Electronic cigarette

From Wikipedia, the free encyclopedia

First generation electronic cigarette resembling a tobacco cigarette
Second generation types of electronic cigarettes
An electronic cigarette (e-cig or e-cigarette), personal vaporizer (!) or electronic nicotine delivery system (E"#S) (not to be conf$sed %ith smokeless
cigarettes) is a battery-po%ered device %hich sim$lates tobacco smoking& 't %as first patented in ()*+ by ,erbert A& -ilbert&.(/ 't generally $ses a heating
element kno%n as an atomizer, that vaporizes a li0$id sol$tion& Some sol$tions contain a mi1t$re of nicotine and flavorings, %hile others release a flavored
vapor %itho$t nicotine&
First generation of electronic cigarettes %ere $s$ally designed to sim$late smoking implements, s$ch as cigarettes or cigars, in their $se and2or appearance&
3hey prod$ce less vapor than second generation personal vaporizers since they $se smaller batteries and that there is no %ay to boost the voltage o$tp$t of
the battery& "e% generation electronic cigarettes offer better performances and are considerably different in appearance& 3hey $s$ally ho$se a m$ch bigger
battery and comes in vario$s form factors (metal t$bes, bo1 etc&&&).4/.+/.5/
6ost people %ho $se electronic cigarettes have a history of smoking cigarettes %hile some yo$ng people %ho have never smoked cigarettes have tried
electronic cigarettes at least once&.7/
3he benefits and risks of electronic cigarette $se are $ncertain&.*/.8/ 3hey carry a risk of nicotine addiction,.8/ and their reg$lation is the s$b9ect of
ongoing debate&.:/ 3here are concerns that these prod$cts sho$ld be ade0$ately reg$lated, mainly to protect $sers, %hile avoiding $nintended
conse0$ences ca$sed by e1cessive or inappropriate reg$lation&.:/ 3he fre0$ency of $se has increased %ith $p to (;< of high school st$dents having ever
$sed them as of 4;(4 and aro$nd +&5< of ad$lts as of 4;((&.7/
=ontents
( ,ealth
(&( Smoking cessation
(&4 Safety
(&+ Addiction
4 =onstr$ction
4&( Atomizer
4&4 o%er
4&+ >i0$id
+ ?sage statistics
5 =$lt$re
7 ,istory
* >egal stat$s
*&( E$rope
*&4 ?nited States
*&+ @ther co$ntries
8 Aelated nicotine inhalation technologies
: Aeferences
) E1ternal links
,ealth
Smoking cessation
3he World ,ealth @rganization (W,@) has stated that the efficacy of electronic cigarettes as an aid in smoking cessation has not been demonstrated& 3hey
recommend that Bcons$mers sho$ld be strongly advised not to $seB electronic cigarettes $ntil a rep$table national reg$latory body has fo$nd them safe and
effective&.8/
A 4;(( revie% says that electronic cigarettes may aid in smoking cessation and are likely to be more effective than traditional pharmacotherapy, as the
physical stim$li of holding and p$ffing on the electronic cigarette may be better at improving short term craving&.)/ 3he revie% fo$nd no st$dies that
directly meas$red the effectiveness of electronic cigarettes in smoking cessation, and e1amined t%o p$blished st$dies that indirectly considered the iss$e
by meas$ring the effect of the prod$ct on cravings and other short-term indicators&.)/ Another revie% felt that they may be a reasonable s$bstit$te for
cigarette smoking&.:/
3he American Association of $blic ,ealth hysicians (AA,) s$ggests those %ho are $n%illing to 0$it tobacco smoking or $nable to 0$it %ith medical
advice and pharmace$tical methods sho$ld consider other nicotine containing prod$cts s$ch as electronic cigarettes and che%ing tobacco for long term $se
instead of smoking&.(;/
3he Critish 6edical Association (C6A) reports there is a possibility for smoking cessation benefits, b$t has concerns that e-cigarettes are less reg$lated
than nicotine replacement therapy ("A3), and that there is no peer revie%ed evidence of their safety or efficacy& 3hey recommend a Bstrong reg$latory
frame%orkB for e-cigarette distrib$tion in order to ens$re their safety, 0$ality, and that their marketing and sales are restricted to ad$lts& 3he C6A
enco$rages health professionals to recommend conventional nicotine replacement therapies, b$t for patients $n%illing to $se or contin$e those methods,
they say health professionals may present e-cigarettes as a lo%er-risk option than tobacco smoking&.((/
@ne revie% fo$nd electronic systems appear to generally deliver less nicotine than smoking, raising the 0$estion of %hether they can effectively s$bstit$te
for tobacco smoking over a long-term period&.(4/
A 4;(+ randomized controlled trial fo$nd no difference in smoking cessation rates bet%een e-cigarettes %ith nicotine, e-cigarettes %itho$t nicotine and
traditional "A3 patches&.(+/ 3here are some non-controlled st$dies that reported possible benefit&.(5/
Electronic cigarettes %ere not reg$larly associated %ith trying to 0$it tobacco among yo$ng people&.7/ Ad$lts most often $sed electronic cigarettes as a
replacement for tobacco, altho$gh not invariably to 0$it&.7/
Safety
Electronic cigarettes sho$ld have fe%er to1ic effects than traditional cigarettes,.(4/.(7/ and evidence s$ggests they are safer than real cigarettes, and
possibly as safe as other nicotine replacement prod$cts&.)/
'n an intervie%, the director of the @ffice on Smoking and ,ealth for the ?&S& federal agency =enters for #isease =ontrol and revention (=#=) believes
that there is eno$gh evidence to say that s%itching to electronic cigarettes %o$ld likely be healthier than smoking& ,o%ever, d$e to the lack of reg$lation of
the contents of the n$mero$s different brands of electronic cigarettes and the presence of nicotine, %hich is not a benign s$bstance, the =#= has iss$ed
%arnings&.(*/
@ne revie% raised concerns abo$t the lack of reg$latory oversight over the man$fact$ring process, marketing, as %ell as 0$ality control& Also of concern
%ere the p$rity of ingredients as %ell as the ease %ith %hich these devices can be modified&.(4/
3he C6A has noted literat$re finding electronic cigarettes as safer than tobacco smoking, b$t also is concerned by the lack of high 0$ality peer-revie%ed
