/0897190012451909. PMID 22797832.
115. ^ Durmowicz, E. L. (2014). "The impact of electronic cigarettes on the paediatric population". Tobacco Control. 23 (Supplement 2): ii41–ii46. doi:10.1136/tobaccocontrol-2013-051468. ISSN 0964-4563. PMID 24732163.
116. Detailed reference list is located on a separate image page.
117. Chang, H. (2014). "Research gaps related to the environmental impacts of electronic cigarettes". Tobacco Control. 23 (Supplement 2): ii54–ii58. doi:10.1136/tobaccocontrol-2013-051480. ISSN 0964-4563. PMC 3995274. PMID 24732165.
118. Centers for Disease Control and Prevention, (CDC) (6 September 2013). "Notes from the field: electronic cigarette use among middle and high school students – United States, 2011–2012". MMWR. Morbidity and mortality weekly report. 62 (35): 729–30. PMID 24005229.
119. ^ "DrugFacts: Electronic Cigarettes (e-Cigarettes)". National Institute on Drug Abuse. September 2014. Retrieved 15 October 2014.
120. "Teens like different forms of tobacco and nicotine". American Cancer Society. Retrieved 18 August 2015.
121. "Position Statement on Electronic Cigarettes [ECs] or Electronic Nicotine Delivery Systems [ENDS]" (PDF). The International Union against Tuberculosis and Lung Disease. October 2013.
122. Korioth, Trisha. "E-cigarettes easy to buy, can hook kids on nicotine". The American Academy of Pediatrics. Retrieved 17 November 2013.
123. "FDA Warns of Health Risks Posed by E-Cigarettes". FDA. 23 July 2009. Retrieved 17 November 2013—Reviewed 17 September 2013{{cite web}}: CS1 maint: postscript (link)
124. Evans, S. E.; Hoffman, A. C. (2014). "Electronic cigarettes: abuse liability, topography and subjective effects". Tobacco Control. 23 (Supplement 2): ii23–ii29. doi:10.1136/tobaccocontrol-2013-051489. ISSN 0964-4563. PMID 24732159.
125. Noah Charney (7 December 2014). "America's vaping revolution: How suspicious should we really be of the e-cigarette craze?". Salon magazine. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
126. "US Patent 3200819. Smokeless non-tobacco cigarette". Retrieved 29 February 2012.
127. ^ Mary Bellis (2015). "Who Invented Electronic Cigarettes?". About.com.
128. ^ P.H. (17 March 2014). "A case of the vapers". The Economist.
129. Julie Beck (13 June 2014). "Schrödinger's Cigarette: Is Electronic Safer?". The Atlantic.
130. Seth Millstein (25 April 2009). "The Push to Ban E-Cigarettes: Where's the Proof?". TimeLine.
131. "Electronic Cigarette Sales on the Rise". WalesOnline. 24 August 2011.
132. ^ "Electronic Atomization Cigarette". Worldwide.espacenet.com. 22 November 2007.
133. ^ Sridi, Nicolas (10 July 2013). "I was sure that the electronic cigarette would be welcomed with open arms". Sciences et Avenir.
134. Debbie Elliott (5 August 2009). "E-Cigarettes: The New Frontier In War On Smoking". NPR.
135. Tom Hancock (4 October 2013). "Chinese e-cigarette inventor fights for royalties". The Japan Times.
136. CSD Staff (21 August 2013). "Dragonite Sells E-Vapor Business To ITG". Convenient Store Decisions.
137. ^ Tom Hancock (1 October 2013). "China's e-cigarette inventor fights for financial rewards". Fox News Channel.
138. ^ Mike K (9 June 2015). "What Does The Future Hold For Vaping Technology?". Steve K's Vaping World.
139. Annabel Denham (10 June 2013). "Brothers who took a punt on a new market". CityAM. Retrieved 4 April 2014.
140. "Patent document and information service (Ipsum)". Intellectual Property Office. Retrieved 20 November 2013.
