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Some basic facts about e-cigarettes

Electronic nicotine delivery systems go by many names. The most common name is “e-cigarettes,” but others such as e-cigs, vapes, vape pens, mods and tanks are also common terms.

What is an e-cigarette?

E-cigarettes are devices that operate by heating a liquid solution to a high enough temperature so that it produces an aerosol that is inhaled.

Solutions, sometimes called e-liquids, typically include nicotine, flavouring and a humectant, such as propylene glycol to retain moisture and create an aerosol when heated. Many of the flavourings and humectants used in e-liquids have been approved by the US's Food and Drug Administration for oral consumption but not for inhalation, due to the lack of research regarding the safety of these compounds when inhaled.

Some newer e-cigarettes on the market have nicotine salts in e-liquids — prompting questions about the use, purpose and safety of this novel form of nicotine. The makers of JUUL claim that their nicotine salt formulation increases the rate and amount of nicotine delivered into the blood, compared with other formulations.

While using an e-cigarette is often called “vaping,” the devices produce an aerosol, not a vapor. Unlike vapor, which is simply a substance in gas form, the aerosol from an e-cigarette can contain tiny chemical particles from both the liquid solution and the device (e.g., metals from the heating coil).

Are there different types of e-cigarettes?

Some e-cigarettes are designed to resemble regular cigarettes, while others look more like cigars, pipes, pens and even USB flash drives.

To account for the diversity in product design, some researchers have classified e-cigarettes as first, second or third generation devices. A first generation e-cigarette is one that closely resembles a cigarette and is disposable. A second generation e-cigarette is a larger, usually pen-shaped device that can be recharged. A third generation e-cigarette refers to a device that does not resemble a combustible cigarette and often has a very large and sometimes customizable battery. Some parts may be replaceable, which is why they are sometimes called “mods.” These devices are refillable.

More recently, e-cigarettes that have a sleek, high-tech design and easily rechargeable batteries have entered the market. One device, JUUL, emerged in 2016 and quickly established itself as a leading e-cigarette product by early 2018. There has also been an emergence of copycat products, such as Suorin Drop and myblu™, that follow JUUL’s blueprint of a high-tech look and high nicotine delivery through the use of nicotine salt e-liquid formulations.

In addition to e-cigarette products, tobacco companies have introduced “heat-not-burn” tobacco products. These devices work by heating tobacco instead of burning it. Sometimes the tobacco is treated with a humectant, like propylene glycol, to produce an aerosol inhaled by the user. Manufacturers claim this delivery method is substantially less harmful than traditional cigarettes, but current data on the health effects of these devices are sparse (and most of what has been published has been by tobacco industry scientists).

While these products have not been approved by the FDA for use in the US, a new product application for IQOS — a heat-not-burn product by Philip Morris International — is currently pending. Data in foreign markets submitted by Philip Morris indicate that dual use of heat-not-burn products along with cigarettes is, by far, the most dominant pattern of use, which raises substantial issues about what impact they might have on overall public health. Read comments from Truth Initiative® on the IQOS application.

How much nicotine is in an e-cigarette?

Nicotine levels in e-cigarettes are highly variable, with some reaching levels near combustible cigarettes.

Labeling is not always a reliable indicator of nicotine content, as studies have found mislabeling to be a common issue for e-cigarettes.

The way an e-cigarette is used or modified affects the delivery of nicotine to an individual user.

Some e-cigarette products deliver nicotine almost as efficiently as a cigarette. For example, the maker of JUUL e-cigarettes claims the product has a nicotine content like traditional cigarettes, and that it delivers the nicotine up to 2.7 times faster than other e-cigarettes. While that may make them more attractive to smokers as an alternative to cigarettes, it increases the potential for youth addiction and suggests such products should be carefully regulated to reduce youth access and use.

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