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This past summer, the Atlanta suburb of Roswell, Georgia, banned use of e-cigarettes and vapor pens in public parks. Officials enacted the restriction not because of rampant use of the devices in the city but, as mayor Jere Wood said, to “get ahead of the curve. Smokeless device use is soaring. To fulfill demand, vapor shops are popping up all over.
Electronic cigarettes are growing in popularity around the world. With the announcement of vape as our Word of the Year, we have put together a timeline of the history of e-cigarettes.
February 2012 Nicotine and Tobacco Research publishes a study, entitled “Electronic Cigarettes: Effective Nicotine Delivery After Acute Administration,” which explores nicotine intake with different electronic cigarette devices.
June 2013
The Medicines and Healthcare Products Regulatory Agency will regulate e-cigarettes as medicines from 2016 when new European tobacco laws come into force.
December 2013 Nicotine and Tobacco Research publishes a study, entitled “Secondhand Exposure to Vapors From Electronic Cigarettes.” It reveals that “using an e-cigarette in indoor environments may involuntarily expose non-users to nicotine, but not to toxic tobacco-specific combustion products.”
Different types of electronic cigarettes by TBEC Review. CC BY 2.0 via Flickr.
December 2013
“World leading tobacco experts argue that a recently published World Health Organization (WHO)-commissioned review of evidence on e-cigarettes contains important errors, misinterpretations, and misrepresentations, putting policy-makers and the public in danger of foregoing the potential public health benefits of e-cigarettes.”
September 2013 The American Academy of Pediatrics (AAP) urges the US Food and Drug Administration (FDA) to “issue a rule to regulate all tobacco products, including cigars, little cigars, e-cigarettes and others.”
15 January 2014
The Chicago City Council voted to regulate electronic cigarettes the same as traditional cigarettes, which “prohibits the use of e-cigarettes in public places, requires stores selling them to keep them behind the counter, and prohibits their sale to minors.”
February 2014
The European Parliament approves regulations on e-cigarettes. “Beginning in mid-2016, advertising for e-cigarettes would be banned in the 28 nations of the European Union, as it already is for ordinary tobacco products. E-cigarettes would also be required to carry graphic health warnings and must be childproof. The amount of nicotine would be limited to 20 milligrams per milliliter, similar to ordinary cigarettes.”
March 2014 Journal of Psychiatric Research reports on e-cigarette use within different age groups and finds that “a notable proportion of adolescents and young adults who never smoked cigarettes had ever-used e-cigarettes. E-cigarette use was not consistently associated with attempting to quit tobacco among young adults. Adults most often reported e-cigarettes as a substitute for tobacco, although not always to quit. Reviewed studies showed a somewhat different pattern of e-cigarette use among young people (new e-cigarette users who had never used tobacco) versus adults (former or current tobacco users).”
14 April 2014
A US congressional report surveys the marketing tactics of e-cigarette companies, which directs sales towards youth, and calls on the FDA to set regulations for e-cigarette marketing.
24 April 2014
The FDA proposes regulations on e-cigarettes, which gives them authority over e-cigarettes and expands its’ authority over tobacco products. The AAP still urges the FDA to protect young people from the effects of e-cigarettes.
April 2014
A proposal from the FDA requires e-cigarettes to “undergo an agency review,” which would ban e-cigarette sales to minors and require e-cigarettes to have warning labels.
4 May 2014 The AAP surveyed a random sample of adults, and according to the research presented, “the vast majority of young adults who have used the devices believe they are less harmful than regular cigarettes…”
12 May 2014 Tobacco Control BMJ releases a study on e-cigarette use and individuals with mental health conditions.
May 2014
A study for Nicotine and Tobacco Researchfinds that the vapors from e-cigarettes contain “toxic and carcinogenic carbonyl compounds,” and the amount of formaldehyde in the vapors is similar to the amount reported in tobacco smoke.
26 June 2014 The British Medical Association (BMA) calls to ban e-cigarette use in public. Doctors and medical students decide that e-cigarettes may lead to nicotine addiction.
July 2014
The BBC bans the use of e-cigarettes in all its offices and studios.
August 2014
A study from Nicotine and Tobacco Research states that “there is a risk of thirdhand exposure to nicotine from e-cigarettes,” although the exposure levels differ depending on the brand of the devices used.
