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Electronic cigarettes: Product characterisation and design considerations

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To review the available evidence regarding electronic cigarette (e-cigarette) product characterisation and design features in order to understand their potential impact on individual users and on public health. Systematic literature searches in 10 reference databases were conducted through October 2013. A total of 14 articles and documents and 16 patents were included in this analysis. Numerous disposable and reusable e-cigarette product options exist, representing wide variation in product configuration and component functionality. Common e-cigarette components include an aerosol generator, a flow sensor, a battery and a nicotine-containing solution storage area. e-cigarettes currently include many interchangeable parts, enabling users to modify the character of the delivered aerosol and, therefore, the product's 'effectiveness' as a nicotine delivery product. Materials in e-cigarettes may include metals, rubber and ceramics. Some materials may be aerosolised and have adverse health effects. Several studies have described significant performance variability across and within e-cigarette brands. Patent applications include novel product features designed to influence aerosol properties and e-cigarette efficiency at delivering nicotine. Although e-cigarettes share a basic design, engineering variations and user modifications result in differences in nicotine delivery and potential product risks. e-cigarette aerosols may include harmful and potentially harmful constituents. Battery explosions and the risks of exposure to the e-liquid (especially for children) are also concerns. Additional research will enhance the current understanding of basic e-cigarette design and operation, aerosol production and processing, and functionality. A standardised e-cigarette testing regime should be developed to allow product comparisons.
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Electronic cigarettes: product characterisation
and design considerations
Christopher J Brown, James M Cheng
Center for Tobacco Products,
U.S. Food and Drug
Administration, Rockville,
Maryland, USA
Correspondence to
Christopher J Brown, Center
for Tobacco Products, U.S.
Food and Drug Administration,
Ofce of Science, 9200
Corporate Blvd, Rockville,
MD 20850, USA;
Christopher.Brown@fda.hhs.gov
Received 3 December 2013
Accepted 4 March 2014
To cite: Brown CJ,
Cheng JM. Tob Control
2014;23:
ii4ii10.
ABSTRACT
Objective To review the available eviden ce regarding
electronic cigarette (e-cigarette) product characterisation
and design features in order to understand their
potential impact on individual users and on public
health.
Methods Systematic literature searches in 10 reference
databases were conducted through October 2013. A
total of 14 articles and documents and 16 patents were
included in this analysis.
Result s Numerous disposable and reusable e-cigarette
product options exist, representing wide variation in
product conguration and component functionality.
Common e-cigarette components include an aerosol
generator, a ow sensor, a battery and a nicotine-
containing solution storage area. e-cigarettes currently
include many interchangeable parts, enabling users to
modify the character of the delivered aerosol and,
therefore, the products effectiveness as a nicotine
delivery product. Materials in e-cigarettes may include
metals, rubber and ceramics. Some materials may be
aerosolised and have adverse health effects. Several
studies have described signicant performance variability
across and within e-cigarette brands. Patent applications
include novel product features designed to inuence
aerosol properties and e-cigarette efciency at delivering
nicotine.
Conclusions Although e-cigarettes share a basic
design, engineering variations and user modications
result in differences in nicotine delivery and potential
product risks. e-cigarette aerosols may include harmful
and potentially harmful constituents. Battery explosions
and the risks of exposure to the e-liquid (especially for
children) are also concerns. Additional research will
enhance the current understanding of basic e-cigarette
design and operation, aerosol production and
processing, and functionalit y. A standardised e-cigarette
testing regime should be developed to allow product
comparisons.
BACKGROUND
Electronic cigarettes (e-cigarettes) comprise a sub-
category of a broader range of products described
as personal vaporisers (PV), advanced personal
vaporisers (APV) or electronic nicotine delivery
systems (ENDS). These products have a range of
designs. Adequate characterisation of e-cigarette
design features is necessary to evaluate the potential
risks and benets associated with their use.
METHODS
Systematic literature searches were conducted
through October 2013 to identify research related
to e-cigarettes and electronic nicotine delivery
systems. Ten reference databases (Web of
Knowledge, PubMed, SciFinder, Legacy Tobacco
Documents Library, Embase, EBSCOhost,
Espacenet, Google Scholar, Google Patent and the
US Patent Ofce) were searched using a set of rele-
vant search terms used singly or in combination.
Search terms included the following: thermal
runaway OR battery re OR battery explosion
OR lithium battery explosion OR electronic nico-
tine devices OR electronic nicotine delivery
systems OR electronic cigarettes OR e-cigarette
OR electronic AND cigarette.
To be considered for inclusion, the article or
patent (granted and applications) had to (1) be
written in English; (2) be publicly available; and (3)
deal partly or exclusively with engineering design
or operation, or lithium battery res or explosions.
The search yielded a total of 296 e-cigarette articles
or documents that met the inclusion criteria.
Article titles and abstracts (when titles provided
insufcient detail) were then screened for rele-
vance. In addition, thousands of battery and patent
documents were identied; approximately 100
documents related to battery operation and 460
patents were screened for inclusion. Overall, the
search yielded 54 articles and 28 patents for full-
text review, which included a manual search of the
reference lists of selected articles to identify add-
itional relevant publications.
Following the full-text review, 14 articles and
documents and 16 patent documents were deemed
directly relevant for this analysis. The articles and
patent documents were published between 2004
and 2013. The validity and strength of each study
were determined based on a qualitative assessment
of depth and breadth of analysis, uniqueness and
relevance to engineering concerns.
Additional documents considered for review
included conference presentations/posters, reports
not published in peer-reviewed journals, national
and international standards, and government
reports. Three documents from either online
sources or conference proceedings are cited. Two
websites that provide e-cigarette design and oper-
ation information are also cited. Although not peer-
reviewed, these websites and documents provide
valuable insight on product design and operation.
SCIENTIFIC REVIEW
Basic design and operation
e-cigarettes are generally designed to resemble trad-
itional cigarettes in dimensions and, to some
extent, graphic design. The common components
for most e-cigarettes include an aerosol generator, a
ow sensor, a battery and a solution (or e-liquid)
storage area (see gure 1).
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ii4 Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476
Original article
e-cigarettes currently are classied as either disposable or
reusable. Disposable units do not have rechargeable batteries
and are usually not rellable. They may have a light-emitting
diode (LED). The e-liquid container or cartridge may be separ-
ate from the aerosol generator or atomizer; a combined atom-
izer and cartridge is called a cartomizer. Currently marketed
e-cigarettes typically have an aerosol generator with a metal or
ceramic heating element coiled around a wick bundle.
A wide variety of materials may be used in an e-cigarette.
They include metals, ceramics, plastics, rubber, bres and
foams.
