10.2. SR 09-08-2015 - Laserfiche WebLink

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E-cigarettes: an evidence update 15 In 2004, the first EC was marketed in China, and EC started to appear in England in 2006/7. The subsequent three years saw a rapid rise in their use. Whilst Professor Russell died in 2009, predating the arrival of these products in England, proponents of EC similarly recognised their potential to contribute towards making a smoke-free society more rapidly achievable [4]. Those against EC, however, believed that they were at best a distraction, at worst a means of undoing decades of progress in reducing smoking [5]. Any new tobacco control strategy for England must therefore incorporate a nicotine strategy, which should include recommendations and an appropriate regulatory framework for EC. This report attempts to inform that strategy by reviewing recent evidence and surveys relating to the use of EC and how they impact smoking behaviour. The focus is England, although we also draw on evidence from elsewhere in the UK and internationally. Description of e-cigarettes EC use battery power to heat an element to disperse a solution that usually contains nicotine. The dispersion of the solution leads to the creation of an aerosol that can be inhaled by the user. The heated solution typically contains propylene glycol or glycerine, water, nicotine, and flavourings. EC do not contain tobacco, do not create smoke and do not rely on combustion. Whilst EC ‘smoke’ is technically an aerosol, throughout this report we use the established terminology of vapour, vaping and vaper. There is substantial heterogeneity between different types of EC and the speed with which they are evolving making them difficult to categorise. ECs available in England can be classified into three basic types: (1) EC that are either (a) disposable or (b) use pre-filled cartridges that need to be replaced once emptied. We will refer to these using their most common name, ‘cigalikes’. Most cigalikes resemble cigarettes, although it is important to note that some do not; (2) EC that are designed to be refilled with liquid by the user. We will refer to these using their common name ‘tank systems’. (3) Finally, some EC products, mostly tank systems that allow users to regulate the power delivery from the batteries to the atomizer. These we refer to as mods or ‘variable power EC’. In the UK, the most prominent brands of cigalikes are now owned by the tobacco industry. To the authors’ knowledge only one tobacco company sells a tank model in the UK, with the rest of the market consisting of non-tobacco industry companies. Some products have also been introduced by the tobacco industry that could be referred to as ‘hybrids’ such that they use pre-filled nicotine cartridges but look like tank models. Additionally, a few EC that are similar to cigalikes in function are also sold that use cartridges that can be refilled, and some users will puncture holes/remove the ends of cigalike cartridges to refill them instead of buying new cartridges.