On October 12th this year, the U.S Food and Drug Administration (FDA) permitted the marketing of vaping products. Supposedly, vaping poses fewer risks to our health than smoking does. But is this really the case?
Scientists didn’t establish a firm connection between smoking and cancer until 50 years after cigarettes were first invented. Widespread vaping (in the form we see today) is less than 20 years old.
What is vaping and why is it FDA approved?
Vaping involves inhaling the vapour of an electronic cigarette (e-cigarette) or another vaping device. These battery-powered devices warm an enclosed liquid that usually contains nicotine, flavouring and chemicals.
The RJ Reynolds Vapour Company submitted data to the FDA, arguing it is appropriate to market these products for the protection of public health (on the basis that vaping is a healthier alternative to smoking). The FDA approved this data and supplied marketing granted orders to RJ Reynolds Vapour Company. Specifically, these grants permit marketing of the vaping company’s Vuse Solo closed ENDS device and its tobacco-flavoured e-liquid pods.
The vaping manufacturer’s data showed that its tobacco-flavoured products might be an advantage to addicted smokers. Supposedly, by switching to vaping, smokers will consume fewer cigarettes and have less exposure to harmful chemicals. But is vaping really less harmful than smoking?
Interestingly, despite legalising the products for RJ, the FDA recognised that vaping products are not necessarily safe. It noted that all tobacco products are harmful and addictive and those who do not use tobacco products should not start.
How did vaping start?
The origins of vaping give insight into why e-cigarette manufacturers and the FDA support the view of vapes as a healthier alternative. As doctors linked lung and lip cancers with cigarette smoking in the 1950s and 1960s, inventors embarked on a mission to find a less harmful – and less smelly – way to inhale nicotine.
In 1963, Herbert Gilbert designed a ‘smokeless non-tobacco cigarette.’ Gilbert intended his machinery to be ‘a safe and harmless means for and method of smoking.’
Gilbert dubbed his device ‘the Smokeless.’ The battery-powered machinery warmed an enclosed liquid, creating vapour when a person inhaled. Gilbert flaunted the device’s seemingly remarkable potential in inhibiting the risk of disease from tobacco use. He even promoted it for weight loss! This original device contained zero nicotine.
However, he struggled to convince any manufacturers to bring the device to market.
In 1979, Phil Ray (one of the pioneers of computers) worked with Norman Jacobson (his personal physician) to craft the first commercialised version of the e-cigarette. The product reached major retailers, but the device was not a promising technology for the nicotine delivery that many smokers sought.
In the 1990s, products that closely resembled contemporary e-cigarettes gravitated toward commercialisation. Both tobacco companies and individual inventors filed patents for nicotine inhaler devices throughout the 20th century.
In 2003, Chinese pharmacist Hon Lik invented the first commercially successful vaping device. Lik created the e-cigarette after his father (a heavy cigarette smoker) died of lung cancer. The reasoning behind Lik’s invention is where the idea that vaping is better than smoking originated. He created the vaping device to help smokers quit. Golden Dragon Holdings soon developed the device and marketed it under the name ‘Ruyan’, meaning ‘like smoke.’
In 2006, e-cigarette devices were introduced to Europe and to the U.S. However, two years later, in 2008, the World Health Organisation (WHO) announced that e-cigarettes were not a legitimate smoking cessation aid. They demanded that marketers immediately remove the suggestion that vaping devices are safe and effective.
WHO have maintained this position well into 2021. The global health body branded e-cigarettes as harmful. Additionally, they warned there need to be stronger regulations to protect children and teenagers who may use the devices as a gateway to tobacco consumption.
As the vape market expands, e-cigarettes and other vaping devices are technologically morphing to remain relevant and desirable.
From when it first started, the vaping industry today looks remarkably different. Modern vaping technology now guarantees a smooth experience with options for Bluetooth, voice activation and long-lasting battery enhancements.
The most popular vapes among young people are pod mods. Due to their user-friendliness and auto-firing function, these devices are portable and easy to use. With most pod mods, users can simply open the packaging, put a liquid-filled pod into the device and begin vaping.
There are three categories of pod mod vaping devices. An open system, a closed system, or a system that uses both.
Open pod systems consist of a pod mod and a refillable pod cartridge. This system gives users the advantage of choosing any e-liquid they like.
