Electronic Cigarettes

Electronic cigarettes (also known as e-cigarettes, vaping devices or vapes, electronic nicotine delivery systems, or other nicknames) rapidly grew in popularity after the first international patent was issued in 2007. Originally marketed as devices for smoking cessation, over the years they acquired a more fashionable status and became commonly available in retail stores and through websites. With their increased popularity, electronic cigarettes attracted scrutiny from health and consumer organizations regarding their actual effectiveness as tobacco replacement devices. The debate on the health hazards linked to e-cigarettes is still in flux, although several research studies have determined that they are harmful to human lungs. Because of the uncertain consequences of electronic cigarettes, legislation varies greatly from country to country. Different options may include the complete ban of the product, age restrictions on its sale, or prohibition against its advertising.

Overview

Electronic cigarettes are devices that vaporize nicotine or non-nicotine solutions that are then inhaled by the smoker. This gives the smoker a similar experience to that of tobacco but without the combustion and therefore the smoke of a traditional cigarette, which contains numerous harmful chemicals. In electronic cigarettes, the vaporization is not induced by the process of combustion, but by a battery-activated atomizer that heats up the liquid solution contained in a cartridge (also called mouthpiece), thus producing the vapor that can be inhaled. These liquid solutions may or may not contain nicotine, which is diluted into propylene glycol. In reusable models, atomizers are usually replaced every five or six months, while batteries are usually lithium-ion and rechargeable. Some electronic cigarettes have the shape of a tobacco cigarette, cigar, or pipe, while others look like USB flash drives or have varying shapes that may look nothing like a traditional smoking product. Some use technology that allows for the cigarette to automatically switch on its battery and activate the atomizer as the smoker starts to inhale, while others have an on/off button.

A precursor to the electronic cigarette dates back to the 1960s, when Herbert A. Gilbert announced a patent for a smokeless cigarette that used heated and flavored air rather than burning tobacco. Several companies expressed interest in the product, but in the end companies such as RJ Reynolds abandoned the idea and no one commercialized the patent. A Chinese pharmacist, Hon Lik, started to develop the prototype for the modern electronic cigarette in 2000, coming up with the idea of diluting nicotine into a propylene glycol solution. Lik worked for Golden Dragon Holdings, which initially commercialized the product only for the Chinese market, marketing it as a device for smoking cessation in 2004. The company obtained an international patent in 2007 and began marketing the product worldwide.

Electronic cigarettes quickly boomed in popularity, attracting considerable attention from the media and from public health organizations in the 2010s. The CDC reported in 2015 that in 2014, e-cigarette use among adults increased approximately 12.6%. However, the number of American middle- and high-school students who regularly used electronic cigarettes tripled between 2013 and 2014. This was the first time since 2011, when the CDC began collecting data on e-cigarettes, that e-cigarette use by middle- and high-school students surpassed their use of traditional tobacco products. The most common product used by high schoolers in 2014 were e-cigarettes. Traditional cigarette use declined for this age group during this period but remained unchanged for middle-school students.

Proponents of electronic cigarettes claimed that they were less harmful than regular cigarettes and other traditional tobacco products, and could help smokers quit. Some studies did provide a degree of support for these claims, but health experts increasingly found that electronic cigarettes still were harmful and also might attract nonsmokers. Critics warned that the liquid solutions were unregulated and could include a variety of potentially harmful substances without the consumer's knowledge. Many products still contain the addictive power of nicotine, nitrosamines (a type of carcinogenic that is also found in traditional cigarettes), and the toxin dietylene glycol. In addition, users of electronic cigarettes seem to develop an increased airway resistance, which is damaging to the lungs, and according to the director of the US Centers for Disease Control and Prevention (CDC), exposure to nicotine at a young age can affect brain development. Concerns over the health hazards of electronic cigarettes especially focused on their possible appeal to children and teenagers for their flavored solutions.

