Electronic cigarettes embraced by users as a healthier alternative to smoking or a good way to quit are picking up steam.
Theres little research on how safe they might be or whether theyre an effective strategy for kicking the habit, but more people are giving e-cigarettes a try every day.
About one in five adult cigarette smokers in the U.S. had tried electronic cigarettes in 2011, nearly twice as many as in 2010. Sales reached nearly $500 million in 2012 and are expected to double to $1 billion this year. As the market grows, even tobacco companies are jumping on board.
Winston-Salem-based R.J. Reynolds Vapor Company launched its Vuse electronic cigarette this summer in Colorado. Altria Group Inc., parent company of the nations largest cigarette maker, Philip Morris USA, will soon debut its product, MarkTen, in Indiana.
Electronic cigarettes, or e-cigarettes, are a smoke-free alternative to the traditional paper cigarette. The most basic version, one that could be mistaken for an actual cigarette, is comprised of a liquid cartridge attached to a white cylinder containing a battery.
The battery heats the liquid into a vapor that the user inhales. Instead of smoking, its come to be called vaping.
The liquid is a mixture of propylene glycol (a common chemical used in many in food products), vegetable glycerin, flavoring and nicotine. The composition can vary greatly by manufacturer.
Typical electronic cigarettes range from around $10 for a standard e-cigarette that requires replacement liquid cartridges to as much as $70 for a polished wooden model that can be refilled.
Although prices vary, pre-filled liquid cartridges, each lasting about as long as a pack of cigarettes, usually cost a few dollars, and bottles of flavored e-liquid range from a few dollars to more than $10 depending on size.
Many questions remain
But as the market grows, little conclusive research has been done to determine the health effects of inhaling a nicotine-laced vapor.
The e-liquids themselves are not required to meet any federal standards, although the FDA is expected to exercise its regulatory authority over the products later this year.
Approval by the FDA means that a nicotine product, such as a patch or gum, has met standards of safety and effectiveness, said Dr. Anne Joseph, a tobacco researcher at the University of Minnesota. For now, e-cigarettes are in a gray area and are not regulated as tobacco products or medical devices, even though they share similarities with both product categories.
Joseph adds that electronic cigarettes may not be all bad for current tobacco users, with a couple of important caveats: Nonsmokers shouldnt start, and e-cigarette consumers should use them only with the goal of quitting.
Theres a lot scientists still dont know. That includes the actual chemical exposure that users receive compared with traditional smokers intake; the way vaporized nicotine is absorbed by the body; and the effects of secondhand vapor.
States and local governments are having to revisit clean indoor air laws, and thats important for a couple reasons, Joseph said. One, we dont know what they are emitting into the air.
Also, she worries that use of e-cigarettes will undermine years of antismoking campaigns that have taken cigarettes out of public places.
Compared with traditional cigarettes, electronic cigarettes appear to have fewer toxins, but the impact of e-cigarettes on long-term health must be studied, the Centers for Disease Control and Prevention said in February.
E-cigarette use is growing rapidly, Dr. Thomas Frieden, director of the CDC, said in a statement at the time. There is still a lot we dont know about these products, including whether they will decrease or increase use of traditional cigarettes.
Lesser of two evils
Katie Forster, who had tried to quit smoking with nicotine gum and patches, recently bought an e-cigarette.
I did a lot of research about the safety, said Forster, 26, who works for an accounting firm uptown. And if Im picking between a cigarette and an (e-cigarette), its the lesser of the two evils for me.
Forster, who said shell stick with it until she can quit smoking completely, chose a more elaborate device with a rechargeable battery and a refillable liquid cartridge.
The liquid is available in hundreds of flavors with varying levels of nicotine. Its those flavors, with appealing names such as Mocha Madness, Cotton Candy, Bourbon, Cowboy and Cuban Supreme, that have been a point of contention for some who worry that teenagers may be enticed. And for now, there is no federal restriction on the sale of e-cigarettes to minors.
But a North Carolina state law prohibiting the sale of electronic cigarettes to minors went into effect Thursday.
Unlike smoking, which is banned in North Carolina bars and restaurants, e-cigarettes are allowed at a business owners discretion. But observers of the bar scene in Charlotte say they arent too common yet. A statewide trade group for restaurants and hotels says electronic cigarettes havent been an issue among its members.
As questions about the safety and regulation of e-cigarettes linger, some North Carolina entrepreneurs are beginning to self-regulate ahead of state and federal agencies.
Joe Wofford, the owner of Volcano of Raleigh, an electronic cigarette shop that opened in late 2012, says his average customer is a 40-year-old woman who smoked cigarettes for 20 years before deciding to make the switch. Wofford said his shop, also known as The Puffing Monkey, doesnt sell to anyone younger than 19.
600 orders a day
MadVapes, a manufacturer of electronic cigarettes based in Mooresville, began as a home office operation in 2009 and has now expanded to fill 30,000 square feet of warehouse space and run four Charlotte-area retail locations.
Four years ago, owner Mark Hoogendoorn, a computer programmer by trade, took his first online order. It all began when Hoogendoorn, a smoker himself who tried to quit for at least 20 years, puffed on an electronic cigarette and decided that he could do better. Today, his company has about 60 employees and ships as many as 600 online orders a day.
Were trying to be a really responsible company, said Hoogendoorn, 51, of Denver, N.C. I would personally like to see some sort of regulation on how e-liquid is manufactured.
MadVapes follows e-liquid production standards set by a volunteer trade organization that aims to promote safety and responsibility through self-regulation.
Hoogendoorn said his company periodically sends batches of its e-liquid to a lab in Raleigh for chemical analysis.
Giving them a try
Cindy Armstrong, 57, of east Charlotte, smoked for more than 30 years. She tried to quit smoking many times, and had gotten down to about five cigarettes per day, but couldnt give them up completely.
I analyzed when I liked to smoke, and I realized that it wasnt the nicotine so much as having the cigarette in my hand, she said.
When her boyfriend gave her an e-cigarette starter kit for Christmas, she never went back to smoking traditional cigarettes, and now, she only uses a disposable e-cigarette occasionally.
John Toohey, 45, of Ballantyne, quit smoking cigarettes within a few weeks of ordering an electronic cigarette.
One of the great things with the e-cig is that you can gauge the nicotine, he said. Even when I go to zero (nicotine), Ill probably still use it because it satisfies the hand-to-mouth craving.
Scientists and medical professionals, meanwhile, continue to offer the following caution: Long-term health effects of electronic cigarettes are unknown, and it could be years before consensus is reached about their safety.
Staff researcher Maria David contributed.