August 2014
A study from Nicotine and Tobacco Research states that “in 2013, over a quarter million never-smoking youth had used e-cigarettes. E-cigarette use was associated with increased intentions to smoke cigarettes.”
24 August 2014
The American Heart Association (AHA) calls on the FDA for more research on e-cigarettes, to apply the same regulations on e-cigarettes as tobacco and nicotine products, and to create new regulations to prevent access, sale, and marketing to youth.
26 August 2014 A World Health Organization (WHO) report states that e-cigarettes need regulation to “impede e-cigarette promotion to non-smokers and young people; minimize potential health risks to e-cigarette users and nonusers; prohibit unproven health claims about e-cigarettes; and protect existing tobacco control efforts from commercial and other vested interests of the tobacco industry.”
The WHO reports that “governments should ban the use of electronic cigarettes in public places and outlaw tactics to lure young users.”
4 September 2014 The New England Journal of Medicine’s findings state that “like conventional cigarettes, electronic cigarettes may function as a ‘gateway drug’ that can prime the brain to be more receptive to harder drugs.”
October 2014
A study for Nicotine and Tobacco Research states that “over 75% of US adults reported uncertainty or disapproval of the use of e-cigarettes in smoke-free areas. Current cigarette smokers, adults aware or have ever used e-cigarettes were more supportive to exempting e-cigarettes from smoking restrictions.”
Headline image credit: Vaping an electronic cigarette by Jon Williams. CC BY 2.0 via Flickr.
Oxford Dictionaries has selected vape as Word of the Year 2014, so we asked several experts to comment on the growth of electronic cigarettes and the vaping phenomenon.
Vaping is the term for using an electronic cigarette (e-cigarette). Since e-cigarettes involve inhaling vapour rather than smoke, it is distinct from smoking. The vapour looks a somewhat like cigarette smoke but dissipates much more quickly and has very little odour since it mostly consist of water droplets.
E-cigarettes started to become popular around 2010 and it is estimated they are currently being used by more than 2 million people in the United Kingdom and more than 5 million in the United States. Their sale is banned in many countries, including Australia and Canada, although surveys show that use in these is widespread since they can easily be obtained via the Internet.
E-cigarettes are devices in which a battery-powered heating element vaporises an ‘e-liquid’ usually containing propylene glycol or glycerol, nicotine, and flavourings. They are designed to provide much of the experience of smoking but with much lower risk, less annoyance to bystanders, and usually much more cheaply. Because they do not involve burning of tobacco, the concentrations of toxins in the vapour are typically a tiny fraction of those in cigarette smoke. The precise risk from using them is not known, but based on the vapour constituents it would be expected to be between 1% and 5% that of smoking.
Data on e-cigarette use are not available for most countries. By far the most complete data come from England where the ‘Smoking Toolkit Study’ (STS) collects data on usage from nationally representative samples of adults every month enabling this to be tracked closely over time. This study was established to track ‘key performance indicators’ relating to smoking and smoking cessation and has been going since 2007. Action on Smoking and Health also conduct large national surveys of adults and young people each year. Large scale surveys are also being conducted in the United States and some other countries. The data show that most people use e-cigarettes in an effort to protect their health either by stopping smoking altogether or cutting down. Despite misleading claims by some anti- e-cigarette advocates, use by never-smokers and long-term ex-smokers is extremely rare in the UK and US at present, and in England its prevalence in never-smokers and long-term ex-smokers is similar to the use of ‘licensed nicotine products’ (LNPs) such as nicotine patches, gum, or lozenges.
E-cigarettes come in many different forms. In England, the most commonly used ones at present are known as ‘cigalikes’ because they look something like a cigarette and often have a tip that glows when the user takes a puff. Becoming more popular are devices that involve a refillable ‘tank’. There are also more sophisticated ‘mod’ systems which are highly customised. These are often the choice of aficionados.
Most e-cigarette users probably obtain less nicotine from these devices than people typically do from cigarettes, but experienced vapers using tank systems or mods can obtain at least as much nicotine from their devices as do smokers.
