Electronic cigarette#E-liquid

The mixture used in vapor products such as e-cigarettes is called e-liquid.{{cite journal|last1=Jankowski|first1=Mateusz|last2=Brożek |first2=Grzegorz |last3=Lawson|first3=Joshua|last4=Skoczyński|first4=Szymon|last5=Zejda|first5=Jan |title=E-smoking: Emerging public health problem?|journal=International Journal of Occupational Medicine and Environmental Health|volume=30 |issue=3|pages=329–344|year=2017|issn=1232-1087|doi=10.13075/ijomeh.1896.01046|pmid=28481369|doi-access=free}} E-liquid formulations vary widely. A typical e-liquid is composed of propylene glycol and glycerin (95%) and a combination of flavorings, nicotine, and other additives (5%).{{cite journal |last1=England|first1=Lucinda J.|last2=Bunnell|first2=Rebecca E.|last3=Pechacek|first3=Terry F.|last4=Tong|first4=Van T.|last5=McAfee|first5=Tim A.|title=Nicotine and the Developing Human|journal=American Journal of Preventive Medicine|year=2015|volume=49|issue=2|pages=286–93|issn=0749-3797|doi=10.1016/j.amepre.2015.01.015|pmc=4594223|pmid=25794473}}{{cite journal|last1=Jimenez Ruiz|first1=CA|last2=Solano Reina|first2=S|last3=de Granda Orive|first3=JI|last4=Signes-Costa Minaya|first4=J|last5=de Higes Martinez|first5=E|last6=Riesco Miranda|first6=JA|last7=Altet Gómez|first7=N|last8=Lorza Blasco|first8=JJ|last9=Barrueco Ferrero|first9=M|last10=de Lucas Ramos|first10=P|title=The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes|journal=Archivos de Bronconeumologia|date=August 2014|volume=50|issue=8|pages=362–7|doi=10.1016/j.arbres.2014.02.006|pmid=24684764}} The flavorings may be natural, artificial,{{cite journal|last1=Bertholon|first1=J.F.|last2=Becquemin|first2=M.H.|last3=Annesi-Maesano|first3=I.|last4=Dautzenberg|first4=B.|title=Electronic Cigarettes: A Short Review|journal=Respiration|year=2013|issn=1423-0356 |volume=86|issue=5|pages=433–8|doi=10.1159/000353253|pmid=24080743|doi-access=free}} or organic.{{cite news|author1=Dan Nosowitz|title=America's First Certified Organic E-Cigarette Vaping Liquid Is Here|url=http://modernfarmer.com/2015/06/americas-first-certified-organic-e-cigarette-vaping-liquid-is-here/|publisher=Modern Farmer|date=5 June 2015}} Over 80 harmful chemicals such as formaldehyde and metallic nanoparticles have been found in e-liquids at trace quantities.{{cite journal|last1=Thirión-Romero|first1=Ireri|last2=Pérez-Padilla|first2=Rogelio |last3=Zabert|first3=Gustavo|last4=Barrientos-Gutiérrez|first4=Inti |title=Respiratory Impact of Electronic Cigarettes and Low-Risk Tobacco|journal=Revista de investigación Clínica|volume=71|issue=1|pages=17–27|year=2019 |issn=0034-8376|doi=10.24875/RIC.18002616|pmid=30810544 |doi-access=free|s2cid=73511138}} There are many e-liquid manufacturers,{{cite web |url=http://www.richmond.com/business/local/article_9f65201a-94c0-51b1-9663-f9fbb5c522af.html |title=Avail Vapor offers glimpse into the 'art and science' of e-liquids|author=John Reid Blackwell|publisher=Richmond Times-Dispatch|date=7 June 2015}} and more than 15,000 flavors.{{cite journal|last1=Henry|first1=Travis S.|last2=Kligerman|first2=Seth J.|last3=Raptis|first3=Constantine A.|last4=Mann |first4=Howard|last5=Sechrist|first5=Jacob W.|last6=Kanne|first6=Jeffrey P. |title=Imaging Findings of Vaping-Associated Lung Injury|journal=American Journal of Roentgenology|volume=214|issue=3|year=2020|pages=498–505 |issn=0361-803X|doi=10.2214/AJR.19.22251|pmid=31593518|s2cid=203985885}}

Many countries regulate what e-liquids can contain. In the US, there are Food and Drug Administration (FDA) compulsory manufacturing standards{{cite web |url=https://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/Manufacturing/default.htm|title=Manufacturing|publisher=United States Food and Drug Administration|date=12 August 2016}} and American E-liquid Manufacturing Standards Association (AEMSA) recommended manufacturing standards.{{Cite book|title=E-Liquid Manufacturing Standards|url=http://www.aemsa.org/wp-content/uploads/2015/09/AEMSA-Standards-v2.3.pdf|location=US|publisher=American E-Liquid Manufacturing Standards Association (AEMSA)|date=4 September 2015|pages=1–13}} European Union standards are published in the EU Tobacco Products Directive.{{cite journal|last1=Famele|first1=M.|last2=Ferranti|first2=C.|last3=Abenavoli|first3=C.|last4=Palleschi|first4=L.|last5=Mancinelli|first5=R.|last6=Draisci|first6=R.|title=The Chemical Components of Electronic Cigarette Cartridges and Refill Fluids: Review of Analytical Methods|journal=Nicotine & Tobacco Research|volume=17|issue=3|year=2014|pages=271–279|issn=1462-2203|doi=10.1093/ntr/ntu197|pmc=5479507 |pmid=25257980}}

In 2019 a study found that the metal coils of e-cigarettes can leach metal into the e-liquid leading to permanent lung damage in some cases. Research has shown that higher voltages generate more heat and release more toxic substances into the e-liquid. Vaping cannabis usually involves higher temperatures than nicotine.{{cite news |title=Toxic metal, leached from e-cigarette coil, permanently scars woman's lung |website=NBC News |url=https://www.nbcnews.com/health/vaping/toxic-metal-leached-e-cigarette-coil-permanently-scars-woman-s-n1095156}}

File:9 - Estimated Trends in the Worldwide Number of Vapers.png

Since entering the market around 2003, e-cigarette use has risen rapidly.{{cite journal|last1=Bourke|first1=Liam|last2=Bauld|first2=Linda|last3=Bullen |first3=Christopher |last4=Cumberbatch|first4=Marcus|last5=Giovannucci|first5=Edward|last6=Islami |first6=Farhad|last7=McRobbie|first7=Hayden|last8=Silverman|first8=Debra T.|last9=Catto|first9=James W.F. |title=E-cigarettes and Urologic Health: A Collaborative Review of Toxicology, Epidemiology, and Potential Risks|journal=European Urology|volume=71|issue=6|pages=915–923|year=2017|issn=0302-2838|doi=10.1016/j.eururo.2016.12.022|pmid=28073600|hdl=1893/24937 |hdl-access=free |url=http://dspace.stir.ac.uk/bitstream/1893/24937/1/E-cigarettes_review%20091216.pdf}}{{cite journal|last1=Schraufnagel|first1=Dean E.|last2=Blasi|first2=Francesco |last3=Drummond|first3=M. Bradley|last4=Lam|first4=David C. L.|last5=Latif|first5=Ehsan|last6=Rosen |first6=Mark J.|last7=Sansores|first7=Raul|last8=Van Zyl-Smit|first8=Richard|title=Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies|journal=American Journal of Respiratory and Critical Care Medicine|volume=190|issue=6|year=2014|pages=611–618|issn=1073-449X|doi=10.1164/rccm.201407-1198PP |pmid=25006874 |s2cid=43763340 |url=https://figshare.com/articles/journal_contribution/10758143}} In 2011 there were about 7 million adult e-cigarette users globally, increasing to 68 million in 2020 compared with 1.1 billion cigarette smokers.{{Cite web|last=Shapiro|first=Harry|date=2020|title=Burning Issues: The Global State of Tobacco Harm Reduction |url=https://gsthr.org/resources/item/burning-issues-global-state-tobacco-harm-reduction-2020}} There was a further rise to 82 million e-cigarette users in 2021.{{cite web |title=82 million vapers worldwide in 2021: the GSTHR estimate |url=https://gsthr.org/briefing-papers/82-million-vapers-worldwide-in-2021-the-gsthr-estimate/ |website=Global State of Tobacco Harm Reduction |access-date=13 November 2022}} This increase has been attributed to targeted marketing, lower cost compared to conventional cigarettes, and the better safety profile of e-cigarettes compared to tobacco.{{cite journal |last1=Camenga|first1=Deepa R.|last2=Klein|first2=Jonathan D.|title=Tobacco Use Disorders|journal=Child and Adolescent Psychiatric Clinics of North America|volume=25|issue=3|year=2016|pages=445–460|issn=1056-4993 |doi=10.1016/j.chc.2016.02.003|pmc=4920978|pmid=27338966}} E-cigarette use is highest in China, the US, and Europe, with China having the most users.{{cite journal |last1=Cai|first1=Hua|last2=Wang|first2=Chen|title=Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns|journal=Redox Biology|volume=13|year=2017|pages=402–406|issn=2213-2317 |doi=10.1016/j.redox.2017.05.013|pmc=5493817|pmid=28667909}}

File:Reasons for initiating e-cigarette use (EU 2018).jpg, in a 2018 Eurobarometer poll{{cite news |url=https://www.europeandatajournalism.eu/index.php/eng/News/Data-news/Lung-cancer-deaths-on-the-rise-in-two-thirds-of-European-countries|title=Lung cancer deaths on the rise in two thirds of European countries |last1=Aguilar|first1=Carmen|publisher=VoxEurop/The European Data Journalism Network (EDJNet)|date=11 June 2018}}]]

There are varied reasons for e-cigarette use.{{cite journal|last1=Rahman|first1=Muhammad|last2=Hann|first2=Nicholas|last3=Wilson|first3=Andrew|last4=Worrall-Carter|first4=Linda|title=Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues|journal=Tobacco Induced Diseases|volume=12|issue=1|year=2014|pages=21|doi=10.1186/1617-9625-12-21|pmc=4350653|pmid=25745382 |doi-access=free }} Most users are trying to quit smoking, but a large proportion of use is recreational or as an attempt to get around smoke-free laws. Many people vape because they believe vaping is safer than smoking.{{cite journal|last1=Tomashefski|first1=A|title=The perceived effects of electronic cigarettes on health by adult users: A state of the science systematic literature review.|journal=Journal of the American Association of Nurse Practitioners|volume=28|issue=9|pages=510–515|date=21 March 2016|doi=10.1002/2327-6924.12358|pmid=26997487|s2cid=42900184}}{{cite journal|last1=Wang|first1=Meng|last2=Wang|first2=Jian-Wei|last3=Cao|first3=Shuang-Shuang|last4=Wang|first4=Hui-Qin|last5=Hu|first5=Ru-Ying |title=Cigarette Smoking and Electronic Cigarettes Use: A Meta-Analysis|journal=International Journal of Environmental Research and Public Health|volume=13|issue=1|year=2016|pages=120|issn=1660-4601|doi=10.3390/ijerph13010120 |pmc=4730511|pmid=26771624|doi-access=free}}{{sfn|McNeill|2018|p=178}} The wide choice of flavors and lower price compared to cigarettes are also important factors.{{cite journal |last1=Hefner|first1=Kathryn|last2=Valentine|first2=Gerald|last3=Sofuoglu|first3=Mehmet|title=Electronic cigarettes and mental illness: Reviewing the evidence for help and harm among those with psychiatric and substance use disorders|journal=The American Journal on Addictions|volume=26|issue=4|pages=306–315|year=2017|issn=1055-0496|doi=10.1111/ajad.12504|pmid=28152247|s2cid=24298173}}{{PD-notice}}

Other motivations include reduced odor and fewer stains.{{cite journal|last1=Gibson|first1=Laura A.|last2=Creamer|first2=MeLisa R.|last3=Breland|first3=Alison B.|last4=Giachello|first4=Aida Luz |last5=Kaufman|first5=Annette|last6=Kong|first6=Grace|last7=Pechacek|first7=Terry F.|last8=Pepper|first8=Jessica K.|last9=Soule|first9=Eric K.|last10=Halpern-Felsher|first10=Bonnie|title=Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity|journal=Addictive Behaviors|volume=79|pages=219–225|year=2018|issn=0306-4603|doi=10.1016/j.addbeh.2017.11.017|pmc=5807230|pmid=29175027}} E-cigarettes also appeal to technophiles who enjoy customizing their devices.

The gateway hypothesis is the idea that using less harmful drugs can lead to more harmful ones.{{cite journal|last1=Lee|first1=Peter N|title=Appropriate and inappropriate methods for investigating the "gateway" hypothesis, with a review of the evidence linking prior snus use to later cigarette smoking|journal=Harm Reduction Journal|volume=12|issue=1|year=2015|pages=8|issn=1477-7517|doi=10.1186/s12954-015-0040-7|pmc=4369866|pmid=25889396 |doi-access=free }}{{CC-notice|cc=by4|url=https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-015-0040-7?optIn=false|author=Peter N Lee}} Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes.{{cite journal|last1=Baenziger|first1=Olivia|last2=Ford|first2=Laura|last3=Yazidjoglou|first3=Amelia|last4=Joshy|first4=Grace|last5=Banks |first5=Emily|title=E-cigarette use and combustible tobacco cigarette smoking uptake among non-smokers, including relapse in former smokers: umbrella review, systematic review and meta-analysis|journal=BMJ Open|volume=11 |issue=3|year=2021|pages=e045603|issn=2044-6055|doi=10.1136/bmjopen-2020-045603|pmid=33785493|pmc=8011717|url=https://bmjopen.bmj.com/content/11/3/e045603}}{{sfn|WHO|2014|p=6}}{{cite journal |last1=Franck|first1=C.|last2=Budlovsky|first2=T.|last3=Windle|first3=S. B.|last4=Filion|first4=K. B.|last5=Eisenberg|first5=M. J.|title=Electronic Cigarettes in North America: History, Use, and Implications for Smoking Cessation|journal=Circulation|volume=129|issue=19|year=2014|pages=1945–1952|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.113.006416|pmid=24821825|doi-access=free}}{{cite journal|last1=Yoong|first1=Sze Lin|last2=Hall|first2=Alix|last3=Turon|first3=Heidi|last4=Stockings|first4=Emily|last5=Leonard|first5=Alecia|last6=Grady|first6=Alice|last7=Tzelepis|first7=Flora|last8=Wiggers|first8=John |last9=Gouda|first9=Hebe|last10=Fayokun|first10=Ranti|last11=Commar|first11=Alison|last12=Prasad|first12=Vinayak M|last13=Wolfenden|first13=Luke |title=Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis|journal=PLOS ONE|volume=16|issue=9|year=2021|at=e0256044|pmid=34495974|pmc=8425526 |doi=10.1371/journal.pone.0256044|bibcode=2021PLoSO..1656044Y|eissn=1932-6203|doi-access=free}}{{excessive citations inline|date=December 2024}} People with mental illnesses, who as a group are more susceptible to nicotine addiction, are at particularly high risk of dual use.{{cite journal|last1=Dautzenberg|first1=B.|last2=Adler|first2=M.|last3=Garelik|first3=D.|last4=Loubrieu|first4=J.F.|last5=Mathern|first5=G.|last6=Peiffer|first6=G. |last7=Perriot|first7=J.|last8=Rouquet|first8=R.M.|last9=Schmitt|first9=A.|last10=Underner|first10=M.|last11=Urban|first11=T.|title=Practical guidelines on e-cigarettes for practitioners and others health professionals. A French 2016 expert's statement|journal=Revue des Maladies Respiratoires|volume=34|issue=2|pages=155–164|year=2017|issn=0761-8425|doi=10.1016/j.rmr.2017.01.001|pmid=28189437}}{{cite journal |last1=Nansseu|first1=Jobert Richie N.|last2=Bigna|first2=Jean Joel R.|title=Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa|journal=Pulmonary Medicine|volume=2016|year=2016|pages=1–9|issn=2090-1836|doi=10.1155/2016/4894352|pmc=5220510|pmid=28116156|doi-access=free}}{{CC-notice|cc=by4|url=https://www.hindawi.com/journals/pm/2016/4894352/|author(s)=Jobert Richie N. Nansseu and Jean Joel R. Bigna}}

However, an association between vaping and subsequent smoking does not necessarily imply a causal gateway effect.{{Cite journal |last=Etter |first=Jean-François |date=2017-06-19 |title=Gateway effects and electronic cigarettes: Gateway effects and e-cigarettes |url=https://onlinelibrary.wiley.com/doi/10.1111/add.13924 |journal=Addiction |language=en |volume=113 |issue=10 |pages=1776–1783 |doi=10.1111/add.13924|pmid=28786147 }} Instead, people may have underlying characteristics that predispose them to both activities.{{Cite journal |last1=Hall |first1=Wayne |last2=Chan |first2=Gary |date=2021-03-18 |title=The "gateway" effect of e-cigarettes may be explained by a genetic liability to risk-taking |journal=PLOS Medicine |language=en |volume=18 |issue=3 |pages=e1003554 |doi=10.1371/journal.pmed.1003554 |issn=1549-1676 |pmc=7971461 |pmid=33735167 |doi-access=free }}{{Cite journal |last1=Kozlowski |first1=Lynn T. |last2=Warner |first2=Kenneth E. |date=2017-05-01 |title=Adolescents and e-cigarettes: Objects of concern may appear larger than they are |url=https://www.sciencedirect.com/science/article/pii/S0376871617300236 |journal=Drug and Alcohol Dependence |language=en |volume=174 |pages=209–214 |doi=10.1016/j.drugalcdep.2017.01.001 |pmid=29350617 |issn=0376-8716}} There is a genetic association between smoking, vaping, gambling, promiscuity and other risk-taking behaviors.{{Cite journal |last1=Khouja |first1=Jasmine N. |last2=Wootton |first2=Robyn E. |last3=Taylor |first3=Amy E. |last4=Smith |first4=George Davey |last5=Munafò |first5=Marcus R. |date=2021-03-18 |title=Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study |journal=PLOS Medicine |language=en |volume=18 |issue=3 |pages=e1003555 |doi=10.1371/journal.pmed.1003555 |issn=1549-1676 |pmc=7971530 |pmid=33735204 |doi-access=free }} Young people with poor executive functioning use e-cigarettes, cigarettes, and alcohol at higher rates than their peers.{{Cite journal |last1=Pentz |first1=Mary Ann |last2=Shin |first2=HeeSung |last3=Riggs |first3=Nathaniel |last4=Unger |first4=Jennifer B. |last5=Collison |first5=Katherine L. |last6=Chou |first6=Chih-Ping |date=2015-03-01 |title=Parent, peer, and executive function relationships to early adolescent e-cigarette use: A substance use pathway? |journal=Addictive Behaviors |language=en |volume=42 |pages=73–78 |doi=10.1016/j.addbeh.2014.10.040 |pmid=25462657 |pmc=4292878 |issn=0306-4603}} E-cigarette users are also more likely to use both cannabis and unprescribed Adderall or Ritalin.{{Cite journal |last1=Bentivegna |first1=Kathryn |last2=Atuegwu |first2=Nkiruka C. |last3=Oncken |first3=Cheryl |last4=DiFranza |first4=Joseph R. |last5=Mortensen |first5=Eric M. |date=2021-01-01 |title=Electronic Cigarettes Associated With Incident and Polysubstance Use Among Youth |url=https://www.jahonline.org/article/S1054-139X(20)30278-0/abstract |journal=Journal of Adolescent Health |language=English |volume=68 |issue=1 |pages=123–129 |doi=10.1016/j.jadohealth.2020.05.026 |issn=1054-139X |pmid=32641242|s2cid=220435106 }} Longitudinal studies of e-cigarettes and smoking have been criticized for failing to adequately control for these and other confounding factors.{{Cite journal |last1=Chan |first1=Gary C. K. |last2=Stjepanović |first2=Daniel |last3=Lim |first3=Carmen |last4=Sun |first4=Tianze |last5=Shanmuga Anandan |first5=Aathavan |last6=Connor |first6=Jason P. |last7=Gartner |first7=Coral |last8=Hall |first8=Wayne D. |last9=Leung |first9=Janni |date=2020-09-04 |title=Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation |url=https://onlinelibrary.wiley.com/doi/10.1111/add.15246 |journal=Addiction |language=en |volume=116 |issue=4 |pages=743–756 |doi=10.1111/add.15246 |pmid=32888234 |s2cid=221503932 |issn=0965-2140 |quote=Only two studies comprehensively adjusted for confounding. The median E‐value was 2.90, indicating that the estimates were not robust against unmeasured confounding.}}{{Cite journal |last=Phillips |first=Carl V. |date=2015-05-21 |title=Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would) |journal=International Journal of Environmental Research and Public Health |language=en |volume=12 |issue=5 |pages=5439–5464 |doi=10.3390/ijerph120505439 |issn=1660-4601 |pmc=4454978 |pmid=26006122|doi-access=free }}{{Cite journal |last1=Khouja |first1=Jasmine N. |last2=Suddell |first2=Steph F. |last3=Peters |first3=Sarah E. |last4=Taylor |first4=Amy E. |last5=Munafò |first5=Marcus R. |date=2021-01-01 |title=Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis |url=https://tobaccocontrol.bmj.com/content/30/1/8 |journal=Tobacco Control |language=en |volume=30 |issue=1 |pages=8–15 |doi=10.1136/tobaccocontrol-2019-055433 |issn=0964-4563 |pmc=7803902 |pmid=32156694 |quote=None of the studies included negative controls which would provide stronger evidence for whether the association may be causal.}}

Smoking rates have continually declined as e-cigarettes have grown in popularity, especially among young people, suggesting that there is little evidence for a gateway effect at the population level. This observation has been criticized, however, for ignoring the effect of anti-smoking interventions.{{Cite journal |last1=Chapman |first1=Simon |last2=Bareham |first2=David |last3=Maziak |first3=Wasim |date=2019-04-17 |title=The Gateway Effect of E-cigarettes: Reflections on Main Criticisms |url=https://academic.oup.com/ntr/article/21/5/695/4962533 |journal=Nicotine & Tobacco Research |language=en |volume=21 |issue=5 |pages=695–698 |doi=10.1093/ntr/nty067 |issn=1469-994X |pmc=6468127 |pmid=29660054}}

Worldwide, increasing numbers of young people are vaping.{{Cite journal|title=The Vaping Epidemic in Adolescents|last1=Jones|first1=Kristen|last2=Salzman|first2=Gary A.|date=2020|journal=Missouri Medicine|issue=1|volume=117|pages=56–58|pmc=7023954 |pmid=32158051}}{{cite journal |last1=Schneider|first1=Sven|last2=Diehl|first2=Katharina|title=Vaping as a Catalyst for Smoking? An Initial Model on the Initiation of Electronic Cigarette Use and the Transition to Tobacco Smoking Among Adolescents|journal=Nicotine & Tobacco Research|volume=18|issue=5|year=2016|pages=647–653|issn=1462-2203 |doi=10.1093/ntr/ntv193 |pmid=26386472|doi-access=free}}{{cite journal|last1=Yoong |first1=Sze Lin|last2=Stockings|first2=Emily|last3=Chai|first3=Li Kheng|last4=Tzelepis|first4=Flora |last5=Wiggers|first5=John|last6=Oldmeadow |first6=Christopher|last7=Paul|first7=Christine|last8=Peruga |first8=Armando|last9=Kingsland|first9=Melanie|last10=Attia|first10=John|last11=Wolfenden|first11=Luke |title=Prevalence of electronic nicotine delivery systems (ENDS) use among youth globally: a systematic review and meta-analysis of country level data|journal=Australian and New Zealand Journal of Public Health|volume=42|issue=3|pages=303–308|year=2018|issn=1326-0200|pmid=29528527 |doi=10.1111/1753-6405.12777|doi-access=free}} With access to e-cigarettes, young people's tobacco use has dropped by about 75%.{{cite journal |last1=Levy |first1=David T. |last2=Warner |first2=Kenneth E. |last3=Cummings |first3=K. Michael |last4=Hammond |first4=David |last5=Kuo |first5=Charlene |last6=Fong |first6=Geoffrey T. |last7=Thrasher |first7=James F. |last8=Goniewicz |first8=Maciej Lukasz |last9=Borland |first9=Ron |title=Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check |journal=Tobacco Control |date=1 November 2019 |volume=28 |issue=6 |pages=629–635 |doi=10.1136/tobaccocontrol-2018-054446 |pmid=30459182 |pmc=6860409 |language=en |issn=0964-4563}}{{cite journal |last1=West |first1=Robert |last2=Brown |first2=Jamie |last3=Jarvis |first3=Martin |title=Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey reveal about high school e-cigarette use in the USA? (Preprint) |journal=Qeios |date=7 October 2019 |doi=10.32388/745076.3 |doi-access=free |issn=2632-3834 |url=https://www.qeios.com/read/article/391 |access-date=24 February 2020}}{{cite journal |last1=Hallingberg |first1=Britt |last2=Maynard |first2=Olivia M. |last3=Bauld |first3=Linda |last4=Brown |first4=Rachel |last5=Gray |first5=Linsay |last6=Lowthian |first6=Emily |last7=MacKintosh |first7=Anne-Marie |last8=Moore |first8=Laurence |last9=Munafo |first9=Marcus R. |last10=Moore |first10=Graham |title=Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales |journal=Tobacco Control |date=1 March 2020 |volume=29 |issue=2 |pages=207–216 |pmid=30936390 |pmc=7036293 |doi=10.1136/tobaccocontrol-2018-054584 |issn=0964-4563}}{{cite web |title=Historical NYTS Data and Documentation |publisher=Centers for Disease Control and Prevention |date=17 December 2019 |url=https://www.cdc.gov/tobacco/data_statistics/surveys/nyts/data/index.html |website=www.cdc.gov |access-date=24 February 2020}}{{excessive citations inline|date=December 2024}}

Most young e-cigarette users have never smoked,{{cite journal|last1=Zhong |first1=Jieming|last2=Cao|first2=Shuangshuang|last3=Gong|first3=Weiwei|last4=Fei|first4=Fangrong |last5=Wang|first5=Meng |title=Electronic Cigarettes Use and Intention to Cigarette Smoking among Never-Smoking Adolescents and Young Adults: A Meta-Analysis|journal=International Journal of Environmental Research and Public Health|volume=13|issue=5 |year=2016|pages=465|issn=1660-4601|pmc=4881090 |pmid=27153077|doi=10.3390/ijerph13050465|doi-access=free}} but there is a substantial minority who both vape and smoke.{{cite journal|last1=Grana |first1=R|author2=Benowitz, N|author3=Glantz, SA|title=E-cigarettes: a scientific review.|journal=Circulation|date=13 May 2014 |volume=129|issue=19|pages=1972–86|doi=10.1161/circulationaha.114.007667|pmc=4018182 |pmid=24821826}} Many young people who would not smoke are vaping.{{cite journal |last1=Modesto-Lowe|first1=Vania|last2=Alvarado|first2=Camille|title=E-cigs ... Are They Cool? Talking to Teens About E-Cigarettes|journal=Clinical Pediatrics|volume=56|issue=10|year=2017|pages=947–952 |issn=0009-9228|doi=10.1177/0009922817705188|pmid=28443340|s2cid=44423931}}{{cite journal |last1=Glantz|first1=Stanton A.|last2=Bareham|first2=David W. |title=E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications|journal=Annual Review of Public Health|volume=39|issue=1|pages=215–235|date=January 2018|issn=0163-7525|doi=10.1146/annurev-publhealth-040617-013757|doi-access=free |pmc=6251310|pmid=29323609}}{{CC-notice|cc=by4 |url=http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040617-013757 |author(s)=Stanton A. Glantz and David W. Bareham}} Young people who smoke tobacco or marijuana, or who drink alcohol, are much more likely to vape.{{cite journal |last1=Chadi|first1=Nicholas|last2=Schroeder|first2=Rachel|last3=Jensen|first3=Jens Winther|last4=Levy |first4=Sharon|title=Association Between Electronic Cigarette Use and Marijuana Use Among Adolescents and Young Adults |journal=JAMA Pediatrics|volume=173|issue=10|year=2019|pages=e192574|issn=2168-6203 |doi=10.1001/jamapediatrics.2019.2574|pmc=6692686|pmid=31403684}} Among young people who have tried vaping, most used a flavored product the first time.{{cite report |url=https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf |author=U.S. Department of Health and Human Services |title=E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General |place=Atlanta, GA |publisher=U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health |pages=1–298 |year=2016}}{{PD-notice}}{{cite journal|last1=Cormet-Boyaka|first1=Estelle|last2=Zare|first2=Samane|last3=Nemati |first3=Mehdi |last4=Zheng|first4=Yuqing|title=A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type|journal=PLOS ONE|volume=13|issue=3|year=2018|at=e0194145|issn=1932-6203|doi=10.1371/journal.pone.0194145|pmc=5854347|pmid=29543907|bibcode=2018PLoSO..1394145Z|doi-access=free}}{{CC-notice|cc=by4|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194145|author(s)=Samane Zare, Mehdi Nemati, and Yuqing Zheng}}

Vaping correlates with smoking among young people, even in those who would otherwise be unlikely to smoke.{{cite journal|last1=Chatterjee|first1=Kshitij|last2=Alzghoul|first2=Bashar|last3=Innabi|first3=Ayoub|last4=Meena|first4=Nikhil|title=Is vaping a gateway to smoking: a review of the longitudinal studies|journal=International Journal of Adolescent Medicine and Health|issue=3|year=2018|volume=30|issn=2191-0278|doi=10.1515/ijamh-2016-0033|pmid=27505084|s2cid=23977146}} Experimenting with vaping encourages young people to continue smoking. A 2015 study found minors had little resistance to buying e-cigarettes online. Teenagers may not admit to using e-cigarettes, but use, for instance, a hookah pen.{{cite journal|last1=Schraufnagel|first1=Dean E.|title=Electronic Cigarettes: Vulnerability of Youth|journal=Pediatric Allergy, Immunology, and Pulmonology|volume=28|issue=1|year=2015|pages=2–6|issn=2151-321X|doi=10.1089/ped.2015.0490|pmc=4359356|pmid=25830075}} As a result, self-reporting may be lower in surveys.

