Electronic cigarette

An electronic cigarette or e-cigarette is a handheld battery-powered vaporizer that simulates smoking by providing some of the behavioral aspects of smoking, including the hand-to-mouth action of smoking, but without burning tobacco. Using an e-cigarette is known as 'vaping' and the user is referred to as a 'vaper.' Instead of cigarette smoke, the user inhales an aerosol, commonly called vapor. E-cigarettes typically have a heating element that atomizes a liquid solution called e-liquid. E-cigarettes are automatically activated by taking a puff; others turn on manually by pressing a button. Some e-cigarettes look like traditional cigarettes, but they come in many variations. Most versions are reusable, though some are disposable. There are first-generation, second-generation, third-generation, and fourth-generation devices. E-liquids usually contain propylene glycol, glycerin, nicotine, flavorings, additives, and differing amounts of contaminants. E-liquids are also sold without propylene glycol, nicotine, or flavors. The benefits and the health risks of e-cigarettes are uncertain. There is tentative evidence they may help people quit smoking, although they have not been proven to be more effective than smoking cessation medicine. There is concern with the possibility that non-smokers and children may start nicotine use with e-cigarettes at a rate higher than anticipated than if they were never created. Following the possibility of nicotine addiction from e-cigarette use, there is concern children may start smoking cigarettes. Youth who use e-cigarettes are more likely to go on to smoke cigarettes. Their part in tobacco harm reduction is unclear, while another review found they appear to have the potential to lower tobacco-related death and disease. Regulated US Food and Drug Administration nicotine replacement products may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products. It is estimated their safety risk to users is similar to that of smokeless tobacco. The long-term effects of e-cigarette use are unknown. The risk from serious adverse events is low. Less serious adverse effects include abdominal pain, headache, blurry vision, throat and mouth irritation, vomiting, nausea, and coughing. Nicotine itself is associated with some health concerns. E-cigarettes create vapor made of fine and ultrafine particles of particulate matter, which have been found to contain propylene glycol, glycerin, nicotine, flavors, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other substances. Its exact composition varies across and within manufacturers, and depends on the contents of the liquid, the physical and electrical design of the device, and user behavior, among other factors. E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke. E-cigarette vapor contains fewer toxic chemicals, and lower concentrations of potential toxic chemicals than cigarette smoke. The vapor is probably much less harmful to users and bystanders than cigarette smoke, although concern exists that the exhaled vapor may be inhaled by non-users, particularly indoors. Since their entrance to the market in 2003, global use has risen exponentially. In a 2014 survey, about 13% of American high school students reported using them at least once in the previous month, and in 2015 around 10% of American adults were users. In the UK, users have increased from 700,000 in 2012 to 2.6 million in 2015. About 60% of UK users are smokers and about 40% are ex-smokers, while use among never-smokers in the UK is negligible. Most still use traditional cigarettes, raising concern that dual use may 'delay or deter quitting'. Most peoples' reason for using e-cigarettes involve trying to quit smoking, though a large proportion use them recreationally. It is commonly stated that the modern e-cigarette was invented in 2003 by Chinese pharmacist Hon Lik, but tobacco companies have been developing nicotine aerosol generation devices since as early as 1963. As of 2018 most e-cigarettes were made in China. Because of overlap with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries. The revised EU Tobacco Products Directive came into effect May 2016, providing regulation for e-cigarettes. As of August 2016, the FDA extended its regulatory power to include e-cigarettes. Large tobacco companies have greatly increased their marketing efforts. As of 2014, there were 466 brands of e-cigarettes, with global sales of around $7 billion. Since their introduction to the market in 2003, global usage of e-cigarettes has risen exponentially. By 2013, there were several million users globally. Awareness and use of e-cigarettes greatly increased over the few years leading up to 2014, particularly among young people and women in some parts of the world. A 2013 four-country survey found there was generally greater awareness among white adult smokers compared with non-white ones. Vaping is increasing in the majority of high-income countries. E-cigarette use in the US and Europe is higher than in other countries, except for China which has the greatest number of e-cigarette users. Growth in the US had reportedly slowed in 2015, lowering market forecasts for 2016. Growth in the UK as of January 2018 had reportedly slowed since 2013. The growing frequency of e-cigarette use may be due to heavy promotion in youth-driven media channels, their low cost, and the misbelief that e-cigarettes are safer than traditional cigarettes, according to a 2016 review. Surveys in 2010 and 2011 suggested that adults with higher incomes were more likely to have heard of e-cigarettes, but those with lower incomes may have been more likely to try them. Most users had a history of smoking regular cigarettes, while results by race were mixed. At least 52% of smokers or ex-smokers have used an e-cigarette. Of smokers who have, less than 15% become everyday e-cigarette users. Though e-cigarette use among those who have never smoked is very low, it continues to rise. Daily vapers are typically recent former smokers. E-cigarettes are commonly used among non-smokers. This includes young adult non-smokers. Vaping is the largest among adults between 18 and 24 years of age, and use is the largest among adults who do not have a high school diploma. Young adults who vape but do not smoke are more than twice as likely to intend to try smoking than their peers who do not vape. A worldwide survey of e-cigarette users conducted in 2014 found that only 3.5% of respondents used liquid without nicotine. Greater than 10 million people vape daily, as of 2018. Everyday use is common among e-cigarette users. E-cigarette users mostly keep smoking traditional cigarettes. Adults often vape to replace tobacco. Most vapers still use nicotine liquids after stopping smoking for several months. Most e-cigarette users are middle-aged men who also smoke traditional cigarettes, either to help them quit or for recreational use. Older people are more likely to vape for quitting smoking than younger people. Men were found to use higher nicotine doses, compared with women who were vaping. Gender was found to be a predictor of current e-cigarette use with males being significantly more likely to declare having already tried it than females. Among young adults e-cigarette use is not regularly associated with trying to quit smoking. The research indicates that the most common way people try to quit smoking in the UK is with e-cigarettes. Dual use of e-cigarettes and traditional tobacco is still a definite concern. Dual use of e-cigarettes with cigarettes is the most frequent pattern. One-time e-cigarette use seems to be higher in people with greater levels of educational achievement. Women smokers who are poorer and did not finish high school are more likely to have tried vaping at least once. Vocational school career, lower school performance, being out of school, and studying at a disadvantaged school have been shown to be associated with both e-cigarette ever use and e-cigarette daily use. Vaping is increasing among people with cancer who are frequent smokers.