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Home » Chapter 18: Harm Reduction » InDepth 18B: E-cigarettes

InDepth 18B Electronic cigarettes (e-cigarettes)

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from:  http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

  

In this section:

  • 18B.0 Introduction
  • 18B.1 The e-cigarette market
  • 18B.2 Advertising and promotion
  • 18B.3 Extent of use
  • 18B.4 Safety and abuse potential
  • 18B.5 Health risks of e-cigarettes
  • 18B.6 Potential negative impacts
  • 18B.7 Potential positive impacts
  • 18B.8 Legal status in Australia
  • 18B.9 International regulatory overview
  • 18B.10 Key Australian and international position statements on e-cigarettes, health, and options for regulation
  • 18B.11 Public perceptions of e-cigarettes
 
 
  • Home
    • Further updates
    • Forthcoming updates to Tobacco in Australia: Facts & issues
  • Foreword
  • Acknowledgments
  • Introduction
  • Chapter 1 Trends in the prevalence of smoking
    • 1.1 A brief history of tobacco smoking in Australia
    • 1.2 Overview of major Australian data sets
    • 1.3 Prevalence of smoking—adults
    • 1.4 Prevalence of smoking—young adults
    • 1.5 Prevalence of smoking—middle-aged and older adults
    • 1.6 Prevalence of smoking—teenagers
    • 1.7 Trends in the prevalence of smoking by socio-economic status
    • 1.8 Trends in prevalence of smoking by country of birth
    • 1.9 Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders
    • 1.10 Prevalence of smoking in other high-risk sub-groups of the population
    • 1.11 Prevalence of smoking among health professionals
    • 1.12 Prevalence of use of different types of tobacco product
    • 1.13 Smoking by Australian states and territories
  • Chapter 2 Trends in tobacco consumption
    • 2.0 Introduction
    • 2.1 Production and trade data as a basis for estimating tobacco consumption
    • 2.2 Dutiable tobacco products as an estimate of tobacco consumption
    • 2.3 Self-reported measures of tobacco consumption
    • 2.4 Expenditure on tobacco products
    • 2.5 Industry sales figures as estimates for consumption
    • 2.6 Comparisons of quality and results using various estimates of tobacco consumption in Australia
    • 2.7 Per capita consumption in Australia compared with other countries
    • 2.8 Tobacco consumption not captured in government or industry figures
    • 2.9 Best estimate of recent tobacco consumption in Australia
    • 2.10 Factors driving changes in tobacco consumption
  • Chapter 3 The health effects of active smoking
    • 3.0 Introduction
    • 3.1 Smoking and cardiovascular disease
    • 3.2 Respiratory diseases (excluding lung cancer)
    • 3.3 Smoking and cancer
    • 3.4 Lung cancer
    • 3.5 Other cancers
    • 3.6 Reproductive health
    • 3.7 Pregnancy and smoking
    • 3.8 Child health and maternal smoking before and after birth
    • 3.9 Increased susceptibility to infection in smokers
    • 3.10 Eye diseases
    • 3.11 Dental diseases
    • 3.12 Gastro-intestinal diseases
    • 3.13 Musculoskeletal conditions
    • 3.14 Skin
    • 3.15 The impact of smoking on treatment of disease
    • 3.16 Smoking and diabetes
    • 3.17 Inflammatory conditions and autoimmune disease
    • 3.18 Other conditions with possible links to smoking
    • 3.19 Smoking and accidents
    • 3.20 Nicotine and carbon monoxide poisoning
    • 3.21 Health effects for younger smokers
    • 3.22 Poorer quality of life and loss of function
    • 3.23 Smoking, dementia and cognition
    • 3.24 Genetic influences on tobacco-caused disease
    • 3.25 Smoking compared with or in combination with other pollutants
    • 3.26 Health effects of brands of tobacco which claim or imply delivery of lower levels of tar, nicotine and carbon monoxide
    • 3.27 Health effects of smoking tobacco in other forms
    • 3.28 Health 'benefits' of smoking?
    • 3.29 Smoking and body weight
    • 3.30 Total burden of death and disease attributable to tobacco by disease category
    • 3.31 Morbidity and mortality due to tobacco-caused disease and socio-economic disadvantage
    • 3.32 Health effects of smoking other substances
    • 3.33 Health effects of chewing tobacco, and of other smokeless tobacco products
    • 3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking
    • 3.35 Health and other benefits of quitting
    • 3.36 The global tobacco pandemic
  • Chapter 4 The health effects of secondhand smoke
    • 4.0 Background
    • 4.1 What is secondhand smoke?