More recent studies show a trend of an increasing proportion of young people who use e-cigarettes. In 2018, 20% of high school students were using e-cigarettes. In 2020, however, this number increased to 50% of high school students reported to have used e-cigarettes.{{Cite journal |last1=Virgili |first1=Fabrizio |last2=Nenna |first2=Raffaella |last3=Ben David |first3=Shira |last4=Mancino |first4=Enrica |last5=Di Mattia |first5=Greta |last6=Matera |first6=Luigi |last7=Petrarca |first7=Laura |last8=Midulla |first8=Fabio |date=December 2022 |title=E-cigarettes and youth: an unresolved Public Health concern |journal=Italian Journal of Pediatrics |language=en |volume=48 |issue=1 |pages=97 |doi=10.1186/s13052-022-01286-7 |issn=1824-7288 |pmc=9194784 |pmid=35701844 |doi-access=free }} Similarly, in Canada, there has been trend showing 29% of young people reporting to have used e-cigarettes in 2017, increasing to 37% in 2018.{{Cite journal |last1=Sun |first1=Jiahong |last2=Xi |first2=Bo |last3=Ma |first3=Chuanwei |last4=Zhao |first4=Min |last5=Bovet |first5=Pascal |date=April 2022 |title=Prevalence of E-Cigarette Use and Its Associated Factors Among Youths Aged 12 to 16 Years in 68 Countries and Territories: Global Youth Tobacco Survey, 2012‒2019 |journal=American Journal of Public Health |language=en |volume=112 |issue=4 |pages=650–661 |doi=10.2105/AJPH.2021.306686 |issn=0090-0036 |pmc=8961851 |pmid=35319939}}

{{main|Health effects of electronic cigarettes}}

The health risks of e-cigarettes are not known for certain, but the risk of serious adverse events is thought to be low,{{cite journal|last1=Paley|first1=Grace L.|last2=Echalier |first2=Elizabeth|last3=Eck|first3=Thomas W.|last4=Hong|first4=Augustine R.|last5=Farooq|first5=Asim V.|last6=Gregory|first6=Darren G.|last7=Lubniewski|first7=Anthony J.|title=Corneoscleral Laceration and Ocular Burns Caused by Electronic Cigarette Explosions|journal=Cornea|volume=35|issue=7|year=2016|pages=1015–1018|issn=0277-3740|doi=10.1097/ICO.0000000000000881|pmc=4900417|pmid=27191672}}{{cite journal |last1=Bals |first1=Robert |last2=Boyd |first2=Jeanette |last3=Esposito |first3=Susanna |last4=Foronjy |first4=Robert |last5=Hiemstra |first5=Pieter |last6=Jiménez-Ruiz |first6=Carlos A. |last7=Katsaounou |first7=Paraskevi |last8=Lindberg |first8=Anne |last9=Metz |first9=Carlos |last10=Schober |first10=Wolfgang |last11=Spira |first11=Avrum |last12=Blasi |first12=Francesco |date=February 2019 |title=Electronic cigarettes: a task force report from the European Respiratory Society |journal=European Respiratory Journal |volume=53 |issue=2 |pages=1801151 |doi=10.1183/13993003.01151-2018 |issn=0903-1936 |pmid=30464018 |s2cid=53711734 |quote="The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out." |doi-access=free}} and e-cigarettes are likely safer than combusted tobacco products.{{#tag:ref|A 2019 review concluded that, "no long term vaping toxicological/safety studies have been done in humans; without these data, saying with certainty that e-cigarettes are safer than combustible cigarettes is impossible."{{cite journal|last1=Gotts|first1=Jeffrey E|last2=Jordt|first2=Sven-Eric|last3=McConnell|first3=Rob|last4=Tarran|first4=Robert|title=What are the respiratory effects of e-cigarettes?|journal=BMJ|volume=366|year=2019|pages=l5275|issn=0959-8138|doi=10.1136/bmj.l5275|pmid=31570493|pmc=7850161|doi-access=free}}|group=note}} However, this does not mean that e-cigarettes are harmless. E-cigarette use is associated with increased risk of chronic obstructive pulmonary disease, asthma, chronic bronchitis, and emphysema. Those who use e-cigarettes daily have higher risk than those who use them occasionally.{{cite journal |title=Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017 |journal=American Journal of Preventive Medicine |author1=Albert D. Osei |author2=Mohammadhassan Mirbolouk |author3=Olusola A. Orimoloye |author4=Omar Dzaye |author5=S.M. Iftekhar Uddin |author6=Emelia J. Benjamin |author7=Michael E. Hall |author8=Andrew P. DeFilippis |author9=Aruni Bhatnagar |author10=Shyam S. Biswal |author11=Michael J. Blaha |date=January 1, 2020 |volume=58 |issue=3 |pages=336–332 |doi=10.1016/j.amepre.2019.10.014|pmid=31902685 |pmc=9843649 }} According to the National Academies of Sciences, Engineering, and Medicine, "Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes." Randomized controlled trials provide "high-certainty" evidence that e-cigarettes containing nicotine are more effective than nicotine replacement therapy for discontinuing tobacco smoking, and moderate‐certainty evidence that they are more effective than e-cigarettes free of nicotine.{{#tag:ref|Two of the authors of this study received funding from Pfizer, which manufactures nicotine replacement therapy products.|group=note}}

Some of the most common but less serious adverse effects include abdominal pain, headache, blurry vision,{{cite journal|last1=Breland|first1=Alison B.|last2=Spindle|first2=Tory|last3=Weaver|first3=Michael|last4=Eissenberg|first4=Thomas |title=Science and Electronic Cigarettes|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=223–233|issn=1932-0620|doi=10.1097/ADM.0000000000000049|pmc=4122311|pmid=25089952}} throat and mouth irritation, vomiting, nausea, and coughing. Nicotine is addictive and harmful to fetuses, children, and young people.{{Cite web |last=CDC |date=2025-01-31 |title=Health Effects of Vaping |url=https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html |access-date=2025-04-01 |website=Smoking and Tobacco Use |language=en-us}} In 2019 and 2020, an outbreak of severe vaping lung illness in the US was strongly linked to vitamin E acetate by the CDC. While it is still widely debated which particular component of vape liquid is the cause of illness, vitamin E acetate, specifically, has been identified as a potential culprit in vape-related illnesses.{{cite journal|last1=Boudi|first1=F Brian|last2=Patel|first2=Sonia|last3=Boudi|first3=Ava|last4=Chan|first4=Connie|title=Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness|journal=Cureus|volume=11|issue=12|pages=e6350|year=2019|issn=2168-8184|doi=10.7759/cureus.6350|doi-access=free |pmc=6952050|pmid=31938636}}{{CC-notice|cc=by3|url=https://www.cureus.com/articles/25498-vitamin-e-acetate-as-a-plausible-cause-of-acute-vaping-related-illness|author(s)=F Brian Boudi, Sonia Patel, Ava Boudi, Connie Chan}} There was likely more than one cause of the outbreak.{{cite journal|last1=King|first1=Brian A.|last2=Jones|first2=Christopher M.|last3=Baldwin|first3=Grant T.|last4=Briss |first4=Peter A.|title=The EVALI and Youth Vaping Epidemics — Implications for Public Health|journal=New England Journal of Medicine|volume=382|issue=8|pages=689–691|year=2020|issn=0028-4793|doi=10.1056/NEJMp1916171 |pmid=31951683|pmc=7122126|doi-access=free}}{{cite web |date=17 January 2020 |title=Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products |url=https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html |publisher=Centers for Disease Control and Prevention}}

E-cigarettes produce similar levels of particulates to tobacco cigarettes.{{Cite journal|last1=Li|first1=Liqiao|last2=Lin|first2=Yan|last3=Xia|first3=Tian|last4=Zhu|first4=Yifang|date=7 January 2020|title=Effects of Electronic Cigarettes on Indoor Air Quality and Health |journal=Annual Review of Public Health|volume=41|pages=363–380|doi=10.1146/annurev-publhealth-040119-094043|pmid=31910714|pmc=7346849|issn=0163-7525|doi-access=free}} There is "only limited evidence showing adverse respiratory and cardiovascular effects in humans", with the authors of a 2020 review calling for more long-term studies on the subject. E-cigarettes increase the risk of asthma by 40% and chronic obstructive pulmonary disease by 50% compared to not using nicotine at all.{{Cite journal|last1=Wills|first1=Thomas A.|last2=Soneji|first2=Samir S.|last3=Choi|first3=Kelvin|last4=Jaspers|first4=Ilona |last5=Tam|first5=Elizabeth K.|date=10 October 2020|title=E-cigarette Use and Respiratory Disorder: An Integrative Review of Converging Evidence from Epidemiological and Laboratory Studies|journal=European Respiratory Journal|volume=56|issue=5|pages=363–380|doi=10.1183/13993003.01815-2019|pmid=33154031|pmc=7817920|issn=1399-3003|doi-access=free}}

The British Royal College of Midwives states: "While vaping devices such as electronic cigarettes (e-cigs) do contain some toxins, they are at far lower levels than found in tobacco smoke. If a pregnant woman who has been smoking chooses to use an e-cig and it helps her to quit smoking and stay smokefree, she should be supported to do so." Based on the available evidence on e-cigarette safety, there was also "no reason to believe that use of an e-cig has any adverse effect on breastfeeding." The statement went on to say, "vaping should continue, if it is helpful to quitting smoking and staying smokefree". The UK National Health Service says: "If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke." Many women who vape continue to do so during pregnancy because of the perceived safety of e-cigarettes compared to tobacco.{{cite journal|last1=Qasim|first1=Hanan|last2=Karim|first2=Zubair A.|last3=Rivera|first3=Jose O.|last4=Khasawneh|first4=Fadi T.|last5=Alshbool|first5=Fatima Z.|title=Impact of Electronic Cigarettes on the Cardiovascular System|journal=Journal of the American Heart Association|volume=6|issue=9|year=2017|pages=e006353|issn=2047-9980|doi=10.1161/JAHA.117.006353|pmc=5634286|pmid=28855171}}

In one of the few studies identified, a 2015 survey of 316 pregnant women in a Maryland clinic found that the majority had heard of e-cigarettes, 13% had used them, and 0.6% were current daily users. These findings are of concern because the dose of nicotine delivered by e-cigarettes can be as high or higher than that delivered by traditional cigarettes.

Data from two states in the Pregnancy Risk Assessment System (PRAMS) show that in 2015—roughly the mid-point of the study period—10.8% of the sample used e-cigarettes in the three months prior to the pregnancy while 7.0%, 5.8%, and 1.4% used these products at the time of the pregnancy, in the first trimester, and at birth respectively.{{cite journal |last1=Kapaya |first1=Martha |title=Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth — Oklahoma and Texas, 2015 |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |doi=10.15585/mmwr.mm6808a1 |date=2019|volume=68 |issue=8 |pages=189–194 |pmid=30817748 |pmc=6394383 }} According to National Health Interview Survey (NHIS) data from 2014 to 2017, 38.9% of pregnant smokers used e-cigarettes compared to only 13.5% of non-pregnant, reproductive age women smokers.{{cite journal |last1=Liu |first1=Buyun |last2=Xu |first2=Guifeng |last3=Rong |first3=Shuang |last4=Santillan |first4=Donna A. |last5=Santillan |first5=Mark K. |last6=Snetselaar |first6=Linda G. |last7=Bao |first7=Wei |title=National Estimates of e-Cigarette Use Among Pregnant and Nonpregnant Women of Reproductive Age in the United States, 2014-2017 |journal=JAMA Pediatrics |date=2019 |volume=173 |issue=6 |pages=600–602 |doi=10.1001/jamapediatrics.2019.0658 |pmid=31034001 |pmc=6547070 |issn=2168-6211}} A health economic study found that passing an e-cigarette minimum legal sale age law in the United States increased teenage prenatal smoking by 0.6 percentage points and had no effect on birth outcomes.{{cite journal |last1=Pesko |first1=Michael F. |last2=Currie |first2=Janet M. |title=E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers |journal=Journal of Health Economics |date=1 July 2019 |volume=66 |pages=71–90 |pmid=31121389 |pmc=7051858 |doi=10.1016/j.jhealeco.2019.05.003 |issn=0167-6296}} Nevertheless, additional research needs to be done on the health effects of electronic cigarette use during pregnancy.{{harvnb|National Academies of Sciences, Engineering, and Medicine|2018|loc=[https://nap.nationalacademies.org/read/24952/chapter/18 13 Developmental and Reproductive Effects]}}

According to the CDC, E-cigarettes are not safe during pregnancy. "Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby's brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby."{{Cite web |url= https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/e-cigarettes-pregnancy.htm |title=E-Cigarettes and Pregnancy |website=Centers for Disease Control |date=March 2019}}

A popular vaporizer named Juul was widely used by American young people until 2022, when the FDA banned its products from sale.{{cite news |last1=Sampath |first1=Uday |last2=Tanna |first2=Shivani |last3=Sharma |first3=Akriti |title=Juul ban put on hold as FDA starts additional review |url=https://www.reuters.com/business/healthcare-pharmaceuticals/juul-gets-temporary-reprieve-us-fda-ban-2022-07-06/ |access-date=15 January 2023 |work=Reuters |date=6 July 2022}}{{cite news|url=https://www.washingtontimes.com/news/2018/apr/25/juul-maker-popular-e-cigarettes-invests-30m-youth-/|title=JUUL, maker of popular e-cigarettes, invests $30M in youth awareness|author=Laura Kelly and Tom Howell Jr.|work=The Washington Times|date=25 April 2018}} Close to 80% of respondents in a 2017 Truth Initiative study aged 15–24 reported using Juul also used the device in the last 30 days.{{cite journal|last1=Willett|first1=Jeffrey G|last2=Bennett|first2=Morgane|last3=Hair|first3=Elizabeth C|last4=Xiao|first4=Haijuan |last5=Greenberg |first5=Marisa S|last6=Harvey|first6=Emily|last7=Cantrell|first7=Jennifer|last8=Vallone|first8=Donna |title=Recognition, use and perceptions of JUUL among youth and young adults|journal=Tobacco Control |volume=28|issue=1|pages=tobaccocontrol–2018–054273|date=18 April 2018|doi=10.1136/tobaccocontrol-2018-054273|pmid=29669749|s2cid=4953543|url=https://truthinitiative.org/sites/default/files/Recognition-use-and-perceptions-of-JUUL-among-youth-and-young-adults.pdf|archive-date=7 December 2018|archive-url=https://web.archive.org/web/20181207152101/https://truthinitiative.org/sites/default/files/Recognition-use-and-perceptions-of-JUUL-among-youth-and-young-adults.pdf|url-status=dead}} In the 2010s, US teenagers used the verb "Juuling" to describe vaping, and Juuling was the subject of widespread memes on social media.{{cite news |url=https://www.nytimes.com/2018/04/07/style/the-juul-is-too-cool.html|title=The Juul Is Too Cool |last1=Barshad|first1=Amos|work=The New York Times|date=7 April 2018}}

File:Effects of vaping compared to smoking (raster).pngDetailed reference list is located at a separate image page.|alt=Switching from tobacco to vaping may reduce weight gain after smoking cessation, increase exercise tolerance, reduce exposure to toxic chemicals, and reduce risk of death. Vaping may reduce shortness of breath, reduce coughing, reduce spitting, and reduce sore throat compared to tobacco.]]

Harm reduction refers to any reduction in harm from a prior level. Harm minimization strives to reduce harms to the lowest achievable level. When a person does not want to quit nicotine, harm minimization means striving to eliminate tobacco exposure by replacing it with vaping.{{cite journal|last1=Abrams|first1=David B.|last2=Glasser|first2=Allison M. |last3=Pearson|first3=Jennifer L.|last4=Villanti|first4=Andrea C.|last5=Collins|first5=Lauren K.|last6=Niaura|first6=Raymond S.|title=Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives|journal=Annual Review of Public Health|volume=39|issue=1|year=2018|pages=193–213|issn=0163-7525|doi=10.1146/annurev-publhealth-040617-013849|pmid=29323611|pmc=6942997}}{{CC-notice|cc=by4 |url=https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040617-013849|author(s)=David B. Abrams, Allison M. Glasser, Jennifer L. Pearson, Andrea C. Villanti, Lauren K. Collins, and Raymond S. Niaura}} E-cigarettes can reduce smokers' exposure to carcinogens and other toxic chemicals found in tobacco.{{cite journal|last1=Weaver|first1=Michael|last2=Breland|first2=Alison |last3=Spindle|first3=Tory |last4=Eissenberg|first4=Thomas|title=Electronic Cigarettes|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=234–240|issn=1932-0620|pmc=4123220|pmid=25089953 |doi=10.1097/ADM.0000000000000043}}

Tobacco harm reduction has been a controversial area of tobacco control. Health advocates have been slow to support a harm reduction method out of concern that tobacco companies cannot be trusted to sell products that will lower the risks associated with tobacco use. A large number of smokers want to reduce harm from smoking by using e-cigarettes. The argument for harm reduction does not take into account the adverse effects of nicotine. There cannot be a defensible reason for harm reduction in children who are vaping with a base of nicotine.{{cite journal|last1=Ferkol|first1=Thomas W.|last2=Farber|first2=Harold J.|last3=La Grutta|first3=Stefania|last4=Leone|first4=Frank T.|last5=Marshall|first5=Henry M.|last6=Neptune|first6=Enid |last7=Pisinger|first7=Charlotta|last8=Vanker|first8=Aneesa|last9=Wisotzky|first9=Myra|last10=Zabert|first10=Gustavo E.|last11=Schraufnagel|first11=Dean E.|title=Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies|journal=European Respiratory Journal|volume=51|issue=5|year=2018|pages=1800278|issn=0903-1936|doi=10.1183/13993003.00278-2018|pmid=29848575|doi-access=free}} Quitting smoking is the most effective strategy to tobacco harm reduction.{{cite journal|last1=Scherer|first1=Gerhard|title=Suitability of biomarkers of biological effects (BOBEs) for assessing the likelihood of reducing the tobacco related disease risk by new and innovative tobacco products: A literature review|journal=Regulatory Toxicology and Pharmacology|volume=94|year=2018|pages=203–233|issn=0273-2300|doi=10.1016/j.yrtph.2018.02.002 |pmid=29428304}}

Tobacco smoke contains 100 known carcinogens and 900 potentially cancer-causing chemicals, but e-cigarette vapor contains less of the potential carcinogens than found in tobacco smoke.{{cite journal |last1=Oh|first1=Anne Y.|last2=Kacker|first2=Ashutosh|title=Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke|journal=The Laryngoscope|date=December 2014|volume=124|issue=12|pages=2702–2706|doi=10.1002/lary.24750|pmid=25302452|s2cid=10560264|doi-access=free}} A study in 2015 using a third-generation device found levels of formaldehyde were greater than with cigarette smoke when adjusted to a maximum power setting.{{sfn|Wilder|2016|p=82}} E-cigarettes cannot be considered safe because there is no safe level for carcinogens.{{cite journal|first2=M. |last1=Cahn|first1=Z.|last2=Siegel|title=Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?|journal=Journal of Public Health Policy|date=February 2011 |volume=32|issue=1|pages=16–31|doi=10.1057/jphp.2010.41|pmid=21150942|doi-access=free}} Due to their similarity to traditional cigarettes, e-cigarettes could play a valuable role in tobacco harm reduction. The public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals.

The core concern is that smokers who could have quit entirely will develop an alternative nicotine addiction. Dual use may be an increased risk to a smoker who continues to use even a minimal amount of traditional cigarettes, rather than quitting. Because of the convenience of e-cigarettes, it may further increase the risk of addiction.{{Cite journal |last1=Warner |first1=Kenneth E. |last2=Kiessling |first2=Karalyn A. |last3=Douglas |first3=Clifford E. |last4=Liber |first4=Alex C. |date=2022-09-01 |title=A Proposed Policy Agenda For Electronic Cigarettes In The US: Product, Price, Place, And Promotion: Policy Insight offers a proposed agenda for electronic cigarettes in the United States: product, price, place, and promotion. |url=http://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00187 |journal=Health Affairs |language=en |volume=41 |issue=9 |pages=1299–1306 |doi=10.1377/hlthaff.2022.00187 |pmid=36067433 |s2cid=252110211 |issn=0278-2715}} The promotion of vaping as a harm reduction aid is premature,{{cite journal|last1=Drummond|first1=MB|last2=Upson|first2=D|title=Electronic cigarettes. Potential harms and benefits.|journal=Annals of the American Thoracic Society|date=February 2014|volume=11|issue=2|pages=236–242 |doi=10.1513/annalsats.201311-391fr|pmc=5469426|pmid=24575993}} while a 2011 review found they appear to have the potential to lower tobacco-related death and disease. Evidence to substantiate the potential of vaping to lower tobacco-related death and disease is unknown. The health benefits of reducing cigarette use while vaping is unclear.{{cite book|author1=V.Courtney Broaddus|author2=Robert C Mason|author3=Joel D Ernst|author4=Talmadge E King Jr.|author5=Stephen C Lazarus|author6=John F. Murray|author7=Jay A. Nadel|author8=Arthur Slutsky|author9=Michael Gotway|title=Murray & Nadel's Textbook of Respiratory Medicine|url=https://books.google.com/books?id=Hux1BwAAQBAJ&pg=PR20|date=17 March 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-26193-7|page=820}} E-cigarettes could have an influential role in tobacco harm reduction. 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.