Closed pod systems were the first type of pod device on the market. This system consists of a battery and a pod cartridge. However, the cartridge is not refillable, and it already contains juice.
Sub-Ohm vapes are another type of vape that is increasingly in demand. These devices have atomisers with resistance that falls lower than 1 ohm. Owing to this low resistance, they can produce intense vapour clouds. Many users prefer sub-ohm use for the aesthetics and ‘party tricks.’ However, research suggests sub-ohm vaping may be more detrimental to lung health than regular vaping conditions.
Culture of vaping
Vaping is no longer just an alternative to cigarette smoking. The devices are no longer just being used by people wanting to quit smoking tobacco. Rather, vaping in itself has become enmeshed within an elaborate culture, and for many teens, it’s difficult to ‘just say no.’
Many vaping companies have their own conventions and expos, offering a range of products and vendors. At these events, parties, vaping contests and trading shows provide opportunities for vapers and manufacturers to socialise.
Moreover, people can buy vape company products. From phone covers and headphones to backpacks and skateboards, vaping merchandise proliferates beyond a simple battery-powered stick.
Today, increasing laws around smoking and vaping in different parts of the world have caused online vaping forums to flourish. In these digital spaces, people share ideas on vaping and consolidate harmful behaviour.
Vaping as trendy
For many young people, vaping is an artistic way to play and create. Vaping ‘tricks’ range from smoke-filled rings that glide from the user’s mouth or the phenomenon of ‘cloud chasing.’ Cloud chasing –now a competitive sport supported by sponsors – involves blowing enormous vapour clouds with a vaping device. Users who participate in this trend are known as ‘cloud chasers’, and they are constantly looking for new ways to generate the biggest vapour clouds. Sometimes, this involves lower ohm coils, higher wattages and masses of airflow – all of which can increase the health risks of vaping.
Vaping as a social practice
According to a study, it is clear that vapers treat vaping as a practice distinct from the behaviour of smoking.
The practice of vaping fits into the acquainted routines of charging and carrying personal hand-held electronic devices such as smartphones. In this way, vaping bears similarities to the technological field young people know and love today.
Unlike smoking (which is typically spatially restricted), vaping can be easily integrated with a range of social practices from driving, eating out, watching television and working.
When researchers asked participants when they vaped, the responses illuminated the way vaping has become easily integrated into everyday life:
‘In the car to and from work, in the office, at home watching TV, on my computer, with my morning coffee, anywhere really, although at a pub I always check with management if they will allow me to use my PV.’
‘I use it everywhere I would have used a cigarette in the old times, at home, visiting friends, in cafes …’
‘At work, during a break at home, relaxing, social venues, pubs, clubs, and anytime, anywhere and everywhere I normally wanted to smoke previously.’
‘All the time. It’s like having a giant cup of coffee that never runs out or gets cold. All day long whenever I feel like it’
Statistics and demographics of vaping
In a U.S. context, the use of e-cigarettes has steadily increased since they were first introduced. In particular, vaping amongst young people has been on the rise with about 28% of high school students and 11% of middle school students reporting current use of vaping devices in 2017.
A more recent study found over 40% of college students in South-central Appalachia were vaping. Interestingly, the findings noted that gender, high school location, seatbelt usage, and texting or emailing were indicative factors of whether or not someone took up vaping. Those who engaged in other risky behaviours were more likely to be vapers.
A study in 2020 discovered that men were more likely than women to take up vaping. The prevalence of E-cigarette usage was significantly higher among non-Hispanic White individuals and those with higher education level (excluding individuals with a college degree who had the lowest usage rate). This study also found that across all demographics, most vapers were current or former smokers. However, there were differences by age. Most vapers who never smoked were between 18 and 24 years old (63.4%), with 23.8% between 25 and 34 years old. Contrastingly, vapers who were current or former smokers tended to be older.
Most vapers were younger than 35 years. Nicotine is extremely addictive. Prolonged use can negatively affect brain development in young people, which continues until the age of 25 years.
Vaping and teens
In the U.S., researchers describe vaping among teens as an ‘epidemic.’ While there has been a decrease in the number of teenagers smoking tobacco cigarettes over the past 20 years, vaping has doubled among adolescents since 2017. With the appealing vapours and less harsh draw, youths report that vapours are easier and more enjoyable to inhale than burned tobacco.