    • 4.2 What is in secondhand smoke?
    • 4.3 Thirdhand smoke
    • 4.4 Measuring exposure to secondhand smoke
    • 4.5 Prevalence of exposure to SHS in the home
    • 4.6 Mechanisms of disease
    • 4.7 Estimates of morbidity and mortality attributable to secondhand smoke
    • 4.8 Cardiovascular disease and secondhand smoke
    • 4.9 Lung cancer and secondhand smoke
    • 4.10 Cancers of other sites
    • 4.11 Effects of secondhand smoke on the respiratory system in adults
    • 4.12 Secondhand smoke and increased risk of infectious disease
    • 4.13 Secondhand smoke and type 2 diabetes mellitus
    • 4.14 Secondhand smoke and mental health
    • 4.15 Oral health
    • 4.16 Secondhand smoke and pregnancy
    • 4.17 Health effects of secondhand smoke for infants and children
    • 4.18 Other health effects
    • 4.19 Public attitudes to secondhand smoke
    • 4.20 Health effects of secondhand smoke on pets
  • Chapter 5 Influences on the uptake and prevention of smoking
    • 5.0 Introduction
    • 5.1 Stages in the uptake of smoking
    • 5.2 Factors influencing uptake by young people overview
    • 5.3 Early biological factors
    • 5.4 Adolescence and brain maturation
    • 5.5 Temperament, mental health problems and self-concept
    • 5.6 Intentions, attitudes and beliefs
    • 5.7 The home environment
    • 5.8 The smoking behaviour of peers, and peer attitudes and norms
    • 5.9 The educational environment
    • 5.10 Cultural background
    • 5.11 Accessibility of tobacco products to young smokers
    • 5.12 Affordability of tobacco products
    • 5.13 Products and packaging created to appeal to new users
    • 5.14 Smokefree policies
    • 5.15 Tobacco advertising and promotion targeted at young people
    • 5.16 Smoking in movies, TV and other popular culture media
    • 5.17 Factors influencing uptake of smoking later in life
    • 5.18 Uptake: a concluding note
    • 5.19 Prevention: an introductory note
    • 5.20 Approaches to youth smoking prevention
    • 5.21 Reducing tobacco access and supply
    • 5.22 Taxation and pricing of tobacco products
    • 5.23 Reducing product appeal
    • 5.24 The profound effects of the denormalisation of smoking
    • 5.25 Media campaigns and young people
    • 5.26 Appropriate responses to the problem of smoking and movies
    • 5.27 Parent family home targeted interventions
    • 5.28 Peer-based approaches
    • 5.29 School-based interventions
    • 5.30 Harnessing predictors of uptake to prevent smoking
    • 5.31 Other drug use
  • Chapter 6 Addiction
    • 6.0 Introduction
    • 6.1 Defining nicotine as a drug of addiction
    • 6.2 Pharmacokinetics
    • 6.3 Mechanism of action
    • 6.4 Pharmacological effects
    • 6.5 Mood effects
    • 6.6 Cognitive effects
    • 6.7 Clinical populations
    • 6.8 Medication interaction effects
    • 6.9 Predictors of nicotine dependence
    • 6.10 Acute effects of nicotine on the body
    • 6.11 Tolerance, dependence and withdrawal
    • 6.12 Measures of tobacco dependence
    • 6.13 Addiction and the adolescent smoker
    • 6.14 Smokers’ attitudes to and beliefs about addiction
  • Chapter 7 Smoking cessation
    • 7.0 Introduction
    • 7.1 Health and other benefits of quitting
    • 7.2 Quitting activity
    • 7.3 Theories about smoking and quitting
    • 7.4 What finally prompts smokers to attempt to quit?
    • 7.5 What we know about how smokers are persuaded to attempt to quit
    • 7.6 How smokers go about quitting
    • 7.7 Factors that predict success or failure in quit attempts
    • 7.8 How can relapse be prevented?