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.{{cite journal|last1=Saitta|first1=D|author2=Ferro, GA|author3=Polosa, R|title=Achieving appropriate regulations for electronic cigarettes.|journal=Therapeutic Advances in Chronic Disease|date=March 2014|volume=5|issue=2|pages=50–61|doi=10.1177/2040622314521271|pmc=3926346|pmid=24587890}} 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.{{cite journal|last1=Caponnetto|first1=Pasquale|last2=Campagna|first2=Davide|last3=Papale|first3=Gabriella|last4=Russo|first4=Cristina|last5=Polosa|first5=Riccardo|title=The emerging phenomenon of electronic cigarettes|journal=Expert Review of Respiratory Medicine|volume=6|issue=1|year=2012|pages=63–74|issn=1747-6348|doi=10.1586/ers.11.92|pmid=22283580|s2cid=207223131}} There is no research available on vaping for reducing harm in high-risk groups such as people with mental disorders.{{cite journal|author1=Nowak D |author2=Jörres RA |author3=Rüther T|title=E-cigarettes—prevention, pulmonary health, and addiction|journal=Dtsch Ärztebl Int|volume=111|issue=20|pages=349–55|year=2014|doi=10.3238/arztebl.2014.0349|pmc=4047602|pmid=24882626}}

A 2014 PHE report concluded that hazards associated with products currently on the market are probably low, and apparently much lower than smoking. However, harms could be reduced further through reasonable product standards.{{cite web|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311887/Ecigarettes_report.pdf|title=Electronic cigarettes – A report commissioned by Public Health England|publisher=Public Health England|date=15 May 2014|author1-first=John|author1-last=Britton|author2-first=Ilze|author2-last=Bogdanovica}} 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.{{cite web|url=http://bma.org.uk/-/media/Files/PDFs/Working%20for%20change/Improving%20health/tobaccoecigarettespublicplaces_jan2013.pdf|title=BMA calls for stronger regulation of e-cigarettes|publisher=British Medical Association|date=January 2013|access-date=11 August 2013|archive-date=7 November 2013|archive-url=https://web.archive.org/web/20131107014659/http://bma.org.uk/-/media/Files/PDFs/Working%20for%20change/Improving%20health/tobaccoecigarettespublicplaces_jan2013.pdf|url-status=dead}}

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 e-cigarettes and smokeless tobacco for long-term use instead of smoking.{{cite web|url=http://www.aaphp.org/tobacco|title=Principles to Guide AAPHP Tobacco Policy|publisher=American Association of Public Health Physicians|date=June 2013}} A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both.{{sfn|WHO|2014|p=6}} 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."{{sfn|WHO|2014|p=6}}

Whether e-cigarettes help people quit smoking is debated.{{cite journal|author1=Orellana-Barrios MA|author2=Payne D|author3=Medrano-Juarez RM|author4=Yang S|author5=Nugent K|year=2016 |title=Electronic Cigarettes for Smoking Cessation.|journal=The American Journal of the Medical Sciences|volume=52|issue=4|pages=420–426|doi=10.1016/j.amjms.2016.07.013 |pmid=27776725|s2cid=23548705}} Limited evidence suggests that e-cigarettes likely do help people to stop smoking when used in clinical settings. However, more smokers become dual users than succeed in complete abstinence.{{cite journal |last1=Traboulsi |first1=Hussein |last2=Cherian |first2=Mathew |last3=Abou Rjeili |first3=Mira |last4=Preteroti |first4=Matthew |last5=Bourbeau |first5=Jean |last6=Smith |first6=Benjamin M. |last7=Eidelman |first7=David H. |last8=Baglole |first8=Carolyn J. |title=Inhalation Toxicology of Vaping Products and Implications for Pulmonary Health |journal=International Journal of Molecular Sciences |date=15 May 2020 |volume=21 |issue=10 |pages=3495 |doi=10.3390/ijms21103495 |pmid=32429092 |pmc=7278963 |doi-access=free }} Outside clinical settings, vaping does not greatly change the odds of quitting smoking.{{cite journal|last1=Patil|first1=Shankargouda |last2=Arakeri|first2=Gururaj|last3=Patil|first3=Shekar|last4=Ali Baeshen|first4=Hosam|last5=Raj |first5=Thirumal|last6=Sarode|first6=Sachin C.|last7=Sarode|first7=Gargi S.|last8=Awan|first8=Kamran H.|last9=Gomez |first9=Ricardo|last10=Brennan|first10=Peter A|title=Are electronic nicotine delivery systems (ENDs) helping cigarette smokers quit? – A current evidence|journal=Journal of Oral Pathology & Medicine|year=2019|volume=49 |issue=3|pages=181–189|issn=0904-2512|doi=10.1111/jop.12966|pmid=31642553 |s2cid=204850725}}

A small number of studies have looked at whether using e-cigarettes reduces the number of cigarettes smokers consume. E-cigarette use may decrease the number of cigarettes smoked,{{cite journal|last1=Orr|first1=KK|last2=Asal|first2=NJ|title=Efficacy of electronic cigarettes for smoking cessation.|journal=The Annals of Pharmacotherapy|date=November 2014|volume=48|issue=11|pages=1502–1506 |doi=10.1177/1060028014547076|pmid=25136064|s2cid=29307238}} but smoking just one to four cigarettes daily greatly increases the risk of cardiovascular disease compared to not smoking. The extent to which decreasing cigarette smoking with vaping leads to quitting is unknown.{{cite journal|last1=Bullen|first1=Christopher|year=2014|title=Electronic Cigarettes for Smoking Cessation |url=http://qmro.qmul.ac.uk/xmlui/handle/123456789/16169|journal=Current Cardiology Reports|volume=16|issue=11|pages=538|doi=10.1007/s11886-014-0538-8|issn=1523-3782|pmid=25303892|s2cid=2550483}}

It is unclear whether e-cigarettes are only helpful for particular types of smokers.{{cite journal|last1=Malas|first1=Muhannad|last2=van der Tempel|first2=Jan|last3=Schwartz|first3=Robert |last4=Minichiello|first4=Alexa|last5=Lightfoot|first5=Clayton|last6=Noormohamed|first6=Aliya|last7=Andrews|first7=Jaklyn|last8=Zawertailo|first8=Laurie|last9=Ferrence|first9=Roberta|title=Electronic Cigarettes for Smoking Cessation: A Systematic Review|journal=Nicotine & Tobacco Research|date=25 April 2016|volume=18|issue=10|pages=1926–1936|issn=1462-2203|doi=10.1093/ntr/ntw119|pmid=27113014|doi-access=free}} Vaping with nicotine may reduce tobacco use among daily smokers.{{cite journal|last1=Vanderkam|first1=Paul|last2=Boussageon|first2=Rémy|last3=Underner|first3=Michel|last4=Langbourg|first4=Nicolas |last5=Brabant|first5=Yann|last6=Binder|first6=Philippe|last7=Freche|first7=Bernard|last8=Jaafari|first8=Nematollah|title=Efficacité et sécurité de la cigarette électronique pour la réduction du tabagisme : revue systématique et méta-analyse|journal=La Presse Médicale|volume=45|issue=11|pages=971–985|year=2016|issn=0755-4982|doi=10.1016/j.lpm.2016.05.026|pmid=27597300}} Whether vaping is effective for quitting smoking may depend on whether it was used as part of an effort to quit.{{cite journal|last1=El Dib|first1=Regina|last2=Suzumura|first2=Erica A|last3=Akl|first3=Elie A|last4=Gomaa|first4=Huda|last5=Agarwal|first5=Arnav |last6=Chang|first6=Yaping|last7=Prasad|first7=Manya|last8=Ashoorion|first8=Vahid|last9=Heels-Ansdell|first9=Diane|last10=Maziak|first10=Wasim|last11=Guyatt|first11=Gordon|title=Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis|journal=BMJ Open|volume=7|issue=2|year=2017|pages=e012680|issn=2044-6055|doi=10.1136/bmjopen-2016-012680|pmc=5337697|pmid=28235965}}

One of the challenges in studying e-cigarettes is that there are hundreds of brands and models of e-cigarettes sold that vary in the design and operation of the devices and composition of the liquid, and the technology continues to change.{{cite journal|last1=McRobbie|first1=Hayden|last2=Bullen|first2=Chris|last3=Hartmann-Boyce|first3=Jamie|last4=Hajek|first4=Peter|last5=McRobbie|first5=Hayden|title=Electronic cigarettes for smoking cessation and reduction|journal=The Cochrane Database of Systematic Reviews|year=2014|volume=12|issue=12|pages=CD010216|doi=10.1002/14651858.CD010216.pub2|pmid=25515689|hdl=2292/27824|hdl-access=free}} E-cigarettes have not been subjected to the same type of efficacy testing as nicotine replacement products. There are also social concerns - use of e-cigarettes may normalize tobacco use and prolong cigarette use for people who could have quit instead, or it could put extra pressure on smokers to stop cigarette smoking because e-cigarettes are a more socially acceptable alternative. The evidence indicates smokers are more frequently able to completely quit smoking using tank devices compared to cigalikes, which may be due to their more efficient nicotine delivery. One study supports the claim that smokers are more likely to use e-cigarettes as a nicotine replacement product to aid in smoking cessation than other pharmaceutical products.

There is low quality evidence that vaping assists smokers to quit smoking in the long-term compared with nicotine-free vaping. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2013 study in smokers who were not trying to quit, found that vaping, with or without nicotine decreased the number of cigarettes consumed.{{cite journal|last1=Lindson-Hawley|first1=Nicola|last2=Hartmann-Boyce|first2=Jamie |last3=Fanshawe|first3=Thomas R|last4=Begh|first4=Rachna|last5=Farley|first5=Amanda|last6=Lancaster|first6=Tim|last7=Lindson-Hawley|first7=Nicola|title=Interventions to reduce harm from continued tobacco use|journal=The Cochrane Database of Systematic Reviews|volume=10|pages=CD005231|year=2016|issue=12|doi=10.1002/14651858.CD005231.pub3|pmc=6463938|pmid=27734465}} E-cigarettes without nicotine may reduce tobacco cravings because of the smoking-related physical stimuli.

A 2015 meta-analysis on clinical trials found that e-cigarettes containing nicotine are more effective than nicotine-free ones for quitting smoking. They compared their finding that nicotine-containing e-cigarettes helped 20% of people quit with the results from other studies that found nicotine replacement products helps 10% of people quit.{{cite journal|last1=Rahman|first1=Muhammad Aziz|title=E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis.|journal=PLOS ONE|date=30 March 2015|volume=10|issue=3 |pages=e0122544|bibcode=2015PLoSO..1022544R|doi=10.1371/journal.pone.0122544|pmc=4378973|pmid=25822251|doi-access=free}} A 2016 review found low quality evidence of a trend towards benefit of e-cigarettes with nicotine for smoking cessation.{{cite journal|last1=Khoudigian|first1=S.|last2=Devji|first2=T.|last3=Lytvyn|first3=L.|last4=Campbell|first4=K.|last5=Hopkins|first5=R.|last6=O'Reilly|first6=D.|title=The efficacy and short-term effects of electronic cigarettes as a method for smoking cessation: a systematic review and a meta-analysis|journal=International Journal of Public Health|volume=61|issue=2|date=29 January 2016 |pages=257–267|issn=1661-8556|doi=10.1007/s00038-016-0786-z|pmid=26825455|s2cid=22227035}} In terms of whether flavored e-cigarettes assisted quitting smoking, the evidence is inconclusive. Tentative evidence indicates that health warnings on vaping products may influence users to give up vaping.{{cite journal|last1=Al-Hamdani|first1=Mohammed|last2=Hopkins |first2=D. Brett|last3=Park|first3=Tristan|year=2020|title=Vaping among youth and young adults: a "red alert" state|journal=Journal of Public Health Policy|volume=41|issue=1|pages=63–69|doi=10.1057/s41271-019-00193-2 |issn=0197-5897|pmid=31664162|s2cid=204966830}}

As of 2020, the efficacy and safety of vaping for quitting smoking during pregnancy was unknown.{{Cite journal|last1=Claire|first1=Ravinder|last2=Chamberlain|first2=Catherine|last3=Davey|first3=Mary-Ann|last4=Cooper |first4=Sue E.|last5=Berlin|first5=Ivan|last6=Leonardi-Bee|first6=Jo|last7=Coleman|first7=Tim|date=4 March 2020|title=Pharmacological interventions for promoting smoking cessation during pregnancy|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=3|pages=CD010078|doi=10.1002/14651858.CD010078.pub3|issn=1469-493X|pmc=7059898|pmid=32129504}} No research is available to provide details on the efficacy of vaping for quitting smoking during pregnancy.{{cite journal|last1=Franks|first1=Andrea S|last2=Sando|first2=Karen|last3=McBane|first3=Sarah|title=Do Electronic Cigarettes Have a Role in Tobacco Cessation?|journal=Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy|volume=38|issue=5|pages=555–568|year=2018|issn=0277-0008|doi=10.1002/phar.2103|pmid=29573440|s2cid=4365503}} There is robust evidence that vaping is not effective for quitting smoking among adolescents. In view of the shortage of evidence, vaping is not recommend for cancer patients, although for all patients vaping is likely less dangerous than smoking cigarettes.{{cite journal|last1=Lucchiari|first1=Claudio|last2=Masiero|first2=Marianna|last3=Botturi|first3=Andrea|last4=Pravettoni|first4=Gabriella|title=Helping patients to reduce tobacco consumption in oncology: a narrative review|journal=SpringerPlus|volume=5|issue=1|pages=1136|year=2016|issn=2193-1801|doi=10.1186/s40064-016-2798-9 |pmc=4954805|pmid=27504234 |doi-access=free }} The effectiveness of vaping for quitting smoking among vulnerable groups is uncertain.{{cite journal|last1=Gentry|first1=Sarah|last2=Forouhi|first2=Nita|last3=Notley|first3=Caitlin|title=Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence|journal=Nicotine & Tobacco Research|volume=21|issue=5|pages=602–616 |year=2018|issn=1462-2203|doi=10.1093/ntr/nty054|pmc=6697178|pmid=29608714}}

{{Main|Health effects of electronic cigarettes}}

{{further|Composition of electronic cigarette aerosol}}

There is no consensus on the risks of e-cigarette use.{{cite journal|last1=Siu|first1=AL|title=Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.|journal=Annals of Internal Medicine|date=22 September 2015|volume=163|issue=8|pages=622–634 |doi=10.7326/M15-2023|pmid=26389730|doi-access=free}}{{cite journal|last1=Harrell|first1=PT|last2=Simmons|first2=VN|last3=Correa |first3=JB|last4=Padhya|first4=TA|last5=Brandon|first5=TH |title=Electronic Nicotine Delivery Systems ("E-cigarettes"): Review of Safety and Smoking Cessation Efficacy.|journal=Otolaryngology–Head and Neck Surgery|date=4 June 2014|volume=151|issue=3|pages=381–393 |doi=10.1177/0194599814536847|pmc=4376316 |pmid=24898072}} There is little data about their safety, and a considerable variety of liquids are used as carriers,{{cite journal |last1=Patnode|first1=Carrie D. |last2=Henderson|first2=Jillian T.|last3=Thompson|first3=Jamie H.|last4=Senger|first4=Caitlyn A. |last5=Fortmann|first5=Stephen P.|last6=Whitlock|first6=Evelyn P.|title=Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force|journal=Annals of Internal Medicine|volume=163 |issue=8|date=September 2015|pages=608|issn=0003-4819|doi=10.7326/M15-0171|pmid=26491759|s2cid=207538340 |url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079361/pdf/PubMedHealth_PMH0079361.pdf}} and thus are present in the aerosol delivered to the user. Reviews of the safety of e-cigarettes have reached quite different conclusions.{{cite journal|last1=Farsalinos|first1=Konstantinos |last2=LeHouezec |first2=Jacques|title=Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)|journal=Risk Management and Healthcare Policy|volume=8|year=2015|pages=157–167 |doi=10.2147/RMHP.S62116|pmc=4598199 |pmid=26457058|issn=1179-1594 |doi-access=free }} A 2014 WHO report cautioned about potential risks of using e-cigarettes.{{sfn|WHO|2014|p=10}} Regulated US FDA products such as nicotine inhalers may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products{{cite journal |last1=Knorst|first1=Marli Maria|last2=Benedetto|first2=Igor Gorski|last3=Hoffmeister|first3=Mariana Costa|last4=Gazzana|first4=Marcelo Basso|title=The electronic cigarette: the new cigarette of the 21st century?|journal=Jornal Brasileiro de Pneumologia|volume=40|issue=5|year=2014|pages=564–572|issn=1806-3713|doi=10.1590/S1806-37132014000500013|pmc=4263338|pmid=25410845}} such as cigarettes and cigars.

The risk of early death is anticipated to be similar to that of smokeless tobacco. Since vapor does not contain tobacco and does not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke, such as ash, tar, and carbon monoxide.{{cite journal|last1=Smith|first1=L|last2=Brar|first2=K|last3=Srinivasan|first3=K|last4=Enja|first4=M |last5=Lippmann|first5=S|title=E-cigarettes: How "safe" are they?|journal=J Fam Pract|date=June 2016 |volume=65|issue=6|pages=380–385|url=http://www.mdedge.com/jfponline/article/109243/addiction-medicine/e-cigarettes-how-safe-are-they|pmid=27474819}} However, e-cigarette use with or without nicotine cannot be considered risk-free{{cite journal|last1=Glover|first1=Marewa |last2=Breier|first2=Bernhard H.|last3=Bauld|first3=Linda|title=Could Vaping be a New Weapon in the Battle of the Bulge?|journal=Nicotine & Tobacco Research |volume=19|issue=12|year=2016|pages=1536–1540 |issn=1462-2203|doi=10.1093/ntr/ntw278|pmid=27798086|hdl=1893/26149|s2cid=3799963|hdl-access=free}} because the long-term effects of e-cigarette use are unknown.{{cite journal|last1=Brady|first1=Benjamin R.|last2=De La Rosa |first2=Jennifer S.|last3=Nair|first3=Uma S.|last4=Leischow |first4=Scott J.|title=Electronic Cigarette Policy Recommendations: A Scoping Review|journal=American Journal of Health Behavior|volume=43|issue=1 |year=2019|pages=88–104|issn=1087-3244|doi=10.5993/AJHB.43.1.8|pmid=30522569 |s2cid=54566712}}

File:Side effects of nicotine.pngs of nicotineDetailed reference list is located at a separate image page.|alt=Possible side effects of nicotine include increased clotting tendency, atherosclerosis, enlargement of the aorta, bronchospasm, muscular tremor and pain, gastrointestinal nausea, dry mouth, dyspepsia, diarrhea, heartburn, peptic ulcer, cancer, lightheadedness, headache, sleep disturbances, abnormal dreams, irritability, dizziness, blood restriction, increased or decreased heart rate, increased blood pressure, tachycardia, more (or less) arrhythmias, coronary artery constriction, coronary artery disease, high insulin, insulin resistance, and risks to the child later in life during pregnancy include type 2 diabetes, obesity, hypertension, neurobehavioral defects, respiratory dysfunction, and infertility.]]

The cytotoxicity of e-liquids varies,{{cite journal|last1=Cooke|first1=Andrew |last2=Fergeson|first2=Jennifer|last3=Bulkhi|first3=Adeeb|last4=Casale|first4=Thomas B.|title=The Electronic Cigarette: The Good, the Bad, and the Ugly|journal=The Journal of Allergy and Clinical Immunology: In Practice|volume=3|issue=4|year=2015|pages=498–505|issn=2213-2198|pmid=26164573 |doi=10.1016/j.jaip.2015.05.022}} and contamination with various chemicals have been detected in the liquid. Metal parts of e-cigarettes in contact with the e-liquid can contaminate it with metal particles.{{cite journal |last1=Farsalinos |first1=K. E.|last2=Polosa|first2=R.|title=Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review|journal=Therapeutic Advances in Drug Safety |volume=5|issue=2|year=2014|pages=67–86|issn=2042-0986|doi=10.1177/2042098614524430|pmc=4110871 |pmid=25083263}} Many chemicals including carbonyl compounds such as formaldehyde can inadvertently be produced when the nichrome wire (heating element) that touches the e-liquid is heated and chemically reacted with the liquid. Normal usage of e-cigarettes,{{sfn|Wilder|2016|p=82}} and reduced voltage (3.0 V) devices generate very low levels of formaldehyde.

The later-generation and "tank-style" e-cigarettes with a higher voltage (5.0 V) may generate equal or higher levels of formaldehyde compared to smoking. A 2015 report by Public Health England found that high levels of formaldehyde only occurred in overheated "dry-puffing".{{sfn|McNeill|2015|p=77}} Users detect the "dry puff" (also known as a "dry hit"{{sfnp|National Academies of Sciences, Engineering, and Medicine|2018|loc=Characteristics of E-Cigarette Devices |p=56}}) and avoid it, and they concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes."{{sfn|McNeill|2015|p=77}} However, e-cigarette users may "learn" to overcome the unpleasant taste due to elevated aldehyde formation, when the nicotine craving is high enough.{{cite journal|last1=Rowell|first1=Temperance R|last2=Tarran|first2=Robert|title=Will Chronic E-Cigarette Use Cause Lung Disease?|journal=American Journal of Physiology. Lung Cellular and Molecular Physiology |year=2015|volume=309|issue=12|pages=L1398–L1409|issn=1040-0605|doi=10.1152/ajplung.00272.2015 |pmc=4683316|pmid=26408554}}

Another common chemical found in e-cigarettes is ketene. When it enters the lungs after inhaled, this chemical causes damage to the cellular structure of lung tissue causing the cells to not function at maximum capacity and not absorb gasses as readily. This can cause shortness of breath which can lead to other health conditions such as tachycardia and respiratory failure. E-cigarette users who use devices that contain nicotine are exposed to its potentially harmful effects.

Nicotine is associated with cardiovascular disease, possible birth defects, and poisoning. In vitro studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated in vivo.{{cite journal|author1=Jerry JM|author2=Collins GB|author3=Streem D|title=E-cigarettes: Safe to recommend to patients?|journal=Cleve Clin J Med|volume=82|issue=8|pages=521–526|year=2015|pmid=26270431 |doi=10.3949/ccjm.82a.14054 |doi-access=free}} There is inadequate research to show that nicotine is associated with cancer in humans.{{sfn|SGUS|2014|p=115}} 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.

In October 2021, researchers at Johns Hopkins University reported over 2,000 unknown chemicals in the vape clouds that they tested from Vuse, Juul, Blu and Mi-Salt vape devices.{{Cite web|title=Johns Hopkins Finds Thousands of Unknown Chemicals in E-Cigarettes|url=https://releases.jhu.edu/2021/10/06/johns-hopkins-finds-thousands-of-unknown-chemicals-in-e-cigarettes/|publisher=Johns Hopkins University|access-date=24 November 2021|language=en-US}}

In 2019–2020, there was an outbreak of vaping-related lung illness in the US and Canada, primarily related to vaping THC with vitamin E acetate.{{Cite journal |last1=Layden|first1=Jennifer E.|last2=Ghinai|first2=Isaac|last3=Pray|first3=Ian|last4=Kimball|first4=Anne|last5=Layer|first5=Mark|last6=Tenforde|first6=Mark W.|last7=Navon|first7=Livia|last8=Hoots|first8=Brooke |last9=Salvatore|first9=Phillip P.|last10=Elderbrook|first10=Megan|last11=Haupt|first11=Thomas|date=6 September 2019|title=Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report|journal=New England Journal of Medicine|volume=382|issue=10|pages=903–916|language=en|doi=10.1056/NEJMoa1911614|pmid=31491072|doi-access=free}}{{Cite journal|last1=Blount|first1=Benjamin C.|last2=Karwowski|first2=Mateusz P. |last3=Shields|first3=Peter G.|last4=Morel-Espinosa|first4=Maria|last5=Valentin-Blasini|first5=Liza|last6=Gardner|first6=Michael|last7=Braselton|first7=Martha|last8=Brosius|first8=Christina R.|last9=Caron|first9=Kevin T. |last10=Chambers|first10=David|last11=Corstvet|first11=Joseph|date=20 December 2019|title=Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI|url= |journal=New England Journal of Medicine|volume=382 |issue=8|pages=697–705|language=en|doi=10.1056/NEJMoa1916433|pmc=7032996|pmid=31860793}}

E-cigarettes create vapor that consists of fine and ultrafine particles of particulate matter, with the majority of particles in the ultrafine range. The vapor have been found to contain propylene glycol, glycerin, nicotine, flavors, small amounts of toxicants, carcinogens, and heavy metals, as well as metal nanoparticles, and other substances. Many carcinogenic compounds have been detected in e-cigarettes, such as N-Nitrosonornicotine (NNN), N-Nitrosoanatabine (NAT), etc., all of which have been proven to be harmful to human health.{{Cite journal |last1=Cetinkaya |first1=Pelin Duru |last2=Pazarli Bostan |first2=Pinar |last3=Salepci |first3=Banu |last4=Gorekdilektasli |first4=Asli |last5=Elbek |first5=Osman |last6=Uyanusta Kucuk |first6=Filiz Cagla |last7=Karadogan |first7=Dilek |last8=Arpaz |first8=Seren |last9=Dülger |first9=Seyhan |last10=Atilla Uysal |first10=Mehmet |last11=Uzaslan |first11=Esra |last12=Özge |first12=Cengiz |last13=Kılınç |first13=Oğuz |last14=Dağlı |first14=Elif |last15=Itil |first15=Oya |date=2022-07-18 |title=Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products |url=https://turkthoracj.org/en/turkish-thoracic-society-s-statement-report-on-electronic-cigarettes-and-heated-tobacco-products-132180 |journal=Turkish Thoracic Journal |volume=23 |issue=4 |pages=296–301 |doi=10.5152/TurkThoracJ.2022.22018 |pmc=9361150 |pmid=35848438}} Exactly what the vapor consists of varies in composition and concentration 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. The majority of toxic chemicals found in cigarette smoke are absent in e-cigarette vapor. E-cigarette vapor contains lower concentrations of potentially toxic chemicals than with cigarette smoke.{{cite journal|last1=Fernández |first1=Esteve|last2=Ballbè|first2=Montse|last3=Sureda|first3=Xisca|last4=Fu|first4=Marcela|last5=Saltó |first5=Esteve|last6=Martínez-Sánchez|first6=Jose M. |title=Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study|journal=Current Environmental Health Reports|volume=2|issue=4|pages=423–429|year=2015|issn=2196-5412|doi=10.1007/s40572-015-0072-x |pmid=26452675|doi-access=free|bibcode=2015CEHR....2..423F }} Those which are present, are mostly below 1% of the corresponding levels permissible by workplace safety standards.{{cite journal|last1=Burstyn|first1=Igor|title=Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks|journal=BMC Public Health|volume=14|issue=1|date=9 January 2014|pages=18|issn=1471-2458|doi=10.1186/1471-2458-14-18|pmc=3937158|pmid=24406205 |doi-access=free }} But workplace safety standards do not recognize exposure to certain vulnerable groups such as people with medical ailments, children, and infants who may be exposed to second-hand vapor.

Concern exists that some of the mainstream vapor exhaled by e-cigarette users may be inhaled by bystanders, particularly indoors, although e-cigarette pollutant levels are much lower than for cigarettes and likely to pose a much lower risk, if any, compared to cigarettes. E-cigarette use by a parent might lead to inadvertent health risks to offspring. 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.{{cite journal|last1=Chang|first1=H. |title=Research gaps related to the environmental impacts of electronic cigarettes|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii54–ii58|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051480 |pmc=3995274|pmid=24732165}} E-cigarettes that are not reusable may contribute to the problem of electronic waste.