st$dies abo$t safety& 3hey have noted that the amo$nt of nicotine delivered can be highly variable bet%een devices d$e to differences in ho% %ell the
nicotine is vaporized& 3hey have also raised concerns that the delivered dose may be inconsistent or misleading compared to the nicotine level stated on the
li0$id container, %ith identically labelled cartridges emitting Bmarkedly differentB levels of nicotine& 'ss$es aro$nd proper labeling, child-proof packaging,
and electrical safety have also been raised&.((/
A preliminary analysis of e-cigarette cartridges by the ?S Food and #r$g Administration (F#A) in 4;;) identified that some contain tobacco-specific
nitrosamines (3S"As), kno%n cancer-ca$sing agents&.(8/.(:/ 3he amo$nts of 3S"As present %ere on par %ith e1isting "A3 prod$cts like nicotine g$m
and inhalers& 3he F#ADs analysis also detected diethylene glycol, a poisono$s and hygroscopic li0$id, in a single cartridge man$fact$red by Smoking
Every%here and nicotine in one.()/ cartridge claimed to be nicotine-free&.(8/.(:/ #iethylene glycol %as fo$nd in a cartridge tested in 4;;) by the F#A,
b$t in 4;(( researchers revie%ed the data and noted that (7 other st$dies had failed to find any evidence of this chemical in e-cigarettes&.4;/ F$rther
concerns %ere raised over inconsistent amo$nts of nicotine delivered %hen dra%ing on the device&.()/ 'n some e-cigarettes, B3obacco-specific imp$rities
s$spected of being harmf$l to h$mans E anabasine, myosmine, and F-nicotyrine E %ere detected in a ma9ority of the samples tested&B 't is not clear if these
chemicals %ere detectable in e1haled vapo$r&.4(/ 3he ?G "ational ,ealth Service noted that the to1ic chemicals fo$nd by the F#A %ere at levels one-
tho$sandth that of cigarette smoke, and that %hile there is no certainty that these small traces are harmless, initial test res$lts are reass$ring&.44/
Addiction
A n$mber of organizations incl$ding the =enters for #isease =ontrol and revention,.(*/ the 'nternational ?nion Against 3$berc$losis and >$ng #isease,
.4+/ the American Academy of ediatrics.45/ and the Food and #r$g Administration.47/ have concerns that e-cigs might increase addiction to and $se of
nicotine and tobacco prod$cts in children&.4*/.48/ 3he World ,ealth @rganization raises the concern of addiction for nonsmokers from their $se&.4:/
=onstr$ction
#isassembled cigarette-styled electronic cigarette&
A& >E# light cover
C& battery (also ho$ses circ$itry)
=& atomizer (heating element)
#& cartridge (mo$thpiece)
Cattery connected to a ?SC charger
6ost electronic cigarettes take an overall cylindrical shape altho$gh a %ide array of shapes can be fo$ndH bo1, pipe styles etc& 6any are made to look like
tobacco cigarettes& =ommon components incl$de a li0$id delivery and container system, an atomizer, and a po%er so$rce&.4)/ 6any electronic cigarettes
are composed of streamlined replaceable parts, %hile disposable devices combine all components into a single part that is discarded %hen its li0$id is
depleted&.+;/
Atomizer
Along %ith the battery, the atomizer is the central component of every personal vaporizer& Altho$gh many kinds of atomizers are in $se, they generally
consist of a small heating element responsible for vaporizing li0$id, as %ell as a %icking material that dra%s li0$id in&
A small length of resistance %ire is %rapped aro$nd the %icking material and then connected to the positive and negative poles of the device& When
activated the resistance %ire (or coil) 0$ickly heats $p th$s t$rning the li0$id into a vapor, %hich is then inhaled by the $ser&.+(/
3he electrical resistance of the coil, the voltage o$tp$t of the device, the airflo% of the atomizer and the efficiency of the %ick play important roles in the
perceived 0$ality of the vapor that is prod$ced by an atomizer& 3hey also greatly affect the 0$antity or vol$me of vapor that %ill be prod$ced by the
atomizer&
Atomizer resistances $s$ally vary from (&7I (ohms) to +&;I from one atomizer to the ne1t b$t can go as lo% as ;&(I in the most e1treme cases of #'J
coil b$ilding %hich prod$ce large amo$nts of vapor b$t co$ld present a fire hazard and other dangero$s battery fail$res if the $ser is not kno%ledgeable
eno$gh abo$t basic electrical principles and ho% they relate to battery safety&.+4/.++/
Wicking materials vary greatly from one atomizer to another b$t silica fibers are the most commonly $sed in man$fact$red atomizers& BAeb$ildableB or Bdo
it yo$rselfB atomizers can $se silica, cotton, poro$s ceramic, hemp, bamboo yarn, o1idized stainless steel mesh and even %ire rope cables as %icking
materials&.+5/
A %ide array of atomizers and e-li0$id container combinations are availableH.+7/
=artomizers
6ost of the devices that imitate the cigarette form factor $se a BcartomizerB (a portmantea$ of cartridge and atomizer) or BcartoB as an e-li0$id delivery
system& 3he piece consists of a heating element s$rro$nded by a li0$id-soaked poly-foam that acts as an e-li0$id holder& 't is $s$ally disposed of once the
e-li0$id ac0$ires a b$rnt taste, %hich is $s$ally d$e to an activation %hen the coil is dry or %hen the cartomizer gets consistently flooded (g$rgling)
beca$se of sedimentation of the %ick& 6ost cartomizers are refillable even if not advertised as s$ch&.+*/
=artomizers can be $sed on their o%n or in con9$nction %ith a tank that allo%s more e-li0$id capacity& 'n this case the portmantea$ %ord of BcartotankB has
been coined& When $sed in a tank, the cartomizer is inserted in a plastic, glass or metal t$be and holes or slots have to be p$nched on the sides of the
cartomizer to allo% li0$id to reach the coil&
=learomizers
e-o style e-cigarette %ith a top-coil clearomizer& Silica fibers are hanging do%n freely inside of the tank, dra%ing e-li0$id by capillary action to the coil
that is locate directly $nder the mo$th piece&
=learomizers or BclearosB, not $nlike cartotanks, $se a clear tank in %hich an atomizer is inserted&.+8/ ?nlike cartotanks, ho%ever, no poly-foam material