    • 7.9 Approaches to increasing the proportion of ever smokers who have quit
    • 7.10 Role of health professionals and social services
    • 7.11 Smoking cessation and pregnancy
    • 7.12 Smoking and mental health
    • 7.13 Cessation assistance: printed self-help materials
    • 7.14 Cessation assistance: telephone- and internet-based interventions
    • 7.15 Individual and group-based cessation assistance
    • 7.16 Pharmacotherapies
    • 7.17 Contingency management/incentives
    • 7.18 Alternative therapies and emerging treatments
    • 7-19-interventions-for-particular-groups
    • 7.20 National policy and progress in encouraging and supporting cessation
  • Chapter 8 Tobacco use among Aboriginal peoples and Torres Strait Islanders
    • 8.0 Introductory note
    • 8.1 Aboriginal people and Torres Strait Islanders: social disadvantage, health and smoking—an overview
    • 8.2 History of tobacco use among Aboriginal peoples and Torres Strait Islanders
    • 8.3 Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders
    • 8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers
    • 8.5 Types of tobacco used by and levels of consumption among Aboriginal peoples and Torres Strait Islanders
    • 8.6 Smoking cessation and Aboriginal peoples and Torres Strait Islanders
    • 8.7 Morbidity and mortality caused by smoking among Aboriginal and Torres Strait Islander peoples
    • 8.8 Economic issues relating to tobacco use among Aboriginal peoples and Torres Straits Islanders
    • 8.9 Attitudes to and beliefs about smoking among Aboriginal peoples and Torres Strait Islanders
    • 8.10 Tobacco action initiatives targeting Aboriginal peoples and Torres Straits Islanders
    • 8.11 The relationship between tobacco and other drug use in Aboriginal and Torres Strait Islander communities
    • 8.12 The tobacco industry and Indigenous communities
    • 8.13 Policies for advancing tobacco control programs among Aboriginal and Torres Strait Islander peoples
  • Chapter 9 Smoking and social disadvantage
    • 9.0 Introduction
    • 9.1 Socio-economic position and disparities in tobacco exposure and use
    • 9.2 Socio-economic disparities in tobacco exposure and use: are the gaps widening?
    • 9.3 Contribution of smoking to health inequality
    • 9.4 The relationship between tobacco smoking and financial stress
    • 9.5 Smoking and intergenerational poverty
    • 9.6 Smoking, ill health, financial stress and smoking-related poverty among highly disadvantaged groups
    • 9.7 Explanations of socio-economic disparities in smoking
    • 9.8 Are current strategies to discourage smoking in Australia inequitable?
    • 9.9 Are there inequalities in access to and use of treatment for dependence on tobacco-delivered nicotine?
  • Chapter 10 The tobacco industry in Australian society
    • 10.0 Introduction
    • 10.1 The tobacco growing industry
    • 10.2 The global tobacco manufacturing industry
    • 10.3 The manufacturing and wholesaling industry in Australia - major international companies
    • 10.4 Other importers operating in the Australian market
    • 10.5 Retailing of tobacco products in Australia
    • 10.6 Retail value and volume of the Australian tobacco market
    • 10.7 Market share and brand share in Australia
    • 10.8 Trends in products and packaging
    • 10.9 Brand portfolio strategies in the Australia market
    • 10.10 The tobacco industry exposed: tobacco industry document repositories
    • 10.11 Corporate responsibility and the birth of good corporate citizenship
    • 10.12 The tobacco industry's revised stance on health issues
    • 10.13 Industry efforts to discourage smoking
    • 10.14 Ethical issues related to farming
    • 10.15 The environmental impact of tobacco production
    • 10.16 The environmental impact of tobacco use
    • 10.17 Public attitudes to the tobacco industry
    • 10.18 The investment of public funds in tobacco - the case for divestment
    • 10.19 The future of the tobacco industry
    • In Depth 10A-Strategies-for-influence
      • 10A.1 Strategies for influence - Overview
      • 10A.2 The arguments
      • 10A.3 Mechanisms of influence—Industry-funded research
      • 10A.4 Mechanisms of influence—undermining public health organisations
      • 10A.5 Mechanisms of influence—mobilising support from the industry and those with shared aims