15
Some materials may be aerosolised, possibly contrib-
uting to adverse health effects.
Although e-cigarettes range in complexity, the following
describes the basic operation of a rst-generation e-cigarette:
1. The user draws upon the e-cigarette, which activates an
airow sensor.
2. The airow sensor detects pressure changes and prompts the
ow of power to an LED and a heating element.
3. The e-liquid saturates a wick via capillary action and is then
aerosolised by the heating element.
6
4. The aerosolised droplets of e-liquid subsequently ow into
the users mouth and lungs.
7
Detailed operation and components
For some advanced e-cigarettes, prior to pufng, the consumer
can select feature adjustments that determine heating element
temperature, air ow rate or other functions. Figure 2 outlines a
more detailed, but typical, e-cigarette operations cycle. The
cycle is initiated by single or multiple sensor responses and/or
the use of a button.
8
The initiating sensor(s) may be an acoustic,
pressure, touch, capacitive, optical, Hall Effect or electromag-
netic eld type.
910
The sensor(s) and/or button initiates power
ow to pumps, heating elements, LEDs and other elements.
1
Anecdotal evidence suggests sensors or buttons may provide the
ability to extend puff duration.
11
The cartridge (or cartomizer) and sometimes the battery
holder have air holes to help facilitate the ow of air required
for pufng while also controlling for pressure drop. However,
air holes may serve multiple purposes. For instance, the
European and International Organization for Standardization
Figure 1 Typical e-cigarette conguration. This shows a wick/heater as aerosol generator, gauze saturated with e-liquid, a microprocessor
(optional) to control operations and an LED (optional) to imitate a burning coal.
Figure 2 Basic e-cigarette operation. This owchart outlines basic actions and functions to transform and deliver e-liquid-based aerosol.
Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476 ii5
Original article
(ISO) have ink pen lid standards that mandate air holes to
prevent a child-choking hazard associated with pen lids.
12
Aerosol production generally involves three stages: preproces-
sing, aerosol generation and postprocessing. The rst stage
involves the transport of the e-liquid to the aerosol generator.
Capillary action through a wick is the primary means used by
rst-generation and possibly the majority of current e-cigarettes
to control the delivery of e-liquid to the aerosolising element.
Other possible transport mechanisms include programmed or
mechanically controlled pumps, nozzles and diaphragms. The
pump may be peristaltic, plunger, eccentric or screw, and
powered by electrostatic, piezoelectric, magnetorestrictive,
thermal contractive or thermal bubble processes.
113
Additionally, uid jet, micromesh, microetched screen or elec-
tropermeable membrane methods of transport are available.
19
Another method of e-liquid delivery to the aerosol generator
involves micro-pumps on microelectromechanical systems
(MEMS). Miniaturised pumps and/or nozzles/jets deliver specif-
ically programmed quantities and combinations of e-liquids to
an aerosol generator.
1
Alternately, a consumer may directly drip
e-liquid onto a heating element before pufng.
11 14
The second stage of aerosol processing involves aerosol gener-
ation, which involves (1) heating, in which the e-liquid comes in
contact with the heating element as described above; and/or (2)
mechanical processing, in which an ultrasonic vibration generator
or other mechanical device produces an aerosol by mechanical
dispersion.
13 15
At least one e-cigarette (cigar) introduced to the overseas
market uses ultrasonic vibration to produce an unheated aerosol
of 0.51.5 μm particle size, and another described in patent
documents combines heating and vibrating elements.
16 2
In add-
ition to heating and ultrasonic vibration, e-cigarettes may
incorporate MEMS that use pumps and nozzles ( jets) or ultra-
sonic piezoelectric elements for aerosol generation.
Possible heating element arrangements include straight line,
multiple spiral, cluster, nozzle, laser or element combinations.
Coil arrangements may incorporate wicks and coil covers
(bridged) or no covers (debridged for dripping). The heating
elements resistance, material and the voltage across it determine
the current ow and element temperature. The heating element
temperature and temperature duration inuence the aerosol
properties. Element degradation, fouling and other factors also
inuence the heating element temperature.
The nal stage of aerosol processing occurs as the aerosol
travels through the central air passage to the consumer. Unless the
aerosol is heated, its temperature decreases as it ows and conden-
sation occurs. Larger droplets that condense on the inside of the
central air passage may be removed from the passage and subse-
quently discarded or reprocessed into an aerosol.
17
To further
simulate traditional smoking, the appearance of sidestream smoke
is engineered into one e-cigarette design using pumps.
13
Microprocessors, programmable logic units, integrated cir-
cuits and other electronic components may be incorporated into
some e-cigarette products. The electronic components may be
used to power components and in conjunction with a liquid
crystal screen to display and/or record operating state para-
meters, such as battery life, use frequency per day, average use
cycle and safety warnings. However, the microprocessor may
also have additional functions such as the ability to control inte-
grated MEMS (eg, pumps and/or motors) that deliver speci c-
ally programmed product quantities or concentrations. One
patent describes Bluetooth communication protocol integration
and multiple smoking software programs based on uid type
and user preference.
13
The presence of microprocessors and memory chips in e-
cigarettes raises concerns about the collection and use of per-
sonal privacy information. A microprocessor may facilitate con-
sumer data collection for dissemination to a third party, either
wirelessly by Bluetooth or through the universal serial bus
(USB) interface when the battery is recharged.
9
Data may
include the smokers personal information (eg, gender, age,
address), smoking topography and possibly health-related
data.
918
Of further concern is the ability of the software and
microprocessor to directly or covertly manipulate nicotine deliv-
ery, and software viruses.
Some e-cigarettes may be used while connected by USB cord
to a power source. Additionally, some e-cigarettes may be
powered by permanent rechargeable battery (a manufacturer-
supplied sealed unit), a non-rechargeable battery or a user-
replaceable battery (rechargeable or non-rechargeable). Portable
chargeable carrying cases are available for remote e-cigarette
charging for some brands. Nickel-cadmium (NiCad), nickel
metal-hydride (NiMh), lithium ion (Li-ion), alkaline and lithium
polymer (Li-poly), and lithium manganese (LiMn) batteries may
be used to power e-cigarettes.
19
Performance considerations
Several studies have described signicant performance variability
among e-cigarette brands and within the same brand/product
and compared the performance of e-cigarettes with that of con-
ventional cigarettes. The performance parameters investigated
included pressure drop, airow, aerosol products and puff
count.
