E-cigarettes seem to be emerging everywhere, and so far, there is no regulation at the federal and most local and state levels.
In 2003, a Chinese pharmacist invented the e-cigarette as an alternative to smoking. Instead of lighting up traditional tobacco-filled cigarettes, smokers use a battery-powered device to inhale nicotine in the form of a vapor.
The process known as “vaping” has been sold to consumers as a healthier alternative to regular cigarettes.
As more studies of vapor and its second-hand effects are conducted, more municipalities and states are considering bans. Forty-four states across the country do not currently include e-cigarettes in their smoke-free laws, according to research done by the American Lung Association.
They are banned wherever regular smoking is prohibited in New Jersey and North Dakota.
A bill in California being considered would require e-cigarettes to be regulated as a tobacco product and be included in existing smoke-free laws. Lawmakers in two other states, Massachusetts and Connecticut, are considering laws that would do the same.
In mid-December, New York City council members passed a similar law, putting e-cigarettes under the same regulation as regular cigarettes. Los Angeles and Chicago have passed similar laws.
Stanton Glantz, professor of medicine at the University of California, said he supports the passage of the bill in California. Glantz told reporters California should mandate that people cannot use an e-cigarette where traditional cigarettes are banned.
But many users argue e-cigarettes are a better choice than tobacco cigarettes.
Christine Gentry smoked at home, in the car and at her job in a casino until she started using e-cigarettes. And she has not gone back.
"It doesn't smell bad," said Gentry. "It's much cheaper. No yellow teeth."
Gentry is the chief operating officer of Vapure, a San Diego-based e-cigarette company with seven stores. The company's store in Mission Valley, north of San Diego, is inside a regular office building.
It was busy during the entire interview with Gentry.
She said they do not sell e-cigarettes as a smoking cessation device, though she said many customers turn to the product to quit smoking regular tobacco cigarettes.
"If they ask us, we tell them there are over 4,000 chemicals in a cigarette and they are hundreds of dollars a month," Gentry said. "In electronic cigarettes, there are four ingredients. We make it ourselves and the price is a fraction of the cost."
She said those ingredients are pharmaceutical-grade nicotine like found in the patch, vegetable glycerin, propylene glycol and flavorings for the refill liquid made by food-grade companies.
Glantz, a medical professor described how e-cigarettes work.
"The way an e-cigarette works is it heats up a mixture of nicotine, propylene glycol and other chemicals and that heated mixture becomes an aerosol which is inhaled deeply into your lungs to deliver the addictive drug nicotine,” he said.
He and other critics believe e-cigarettes do not help people quit smoking because users reportedly use e-cigarettes and cigarettes at the same time.
E-cigarettes: good or bad? Take the poll here.
"About 80 percent of people who use e-cigarettes keep smoking regular cigarettes," Glantz said.
Young adults, children
Some believe e-cigarette companies market to children.
"It is very much like old-fashioned cigarette marketing, with the addition of all these high tech and kiddie things, like flavors," Glantz said.
Users may choose from hundreds of different flavored liquids. Some of the favorites at Vapure are strawberry mango freeze, melon and snickerdoodle, Gentry said.
It’s the flavors, according to critics, that are a draw for kids -- a way to get younger people to get into smoking.
Gentry said her business does not market to kids and does not sell to underage customers. She said police monitor to whom she sells and have stopped in to check.
"We aren't posting billboards in front of elementary schools, but at the same time, if we are marketing to children, then so is cherry vodka or vanilla rum," Gentry said.
Glantz sees it differently. He said smoking for kids is at an all-time high and points to a Center for Disease Control Study that says cigarette use has doubled among kids in middle and high school.
READ: CDC report on electronic cigarette use among middle and high school students — United States, 2011–2012.
"They could well be serving as a new route in nicotine addiction for adolescents," he said, adding the slick advertising is attractive to kids, too.
Advertising
The government banned television and radio ads for cigarettes in 1970 and ads on smokeless tobacco were banned in 1986.
But big tobacco is back on air, now pushing electronic cigarettes.
Actor Stephen Dorf did a series of ads for Blu, an e-cigarette brand owned by the tobacco company Lorillard. Reynolds America is running a commercial in Colorado for their e-cigarette, Vuse.
"They are using celebrities; they are using sex; they are using glamour," Glantz said.
He also said research shows the e-cigarette ads are triggering relapses in people who long ago quit smoking.
The e-cigarette industry maintains its product can only help smokers, not hurt them.
Mobile users click here to view teenagers and tobacco use infographic.
Proposed ban
When cities consider a ban of e-cigarettes, Glantz said it is important “to include them in clean indoor air laws -- can't be used indoors where you can't smoke conventional cigarettes.”
A lot of e-cigarette company leaders like Gentry believe the bans are misguided and not fair for e-cigarette users.
