Since 2007, when they were introduced to the US market, the popularity of electronic cigarettes (known as e-cigarettes or electronic nicotine delivery systems (ENDS)) has increased. Chinese pharmacist Hon Lik invented the device in its current form in 2003, intending its use for smoking cessation.

E-cigarette design

E-cigarettes were developed to mimic the efficient nicotine delivery system of a conventional cigarette without the significant harmful effects of tobacco smoke.12Unlike combustible and smokeless tobacco products, the federal government does not currently regulate e-cigarettes; therefore, engineering and ingredients vary greatly from brand to brand, and even within brands.14 The US Food and Drug Administration (FDA) does not currently oversee the evaluation of e-cigarettes for consumer safety, health effects, or efficacy in cessation treatment.

Most e-cigarettes consist of the following

o A battery with which to heat the e-cigarette liquid

o E-cigarette liquid (e-liquid), which usually contains nicotine in a propylene glycol or glycerin solution; many of the liquids also add flavoring (options include tobacco, menthol, coffee, fruit, candy, soda and alcohol)

o An atomizer or cartomizer (combined cartridge and atomizer), which heats the e-liquid so that it becomes aerosolized, and may house a microprocessor, a metal coil and a wick

o A light emitting diode at the end of the e-cigarette, mimicking the appearance of a lit combustible cigarette

Sales

The e-cigarette market has grown rapidly over the past few years, accompanied by an increase in marketing. By 2014, global consumers spent USD3 billion on 466 separate brands. 24 E-cigarettes are being marketed widely through television commercials, sports and cultural event sponsorship, celebrity endorsement, social networking, online advertising, point-of-sale displays, discount pricing, and product innovation.24 A recent study counted 7,764 unique ecigarette flavors – while the role of flavoring in market uptake is just starting to be studied, past cigarette marketing trends and expert opinion indicate candy-like flavors typically entice youths to begin use.

E-cigarette marketing and related issues

E-cigarettes are marketed heavily in both traditional (e.g., television and print) and digital modalities, with messages that often feature celebrities and ads that bear striking similarities to those advertising conventional tobacco products. Ads portray e-cigarettes as safer alternatives to conventional smoking, as useful for quitting smoking and reducing cigarette consumption, and as a way to circumvent smoke-free laws by enabling users to “smoke anywhere,” even despite lack of evidence to support these claims. Because ecigarettes are not currently subject to the same marketing restrictions as conventional cigarettes, researchers and the public health community have expressed concern regarding potential consequences of rapid expansion of e-cigarette marketing, including:

o Increased e-cigarette initiation and subsequent nicotine addiction

o Dual use of both electronic and combustible cigarettes, given mounting evidence that using e-cigarettes in addition to regular cigarettes may decrease quitting both types

o False belief in efficacy for smoking substitution or cessation

o Potential role in conventional cigarette uptake

o Renormalization of smoking

Marketing and disparate health outcomes

Targeted marketing strategies, such as sponsorship of events, and grants to community organizations, are thought to contribute to disparities in tobacco use and health outcomes. Tobacco use and related health disparities have been documented by race and ethnicity, level of acculturation (i.e., first generation vs. third generation immigrant), E-cigarettes.

Conclusion

Though it is often believed that e-cigarettes are less harmful than the conventional ones (tobacco products), there are still so much to be doubtful about.