can be fo$nd in them& 3here are a lot of different %icking systems employed inside of clearomizers to ens$re good moistening of the %ick %itho$t flooding
the coil& Some rely on gravity to bring the e-li0$id to the %ick and coil assembly (bottom coil clearomizers for e1ample) %hereas others rely on capillary
action and to some degree the $ser agitating the e-li0$id %hile handling the clearomizer (top coil clearomizers)&.+:/
Aeb$ildable Atomizers
A reb$ildable atomizer or an ACA is an atomizer that allo%s the $ser to assemble or Bb$ildB the %ick and coil themselves instead of replacing them by an
off-the-shelf atomizer BheadB& 3hey also allo% the $ser to b$ild atomizers at any desired electrical resistance& 3he materials needed to Breb$ildB the
atomizers are $s$ally m$ch cheaper than the $s$al prefabricated replaceable %ick and coil assemblies destined to clearomizers&
3hese atomizers are divided into t%o main categoriesK reb$ildable tank atomizers (A3ADs) and reb$ildable dripping atomizers (A#ADs)&
Aeb$ildable tank atomizers or A3ADs are similar to clearomizers in that they $se a tank or container to hold and bring li0$id to the coil& 3hey $s$ally hold a
lot more e-li0$id than their A#A co$nterparts&
Aeb$ildable dripping atomizers or A#ADs on the other hand lack the container section and hold very little li0$id compared to A3ADs b$t are $s$ally a lot
smaller& 3hey $s$ally consist only of an atomizer Bb$ilding deckB %hich can accept one or more coils and a Btop capB to cover the coils %here a mo$th
piece can be attached& 3he $ser needs to man$ally keep the atomizer %et by dripping li0$id on the bare %ick and coil assembly, hence their name&
o%er
6ost portable devices contain a rechargeable battery, %hich tends to be the largest component of an electronic cigarette& 3he battery may contain an
electronic airflo% sensor %hereby activation is triggered simply by dra%ing breath thro$gh the device, %hile other models employ a po%er b$tton that
m$st be held d$ring operation& An >E# to indicate activation may also be employed& Some man$fact$rers also offer a cigarette pack-shaped portable
charging case (==), %hich contains a larger battery capable of charging e-cigarettes& #evices aimed at more e1perienced $sers may sport additional
feat$res, s$ch as variable po%er o$tp$t and s$pport of a %ide range of internal batteries and atomizers config$rations and tend to stray a%ay from the
cigarette form factor& Some cheaper recent devices $se an electret microphone %ith a c$stom '= to detect airflo% and indicate battery stat$s on the incl$ded
bl$e >E#&.+)/.not in citation given/
!ariable po%er and voltage devices
! %ith variable and reg$lated po%er offering battery protection
!ariable voltage or po%er personal vaporizers are devices that contain a b$ilt in electronic chip that allo%s the $ser to ad9$st the po%er that goes thro$gh
the heating element& 3hey $s$ally incorporate a >E# screen to display vario$s information& !ariable !Ds eliminate the need of having to replace an
atomizer %ith another one of lo%er or higher electrical resistance to change the intensity of the vapor&.5;/ 3hey also feat$re voltage reg$lation and some
battery protection&.5(/.54/
Some of these device offer additional feat$res thro$gh their men$ system s$ch asH atomizer resistance checker, remaining battery voltage, p$ff co$nter,
activation c$t-off etc&.5+/
6echanical personal vaporizers
6echanical ! %ith a reb$ildable atomizer
6echanical !s or mechanical BmodsB, often called BmechsB are devices %itho$t electronic components and battery protection (apart from vent holes
drilled in some mechanical devices) or electric reg$lation& Ceca$se there is neither protection nor reg$lation, they %ill %ork no matter %hich %ay the
battery is placed& 3hey are activated by spring loaded or opposing magnetic mechanical s%itches, hence their name& 3hey rely entirely on the nat$ral
voltage o$tp$t of a battery&.citation needed/
3hey are commonly $sed %ith Blo% resistanceB ((&;I L ;&7I) reb$ildable atomizers& Seeing that most e-cigarettes containing electronic battery protection
%ill interpret s$b ohm resistance coils as a short circ$it, th$s prohibiting the device from being activated, mechanical mods are among the only devices that
%ill accept s$ch atomizer resistances&.citation needed/
Since mechanical !s are $nreg$lated and $nprotected, they re0$ire special attention on the $serDs part that other reg$lated and protected !s do not need&
6aking s$re that the battery does not over-discharge and that the atomizer %ill not re0$ire more amperage than %hat the battery can safely allo% are the
$serDs responsibilities&.citation needed/
>i0$id
>i0$id for prod$cing vapor in electronic cigarettes, commonly kno%n as e-9$ice or e-li0$id, is a sol$tion of propylene glycol (-), vegetable glycerin
(!-), and2or polyethylene glycol 5;; (E-5;;) mi1ed %ith concentrated flavorsK and optionally, a variable concentration of nicotine&.55/
3he sol$tion is often sold in a bottle or in pre-filled disposable cartridges& 3hey are man$fact$red %ith vario$s tobacco, fr$it, and other flavors, as %ell as
variable nicotine concentrations (incl$ding nicotine-free versions)& 3he standard notation Bmg2mlB is often $sed in labeling for denoting nicotine
concentration, and is sometimes shortened to a simple BmgB&.57/
?sage statistics
Electronic cigarette sales increased from 7;,;;; in 4;;: to +&7 million in 4;(4&.55/ As of 4;((, in the ?nited States, one in five ad$lts %ho smoke have
tried electronic cigarettes&.5*/ 'n a ?G s$rvey cond$cted in 4;(+ of more than (4,;;; ad$lts, ((< of reg$lar smokers in the sample identified themselves
as $sing electronic cigarettes and 45< stated that they had $sed them in the past& Amongst non-smokers in the same sample, (< said they had tried them
and ;< stated that they %ere c$rrently $sing them&.58/
Among grade * to (4 st$dents in the ?nited States, those %ho have ever $sed the prod$ct increased from +&+< in 4;(( to *&:< in 4;(4&.5:/ 3hose