When used in a quit attempt, on average e-cigarettes seem to improve the chances of successful quitting by about 50%, similar to licensed nicotine products when used as directed. The main difference appears to be that these devices are much more popular, and they seem to be effective when people use them without any support from a health professional. Currently the evidence still indicates that use of the drug varenicline or a licensed nicotine product with specialist behavioural support provides the best chance of quitting for those smokers who are willing to use this support and where such support is available.
When used for cutting down, daily (but not non-daily) use of e-cigarettes seems to be associated with a modest reduction in cigarette consumption on average. Use of licensed nicotine products for cutting down has been found to be associated with an increased likelihood of later smoking cessation. This has not yet been demonstrated for e-cigarettes, although smokers who use e-cigarettes daily do try to quit smoking more often than those who are not ‘dual users’.
Despite claims from some anti- e-cigarette advocates, in England and the United States, e-cigarettes are currently not acting as a ‘gateway’ to smoking in adolescents or ‘renormalising’ smoking. Youth and adult smoking have continued to decline steadily as e-cigarette use has grown and in England adult smoking cessation rates are somewhat higher than they were before e-cigarettes started to become popular. E-cigarette use in indoor public areas has not led to any increase in smoking in these areas in the UK and compliance with smoke-free legislation remains extremely high.
Some e-cigarette advertising seeks to glamorise vaping and in some countries appears to blur the boundaries between smoking and vaping. This has led to concern that it might make vaping attractive to non-smokers and countries such as the UK have regulated to prevent this.
There is some controversy over vaping. A number of high-profile public health advocates have engaged in what appears to be a propaganda campaign against them, creating an impression in the public consciousness that they are more dangerous than they are and that they are undermining tobacco control efforts when the evidence does not support this. It is reasonable to be concerned about what may happen in the future with tobacco companies dominating the e-cigarette market and being incentivised to maximise tobacco sales, but much of the anti- e-cigarette propaganda appears to be motivated more by a puritanical ethic than a dispassionate assessment of the evidence. Maximising the public heath opportunity presented by e-cigarettes, while minimising the potential threat, requires collecting good data, using this information to construct an appropriate regulatory strategy, and monitoring the situation closely to adjust the strategy as required. England appears to be leading the way in this approach designed to encourage smokers to use e-cigarettes to stop smoking, while not undermining use of potentially more effective quitting methods, and preventing e-cigarettes becoming a gateway into smoking. The Smoking Toolkit Study, the ASH surveys, and other research will continue to provide essential information needed to inform this strategy.
Vaping is having an interesting cultural moment. Use of the word is increasing rapidly, as the Oxford Dictionaries editors note, although many people are still unfamiliar with it. (In a totally scientific survey of ten 40-year-old parents on the playground of my son’s school, none had heard the word before. In my husband’s university department, some of the graduate students used the word, but the consensus among the faculty was that to vape meant to live life as a Visiting Assistant Professor.) This increased use comes as people attempt to define boundaries for the activity, to figure out where it is socially acceptable, and where it is not. Is vaping like smoking, and thus offensive and possibly dangerous to non-vapers? Or is it more like chewing gum — not polite, exactly, but something you might do surreptitiously at work or in a movie theater? Would you vape in a childcare center? In a hospital? These are not just questions of etiquette, but also of law — will vapers, like smokers, be required to keep a distance of 15 to 25 feet from any doors or windows?
The word vaping has already caused devotees of juice (the liquid used in e-cigarettes) to lose the first battle in the propaganda war. Vaping carries overtones of illicit drug use — vaporizers provided a cleaner high for marijuana-smokers for years before they were used in e-cigarettes — and sounds, as was reported in The Guardian last year, “worryingly like a form of sexual assault, or a bewilderingly ill-advised 1980s dance craze.” Let’s look now at some words from smoking’s history, to see how earlier battles over tobacco use played out, and how current questions about vaping might be resolved.
Like many of our other good stimulants, tobacco was brought to Europe from the Americas, first imported by the Spanish in the early 16th century. Tobacco (first English use, 1577) comes from Native American words for a pipe or a sort of cigar, which the Spanish assumed referred to the leaves of the plant itself. Columbus’s conscience, Friar Bartolomé de las Casas, described how when their expedition landed in Cuba, they found the Taino smoking these cigar-like “tabacos,” “by which they become benumbed and almost drunk, and so it is said they do not feel fatigue.” It was not a forgone conclusion that tobacco would be the English name for this miraculous plant — other candidates at the time were petum (1568), possibly derived from another Native American word, and nicotian (1577), from Jean Nicot, who brought the plant to France for the first time. (Nicot eventually gave his name to the tobacco genus, Nicotiana, as well as to its chemical of interest, nicotine (1817)).
