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It has been suggested that Electronic cigars be merged into this article. (Discuss) Proposed since May 2013.

Electronic cigarettea, also known as an e-cigarettes, personal vaporisers (PV), or electronic nicotine delivery systems (ENDS) are electronic inhalers that vaporise a liquid solution into an aerosol mist, simulating the act of tobacco smoking. Electronic cigarettes are no longer marketed as smoking cessation aids or tobacco replacement in most countries. There may be similarities between conventional and some electronic cigarettes in the physical design and the nicotine release, which may approximate the same amount of nicotine as a conventional cigarette. There are many electronic cigarettes that do not resemble conventional cigarettes at all.

The benefits and risks of electronic cigarette use are uncertain as they have been poorly studied. The World Health Organization recommends against making claims that they are safer than cigarettes or that they help with stopping smoking. Laws vary widely concerning the use and sale of electronic cigarettes and accompanying liquid solutions, with pending legislation and ongoing debate.

Health effects

As of July 2013 no rigorous studies have been conducted showing that electronic cigarette are safe or that they are effective as nicotine replacement therapy. However, the health effects of e-cigarettes need to be kept in the context that users of e-cigarettes tend to use fewer tar-containing cigarettes. Proponents of electronic cigarettes often claim that electronic cigarettes deliver the experience of smoking while eliminating the smell and health risks associated with tobacco smoke.

Smoking cessation

A number of organization have concluded that there is limited or no evidence to support the use electronic cigarettes for stopping smoking or decreasing the amount smoked including: the World Health Organization in July 2013, the National Institute for Health and Care Excellence in June 2013, and the British Medical Association (BMA).

The World Health Organization does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid, but insisted that claims that electronic cigarettes can help smokers quit need to be backed up by clinical studies. The BMA had concerns that the use of e-cigarettes may undermine smoking prevention and cessation by reinforcing the normalcy of cigarette use in public and workplaces.

A 2011 study found that they may aid in smoking cessation. The American Association of Public Health Physicians (AAPHP) view electronic cigarettes as similar to other nicotine replacement therapy and recommend them as a harm reduction method for those who have failed to quit by other means.

Toxicity

Tentative evidence supports that electronic cigarettes are safer than real cigarettes and possibly as safe as other nicotine replacement products.

There are concerns of nicotine poisoning with misuse. The electronic systems appear to usually deliver less nicotine than smoking.

They may contain ingredients that are known to be toxic to humans. The U.S. Food and Drug Administration (FDA) states that, as no evidence was submitted to them, they have no way of knowing if they are safe, which chemicals they contain, or how much nicotine people are inhaling. One study of one brand of product concluded that carcinogens and toxicants are present only below harmful levels: "Based on the manufacturer’s information, the composition of the cartridge liquid is not hazardous to health, if used as intended."

Diethylene glycol, a poisonous and hygroscopic liquid, was detected in one of the cartridges manufactured by Smoking Everywhere. Tobacco-specific nitrosamines (TSNAs), known cancer-causing agents, were detected in all of the cartridges from one brand and two of the cartridges from the other brand. Nicotine can also be traced in some claimed nicotine-free cartridges.Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device. In some e-cigarettes, "Tobacco-specific impurities suspected of being harmful to humans—anabasine,myosmine, and β-nicotyrine—were detected in a majority of the samples tested." It is not clear if these chemicals were detectable in exhaled vapour.

Trace amounts of 'volatile organic compounds', namely formaldehyde, as well as traces of ketones, mercury and tetramethylpyrazine, have been found in electronic cigarette vapour, but the quantities are significantly smaller than the quantities found in tobacco smoke and do not pose a significant health risk.

Addiction

Concerns have been raised regarding the risk of addiction. In July 2009, the FDA raised concerns that electronic cigarettes may be marketed to young people.

Components

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An electronic cigarette contains three essential components: a plastic cartridge that serves as a mouthpiece and a reservoir for liquid, an "atomizer" that vaporises the liquid, and a battery.

Cartridge

The cartridge, a small plastic, glass or metal container with openings at each end, serves as both a liquid reservoir and mouthpiece. It allows the passage of liquid into the atomizer, and vapour from the atomizer to the user's mouth, without any leakage of liquid into the mouth.