c$rrently $sing electronic cigarettes increased from ;&*< to (&(<& @ver the same period the percentage of grade * to (4 st$dents %ho reg$larly smoke
tobacco cigarettes fell from 8&7< to *&8<&.5)/ (;< of st$dents %ho have $sed e-cigs at least once have never smoked&.5:/ A 4;(+ ?G s$rvey by Action
on Smoking and ,ealth fo$nd that among non-smokers $nder (:, (< reported having tried e-cigarettes Bonce or t%ice,B ;< reported contin$ing $se, and
;< intended to try them in the f$t$re& AS, concl$ded that among children %ho have heard of e-cigarettes, s$stained $se is rare and confined to children
%ho smoke or have smoked&.58/
A Febr$ary 4;(5 s$rvey by the French 6onitoring =entre for #r$gs and #r$g Addiction of 4;74 individ$als estimated that bet%een 8&8 and )&4 million
individ$als have e1perimented %ith $sing electronic cigarettes, %ith bet%een (&( and (&) million $sing on a daily basis& *8< of tobacco smokers in the
s$rvey $sed electronic cigarettes to red$ce or 0$it tobacco smoking& )< of those %ho e1perimented %ith electronic cigarettes had never smoked tobacco&
@f the (&4< that had recently stopped tobacco smoking at the time of the s$rvey, :5< (or (< of the pop$lation s$rveyed) credited electronic cigarettes for
stopping tobacco $se&.7;/
=$lt$re
.icon/ 3his section re0$ires e1pansion& (April 4;(5)
As the electronic cigarette ind$stry gro%s, a s$bc$lt$re has emerged %hich calls itself Bthe vaping comm$nityB&.+7/.7(/.74/ 6embers of this emerging
s$bc$lt$re often vie% electronic cigarettes as a safer alternative to smoking and some even vie% it as a hobby& 3hey tend to $se highly c$stomized devices
that do not resemble %hat are kno%n, by some, as Bcig-a-likes,B or electronic cigarettes that resemble real cigarettes&.7+/ Well kno%n celebrities have also
embraced this ne% fo$nd c$lt$re by taking their electronic cigarettes to p$blic events s$ch as movie a%ard sho%s and press conferences&.75/
,istory
3his section is incomplete& (@ctober 4;(+)
3he earliest electronic cigarette can be traced to ,erbert A& -ilbert,.77/ %ho in ()*+ patented a device described as Ba smokeless non-tobacco cigaretteB
that involved Breplacing b$rning tobacco and paper %ith heated, moist, flavored air&B 3his device heated the nicotine sol$tion and prod$ced steam& 'n ()*8,
-ilbert %as approached by several companies interested in man$fact$ring it, b$t it %as never commercialized and disappeared from the p$blic record after
()*8&.7*/.78/.7:/.7)/.*;/.*(/
,on >ik, a =hinese pharmacist, is %idely credited.*4/.*+/.*5/ %ith the invention of the first generation electronic cigarette& 'n 4;;+,.*7/ he came $p %ith
the idea of $sing a piezoelectric $ltraso$nd-emitting element to vaporise a press$rized 9et of li0$id containing nicotine dil$ted in a propylene glycol
sol$tion&.**/ 3his design prod$ces a smoke-like vapo$r that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the l$ngs&
,e also proposed $sing propylene glycol to dil$te nicotine and placing it in a disposable plastic cartridge %hich serves as a li0$id reservoir and
mo$thpiece&
Electronic cigarettes $sing a different design %ere first introd$ced to the =hinese domestic market in 6ay 4;;5 as an aid for smoking cessation and
replacement& 3he company that ,on >ik %orked for, -olden #ragon ,oldings, changed its name to A$yan (, literally BAesembling smokingB), and
started e1porting its prod$cts in 4;;7E4;;*.*8/ before receiving its first international patent in 4;;8&.*:/
3he electronic cigarette contin$ed to evolve from the first generation three-part device& 'n 4;;* the BcartomizerB %as invented by Critish entreprene$rs
?mer and 3ari0 Sheikh of M> #istrib$tors&.*)/ 3his is a mechanism %hich integrates the heating coil into the li0$id chamber& 3he ne% device %as
la$nched in the ?G in 4;;8 in their -am$cci brand and is no% %idely adopted by the ma9ority of DcigalikeD brands& 3he grant of the ?G patent for the
BcartomizerB %as made to M> #istrib$tors in Febr$ary 4;(+ and p$blished by the ?G 'ntellect$al roperty @ffice&.8;/
3he international tobacco companies, recognising the development of a potential ne% market sector that co$ld render traditional tobacco prod$cts obsolete,
.8(/ are increasingly involved in the prod$ction and marketing of their o%n brands of e-cigarettes and in ac0$iring e1isting e-cigarette companies&.84/ Cl$,
a prominent ?S e-cigarette prod$cer, %as ac0$ired by >orillard 'nc& in 4;(4&.8+/ Critish American 3obacco la$nched !ype in 4;(+, %hile 'mperial
3obaccoDs Fontem !ent$res ac0$ired the intellect$al property o%ned by ,on >ik thro$gh #ragonite for N?S 87 million in 4;(+ and la$nched $ritane in
partnership %ith Coots ?G&.85/.87/ @n + Febr$ary 4;(5, Altria -ro$p, 'nc& ac0$ired pop$lar electronic cigarette brand -reen Smoke for N((; million& 3he
deal is e1pected to be finalized d$ring the second 0$arter of 4;(5&.8*/ Altria also markets its o%n e-cigarette, the 6ark3en, %hile Aeynolds American has
entered the sector %ith its !$se prod$ct&.88/
>egal stat$s
Ceca$se of the relative novelty of the technology and the possible relationship to tobacco la%s and medical dr$g policies, electronic cigarette legislation
and p$blic health investigations are c$rrently pending in many co$ntries& =$rrent reg$lations vary %idely, from regions %ith no reg$lations to others
banning the devices entirely&.8:/
E$rope
@n () #ecember 4;(4 the E$ropean =ommission adopted its proposal to revise the E$ropean ?nion 3obacco rod$cts #irective 4;;(2+82E= %hich
incl$ded proposals to introd$ce restrictions on the $se and sales of e-cigarettes&.8)/.:;/.:(/ @n : @ctober 4;(+ the E$ropean arliament in Strasbo$rg
voted do%n the =ommissionDs proposal to introd$ce medical reg$lation for electronic cigarettes, b$t proposed that cross-border marketing of e-cigarettes
be reg$lated similarly to tobacco prod$cts, meaning that sales of e-cigarettes to $nder (:s %o$ld be prohibited in the E$ropean ?nion, along %ith most
cross-border advertising& Warning labels also %o$ld be re0$ired& 3he arliament and 6ember States are involved in trilog$e disc$ssions to reach a