"It's really unfair to be put in a smoking section, experiencing secondhand smoke, standing with the smokers, when we tried for some years to quit smoking," Gentry said. "Now we are put in the same area with the smokers."
Glantz believes the second-hand vapor of e-cigarettes could be harmful, too.
"If you are around somebody who is using e-cigarettes, you are breathing in ultra-fine particles and you are breathing in nicotine,” he said. “You are breathing in volatile organic campaigns and metals that are in the vapor."
Gentry said it depends on the product and that the Vapure products undergo strict quality control tests.
"We have our own facility, we make all of the liquids, everything -- we don't outsource the liquid from any other country, all the ingredients are from the U.S. and we make it ourselves," she said.
Look at the map below or click here to see how different states categorize e-cigarettes and selling the devices to minors.
Testing for answers
So what, exactly, is in the e-cigarette liquid and resulting vapor?
Reporters found a highly specialized lab –- one of the first in the country –- to test e-cigarettes. Scientist Prue Talbot and her researchers at University of California Riverside conducted recent tests and tested an e-cigarette bought from a San Diego drugstore.
Two brands were tested using the university's lab, which has equipment such as a smoking machine and a scanning electronic microscope.
The first test was done on the e-cigarette, "Smoking Everywhere Platinum.” It's made in China and available online.
It’s distributed out of Florida across the United States.
Results
During the testing, the liquid that is heated and turns into a vapor is put inside a centrifuge and spun. The end product: a small metal pellet.
"There is quite a bit of tin, most of this material is composed of tin," Dr. Talbot said. "There is also some oxygen, some copper and some nickel."
The electronic microscope revealed the solder used to cover the wires inside of the e-cigarette could be the reason for the tin.
“A lot of the solder seems to have come off, some of it has spread and come off and melted on the side,” Dr. Talbot said. "I think the fact there is significant amount of tin in these pellets is important. This means the people using this product are going to be inhaling the tin," she said.
While there are no studies on the long term health effects of inhaling tin, the UC Riverside scientist still is concerned about the very small nanoparticles of tin in the sample.
"Nanoparticles in general can be toxic," she said. “In the case of e-cigarettes, the nanoparticles would tend to go deeper into the respiratory system."
Stanton Glantz explained these particles are so small they go from lungs straight into the bloodstream. They then carry the toxic chemicals into various organs.
Reporters tried to contact 'Smoking Everywhere' in China where it is manufactured, and its distributor in the U.S., based in Plantation, Fla. Phone calls were not returned.
Most e-cigarettes are made in China by different manufacturers with no U.S. government oversight.
“They seemed to be manufactured differently, there are many different styles, there are many different models; there is no such thing as a single e-cigarette,” Talbot said.
For the second test, Dr. Talbot's team looked at the Mistic e-cigarette, a brand reporters purchased at a local drug store.
In the “spin” test, no tin was found because there were no solder joints used in this brand.
What the cigarette machines found while puffing on the Mistic e-cigarettes were low concentrations of copper, calcium and potassium, but Talbot says more research is needed.
A spokesperson for Mistic was reviewing the research before the company would issue any comment.
Gentry said she would welcome the standards her company uses for the rest of the industry she works in. “Its completely unregulated by the FDA right now, people are just selling it and making it,” Gentry said. “It’s unfortunate for the industry some people are making it right out of their garage, making it in office buildings, people are not really going the extra step, people aren't treating it like its food," Gentry said.
The Feds weigh in
The FDA's Center for Tobacco Products began regulating tobacco products in 2009. That regulation does not include e-cigarettes unless the device is used as approved for therapeutic purposes.
If the Center wants to regulate anything else as a "tobacco product," like e-cigarettes, it has to propose a rule and solicit public comment to the Office of Management of Budget, Office of Information and Regulatory Affairs. It did just that on Oct. 1, 2013.
When asked future plans for possible regulation of e-cigarettes, the FDA provided this statement:
"Electronic cigarettes are battery-operated products that turn nicotine, which is highly addictive, and/or other chemicals into a vapor that is inhaled by the user. The FDA regulates electronic cigarettes that are marketed for therapeutic purposes as drugs or devices. The FDA intends to propose a regulation that would extend the agency's 'tobacco product' authorities -- which currently only apply to cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco -- to other categories of tobacco products that meet the statutory definition of 'tobacco product.' Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products."
The tobacco products that currently fall under FDA regulation are: cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco.
The FDA’s Center for Drug Evaluation and Research oversees regulation of e-cigarettes used for therapeutic purposes. So far none have been FDA approved.
Even though the FDA only currently regulates electronic cigarettes if they make a therapeutic claim, consumers may submit voluntary adverse event reports to the FDA for all electronic cigarettes through the HHS Safety Reporting Portal.