Trtchounian et al
20
compared eight brands of traditional
cigarettes to four brands of e-cigarettes. In a comparison of the
rst 10 puffs of each brand, three of the four e-cigarette brands
required signicantly higher average vacuums to produce an
aerosol density comparable to traditional cigarettes. In the same
study, when ve brands (Trtchounian et al added additional
brand) of e-cigarettes were tested, the vacuum required to
produce an aerosol of standardised density increased for each
brand as it was smoked. The puff count at which the increase
would be required varied from a low of 24±12 for one brand
to 121±26, and 114±71 for two brands at the high end. Puff
count to entirely exhaust a cartridge varied for the e-cigarettes
tested from low of 30±43 to a high of 313±115 for different
brands.
Williams and Talbot followed up their collaboration with
Trtchounian and tested four different brands of e-cigarettes that
included duplicates of two brands.
21
An analysis of the rst 10
puffs showed that pressure drop, ow rate and aerosol density
remained relatively constant for a given e-cigarette, but varied
among brands. The investigators analysed the ventilation or air
ow for each brand; they concluded that there was a good cor-
relation between air hole area and pressure drop for half the
e-cigarettes tested. The investigators concluded that the airow
rate required to produce an aerosol varied signicantly among
e-cigarette brands and was usually higher than the airow rate
required to produce smoke from tobacco-containing cigar-
ettes.
21
Additionally, they concluded that standard testing pro-
tocols typically used with traditional cigarettes are not
appropriate for e-cigarettes, stating, E-cigarette laboratory
testing will require its own standard procedure, which is yet to
be developed.
21
Test protocols and standardisation are a concern when com-
paring results from the two studies. In each study, puff counts
are correlated with both puff volume and duration. The investi-
gators produced aerosols of a particular density. This
ii6 Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476
Original article
presupposes that density will drive the puff volume for all e-
cigarettes. However, the satiating effect may be the driving
factor; thus, standardisation of nicotine delivered/absorbed may
be an alternate means of determining the appropriate test proto-
col. The effect of smoking topography on the studies results
and conclusions is unclear and merits further investigation.
Design and aerosol production considerations
Anecdotal evidence suggests that larger capacity tanks, higher
coil voltage and dripping congurations appear to be consumer
innovations adopted by manufacturers. The e-cigarette forums
are a potential source of information concerning emerging
trends regarding e-cigarette design, use and maintenance.
Currently marketed e-cigarettes may have thousands of inter-
changeable parts that modify the character of the delivered
aerosol; connection adapters are available to further enable
interchangeability. Currently advertised features of some
e-cigarettes include
advanced power-on activation (multiple-button click-on
feature)
auto shutoff (safety feature)
short circuit and over current protection (safety feature)
variable voltage ranges (eg, 36 V in 0.1 V increments).
It appears that the variable voltage units introduced the
ability to increase heating element temperature. Increasing
heating element temperature subsequently increases the tem-
perature of the air containing the aerosol and increases the
aerosol generation rate. The warmer air can hold more e-liquid
mass per unit of air volume. Additionally, aerosol particle size
may be altered by the temperature of the heating coil.
5
Referencing Trtchounian et al
20
, Zhang et al
22
noted, Vaping
technique would be especially important if vapers can generate
a different range of particle sizes, or if particle sizes change over
time. Additional research is required to determine whether the
increased coil temperature signicantly increases the e-liquid
mass available and/or alters aerosol particle size.
According to Etter et al
23
, particle size affects absorption and
can directly affect aerosol toxicity. Two studies measured e-
cigarette aerosol particle size. Ingebrethsen et al
24
found that
undiluted e-cigarette aerosols had particle diameters in the 250
450 nm range and particle density concentration of approxi-
mately 109 particles/cm
3
. However, according to the same
report, these e-cigarette numbers differ somewhat from the 50
200 nm particle diameter modes reported in another study by
Schripp et al.
25
Zhang et al
22
constructed an apparatus to deter-
mine in vitro particle size distribution and concluded through
testing that e-cigs and conventional reference cigarettes
produce aerosols having generally similar particle sizes in the
range of 100600 nm.
In 2012, Pellegrino et al compared particulate matter (PM)
from aerosols of Italian brand e-cigarettes with the PM of con-
ventional cigarettes. Data showed that concentration of ne and
ultrane PM was approximately 618 times higher for the con-
ventional cigarettes than the e-cigarettes tested.
26
A limited number of patents (granted and applications) were
reviewed to determine what new features have been incorpo-
rated into products currently on the commercial market or
potentially available to the market. One patent described ports
designed to facilitate reprocessing of accumulated condensate.
15
In their patent application, Tucker et al
19
describe the following
novel features: diffusers (gure 3), which enhance mixing;
airow diverters, which apparently allow the heating element to
maintain a desired temperature, thus optimising nicotine deliv-
ery with puff intensity; multiple e-liquid tanks, each with its
own wick heater; aroma strips to add fragrance to the outside
of the e-cigarette (or into the aerosol); and a movable screen
with openings to vary the airow and thus the pressure drop.
Liu describes multiple heating elements arranged in a series or
in parallel, where aerosol streams converge or remain separ-
ate.
27
In another patent application, Tucker et al
28
describe an
advanced dripping conguration. Alarcon and Healy describe
extensive communications and data collection potential in one
of their patent applications (table 4).
9
Conley et al
29
describe
breath, saliva, sweat, and tissue or cell analysis and conveyance
of the information to a healthcare professional as well as bio-
metrics to couple a device to a particular user. Li et al
30
describe
a feature designed to shift aerosol particle size distribution
towards a range of smaller particles through impacting the
aerosol on a surface.
Safety considerations
Two safety issues are posed by contaminants in the e-liquid or
e-juice and the handling hazards associated with inadvertent
skin contact. Due to a lack of manufacturing standards and con-
trols, e-liquid purity often cannot be assured, and testing of
some products has revealed the presence of hazardous sub-
stances.
7
The nicotine in e-liquid can be hazardous if mis-
handled and can be toxic to infants and children at the levels
present in e-liquid.
31
Child-safe or child-resistant packaging,
child safety locks (such as those present on cigarette lighters)
and proper instruction on the safe handling of e-liquid can help
mitigate some of these risks. One patent discussed the use of
biometrics and sensors to identify consumers by age; this tech-
nology could possibly be used to prevent some child usage by
using age screening.
29
The use of e-cigarettes with illegal substances is a concern.
One patent states that, With slight modication of the solution
storage container, the device and connecting structures of the
present invention can be lled with conventional drug for pul-
monary administration apparatus.
2
Another patent notes that
the unit may be used with narcotics, steroids, the marijuana con-
stituent tetrahydrocannabinol (THC) and other substances.