Most models utilise a plastic sponge to keep the liquid in place, but it is common to find a refillable tank that holds the liquid, with a separate tunnel connecting to the atomizer. When the liquid is depleted, users can refill it or replace with another ready filled cartridge. Some users forgo liquid reservoirs and drip liquid directly onto the atomizer in a method known as "dripping".

A single cartridge can have the same number of puffs as 20 cigarettes.

Atomizer

The atomizer contains a small heating coil that vaporizes the liquid, and generally consists of a simple filament and wicking metal mesh or silica wick to draw the liquid in. It is positioned in the center of the three components that make up the entire electronic cigarette cylinder: the cartridge attaches to one end, and the power unit to the other. The atomizer's filament will lose efficiency over time due to a build-up of sediment, or it "burns out" entirely, requiring replacement. In some models, the cartridge and atomizer component are integrated into what is known as a cartomizer.

Cartomizer

The term cartomizer describes the combination of atomizer and cartridge in the same unit. A cartomizer consists of a heating element surrounded by a poly-foam soaked in the liquid. This combination is mainly used in the devices that are manufactured to look like cigarettes, and is covered by Gamucci's patent.

When the cartomizer has been used it can simply be disposed of and replaced with a new one. This is much easier than having to refill your cartridge and clean and replace the atomizer every now and then.

Battery

Most portable power contain a lithium-ion rechargeable battery which makes up the largest component of an electronic cigarette. The battery may contain an electronic airflow sensor: activation is triggered simply by drawing breath through the device. Other models come with a power switch, which must be held during operation. A LED to announce activation may also be equipped in the front of the power unit casing.

Batteries are usually charged via an AC outlet, car charger socket or USB. Some manufacturers also offer a cigarette pack-like portable charging case (PCC), which contains a larger battery to charge smaller batteries of individual e-cigarettes.

Liquid

Liquid for producing vapour in electronic cigarettes, known as e-juice or e-liquid, is a solution of propylene glycol(PG) and/or vegetable glycerin (VG) and/or polyethylene glycol 400 (PEG400) mixed with concentrated flavors, and optionally, a variable percentage of a liquid nicotine concentrate.

The solution is often sold in a bottle or in disposable cartridges. Many manufacturers offer dozens of flavors which resemble the taste of regular tobacco, menthol, vanilla, coffee, cola and variousfruits, but nicotine concentrations vary by manufacturer. The standard notation "mg/ml" is often used in labelling, sometimes shortened to a simple "mg" (milligram). Nicotine-free solutions are also common.

Some electronic cigarette users prefer to make their own e-juice in a form known as "DIY".

Most e-liquids do not contain beta-carboline alkaloids found in tobacco along with nicotine.

Kits

There are dozens of e-cigarette models which are sold online and in stores, all under hundreds of different brand names. Most electronic cigarette users initially purchase starter kits that contain a battery, USB charger and a selection of cartomizers (cartridges). Some kits also include a portable charging case (PCC).

Disposables

In addition to the kits, there are disposable electronic cigarettes which were first invented and bought to market by the Gamucci brand in 2008. These feature a battery, atomizer, and cartridge all in one piece. Unlike the kits, the entire electronic cigarette is discarded when the cartridge becomes empty. Disposable electronic cigarettes are typically marketed to those new to the electronic cigarette market.

Usage

In the United States as of 2011 about one in five adults who smoke have tried electronic cigarettes. Sales have increased from 50,000 in 2008 to 3.5 million in 2012.

History

The earliest electronic cigarette can be traced to Herbert A. Gilbert, who in 1963 patented a device described as "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air." This device heated the nicotine solution and produced steam. In 1967, Gilbert was approached by several companies interested in manufacturing it, but it was never commercialized and disappeared from the public record after 1967.

Hon Lik, a Chinese pharmacist, is widely credited with the invention of the first generation electronic cigarette. In 2000, he came up with the idea of using a piezoelectric ultrasound-emitting element to vaporise a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution. This design produces a smoke-like vapour that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs. He also proposed using propylene glycol to dilute nicotine and placing it in a disposable plastic cartridge which serves as a liquid reservoir and mouthpiece. These inventions are the basis of the present-day electronic cigarettes.

The device was first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. The company that Hon Lik worked for, Golden Dragon Holdings, changed its name to Ruyan (如烟, literally "Resembling smoking"), and started exporting its products in 2005–2006 before receiving its first international patent in 2007.