      • 10A.6 Mechanisms of influence—media relations
      • 10A.7 Mechanisms of influence—political lobbying
      • 10A.8 Mechanisms of influence—participation in regulatory review processes
      • 10A.9 Mechanisms of influence—litigation
  • Chapter 11 Tobacco advertising and promotion
    • 11.0 Background
    • 11.1 The merits of banning tobacco advertising
    • 11.2 Tobacco industry expenditure on advertising
    • 11.3 Commonwealth (national) legislation
    • 11.4 State and territory legislation
    • 11.5 Tobacco advertising legislation violations
    • 11.6 Marketing of tobacco in the age of advertising bans
    • 11.7 Promotional events
    • 11.8 Trade promotions
    • 11.9 Retail promotion and access
    • 11.10 Smoking in movies as promotion
    • 11.11 Internet promotion
    • InDepth 11A: Packaging as promotion: Evidence for and effects of plain packaging
      • 11A.0 Introduction
      • 11A.1 Plain packaging as a solution to the misleading and promotional power of packaging
      • 11A.2 Australian announcement of plain packaging legislation
      • 11A.3 Analysis of major industry arguments against plain packaging
      • 11A.4 Milestones in adoption of legislation
      • 11A.5 Major milestones in legal challenges to the legislation
      • 11A.6 International flow-on effects
      • 11A.7 Initial industry responses to attempt to mitigate the impact of legislation
      • 11A.8 Experimental research on the effects of plain packaging
      • 11A.9 Real-world research on the effects of plain packaging
    • Attachment 11.1 TAP Act report to parliament
  • Chapter 12 The construction and labelling of Australian cigarettes
    • 12.0 Introduction
    • 12.1 Tobacco in Australian cigarettes
    • 12.2 Measuring cigarette smoke constituents
    • 12.3 Labelling of 'tar', nicotine and carbon monoxide yields of Australian cigarettes
    • 12.4 General engineering features of Australian cigarettes and their relation to compensatory smoking
    • 12.5 Comparison of Australian and United States cigarettes
    • 12.6 Comparison of Australian cigarettes in different yield categories
    • 12.7 Additives in Australian cigarettes
    • 12.8 Menthol and confectionery/liqueur flavoured cigarettes
    • 12.9 Specific carcinogens and cardiovascular toxicants in Australian cigarettes
    • Attachment 12.1 Health warnings
      • 12A.0  Introduction and rationale for health warnings
      • 12A.1 History of health warnings in Australia
      • 12A.2 Health warnings used in other countries
      • 12A.3 Evidence about the effects of health warnings
      • 12A.4 What makes an effective health warning?
      • 12A.5 What has been the impact of pictorial health warnings in Australia?
      • 12A.6 World Health Organization recommendations on health warnings
      • 12A.7 Public support for health warnings
      • 12A.8 Future directions for warnings
    • Attachment 12.2 Reduced fire risk (RFR) cigarettes
  • Chapter 13 The pricing and taxation of tobacco products in Australia
    • 13.0 Introduction
    • 13.1 Price elasticity of demand for tobacco products
    • 13.2 Tobacco taxes in Australia
    • 13.3 The price of tobacco products in Australia
    • 13.4 The affordability of tobacco products
    • 13.5 Impact of price increases on tobacco consumption in Australia
    • 13.6 Revenue from tobacco taxes in Australia
    • 13.7 Avoidance and evasion of taxes on tobacco products
    • 13.8 What is the 'right' level of tobacco taxation
    • 13.9 Future directions for reform of tobacco taxes
    • 13.10 Arguments against tax increases promoted by the tobacco industry
    • 13.11 Are tobacco taxes regressive?
    • 13.12 Public opinion about tobacco tax increases
  • Chapter 14 Social marketing and public education campaigns
    • 14.0 Introduction
    • 14.1 Mass media public education campaigns: an overview
    • 14.2 The role of mass media campaigns within a comprehensive smoking control program
    • 14.3 Public education campaigns to discourage smoking: the Australian experience
    • 14.4 Examining the effectiveness of public education campaigns
    • 14.5 Targeting of public education campaigns and different types of media channels
    • 14.6 News media coverage
    • Appendix 1 National, State and Territory Contacts
  • Chapter 15 Smokefree environments
    • 15.0 Introduction
    • 15.1 Why implement smokefree environments?