{{Further|Effects of electronic cigarettes on human brain development}}

Nicotine, a key ingredient{{cite journal|last1=Kaisar|first1=Mohammad Abul|last2=Prasad|first2=Shikha|last3=Liles|first3=Tylor|last4=Cucullo|first4=Luca|title=A Decade of e-Cigarettes: Limited Research & Unresolved Safety Concerns|journal=Toxicology|volume=365|pages=67–75|year=2016|issn=0300-483X|doi=10.1016/j.tox.2016.07.020|pmc=4993660|pmid=27477296|bibcode=2016Toxgy.365...67K }} in most e-liquids,{{#tag:ref|Since 2016 the US Food and Drug Administration (US FDA) regulated e-cigarettes under the classification of tobacco products and labeled them as electronic nicotine delivery systems. A 2018 report commissioned by the US FDA decided to use the term e-cigarettes, indicating that for some use e-liquids containing no nicotine.{{cite web|url=https://www.mailman.columbia.edu/public-health-now/news/experts-clear-air-e-cigarettes |title=Experts Clear the Air on E-Cigarettes|publisher=Columbia University Mailman School of Public Health|date=26 January 2018}}|group=note}} is well-recognized as one of the most addictive substances, as addictive as heroin and cocaine. Addiction is believed to be a disorder of experience-dependent brain plasticity.{{cite journal|last1=Kenny|first1=PJ|title=Genetics of Substance Use Disorders|journal=Dialogues Clin Neurosci|volume=16|issue=3|date=September 2014|pages=335–344|doi=10.31887/DCNS.2014.16.3/pkenny|pmc=4214176|pmid=25364284}} The reinforcing effects of nicotine play a significant role in the beginning and continuing use of the drug.{{cite journal|last1=D'Souza|first1=Manoranjan S.|title=Glutamatergic transmission in drug reward: implications for drug addiction|journal=Frontiers in Neuroscience|volume=9|pages=404|year=2015|issn=1662-453X|doi=10.3389/fnins.2015.00404|pmc=4633516|pmid=26594139|doi-access=free}} First-time nicotine users develop a dependence about 32% of the time.{{cite journal|last1=MacDonald|first1=K|last2=Pappa|first2=K|title=WHY NOT POT?: A Review of the Brain-based Risks of Cannabis|journal=Innov Clin Neurosci |volume=13|issue=3–4|date=April 2016|pages=13–22|pmc=4911936|pmid=27354924}} Chronic nicotine use involves both psychological and physical dependence.{{cite journal|last1=Kishioka|first1=Shiroh|last2=Kiguchi|first2=Norikazu|last3=Kobayashi|first3=Yuka|last4=Saika|first4=Fumihiro|title=Nicotine Effects and the Endogenous Opioid System|journal=Journal of Pharmacological Sciences |volume=125|issue=2|year=2014|pages=117–124|issn=1347-8613|doi=10.1254/jphs.14R03CP|pmid=24882143|doi-access=free}} Nicotine-containing e-cigarette vapor induces addiction-related neurochemical, physiological and behavioral changes.{{cite journal|last1=Hiemstra|first1=Pieter S.|last2=Bals|first2=Robert|title=Basic science of electronic cigarettes: assessment in cell culture and in vivo models |journal=Respiratory Research|volume=17|issue=1|pages=127|year=2016|issn=1465-993X|doi=10.1186/s12931-016-0447-z|pmc=5055681|pmid=27717371 |doi-access=free }} Nicotine affects neurological, neuromuscular, cardiovascular, respiratory, immunological and gastrointestinal systems.{{cite journal|last1=Lee|first1=Peter N.|last2=Fariss|first2=Marc W.|title=A systematic review of possible serious adverse health effects of nicotine replacement therapy|journal=Archives of Toxicology|volume=91|issue=4|year=2016|pages=1565–1594|issn=0340-5761|doi=10.1007/s00204-016-1856-y|pmc=5364244|pmid=27699443}}

Addiction to e-cigarettes appears lower than from smoking, with slower nicotine absorption rates.

Neuroplasticity within the brain's reward system occurs as a result of long-term nicotine use, leading to nicotine dependence.{{cite journal|author1=D'Souza MS |author2=Markou A|title=Neuronal mechanisms underlying development of nicotine dependence: implications for novel smoking-cessation treatments|journal=Addict Sci Clin Pract|volume=6|issue=1|pages=4–16|year=2011|pmc=3188825|pmid=22003417}} The neurophysiological activities that are the basis of nicotine dependence are intricate. It includes genetic components, age, gender, and the environment.{{cite journal|last1=Jackson|first1=K.J. |last2=Muldoon|first2=P.P.|last3=De Biasi|first3=M.|last4=Damaj|first4=M.I.|title=New mechanisms and perspectives in nicotine withdrawal|journal=Neuropharmacology|volume=96|issue=Pt B|year=2015|pages=223–234|issn=0028-3908 |doi=10.1016/j.neuropharm.2014.11.009|pmc=4444410|pmid=25433149}} Nicotine addiction is a disorder which alters different neural systems such as dopaminergic, glutamatergic, GABAergic, serotoninergic, that take part in reacting to nicotine.{{cite journal|last1=Hadjiconstantinou|first1=Maria|last2=Neff|first2=Norton H.|title=Nicotine and endogenous opioids: Neurochemical and pharmacological evidence |journal=Neuropharmacology|volume=60|issue=7–8|year=2011|pages=1209–1220|issn=0028-3908|doi=10.1016/j.neuropharm.2010.11.010|pmid=21108953|s2cid=45539554}} Long-term nicotine use affects a broad range of genes associated with neurotransmission, signal transduction, and synaptic architecture. The ability to quitting smoking is affected by genetic factors, including genetically based differences in the way nicotine is metabolized.{{cite journal|last1=Chenoweth|first1=Meghan J.|last2=Tyndale|first2=Rachel F.|title=Pharmacogenetic Optimization of Smoking Cessation Treatment|journal=Trends in Pharmacological Sciences|volume=38|issue=1|year=2017|pages=55–66|issn=0165-6147|doi=10.1016/j.tips.2016.09.006|pmc=5195866|pmid=27712845}}

File:Recolored Overview of reward structures in the human brain2.png, such as nicotine, are associated with its ability to excite the mesolimbic and dopaminergic systems.{{cite journal|last1=Di Matteo|first1=Vincenzo|last2=Pierucci |first2=Massimo|last3=Di Giovanni |first3=Giuseppe|last4=Benigno|first4=Arcangelo|last5=Esposito |first5=Ennio|title=The Neurobiological Bases for the Pharmacotherapy of Nicotine Addiction |journal=Current Pharmaceutical Design|volume=13|issue=12|year=2007 |pages=1269–1284|issn=1381-6128 |doi=10.2174/138161207780618920|pmid=17504235}}
How does the nicotine in e-cigarettes affect the brain? Until about age 25, the brain is still growing. Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people's brains build synapses faster than adult brains. Because addiction is a form of learning, adolescents can get addicted more easily than adults. The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for addiction to other drugs such as cocaine.{{cite web|url=https://e-cigarettes.surgeongeneral.gov/knowtherisks.html#addiction|title=Know The Risks: E-Cigarettes & Young People – Addiction|publisher=Surgeon General of the United States|year=2016}}{{PD-notice}}|alt=An image of the human brain. The reinforcing effects of addictive drugs, such as nicotine, are associated with their ability to excite the mesolimbic and dopaminergic systems. How does the nicotine in e-cigarettes affect the brain? Until about age 25, the brain is still growing. Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people's brains build synapses faster than adult brains. Because addiction is a form of learning, adolescents can get addicted more easily than adults. The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for addiction to other drugs such as cocaine.]]

Nicotine is a parasympathomimetic stimulant{{cite book|author1=Richard Beebe|author2=Jeff Myers|title=Professional Paramedic, Volume I: Foundations of Paramedic Care |url=https://books.google.com/books?id=bS8KAAAAQBAJ&pg=PA640|date=19 July 2012|publisher=Cengage Learning|isbn=978-1-133-71465-1|pages=640–}} that binds to and activates nicotinic acetylcholine receptors in the brain, which subsequently causes the release of dopamine and other neurotransmitters, such as norepinephrine, acetylcholine, serotonin, gamma-aminobutyric acid, glutamate, endorphins,{{cite journal|title=Republished: Nicotine and health|journal=BMJ|volume=349|date=26 November 2014|at=2014.7.0264rep|issn=1756-1833 |doi=10.1136/bmj.2014.7.0264rep|pmid=25428425|s2cid=45426626 |author=Drug Therapeutics Bulletin}} and several neuropeptides, including proopiomelanocortin-derived α-MSH and adrenocorticotropic hormone.{{cite book |author1=Atta-ur-Rahman |author2=Allen B. Reitz|title=Frontiers in Medicinal Chemistry|url=https://books.google.com/books?id=tCyDoIHToBQC&pg=PA279|date=1 January 2005|publisher=Bentham Science Publishers|isbn=978-1-60805-205-9|pages=279–}} Corticotropin-releasing factor, Neuropeptide Y, orexins, and norepinephrine are involved in nicotine addiction.{{cite journal|last1=Bruijnzeel|first1=Adrie W.|title=Tobacco addiction and the dysregulation of brain stress systems|journal=Neuroscience & Biobehavioral Reviews|volume=36|issue=5|year=2012|pages=1418–1441|issn=0149-7634|pmc=3340450 |pmid=22405889|doi=10.1016/j.neubiorev.2012.02.015}} Continuous exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor desensitization and subsequent receptor upregulation.

Long-term exposure to nicotine can also result in downregulation of glutamate transporter 1.{{cite journal|last1=Alasmari|first1=Fawaz|last2=Al-Rejaie|first2=Salim S. |last3=AlSharari|first3=Shakir D.|last4=Sari|first4=Youssef|title=Targeting glutamate homeostasis for potential treatment of nicotine dependence|journal=Brain Research Bulletin |volume=121|year=2016 |pages=1–8|issn=0361-9230 |doi=10.1016/j.brainresbull.2015.11.010|pmc=4783195 |pmid=26589642}} Long-term nicotine exposure upregulates cortical nicotinic receptors, but it also lowers the activity of the nicotinic receptors in the cortical vasodilation region. These effects are not easily understood.{{cite journal |last1=Uchida|first1=Sae|last2=Hotta|first2=Harumi|title=Cerebral Cortical Vasodilatation Mediated by Nicotinic Cholinergic Receptors: Effects of Old Age and of Chronic Nicotine Exposure|journal=Biological & Pharmaceutical Bulletin|volume=32|issue=3 |year=2009|pages=341–344|issn=0918-6158|pmid=19252275 |doi=10.1248/bpb.32.341|doi-access=free}} With constant use of nicotine, tolerance occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain.

After several months of nicotine abstinence, the number of receptors go back to normal. The extent to which alterations in the brain caused by nicotine use are reversible is not fully understood.{{cite journal |last1=Korpi |first1=E. R. |last2=den Hollander |first2=B. |last3=Farooq |first3=U. |last4=Vashchinkina |first4=E. |last5=Rajkumar |first5=R. |last6=Nutt |first6=D. J. |last7=Hyytia |first7=P. |last8=Dawe |first8=G. S. |title=Mechanisms of Action and Persistent Neuroplasticity by Drugs of Abuse|journal=Pharmacological Reviews|volume=67|issue=4 |year=2015|pages=872–1004|issn=1521-0081 |doi=10.1124/pr.115.010967|pmid=26403687|doi-access=free}} Nicotine also stimulates nicotinic acetylcholine receptors in the adrenal medulla, resulting in increased levels of epinephrine and beta-endorphin. Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the central and peripheral nervous systems.{{sfn|SGUS|2014|p=111}}

When nicotine intake stops, the upregulated nicotinic acetylcholine receptors induce withdrawal symptoms. These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating.{{cite web|publisher=Medline Plus |title=Nicotine and Tobacco|author1=Laura J. Martin |author2=David Zieve|author3=Isla Ogilvie|date=7 June 2016|url=https://www.nlm.nih.gov/medlineplus/ency/article/000953.htm}} When trying to quit smoking with vaping a base containing nicotine, symptoms of withdrawal can include irritability, restlessness, poor concentration, anxiety, depression, and hunger. The changes in the brain cause a nicotine user to feel abnormal when not using nicotine. In order to feel normal, the user has to keep his or her body supplied with nicotine.{{cite web|url=https://www.drugabuse.gov/publications/brain-power/grades-6-9/legal-doesn%27t-mean-harmless-module-2/background|title=Nicotine|publisher=National Institute on Drug Abuse|date=June 2007 |access-date=2 June 2019|url-status=dead|archive-date=11 June 2019|archive-url=https://web.archive.org/web/20190611224353/https://www.drugabuse.gov/publications/brain-power/grades-6-9/legal-doesn%27t-mean-harmless-module-2/background}}{{PD-notice}} E-cigarettes may reduce cigarette craving and withdrawal symptoms.{{cite journal|last1=Shahab |first1=Lion|last2=Brose|first2=Leonie S.|last3=West|first3=Robert|title=Novel Delivery Systems for Nicotine Replacement Therapy as an Aid to Smoking Cessation and for Harm Reduction: Rationale, and Evidence for Advantages over Existing Systems|journal=CNS Drugs|volume=27 |issue=12|year=2013|pages=1007–1019|issn=1172-7047|doi=10.1007/s40263-013-0116-4|pmid=24114587 |s2cid=207486096}}

It is not clear whether e-cigarette use will decrease or increase overall nicotine addiction,{{cite journal|title=Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review|first1=Dominic L.|last1=Palazzolo|journal=Frontiers in Public Health |volume=1|issue=56|pages=56|date=November 2013|doi=10.3389/fpubh.2013.00056 |pmc=3859972 |pmid=24350225 |doi-access=free}} but the nicotine content in e-cigarettes is adequate to sustain nicotine dependence.{{cite journal|last1=Schroeder|first1=M. J.|last2=Hoffman |first2=A. C. |title=Electronic cigarettes and nicotine clinical pharmacology|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii30–ii35|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051469 |pmc=3995273 |pmid=24732160}} Chronic nicotine use causes a broad range of neuroplastic adaptations, making quitting hard to accomplish. A 2015 study found that users vaping non-nicotine e-liquid exhibited signs of dependence.{{cite journal|last1=Bold|first1=Krysten W.|last2=Sussman|first2=Steve|last3=O'Malley|first3=Stephanie S.|last4=Grana|first4=Rachel|last5=Foulds|first5=Jonathan |last6=Fishbein|first6=Howard|last7=Krishnan-Sarin|first7=Suchitra|title=Measuring E-cigarette dependence: Initial guidance|journal=Addictive Behaviors|volume=79|pages=213–218|year=2018|issn=0306-4603|pmc=5807200 |pmid=29174664|doi=10.1016/j.addbeh.2017.11.015}} Experienced users tend to take longer puffs which may result in higher nicotine intake. It is difficult to assess the impact of nicotine dependence from e-cigarette use because of the wide range of e-cigarette products. The addiction potential of e-cigarettes may have risen because as they have progressed, they have delivered nicotine better.{{sfn|McNeill|2018|p=12}}

A 2015 American Academy of Pediatrics (AAP) policy statement stressed "the potential for these products to addict a new generation of youth to nicotine and reverse more than 50 years of public health gains in tobacco control."{{cite journal|last1=Jenssen|first1=Brian P.|last2=Wilson|first2=Karen M.|title=Tobacco Control and Treatment for the Pediatric Clinician: Practice, Policy, and Research Updates |journal=Academic Pediatrics|volume=17|issue=3|pages=233–242|year=2017|issn=1876-2859|doi=10.1016/j.acap.2016.12.010|pmid=28069410}} The World Health Organization (WHO) is concerned about starting nicotine use among non-smokers,{{sfn|WHO|2014|p=6}} and the National Institute on Drug Abuse said e-cigarettes could maintain nicotine addiction in those who are attempting to quit.{{cite web |url=http://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes|title=DrugFacts: Electronic Cigarettes (e-Cigarettes)|work=National Institute on Drug Abuse|date=September 2014}} The limited available data suggests that the likelihood of excessive use of e-cigarettes is smaller than traditional cigarettes.{{cite journal|last1=Evans|first1=S. E.|last2=Hoffman|first2=A. C.|title=Electronic cigarettes: abuse liability, topography and subjective effects|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii23–ii29|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051489|pmc=3995256|pmid=24732159}} No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction, but some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence.{{cite journal|last1=Orellana-Barrios|first1=Menfil A.|last2=Payne|first2=Drew|last3=Mulkey|first3=Zachary|last4=Nugent|first4=Kenneth |title=Electronic cigarettes-a narrative review for clinicians|journal=The American Journal of Medicine|year=2015|volume=128|issue=7|pages=674–81|issn=0002-9343|doi=10.1016/j.amjmed.2015.01.033|pmid=25731134|doi-access=free}}

There is concern that children may progress from vaping to smoking.{{sfn|WHO|2014|p=6}} Adolescents are likely to underestimate nicotine's addictiveness.{{sfn|Chapman|2015|p=5}} Vulnerability to the brain-modifying effects of nicotine, along with youthful experimentation with e-cigarettes, could lead to a lifelong addiction. A long-term nicotine addiction from using a vape may result in using other tobacco products.{{cite web|url=http://www.cancer.org/cancer/cancercauses/tobaccocancer/childandteentobaccouse/child-and-teen-tobacco-use-other-types|title=Teens like different forms of tobacco and nicotine|publisher=American Cancer Society|archive-url=https://web.archive.org/web/20150920232939/http://www.cancer.org/cancer/cancercauses/tobaccocancer/childandteentobaccouse/child-and-teen-tobacco-use-other-types|archive-date=20 September 2015}} The majority of addiction to nicotine starts during youth and young adulthood.{{cite journal|last1=Singh|first1=Tushar|last2=Arrazola|first2=René A.|last3=Corey|first3=Catherine G.|last4=Husten |first4=Corinne G.|last5=Neff|first5=Linda J.|last6=Homa|first6=David M.|last7=King|first7=Brian A.|title=Tobacco Use Among Middle and High School Students — United States, 2011–2015|journal=MMWR. Morbidity and Mortality Weekly Report|volume=65|issue=14|year=2016|pages=361–367|issn=0149-2195|doi=10.15585/mmwr.mm6514a1|pmid=27077789|doi-access=free}} Adolescents are more likely to become nicotine dependent than adults.

The adolescent brain seems to be particularly sensitive to neuroplasticity as a result of nicotine. Minimal exposure could be enough to produce neuroplastic alterations in the very sensitive adolescent brain. A 2014 review found that in studies up to a third of young people who have not tried a traditional cigarette have used e-cigarettes. The degree to which teens are using e-cigarettes in ways the manufacturers did not intend, such as increasing the nicotine delivery, is unknown,{{cite journal|last1=Durmowicz|first1=E. L.|title=The impact of electronic cigarettes on the paediatric population|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii41–ii46|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051468|pmc=3995262 |pmid=24732163}} as is the extent to which e-cigarette use may lead to addiction or substance dependence in young people.

In 2025 Alder Hey Children's Hospital set up the first NHS clinic for vape addiction in children.{{cite news |title=First NHS vape clinic treating addicts as young as 11 |url=https://www.ft.com/content/9eeca2c8-d2ab-4a0c-92bb-d35221d43b23 |access-date=13 March 2025 |publisher=Financial Times |date=13 March 2025}}

{{Main|Positions of medical organizations on electronic cigarettes}}

Because of overlap with tobacco laws and medical drug policies, e-cigarette legislation is being debated{{When|date=February 2021}} in many countries. The revised EU Tobacco Products Directive came into effect in May 2016, providing stricter regulations for e-cigarettes. In February 2010 the US District Court ruled against the FDA's seizure of E-Cigarettes as a "drug-device" and in December 2010 the US Court of Appeals confirmed them to be tobacco products which were by then subject to regulation under the 2009 FSPTC Act.{{cite web |title=Sottera v US Food and Drug Administration |url=https://www.publichealthlawcenter.org/content/sottera-inc-v-us-food-and-drug-administration |publisher=Public Health Law Center |access-date=23 February 2020 |archive-date=23 February 2020 |archive-url=https://web.archive.org/web/20200223235707/https://www.publichealthlawcenter.org/content/sottera-inc-v-us-food-and-drug-administration |url-status=dead }} In August 2016, the US FDA extended its regulatory power to include e-cigarettes, cigars, and "all other tobacco products". Large tobacco companies have{{When|date=February 2021}} greatly increased their marketing efforts.

The scientific community in US and Europe are primarily concerned with their possible effect on public health.{{cite journal|last1=Gualano|first1=Maria Rosaria|last2=Passi |first2=Stefano |last3=Bert|first3=Fabrizio|last4=La Torre|first4=Giuseppe|last5=Scaioli|first5=Giacomo|last6=Siliquini|first6=Roberta|title=Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies|journal=Journal of Public Health|volume=37|issue=3|date=September 2015|pages=488–497|issn=1741-3842|doi=10.1093/pubmed/fdu055|pmid=25108741|doi-access=free}} There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco,{{cite web|title=Heart and Stroke Foundation: E-cigarettes in Canada |url=http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9207931/k.D09C/Heart_and_Stroke_Foundation_Ecigarettes_in_Canada.htm|publisher=Heart and Stroke Foundation|date=September 2014|archive-url=https://web.archive.org/web/20141006173717/http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9207931/k.D09C/Heart_and_Stroke_Foundation_Ecigarettes_in_Canada.htm|archive-date=6 October 2014|url-status=dead}} and serve as a gateway for smoking among young people. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear.{{cite journal|last1=Franck|first1=Caroline|last2=Filion|first2=Kristian B.|last3=Kimmelman|first3=Jonathan|last4=Grad|first4=Roland|last5=Eisenberg|first5=Mark J.|title=Ethical considerations of e-cigarette use for tobacco harm reduction|journal=Respiratory Research|volume=17|issue=1|pages=53|year=2016|issn=1465-993X|doi=10.1186/s12931-016-0370-3|pmc=4869264|pmid=27184265 |doi-access=free }}{{CC-notice|cc=by4|url=https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-016-0370-3|author(s)=Caroline Franck, Kristian B. Filion, Jonathan Kimmelman, Roland Grad and Mark J. Eisenberg}} Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco.{{cite web|url=https://www.vitalstrategies.org/press/who-right-to-call-for-e-cigarette-regulation/|archive-url=https://web.archive.org/web/20180330075957/https://www.vitalstrategies.org/press/who-right-to-call-for-e-cigarette-regulation/|url-status=usurped|archive-date=30 March 2018|title=WHO Right to Call for E-Cigarette Regulation|publisher=World Lung Federation|date=26 August 2014}} There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.{{cite journal|last1=Bullen|first1=Chris|last2=Knight-West|first2=Oliver|title=E-cigarettes for the management of nicotine addiction|journal=Substance Abuse and Rehabilitation|volume=7|date=August 2016|pages=111–118|issn=1179-8467|doi=10.2147/SAR.S94264|pmc=4993405|pmid=27574480 |doi-access=free }}

Medical organizations differ in their views about the health implications of vaping.{{cite web|url=http://www.fctc.org/images/stories/policy_brief.pdf|title=FCA Policy briefing Electronic Nicotine Delivery Systems|publisher=Framework Convention Alliance on Tobacco Control|date=13–18 October 2014|access-date=2 March 2016|archive-date=6 March 2016|archive-url=https://web.archive.org/web/20160306092109/http://www.fctc.org/images/stories/policy_brief.pdf|url-status=dead}} There is general agreement that e-cigarettes expose users to fewer toxicants than tobacco cigarettes. Some healthcare groups and policy makers have hesitated to recommend e-cigarettes for quitting smoking, because of limited evidence of effectiveness and safety. Some have advocated bans on e-cigarette sales and others have suggested that e-cigarettes may be regulated as tobacco products but with less nicotine content or be regulated as a medicinal product.

A 2019 World Health Organization (WHO) report found that the scientific evidence "does not support the tobacco industry's claim that these products are less harmful relative to conventional tobacco products" and that there is insufficient evidence to support vaping as a smoking cessation tool.{{cite report |author=World Health Organization |year=2019 |section=Offer help to quit tobacco use |section-url=https://apps.who.int/iris/handle/10665/326043 |title=WHO report on the global tobacco epidemic, 2019 |publisher=World Health Organization |isbn=9789241516204}}{{cite report |author=WHO Study Group on Tobacco Product Regulation |title=Report on the Scientific Basis of Tobacco Product Regulation: Fifth Report of a WHO Study Group |date=2015 |series=WHO Technical Report Series |volume=989 |publisher=World Health Organization |location=Geneva |isbn=9789240693807 |url=https://apps.who.int/iris/rest/bitstreams/715269/retrieve |access-date=14 November 2022}}{{cite journal |last1=Farber |first1=Harold J. |last2=Conrado Pacheco Gallego |first2=Manuel |last3=Galiatsatos |first3=Panagis |last4=Folan |first4=Patricia |last5=Lamphere |first5=Thomas |last6=Pakhale |first6=Smita |title=Harms of Electronic Cigarettes: What the Healthcare Provider Needs to Know |journal=Annals of the American Thoracic Society |date=1 April 2021 |volume=18 |issue=4 |pages=567–572 |doi=10.1513/AnnalsATS.202009-1113CME |pmid=33284731 |s2cid=227948907 |issn=2329-6933}} Healthcare organizations in the UK (including the Royal College of Physicians and Public Health England) have encouraged smokers to switch to e-cigarettes or other nicotine replacements if they cannot quit, as this would potentially save millions of lives.{{cite web |last1=Royal College of Physicians |title=Nicotine Without Smoke -- Tobacco Harm Reduction |url=https://www.rcplondon.ac.uk/file/3563/download?token=Mu0K_ZR0 |access-date=30 September 2020 |pages=125 |quote=Use of nicotine alone, in the doses used by smokers, represents little if any hazard to the user.}}{{cite web |url=https://www.gov.uk/government/news/e-cigarettes-an-emerging-public-health-consensus|title=E-cigarettes: an emerging public health consensus |publisher=Public Health England|location=UK|date=15 September 2015}} The American Cancer Society,{{refn|group=note|"The ACS does not recommend the use of e-cigarettes as a cessation method. No e-cigarette has been approved by the Food and Drug Administration (FDA) as a safe and effective cessation product. The long-term risks of exclusive use of e-cigarettes are not fully known but evidence is accumulating that e-cigarette use has negative effects on the cardiovascular system and lungs. Without immediate measures to stop epidemic use of these products, the long-term adverse health effects will increase."{{cite web |title=Position Statement on Electronic Cigarettes |publisher=American Cancer Society |date=19 November 2019 |url=https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarettes-vaping/e-cigarette-position-statement.html |access-date=15 November 2022}}}} American Heart Association,{{refn|group=note|"Companies should not be able to claim that e-cigarettes are a cessation aid unless they are approved by the FDA for that purpose...There is not yet enough evidence for clinicians to counsel their patients who are using combustible tobacco products to use e-cigarettes as a primary cessation aid. The association will continue to monitor the evidence concerning e-cigarettes as cessation devices to determine whether they might be integrated into comprehensive cessation strategies. For patients with existing cardiovascular disease and stroke, or at risk of a cardiovascular disease event, intensive cessation counseling should be offered as soon as possible."{{cite journal |last1=Bhatnagar |first1=Aruni |last2=Whitsel |first2=Laurie P. |last3=Ribisl |first3=Kurt M. |last4=Bullen |first4=Chris |last5=Chaloupka |first5=Frank |last6=Piano |first6=Mariann R. |last7=Robertson |first7=Rose Marie |last8=McAuley |first8=Timothy |last9=Goff |first9=David |last10=Benowitz |first10=Neal |title=Electronic Cigarettes: A Policy Statement From the American Heart Association |journal=Circulation |date=14 October 2014 |volume=130 |issue=16 |pages=1418–1436 |doi=10.1161/CIR.0000000000000107 |doi-access=free |pmid=25156991 |pmc=7643636 |orig-year=Published online 24 August 2014}}}} and the surgeon general of the United States have cautioned that accumulating evidence indicates e-cigarettes may have negative effects on the heart and lungs and should not be used to quit smoking without sufficient evidence that they are safe and effective.