Growing more and more popular with every passing year, tobacco seemed to be doing just fine with its common name, but others were coined for it to better advertise what were seen as its incredible health benefits — the holy herb, the queen mother herb, God’s remedy, and panacea (all 16th century). A panacea is a medicine reputed to cure all diseases, a tall order, but one that it was more than capable of fulfilling, according to proponents such as Anthony Chute, author of Tabaco (1595). The green leaves of the plant could cure any sort of laceration or skin ulcer, from a finger nigh severed by a giant chopping knife to the King’s Evil (Scrofula), the Canker, the Wolfe, and noli me tangere (“don’t touch me”), increasingly awful skin diseases. The smoke was thought to be even more efficacious, because of the humoral theory of medicine that held sway at the time. A healthy body had the proper balance of four humors, blood, yellow bile, black bile, and phlegm, which gave it the proper temperature and moisture. Tobacco smoke was very hot and dry, and so could cure diseases in which the patient was excessively cold and moist — all kinds of coughs, rheums, bowel problems, and, the epitome of cold and wet, drowning.
The “native English” way of getting smoke into the body was the clyster (1398), or glyster — a tobacco enema. It was superseded by the pipe, a Native American invention and a more social way to smoke, but the original practice survived until the mid-19th century as the best way to revive drowning victims, and is still around in the expression to blow smoke up your ass, meaning “to give insincere compliments.” (Though wonderful, this derivation of the idiom is possibly apocryphal. There is a long and independent association between “empty words” and wind, smoke, or vapor.)
Like vaping today, there were questions about the social acceptability of “drinking tobacco,” as smoking was called. Was it genteel for women to smoke, for example? On one hand, smoking was good for women, who were constitutionally a little bit too cold and damp. On the other hand, smoking involved sucking on something in public, generally a no-no. Early tobacco pipes also tended to produce quite a lot of brown, sticky saliva, which stained clothing, created a funk (a strong stink, 1623), and needed to be spit somewhere, often on the floor, until the development of the spittoon (1840). Tobacco use gained its widest social acceptance with the rise of snuff (1683), finely ground tobacco snorted through the nose, which neatly avoided all these problems.
Painting of a man taking snuff using the thumb & forefinger method. Public domain via Wikimedia Commons.
Taking snuff has many similarities with vaping. It required lots of accoutrements, all of which could show off one’s individuality, relative wealth, and taste. Vapers today can buy standard, preassembled e-cigs and tobacco-flavored juice, but many people prefer to customize their equipment, especially if they drip. Dripping involves putting a few drops of juice directly on the coil of an e-cig atomizer (the heating element) instead of using a cartridge with a reservoir of liquid and a wick, which according to drippers (?)…drips (?)…advocates of dripping, provides a purer taste and the option of changing flavors more frequently. It requires vapers to assemble their e-cigs themselves, choosing an atomizer, a drip tip (the part you put in your mouth), possibly a drip shield, and a variety juice flavors, from the hundreds available — “Mother’s Milk” (“a creamy custard with a sweet strawberry exhale”), for example, or “Boba’s Bounty” (“tobacco, honey, and marshmallow”). Snuff-takers needed a snuff-box — some devotees had hundreds, beautifully decorated — a rasp, to grind the tobacco leaves, a tiny spoon if they preferred not to dirty their fingers, and a dark-patterned handkerchief to catch their sneezes and clean their nostrils. Like juice, snuff could be colored and flavored in hundreds of combinations, including orange flower, rose, bergamot, musk, and tonka bean (a flavor like vanilla, now banned by the FDA for containing coumarin, which in high doses can damage the liver).
Two snuff boxes shaped like a pair of lady’s boots, England. Science Museum, London, Wellcome Images. CC-BY-4.0 via Wikimedia Commons.
Vaping has many of the same things going for it that snuff did — it appeals to a knowledgeable, somewhat moneyed, consumer and offers a way to display individuality and discernment. Now all it needs is a better name…any ideas?