common concl$sion&.:4/
'n A$stria nicotine-containing cartridges are classified as medicinal prod$cts and e-cigarettes for nicotine inhalation as medical devices&.:+/
'n C$lgaria, the sale and $se of electronic cigarettes are legal, as %ell as the sale of cartridges and li0$ids %ith nicotine& 3here are no specific reg$lations
from E?&.:5/
'n the =zech Aep$blic, the $se, sale and advertising of electronic cigarettes are legal&.:7/
'n #enmark, the #anish 6edicines Agency classifies electronic cigarettes containing nicotine as medicinal prod$cts& 3h$s, a$thorization is re0$ired
before the prod$ct may be marketed and sold, and no s$ch a$thorization has c$rrently been given& 3he agency has clarified, ho%ever, that electronic
cigarettes that do not administer nicotine to the $ser, and are not other%ise $sed for the prevention or treatment of disease, are not considered medicinal
devices&.:*/
'n Estonia, the Estonian State Agency of 6edicines had previo$sly banned e-cigarettes, b$t the ban %as overt$rned in co$rt on 8 6arch 4;(+&.:8/
=$rrently e-li0$ids containing more than ;&8 mg2ml of nicotine are still considered medicine and as s$ch cannot be legally p$rchased %ithin the co$ntry
d$e to no man$fact$rer being licensed properly& Follo%ing the o$tcome of E? tobacco directive in @ctober 4;(+, the legislation is moving to%ards a more
rela1ed stance on the iss$e& As stated by the Estonian minister of social affairs 3aavi AOivas (in charge of tobacco reg$lation), e-cigarettes %ill receive an
advertisement ban and %ill clearly be banned for minors b$t %ill be available for ad$lts before the end of 4;(+&
'n Finland, the "ational S$pervisory A$thority of Welfare and ,ealth (!alvira) declared that the ne% tobacco marketing ban (effective ( Pan$ary 4;(4)
%ill also cover electronic cigarettes,.::/ res$lting in that Finnish stores or %ebstores canDt advertise e-cigarettes beca$se they might look like reg$lar
cigarettes& 'n theory, e-cigarettes %ith nicotine-free cartridges may still be sold, as long as their images and prices are not visible& @rdering from abroad
remains allo%ed& Sale of nicotine cartridges is c$rrently prohibited, as nicotine is considered a prescription dr$g re0$iring an a$thorization that s$ch
cartridges do not yet have& ,o%ever, the Finnish a$thorities have decided that nicotine cartridges containing less than (; mg nicotine, and e-li0$id
containing less than ;,54 g nicotine per bottle, may be legally bro$ght in from other co$ntries for private $se& 'f the nicotine content is higher, a
prescription from a Finnish physician is re0$ired& From a co$ntry %ithin the E$ropean Economic Area a ma1im$m of one yearDs s$pply may be bro$ght in
for private $se %hen ret$rning to Finland, %hile three monthsD s$pply may be bro$ght in from o$tside the EEA& 6ail order deliveries from EEA co$ntries,
for a ma1im$m of three monthsD s$pply, are also allo%ed&.:)/.);/
'n -ermany, the sale and $se of electronic cigarettes are legal&.)(/
'n ,$ngary, the sale and $se of electronic cigarettes are legal& 3he sale of cartridges and li0$ids %ith nicotine is illegal&
'n 'reland, the sale and $se of electronic cigarettes are legal&.:7/
'n 'taly, by a ,ealth 6inistry decree (-&?& Serie -enerale, n& 45: del 4+ ottobre 4;(4) electronic cigarettes containing nicotine cannot be sold to
individ$als $nder (* years of age&.)4/
'n >atvia, e-cigarettes are legal&.)+/
'n >ith$ania, e-cigarettes are legal&.)+/
'n the "etherlands, $se and sale of electronic cigarettes is allo%ed, advertising is restricted&.:7/
'n "or%ay the sale and $se of electronic cigarettes are legal,.:7/ b$t nicotine cartridges can only be imported from other EEA member states (e&g& the
?G) for private $se&.)5/
'n oland, the sale and $se of electronic cigarettes are legal&.:7/
'n ort$gal, %ith nicotine it is restricted, %itho$t nicotine it is not reg$lated&.:7/
'n Aomania, the sale and $se of electronic cigarettes are legal&.:7/
'n S%itzerland, the sale of nicotine-free electronic cigarettes is legal& 3he $se and importation of electronic cigarettes containing nicotine is legal, b$t
they cannot be sold %ithin the co$ntry&.)7/ As of #ecember 4;((, the tobacco ta1 does not apply to e-cigarettes and respective li0$ids containing nicotine&
.)*/
'n the ?nited Gingdom, the $se, sale and advertising of electronic cigarettes are legal and electronic cigarettes are not covered by smoking bans&.)8/ 'n
4;(5 the government anno$nced legislation %o$ld be bro$ght for%ard to o$tla% the p$rchase of electronic cigarettes by people $nder the age of (:&.)8/
Wales co$ld become the first part of the ?nited Gingdom to ban electronic cigarettes in enclosed p$blic spaces d$e to $ns$pported.):/ fears their $se
co$ld Bre-normaliseB smoking conventional cigarettes&.))/
?nited States
Federal reg$lation
3he F#A classified electronic cigarettes as dr$g delivery devices and s$b9ect to reg$lation $nder the Food, #r$g, and =osmetic Act (F#=A) before
importation and sale in the ?nited States& 3he classification %as challenged in co$rt, and overr$led in Pan$ary 4;(; by Federal #istrict =o$rt P$dge
Aichard P& >eon, citing that Bthe devices sho$ld be reg$lated as tobacco prod$cts rather than dr$g or medical prod$cts&B.(;;/.(;(/
'n 6arch 4;(;, the ?&S& =o$rt of Appeals for the #istrict of =ol$mbia stayed the in9$nction pending an appeal, d$ring %hich the F#A arg$ed the right to
reg$late electronic cigarettes based on their previo$s ability to reg$late nicotine replacement therapies s$ch as nicotine g$m or patches& F$rther, the agency
arg$ed that tobacco legislation enacted the previo$s year Be1pressly e1cl$des from the definition of Dtobacco prod$ctD any article that is a dr$g, device or
combination prod$ct $nder the F#=A, and provides that s$ch articles shall be s$b9ect to reg$lation $nder the pre-e1isting F#=A provisions&B.(;4/ @n 8
#ecember 4;(;, the appeals co$rt r$led against the F#A in a +E; $nanimo$s decision, r$ling the F#A can only reg$late electronic cigarettes as tobacco