Nowadays, young people can easily get their hands on vaping devices (usually online) without showing any identification of their age. With many youths now exposed to nicotine at an earlier age, there is now an earlier onset of smoking for these people. In other words, vaping is a gateway to tobacco consumption. It lays the groundwork for future addiction.
Undoubtedly, the health risks are worrying. Vaping nicotine at a young age can reduce prefrontal cortex activity in the brain, negatively affecting concentration and memory. Nicotine can also harm parts of the brain that control learning, impulse control, mood and attention. The adolescent brain keeps developing until around the age of 25. But nicotine can hinder this development by changing the way brain synapses are formed.
Young people typically have low awareness of these vaping risks. The youth-targeted marketing campaigns and lack of communication about adverse health effects by vaping companies are partly to blame for this ignorance. In the U.S., a national survey found that only 37% of young JUUL users aged 15-24 knew the product contained nicotine.
Does the FDA approval pose risks to teens?
The FDA’s authorisation only relates to tobacco-flavoured e-liquid for vaping devices, not the fruitier flavours that youth are supposedly more attracted to. Therefore, it’s argued that the FDA’s approval will not affect teens. However, questions may be raised as various e-cigarette companies follow suit and try to get their products authorised. This approval may set a precedent for other harmful products to be marketed and sold in the future.
How to prevent your teen from using E-cigarettes
- Talk to your teen about why e-cigarettes are harmful for them. Tell them what the vaping companies don’t tell us.
- Set a good example by restraining from tobacco use and ensure that your teen is not exposed to the second-hand emissions from all tobacco products.
- Get the Talk With Your Teen About E-Cigarettes tip sheet. Start the conversation early with teens about why e-cigarettes are harmful.
Vaping marketing and advertisement
E-cigarette companies use the ‘healthier alternative’ frame as a persuasive tool to market and sell their products. Let’s not forget that like tobacco companies, vape manufacturers are businesses. Their primary goal is to make a profit, and if this comes at the expense of our health, then ‘too bad’ from the business perspective.
E-cigarette marketing extensively targets young adults. Youth typically have a high awareness of vaping products, which are now the most popular smoking product among younger age groups. By 2016, nearly 4 out of 5 middle and high school students, or more than 20 million youth, saw at least one e-cigarette advertisement.
E-cigarette companies use various marketing tactics to target young consumers.
Firstly, vaping companies have offered monetary prizes (ranging from $250 to $5000) to young people in exchange for vaping essays that emphasise the potential benefits of the harmful behaviour. E-cigarette manufacturers often maintain that their products are intended for adult use only. However, many of these prize offerings are open to younger teens or have no age limit.
Secondly, e-cigarette companies use social media to create buzz that appeals to the younger generation. Brands like JUUL have spent over $1 million to market their sleek product on the internet and social media. The company pays for digital campaigns that promote images associating JUUL with being cool and trendy, having freedom and having sex appeal.
Sponsoring music festivals and events
Thirdly, e-cigarette companies have sponsored music festivals and events to promote their products. In 2013, blu eCigs® sponsored the Sasquatch! Music Festival in Washington. This event featured a vaping lounge complete with device charging stations, e-cig samples and guest appearances from famous artists. In 2018, JUUL sponsored a “Music in Film Summit” at Utah’s 2018 Sundance Film Festival. While these marketing tactics are heavily banned for tobacco companies, e-cigarette companies have found loopholes with experimental marketing (the tactic of encouraging consumers to experience or interact with a brand at recreational venues and events).
Advertising appealing flavours
The Family Smoking Prevention and Tobacco Control Act (2009) bans flavours in conventional cigarettes (excluding menthol). However, seemingly delicious flavours (like apple pie, blueberry ice and cotton candy) are not restricted in e-cigarette products.
The 2016 National Youth Tobacco Survey found that flavours were one of the top reasons young people take to vaping. Moreover, a study with middle and high school participants found that over 40% of young people who had never smoked before tried e-cigarettes because of the appealing flavours.
There are vaping juices available that do not contain any nicotine. However, some e-cigarette labels marked as containing 0% nicotine have been found to contain nicotine. Moreover, nicotine may not be the only harmful chemical. Just because a vape has no nicotine, it doesn’t mean it is ‘healthy.’ For instance, some of the ingredients in e-cigarette aerosols and flavourings pose grave risks to the lungs in the long term.