Legal history

Because of the relative novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation and public health investigations are currently pending in many countries. As flavored tobacco cigarettes (except menthol) have been banned in the US, and roll-your-own (RYO) products are seeing massive increases in taxes (e.g., Iowa), electronic cigarettes remain a viable alternative to tobacco for many Americans.

European Union

The EU Directive 2001/95/EC(6) on general product safety, applies in so far as there are no specific provisions with the same objective in other EU law. This directive provides for restrictive or preventive measures to be taken if the product is found to be dangerous to the health and safety of consumers.

Whether electronic cigarettes could be regarded as falling under Directive 93/42/EEC on medical devices depends on the claimed intended use and whether this intended use has a medical purpose. "It is for each national authority to decide, account being taken of all the characteristics of the product, whether it falls within the definition of a medicinal product by its function or presentation."

Because of this vague EU position, member countries in the European Economic Area currently have varying rules.

United States

Individual states have differing legal treatment of electronic cigarettes.

On 22 September 2009, under the authorization of the Family Smoking Prevention and Tobacco Control Act, the FDA banned flavored tobacco (with the notable exception of menthol cigarettes) due to its potential appeal to children. Wagner says that the use of flavorings, such as chocolate, could encourage childhood use and serve as a gateway to cigarette smoking.

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

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

Concerns about public safety have been raised. However, some former smokers say they have been helped by e-cigarettes, and scientists at the University of California, Berkeley said that e-cigarettes had great potential for reducing the morbidity and mortality related to smoking.

Legal status

The regulation of electronic cigarettes varies globally, as of 2011, from some countries having no regulation to others banning the devices.

The European Economic Area

• In Austria nicotine-containing cartridges are classified as medicinal products and e-cigarettes for nicotine inhalation as medical devices.
• In the Czech Republic, the use, sale and advertising of electronic cigarettes is legal.
• In Denmark, the Danish Medicines Agency classifies electronic cigarettes containing nicotine as medicinal products. Thus, authorization is required before the product may be marketed and sold, and no such authorization has currently been given. The agency has clarified, however, that electronic cigarettes that do not administer nicotine to the user, and are not otherwise used for the prevention or treatment of disease, are not considered medicinal devices. The use of electronic cigarettes has not been prohibited in Copenhagen Airport, but at least one airline (Scandinavian Airlines) has decided to ban their use on board flights.
• In Estonia, It is legal to buy nicotine containing e-liquids for personal use from another citizen or from outside the country as long as the package is sent as a private citizen and contains no more than 100ml of e-liquid per month (up to 500ml at a time). The nicotine amount within the e-liquid is unregulated. Commercial sale of nicotine containing e-liquid is illegal, commercial sale of electronic cigarette hardware and non nicotine e-liquids is legal.
• In Finland, the National Supervisory Authority of Welfare and Health (Valvira) declared that the new tobacco marketing ban (effective 1 January 2012) will also cover electronic cigarettes, resulting in that Finnish stores or webstores can't advertise e-cigarettes because they might look like regular cigarettes. In theory, e-cigarettes with nicotine-free cartridges may still be sold, as long as their images and prices are not visible. Ordering from abroad remains allowed. Sale of nicotine cartridges is currently prohibited, as nicotine is considered a prescription drug requiring an authorization that such cartridges do not yet have. However, the Finnish authorities have decided that nicotine cartridges containing less than 10 mg nicotine, and e-liquid containing less than 0,42 g nicotine per bottle, may be legally brought in from other countries for private use. If the nicotine content is higher, a prescription from a Finnish physician is required. From a country within the European Economic Area a maximum of one year's supply may be brought in for private use when returning to Finland, while three months' supply may be brought in from outside the EEA. Mail order deliveries from EEA countries, for a maximum of three months' supply, are also allowed.
• In Germany, sale of electronic cigarettes and nicotine-containing cartridges is not forbidden. The electronic cigarette ban outspoken by the health minister of NRW on the press conference on 16 December 2011 is not a legally binding ban but merely exercised free speech.
• In Ireland, the sale and use of electronic cigarettes is legal. As they are not considered a tobacco product, they can be displayed where on sale along with prices.
• In Italy, by a Health Ministry decree (G.U. Serie Generale, n. 248 del 23 ottobre 2012) electronic cigarettes containing nicotine cannot be sold to individuals under 16 years old.
• In Latvia, the Ministry of Health has warned that the e-cigarette can cause harm to cardiovascular, hepatic and renal systems, however, e-cigarettes are legal, and are sold in most shopping centers and at Riga's airport, as well as via the internet to individuals at least 18 years old.
• In the Netherlands, use and sale of electronic cigarettes is allowed, but advertising is forbidden pending European Union legislation.
• In Norway electronic cigarettes and nicotine can only be imported from other EEA member states (e.g. the UK) for private use.
• In Poland, the sale and use of electronic cigarettes are legal.
• In Portugal, the sale and use of electronic cigarettes are legal.
• In the United Kingdom, the use, sale and advertising of electronic cigarettes is legal. Electronic cigarettes are also allowed to be used inside pubs, coffee shops, etc. where the smoking of tobacco is illegal.

