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3 <br />1 Background <br />1.1 What are e-cigarettes? <br />E-cigarettes generally consist of a battery, a heating coil and a liquid containing nicotine. Drawing on <br />the e-cigarette or pressing a switch activates the battery to heat the coil, which vaporises the liquid. <br />This is then inhaled and the nicotine absorbed into the blood via mouth, throat and lungs. The <br />liquids contain nicotine, water, a ‘diluent’ such as propylene glycol or glycerol, and a flavouring, such <br />as tobacco, mint, vanilla or fruit. There are now hundreds of flavours and these are an intrinsic part <br />of the appeal. The devices and the liquids can be sold as integrated units or with liquids sold <br />separately. Some look like cigarettes (1st generation ‘cig-a-likes’), some look like pens (2nd generation <br />‘Ego’ type), and the larger ones with tanks can look very distinctively different (3rd generation ‘tanks’ <br />or ‘mods’). <br /> <br />Types of e-cigarette or vaping equipment <br />1.2 How have e-cigarettes come about? <br />The products have emerged only recently (since 2007) thanks to advances in battery technology, <br />which can now provide sufficient power to vaporise an adequate flow of liquid and sufficient battery <br />life to make devices practical. This has been the key enabling development – partly a spin-off from <br />mobile phone technology. E-cigarettes first emerged in China, which is still the largest manufacturer <br />by far, with increasingly sophisticated plant and designs. <br />1.3 How much are e-cigarettes used? <br />A survey conducted for Action on Smoking and Health estimated that there were 2.1 million adults <br />in Great Britain using electronic cigarettes in March 2014. Of these, approximately 700,000 were ex- <br />smokers while 1.3 million continued to use tobacco alongside their electronic cigarette use. <br />Electronic cigarette use amongst never-smokers was negligible 1. For the US, CDC gives frequent use <br />at 1.9% of adults and any e-cigarette use at 4.2% of adults 2, equating to around 4.6 and 10.1 million <br />users respectively. A synthesis of 10 country surveys 3 identified widespread use in many countries, <br />including substantial use in those such as Australia where the products are, in practice, banned. <br />According to this survey 7% of Australian smokers and former smokers were current users of e- <br />cigarettes in 2013. This is likely to be a significant contributor to declines in smoking in Australia. <br /> <br />1 ASH, Fact sheet: Use of electronic cigarettes in Great Britain, October 2014 [link] <br />2 CDC, Tobacco Product Use Among Adults — United States, 2012–2013 [link] <br />3 Gravely S, Fong GT, Cummings KM, et al. Awareness, Trial, and Current Use of Electronic Cigarettes in 10 Countries: <br />Findings from the ITC Project. Int J Environ Res Public Health 2014; 11: 11691–704. [link]