141. ^ Mangan, Dan (15 July 2014). "Feeling blu? E-cig company spun off in major tobacco deal". CNBC.
142. ^ "Japan Tobacco's Global Ambitions Lead to Logic Acquisition". Convenience Store News. 30 April 2015.
143. "Kodak moment". The Economist. 28 September 2013. Retrieved 11 March 2014.
144. ^ Mike Esterl (3 February 2014). "Altria Expands in E-Cigarettes With Green Smoke". Wall Street Journal. Retrieved 7 March 2014.
145. Brian Montopoli (11 June 2013). "Tobacco companies bet on electronic cigarettes". CBS News. Retrieved 16 August 2013.
146. Gustafsson, Katarina (2 September 2013). "Imperial Tobacco Agrees to Acquire Dragonite's E-Cigarette Unit". Bloomberg. Retrieved 20 November 2013.
147. "Lorillard, Inc. Acquires British-based SKYCIG, Expanding its Electronic Cigarette Business". Retrieved 1 October 2013.
148. "Lorillard to Rebrand SKYCIG as blu eCigs". Convenience Store News. 27 March 2014.
149. ^ "Altria Completes Acquisition of Green Smoke". BusinessWire. 1 April 2014. Retrieved 21 November 2014.
150. Melissa Vonder Haar (1 April 2015). "Electronic Cigarette Growth Re-Accelerates". CSPnet.com. Retrieved 1 May 2015.
151. Richard Craver (29 May 2015). "Vuse overwhelming e-cig competition". Winston-Salem Journal. Retrieved 29 July 2015.
152. ^ Couts, Andrew (13 May 2013). "Inside the world of vapers, the subculture that might save smokers' lives". Digital Trends. Retrieved 20 November 2013.
153. Park, Andy (26 August 2013). "The Feed: The subculture around e-cigarettes". SBS World News. Retrieved 20 November 2013.
154. ^ Michael Grothaus (1 October 2014). "Trading addictions: the inside story of the e-cig modding scene". Engadget.
155. ^ Eric Larson (25 January 2014). "Pimp My Vape: The Rise of E-Cigarette Hackers". Mashable. Retrieved 22 November 2014.
156. Barbeau, Amanda M; Burda, Jennifer; Siegel, Michael (2013). "Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach". Addiction Science & Clinical Practice. 8 (1): 5. doi:10.1186/1940-0640-8-5. ISSN 1940-0640. PMID 23497603.{{cite journal}}: CS1 maint: unflagged free DOI (link)
157. Stephen Ricker (9 November 2013). "Crutch or cure: issues surround use of e-cigarettes". Fremont Tribune.
158. Molly Osberg (25 February 2014). "CVape life: welcome to the weird world of e-cig evangelists". The Verge.
159. ^ McKee, M. (2014). "Electronic cigarettes: peering through the smokescreen". Postgraduate Medical Journal. 90 (1069): 607–609. doi:10.1136/postgradmedj-2014-133029. ISSN 0032-5473. PMID 25294933.
160. Gavin Haynes (22 April 2015). "Daft vapers: the competitive world of e-cigarette smoking". The Guardian. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
161. Mike Esterl (29 May 2014). "'Vaporizers' Are the New Draw in E-Cigarettes". The Wall Street Journal.
162. Staff (13 February 2014). "Generation V E-Cigarettes and Vape Bar aims to convert smokers to e-cigarettes". Daily Nebraskan.
163. "Vapor Store Owner Beliefs and Messages to Customers". Nicotine Tob. Res. 2015. doi:10.1093/ntr/ntv129. PMID 26113622. {{cite journal}}: Unknown parameter |authors= ignored (help)
164. Neil Nisperos (4 September 2014). "Vaping convention coming to Ontario Convention Center Friday". Inland Valley Daily Bulletin.