United States

• California Governor Arnold Schwarzenegger vetoed a bill that would regulate the sale of electronic cigarettes within the state on grounds that "if adults want to purchase and consume these products with an understanding of the associated health risks, they should be able to do so."
• In 2009, New Jersey voted to treat the electronic cigarette in the same category as tobacco products by including under the New Jersey Smoke Free Air Act. Assemblywoman Connie Wagner sponsored the legislation arguing that they "looked like the real thing"; she also objected to the potential appeal of flavored electric cigarettes to children.
• The sale of electronic cigarettes to minors in New Hampshire was legal. A group of students and a group called "Breathe New Hampshire" were concerned that electronic cigarettes will serve as a gateway to smoking cigarettes through appearing to be trendy: one compared electronic cigarettes to "having a new cell phone. It’s cool. It’s electronic." They launched petitions to the state government to ban the sale of electronic cigarettes to minors. It is now illegal to sell e-cigarettes to minors as of July 2010.
• Arizona has a planned ban of selling electronic cigarettes to minors.
• In Washington, the King County board of health has banned smoking of electronic cigarettes in public places, and prohibited sales to minors. Neighboring Pierce County also prohibits sales to minors, but allows e-cigarette use in places such as bars and workplaces.
• In Maryland HB1272 was introduced by Delegate Aruna Miller and was passed by the General Assembly that bans the sale of electronic cigarettes to minors.
• In Oregon in February 2012, Continental Airlines flight 1118 was diverted back to its airport of origin when an unruly passenger with unspecified mental disorders refused to stop using his e-cigarette. The passenger was detained by fellow passengers and later pled guilty to charges of interfering with a flight crew. FAA had not ruled on E-cigarette use on airplanes at the time of the incident, but airlines were and are permitted to establish their own more-restrictive policies on E-cigarette use on planes; Continental (now United Airlines) has a company policy banning them.
• In Iowa in 2012, the Linn County commissioners approved a decision to regulate the retail sale of electronic cigarettes like tobacco cigarettes. As a result of this decision, retailers who sell electronic cigarettes to persons in Linn County are required to have a retail tobacco license.
• New York State banned the smoking of e-cigarettes within 100 feet of a public or private school entrance in September 2012, and banned e-cigarette sales to minors starting on 1 January 2013.