29
Part interchangeability is of particular concern since the per-
formance, risks and safety associated with a particular brands
conguration might change signicantly when that conguration
is modied using third-party products. One study showed some
variability in cartomizer unit performance when batteries were
exchanged with those of the same brand.
21
In the same study,
one e-cigarette stopped producing aerosol when parts were
exchanged with another (same model) unit. Furthermore,
brand-specic e-liquid cartridges performed signicantly better
at producing aerosols than third-party cartridges provided by a
vendor.
Figure 3 Diffuser. This diagram shows multiple angled openings that
increase aerosol dispersion and buccal cavity contact. The numbers
reference descriptive text in the patent.
519
Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476 ii7
Original article
Other concerns involve materials used in the aerosol gener-
ation process, aging and fouling. e-cigarettes that use a heating
mechanism to create a nicotine vapour emit metallic particles
and even nanoparticles of heating coil components in the
aerosol, such as tin, iron, nickel and chromium.
3
Lead, nickel
and chromium appear on the US Food and Drug
Administrations (FDA) harmful and potentially harmful consti-
tuents (HPHC) list.
32
The safety of the inhalation of these
metallic particles and nanoparticles has not been studied and
could be a cause for concern. The use of alternative aerosol gen-
eration mechanisms may mitigate some of these safety questions,
although it is uncertain whether these alternatives may also gen-
erate particle and nanoparticle emissions. Moreover, long-term
e-cigarette performance and the associated generation of
HPHCs have not been studied. As e-cigarettes age and become
fouled, the products they generate may change. Automatic or
manual heating element cleaning should be design
considerations.
Many e-cigarettes use lithium batteries due to their ability to
store large amounts of energy in a compact amount of space.
However, the inherent characteristics of lithium batteries can
pose a risk of re and explosion. Poor design, use of low-quality
materials, manufacturing aws and defects, and improper use
and handling can all contribute to a condition known as
thermal runaway, whereby the internal battery temperature
can increase to the point of causing a battery re or even an
explosion.
33
The use of overcharging protection circuits,
thermal power cut-offs and internal overpressure relief mechan-
isms can help prevent and mitigate thermal runaway.
34
Critical information/tool gap s
Additional scientic studies are needed to evaluate the safety
and effectiveness of e-cigarettes. Topics for future research
include the following:
1. Understanding of the designs and functions of products cur-
rently on the US market is incomplete.
2. Variable and increased voltage e-cigarettes appear to intro-
duce the ability to deliver increased nicotine concentra-
tions.
35
Higher voltages and other features may introduce
the ability to manipulate particle size and increase aerosol
mass. Little research is available concerning these functions.
3. Knowledge of all the materials involved in aerosol produc-
tion is lacking.
Figure 4 Communications features. This diagram shows bidirectional data transfer between the consumer, computer, pack, social networks and
stakeholders. The numbers reference descriptive text in the patent.
9
ii8 Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476
Original article
4. Hazards associated with the use of batteries require further
study. Failure mechanisms and the frequency of burn, shock
and explosion hazards are unknown.
5. The possible presence, function and capabilities of the soft-
ware, sensors and microprocessors incorporated into
e-cigarettes are unknown. It is not known what health or
topographical data are being collected or how the data may
inuence or affect regulation and health policies. Software
vulnerabilities are also unknown.
6. The absence of standardised testing protocols compromises
comparisons across studies. Standardised test protocols that
allow for meaningful testing, categorisation and comparison
of e-cigarette test results would be a valuable research tool.
7. Knowledge of product lifecycles, degradation over time,
third-party component performance and misuse is needed.
CONC LUSIONS
Although e-cigarettes share a basic design, engineering variations
and user modications result in differences in nicotine delivery
and potential product risks. Performance appears to greatly vary
among commercial products. e-cigarette aerosols may include
HPHCs dened by the FDA. Battery explosions and risk of
exposure to the e-liquid (especially for children) are also poten-
tial concerns. A number of safety features that could enhance
consumer safety do not appear to be widely used.
Current e-cigarette features have the potential to increase
nicotine delivery though advanced aerosol production methods.
Patents show that novel features are available that will likely
further maximise aerosol properties and e-cigarette efciency
for delivering nicotine. e-cigarette forums and websites provide
information on current e-cigarette use, misuse, innovations and
concerns that may inuence the commercial market.
Additional research will improve the current understanding of
basic e-cigarette design and operation, aerosol production and
processing, data collection capability, sensor and software/micro-
processor functionality and vulnerability, performance variation,
lifecycle degradation, unintended use and user safety. In add-
ition, a standardised e-cigarette testing protocol should be devel-
oped to allow product comparisons. Although of signicant
importance, specic guidance for development of a standardised
test regime is beyond the scope of this paper. e-cigarettes with
unique designs may require specialised testing protocols.
What this paper adds
To our knowledge, this is the rst comprehensive review of
the literature related to e-cigarette product design features
and their potential health consequences.
e-cigarettes are highly engineered products representing a
wide variation in product conguration, components and
safety features; furthermore, exibility in many e-cigarette
designs allows user modications. This results in
cross-product and within-product differences in aerosol
production, nicotine delivery and potential product use risks,
making it difcult to evaluate the impact of e-cigarettes on
individual users and the public health.
Additional research is required to ascertain the health
consequences of e-cigarette use; a standardised e-cigarette
testing regime should be developed in order to facilitate
cross-product and within-product comparisons.
Acknowledgements The authors thank Elizabeth L. Durmowicz, M.D., Deborah
Neveleff, M.B.A., Paul Aguilar, M.P.H., Thomas Eads, Ph.D., M.P.A., and R. Philip
Yeager, Ph.D., DABT, for their support and assistance.
Contributors CJB performed the broad literature search on electronic cigarettes,
and JMC performed the literature search on battery-related items. CJB and JMC
cowrote the article; CJB, the lead author, focused on design, operation and
performance, while JMC focused on batteries and exposure.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Open Access This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/3.0/
REFERENCES
1 Hon L, inventor; Best Partners Worldwide Limited, assignee. A ameless electronic
atomizing cigarette. European Patent Specication EP1618803B1. 2006 Jan 25.
http://worldwide.espacenet.com/publicationDetails/originalDocument?
FT=D&date=20081203&DB=worldwide.espacenet.com&locale=en_
EP&CC=EP&NR=1618803B1&KC=B1&ND=5 (accessed 13 Feb 2013).
2 Hon L, inventor; Best Partners Worldwide Limited, assignee. An aerosol electronic
cigarette European Patent Specication. EP1736065B1. 2006 Dec 27.
http://worldwide.espacenet.com/publicationDetails/originalDocument?