165. Rose, S. W.; Barker, D. C.; D'Angelo, H.; Khan, T.; Huang, J.; Chaloupka, F. J.; Ribisl, K. M. (2014). "The availability of electronic cigarettes in US retail outlets, 2012: results of two national studies". Tobacco Control. 23 (Supplement 3): iii10–iii16. doi:10.1136/tobaccocontrol-2013-051461. ISSN 0964-4563. PMID 24935892.
166. Mary Plass (29 January 2014). "The Cloud Chasers". Vape News Magazine.
167. ^ Sean Cooper (23 May 2014). "What you need to know about vaporizers". Engadget.
168. Dominique Mosbergen (5 August 2014). "This Man Is An Athlete In The Sport Of 'Cloud Chasing'". The Huffington Post.
169. Victoria Bekiempis (1 April 2015). "Veteran E-Cigarette Users Fret 'Cloud Chasers' Give Them a Bad Name". Newsweek.
170. Fallon, Claire (19 November 2014). "'Vape' Is Oxford Dictionaries' Word Of The Year". The Huffington Post.
171. Barnaby Page (5 March 2015). "World's law-makers favour basing e-cig rules on tobacco". ECigIntelligence. Tamarind Media Limited.
172. "Public health officers tackle hazy issue of e-cigarettes". The Globe and Mail. 29 September 2014.
173. Tremblay, MarieClaude; Pluye, Pierre; Gore, Genevieve; Granikov, Vera; Filion, Kristian B.; Eisenberg, Mark J. (2015). "Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis". BMC Medicine. 13 (1). doi:10.1186/s12916-015-0370-z. ISSN 1741-7015. PMID 26041672.{{cite journal}}: CS1 maint: unflagged free DOI (link)
174. Biyani, S; Derkay, CS (28 April 2015). "E-cigarettes: Considerations for the otolaryngologist". International journal of pediatric otorhinolaryngology. doi:10.1016/j.ijporl.2015.04.032. PMID 25998217.
175. 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.
176. "Heart group: E-cigarettes might help smokers quit". WHEC-TV. A Hubbard Broadcasting Company. 25 August 2014.
177. 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.
178. 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.
179. Andrew Higgins (9 November 2013). "Aided by Army of 'Vapers', E-Cigarette Industry Woos and Wins Europe". The New York Times. Retrieved 22 November 2014.
180. Makiko Kitamura (19 February 2014). "Glaxo Memo Shows Drug Industry Lobbying on E-Cigarettes". Bloomberg News. Retrieved 22 November 2014.
181. Eliza Gray (27 February 2014). "Europe Sets New Rules for E-Cigs While the U.S. Drags Its Feet". Time (magazine). {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
182. "Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products". US FDA Federal Register. 25 April 2014.
183. Sabrina Tavernise (24 April 2014). "F.D.A. Will Propose New Regulations for E-Cigarettes". The New York Times.
184. Aleisha Orr (26 June 2014). "E-cigarette message goes up in smoke". WAtoday.
185. "E-cigarettes can appear in TV adverts, watchdog rules". BBC News Online. 9 October 2014.
186. Alex Bell (10 November 2014). "E-cigarette firm KiK to make TV history". Manchester Evening News.
187. "E-Cigarette use among children and young people: the need for regulation". Expert Rev Respir Med: 1–3. 2015. doi:10.1586/17476348.2015.1077120. PMID 26290119. {{cite journal}}: Unknown parameter |authors= ignored (help)
188. ^ Daniel Nasaw (5 December 2012). "Electronic cigarettes challenge anti-smoking efforts". BBC News Online.
189. ^ Duke, J. C.; Lee, Y. O.; Kim, A. E.; Watson, K. A.; Arnold, K. Y.; Nonnemaker, J. M.; Porter, L. (2014). "Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults". PEDIATRICS. 134 (1): e29–e36. doi:10.1542/peds.2014-0269. PMID 24918224.
190. "E-cigarettes and Lung Health". American Lung Association. 2015.