Other countries

• In Australia, the Federal Department of Health and Ageing classifies every form of nicotine, except for replacement therapies and cigarettes, as a form of poison. In the state of Victoria, the Therapeutic Goods Administration has said that there were no laws preventing the importation of e-cigarettes bought over the internet for personal use, unless prohibited by state and territory legislation.
• In Brazil, the sale, importation and advertising of any kind of electronic cigarette is forbidden. The Brazilian health and sanitation federal agency, Anvisa, found the current health safety assessments about e-cigarettes to not be yet satisfactory for commercial approval eligibility.
• In Canada, as of March 2009, while the importation, sale, and advertising of electronic cigarettes containing nicotine is not endorsed, the products may be sold and used. Health Canada has advised Canadian consumers not to purchase or use any electronic smoking products, citing the prohibition of electronic smoking products containing tobacco in the Food and Drugs Act. Canadian Customs now confiscate any parcel containing e-cigarettes with nicotine and notify the receiving party via a mail letter. The parcel is returned to the sender only at the request of the receiving party or otherwise destroyed.
• In China, the sale and use of electronic cigarettes is legal.
• In Egypt, the Egyptian Ministry of Health technical committee has rejected applications for marketing authorization of electronic cigarettes on the grounds that they contain harmful chemicals, and lack safety and toxicity data.
• In Hong Kong the sale and possession of nicotine-based electronic cigarettes, classified as a Type I Poison, is governed under the Pharmacy and Poisons Ordinance. Sale or possession is not authorized and both are considered punishable with a fine of up to HK$100,000 and/or a prison term of 2 years. However, the law does not cover any non-nicotine inhalers.
• In India, the use of electronic cigarettes is currently legal. Under the Indian Health Law of 2006, tobacco smoking has been banned in public. Since e-cigarettes avoid the use of tobacco, they do not fall under this law.
• In Lebanon, the council of ministers has banned the sale and use of electronic cigarettes, starting 21 September 2011.
• In Malaysia, the sale of e-cigarettes is an offence under the Poisons Act 1952 and the Control of Drugs and Cosmetics Regulations 1984. Those found guilty of selling and distributing the product (as well as liquid nicotine for use in electronic cigarettes) will be fined no more than RM3,000, be jailed for no more than two years, or both. The Malaysian Health Minister stated that e-cigarettes containing liquid nicotine is more harmful than normal cigarettes and warned Malaysians to avoid them.
• In Mexico, the Federal Commission for the Protection Against Sanitary Risks, announced that according to Mexican Law, the selling and promotion of non-tobacco objects that include elements generally associated with tobacco products are forbidden.
• In Nepal, under current cigarette laws, the use and sale of e-cigarettes is permitted.
• In New Zealand, the Ministry of Health has ruled that the Ruyan e-cigarette falls under the requirements of the Medicines Act, and cannot be sold except as a registered medicine. Since the ruling, Ruyan has obtained registration, and sale is currently allowed in pharmacies.
• In Pakistan, the import and sale of electronic cigarettes is legal, but Pakistan Medical and Dental council find that the current health safety assessments of e-cigarettes to not yet be satisfactory.
• In Panama, the importation, distribution and sale of electronic cigarettes have been prohibited since June 2009. The Ministry of Health cites the FDA findings as their reasoning for the ban.
• In Singapore, the sale and importation of electronic cigarettes, even for personal consumption, is illegal. According to Health Minister Khaw Boon Wan, electronic cigarettes are the industry's attempt to attract new users and were marketed to appeal to younger customers, including women.
• In South Korea, the sale and use of electronic cigarettes is legal, but is heavily taxed. Electric cigarette possession among teenagers remains an issue.
• In Switzerland, the sale of nicotine-free electronic cigarettes is legal. The use and importation of electronic cigarettes containing nicotine is legal, but they cannot be sold within the country. As of December 2011, the tobacco tax does not apply to e-cigarettes and respective liquids containing nicotine.

Other non-tobacco nicotine inhalation technologies

There are other technologies currently under development which seek to deliver nicotine for oral inhalation which simultaneously mimic the ritualistic and behavioural aspects of traditional cigarettes.

Propellant-based nicotine delivery

An alternative nicotine delivery platform based on existing asthma inhaler technology is under development by a UK-based healthcare company, Kind Consumer Limited. The technology is currently under development and the company has submitted a Marketing Authorisation Application to the UK MHRA for licensing of the technology as an approved nicotine containing product. The technology is under licence to Nicoventures Limited a subsidiary of British American Tobacco who are responsible for the launch and commercialisation of the technology as an approved nicotine replacement therapy product.

Nicotine pyruvate technology

Philip Morris International bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University. The technology is based around the chemical reaction between nicotine acid and a base which produces a nicotine pyruvate vapour for inhalation. It has undergone preliminary clinical evaluation which has shown delivery of nicotine to the lungs.

See also

• Electronic hookah

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External links

• Media related to Electronic cigarettes at Wikimedia Commons
• FDA information page on electronic cigarettes

Further reading

• Erbach, Gregor. "Electronic cigarettes" (PDF). Library Briefing. Library of the European Parliament. Retrieved 27 March 2013.

• Articles to be merged from May 2013
• Use dmy dates from November 2012
• 2003 introductions
• Chinese inventions
• Cigarette types
• Smoking
• Smoking cessation
• Tobacco