FT=D&date=20090603&DB=worldwide.espacenet.com&locale=en_
EP&CC=EP&NR=1736065B1&KC=B1&ND=4 (accessed 13 Feb 2013).
3 Williams M, Villarreal A, Bozhilov K, et al. Metal and silicate particles including
nanoparticles are present in electronic cigarette cartomizer uid and aerosol. PLoS
ONE 2013;8:e57987. http://www.plosone.org/article/fetchObject.action?uri=info%
3Adoi%2F10.1371%2Fjournal.pone.0057987&representation=PDF (accessed 16
July 2013).
4Moit B, Torrence K, Lam K, et al. New product focus team test plan & status
report for Beijing Saybolt Ruyan Technologies product. University of California,
San Francisco, Legacy Tobacco Documents Library, Philip Morris Collection 2004.
Retrieved 2/21/2013 http://legacy.library.ucsf.edu/tid/sze91g00 (accessed 21 Feb
2013).
5 Tucker CS, Jordan GB. inventors; Altria Client Service Inc., assignee. Electronic
smoking article and improved heating element. United States patent application.
20130213419 A1. 2013 Aug 22. http://appft.uspto.gov/netacgi/nph-Parser?
Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.
html&r=1&f=G&l=50&d=PG01&p=1&S1=20130213419.PGNR.&OS=DN/
20130213419&RS=DN/20130213419 (accessed 26 Sep 2013).
6 Newton KD. Inventor. Electronic cigarette with liquid reservoir. United States patent
8528569 B1. 2013 Sep 10. http://patft.uspto.gov/netacgi/nph-Parser?
Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.
htm&r=1&f=G&l=50&s1=8528569.PN.&OS=PN/8528569&RS=PN/8528569
(accessed 26 Sep 2013).
7 Wollscheid KA, Kremzner ME. Electronic cigarettes: Safety concerns and regulatory
issues. Am J Health Syst Pharm 2009;66:174 042. http://www.ajhp.org/content/66/
19/1740.full (accessed 15 Feb 2013)
8 Cheah NP, Chong NW, Tan J, et al. Electronic nicotine delivery systems: regulatory
and safety challenges: Singapore perspective. Tob Control. 2014;23:11925. http://
tobaccocontrol.bmj.com/content/early/2012/11/30/tobaccocontrol-2012050483.
full.pdf+html?sid=05289f336563407b-b9fc-850ba38895ff (accessed 05 Dec
2012).
9 Alarcon R, Healy J, inventors; Electronic smoking device. United States patent
application 20110265806 A1. 2011 Nov 03. http://appft.uspto.gov/netacgi/
nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%
2Fsrchnum.html&r=1&f=G&l=50&s1=%2220110265806%22.PGNR.&OS=DN/
20110265806&RS=DN/20110265806 (accessed 26 Sept 2013).
10 Terry N, Minskoff N, inventors; Personal vaporizing inhaler with mouthpiece cover.
United States patent application 20110277780A1. 2011 Nov 17. http://worldwide.
espacenet.com/publicationDetails/originalDocument?
FT=D&date=20111117&DB=EPODOC&locale=en_
EP&CC=US&NR=2011277780A1&KC=A1&ND=4 (accessed 18 Nov 2013).
11 E-Dripping.com. How do you Drip with an Electronic Cigarette? http://edripping.
com/about-ecigarettes/e-cigarette-dripping-how-to/ (accessed 25 Jul 2013).
12 European Child Satiety Alliance (ECOSA). A guide to child safety regulations and
standards in Europe. AD, Netherlands. 2003. http://www.childsafetyeurope.org/
publications/info/child-safety-regulations-standards.pdf (accessed 31 Jan 2013).
13 Katase M, inventor. Electronic cigarette. United States patent application
20050016550 A1. 2005 Jul 25. http://www.google.com/patents?
hl=en&lr=&vid=USPATAPP10886508&id=SY-SAAAAEBAJ&oi=fnd&dq=ELECTRONIC
+CIGARETTE&printsec=abstract (accessed 8 Feb 2013).
Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476 ii9
Original article
14 E-Cigarette Forum. E-cigarette Technical; Tips and Tricks, Do Y ou Drip? http://www.
e-cigarette-forum.com/forum/tips-tricks/9069-do-you-drip-2.html (accessed 29 Aug 2013).
15 Alelov E, inventor. Inhalation device including substance usage controls. United
States patent 8550069 B2. 2013 Oct 8. http://worldwide.espacenet.com/
publicationDetails/originalDocument?FT=D&date=20131008&DB=worldwide.
espacenet.com&locale=en_EP&CC=US&NR=8550069B2&KC=B2&ND=4 (accessed
18 Nov 2013).
16 Pauly J, Li Q, Barry MB. Tobacco-free electronic cigarettes and cigars deliver
nicotine and generate concern. Tob Control 2007;16:357. http://www.ncbi.nlm.nih.
gov/pmc/articles/PMC2598554/ (accessed 15 Feb 2013)
17 Hon L, inventor; Ruyan Investment (Holdings) Limited, assignee. Electronic
atomization cigarette. United States patent 8,490,628 B2. 2013 July 23. http://
patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=
%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=8490628.PN.
&OS=PN/8490628&RS=PN/8490628 (accessed 26 Sep 2013).
18 Marangos B, inventor; Electronic cigarette. Canadian patent application 02731485.
2011 Feb 09. http://worldwide.espacenet.com/publicationDetails/originalDocument?
CC=CA&NR=2731485A1&KC=A1&FT=D&ND=4&date=20120809&DB=worldwide.
espacenet.com&locale=en_EP (accessed 18 Nov 2013).
19 Tucker CS, Jordan GB, Smith BS, et al. inventors; Altria Client Service Inc., assignee.
Electronic cigarette. United States patent application 20130192623 A1. 2013 Aug
1. http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=
PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%
2220130192623%22.PGNR.&OS=DN/20130192623&RS=DN/20130192623
(accessed 26 Sep 2013).
20 Trtchounian A, Williams M, Talbot P. Conventional and electronic cigarettes
(e-cigarettes) have different smoking characteristics. Nicotine Tob Res
2010;12:90512. http://ntr.oxfordjournals.org/content/12/9/905.abstract?
sid=7ee8d8e7-dc0f-4b26-ab8f-719f7a2fb312 (accessed 2 Nov 2012).
21 Williams M, Talbot P. Variability among electronic cigarettes in the pressure drop,
airow rate, and aerosol production. Nicotine Tob Res 2011;13:127683. http://ntr.
oxfordjournals.org/content/13/12/1276.abstract?sid=d4f38075063c-4812-be93
604f99e02a3e (accessed 02 Nov 2013).