191. "E-Cigarette Myths and Facts". American Lung Association. 2015.
192. Born, H.; Persky, M.; Kraus, D. H.; Peng, R.; Amin, M. R.; Branski, R. C. (2015). "Electronic Cigarettes: A Primer for Clinicians". Otolaryngology – Head and Neck Surgery. doi:10.1177/0194599815585752. ISSN 0194-5998. PMID 26002957.
193. Wendy Koch. "E-cigarettes: No smoke, but fiery debate over safety". USA Today. Retrieved 20 July 2013.
194. Meera Senthilingam (23 March 2015). "E-cigarettes: Helping smokers quit, or fueling a new addiction?". CNN.
195. ^ Melissa Vonder Haar (28 May 2014). "Nielsen: Electronic Cigarette Dollar Sales Decline". CSP Magazine.
196. Tom Gara (14 April 2014). "Are E-Cigarettes Losing Ground in the Vapor Market?". The Wall Street Journal.
197. Owen Bennett Jones (6 April 2015). "California vaping: The new subculture". BBC News.
198. "E-cigarette industry booming in Saskatchewan". CBC News. 14 August 2014.
199. Aedan Helmer (6 April 2014). "E-cig retailers stand up to Health Canada". Ottawa Sun.
200. Scott Rollans (8 April 2013). "E-cigarette sales explode as Smoke NV dominates Canadian market". Rogers Media. Canadian Business. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
201. 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.
202. ^ Sanchez Manning (29 July 2013). "British American Tobacco enters electronic cigarette market in Britain with the 'Vype'". The Independent.
203. Gideon Spanier (26 June 2014). "Philip Morris buys e-cigarette maker Nicocigs as it warns of falling profits". The Independent.
204. Joe Lenane (24 March 2014). "Nicolites and Vivid Dominate E-cigarette Market". National Federation of Retail Newsagents.
205. Celestine Bohlen (21 October 2013). "In France, an E-Cigarette Bubble?". The New York Times.
206. ^ Angelique Chrisafis (28 May 2013). "France considers electronic cigarette ban in public places". The Guardian.
207. "BAT unit to market nicotine inhaler". Tobacco Journal International. 2011.
208. Mark Odell (12 September 2014). "British American Tobacco nicotine inhaler wins regulatory approval". Financial Times. Retrieved 18 September 2014.
209. Michael Felberbaum (26 May 2011). "Philip Morris Int'l buys rights to nicotine system". The Boston Globe. The Associated Press.
210. "New smoking cessation therapy proves promising". Esciencenews.com. 27 February 2010. Retrieved 27 August 2013.
211. Harriet Hernando (26 June 2014). "Now it's the Marlboro HeatStick: Cigarette maker Philip Morris to sell new product that heats tobacco rather than burning it". Mail Online.
212. ^ Will Yakowicz (10 June 2015). "This Silicon Valley Company Just Raised $47 Million to Smoke Cigarette Makers". Inc. (magazine).
213. Brad Stone (21 November 2013). "Ploom's E-Cigarettes and Vaporizers Use Real Tobacco". Bloomberg Businessweek.
214. Melissa Vonder Haar (11 March 2015). "PAX Labs CEO Teases 'Fundamentally Different' E-Cigarette". CSP Magazine.
215. Candice Nguyen (1 February 2014). "'E-Hookah' Debuts in San Diego Amid Critics". NBCUniversal.
216. Sativa Galore (29 January 2012). "THC e-Cig Goes to Market". The Daily Chronic.
217. Gaspard Glanz (17 December 2014). "'E-Hookah' Debuts in San Diego Amid Critics". Vice.
218. Alexandra Ma (11 August 2015). "This Is What It's Like To Vape Caffeine". The Huffington Post.

External links

• Media related to Electronic cigarettes at Wikimedia Commons

• Cigarette types
• Chinese inventions
• Smoking cessation
• 2003 introductions
• Electronic cigarettes