The latest chic accessory is not a snakeskin clutch or ankle boot, but a nicotine-delivery system known as the e-cigarette. Models at New York Fashion Week breathed flavoured nicotine vapour from slim, battery-operated inhalers handed out by the event's sponsor, NJOY King electronic cigarettes. Swag bags at the 2013 Oscars included e-cig starter packs.
Many physicians, however, do not welcome the trend. A Canadian Medical Journal editorial published this week warned that e-cigarettes may be a "slippery slope to tobacco addiction." A recent study in the journal The Lancet found that e-cigarettes were comparable to nicotine patches in helping smokers quit cigarettes over six months. However, only a small per cent of patients in either group succeeded in quitting long-term. The rest, despite using a free supply of e-cigarettes, or nicotine patch, continued to smoke regular cigarettes at an average rate of half a pack a day.
But even as medical researchers and tobacco-industry scientists debate their merits as a smoking-cessation device, e-cigarettes have become a hit among North American youth. The sale and marketing of e-cigarettes is illegal in Canada, but aficionados say contraband products are easy to find. E-cigarette users – or "vapers" as they are known – describe their new habit as a hip lifestyle choice.
How did e-cigarettes become the Marlboros of our time?
Then and now
E-cigarettes are the brainchild of Herbert A. Gilbert, who in 1963 patented "a smokeless non-tobacco cigarette" designed to avoid the known health hazards of cigarette smoking by heating a nicotine solution into steam. Hon Lik, a Chinese pharmacist whose father died of lung cancer, perfected the device in 2003 using a more sophisticated heating element and a pressured jet of nicotine fluid to produce a visible, smoke-like vapour. E-cigarettes hit the U.S. market in 2006, but didn't really take off until about 2011.
How they work
E-cigarettes include a mouthpiece and cartridge filled with fluid containing nicotine and ingredients such as glycerin and artificial flavouring. The cartridge is screwed onto an atomizer with a heating element to vaporize the liquid, a rechargeable battery and an LED light at the end that mimics the glow of a burning cigarette. Batteries are recharged using a USB port, or in a portable charging case shaped like a cigarette pack that can be twisted in a T-shirt sleeve à la James Dean.
E-cigarette manufacturers promote their products as a cool alternative to smelly cigarettes. In one ad, actor Stephen Dorff praises e-cigarettes because they can be smoked "at a basketball game … in a bar with your friends." E-cigarette companies are using the same tactics to target youth – TV ads, fruit flavours, celebrity endorsements, event sponsorships – that have been banned for cigarette marketing, according to researchers Rachel Grana and Stanton Glantz at the University of California, San Francisco. Manufacturers are promoting the idea of "vaping" in smoke-free environments to re-establish social norms for nicotine addiction, the researchers wrote in a recent letter to the British Medical Journal: "These messages undermine existing smoke-free laws and contribute to keeping people smoking cigarettes."
By the numbers
Percentage of U.S. high-school students who said they had used an e-cigarette in 2012 – more than double the number in 2011, according to the U.S. Centers for Disease Control and Prevention.
Percentage of U.S. middle- and high-school students who said they had used e-cigarettes within the past month who also smoked regular cigarettes. "Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes," CDC director Dr. Tom Frieden said.
Number of Facebook "likes" for E-Cigarette-Forum.com, the largest of a growing number of online "vaping communities" devoted to topics such as instructions for DIY "e-juice" (nicotine fluid).
Estimated sales in U.S. dollars of e-cigarettes in 2013, according to a Wells Fargo analyst.
Celebrity "vapers" include actors Leonardo DiCaprio, Katherine Heigl and Sienna Miller, who took a hit from her e-cigarette at the Golden Globes. The devices have become a fixture at Hollywood parties and on film sets, says Elaine Lui, etalk reporter and co-host of CTV's The Social. "Everyone smokes in Hollywood," she said. "They do it to stay up, they do it to stay thin." Lui switched to e-cigarettes nine months ago. "In 25 years of smoking, this is the only thing that has kept me off cigarettes," she said. "I feel so much better."
Pros and cons
Tobacco-industry scientists argue that e-cigarettes deliver lower amounts of nicotine than regular cigarettes, are less toxic and don't expose others to second-hand smoke. A recent study from France's National Consumers Institute, however, concluded that e-cigarettes are "potentially carcinogenic" because some brands contain levels of formaldehyde that approach those of conventional cigarettes. Research on the health risks and efficacy of e-cigarettes as a smoking-cessation aid is still in the early stages, said Dr. Matthew Stanbrook, deputy editor of the CMAJ. "We should not assume they are safe simply because they appear to be less harmful than traditional cigarettes."