22 Zhang Y, Sumner W, Chen D. In vitro particle size distributions in electronic and
conventional cigarette aerosols suggest comparable deposition patterns. Nicotine
Tob Res 2012;15:5018.
23 Etter JF, Bullen C, Flouris AD, et al. Electronic nicotine delivery systems: a research
agenda. Tob Control 2011;20:24348. Retrieved 11/02/2012. http://tobaccocontrol.
bmj.com/content/20/3/243.abstract?sid=68114618566f-4315-a6e5-
b1a6c2d6a9e7 (accessed 02 Nov 2012).
24 Ingebrethsen BJ, Cole SK, Alderman SL. Electronic cigarette aerosol particle size
distribution measurements. Inhal Toxicol 2012;24:97684.
25 Schripp T, Markewitz D, Uhde E, et al. Does e-cigarette consumption cause passive
vaping? Indoor Air 2013;23:2531.
26 Pellegrino RM, Tinghino B, Mangiaracina G, et al. Electronic cigarettes: an
evaluation of exposure to chemicals and ne particulate matter (PM). Ann Ig
2012;24:27988.
27 Liu Q, inventor; Electronic cigarette, electronic cigarette are and atomizer thereof.
European patent application EP2641490A1. 2013 Sep 25. http://worldwide.
espacenet.com/publicationDetails/originalDocument?
FT=D&date=20130925&DB=worldwide.espacenet.com&locale=en_
EP&CC=EP&NR=2641490A1&KC=A1&ND=5 (accessed 18 Nov 2013).
28 Tucker CS, Kobal G, Jordan GB, et al. inventors; Altria Client Service Inc., assignee.
Electronic smoking article. United States patent application. 20130213418 A1.
2013 Aug 22. http://appft.uspto.gov/netacgi/nph-Parser?
Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.
html&r=1&f=G&l=50&s1=%2220130213418%22.PGNR.&OS=DN/
20130213418&RS=DN/20130213418 (accessed 26 Sep 2013).
29 Conley GD, Hillenbrandt DC, Mandela M, et al. inventors; Fuma International,
assignee. Electronic vaporizer. United States patent application 20130220315 A1.
2013 Aug 29. http://appft.uspto.gov/netacgi/nph-Parser?
Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.
html&r=1&f=G&l=50&s1=%2220130220315%22.PGNR.&OS=DN/
20130220315&RS=DN/20130220315
30 Li S, Karles G, Munmaya KM, et al. inventors; Altria Client Service Inc., assignee.
Electronic smoking article. United States patent application 20130192621 A1. 2013
Aug 1. http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%
2Fnetahtml%2FPTO%2Fsearch-adv.html&r=1&p=1&f=G&l=50&d=PG01&
S1=20130192621&OS=20130192621&RS=20130192621 (accessed 21 Nov 2013).
31 Connolly GN, Richter P, Aleguas A, et al. Unintentional child poisonings through
ingestion of conventional and novel tobacco products. Pediatrics 2010;125:8969.
32 U.S. Food and Drug Administration. Harmful and Potentially Harmful Constituents in
Tobacco Products and Tobacco Smoke; Established List. Docket No.
FDA-2012-N-0143. Federal Register 2012;64. http://www.fda.gov/downloads/
TobaccoProducts/GuidanceComplianceRegulatoryInformation/UCM297981.pdf
33 Wang Q, Ping P, Zhao X, et al. Thermal runaway caused re and explosion of
lithium ion battery. Journal of power sources 2012;208:21024.
34 Ballard GE, inventor; Standard Oil Company, assignee. Explosion resistant battery
cells. United States patent 4397919. 1983 Aug 9.
35 Shihadeh A, Salman R, Zainab Balhas Z, et al. Factors inuencing the toxicant
content of electronic cigarette vapor: device characteristics and puff topography.
Poster session presented at annual meeting of the Society for Research on Nicotine
and Tobacco. Boston, MA. 2013. from Joseph Lisko, CDC. Atlanta, GA; (ivv0@cdc.
gov). 15 April 2013.
ii10 Brown CJ, et al. Tob Control 2014;23:ii4ii10. doi:10.1136/tobaccocontrol-2013-051476
Original article
... Health risks associated with the use of electronic cigarettes (e-cigarettes) have become an important research topic in recent years, as the rising popularity of vaping, especially among younger populations, has followed an alarming trend [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. To understand the negative health consequences of vaping, it is essential to characterize e-cigarette aerosols and users' vaping patterns through quantitative measures. ...
... Optical attenuation through a highly scattering medium, such as an e-cigarette aerosol, can be precisely described by the modified Beer-Lambert law, given in Equation (2) [58][59][60][61][62]. Considering a monodispersed aerosol with a concentration of c, the optical attenuation for wavelength λ caused by this medium can be given by (2) in which ϵ λ is the extinction coefficient (including absorption and scattering) of the particle for wavelength λ, L is the distance between the light source and the detector, DPF λ is the differential path length factor to account for the increase in optical path length for scattered light, and G λ is a geometry-related factor [58,60]. The optical attenuation depends on both wavelength and particle size and scales up with increasing PM concentration. ...
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To monitor health risks associated with vaping, we introduce a multi-spectral optical sensor powered by machine learning for real-time characterization of electronic cigarette aerosols. The sensor can accurately measure the mass of particulate matter (PM) in specific particle size channels, providing essential information for estimating lung deposition of vaping aerosols. For the sensor’s input, wavelength-specific optical attenuation signals are acquired for three separate wavelengths in the ultraviolet, red, and near-infrared range, and the inhalation pressure is collected from a pressure sensor. The sensor’s outputs are PM mass in three size bins, specified as 100–300 nm, 300–600 nm, and 600–1000 nm. Reference measurements of electronic cigarette aerosols, obtained using a custom vaping machine and a scanning mobility particle sizer, provided the ground truth for size-binned PM mass. A lightweight two-layer feedforward neural network was trained using datasets acquired from a wide range of puffing conditions. The performance of the neural network was tested using unseen data collected using new combinations of puffing conditions. The model-predicted values matched closely with the ground truth, and the accuracy reached 81–87% for PM mass in three size bins. Given the sensor’s straightforward optical configuration and the direct collection of signals from undiluted vaping aerosols, the achieved accuracy is notably significant and sufficiently reliable for point-of-interest sensing of vaping aerosols. To the best of our knowledge, this work represents the first instance where machine learning has been applied to directly characterize high-concentration undiluted electronic cigarette aerosols. Our sensor holds great promise in tracking electronic cigarette users’ puff topography with quantification of size-binned PM mass, to support long-term personalized health and wellness.