In 2016, the US Food and Drug Administration (US FDA) stated that "Although ENDS [electronic nicotine delivery systems] may potentially provide cessation benefits to individual smokers, no ENDS have been approved as effective cessation aids."{{cite journal|title=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; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products |journal=Federal Register|volume=81 |issue=90|pages=28974–29106|date=10 May 2016|publisher=United States Food and Drug Administration|url=https://www.federalregister.gov/articles/2016/05/10/2016-10685/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the}} In 2019 the European Respiratory Society stated that "The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term" and that "[t]he tobacco harm reduction strategy is based on well-meaning but incorrect or undocumented claims or assumptions."{{cite journal |last1=Pisinger |first1=Charlotta |last2=Dagli |first2=Elif |last3=Filippidis |first3=Filippos T. |last4=Hedman |first4=Linnea |last5=Janson |first5=Christer |last6=Loukides |first6=Stelios |last7=Ravara |first7=Sofia |last8=Saraiva |first8=Isabel |last9=Vestbo |first9=Jørgen |title=ERS and tobacco harm reduction |journal=European Respiratory Journal |date=December 2019 |volume=54 |issue=6 |pages=1902009 |doi=10.1183/13993003.02009-2019|pmid=31801824 |s2cid=208642811|hdl=10044/1/75851 |hdl-access=free }} Following hundreds of possible cases of severe lung illness and five confirmed deaths associated with vaping in the US, the Centers for Disease Control and Prevention stated on 6 September 2019 that people should consider not using vaping products while their investigation is ongoing.{{cite web |author=((CDC's Office on Smoking and Health)) |date=3 August 2021 |title=Smoking and Tobacco Use; Electronic Cigarettes |website=Centers for Disease Control and Prevention |url=https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html}}

It is commonly stated that the modern e-cigarette was invented in 2003 by Chinese pharmacist Hon Lik, but tobacco companies had been developing nicotine aerosol generation devices since as early as 1963.{{cite journal|last1=Dutra|first1=Lauren M|last2=Grana|first2=Rachel|last3=Glantz|first3=Stanton A|year=2016|title=Philip Morris research on precursors to the modern e-cigarette since 1990|journal=Tobacco Control|volume=26|issue=e2|pages=tobaccocontrol–2016–053406|doi=10.1136/tobaccocontrol-2016-053406|issn=0964-4563|pmc=5432409|pmid=27852893}}

In 1927, Joseph Robinson applied for a patent for an electronic vaporizer to be used with medicinal compounds.{{cite news|url=https://www.techpluto.com/a-modern-device-with-an-illustrious-history/|title=A Modern Device with an Illustrious History|publisher=TechPluto|author=Prashant Sharma|date=6 November 2015}} The patent was approved in 1930 but the device was never marketed.{{cite news|url=http://www.casaa.org/historical-timeline-of-electronic-cigarettes/|title=A Historical Timeline of Electronic Cigarettes|publisher=The Consumer Advocates for Smoke-free Alternatives Association|year=2016}} In 1930, the United States Patent and Trademark Office reported a patent stating, "for holding medicinal compounds which are electrically or otherwise heated to produce vapors for inhalation."{{cite book |last1=Farsalinos |first1=Konstantinos E. |url=https://books.google.com/books?id=j20kDAAAQBAJ |title=Analytical Assessment of e-Cigarettes: From Contents to Chemical and Particle Exposure Profiles |last2=Gillman |first2=I. Gene |last3=Hecht |first3=Stephen S. |last4=Polosa |first4=Riccardo |last5=Thornburg |first5=Jonathan |date=16 November 2016 |publisher=Elsevier Science |isbn=978-0-12-811242-7 |page=1 |author-link4=Riccardo Polosa}} In 1934 and 1936, further similar patents were applied for.

The earliest e-cigarette can be traced to American Herbert A. Gilbert.{{cite news|url=http://www.salon.com/2014/12/07/americas_vaping_revolution_how_suspicious_should_we_really_be_of_the_e_cigarette_craze|title=America's vaping revolution: How suspicious should we really be of the e-cigarette craze?|work=Salon|author=Noah Charney|date=7 December 2014}} In 1963, Gilbert applied for a patent for "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air".{{cite web|url=https://www.google.com/patents?id=RjlUAAAAEBAJ&printsec=abstract&zoom=4&source=gbs_overview_r&cad=0#v=onepage&q&f=false|archive-url=https://web.archive.org/web/20111012190130/http://www.google.com/patents?id=RjlUAAAAEBAJ&printsec=abstract&zoom=4&source=gbs_overview_r&cad=0#v=onepage&q&f=false|url-status=dead|archive-date=12 October 2011|title=US Patent 3200819. Smokeless non-tobacco cigarette|date=17 August 1965}} This device produced flavored steam without nicotine. The patent was granted in 1965.{{cite news|url=https://www.economist.com/blogs/schumpeter/2014/03/e-cigarette-patent-wars|title=A case of the vapers|publisher=Economist Group|author=P.H.|date=17 March 2014}} Gilbert's invention was ahead of its time.{{cite news|url=https://www.theatlantic.com/health/archive/2014/06/schrodingers-cigarette-is-electronic-safer/372671/|title=Schrödinger's Cigarette: Is Electronic Safer?|work=The Atlantic|author=Julie Beck|date=13 June 2014}} However, it received little attention{{cite news|url=https://timeline.com/stories/e-cigarettes-vape-ban-health-nicotine-smoking|title=The Push to Ban E-Cigarettes: Where's the Proof?|last1=Millstein|first1=Seth|work=TimeLine|date=25 April 2009|url-status=dead|archive-url=https://web.archive.org/web/20150702161454/https://timeline.com/stories/e-cigarettes-vape-ban-health-nicotine-smoking|archive-date=2 July 2015}} and was never commercialized{{cite web|url=http://inventors.about.com/od/estartinventions/a/Electronic-Cigarettes.htm|title=Who Invented Electronic Cigarettes?|publisher=About.com|author=Mary Bellis|year=2015|access-date=21 September 2013|archive-date=1 August 2022|archive-url=https://web.archive.org/web/20220801004411/https://www.thoughtco.com/famous-inventions-4133301|url-status=dead}} because smoking was still fashionable at that time.{{cite news|url=http://www.walesonline.co.uk/special-features/electronic-cigarette-sales-rise-1817925|title=Electronic Cigarette Sales on the Rise|publisher=WalesOnline|date=24 August 2011}} Gilbert said in 2013 that today's electric cigarettes follow the basic design set forth in his original patent.

The Favor cigarette, introduced in 1986 by public company Advanced Tobacco Products, was another early noncombustible product promoted as an alternative nicotine-containing tobacco product. Favor was conceptualized by Phil Ray, one of the founders of Datapoint Corporation and inventors of the microprocessor. Development started in 1979 by Phil Ray and Norman Jacobson.{{cite web | url=https://www.ecigarettedirect.co.uk/ashtray-blog/2014/06/favor-cigarette-interview-dr-norman-jacobson.html | publisher=Ashtray Blog | title=Vaping 1970's Style: An Interview with One of the Pioneers | first=James | last=Dunworth | date=June 2014 | access-date=27 June 2021}} Favor was a "plastic, smoke-free product shaped and colored like a conventional cigarette that contained a filter paper soaked with liquid nicotine so users could draw a small dose by inhaling. There was no electricity, combustion, or smoke; it delivered only nicotine."{{cite thesis |last=MCGonegal |first=Matthew |date=November 2019 |title="Can I rip your Juul?" |type=Bsc |chapter= |publisher=University of Oregon | url=https://scholarsbank.uoregon.edu/xmlui/handle/1794/25781 | access-date=27 June 2021}}

Favor cigarettes were sold in California and several Southwestern states, marketed as "an alternative to smokers, and only to smokers, to use where smoking is unacceptable or prohibited."{{cite news | url=https://www.chicagotribune.com/news/ct-xpm-1986-05-27-8602070938-story.html | title=Company sniffs profits from a smokeless cigarette | newspaper=Chicago Tribune | date=27 May 1986 | access-date=27 June 2021}} In 1987, the FDA exercised jurisdiction over products analogous to E-Cigarettes.{{cite web | title=FDA's Brief in Opposition to Motion for Preliminary Injunction | date=11 May 2009 | url=https://www.fda.gov/media/77379/download | publisher=Food and Drug Administration}} Advanced Tobacco Products never challenged the Warning Letter and ceased all distribution of Favor.{{cite web | title=Spotlight on Tobacco {{!}} Future Developments in the Regulation of Electronic Nicotine Delivery Systems: Potential Over-the-Counter Pathway | url=https://www.fdli.org/2018/10/spotlight-on-tobacco-future-developments-in-the-regulation-of-electronic-nicotine-delivery-systems-potential-over-the-counter-pathway/ | first1=Azim | last1=Chowdhury | first2=Samuel | last2=Jockel | publisher=Food and Drug Law Institute | series=Update magazine | date=October–November 2018 | access-date=27 June 2021}} Ray's wife Brenda Coffee coined the term vaping.{{cite web | url=https://www.1010parkplace.com/a-deadly-addicting-lie/ | first=Brenda | last=Coffee | publisher=1010ParkPlace | title=A deadly addicting lie | date=22 December 2018 | access-date=27 June 2021}} Philip Morris' division NuMark, launched in 2013 the MarkTen e-cigarette that Philip Morris had been working on since 1990.

Despite these earlier efforts, Hon Lik, a Chinese pharmacist and inventor, who worked as a research pharmacist for a company producing ginseng products,{{cite news|url=https://www.latimes.com/archives/la-xpm-2009-apr-25-fg-china-cigarettes25-story.html|author=Barbara Demick|title=A high-tech approach to getting a nicotine fix|work=Los Angeles Times|date=25 April 2009}} is frequently credited with the invention of the modern e-cigarette. Hon quit smoking after his father, also a heavy smoker, died of lung cancer. In 2001, he thought of using a high frequency, piezoelectric ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine.{{cite web|url=http://www.sciencesetavenir.fr/sante/20131007.OBS0070/i-was-sure-that-the-electronic-cigarette-would-be-welcomed-with-open-arms.html|title=I was sure that the electronic cigarette would be welcomed with open arms|last1=Sridi|first1=Nicolas|publisher=Sciences et Avenir|date=10 July 2013}} This design creates a smoke-like vapor. Hon said that using resistance heating obtained better results and the difficulty was to scale down the device to a small enough size. Hon's invention was intended to be an alternative to smoking. Hon Lik sees the e-cigarette as comparable to the "digital camera taking over from the analogue camera." Ultimately, Hon Lik did not quit smoking. He is now a dual user, both smoking and vaping.{{cite news|url=https://www.thetimes.com/uk/healthcare/article/vape-nation-how-did-britain-end-up-so-hooked-on-e-cigarettes-q5r5vg89s|title=Vape nation: how did Britain end up so hooked on e‑cigarettes?|date=30 October 2021|work=The Times|last1=Spencer|first1=Ben|last2=Calver|first2=Tom}}

File:Ruyan electronic cigar first generation.jpg e-cigar was first launched in China in 2004.{{cite news|url=https://www.nbcnews.com/id/29435175/ns/health-addictions/t/e-cigarettes-attracting-attention-scrutiny/#.V7guajZRE5s|archive-url=https://web.archive.org/web/20160306082410/http://www.nbcnews.com/id/29435175/ns/health-addictions/t/e-cigarettes-attracting-attention-scrutiny/#.V7guajZRE5s|url-status=dead|archive-date=6 March 2016|title=E-cigarettes attracting attention — and scrutiny|work=NBCNews.com |agency=Associated Press|date=27 February 2009}}|alt=Ruyan first-generation electronic cigar.]]

Hon Lik registered a patent for the modern e-cigarette design in 2003. Hon is credited with developing the first commercially successful electronic cigarette.{{cite news|url=http://www.japantimes.co.jp/news/2013/10/04/business/chinese-e-cigarette-inventor-fights-for-royalties/#.VWv8ulJI3s1|title=Chinese e-cigarette inventor fights for royalties|work=The Japan Times|author=Tom Hancock|date=4 October 2013|access-date=1 June 2015|archive-date=1 August 2022|archive-url=https://web.archive.org/web/20220801004413/https://www.japantimes.co.jp/article-expired/#.VWv8ulJI3s1|url-status=dead}} The e-cigarette was first introduced to the Chinese domestic market in 2004. Many versions made their way to the US, sold mostly over the Internet by small marketing firms. E-cigarettes entered the European market and the US market in 2006 and 2007. The company that Hon worked for, Golden Dragon Holdings, registered an international patent in November 2007.{{cite web|url=http://worldwide.espacenet.com/publicationDetails/biblio?CC=US&NR=2007267031&KC=&FT=E&locale=en_EP|title=Electronic Atomization Cigarette |website=Worldwide.espacenet.com|date=22 November 2007}} The company changed its name to Ruyan (如烟, literally "like smoke") later the same month, and started exporting its products.

Many US and Chinese e-cigarette makers copied his designs illegally, so Hon has not received much financial reward for his invention (although some US manufacturers have compensated him through out-of-court settlements).{{cite news |url=https://www.foxnews.com/world/chinas-e-cigarette-inventor-fights-for-financial-rewards/ |title=China's e-cigarette inventor fights for financial rewards |author=Tom Hancock|publisher=Fox News Channel|date=1 October 2013}} Ruyan later changed its company name to Dragonite International Limited.{{cite news |url=http://www.cstoredecisions.com/2013/08/21/dragonite-sells-e-vapor-business-to-itg/#_|title=Dragonite Sells E-Vapor Business To ITG|publisher=Convenient Store Decisions|author=Staff|date=21 August 2013}} As of 2014, most e-cigarettes used a battery-powered heating element rather than the earlier ultrasonic technology design.

Initially, their performance did not meet the expectations of users. The e-cigarette continued to evolve from the first-generation three-part device. In 2007, British entrepreneurs Umer and Tariq Sheikh invented the cartomizer.{{cite web|url=http://stevevape.com/what-does-the-future-hold-for-vaping-technology/|title=What Does The Future Hold For Vaping Technology?|publisher=Steve K's Vaping World|author=Mike K|date=9 June 2015}} 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{{cite web|url=http://www.cityam.com/article/brothers-who-took-punt-new-market/|title=Brothers who took a punt on a new market|publisher=CityAM|author=Annabel Denham|date=10 June 2013|archive-url=https://web.archive.org/web/20160507042819/http://www.cityam.com/article/brothers-who-took-punt-new-market/|archive-date=7 May 2016|url-status=dead}} and the design is now widely adopted by most "cigalike" brands. Other users tinkered with various parts to produce more satisfactory homemade devices, and the hobby of "modding" was born. The first mod to replace the e-cigarette's case to accommodate a longer-lasting battery, dubbed the "screwdriver", was developed by Ted and Matt Rogers in 2008.{{cite web |url=https://www.coresta.org/sites/default/files/technical_documents/main/ECIG-RefRep_Ecig-History-Operation-Regulation_Feb2014b.pdf|title=A Brief Description of History, Operation and Regulation |last1=Garner|first1=Charles|last2=Stevens|first2=Robert|website=Coresta|date=February 2014|archive-url=https://web.archive.org/web/20160303041105/http://www.coresta.org/Reports/ECIG-RefRep_Ecig-History-Operation-Regulation_Feb2014b.pdf|archive-date=3 March 2016|url-status=dead}} Other enthusiasts built their own mods to improve functionality or aesthetics. When pictures of mods appeared at online vaping forums many people wanted them, so some mod makers produced more for sale.

In 2008, a consumer created an e-cigarette called the screwdriver. The device generated a lot of interest back then, as it let the user to vape for hours at one time. The invention led to demand for customizable e-cigarettes, prompting manufacturers to produce devices with interchangeable components that could be selected by the user. In 2009, Joyetech developed the eGo series which offered the power of the screwdriver model and a user-activated switch to a wide market. The clearomizer was invented in 2009. Originating 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. Soon after the clearomizer reached the market, replaceable atomizer coils and variable voltage batteries were introduced. Clearomizers and eGo batteries became the best-selling customizable e-cigarette components in early 2012.

The market for electronic cigarettes rose rapidly during the early 2010s and it started gaining attention in mainstream media.{{Cite journal |last1=Drummond |first1=M Bradley |last2=Upson |first2=Dona |date=Feb 2014 |title=Electronic Cigarettes. Potential Harms and Benefits |journal=Annals of the American Thoracic Society |language=en |volume=11 |issue=2 |pages=236–242 |doi=10.1513/AnnalsATS.201311-391FR |pmid=24575993 |pmc=5469426 }}{{Cite journal |last1=Caponnetto |first1=Pasquale |last2=Campagna |first2=Davide |last3=Papale |first3=Gabriella |last4=Russo |first4=Cristina |last5=Polosa |first5=Riccardo |date=2012-02-01 |title=The emerging phenomenon of electronic cigarettes |url=https://www.tandfonline.com/doi/full/10.1586/ers.11.92 |journal=Expert Review of Respiratory Medicine |volume=6 |issue=1 |pages=63–74 |doi=10.1586/ers.11.92 |issn=1747-6348 |pmid=22283580}} In the United States, some of the most notable start-ups in the market were blu eCigs, NJOY, V2 Cigs, and Logic, as of 2013.{{Cite web |last=Robehmed |first=Natalie |date=September 17, 2013 |title=E-cigarette Sales Surpass $1 Billion As Big Tobacco Moves In |url=https://www.forbes.com/sites/natalierobehmed/2013/09/17/e-cigarette-sales-surpass-1-billion-as-big-tobacco-moves-in/ |access-date=2025-01-22 |website=Forbes |language=en}}{{cite journal | pmc=6510614 | date=2019 | last1=Nicksic | first1=N. E. | last2=Brosnan | first2=P. G. | last3=Chowdhury | first3=N. | last4=Barnes | first4=A. J. | last5=Cobb | first5=C. O. | title="Think it. Mix it. Vape it.": A Content Analysis on E-cigarette Radio Advertisements | journal=Substance Use & Misuse | volume=54 | issue=8 | pages=1355–1364 | doi=10.1080/10826084.2019.1581219 | pmid=30860933 }} International tobacco companies dismissed e-cigarettes as a fad at first.{{cite news |last1=Akam |first1=Simon |date=27 May 2015 |title=Big Tobacco fights back: how the cigarette kings bought the vaping industry |url=http://europe.newsweek.com/big-tobacco-fights-back-how-cigarette-kings-bought-vaping-industry-327758 |work=Newsweek}} However, recognizing the development of a potential new market sector that could render traditional tobacco products obsolete,{{Cite news |date=28 September 2013 |title=Kodak moment |url=https://www.economist.com/news/business/21586867-regulators-wrestle-e-smokes-tobacco-industry-changing-fast-kodak-moment |newspaper=The Economist}} they began to produce and market their own brands of e-cigarettes and acquire existing e-cigarette companies.{{cite web |author=Mike Esterl |date=3 February 2014 |title=Altria Expands in E-Cigarettes With Green Smoke |url=https://www.wsj.com/news/articles/SB10001424052702304626804579360552508696542 |work=The Wall Street Journal}}

The large tobacco companies bought some of the established e-cigarette companies. blu eCigs, a prominent US e-cigarette manufacturer, was acquired by Lorillard Inc.{{cite web |author=Brian Montopoli |date=11 June 2013 |title=Tobacco companies bet on electronic cigarettes |url=https://www.cbsnews.com/news/tobacco-companies-bet-on-electronic-cigarettes/ |work=CBS News}} for $135 million in April 2012. Japan Tobacco invested in Ploom. British American Tobacco was the first tobacco business to sell e-cigarettes in the UK and launched the e-cigarette Vype in July 2013.{{cite news |url=https://www.independent.co.uk/news/uk/home-news/british-american-tobacco-enters-electronic-cigarette-market-in-britain-with-the-vype-8737286.html|author=Sanchez Manning|title=British American Tobacco enters electronic cigarette market in Britain with the 'Vype'|work=The Independent|date=29 July 2013}} 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.{{cite news|url=https://www.bloomberg.com/news/2013-09-02/imperial-tobacco-agrees-to-acquire-dragonite-s-e-cigarette-unit.html |title=Imperial Tobacco Agrees to Acquire Dragonite's E-Cigarette Unit|last1=Gustafsson|first1=Katarina|work=Bloomberg News|date=2 September 2013}} On 1 October 2013 Lorillard Inc. acquired another e-cigarette company, this time the UK based company SKYCIG.{{cite news|url=http://www.bizjournals.com/triad/blog/2013/10/lorillard-acquires-british-e-cig.html|title=Lorillard acquires British e-cig maker for $48.6M|last1=Arcieri |first1=Katie|publisher=Triad Business Journal|date=1 October 2013}} SKY was rebranded as blu.{{cite news|url=http://www.csnews.com/product-categories/tobacco/lorillard-rebrand-skycig-blu-ecigs?nopaging=1 |title=Lorillard to Rebrand SKYCIG as blu eCigs|work=Convenience Store News|date=27 March 2014}}File:All e-cigarettes vs. Juul.jpg]]

On 3 February 2014, Altria Group, Inc. acquired popular e-cigarette brand Green Smoke{{cite news |last=Crook |first=Jordan |date=20 December 2018 |title=Juul Labs gets $12.8 billion investment from Marlboro Maker Altria Group |url=https://techcrunch.com/2018/12/20/juul-labs-gets-12-8-billion-investment-from-marlboro-maker-altria-group/ |work=TechCrunch}}{{refn|group=note|Alteria no longer sells e-cigarettes.}} for $110 million.{{cite news |title=RPT-Fitch: Altria Green Smoke Buy Highlights Industry e-Cig Interest |url=https://www.reuters.com/article/fitch-altria-green-smoke-buy-highlights/rpt-fitch-altria-green-smoke-buy-highlights-industry-e-cig-interest-idUSFit68990920140205 |access-date=13 November 2022 |work=Reuters |date=5 February 2014 |language=en}} The deal was finalized in April 2014 for $110 million with $20 million in incentive payments.{{cite news |last1=Egan |first1=Matt |title=Altria Bolsters E-Cigarette Business With $110M Buy of Green Smoke |url=https://www.foxbusiness.com/markets/altria-bolsters-e-cigarette-business-with-110m-buy-of-green-smoke |access-date=13 November 2022 |work=FOXBusiness |date=9 January 2016}} Altria also markets its own e-cigarette, the MarkTen, while Reynolds American has entered the sector with its Vuse product. Philip Morris, the world's largest tobacco company, purchased UK's Nicocigs in June 2014.{{cite news |url=https://www.independent.co.uk/news/business/news/philip-morris-buys-ecigarette-maker-nicocigs-as-it-warns-of-falling-profits-9565087.html|author=Gideon Spanier|title=Philip Morris buys e-cigarette maker Nicocigs as it warns of falling profits|work=The Independent|date=26 June 2014}} On 30 April 2015, Japan Tobacco bought the US Logic e-cigarette brand. Japan Tobacco also bought the UK E-Lites brand in June 2014.{{cite news|url=https://csnews.com/japan-tobaccos-global-ambitions-lead-logic-acquisition|title=Japan Tobacco's Global Ambitions Lead to Logic Acquisition |work=Convenience Store News|date=30 April 2015}} On 15 July 2014, Lorillard sold blu to Imperial Tobacco as part of a deal for $7.1 billion.{{cite news |url=https://www.cnbc.com/2014/07/15/feeling-blu-e-cig-company-spun-off-in-major-tobacco-deal.html|title=Feeling blu? E-cig company spun off in major tobacco deal|first1=Dan |last1=Mangan|publisher=CNBC|date=15 July 2014}}

Following these changes, the main players in the e-cigarette market (at least in the US) were as follows (as of end 2015):{{cite web|date= January 5, 2016 |url=https://www.akleg.gov/basis/get_documents.asp?session=29&docid=40849 |title=Nielsen: Tobacco "All Channel" Data Through 12/26|first1=Bonnie |last1=Herzog|first2=Adam |last2=Scott|first3=Patty |last3=Kanada}}

Despite the acquisitions by big tobacco companies, some independent e-cigarette companies had more success, most notably Juul Labs, as of 2018.{{Cite web |last=Journal |first=Richard Craver Winston-Salem |date=2018-07-17 |title=Reynolds Vapor prepares national launch of new e-cig rival to Juul |url=https://journalnow.com/business/reynolds-vapor-prepares-national-launch-of-new-e-cig-rival/article_7ba10442-d438-575e-af23-794173089a8a.html |access-date=2025-01-22 |website=Winston-Salem Journal |language=en}}

{{As of|2018}}, 95% of e-cigarettes were made in China. Despite international growth of e-cigarettes during the 2010s, not all regions around the world have yet embraced it as much. In 2018, Indonesia became only one of the first in Asia or the Global South to recognise e-cigarettes as a genuine alternative to smoking tobacco.{{Cite web |last=Chowdhery |first=Samrat |date=2024-11-22 |title=Will Indonesia, a Key Tobacco Control Outlier, Keep Vaping Legal? |url=https://filtermag.org/will-indonesia-a-key-tobacco-control-outlier-keep-vaping-legal/ |access-date=2025-01-22 |website=Filter |language=en-US}}

In the United States between 2020 and 2022, the number of e-cigarettes sold had climbed to 22.7 million units. Elf Bar/EBDESIGN, Vuse, JUUL, NJOY and Breeze Smoke were recognized as the five most popular brands as of December 2022.{{Cite web |date=June 22, 2023 |title=U.S. E-cigarette Sales Climbed during 2020-2022 |url=https://www.cdc.gov/media/releases/2023/p0622-ecigarettes-sales.html |access-date=2025-01-22 |website=Centers for Disease Control and Prevention |language=en-us}} The surge was driven by non-tobacco flavors such as menthol (for prefilled cartridges) and fruit and candy (for disposables), according to the CDC's health economist Fatma Romeh Ali.

In the UK, where most vaping uses refillable sets and e-liquid, there is now support from the National Health Service,{{Cite web |date=24 November 2021 |title=Using e-cigarettes to stop smoking |url=https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/ |access-date=7 April 2022 |website=nhs.uk |language=en}} and other medical bodies now embrace the use of e-cigarettes as a viable way to quit smoking. This has contributed to record numbers of people vaping, with estimated 3.6 million in 2019, 3.2 million in 2020, rising to 3.6 million in 2021.{{Cite journal |last=(ASH) |first=Action on Smoking and Health |date=June 2021 |title=Use of e-cigarettes (vapes) among adults in Great Britain. 2021 |url=https://ash.org.uk/wp-content/uploads/2021/06/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2021.pdf |journal=Use of E-cigarettes (Vapes) Among Adults in Great Britain. 2021}} Current vapers being 2.2 million as of 2024.{{Cite news |last1=Thomas |first1=Tobi |last2=Health |first2=Tobi Thomas |date=2024-08-11 |title=Number of UK adults who vape reaches record level, report finds |url=https://www.theguardian.com/politics/article/2024/aug/12/number-of-uk-adults-who-vape-reaches-record-level-report-finds#:~:text=The%20proportion%20of%20adults%20who,equivalent%20of%202.2%20million%20people. |access-date=2024-08-22 |work=The Guardian |language=en-GB |issn=0261-3077}}

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Consumers have shown passionate support for e-cigarettes that other nicotine replacement products did not receive. They have a mass appeal that could challenge combustible tobacco's market position.