In addition to bans on traditional tobacco products, several US states enacted age restrictions for purchase and use of e-cigarettes as well as restrictions on areas in which e-cigarettes can be used. For instance, several states prohibit the use of a vapor product or e-liquid on any school grounds or school-sponsored events (including colleges and universities) and in or on the grounds of daycare and healthcare facilities. In May 2016, the US Department of Health and Human Services and the Food and Drug Administration (FDA) announced an amendment to the Federal Food, Drug, and Cosmetic Act that redefined the term "tobacco product." In this amendment, e-cigarettes, hookahs (water pipes through which flavored tobacco is smoked), pipe tobacco, and premium and small cigars were considered tobacco products, which allowed the federal government to evaluate and regulate proposed, new, and currently available products and devices. For example, any state with an age restriction on the sale of cigarettes would have to apply the same restriction to the purchase of the amended products. Also, products would have to be manufactured and sold with child-resistant packaging and health warnings would have to be included on the packaging. The amendment became effective in August 2016. The regulations did not effect advertising or use of flavors in tobacco products, however.

Though in-depth reports or consistent statistics on such incidents were not regularly maintained, cases of exploding e-cigarettes and subsequent injuries also led to concern regarding the safety of the batteries and power mechanisms used on the devices. While relatively rare, e-cigarette explosions had been linked to two deaths in early 2019. By October 2019, the CDC and the FDA were also reporting an outbreak across several states of severe respiratory illness believed to be linked to the use of e-cigarettes. According to the CDC, over 1,800 cases of what was being referred to as e-cigarette, or vaping, product use associated lung injury had been reported from forty-nine states, and approximately thirty-seven deaths had been confirmed. The organizations also reported finding that tetrahydrocannabinol (THC), the active ingredient in cannabis (marijuana), was present in many of the cases. As concerns over such illnesses grew, some states, including Rhode Island, New York, and Michigan, instituted bans on the sales of flavored e-cigarette products, some of which were challenged. Massachusetts put a contested four-month ban on the sale of all vaping products in place. Some critics of such bans expressed concerns that people with nicotine addictions would then smoke cigarettes or purchase e-cigarettes from unregulated sources.

Growing Popularity Among Youth

The use of electronic cigarettes by young people attracted much scrutiny through the 2010s and into the 2020s. In 2014, 9.2 percent of high school students said they had smoked cigarettes within the previous thirty days, which was a decrease from 2011 figures. Analysts agree that the decrease was due in part to the growing popularity of e-cigarettes among adolescents and teenagers. Among high school students in 2014, 13.4 percent said that they had smoked an e-cigarette within the last month. This was a notable increase from the 1.5 percent reported in 2011. Among middle schoolers in 2014, 2.5 percent reported having smoked a cigarette within the past month, and 3.9 percent reported having smoked an e-cigarette. Overall, these numbers represented a decline in cigarette smoking, but an increase overall in tobacco product use because of the increasing popularity and availability of e-cigarettes among young people. A study published by the University of California, San Francisco, in January 2017 reported that not only had e-cigarettes not contributed to a decline in smoking among US youth, e-cigarettes had actually led to an increase in smoking rates among what was considered a low-risk group: youths who would normally have not used nicotine products if e-cigarettes were not available. According to statistics from the CDC, in 2018, 3.6 million middle and high school students surveyed had used e-cigarettes within the previous thirty days.

By 2018, the FDA was growing increasingly concerned about the continued rise in e-cigarette use among American youth, and the availability and advertising of a variety of flavors for the products were considered a driving factor. In addition to beginning the Youth Tobacco Prevention Plan, the regulatory organization sent letters to several of the most prominent producers of e-cigarettes, including Juul and Vuse, warning them that their products must have appropriate labeling and should not be targeting youths. In 2020, the FDA finalized a new policy banning prefilled e-cigarette cartridges with any flavor other than tobacco or menthol unless given specific approval. It subsequently took action against several companies for selling unauthorized electronic cigarettes and flavored liquids meant to appeal to young people.

CDC figures showed e-cigarette use among US middle and high school students declined significantly from 2019 to 2020. However, 19.6 percent of high school students and 4.7 percent of middle school students still reported current use of e-cigarettes. Over 80 percent of those using the products reported using flavored liquids.

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