... An increase in the popularity of e-cigarettes has been observed in many countries. E-cigarettes were initially introduced as a less harmful and more socially acceptable alternative to tobacco smoking; however, nowadays, the safety of e-cigarette use is still unknown [23,25,[29][30][31]. E-cigarette users report several side effects, including cough, dry throat, conjunctival irritation, and increased heart rate. ...
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Background/Objectives: Electronic cigarettes (e-cigarettes) are commonly used by former smokers as an alternative product to conventional cigarettes and also by young adults and adolescents to deliver nicotine. E-cigarettes are thought to be a less harmful and more socially acceptable alternative to tobacco smoking; however, their long-term effects on health, including oral health, are currently unknown. Methods: A literature search for relevant papers indexed in the literature from 2016 to 2023 was conducted using the PubMed, Scopus, and Google Scholar databases. In our paper, we included clinical trials and both in vivo and in vitro research concerning the impact of e-cigarettes on oral health. Results: E-cigarettes impact the oral cavity, which is directly exposed to inhaled chemicals present in e-cigarette aerosols. The use of e-cigarettes has been linked to teeth discoloration and dental caries, promoting the development of periodontal diseases and causing oral mucosa lesions, including oral cancer. E-cigarette aerosols might also negatively affect the oral microbiome by suppressing the growth of commensal bacteria and increasing the population of bacteria responsible for developing numerous oral disorders. E-cigarettes also impact saliva composition and its properties, including reducing saliva’s antibacterial and antioxidant properties, which may subsequently lead to the promotion of oral diseases. Conclusions: The outcomes suggest that e-cigarette usage may cause the development of oral diseases, however further longitudinal studies of a larger and homogenous group of e-cigarette users are required.
... Nonetheless, it is crucial to acknowledge that the long-term health implications of e-cigarette usage remain predominantly uncertain, and investigations into their safety are continuing (Buljubasich, 2015;Kaisar et al., 2016). E-cigarettes are available in several forms, ranging from compact, inconspicuous devices akin to conventional cigarettes to larger, sophisticated modifications that enable users to personalize their vaping experience (Brown & Cheng, 2014;Carr, 2014;Grana et al., 2014). Certain devices are designed for single use, whilst others are rechargeable and refillable, enabling users to experiment with various flavors and nicotine concentrations (Ma et al., 2022). ...
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Although marketed as a safer alternative to traditional cigarettes, e-cigarettes still contain nicotine and other harmful chemicals that can negatively impact adolescent health. E-cigarette use by adolescents is associated with an increased risk of transitioning to smoking traditional cigarettes, as well as negative impacts on their overall wellbeing. Numerous factors contribute to the rise in e-cigarette use among adolescents. By acquiring a more profound comprehension of the concerns about e-cigarettes in young populations, researchers can formulate more efficacious preventative and intervention techniques to diminish e-cigarette consumption among adolescents and alleviate any health risks linked to their use.
... The primary ingredients in e-liquids are PG, also called 1,2-propanediol, and glycerol, also known as glycerin or propane-1,2,3-triol. These substances act as humectants, ensuring that the e-liquid retains moisture and does not dry out [23]. The Food and Drug Administration has rated them as safe [24]. ...
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This comprehensive review deals with the multifaceted aspects of electronic cigarettes (e-cigarettes), examining their composition, health implications, regulatory challenges, and market dynamics. E-cigarettes, also known as vaping devices, function by warming a solution of liquid containing flavors, nicotine, and various other compounds to produce an aerosol for users to inhale. This review underscores the evolution and widespread adoption of e-cigarettes since their introduction in 2003, highlighting their appeal as alternatives to traditional tobacco smoking. The essential parts of e-cigarettes are the battery, heating element, e-liquid (or e-juice), and mouthpiece. Propylene glycol and vegetable glycerin are common ingredients in e-liquids, along with nicotine and other flavors. Concerns over the health impacts of e-cigarettes have grown, particularly in light of incidents like the e-cigarette or vaping-associated lung injury outbreak in 2019 linked to vaping-associated lung injuries. Evidence suggests that while e-cigarettes may pose fewer risks than conventional cigarettes, they are not without health consequences, including potential respiratory and cardiovascular effects. Regulatory efforts worldwide have struggled to keep pace with the rapid evolution of e-cigarettes, exacerbated by their diverse flavors and marketing strategies that appeal to youth. The review discusses global regulatory responses, including bans and restrictions, to curb youth uptake and address public health concerns. Furthermore, the rise of a black market for e-cigarettes poses additional challenges to effective regulation and tobacco control efforts. In conclusion, while e-cigarettes offer potential harm reduction benefits for adult smokers seeking alternatives to traditional tobacco products, their widespread availability and evolving landscape necessitate vigilant regulatory oversight to protect public health, especially among youth. Future research should continue to explore the long-term health impacts and efficacy of e-cigarettes as smoking elimination aids, informing evidence-based policies and interventions.
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Head and neck cancers (HNCs) encompass a variety of sites including paranasal sinuses, nasal cavity, pharynx, nasopharynx, oropharynx, hypopharynx, oral cavity, tongue, salivary glands, larynx, and lymph nodes in the upper parts of the neck. HNCs are a heterogeneous group of highly aggressive tumors, and complete remission cannot be achieved in more than 50% of newly diagnosed cases. Although early-stage cases (stage I–II) generally have a favorable prognosis following surgery and radiotherapy, two thirds of advanced-stage (stage III–IV) cases display poor prognosis. Despite improved chemoradiotherapy and innovative surgery, the 5-year survival rate in HNC patients has not been significantly improved. Early identification of risk factors is crucial in reducing the morbidity and mortality of HNC. HNCs present with multifaceted risk factors from smoking to socioeconomic status. Cardiovascular disease (CVD) and HNC share common risk factors such as alcohol consumption, smoking, some viral infections and genetic changes. HNC risk is also associated with obesity, high cholesterol levels, and metabolic syndrome. Novel therapies utilizing the therapeutic targets in the cholesterol cycle have changed the clinical practice substantially. Lipids are responsible for maintaining cell integrity and are the regulators of cellular senescence in normal and malignant cells. The changes in lipid profile in HNCs are a subject of recent research. HNC patients suffer from cachexia, malnutrition, and suppressed immunity. For this reason, determining lipid levels in the early stages of cancer becomes important. The association between cancer and cholesterol has been a controversial debate. On one hand, shared mechanisms of dyslipidemia, atherosclerosis, metabolic syndrome, and insulin resistance stimulate carcinogenesis by causing inflammation. In advanced cancer, cholesterol levels tend to decline, and at that stage, low levels of cholesterol are associated with poor prognosis. Therefore, depending on the stage of cancer whether in the early or terminal stages, or depending on the pathophysiology of the individual cancer whether it is dependent on hormones or metabolic parameters such as breast cancer, the relationship between carcinogenesis and cholesterol changes. In near future, with the escalation of genetic susceptibility studies uncovering alterations in lipid metabolism, our comprehension of how this metabolism impacts HNC will improve. Modifying lipid levels favorably can be a future therapeutic target in HNC.