prod$cts, and th$s cannot block their import&.(;+/ 3he 9$dges r$led that s$ch devices %o$ld only be s$b9ect to dr$g legislation if they are marketed for
therape$tic $se E E-cigarette man$fact$rers had s$ccessf$lly proven that their prod$cts %ere targeted at smokers and not at those seeking to 0$it& 3he
#istrict =ol$mbia =irc$it appeals co$rt, on 45 Pan$ary 4;((, declined to revie% the decision en banc, blocking the prod$cts from F#A reg$lation as
medical devices&.(;5/
State reg$lation
With an absence of federal reg$lations, many states and cities have adopted their o%n e-cigarette reg$lations, most commonly to prohibit sales to minors,
incl$ding 6aryland, Gent$cky, 6innesota, "e% Persey, "e% ,ampshire, 3ennessee, ?tah, Wisconsin, and =olorado& @ther states are considering similar
legislation&.(;7/
=alifornia -overnor Arnold Sch%arzenegger vetoed a bill that %o$ld reg$late the sale of electronic cigarettes %ithin the state on gro$nds that Bif ad$lts
%ant to p$rchase and cons$me these prod$cts %ith an $nderstanding of the associated health risks, they sho$ld be able to do so&B.(;*/ Senate Cill
*5:(A$thored by Senator Ellen =orbett), proposed a bill that %o$ld classify e=igarettes as tobacco prod$cts, th$s banning their $se %herever smoking %as
banned& 'n A$g$st 4;(+, SC*5: %as shelved for the session, 9$st ho$rs before its hearing in the State Assembly& 't has not been determined if Sen =orbett
%ill revise the bill and re-introd$ce it ne1t year&.(;8/
A n$mber of =alifornia cities have chosen to ban electronic cigarettes from p$blic places, incl$ding >os Angeles.(;:/ and =arlsbad.(;)/&
"e% Persey voted in 4;;) to treat the electronic cigarette in the same category as tobacco prod$cts by incl$ding them $nder the "e% Persey Smoke-Free
Air Act, %hich prohibits smoking in indoor %ork and p$blic places& Assembly%oman =onnie Wagner sponsored the legislation, claiming Bthat yo$ng
people %ho $se these things %ill get hooked on the nicotine and event$ally move onto the real thingB&.((;/
'n "e% ,ampshire, the sale of electronic cigarettes to minors is illegal as of P$ly 4;(;&.(((/
Arizona is planning to ban the sale of electronic cigarettes to minors&.((4/
'n 6aryland, sales to minors are banned&.((+/
"e% Jork State banned the $se of e-cigarettes %ithin (;; feet of a p$blic or private school entrance in September 4;(4, and banned e-cigarette sales to
minors starting on ( Pan$ary 4;(+&.((5/
@n +; #ecember 4;(+, "e% Jork =ity mayor 6ichael Cloomberg signed a bill reg$lating e-cig $sage in the same %ay as that of normal cigarettes&
3he bill %as signed on his second to last day in office after the co$ncil approved reg$lation& @ne of the arg$ments from proponents of the bill %as a need
for contrast bet%een on one hand claiming $sage BsafeB and on the other Bsafer than cigarettes, b$t still potentially dangero$s&B.((7/.((*/.((8/
'n ennsylvania, SC (;77 %as introd$ced by Sen& 3im Solobay in 4;(+ and %o$ld ban sales to minors&.((:/ 3hat same year physician members of the
ennsylvania 6edical Society called $pon the state legislat$re to pass electronic cigarette la%s that have safeg$ards e0$ivalent to e1isting tobacco la%s&
.(()/
"e% Gansas la% that goes into effect P$ly (, 4;(4 bans possession of e-cigarettes by anyone $nder (:&.(4;/
@ther co$ntries
'n A$stralia, the Federal #epartment of ,ealth and Ageing classifies every form of nicotine, e1cept for replacement therapies and cigarettes, as a form of
poison&.(4(/.(44/ 3he 3herape$tic -oods Administration has said that there %ere no la%s preventing the importation of e-cigarettes bo$ght over the
internet for personal $se, $nless prohibited by state and territory legislation&.(4+/ State la%s in A$straliaDs vario$s states are a little bit conflicting&
According to the oisons Standard of 4;(;, inhaled nicotine is harmacy @nly, or a Sched$le 4 medication %hen $sed to help 0$it smoking&.(45/.(47/ 'n
April 4;(5 Western A$stralia made it illegal to sell or s$pply electronic cigarettes regardless of their appearance& revio$sly they %ere banned if they
looked like cigarettes& 3he co$rt r$led that the action they provided in and of itself looks like cigarettes&
'n Argentina, sales, importation and man$fact$ring have been banned by the local reg$latory a$thority as %ell as its $se has been disco$raged by the
"ational =linical ractice -$ideline for 3obacco =essation from lack of eno$gh evidence&.(4*/
'n Crazil, the sale, importation and advertising of any kind of electronic cigarette is forbidden& 3he Crazilian health and sanitation federal agency,
Anvisa, fo$nd the c$rrent health safety assessments abo$t e-cigarettes to not be yet satisfactory for commercial approval eligibility&.(48/
'n =anada, as of 6arch 4;(5, %hile the importation, sale, and advertising of electronic cigarettes containing nicotine is permitted, man$fact$rers and
retailers may not make any claims abo$t the prod$ctsD efficacy for any health p$rpose&.citation needed/
'n =hina, the sale and $se of electronic cigarettes is legal&.citation needed/
'n ?nited Arab Emirates, the sale and $se of electronic cigarettes is illegal&.(4:/
'n Egypt, the Egyptian 6inistry of ,ealth technical committee has re9ected applications for marketing a$thorization of electronic cigarettes on the
gro$nds that they contain harmf$l chemicals, and lack safety and to1icity data&.citation needed/
'n ,ong Gong the sale and possession of nicotine-based electronic cigarettes, classified as a 3ype ' oison, is governed $nder the harmacy and oisons
@rdinance& Sale or possession is not a$thorized and both are considered p$nishable %ith a fine of $p to ,GN(;;,;;; and2or a prison term of 4 years&
,o%ever, the la% does not cover any non-nicotine inhalers&.(4)/
'n 'ndia, the $se of electronic cigarettes is legal& ?nder the 'ndian ,ealth >a% of 4;;*, tobacco smoking has been banned in p$blic& Since e-cigarettes
avoid the $se of tobacco, they do not fall $nder this la%&.(+;/
'n 'srael in 4;(+, the 6inistry of ,ealth planned to e1tend e1isting la%s on smoking in p$blic places to e-cigarettes, a year after %arning against the