    • 15.2 Public opinion about smokefree environments
    • 15.3 Opposition to and weakening of smokefree environment
    • 15.4 Smoking bans in key public areas and environments
    • 15.5 Smoking bans in outdoor areas
    • 15.6 Smoking bans in the home and car
    • 15.7 Legislation to ban smoking in public spaces
      • Summary of smokefree legislation across Australian states and territories
    • 15.8 Immediate impact of smokefree legislation in improving air quality
    • 15.9 Effectiveness of smokefree legislation in reducing exposure to tobacco toxins, improving health, and changing smoking behaviours
  • Chapter 16 Tobacco litigation in Australia
    • 16.0 Introduction
    • 16.1Personal injury claims against the tobacco industry
    • 16.2 Litigation brought by Australian consumer and regulatory groups against the tobacco industry
    • 16.3 Litigation relating to injury from exposure to second-hand smoke
    • 16.4 Criminal cases against the tobacco industry
    • 16.5 Legal cases initiated by tobacco industry
    • Attachment 16.1 McCabe
    • Attachment 16.2 Australian cases
  • Chapter 17 The economics of tobacco control
    • 17.0 Introduction
    • 17.1 Economic terminology and methods
    • 17.2 The costs and benefits of smoking to the Australian economy
    • 17.3 The economic rationale for intervention in the tobacco market
    • 17.4 Economic evaluations of tobacco control interventions
    • 17.5 Impact of tobacco control strategies on the Australian economy
    • 17.6 Optimal investment in tobacco control
  • Chapter 18 Potential for harm reduction in tobacco control
    • 18.0 Introduction
    • 18.1 Assessing the harmfulness
    • 18.2 Regulation
    • 18.3 Smoking reduction
    • 18.4 Low nicotine
    • 18.5 Chemoprevention
    • 18.6 Screening
    • InDepth 18A: Smokeless tobacco
      • 18A.1 Forms of smokeless tobacco
      • 18A.2 Prevalence smokeless tobacco
      • 18A.3 Health effects
      • 18A.4 Snus
      • 18A.5 Regulating sale and promotion of smokeless tobacco, other jurisdictions
    • InDepth 18B: E-cigarettes
      • 18B.0 Introduction
      • 18B.1 The e-cigarette market
      • 18B.2 Advertising and promotion
      • 18B.3 Extent of use
      • 18B.4 Safety and abuse potential
      • 18B.5 Health risks of e-cigarettes
      • 18B.5 Safety
      • 18B.6 Potential negative impacts
      • 18B.7 Potential positive impacts
      • 18B.8 Legal status
      • 18B.9 Regulatory overview
      • 18B.10 Position statements
      • 18B.11 Public perceptions of e-cigarettes
    • InDepth 18C: Heated tobacco (‘heat-not-burn’) products
      • 18C.0 Introduction
      • 18C.1 The heated tobacco product market
      • 18C.2 Extent of use
      • 18C.3 Health risks of heated tobacco products
      • 18C.4 Potential risks/benefits to public health
      • 18C.5 Legal status in Australia
      • 18C.6 International regulatory overview
      • 18C.7 Key Australian and international position statements on heated tobacco products
  • Chapter 19 The WHO Framework Convention on Tobacco Control
    • 19.0 Background to the WHO Framework Convention on Tobacco Control
    • 19.1 WHO FCTC Governance Framework
    • 19.2 Implications of the WHO FCTC for Australia
    • 19.3 WHO FCTC guiding principles and general obligations
    • 19.4 Obligations relating to demand reduction for tobacco products
    • 19.5 Obligations relating to supply-reduction for tobacco products
    • 19.6 Other substantive obligations
    • 19.7 Obligations regarding international cooperation and exchange of information and resources
    • 19.8 Enforcement of the WHO FCTC
    • 19.9 Impact of the WHO FCTC and role in the context of global governance
    • 19.10 WHO FCTC in a domestic context: Case study example of Australia’s Tobacco Plain Packaging
  • Appendix 1 Useful weblinks to tobacco resources
    • A1.1 International data repositories
    • A1.2 Australian data repositories
    • A1.3 International tobacco control strategies
    • A1.4 Australian tobacco control strategies and documentation
    • A1.5 Major reviews on smoking and health
    • A1.6 History of tobacco in Australia
    • A1.7 Current Australian legislation
    • A1.8 Smoking cessation
    • A1.9 Smoking and Australia's Indigenous population
    • A1.10 Economic costs of tobacco
    • A1.11 Tobacco industry document repositories
    • A1.12 Some key peer-review journals
    • A1.13 Current international legislation

See also our 'InDepth' discussions of: 

  • E-cigarettes
  • Heated tobacco ('heat-not-burn') products
  • Smokeless tobacco
  • Tobacco industry—Strategies for influence 
  • Evidence for and effects of plain packaging
  • Health warnings
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