By 2013, a subculture had emerged calling itself "the vaping community".{{cite web|url=http://www.digitaltrends.com/features/inside-the-world-of-vapers-the-subculture-that-might-save-smokers-lives/ |title=Inside the world of vapers, the subculture that might save smokers' lives|date=13 May 2013|last1=Couts|first1=Andrew|publisher=Digital Trends}}{{cite news|last1=Park |first1=Andy|date=26 August 2013 |url=http://www.sbs.com.au/news/article/2013/06/18/feed-subculture-around-e-cigarettes|title=The Feed: The subculture around e-cigarettes|publisher=SBS World News}} Members often see e-cigarettes as a safer alternative to smoking,{{cite journal|last1=Hajek|first1=P|last2=Etter|first2=JF|last3=Benowitz|first3=N|last4=Eissenberg|first4=T|last5=McRobbie|first5=H|title=Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit|journal=Addiction|date=31 July 2014|volume=109|issue=11|pages=1801–1810 |doi=10.1111/add.12659|pmc=4487785|pmid=25078252}} and some view it as a hobby.{{cite journal|last1=Barbeau|first1=Amanda M|last2=Burda|first2=Jennifer|last3=Siegel|first3=Michael |title=Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach|journal=Addiction Science & Clinical Practice|volume=8|issue=1 |year=2013|pages=5|issn=1940-0640|doi=10.1186/1940-0640-8-5|pmc=3599549|pmid=23497603 |doi-access=free }} The online forum E-Cig-Reviews.com was one of the first major communities. It and other online forums, such as UKVaper.org, were where the hobby of modding started.{{cite news|title=Trading addictions: the inside story of the e-cig modding scene|author=Michael Grothaus|date=1 October 2014|work=Engadget|url=https://www.engadget.com/2014/10/01/inside-story-e-cig-modding-uk/}} There are also groups on Facebook and Reddit.{{cite news|author1=Eric Larson|title=Pimp My Vape: The Rise of E-Cigarette Hackers|url=http://mashable.com/2014/01/25/vaping-subculture/|publisher=Mashable|date=25 January 2014}} Online forums based around modding have grown in the vaping community.{{cite news|title=CVape life: welcome to the weird world of e-cig evangelists|url=https://www.theverge.com/2014/2/25/5445662/vape-life-welcome-to-the-weird-world-of-e-cig-evangelists|work=The Verge|author=Molly Osberg|date=25 February 2014}}

Vapers embrace activities associated with e-cigarettes and sometimes evangelise for them.{{cite journal|author1=Sanford Z |author2=Goebel L|title=E-cigarettes: an up to date review and discussion of the controversy|journal=W V Med J|volume=110|issue=4|pages=10–5|year=2014|pmid=25322582}} E-cigarette companies have a substantial online presence, and there are many individual vapers who blog and tweet about e-cigarette related products. A 2014 Postgraduate Medical Journal editorial said 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".{{cite journal|last1=McKee |first1=M.|title=Electronic cigarettes: peering through the smokescreen|journal=Postgraduate Medical Journal|volume=90|issue=1069|year=2014|pages=607–609|issn=0032-5473|doi=10.1136/postgradmedj-2014-133029|pmid=25294933|doi-access=free|url=http://pmj.bmj.com/content/90/1069/607.full.pdf+html}}

Contempt for Big Tobacco is part of vaping culture.{{cite news|title=Are E-Cigarettes Losing Ground in the Vapor Market?|author=Tom Gara|work=The Wall Street Journal|date=14 April 2014 |url=https://blogs.wsj.com/corporate-intelligence/2014/04/14/are-e-cigarettes-losing-ground-in-the-vapor-market/}}{{cite news|last1=Sottile|first1=Leah|title=The Right to Vape |url=https://www.theatlantic.com/health/archive/2014/10/the-right-to-vape/381145/|work=The Atlantic |date=8 October 2014}} 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 Products Directive in October 2013. Grassroots lobbying also influenced the Tobacco Products Directive decision.{{cite news|last1=Jacobs|first1=Emma|last2=Robinson |first2=Duncan|title=E-cigarettes: no smoke without fear |url=http://www.ft.com/cms/s/2/ed185b54-c5e0-11e3-a7d4-00144feabdc0.html|work=FT Magazine|date=17 April 2014}} Tobacco companies have worked with organizations conceived to promote e-cigarette use, and these organizations have worked to hamper legislation intended at restricting e-cigarette use.

File:Smoke Screen (16582794210).jpg.{{cite news|author=Gavin Haynes|date=22 April 2015 |url=https://www.theguardian.com/society/shortcuts/2015/apr/22/cloud-chasing-competitive-sport-blowing-vape-clouds|title=Daft vapers: the competitive world of e-cigarette smoking|work=The Guardian}} |alt=E-cigarette user blowing a large cloud of aerosol (vapor). This activity is known as cloud-chasing.]]

Large gatherings of vapers, called vape meets, take place around the US. They focus on e-cigarette 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.{{cite news|url=https://www.wsj.com/articles/vaporizers-are-the-new-draw-in-e-cigarettes-1401378596|title='Vaporizers' Are the New Draw in E-Cigarettes|author=Mike Esterl|work=The Wall Street Journal|date=29 May 2014}} Some vape shops have a vape bar where patrons can test out different e-liquids and socialize.{{cite news|url=http://www.dailynebraskan.com/news/generation-v-e-cigarettes-and-vape-bar-aims-to-convert/article_f79f2130-9466-11e3-b3d8-0017a43b2370.html|title=Generation V E-Cigarettes and Vape Bar aims to convert smokers to e-cigarettes|author=Staff|work=Daily Nebraskan|date=13 February 2014}} The Electronic Cigarette Convention in North America which started in 2013, is an annual show where companies and consumers meet up.{{cite news|url=http://www.dailybulletin.com/business/20140904/vaping-convention-coming-to-ontario-convention-center-friday|title=Vaping convention coming to Ontario Convention Center Friday|author=Neil Nisperos|work=Inland Valley Daily Bulletin|date=4 September 2014}}

A subclass of vapers configure their atomizers to produce large amounts of vapor by using low-resistance heating coils.{{cite news|url=http://vapenewsmagazine.com/february-2014/vapeview-the-cloud-chasers|title=The Cloud Chasers|author=Mary Plass|publisher=Vape News Magazine|date=29 January 2014}} This practice is called "cloud-chasing".{{cite news|url=https://huffingtonpost.com/2014/08/05/cloud-chasing-vaping-competition_n_5652528.html|title=This Man Is An Athlete In The Sport Of 'Cloud Chasing'|author=Dominique Mosbergen|work=HuffPost|date=5 August 2014}} 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.{{cite news|title=What you need to know about vaporizers|url=https://www.engadget.com/2014/05/23/vaporizers-explainer/|work=Engadget|author=Sean Cooper|date=23 May 2014}} As vaping comes under increased scrutiny, some members of the vaping community have voiced their concerns about cloud-chasing, stating the practice gives vapers a bad reputation when doing it in public.{{cite news|url=http://www.newsweek.com/veteran-e-cigarette-users-fret-cloud-chasers-give-them-bad-name-238978|title=Veteran E-Cigarette Users Fret 'Cloud Chasers' Give Them a Bad Name|author=Victoria Bekiempis|work=Newsweek|date=1 April 2015}} The Oxford Dictionaries' word of the year for 2014 was "vape".{{cite news|first1=Claire|last1=Fallon|title='Vape' Is Oxford Dictionaries' Word Of The Year|url=https://huffingtonpost.com/2014/11/18/vape-word-of-year_n_6178102.html|work=HuffPost|date=19 November 2014}}

{{Main|Regulation of electronic cigarettes|List of vaping bans in the United States}}

Regulation of e-cigarettes varies across countries and states, ranging from no regulation to banning them entirely.{{cite journal|last1=Etter|first1=J. F.|last2=Bullen|first2=C.|last3=Flouris|first3=A. D.|last4=Laugesen|first4=M.|last5=Eissenberg|first5=T.|title=Electronic nicotine delivery systems: a research agenda|journal=Tobacco Control|date=May 2011|volume=20|issue=3|pages=243–8|doi=10.1136/tc.2010.042168|pmc=3215262|pmid=21415064}} For instance, e-cigarettes containing nicotine are illegal in Japan, forcing the market to use heated tobacco products for cigarette alternatives.{{cite journal|last1=Tabuchi|first1=Takahiro|last2=Gallus|first2=Silvano|last3=Shinozaki|first3=Tomohiro|last4=Nakaya|first4=Tomoki|last5=Kunugita|first5=Naoki|last6=Colwell|first6=Brian|title=Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol|journal=Tobacco Control|volume=27|issue=e1|year=2018|pages=e25–e33|issn=0964-4563|doi=10.1136/tobaccocontrol-2017-053947|pmc=6073918|pmid=29248896}} Others have introduced strict restrictions and some have licensed devices as medicines such as in the UK. However, {{as of|February 2018|lc=y}}, there is no e-cigarette device that has been given a medical license that is commercially sold or available by prescription in the UK.{{sfn|McNeill|2018|p=46}} {{As of|2015}}, around two thirds of major nations have regulated e-cigarettes in some way.{{cite news|url=http://ecigintelligence.com/worlds-law-makers-favour-e-cig-regulation-based-on-tobacco/|title=World's law-makers favour basing e-cig rules on tobacco|author=Barnaby Page|work=ECigIntelligence|publisher=Tamarind Media Limited|date=5 March 2015}}

Because of the potential relationship with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries.{{cite journal|last1=Kim|first1=Ki-Hyun|last2=Kabir|first2=Ehsanul|last3=Jahan|first3=Shamin Ara|title=Review of electronic cigarettes as tobacco cigarette substitutes: their potential human health impact|journal=Journal of Environmental Science and Health, Part C|volume=34|issue=4|year=2016|pages=262–275|issn=1059-0501|doi=10.1080/10590501.2016.1236604|pmid=27635466|bibcode=2016JESHC..34..262K |s2cid=42660975}} The companies that make e-cigarettes have been pushing for laws that support their interests.{{cite journal|last1=Lempert|first1=Lauren K|last2=Grana|first2=Rachel|last3=Glantz|first3=Stanton A|title=The importance of product definitions in US e-cigarette laws and regulations|journal=Tobacco Control|volume=25|issue=e1|year=2016|pages=e44–e51|issn=0964-4563|doi=10.1136/tobaccocontrol-2014-051913|pmc=4466213|pmid=25512432}} In 2016 the US Department of Transportation banned the use of e-cigarettes on commercial flights. This regulation applies to all flights to and from the US.{{cite web|url=https://www.transportation.gov/briefing-room/us-department-transportation-explicitly-bans-use-electronic-cigarettes-commercial|title=U.S. Department of Transportation Explicitly Bans the Use of Electronic Cigarettes on Commercial Flights|publisher=United States Department of Transportation|date=2 March 2016}} In 2018, the Royal College of Physicians asked that a balance is found in regulations over e-cigarettes that ensure product safety while encouraging smokers to use them instead of tobacco, as well as keep an eye on any effects contrary to the control agencies for tobacco.{{cite web|url=https://www.rcplondon.ac.uk/projects/outputs/what-rcp-thinks-about-tobacco|title=What the RCP thinks about tobacco|location=UK|publisher=Royal College of Physicians|pages=1–2|date=1 February 2018}}

The legal status of e-cigarettes is currently pending in many countries. Many countries such as Brazil, Singapore, Uruguay,{{cite journal|last1=Beard|first1=Emma|last2=Shahab|first2=Lion|last3=Cummings|first3=Damian M.|last4=Michie|first4=Susan|last5=West|first5=Robert|title=New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?|journal=CNS Drugs|volume=30|issue=10|pages=951–83|year=2016|issn=1172-7047|doi=10.1007/s40263-016-0362-3|pmid=27421270|s2cid=40411008|url=http://discovery.ucl.ac.uk/1498793/1/Beard%20et%20al%202016%20%20New%20Pharmacological%20Agents%20to%20Aid%20Smoking%20Cessation%20and%20Tobacco%20Harm%20Reduction.pdf}} and India have banned e-cigarettes.{{cite news|url=https://www.theverge.com/2019/9/18/20872967/india-e-cigarette-vaping-ban-epidemic-health-risks|title=India bans e-cigarette sales and says there's an 'epidemic' of kids vaping|last1=Robertson|first1=Adi|work=The Verge|date=18 September 2019}} Canada-wide in 2014, they were technically illegal to sell, as no nicotine-containing e-cigarettes are not regulated by Health Canada, but this is generally unenforced and they are commonly available for sale Canada-wide.{{cite news|last1=Sienuic|first1=Kat|url=https://www.theglobeandmail.com/life/health-and-fitness/health/health-officials-set-rules-but-decisions-belong-to-each-person/article20809598/|title=Public health officers tackle hazy issue of e-cigarettes|work=The Globe and Mail|date=29 September 2014}} In 2016, Health Canada announced plans to regulate vaping products.{{cite news|url=http://www.cbc.ca/news/health/vaping-health-canada-legislation-1.3862589|title=Vaping, e-cigarettes to be regulated by Health Canada|publisher=CBC News|date=22 November 2016}} In the US and the UK, the use and sale to adults of e-cigarettes are legal.{{cite journal|last1=Kadowaki|first1=Joy|last2=Vuolo|first2=Mike|last3=Kelly|first3=Brian C.|title=A review of the current geographic distribution of and debate surrounding electronic cigarette clean air regulations in the United States|journal=Health & Place|volume=31|year=2015|pages=75–82|issn=1353-8292|doi=10.1016/j.healthplace.2014.11.003|pmc=4305454|pmid=25463920}}{{rp|US}}{{cite news|url=https://www.bbc.co.uk/news/uk-25900542|title=E-cigarettes to be stubbed out for under-18s|date=26 January 2014|work=BBC News}}{{rp|UK}} The revised EU Tobacco Products Directive came into effect in May 2016, providing stricter regulations for e-cigarettes.{{cite news|url=http://www.businessinsider.com/ap-european-court-tougher-rules-on-electronic-cigarettes-2016-5|title=European court: Tougher rules on electronic cigarettes|work=Business Insider|agency=Associated Press|date=4 May 2016|access-date=2 June 2019|archive-date=2 June 2019|archive-url=https://web.archive.org/web/20190602164019/https://www.businessinsider.com/ap-european-court-tougher-rules-on-electronic-cigarettes-2016-5|url-status=dead}} It limits e-cigarette advertising in print, on television and radio, along with reducing the level of nicotine in liquids and reducing the flavors used.{{cite news|url=http://www.cityam.com/240410/eu-tobacco-products-directive-chokes-off-the-uks-e-cigarette-and-vaping-market-|title=EU Tobacco Products Directive chokes off the UK's e-cigarette and vaping market|author=Francesca Washtell|work=City A.M.|date=5 May 2016}} It does not ban vaping in public places.{{cite journal|last1=Zainol Abidin|first1=Najihah|last2=Zainal Abidin|first2=Emilia|last3=Zulkifli|first3=Aziemah|last4=Karuppiah|first4=Karmegam|last5=Syed Ismail|first5=Sharifah Norkhadijah|last6=Amer Nordin|first6=Amer Siddiq|title=Electronic cigarettes and indoor air quality: a review of studies using human volunteers|journal=Reviews on Environmental Health|volume=32|issue=3|pages=235–244|year=2017|issn=2191-0308|doi=10.1515/reveh-2016-0059|pmid=28107173|s2cid=6885414|url=http://psasir.upm.edu.my/id/eprint/61699/1/Electronic%20cigarettes%20and%20indoor%20air%20quality.pdf}} It requires the purchaser for e-cigarettes to be at least 18 and does not permit buying them for anyone less than 18 years of age.{{sfn|McNeill|2018|p=39}} The updated Tobacco Products Directive has been disputed by tobacco lobbyists whose businesses could be impacted by these revisions.{{cite news|url=http://www.euronews.com/2013/07/10/new-tobacco-products-directive-adopted-regulations-on-e-cigarettes-announced|title=Anger over tobacco lobbyists as Europe nears new rules on e-cigarettes|author=Ashitha Nagesh|publisher=Euronews|date=10 July 2013}}

As of 8 August 2016, the US FDA extended its regulatory power to include e-cigarettes, e-liquid and all related products.{{cite web|url=https://www.fda.gov/tobaccoproducts/labeling/rulesregulationsguidance/ucm394909.htm|title=FDA's New Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products|publisher=United States Food and Drug Administration|date=17 August 2017}} Under this ruling the FDA will evaluate certain issues, including ingredients, product features and health risks, as well their appeal to minors and non-users. The FDA rule also bans access to minors. A photo ID is now required to buy e-cigarettes,{{cite web|url=https://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/Retail/ucm205021.htm|title=Summary of Federal Rules for Tobacco Retailers|publisher=United States Food and Drug Administration|date=23 August 2017}} and their sale in all-ages vending machines is not permitted in the US.{{cite web|title=The Facts on the FDA's New Tobacco Rule|url=https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm506676.htm|publisher=United States Food and Drug Administration|date=2 May 2017}} As of August 2017, regulatory compliance deadlines relating to premarket review requirements for most e-cigarette and e-liquid products have been extended from November 2017 to 8 August 2022,{{cite web|url=https://www.fda.gov/TobaccoProducts/Labeling/RulesRegulationsGuidance/ucm557714.htm|title=Extension of Certain Tobacco Product Compliance Deadlines Related to the Final Deeming Rule (Revised)|publisher=United States Food and Drug Administration|date=4 August 2017}}{{cite web|url=https://www.fda.gov/downloads/TobaccoProducts/Labeling/RulesRegulationsGuidance/UCM557716.pdf|title=Guidance: Extension of Certain Tobacco Product Compliance Deadlines Related to the Final Deeming Rule (Revised*)|publisher=United States Food and Drug Administration|date=August 2017}} which attracted a lawsuit filed by the American Heart Association, American Academy of Pediatrics, the Campaign for Tobacco-Free Kids, and other plaintiffs.{{cite news|url=https://www.dddmag.com/news/2018/03/lawsuit-challenges-fda-delay-e-cigarette-review|title=Lawsuit Challenges FDA Delay of E-cigarette Review|last1=Perrone|first1=Matthew|publisher=Drug Discovery & Development|agency=Associated Press|date=28 March 2018}}

In May 2016, the US FDA used its authority under the Family Smoking Prevention and Tobacco Control Act to deem e-cigarette devices and e-liquids to be tobacco products, which meant it intended to regulate the marketing, labelling, and manufacture of devices and liquids; vape shops that mix e-liquids or make or modify devices were considered manufacturing sites that needed to register with US FDA and comply with good manufacturing practice regulation. E-cigarette and tobacco companies have recruited lobbyists in an effort to prevent the US FDA from evaluating e-cigarette products or banning existing products already on the market.{{cite news|url=https://www.nytimes.com/2016/09/03/us/politics/e-cigarettes-vaping-cigars-fda-altria.html?module=Promotron®ion=Body&action=click&pgtype=article|title=A Lobbyist Wrote the Bill. Will the Tobacco Industry Win Its E-Cigarette Fight?|author=Eric Lipton|work=The New York Times|date=2 September 2016}}

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.{{cite web|url=http://europa.eu/rapid/press-release_MEMO-14-134_en.htm|title=Questions & Answers: New rules for tobacco products|publisher=European Commission|date=26 February 2014}} In April 2014 the US FDA published proposed regulations for e-cigarettes.{{cite journal|url=https://www.federalregister.gov/articles/2014/04/25/2014-09491/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the|title=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|journal=Federal Register|publisher=United States Food and Drug Administration|volume=79|issue=80|pages=23142–23207|date=25 April 2014}}{{cite news|url=https://nytimes.com/2014/04/24/health/fda-will-propose-new-regulations-for-e-cigarettes.html|title=F.D.A. Will Propose New Regulations for E-Cigarettes|author=Sabrina Tavernise|work=The New York Times|date=24 April 2014}} In the US some states tax e-cigarettes as tobacco products, and some state and regional governments have broadened their indoor smoking bans to include e-cigarettes.{{cite journal|last1=Crowley|first1=Ryan A.|title=Electronic Nicotine Delivery Systems: Executive Summary of a Policy Position Paper From the American College of Physicians |journal=Annals of Internal Medicine|volume=162|issue=8|year=2015|pages=583–4|issn=0003-4819|doi=10.7326/M14-2481|pmid=25894027|doi-access=free}} {{As of|April 2017}}, 12 US states and 615 localities had prohibited the use of e-cigarettes in venues in which traditional cigarette smoking was prohibited. In 2015, at least 48 states and 2 territories had banned e-cigarette sales to minors.{{cite web|url=http://www.ncsl.org/research/health/alternative-nicotine-products-e-cigarettes.aspx|title=Alternative Nicotine Products – Electronic Cigarettes|publisher=National Conference of State Legislatures|date=3 March 2017}}

In November 2020, the New Zealand government passed a vaping regulation that requires vape stores to register as specialist vape retailers before they can sell e-cigarettes, the wider range of flavoured e-liquids, and other related vaping products. Vaping products are required to be notified by the government before they can be sold to ensure that the products are following safety requirements and ingredients in liquids do not contain prohibited substances.{{Cite web|title=Vaping Law FAQ - Vaping Regulations Explained {{!}} Shosha NZ|url=https://www.shosha.co.nz/vaping-law|access-date=25 June 2021|website=www.shosha.co.nz|archive-date=25 June 2021|archive-url=https://web.archive.org/web/20210625045235/https://www.shosha.co.nz/vaping-law|url-status=dead}}

E-cigarettes containing nicotine have been listed as drug delivery devices in a number of countries, and the marketing of such products has been restricted or put on hold until safety and efficacy clinical trials are conclusive.{{cite journal|last1=Cervellin|first1=Gianfranco|last2=Borghi|first2=Loris|last3=Mattiuzzi|first3=Camilla|last4=Meschi|first4=Tiziana|last5=Favaloro|first5=Emmanuel|last6=Lippi |first6=Giuseppe|title=E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism|journal=Seminars in Thrombosis and Hemostasis|volume=40|issue=1|year=2013|pages=060–065|issn=0094-6176|doi=10.1055/s-0033-1363468 |pmid=24343348|doi-access=free}} Since they do not contain tobacco, television advertising in the US is not restricted.{{cite journal|last1=Maloney|first1=Erin K.|last2=Cappella |first2=Joseph N.|title=Does Vaping in E-Cigarette Advertisements Affect Tobacco Smoking Urge, Intentions, and Perceptions in Daily, Intermittent, and Former Smokers?|journal=Health Communication|year=2015|volume=31 |issue=1|pages=1–10|issn=1041-0236|doi=10.1080/10410236.2014.993496|pmid=25758192|s2cid=31328176}} Some countries have regulated e-cigarettes as a medical product even though they have not approved them as a smoking cessation aid.{{cite journal|last1=Bekki|first1=Kanae|last2=Uchiyama|first2=Shigehisa|last3=Ohta|first3=Kazushi|last4=Inaba|first4=Yohei|last5=Nakagome|first5=Hideki|last6=Kunugita |first6=Naoki|title=Carbonyl Compounds Generated from Electronic Cigarettes|journal=International Journal of Environmental Research and Public Health|volume=11|issue=11|year=2014|pages=11192–11200|issn=1660-4601 |doi=10.3390/ijerph111111192|pmc=4245608|pmid=25353061|doi-access=free}}{{CC-notice|cc=by4|url=http://www.mdpi.com/1660-4601/11/11/11192/htm|author(s)=Kanae Bekki, Shigehisa Uchiyama, Kazushi Ohta, Yohei Inaba, Hideki Nakagome and Naoki Kunugita}} A 2014 review stated the emerging phenomenon of e-cigarettes has raised concerns in the health community, governments, and the general public and recommended that e-cigarettes should be regulated to protect consumers. It added, "heavy regulation by restricting access to e-cigarettes would just encourage continuing use of much unhealthier tobacco smoking." A 2014 review said regulation of the e-cigarette should be considered on the basis of reported adverse health effects.

Critics of vaping bans state that vaping is a much safer alternative to smoking tobacco products and that vaping bans incentivize people to return to smoking cigarettes.{{Cite web |title=California Is Forcing Smokers To Buy More Dangerous Products |url=https://reason.com/2022/05/06/californias-is-forcing-smokers-to-buy-more-dangerous-products/|date=6 May 2022}} For example, critics cite the British Journal of Family Medicine in August 2015 which stated, "E-cigarettes are 95% safer than traditional smoking."{{Cite web |title=Vaping 95% less harmful than smoking |url=https://www.gmjournal.co.uk/vaping-95-less-harmful-than-smoking#:~:text=E%2Dcigarettes%20are%2095%25%20safer,help%20people%20give%20up%20smoking.|date=August 2015}} Additionally, San Francisco's chief economist, Ted Egan, when discussing the San Francisco vaping ban stated the city's ban on e-cigarette sales will increase smoking as vapers switch to combustible cigarettes.{{Cite web |title=San Francisco's Top Economist Confirms Vape Ban Means More Smoking |url=https://reason.com/2019/07/15/san-franciscos-top-economist-confirms-vape-ban-means-more-smoking/|date=15 July 2019}} Critics of smoking bans stress the absurdity of criminalizing the sale of a safer alternative to tobacco while tobacco continues to be legal. Prominent proponents of smoking bans are not in favor of criminalizing tobacco either, but rather allowing consumers to have the choice to choose whatever products they desire.

In 2022, after two years of review, the Food and Drug Administration (FDA) denied Juul's application to keep its tobacco and menthol flavored vaping products on the market.{{Cite news |title=FDA to Order Juul E-Cigarettes Off U.S. Market |newspaper=Wall Street Journal |url=https://www.wsj.com/articles/fda-to-order-juul-e-cigarettes-off-u-s-market-11655904689|date=22 June 2022|last1=Maloney |first1=Jennifer }} Critics of this denial note that research published in Nicotine and Tobacco Research found that smokers who transitioned to Juuls in North America were significantly more likely to switch to vaping than those in the United Kingdom who only had access to lower-strength nicotine products.{{Cite journal |title=Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom |url=https://academic.oup.com/ntr/article/23/11/1821/6276234?login=false|date=18 May 2021| doi=10.1093/ntr/ntab062 | last1=Goldenson | first1=Nicholas I. | last2=Ding | first2=Yu | last3=Prakash | first3=Shivaani | last4=Hatcher | first4=Cameron | last5=Augustson | first5=Erik M. | last6=Shiffman | first6=Saul | journal=Nicotine & Tobacco Research | volume=23 | issue=11 | pages=1821–1830 | pmc=8653762 }} This happens as the Biden administration seeks to mandate low-nicotine cigarettes which, critics note, is not what makes cigarettes dangerous.{{Cite web |title=Mandating Low-Nicotine Cigarettes Could Make Smoking More Dangerous|url=https://reason.com/2022/06/22/mandating-low-nicotine-cigarettes-could-make-smoking-more-dangerous/|date=22 June 2022}} They also note that vaping does not contain many of the components that make smoking dangerous such as the combustion process and certain chemicals that are present in cigarettes that are not present in vape products.