prod$ctDs $sage&.(+(/
'n Papan, no la%s pertaining specifically to the $se of electronic cigarettes e1ists& ,o%ever, the sale of prod$cts containing nicotine in Papan is reg$lated
and no e1press permission to sell e-li0$ids containing nicotine has been given& Ceca$se of this, the sale of vaporizers is legal, b$t the sale of e-li0$id is not&
'ndivid$als may ho%ever import e-li0$id from overseas for personal $se&
'n >ebanon, the co$ncil of ministers has banned the sale and $se of electronic cigarettes, starting 4( September 4;((&.citation needed/
'n 6alaysia, the sale of e-cigarettes is an offence $nder the oisons Act ()74 and the =ontrol of #r$gs and =osmetics Aeg$lations ():5& 3hose fo$nd
g$ilty of selling and distrib$ting the prod$ct (as %ell as li0$id nicotine for $se in electronic cigarettes) %ill be fined no more than A6+,;;;, be 9ailed for no
more than t%o years, or both&.(+4/ 3he 6alaysian ,ealth 6inister stated that e-cigarettes containing li0$id nicotine are more harmf$l than normal
cigarettes and %arned 6alaysians to avoid them&.(++/
'n 6e1ico, the Federal =ommission for the rotection Against Sanitary Aisks, anno$nced that according to 6e1ican >a%, the selling and promotion of
non-tobacco ob9ects that incl$de elements generally associated %ith tobacco prod$cts are forbidden&.(+5/
'n "epal, $nder c$rrent cigarette la%s, the $se and sale of e-cigarettes is permitted&.citation needed/
'n akistan, the import and sale of electronic cigarettes is legal, b$t akistan 6edical and #ental co$ncil find that the c$rrent health safety assessments
of e-cigarettes to not yet be satisfactory&.citation needed/
'n anama, the importation, distrib$tion and sale of electronic cigarettes have been prohibited since P$ne 4;;)& 3he 6inistry of ,ealth cites the F#A
findings as their reasoning for the ban&.(+7/
'n Singapore, electronic cigarettes (e-cigarettes) are c$rrently prohibited $nder Secion (* (() of the 3obacco (=ontrol of Advertisements and Sale) Act,
%hich is enforced by the ,ealth Sciences A$thority (,SA)& 3his legislation prohibits the importation, distrib$tion, sale or offer for sale of any
confectionery or other food prod$ct or any toy or other article that is designed to resemble a tobacco prod$ct or the packaging of %hich is designed to
resemble the packaging commonly associated %ith tobacco prod$cts& ,SA takes a serio$s vie% on any person %ho contravenes the la%& 3hose g$ilty of the
offence are liable to a fine of $p to N7, ;;; $pon conviction&.(+*/ According to ,ealth 6inister Gha% Coon Wan, electronic cigarettes are the ind$stryDs
attempt to attract ne% $sers and %ere marketed to appeal to yo$nger c$stomers, incl$ding %omen&.(+8/
'n So$th Gorea, the sale and $se of electronic cigarettes is legal, b$t is heavily ta1ed& Electric cigarette possession among teenagers remains an iss$e&
.(+:/
'n 3$rkey, the sale of electronic cigarettes and e-li0$ids are illegal&
Aelated nicotine inhalation technologies
3here are other technologies c$rrently $nder development that seek to deliver nicotine for oral inhalation in an effort to mimic both the rit$alistic and
behavio$ral aspects of traditional cigarettes&
Critish American 3obacco, thro$gh their s$bsidiary "icovent$res >imited, licensed a nicotine delivery system based on e1isting asthma inhaler
technology& 3he technology is being developed by ?G-based healthcare company Gind =ons$mer >imited&
hilip 6orris 'nternational bo$ght the rights to a nicotine pyr$vate technology developed by Ped Aose at #$ke ?niversity&.(+)/ 3he technology is based
on the chemical reaction bet%een nicotine acid and a base, %hich prod$ces an inhalable nicotine pyr$vate vapo$r&.(5;/
QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ-
3obacco cigarettes are the leading ca$se of disease in the ?nited States, %hich is %hy the Rprimary goal of tobacco control is to red$ce mortality and
morbidity associated %ith tobacco $seS (p& +4*)&
4+
Electronic cigarettes are designed to mitigate tobacco-related disease by red$cing cigarette cons$mption
and smoking rates& 3he evidence revie%ed in this article s$ggests that electronic cigarettes are a m$ch safer alternative to tobacco cigarettes& 3hey are
likely to improve $pon the efficacy of traditional pharmacotherapy for smoking cessation&
'n light of this evidence, it is $nfort$nate that in the ?nited States, the American =ancer Society, American >$ng Association, American ,eart Association,
=ampaign for 3obacco-Free Gids, Action on Smoking and ,ealth, American >egacy Fo$ndation, American Academy of ediatrics, and the Association for
the 3reatment of 3obacco ?se and #ependence have all iss$ed statements s$pporting F#A efforts to take them off the ?S market&
+5
'n the ?nited States,
the co$rts %ill $ltimately determine %hether the F#A has the legal a$thority to do this, b$t %e 0$estion the ethical and health policy merits of this
approach&
#o prod$cts %ith established $ser bases %arrant a different reg$latory approach than entirely ne% prod$ctsT 3his %o$ld seem to follo% from consistent
application of the principal of nonmaleficence E Rdo no harm&S rod$cts yet to enter the market have only potential beneficiaries, people %ho can only
spec$late abo$t %hat the precise therape$tic effects of the prod$ct %ill be for them& 'n contrast, prod$cts already on the market have $sers %ho may already
be deriving benefits& Cy definition, enacting a ban %ill harm c$rrent $sers, $nless the evidence s$ggests that the harms o$t%eigh the benefits for those
already using the product& 3he b$rden of proof is on the reg$latory agency to demonstrate that the prod$ct is $nreasonably dangero$s for its intended $se&
,o% does this principle apply to electronic cigarettesT For the many vapers %ho report $sing them in place of cigarettes,
++
the benefits of the prod$ct are
readily observable, already established& Simply demonstrating that electronic cigarettes are Rnot safeS may not be s$fficient gro$nds to ban them& ?nless the