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The particle size distribution of aerosols produced by electronic cigarettes was measured in an undiluted state by a spectral transmission procedure and after high dilution with an electrical mobility analyzer. The undiluted e-cigarette aerosols were found to have particle diameters of average mass in the 250-450 nm range and particle number concentrations in the 10(9) particles/cm(3) range. These measurements are comparable to those observed for tobacco burning cigarette smoke in prior studies and also measured in the current study with the spectral transmission method and with the electrical mobility procedure. Total particulate mass for the e-cigarettes calculated from the size distribution parameters measured by spectral transmission were in good agreement with replicate determinations of total particulate mass by gravimetric filter collection. In contrast, average particle diameters determined for e-cigarettes by the electrical mobility method are in the 50 nm range and total particulate masses calculated based on the suggested diameters are orders of magnitude smaller than those determined gravimetrically. This latter discrepancy, and the very small particle diameters observed, are believed to result from almost complete e-cigarette aerosol particle evaporation at the dilution levels and conditions of the electrical mobility analysis. A much smaller degree, ~20% by mass, of apparent particle evaporation was observed for tobacco burning cigarette smoke. The spectral transmission method is validated in the current study against measurements on tobacco burning cigarette smoke, which has been well characterized in prior studies, and is supported as yielding an accurate characterization of the e-cigarette aerosol particle size distribution.
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Objective: Many electronic nicotine delivery systems (ENDS) are marketed as safer tobacco alternative products or effective cessation therapies. ENDS samples were evaluated for design features, including nicotine and glycols content. This could be useful in developing a legal framework to handle ENDS. Methods: Identification of the nicotine, glycerol and propylene glycol (PPG) contents was conducted using gas chromatography mass spectrometry with quantification performed using flame ionisation techniques. Results: Varying nicotine amounts were found in ENDS cartridges which were labelled with the same concentration. Chemicals such as PPG and glycerol were found to be present in the nicotine-containing liquid of the cartridges. ENDS varied in their contents and packaging information. Limited information was available on the contents of nicotine and other chemicals present in a variety of ENDS sampled. Conclusions: Based on samples tested in this study, many contain misleading information on product ingredients. The results show poor consistency between actual nicotine content analysed on ENDS cartridges and the amount labelled. These findings raise safety and efficacy concerns for current and would-be recreational users or those trying to quit smoking.
Article
IntroductionElectronic cigarette users ("vapers") inhale aerosols of water, nicotine, and propylene glycol (PG) or vegetable glycerin (VG). Aerosol particle sizes should affect deposition patterns in vapers and bystanders.Methods Aerosols were generated by a smoking machine and an electronic cigarette filled with 16mg/ml nicotine in aqueous PG or VG solution. A scanning mobility particle sizer (SMPS) counted particles of 10-1,000nm diameters. A single puff experiment counted particles immediately and after aging 10 and 40 s. A steady-state experiment counted particles emitted from a collection chamber, untreated and after desiccation or organic vapor removal. The International Commission on Radiological Protection (ICRP) human respiratory tract model was used to estimate deposition. Results were compared to similar data from reference cigarettes.ResultsPuffs generated peak particle counts at (VG) 180nm and (PG) 120nm. Steady-state peaks occurred around 400nm. Organic vapor removal eliminated small particles and reduced the size and number of large particles. Desiccation reduced the total volume of particles by 70% (VG, small PG) to 88% (large PG). The ICRP model predicted 7%-18% alveolar delivery; 9%-19% venous delivery, mostly in the head; and 73%-80% losses by exhalation. Reference cigarettes generated more particles initially, but were otherwise similar; however, in vivo smoke particle deposition is higher than the model predicts.Conclusions Nicotine delivery may depend on vaping technique, particle evolution, and cloud effects. Predicted 10% arterial and 15% venous delivery may describe bystander exposure better than vapers exposure.
Article
Unlabelled: Electronic cigarette consumption ('vaping') is marketed as an alternative to conventional tobacco smoking. Technically, a mixture of chemicals containing carrier liquids, flavors, and optionally nicotine is vaporized and inhaled. The present study aims at the determination of the release of volatile organic compounds (VOC) and (ultra)fine particles (FP/UFP) from an e-cigarette under near-to-real-use conditions in an 8-m(3) emission test chamber. Furthermore, the inhaled mixture is analyzed in small chambers. An increase in FP/UFP and VOC could be determined after the use of the e-cigarette. Prominent components in the gas-phase are 1,2-propanediol, 1,2,3-propanetriol, diacetin, flavorings, and traces of nicotine. As a consequence, 'passive vaping' must be expected from the consumption of e-cigarettes. Furthermore, the inhaled aerosol undergoes changes in the human lung that is assumed to be attributed to deposition and evaporation. Practical implications: The consumption of e-cigarettes marks a new source for chemical and aerosol exposure in the indoor environment. To evaluate the impact of e-cigarettes on indoor air quality and to estimate the possible effect of passive vaping, information about the chemical characteristics of the released vapor is needed.
Article
This study investigated the performance of electronic cigarettes (e-cigarettes), compared different models within a brand, compared identical copies of the same model within a brand, and examined performance using different protocols. Airflow rate required to generate aerosol, pressure drop across e-cigarettes, and aerosol density were examined using three different protocols. First 10 puff protocol: The airflow rate required to produce aerosol and aerosol density varied among brands, while pressure drop varied among brands and between the same model within a brand. Total air hole area correlated with pressure drop for some brands. Smoke-out protocol: E-cigarettes within a brand generally performed similarly when puffed to exhaustion; however, there was considerable variation between brands in pressure drop, airflow rate required to produce aerosol, and the total number of puffs produced. With this protocol, aerosol density varied significantly between puffs and gradually declined. CONSECUTIVE TRIAL PROTOCOL: Two copies of one model were subjected to 11 puffs in three consecutive trials with breaks between trials. One copy performed similarly in each trial, while the second copy of the same model produced little aerosol during the third trial. The different performance properties of the two units were attributed to the atomizers. There was significant variability between and within brands in the airflow rate required to produce aerosol, pressure drop, length of time cartridges lasted, and production of aerosol. Variation in performance properties within brands suggests a need for better quality control during e-cigarette manufacture.