Multiple reports from the U.S. Fire Administration conclude that electronic cigarettes have been combusting and injuring people and surrounding areas.{{Cite web|url=https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf|title=Electronic Cigarette Fires and Explosions in the United States 2009-2016}}{{Cite web|url=https://www.icao.int/safety/dangerousgoods/dgpwg15/dgpwg.15.ip.004.2.en.app.pdf|title=E-Cigarette Fire Risks and Reported Incidents}} The composition of a cigarette is the cause of this, as the cartridges that are meant to contain the liquid mixture are in such close proximity to the battery. A research report by the U.S. Fire Administration supports this, stating that, "Unlike mobile phones, some e-cigarette lithium-ion batteries within e-cigarettes offer no protection to stop the coil overheating".

In 2015, the U.S. Fire Administration noted in their report that electronic cigarettes are not created by Big Tobacco or other tobacco companies, but by independent factories that have little quality control. Because of this low quality control when made, electronic cigarettes have led to incidents in which people are hurt, or in which the surrounding area is damaged.

{{Main|Electronic cigarette and e-cigarette liquid marketing}}

They are marketed to men, women, and children as being safer than traditional cigarettes.{{cite journal|last1=Crotty LE|first1=Alexander|last2=Vyas|first2=A |last3=Schraufnagel|first3=DE |last4=Malhotra|first4=A|title=Electronic cigarettes: the new face of nicotine delivery and addiction|journal=Journal of Thoracic Disease|volume=7|issue=8|year=2015 |pages=E248–E251|doi=10.3978/j.issn.2072-1439.2015.07.37 |pmc=4561260|pmid=26380791}} They are also marketed to non-smokers. E-cigarette marketing is common. There are growing concerns that e-cigarette advertising campaigns unjustifiably focus on young adults, adolescents, and women. Large tobacco companies have greatly increased their marketing efforts. This marketing trend may expand the use of e-cigarettes and contribute to re-glamorizing smoking.{{cite web |url=http://wiki.cancer.org.au/policy/Position_statement_-_Electronic_cigarettes#Key_health_concerns |title=Position Statement Electronic Cigarettes|publisher=Cancer Council Australia; National Heart Foundation of Australia|year=2014}} Some companies may use e-cigarette advertising to advocate smoking, deliberately, or inadvertently, is an area of concern.{{cite journal|last1=Rinkoo|first1=ArvindVashishta |last2=Kaur|first2=Jagdish|title=Getting real with the upcoming challenge of electronic nicotine delivery systems: The way forward for the South-East Asia region|journal=Indian Journal of Public Health|volume=61|issue=5 |year=2017|pages=S7–S11|issn=0019-557X|doi=10.4103/ijph.IJPH_240_17|pmid=28928312|doi-access=free}} A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s."

E-cigarette companies are using methods that were once used by the tobacco industry to persuade young people to start using cigarettes. E-cigarettes are promoted to a certain extent to forge a vaping culture that entices non-smokers. Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that are appealing to young people and young adults in traditional cigarette advertising and promotion. A 2017 review found "The tobacco industry sees a future where ENDS accompany and perpetuate, rather than supplant, tobacco use, especially targeting the youth." E-cigarettes and nicotine are regularly promoted as safe and even healthy in the media and on brand websites, which is an area of concern.

While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in several countries may be indirectly encouraging traditional cigarette use. E-cigarette advertisements are also in magazines, newspapers, online, and in retail stores.{{sfn|Chapman|2015|p=7}} Between 2010 and 2014, e-cigarettes were second only to cigarettes as the top advertised product in magazines.{{cite journal|last1=Collins|first1=Lauren|last2=Glasser|first2=Allison M|last3=Abudayyeh|first3=Haneen |last4=Pearson|first4=Jennifer L|last5=Villanti |first5=Andrea C|title=E-Cigarette Marketing and Communication: How E-Cigarette Companies Market E-Cigarettes and the Public Engages with E-cigarette Information|journal=Nicotine & Tobacco Research|volume=21|issue=1|pages=14–24|year=2018|issn=1462-2203 |doi=10.1093/ntr/ntx284|pmc=6610165|pmid=29315420}} As cigarette companies have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction. This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry. There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some stating to want to cooperate in "harm reduction". E-cigarette advertising for using e-cigarettes as a quitting tool have been seen in the US, UK, and China, which have not been supported by regulatory bodies.{{cite journal |last1=Kalkhoran|first1=Sara|last2=Glantz|first2=Stanton A|year=2016|title=E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis|journal=The Lancet Respiratory Medicine|volume=4|issue=2|pages=116–128 |doi=10.1016/S2213-2600(15)00521-4|issn=2213-2600|pmc=4752870|pmid=26776875}}

In the US, six large e-cigarette businesses spent $59.3 million on promoting e-cigarettes in 2013.{{cite journal |last1=Wasowicz|first1=Adam|last2=Feleszko|first2=Wojciech|last3=Goniewicz|first3=Maciej L|title=E-Cigarette use among children and young people: the need for regulation|journal=Expert Rev Respir Med |volume=9|issue=5|pages=1–3|year=2015|doi=10.1586/17476348.2015.1077120|pmid=26290119|s2cid=207206915|doi-access=free}} In the US and Canada, over $2 million is spent yearly on promoting e-cigarettes online.{{cite journal|last1=McCausland|first1=Kahlia|last2=Maycock|first2=Bruce |last3=Jancey|first3=Jonine|title=The messages presented in online electronic cigarette promotions and discussions: a scoping review protocol|journal=BMJ Open|volume=7|issue=11|year=2017|pages=e018633 |issn=2044-6055|doi=10.1136/bmjopen-2017-018633|pmc=5695349|pmid=29122804}} E-cigarette websites often made unscientific health statements in 2012.{{cite journal |last1=Grana|first1=Rachel A.|last2=Ling|first2=Pamela M.|title="Smoking revolution": a content analysis of electronic cigarette retail websites|journal=Am J Prev Med|volume=46 |issue=4|pages=395–403 |year=2014|doi=10.1016/j.amepre.2013.12.010|pmc=3989286|pmid=24650842}} The ease to get past the age verification system at e-cigarette company websites allows underage individuals to access and be exposed to marketing. Around half of e-cigarette company websites have a minimum age notice that prohibited underage individuals from entering.

Celebrity endorsements are used to encourage e-cigarette use.{{sfn|Bauld|2014|p=11}} A 2012 national US television advertising campaign for e-cigarettes starred Stephen Dorff exhaling a "thick flume" of what the advertisement describes as "vapor, not tobacco smoke", exhorting smokers with the message "We are all adults here, it's time to take our freedom back." Opponents of the tobacco industry state that the Blu advertisement, in a context of longstanding prohibition of tobacco advertising on television, seems to have resorted to advertising tactics that got former generations of people in the US addicted to traditional cigarettes. 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 advertisement near an ocean was meant to suggest an association of clean air with the nicotine product.{{cite news|url=https://www.bbc.com/news/magazine-20583902|title=Electronic cigarettes challenge anti-smoking efforts|work=BBC News|author=Daniel Nasaw|date=5 December 2012}} In 2012 and 2013, e-cigarette companies advertised to a large television audience in the US which included 24 million young people.{{cite journal|last1=Duke|first1=J. C.|last2=Lee|first2=Y. O.|last3=Kim|first3=A. E. |last4=Watson|first4=K. A.|last5=Arnold|first5=K. Y.|last6=Nonnemaker|first6=J. M.|last7=Porter|first7=L.|title=Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults|journal=Pediatrics |volume=134|issue=1|year=2014|pages=e29–e36|doi=10.1542/peds.2014-0269|pmid=24918224|doi-access=free}} The channels to which e-cigarette advertising reached the largest numbers of young people (ages 12–17) were AMC, Country Music Television, Comedy Central, WGN America, TV Land, and VH1.

File:Ecig youth chart.jpg

Since at least 2007, e-cigarettes have been heavily promoted across media outlets globally. They are vigorously advertised, mostly through the Internet, as a safe substitute to traditional cigarettes, among other things. E-cigarette companies promote their e-cigarette products on Facebook, Instagram,{{sfn|Chapman|2015|p=7}} YouTube, and Twitter.{{cite journal|last1=Payne|first1=JD|last2=Orellana-Barrios|first2=M|last3=Medrano-Juarez|first3=R|last4=Buscemi|first4=D|last5=Nugent|first5=K|title=Electronic cigarettes in the media.|journal=Proc (Bayl Univ Med Cent).|volume=29|issue=3|pages=280–3|year=2016|doi=10.1080/08998280.2016.11929436|pmc=4900769|pmid=27365871}} They are promoted on YouTube by movies with sexual material and music icons, who encourage minors to "take their freedom back." They have partnered with a number of sports and music icons to promote their products.{{cite book|last1=Bryan|first1=Christiansen|title=Handbook of Research on Global Business Opportunities|url=https://books.google.com/books?id=PyKXBQAAQBAJ&pg=PA411|date=31 October 2014|publisher=IGI Global|isbn=978-1-4666-6552-1|pages=411–}} Tobacco companies intensely market e-cigarettes to young people,{{cite web|archive-url=https://web.archive.org/web/20151004030055/https://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html|url=https://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html|archive-date=4 October 2015|publisher=American Lung Association|year=2015|title=E-cigarettes and Lung Health}} with industry strategies including cartoon characters and candy flavors.{{cite web|archive-url=https://web.archive.org/web/20151204074154/http://www.lung.org/stop-smoking/smoking-facts/myths-and-facts-about-e-cigs.html|url=http://www.lung.org/stop-smoking/smoking-facts/myths-and-facts-about-e-cigs.html|archive-date=4 December 2015|publisher=American Lung Association|year=2015|title=Myths and Facts About E-cigarettes}} Fruit flavored e-liquid is the most commonly marketed e-liquid flavor on social media.{{cite conference|last1=Liang|first1=Yunji|last2=Zheng|first2=Xiaolong|last3=Dajun Zheng|first3=Daniel|last4=Zhou|first4=Xingshe|editor1-first=Xiaolong|editor1-last=Zheng|editor2-first=Daniel|editor2-last=Dajun Zeng|editor3-first=Hsinchun|editor3-last=Chen|editor4-first=Scott J.|editor4-last=Leischow|title=Impact of Flavor on Electronic Cigarette Marketing in Social Media|conference=Smart Health: International Conference, ICSH 2015|location=Phoenix, AZ, USA|date=22 January 2016|url=https://books.google.com/books?id=cM5yCwAAQBAJ&pg=PA279|publisher=Springer|isbn=978-3-319-29175-8|page=283}}

E-cigarette companies commonly promote that their products contain only water, nicotine, glycerin, propylene glycol, and flavoring but this assertion is misleading as researchers have found differing amounts of heavy metals in the vapor, including chromium, nickel, tin, silver, cadmium, mercury, and aluminum.{{cite journal|last1=Hildick-Smith|first1=Gordon J.|last2=Pesko|first2=Michael F.|last3=Shearer|first3=Lee|last4=Hughes|first4=Jenna M.|last5=Chang |first5=Jane|last6=Loughlin|first6=Gerald M.|last7=Ipp|first7=Lisa S.|title=A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population|journal=Journal of Adolescent Health|volume=57|issue=6|pages=574–579 |year=2015|issn=1054-139X|doi=10.1016/j.jadohealth.2015.07.020|pmid=26422289|doi-access=free}} The widespread assertion that e-cigarettes emit "only water vapor" is not true because the evidence demonstrates e-cigarette vapor contains possibly harmful chemicals such as nicotine, carbonyls, metals, and volatile organic compounds, in addition to particulate matter. Massive advertising included the assertion that they would present little risk to non-users. However, "disadvantages and side effects have been reported in many articles, and the unfavorable effects of its secondhand vapor have been demonstrated in many studies",{{cite journal|last1=Heydari|first1=Gholamreza|last2=Ahmady|first2=ArezooEbn|last3=Chamyani|first3=Fahimeh|last4=Masjedi|first4=Mohammadreza|last5=Fadaizadeh |first5=Lida|title=Electronic cigarette, effective or harmful for quitting smoking and respiratory health: A quantitative review papers|journal=Lung India|volume=34|issue=1|year=2017|pages=25–28|issn=0970-2113 |doi=10.4103/0970-2113.197119|pmc=5234193|pmid=28144056 |doi-access=free }} and evidence indicates that use of e-cigarettes degrades indoor air quality.

Many e-cigarette companies market their products as a smoking cessation aid without evidence of effectiveness.{{cite journal|last1=Schivo|first1=Michael|last2=Avdalovic|first2=Mark V.|last3=Murin|first3=Susan|title=Non-Cigarette Tobacco and the Lung |journal=Clinical Reviews in Allergy & Immunology|volume=46|issue=1|date=February 2014|pages=34–53|issn=1080-0549|doi=10.1007/s12016-013-8372-0|pmid=23673789|s2cid=23626872}} E-cigarette marketing has been found to make unsubstantiated health statements (e.g., that they help one quit smoking) including statements about improving psychiatric symptoms, which may be particularly appealing to smokers with mental illness. E-cigarette marketing advocate weight control and emphasize use of nicotine with many flavors. These marketing angles could particularly entice overweight people, young people, and vulnerable groups.{{cite journal|last1=Verhaegen|first1=A.|last2=Van Gaal|first2=L.|title=Do E-cigarettes induce weight changes and increase cardiometabolic risk? A signal for the future|journal=Obesity Reviews|volume=18|issue=10|pages=1136–1146|year=2017|issn=1467-7881|doi=10.1111/obr.12568|pmid=28660671|s2cid=29298086}} Some e-cigarette companies state that their products are green without supporting evidence which may be purely to increase their sales.

The number of e-cigarettes sold increased every year from 2003 to 2014. In 2015 a slowdown in the growth in usage occurred in the US.{{cite news |url=https://www.wsj.com/articles/e-cig-sales-rapidly-lose-steam-1447798921|title=E-Cigarette Sales Rapidly Lose Steam|last1=Mickle|first1=Tripp|date=17 November 2015|work=The Wall Street Journal}} As of January 2018, the growth in usage in the UK has slowed down since 2013.{{cite web|last1=West|first1=Robert|last2=Beard|first2=Emma|last3=Brown|first3=Jamie|date=9 January 2018|title=Electronic cigarettes in England - latest trends (STS140122)|url=http://www.smokinginengland.info/latest-statistics/|publisher=Smoking in England|page=28|access-date=6 December 2015|archive-date=18 December 2015|archive-url=https://web.archive.org/web/20151218144711/http://www.smokinginengland.info/latest-statistics/|url-status=dead}} {{As of|2014}}, there were at least 466 e-cigarette brands.{{cite journal|last1=Born|first1=H.|last2=Persky|first2=M.|last3=Kraus|first3=D. H.|last4=Peng|first4=R.|last5=Amin|first5=M. R.|last6=Branski|first6=R. C.|title=Electronic Cigarettes: A Primer for Clinicians|journal=Otolaryngology–Head and Neck Surgery|year=2015|volume=153|issue=1|pages=5–14|issn=0194-5998|doi=10.1177/0194599815585752|pmid=26002957|s2cid=10199442}} Worldwide e-cigarette sales in 2014 were around US$7 billion.{{cite news|url=https://www.wsj.com/articles/e-cigarette-makers-face-rise-of-counterfeits-1424441348|title=E-Cigarette Makers Face Rise of Counterfeits|author=Peter Evans|work=The Wall Street Journal|date=20 February 2015}} Worldwide e-cigarette sales in 2019 were about $19.3 billion.{{cite news|url=https://www.bbc.com/news/business-44295336|title=Vaping: How popular are e-cigarettes? - Spending on e-cigarettes is growing|last1=Jones|first1=Lora|work=BBC News|date=15 September 2019}} E-cigarette sales could exceed traditional cigarette sales by 2023.{{cite journal|last1=Chun|first1=Lauren F|last2=Moazed|first2=Farzad|last3=Calfee|first3=Carolyn S|author-link3=Carolyn Calfee|last4=Matthay|first4=Michael A.|last5=Gotts|first5=Jeffrey Earl|title=Pulmonary Toxicity of E-cigarettes|journal=American Journal of Physiology. Lung Cellular and Molecular Physiology|volume=313|issue=2|year=2017|pages=L193–L206|issn=1040-0605|doi=10.1152/ajplung.00071.2017|pmc=5582932|pmid=28522559}} Approximately 30–50% of total e-cigarettes sales are handled on the internet.{{cite journal|last1=Rom|first1=Oren|last2=Pecorelli|first2=Alessandra|last3=Valacchi|first3=Giuseppe|last4=Reznick|first4=Abraham Z.|year=2014|title=Are E-cigarettes a safe and good alternative to cigarette smoking?|journal=Annals of the New York Academy of Sciences|volume=1340|issue=1|pages=65–74|bibcode=2015NYASA1340...65R|doi=10.1111/nyas.12609 |issn=0077-8923|pmid=25557889|s2cid=26187171}} Established tobacco companies have a significant share of the e-cigarette market.{{cite news|url=http://www.cnn.com/2015/03/23/health/e-cigarettes-smoking-addiction-nicotine/index.html|title=E-cigarettes: Helping smokers quit, or fueling a new addiction?|author=Meera Senthilingam|publisher=CNN|date=23 March 2015}}

{{As of|2018}}, 95% of e-cigarette devices were made in China,{{cite journal|last1=Jenssen|first1=Brian P.|last2=Boykan|first2=Rachel|title=Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels)|journal=Children|volume=6|issue=2|year=2019|pages=30|issn=2227-9067|doi=10.3390/children6020030|pmc=6406299|pmid=30791645|doi-access=free}}{{CC-notice|cc=by4 |url=https://www.mdpi.com/2227-9067/6/2/30/htm|author(s)=Brian P. Jenssen and Rachel Boykan}} mainly in Shenzhen.{{cite news|last1=Jourdan|first1=Adam|title="Vaping" a slow burner in China, world's maker of e-cigarettes|url=https://www.reuters.com/article/us-china-smoking-idUSBREA0E1JX20140115|work=Reuters|date=25 May 2014}}{{cite news|last1=Liao|first1=Allen|title=Chinese E-cigarette Makers Shift to Domestic Markets|url=http://www.tobaccoasia.com/features/chinese-e-cigarette-makers-shift-to-domestic-markets/|work=Tobacco Asia|date=1 September 2015}} Chinese companies' market share of e-liquid is low.{{cite news|last1=Kessel|first1=Jonah M.|title=China's E-Cigarette Boom|url=https://www.nytimes.com/2014/12/14/business/international/chinas-e-cigarette-boom-lacks-oversight-for-safety-.html?pagewanted=all&_r=1|work=The New York Times|date=13 December 2014}} In 2014, online and offline sales started to increase. Since combustible cigarettes are relatively inexpensive in China a lower price may not be a large factor in marketing vaping products over there.{{cite news|last1=Yao Min-G|title=The e-cigarette is taking off in nation that invented it|url=http://www.shanghaidaily.com/feature/news-feature/The-ecigarette-is-taking-off-in-nation-that-invented-it/shdaily.shtml|work=Shanghai Daily|date=30 May 2015}}

In 2015, 80% of all e-cigarette sales in convenience stores in the US were products made by tobacco companies.{{cite web|url=http://www.journalnow.com/business/business_news/local/vuse-overwhelming-e-cig-competition/article_01f18c48-7ba1-5520-af32-b007025c6f9f.html|title=Vuse overwhelming e-cig competition|work=Winston-Salem Journal|author=Richard Craver|date=29 May 2015}} 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 "vapors-tanks-mods (VTMs)" that are not tracked by Nielsen.{{cite news|url=https://www.cspdailynews.com/tobacco/nielsen-electronic-cigarette-dollar-sales-decline|title=Nielsen: Electronic Cigarette Dollar Sales Decline|author=Melissa Vonder Haar|work=CSP Magazine|date=28 May 2014}} Wells Fargo estimated that VTMs accounted for 57% of the 3.5 billion dollar market in the US for vapor products in 2015.{{cite news|last1=Mickle|first1=Tripp|date=7 July 2015|title=FDA Cloud Hangs Over Vape Shops|work=The Wall Street Journal |url=https://www.wsj.com/articles/SB10130211234592774869404581088451777513530}}

In 2014, dollar sales of customizable e-cigarettes and e-liquid surpassed sales of cigalikes in the US, even though, overall, customizables are a less expensive vaping option.{{cite news|last1=Koebler|first1=Jason|title=Big Tobacco Has Officially Lost Its Hold on the E-Cigarette Market|url=http://motherboard.vice.com/read/big-tobacco-has-officially-lost-its-hold-on-the-e-cigarette-market|work=Motherboard|date=25 September 2014}} In 2014, the Smoke-Free Alternatives Trade Association estimated that there were 35,000 vape shops in the US, more than triple the number a year earlier.{{cite news|last1=Esterl|first1=Mike|title=Big Tobacco's E-Cigarette Push Gets a Reality Check|url=https://www.wsj.com/articles/big-tobaccos-e-cig-push-gets-a-reality-check-1409078319|work=The Wall Street Journal|date=26 August 2014}} However the 2015 slowdown in market growth affected VTMs as well.

Large tobacco retailers are leading the cigalike market.{{cite journal|last1=Das|first1=Smita|last2=Prochaska|first2=Judith J.|title=Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders|journal=Expert Review of Respiratory Medicine|volume=11|issue=10|pages=841–850|year=2017|issn=1747-6348|doi=10.1080/17476348.2017.1361823|pmc=5790168|pmid=28756728}} "We saw the market's sudden recognition that the cigarette industry seems to be in serious trouble, disrupted by the rise of vaping," Mad Money's Jim Cramer stated April 2018. "Over the course of three short days, the tobacco stocks were bent, they were spindled and they were mutilated by the realization that electronic cigarettes have become a serious threat to the old-school cigarette makers," he added.{{cite news |url=https://www.cnbc.com/2018/04/23/cramer-vaping-is-killing-the-cigarette-industry-and-it-may-get-worse.html|title=Cramer: Vaping is decimating the cigarette industry—and it could get even worse|last=Gurdus|first=Elizabeth |publisher=CNBC|date=23 April 2018}} In 2019, a vaping industry organization released a report stating that a possible US ban on e-cigarettes flavors can potentially effect greater than 150,000 jobs around the US.{{cite news|url=https://www.reuters.com/article/us-health-vaping-idUSKBN1XW20K|title=Ban on flavored vapes could lead to loss of 150,000 jobs, $8.4 billion sales hit: report|work=Reuters|date=22 November 2019}}

The leading seller in the e-cigarette market in the US is the Juul e-cigarette,{{cite news|url=https://www.nytimes.com/2018/08/27/science/juul-vaping-teen-marketing.html|title=Did Juul Lure Teenagers and Get 'Customers for Life'?|last1=Richtel|first1=Matt|last2=Kaplan|first2=Sheila|work=The New York Times|date=27 August 2018}} which was introduced in June 2015. {{As of|2018|08}}, Juul accounts for over 72% of the US e-cigarette market monitored by Nielsen, and its closest competitor—RJ Reynolds' Vuse—makes up less than 10% of the market. Juul rose to popularity quickly, growing by 700% in 2016 alone.{{cite news|url=http://wjla.com/features/7-on-your-side/are-your-kids-juuling-at-school-7-on-your-side-investigates|title=Are your kids juuling at school? 7 On Your Side investigates |author=Kimberly Suiters|publisher=WJLA-TV|date=31 January 2018|access-date=29 September 2018|archive-date=22 June 2018|archive-url=https://web.archive.org/web/20180622140236/http://wjla.com/features/7-on-your-side/are-your-kids-juuling-at-school-7-on-your-side-investigates|url-status=dead}} On 17 July 2018 Reynolds announced it will debut in August 2018 a pod mod type device similar Juul.{{cite news|url=https://www.journalnow.com/business/juul-expands-e-cig-market-share-gap-with-reynolds-vuse/article_0bb4d442-fc0f-5c00-8b05-29bbf95dc985.html|title=Juul expands e-cig market share gap with Reynolds' Vuse|last1=Craver|first1=Richard|work=Winston-Salem Journal|date=25 August 2018}} The popularity of the Juul pod system has led to a flood of other pod devices hitting the market.{{cite web |url=https://truthinitiative.org/news/juul-copycats-are-flooding-market|title=JUUL copycats are flooding the e-cigarette market|publisher=Truth Initiative|date=8 August 2018}}

In Canada, e-cigarettes had an estimated value of 140 million CAD in 2015.{{cite news|url=http://www.torontosun.com/2015/07/04/wild-west-for-e-cigarette-use-in-canada-critic-says|title='Wild West' for e-cigarette use in Canada, critic says|last1=Yuen|first1=Jenny|newspaper=Toronto Sun|date=4 July 2015}} There are numerous e-cigarette retail shops in Canada.{{cite news|url=http://www.ottawasun.com/2014/04/06/e-cig-retailers-stand-up-to-health-canada|title=E-cig retailers stand up to Health Canada|author=Aedan Helmer|work=Ottawa Sun|date=6 April 2014}} A 2014 audit of retailers in four Canadian cities found that 94% of grocery stores, convenience stores, and tobacconist shops which sold e-cigarettes sold nicotine-free varieties only, while all vape shops stocked at least one nicotine-containing product.{{cite journal |last1=Hammond|first1=D|last2=White|first2=CM|last3=Czoli|first3=CD|last4=Martin|first4=CL|last5=Magennis|first5=P|last6=Shiplo|first6=S|title=Retail availability and marketing of electronic cigarettes in Canada |journal=Canadian Journal of Public Health|date=9 October 2015|volume=106|issue=6|pages=e408–12|url=http://davidhammond.ca/wp-content/uploads/2014/12/2015-Ecig-Retail-in-Canada-CJPH-Hammond.pdf|doi=10.17269/cjph.106.5105 |pmid=26680433|pmc=6972063}}

By 2015, the e-cigarette market had only reached a twentieth of the size of the tobacco market in the UK.{{cite journal|last1=Hiscock|first1=Rosemary|last2=Branston|first2=J Robert|last3=McNeill |first3=Ann|last4=Hitchman|first4=Sara C|last5=Partos|first5=Timea R|last6=Gilmore|first6=Anna B|title=Tobacco industry strategies undermine government tax policy: evidence from commercial data|journal=Tobacco Control |volume=27|issue=5|year=2017|pages=tobaccocontrol–2017–053891|issn=0964-4563|doi=10.1136/tobaccocontrol-2017-053891|pmc=6109235|pmid=28993519}}{{CC-notice|cc=by4|url=http://tobaccocontrol.bmj.com/content/early/2017/10/09/tobaccocontrol-2017-053891.long#ref-73|author(s)=Rosemary Hiscock, J Robert Branston, Ann McNeill, Sara C Hitchman, Timea R Partos, Anna B Gilmore}} In the UK in 2015 the "most prominent brands of cigalikes" were owned by tobacco companies, however, with the exception of one model, all the tank types came from "non-tobacco industry companies".{{sfn|McNeill|2015|p=15}} Yet some tobacco industry products, while using prefilled cartridges, resemble tank models.{{sfn|McNeill|2015|p=15}}

France's e-cigarette market was estimated by Groupe Xerfi to be €130 million in 2015. Additionally, France's e-liquid market was estimated at €265 million.{{cite news|url=http://www.letelegramme.fr/bretagne/cigarettes-electroniques-le-marche-de-la-vape-en-deux-cartes-07-02-2016-10949003.php|title=Cigarettes électroniques. Le marché de la vape en deux cartes|last1=Lastennet |first1=Vincent|work=Le Télégramme|date=7 February 2016}} In December 2015, there were 2,400 vape shops in France, 400 fewer than in March of the same year. Industry organization Fivape said the reduction was due to consolidation, not to reduced demand.