evidence s$ggests that vaping does not yield the anticipated reduction in harm to the $ser, enacting an electronic cigarette prohibition %ill do harm to
h$ndreds of tho$sands of vapers already $sing electronic cigarettes in place of tobacco ones E a clear violation of nonmaleficence&
3he essential rationale for the F#ADs pre-market approval process E to keep dangero$s prod$cts o$t of the marketplace E may not easily e1tend to ne%
nicotine prod$cts beca$se a range of e1traordinarily deadly nicotine prod$cts is already grandfathered into the market& 3his has led to an a%k%ard nicotine
reg$latory str$ct$re %here dirty tobacco prod$cts face fe% barriers to market entry %hereas cleaner prod$cts are s$b9ect to oft onero$s h$rdles& 3he F#A
contends that they can and sho$ld reg$late electronic cigarettes as Rdr$g-device combinationsS that are re0$ired to meet stringent Federal Food #r$g and
=osmetic Act (F#=A) safety standards& 3he F#A reasons that electronic cigarettes do not 0$alify for the $s$al e1emption from F#=A standards afforded
to most other recreational nicotine prod$cts beca$se Rm$ch less is kno%n abo$t the safety of E-=igarettesS and Rit may be possible for E-=igarettes U to
satisfy the F#=ADs safety, effectiveness, and labeling re0$irements and obtain F#A approvalS (p& 4*)&
+7
'ronically, the only nicotine prod$cts e1empted
from F#=A safety re0$irements are those that are too obvio$sly harmf$l to have any chance of meeting these re0$irements& >itigation presently before the
?S =o$rt of Appeals for the #istrict of =ol$mbia may $ltimately determine %hether the F#A can legally reg$late electronic cigarettes as dr$g-device
combinations&
+*
Aegardless of the co$rtDs decision, %e believe a better reg$latory approach %o$ld not actively disco$rage prod$cers of harm red$ction
prod$cts&
Fairchild and =olgrove
4:
concl$de that Rthe later history of tobacco ind$stry deception and manip$lation %as an important factor contrib$ting to the
erosion of p$blic health s$pport for harm red$ctionS (p& 4;()& With entrenched skepticism to%ard harm red$ction no% manifested as deep cynicism abo$t
electronic cigarettes E a distinct prod$ct that act$ally does red$ce risk and threatens cigarette makers E the tobacco ind$stry is ironically benefiting from its
o%n past d$plicity& 3he p$sh to ban electronic cigarettes may repeat the mistakes of the past in the name of avoiding them& Aeg$latory policy for electronic
cigarettes and other novel nicotine prod$cts m$st be g$ided by an acc$rate $nderstanding of ho% they compare to tobacco cigarettes and "A3 in terms of
red$cing to1ic e1pos$res and helping individ$al smokers 0$it&
@ cerco aos f$madores vai apertar-se em breve& =om a aprovaVWo da nova directiva e$ropeia sobre prod$tos de tabaco a apro1imar-se da recta final,
ort$gal dei1a de ter arg$mentos para contin$ar a adiar a prometida revisWo da lei nacional& @ director-geral da SaXde, Francisco -eorge, acredita 0$e as
alteraVOes legislativas vWo avanVar po$co tempo apYs a entrada em vigor da nova directiva e$ropeia, prevista para 6aio&
A votaVWo final desta directiva 0$e introd$z novas restriVOes Z indXstria do tabaco est[ marcada para a
prY1ima 0$arta-feira no arlamento E$rope$& A directiva ser[ p$blicada no 9ornal oficial da ?niWo
E$ropeia (?E) at\ ao final de Abril e entrar[ no m]s seg$inte em vigor& @s Estados-membros t]m dois
anos para a transp^r, mas ort$gal deve _avanVar logo com o processo`, antecipa Francisco -eorge&
'nicialmente prevista para 4;(+, a revisWo da lei do tabaco tem vindo a ser s$cessivamente adiada em
ort$gal& A Xltima 9$stificaVWo do 6inist\rio da SaXde para $m novo adiamento foi e1actamente a de
0$e nWo fazia sentido m$dar a lei port$g$esa para mais tarde ter 0$e a adaptar Zs novas normas
e$ropeias& Assim, os dois processos - o de revisWo da act$al lei do tabaco transposiVWo da directiva -
serWo efect$ados em sim$ltaneo&
A directiva e$ropeia visa sobret$do introd$zir medidas 0$e diss$adam os 9ovens de f$mar& ara isso,
os alertas de saXde 0$e act$almente cobrem entre +; a 5;< da s$perfbcie dos maVos de tabaco vWo
passar para *7< do espaVo de ambos os lados das embalagens& P[ a $tilizaVWo de aromas distintivos,
como o mentol, vai ser restringida a partir de 4;4;, e1plica o gabinete de imprensa do arlamento
E$rope$ (E), n$ma nota Z imprensa&
A directiva vem ainda reg$lar pela primeira vez o mercado dos cigarros electrYnicos 0$e, se forem
apresentados como poss$indo propriedades c$rativas o$ preventivas de doenVas, deverWo ser
a$torizados como medicamentos& Se nWo, serWo classificados como prod$tos de tabaco, e podem ser
comercializados se o nbvel de nicotina for inferior a 4; mg2ml, e1plica tamb\m a nota do E&
6as, com a revisWo da lei do tabaco, pretende-se ir bem mais longe em ort$gal& @ ob9ectivo \ proibir
o f$mo em todos os locais pXblicos fechados, ainda 0$e de forma faseada& Em vigor desde 4;;:, a lei
0$e veio restringir o f$mo em espaVos pXblicos permite a e1ist]ncia de zonas para f$madores em locais
como resta$rantes, discotecas e bares&
@ secret[rio de Estado ad9$nto do ministro da SaXde, Fernando >eal da =osta, 9[ admiti$ 0$e os
espaVos 0$e investiram em aparelhos de p$rificaVWo do ar para poderem ter zonas para f$madores terWo
$m _perbodo de moratYria` para amortizaVWo do investimento& ?m prazo 0$e dever[ ser de oito anos, o
0$e tem sido criticado por especialistas em prevenVWo do tabagismo&
Em cima da mesa est[ ainda a possibilidade de comparticipaVWo de medicamentos 0$e a9$dem na
cessaVWo tab[gica, $ma medida 0$e chego$ a ser e0$acionada por diversas vezes mas 0$e n$nca
avanVo$&
Sem efeito fico$ a ideia de proibir o f$mo dentro dos carros com crianVas a bordo E 0$e chego$ a ser
defendida pelo ministro da SaXde n$ma ida ao arlamento, em 4;(4&
@ tabagismo contin$a a ser a principal ca$sa de mortes evit[veis na ?E, vitimando cerca de 8;; mil
pessoas por ano& Seg$ndo dados da =omissWo E$ropeia, cerca de 8;< dos f$madores comeVam a
f$mar antes dos (: anos&