In Vietnam, the e-cigarette market is growing rapidly, with the use rate increasing 18 times from 2015 to 2020.{{Cite web |title=Thuốc lá điện tử, nung nóng độc hại, vì sao có sức hút lớn với giới trẻ Việt Nam? - Tin tổng hợp - Cổng thông tin Bộ Y tế |url=https://moh.gov.vn/tin-tong-hop/-/asset_publisher/k206Q9qkZOqn/content/thuoc-la-ien-tu-nung-nong-oc-hai-vi-sao-co-suc-hut-lon-voi-gioi-tre-viet-nam- |access-date=2023-12-15 |website=moh.gov.vn}}{{Cite web |last=Võ |first=Thu |title=5 năm, tỷ lệ hút thuốc lá điện tử ở cả nam và nữ tại Việt Nam tăng 18 lần |url=https://vietnamnet.vn/5-nam-ty-le-hut-thuoc-la-dien-tu-o-ca-nam-va-nu-tang-18-lan-2178336.html |access-date=2023-12-15 |website=VietNamNet News |language=vietnamese}} The use rate of e-cigarettes in adolescents aged 13–15 is 3.5%, up 1.6% from 2019.{{Cite web |title=Tỷ lệ dùng thuốc lá điện tử ở nhóm 13-15 tuổi là 3,5% |url=https://tuoitrethudo.com.vn/ty-le-dung-thuoc-la-dien-tu-o-nhom-13-15-tuoi-la-35-214306.html |access-date=2023-12-15 |website=Báo Tuổi Trẻ Thủ Đô |language=vi}}{{Cite web |last=Lê |first=Nga |title=Học sinh 13-15 tuổi hút thuốc lá điện tử tăng |url=https://vnexpress.net/hoc-sinh-13-15-tuoi-hut-thuoc-la-dien-tu-tang-4552652.html |access-date=2023-12-15 |website=vnexpress.net |language=vi}}{{Cite web |last=VnExpress |title=Học sinh 13-15 tuổi hút thuốc lá điện tử tăng |url=https://baoquangninh.vn/hoc-sinh-13-15-tuoi-hut-thuoc-la-dien-tu-tang-3219632.html |access-date=2023-12-15 |website=baoquangninh.vn |language=vi}} According to estimates by the World Health Organization (WHO), the global economic losses caused by tobacco each year are $1.4 trillion.{{Cite web |date=2023-11-14 |title=Tổn thất kinh tế toàn cầu do thuốc lá gây ra mỗi năm là 1.400 tỷ USD |url=https://vtc.vn/ton-that-kinh-te-toan-cau-do-thuoc-la-gay-ra-moi-nam-la-1-400-ty-usd-ar837864.html |access-date=2023-12-15 |website=Báo điện tử VTC News |language=vi}} Economic losses caused by tobacco are estimated to account for 1% of GDP.{{Cite web |title=Đề xuất cấm lưu hành thuốc lá điện tử tại Việt Nam |url=https://dangcongsan.vn/y-te/de-xuat-cam-luu-hanh-thuoc-la-dien-tu-tai-viet-nam-653229.html |access-date=2023-12-15 |website=dangcongsan.vn |language=en-US}}{{Cite web |date=2023-11-23 |title=Gần 97% bệnh nhân ung thư phổi có hút thuốc lá |url=https://moha.gov.vn/chuyen-doi-so/tin-tong-hop/gan-97-benh-nhan-ung-thu-phoi-co-hut-thuoc-la-d611-t55698.html#:~:text=Th%E1%BB%91ng%20k%C3%AA%20c%E1%BB%A7a%20T%E1%BB%95%20ch%E1%BB%A9c,n%C4%83m%20l%C3%A0%201.400%20t%E1%BB%B7%20USD. |access-date=2023-12-15}} The Vietnamese government is making efforts to control the e-cigarette market.{{Cite web |last=Phương |first=Thảo |title=Sớm "chốt" giải pháp kiểm soát thuốc lá điện tử |url=https://laodongthudo.vn/som-chot-giai-phap-kiem-soat-thuoc-la-dien-tu-157892.html |access-date=2023-12-15 |website=Báo Lao động thủ đô |language=vi}}{{Cite web |date=2023-10-24 |title=Vapor Store |url=http://vaporstore.vn/ |access-date=2023-12-15 |website=Báo Nhân Dân điện tử |language=vi}}{{Cite web |date=2023-10-31 |title=Ưu tiên hỗ trợ Việt Nam thực hiện các mục tiêu của Chiến lược Quốc gia về phòng chống tác hại thuốc lá |url=https://moha.gov.vn/chuyen-doi-so/tin-tong-hop/uu-tien-ho-tro-viet-nam-thuc-hien-cac-muc-tieu-cua-d611-t55636.html |access-date=2023-12-15}} However, here are still many challenges to be addressed, such as consumer's lack of understanding of the harm of e-cigarettes, unclear legal regulations, and fierce competition from imported e-cigarette products.{{Cite web |last=Theo |first=TTXVN |date=2015-05-29 |title=Kiểm soát thuốc lá tại Việt Nam: Vẫn nhiều thách thức |url=https://tuyengiao.vn/kiem-soat-thuoc-la-tai-viet-nam-van-nhieu-thach-thuc-75140 |access-date=2023-12-15}}{{Cite web |date=2023-10-26 |title=Cần sớm quản lý đồng thời thuốc lá điện tử và thuốc lá làm nóng |url=https://moha.gov.vn/chuyen-doi-so/tin-tong-hop/can-som-quan-ly-dong-thoi-thuoc-la-dien-tu-va-thuo-d611-t55628.html |access-date=2023-12-15}}

{{main|Environmental impact of electronic cigarettes}}

File:Tobacco product waste.jpg

Compared to traditional cigarettes, reusable e-cigarettes do not create waste and potential litter from every use in the form of discarded cigarette butts. Traditional cigarettes tend to end up in the ocean where they cause pollution,{{cite web|url=http://voices.nationalgeographic.com/2012/04/11/cigarettes-vs-e-cigarettes-which-is-less-environmentally-harmful/ |archive-url=https://web.archive.org/web/20150324142409/http://voices.nationalgeographic.com/2012/04/11/cigarettes-vs-e-cigarettes-which-is-less-environmentally-harmful/ |url-status=dead |archive-date=24 March 2015 |title=Cigarettes vs. e-Cigarettes: Which Is Less Environmentally Harmful?|first1=Brian Clark|last1=Howard|work=National Geographic|date=11 April 2012}} though once discarded they undergo biodegradation and photodegradation.

E-cigarettes that are not reusable contribute to the problem of electronic waste, which can create a hazard for people and other organisms. If improperly disposed of, they can release heavy metals, nicotine, and other chemicals from batteries and unused e-liquid. A July 2018–April 2019 garbology study found e-cigarette products composed 19% of the waste from all traditional and electronic tobacco and cannabis products collected at 12 public high schools in Northern California.{{cite journal|last1=Mock|first1=Jeremiah|title=Notes from the Field: Environmental Contamination from E-cigarette, Cigarette, Cigar, and Cannabis Products at 12 High Schools — San Francisco Bay Area, 2018–2019|journal=MMWR Morb Mortal Wkly Rep|volume=68|issue=40|year=2019 |pages=897–899|doi=10.15585/mmwr.mm6840a4|pmc=6788397 |pmid=31600185}}

Councils in England and Wales are pushing for a 2024 ban on single-use vapes due to environmental and health risks, as 1.3 million are thrown away weekly. Recycling challenges, waste issues, and fire hazards are cited. Concerns about youth vaping are also raised. The UK Vaping Industry Association defends disposables as quitting aids and warns of potential black market products if banned.{{Cite news |last= Davey |first= James |date=2023-07-15 |title= UK councils call for ban on disposable vapes by 2024 |language=en |work=Reuters |url= https://www.reuters.com/world/uk/uk-councils-call-ban-disposable-vapes-by-2024-2023-07-15/ |access-date=2023-07-24}} Although some brands have begun recycling services for their e-cigarette cartridges and batteries, the prevalence of recycling is unknown.

Other devices to deliver inhaled nicotine have been developed. They aim to mimic the ritual and behavioral aspects of traditional cigarettes.{{cite journal |last1=Giroud |first1=Christian|last2=de Cesare|first2=Mariangela|last3=Berthet|first3=Aurélie |last4=Varlet|first4=Vincent|last5=Concha-Lozano|first5=Nicolas|last6=Favrat|first6=Bernard|title=E-Cigarettes: A Review of New Trends in Cannabis Use|journal=International Journal of Environmental Research and Public Health|volume=12|issue=8|year=2015|pages=9988–10008|issn=1660-4601|pmc=4555324 |pmid=26308021|doi=10.3390/ijerph120809988|doi-access=free}}{{CC-notice|cc=by4|url=http://www.mdpi.com/1660-4601/12/8/9988/htm|author(s)=Christian Giroud, Mariangela de Cesare, Aurélie Berthet, Vincent Varlet, Nicolas Concha-Lozano, and Bernard Favrat}}

British American Tobacco, through their subsidiary Nicoventures, licensed a nicotine delivery system based on existing asthma inhaler technology from UK-based healthcare company Kind Consumer.{{cite news |title=BAT unit to market nicotine inhaler|publisher=Tobacco Journal International |url=http://www.tobaccojournal.com/BAT_unit_to_market__innovative__nicotine_inhaler.50583.0.html |date=7 June 2011}} In September 2014 a product based on this named Voke obtained approval from the United Kingdom's Medicines and Healthcare Products Regulatory Agency.{{cite news |url=http://www.ft.com/cms/s/0/ecff7448-3a86-11e4-bd08-00144feabdc0.html|title=British American Tobacco nicotine inhaler wins regulatory approval|author=Mark Odell|work=Financial Times|date=12 September 2014}}

In 2011, Philip Morris International bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University.{{cite news |author=Michael Felberbaum |date=26 May 2011 |url= https://www.boston.com/business/articles/2011/05/26/philip_morris_intl_buys_rights_to_nicotine_system/ |title=Philip Morris Int'l buys rights to nicotine system|work=The Boston Globe|agency=Associated Press}} The technology is based on the chemical reaction between pyruvic acid and nicotine, which produces an inhalable nicotine pyruvate vapor.{{cite web |date=27 February 2010 |url=http://esciencenews.com/articles/2010/02/27/new.smoking.cessation.therapy.proves.promising |title=New smoking cessation therapy proves promising |website=Esciencenews}} Philip Morris Products S.A. created a different kind e-cigarette named P3L.{{sfnp|National Academies of Sciences, Engineering, and Medicine|2018|loc=Nicotine Salts |p=96}} The device is supplied with a cartridge that contains nicotine and lactic acid in different cavities.{{sfnp|National Academies of Sciences, Engineering, and Medicine|2018|loc=Nicotine Salts |p=96}} When turned on and heated, the nicotine salt called nicotine lactate forms an aerosol.{{sfnp|National Academies of Sciences, Engineering, and Medicine|2018|loc=Nicotine Salts |p=96}}

File:IQOS 01.jpg

The IQOS is a heated tobacco product marketed by Philip Morris International.{{cite news|url=https://huffingtonpost.com/entry/iqos-e-cigarette_us_56fa8639e4b0a372181af0c4|title=Big Tobacco Is Starting To Cash In On Vaping|author1=Taiga Uranaka|author2=Ritsuko Shimizu|work=HuffPost|agency=Reuters|date=29 March 2016}} It heats tobacco at a lower temperature than traditional cigarettes.{{cite journal|last1=Li|first1=Gerard|last2=Saad|first2=Sonia|last3=Oliver|first3=Brian|last4=Chen|first4=Hui|title=Heat or Burn? Impacts of Intrauterine Tobacco Smoke and E-Cigarette Vapor Exposure on the Offspring's Health Outcome|journal=Toxics|volume=6|issue=3|year=2018|pages=43|issn=2305-6304|doi=10.3390/toxics6030043|pmc=6160993|pmid=30071638|doi-access=free|bibcode=2018Toxic...6...43L }}{{CC-notice|cc=by4|url=https://www.mdpi.com/2305-6304/6/3/43/htm|author(s)=Gerard Li, Sonia Saad, Brian G. Oliver, and Hui Chen}} The tobacco sticks reach a temperature up to 350 °C.{{cite news |url=http://www.salon.com/2014/06/26/philip_morris_intl_to_sell_marlboro_heatsticks/|title=Philip Morris Int'l to sell Marlboro Heatsticks|author=Michael Felberbaum|publisher=Salon Media Group |agency=Associated Press|date=26 June 2014|access-date=2 June 2019|archive-date=28 June 2014|archive-url=https://web.archive.org/web/20140628134323/http://www.salon.com/2014/06/26/philip_morris_intl_to_sell_marlboro_heatsticks/|url-status=dead}} It sold first in Japan since November 2014.{{cite journal|last1=Tabuchi|first1=Takahiro|last2=Kiyohara|first2=Kosuke |last3=Hoshino|first3=Takahiro|last4=Bekki|first4=Kanae|last5=Inaba|first5=Yohei|last6=Kunugita |first6=Naoki|title=Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan|journal=Addiction|volume=111|issue=4|year=2016|pages=706–713|issn=0965-2140|doi=10.1111/add.13231 |pmid=26566956}} In December 2016, the United Tobacco Vapor Group's (UTVG) stated that they have been given a patent for their vaporizing component system. qmos from UTVG does not contain a wick or sponge and the number of components is 5 compared to 20 for traditional e-cigarettes.{{cite news|url=https://finance.yahoo.com/news/vaporizing-technology-qmos-set-revolutionize-140000566.html|title=New Vaporizing Technology, qmos, set to Revolutionize Vaping and E-Cigarette Industries|publisher=Yahoo! Finance|agency=PR Newswire|date=2 December 2016}}

Pax Labs has developed vaporizers that heats the leaves of tobacco to deliver nicotine in a vapor.{{cite news|url=https://www.bloomberg.com/bw/articles/2013-11-21/plooms-e-cigarettes-vaporizers-use-real-tobacco|title=Ploom's E-Cigarettes and Vaporizers Use Real Tobacco|author=Brad Stone|work=Bloomberg Businessweek|date=21 November 2013}}{{cite news|author=Melissa Vonder Haar|work=CSP Magazine|date=11 March 2015|url=http://www.cspnet.com/category-news/tobacco/articles/pax-labs-ceo-teases-fundamentally-different-e-cigarette|title=PAX Labs CEO Teases 'Fundamentally Different' E-Cigarette |archive-url=https://web.archive.org/web/20160419214721/http://www.cspnet.com/category-news/tobacco/articles/pax-labs-ceo-teases-fundamentally-different-e-cigarette |archive-date=19 April 2016|url-status=dead}} In June 2015, they introduced Juul, a type of e-cigarette which delivers 10 times as much nicotine as other e-cigarettes, equivalent to an actual cigarette puff.{{cite news|url=http://www.inc.com/will-yakowicz/pax-labs-vaporizer-company-raises-47-million.html|title=This Silicon Valley Company Just Raised $47 Million to Smoke Cigarette Makers|author=Will Yakowicz |work=Inc.|date=10 June 2015}} Juul was spun off from Pax Labs in June 2017 and is now available by the independent company Juul Labs.{{cite news |url=https://techcrunch.com/2018/02/08/pax-labs-brings-on-bharat-vasan-as-new-ceo/|last1=Crook |first1=Jordan|title=PAX Labs brings on Bharat Vasan as new CEO|work=TechCrunch|date=8 February 2018}} The eTron 3T from Vapor Tobacco Manufacturing, launched in December 2014, employs a patented, aqueous system whereby the tobacco is extracted into water.{{cite web|last1=O'Connell|first1=Thomas|title=US8479747B2 - Method for preparing tobacco extract for electronic smoking devices|url=https://patents.google.com/patent/US8479747 |website=Google Patents|date=9 July 2013}} The e-liquid contains organic tobacco, organic glycerin, and water.{{cite news|last1=Tuinstra|first1=Taco |url=http://www.tobaccoreporter.com/2014/12/certified-organic-e-liquids-being-launched-by-vtm/ |title=Certified organic e-liquids being launched by VTM |work=Tobacco Reporter|date=16 December 2014}}

In December 2013, Japan Tobacco launched Ploom in Japan.{{cite news|url=http://www.tobaccoreporter.com/2016/01/jt-announces-launch-of-next-generation-ploom/|title=JT announces launch of next-generation Ploom|first=Taco |last=Tuinstra|work=Tobacco Reporter|date=26 January 2016}} In January 2016, they launched Ploom TECH{{cite news|url=http://www.tobaccoreporter.com/2016/07/blending-nature-and-technology/|title=Blending nature and technology|first=Stefanie |last=Rossel|work=Tobacco Reporter|date=1 July 2016}} that produces a vapor from a heated liquid that moves through a capsule of granulated tobacco leaves.{{cite news|url=https://www.bloomberg.com/news/articles/2017-02-03/japan-tobacco-sees-no-quick-fix-for-heat-not-burn-shortage|title=Japan Tobacco Sees No Quick Fix for Heat-Not-Burn Shortage|first=Sam |last=Chambers|work=Bloomberg News|date=3 February 2017}} In 2016, British American Tobacco (BAT) released its own version of the heat but not burn technology called glo in Japan{{cite news |url=http://www.japantimes.co.jp/news/2017/03/22/business/corporate-business/bat-finds-strong-japan-demand-glo-smokeless-tobacco-device/|title=BAT finds strong Japan demand for its Glo smokeless tobacco device|work=The Japan Times|agency=Reuters|date=22 March 2017}} and Switzerland.{{cite news|url=https://www.nytimes.com/reuters/2017/04/26/business/26reuters-brit-am-tobacco-agm.html?_r=0|title=British American Says 2017 Trading in Line With Expectations|work=The New York Times|agency=Reuters|date=26 April 2017}} It uses tobacco sticks rather than nicotine liquid,{{cite news|url=https://www.reuters.com/article/us-brit-am-tobacco-smokeless-idUSKBN18Q0EB|title=British American Tobacco will expand sales of its "glo" tobacco-heating device to Tokyo and Osaka from July|last1=Uranaka|first1=Taiga|last2=Sarkar|first2=Himani|publisher=Reuters |date=30 May 2017}} and does not directly heat or burn tobacco.{{cite news |url=http://www.india.com/buzz/now-safer-e-cigarette-with-tobacco-flavour-less-harmful-smoke-1010152/ |title=Now, 'safer' e-cigarette with tobacco flavour, less harmful smoke|author=ANI|publisher=Penske Media Corporation|agency=India WebPortal Private Limited|date=6 March 2016}} Heated tobacco products were first introduced in 1988, but were not a commercial success.{{cite journal|last1=Caputi|first1=TL|title=Heat-not-burn tobacco products are about to reach their boiling point.|journal=Tobacco Control|volume=26|issue=5|pages=609–610|date=24 August 2016|pmid=27558827 |s2cid=46170776|doi=10.1136/tobaccocontrol-2016-053264}}

BLOW started selling e-hookahs, an electronic version of the hookah in 2014.{{cite news |url=http://www.nbcsandiego.com/news/local/E-Hookah-vape-cigarette-smoke-243042311.html|title='E-Hookah' Debuts in San Diego Amid Critics|author=Candice Nguyen|publisher=NBCUniversal|date=1 February 2014}} The handle of each hose for the e-hookah contains a heating element and a liquid, which produces vapor.{{cite news |url=http://www.pcworld.com/article/2099480/blow-hookah-no-fire-no-charcoal-just-vapor-and-lasers.html|title=Blow Hookah: No fire, no charcoal, just vapor and lasers |author=Susie Ochs|work=PC World |agency=TechHive |date=20 February 2014|access-date=2 June 2019 |archive-url=https://web.archive.org/web/20170318200026/http://www.pcworld.com/article/2099480/blow-hookah-no-fire-no-charcoal-just-vapor-and-lasers.html|archive-date=18 March 2017|url-status=dead}} Gopal Bhatnagar, based in Toronto, Canada, invented a 3D printed adapter to turn a traditional hookah into an e-hookah.{{cite news |url=https://3dprint.com/17857/3d-printed-hookah/|title=Canadian Doctor Promotes a 3D Printed Adapter for Converting Hookahs to E-Hookahs |author=Debra Thimmesch|publisher=3DPrint.com|agency=3DR Holdings|date=7 October 2014}} It is used instead of the ceramic bowl that contains shisha tobacco. Rather than the tobacco, users can insert e-cigarettes.{{cite news |url=https://3dprintingindustry.com/news/3dpi-tv-3d-printed-e-hookah-adapter-help-smokers-27401/ |title=3DPI.TV – 3D Printed e-Hookah Adapter Could Help Smokers|publisher=3DPI.TV|agency=3D Printing Industry|date=20 May 2014}}

{{Further|CBD cigarette}}

Some vape pens, generally not referred to as "e-cigarettes", contain cannabis derivatives instead of nicotine and tobacco derivatives. Some cannabis pens, known as "dab pens", contain cannabis extracted using butane as solvent ("butane hash oil"). Other vaporizers contain e-liquid made with pure THC, and they generally resemble conventional e-cigarettes. A 2020 study shows that one third of teenagers engaged in conventional, tobacco vaping also engage in THC vaping.{{cite journal |last1=Chadi |first1=Nicholas |last2=Minato |first2=Claudia |last3=Stanwick |first3=Richard |title=Cannabis vaping: Understanding the health risks of a rapidly emerging trend |journal=Paediatrics & Child Health |pages=S16–S20 |doi=10.1093/pch/pxaa016 |date=June 2020|volume=25 |issue=Suppl 1 |pmid=33390752 |pmc=7757764 }}

KanaVape is an e-cigarette containing cannabidiol (CBD) and no THC.{{cite news |url=http://www.vice.com/en_se/read/kanavape-antonin-cohen-interview-france-cannabis-e-cigarette-legal-876 |author=Gaspard Glanz|author-link=Gaspard Glanz |title=France's First Cannabis E-Cigarette Is Completely Legal|publisher=Vice|date=17 December 2014}} Several companies including Canada's Eagle Energy Vapor are selling caffeine-based e-cigarettes instead of containing nicotine.{{cite news|author=Alexandra Ma|date=11 August 2015|title=This Is What It's Like To Vape Caffeine |work=HuffPost |url=https://huffingtonpost.com/entry/eagle-energy-vapor-caffeine_55c8c514e4b0f1cbf1e5a202}}

• Vaping cessation

{{Reflist|group=note}}

{{Reflist}}

• {{cite web|url=https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf |archive-date=2022-10-09 |url-status=live|title=E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General|publisher=United States Department of Health and Human Services|agency=Surgeon General of the United States|pages=1–298|year=2016|ref={{harvid|SGUS|2016}}}}{{PD-notice}}
• {{cite web|url=http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf|title=Electronic nicotine delivery systems|website=World Health Organization|pages=1–13|date=21 July 2014|ref={{harvid|WHO|2014}}}}
• {{cite web|author1=Linda Bauld|author2=Kathryn Angus|author3=Marisa de Andrade|date=May 2014 |url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311491/Ecigarette_uptake_and_marketing.pdf|title=E-cigarette uptake and marketing|location=UK|website=Public Health England |pages=1–19|ref={{harvid|Bauld|2014}}}}
• {{cite web|last1=McNeill|first1=A|last2=Brose|first2=LS|last3=Calder|first3=R|last4=Bauld|first4=L |last5=Robson|first5=D|title=Evidence review of e-cigarettes and heated tobacco products 2018 |url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf|location=UK|website=Public Health England|pages=1–243|date=February 2018|ref={{harvid|McNeill|2018}}}}
• {{cite web|last1=McNeill|first1=A|last2=Brose|first2=LS|last3=Calder|first3=R|last4=Hitchman|first4=SC |last5=Hajek|first5=P|last6=McRobbie|first6=H|title=E-cigarettes: an evidence update |url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454516/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England.pdf|location=UK|website=Public Health England |pages=1–113 |date=August 2015|ref={{harvid|McNeill|2015}}}}
• {{cite book|editor-last1=Stratton |editor-first1=Kathleen |editor-last2=Kwan |editor-first2=Leslie Y. |editor-last3=Eaton |editor-first3=David L. |title=Public Health Consequences of E-Cigarettes |author=((National Academies of Sciences, Engineering, and Medicine)) |publisher=National Academies Press |place=Washington, DC |date=January 2018 |doi=10.17226/24952 |pmid=29894118 |isbn=978-0-309-46834-3 |collaboration=Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems |url=https://nap.nationalacademies.org/read/24952/chapter/1#vii |access-date=15 January 2023}} [https://www.ncbi.nlm.nih.gov/books/n/nap24952/Sum1/ Summary]
• {{cite book|url=https://stacks.cdc.gov/view/cdc/21569/Share|title=The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General|publisher=Surgeon General of the United States |pmid=24455788 |author1=National Center for Chronic Disease Prevention Health Promotion (US) Office on Smoking Health|pages=1–943|year=2014|ref={{harvid|SGUS|2014}}}}
• {{cite web|title=State Health Officer's Report on E-Cigarettes: A Community Health Threat |website=California Tobacco Control Program|agency=California Department of Public Health |pages=1–21|date=January 2015 |url=https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/ElectronicSmokingDevices/StateHealthEcigReport.pdf |ref={{harvid|Chapman|2015}}}}{{PD-notice}}
• {{cite web|last1=Wilder|first1=Natalie|last2=Daley|first2=Claire|last3=Sugarman|first3=Jane |last4=Partridge|first4=James|title=Nicotine without smoke: Tobacco harm reduction |url=https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0 |location=UK|website=Royal College of Physicians|pages=1–191|date=April 2016|ref={{harvid|Wilder|2016}}}}

• {{Commons category-inline|Electronic cigarettes}}

{{Electronic cigarettes}}

{{Authority control}}

Category:Cigarette types

Category:Chinese inventions

Category:Smoking cessation

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