What is an e-cigarette aerosol? It is NOT harmless water vapour. The aerosol breathed in from the battery-powered device can contain harmful substances such as cancer-causing chemicals, heavy metals like nickel and lead, and tiny particles that get lodged deep in the lungs.
FDA vaping marketing restrictions
The FDA’s recent approval of marketing for vaping products has some restrictions. RJ Reynolds Vapour Company will have TV and radio advertising restrictions to reduce the potential for youth exposure. The vape company will also have to report frequently to the FDA with information regarding the marketed products. Moreover, they will have to provide ongoing information related to consumer research studies, marketing plans, sales data and manufacturing changes.
Vaping dangers backed by scientific research
E-cigarettes were initially invented to help cigarette smokers quit. However, whether or not vaping actually fulfils this function remains unclear. In one study, only 9% of those who tried e-cigarettes to decrease their use of tobacco cigarettes were successful in quitting (Franck, Filion, Kimmelman, Grad, & Eisenberg, 2016).
Even if people are successful at making the digital switch, they may not be making a ‘healthier’ choice. Numerous medical studies have emerged detailing the links between vaping and severe health issues such as heart disease and lung cancer. So, even if smokers relinquish their tobacco obsession and turn to the digital form, the health risks are not alleviated.
Cardiovascular diseases are one of the major health threats around the world. It is one of our biggest killers.
Research shows that high nicotine levels in adults with pre-existing cardiac disease can increase the risk of injury or death because it increases cardiac adrenaline levels and blood pressure.
E-cigarettes produce an aerosol that consists of ultrafine particles in greater concentration than cigarette smoke. According to Penn Medicine, these particles can become lodged deep in the lungs and aggravate asthma. They may also constrict arteries which increases the risk of a heart attack. Vaping can raise blood pressure and spike adrenaline, again increasing the risk of having a heart attack.
In 2017, a survey found that the likelihood of having a heart attack increased by 42 per cent among e-cigarette users compared to their non-vaping counterparts.
E-cigarette vapour contains numerous chemicals that scientists have linked to lung diseases:
- Diacetyl: a butter-flavoured chemical linked to lung disease
- Benzene: a cancer-causing chemical used to create dyes and pesticides
- Formaldehyde: a cancer-causing chemical used in building materials and household products
- Acrolein: a herbicide linked to lung injury
In 2019, researchers found that vaping increases the likelihood of developing asthma and chronic obstructive pulmonary disease – conditions prevalent among cigarette smokers. While research on the long-term effects of vaping is still on-going, so far, the early science tells us that vaping is certainly not a ‘healthier’ alternative to cigarette smoking.
Vaping associated acute lung injury
In 2019, there was a worrying increase in lung injury cases in patients who had a vaping history in the US. This lung injury is known as ‘E-cigarette or Vaping Associated Lung Injury’ or EVALI. In January 2020, researchers reported over 2600 cases of EVALI to the centres for disease control and prevention. Shockingly, 16% of these cases existed in people under the age of 18. Although the exact cause of EVALI is unproven, there is a strong association with the use of vaping products that contain vitamin E acetate.
The symptoms of EVALI or vaping illness are:
- Shortness of breath
- Fever and chills
- Rapid heart rate
- Chest pain.
The case of Dakota
In Australia, a 15-year-old girl called Dakota found herself in the ICU last year. Her doctors thought she might have COVID, but it was actually vaping that caused her ill-health. Dakota had been vaping for the past seven months, up to three times a week. As a result, she developed EVALI. At the peak of her condition, she had to be ventilated on oxygen for three days to save her from drowning after her lungs filled with fluid. The teen now warns others about the potential dangers of vaping.
Vaping and addiction
Over time, the brain and body become accustomed to nicotine. After only a few days to weeks of use, vapers may have nicotine withdrawal symptoms if they try to quit.
Common vaping withdrawal symptoms include:
- Feeling irritable, restless, or jittery
- Having headaches
- Increased sweating
- Feeling sad, anxious or tired
- Having trouble thinking clearly, concentrating, or trouble sleeping
- Feeling hungry
- Having intense cravings for e-cigarettes
Research shows that the appealing flavours offered by vape companies are key promoters of addiction. This study found that those who used flavoured e-cigarettes reported greater satisfaction and self-perceived addiction than those who used non-flavoured e-cigarettes.
Conclusion: FDA’s vaping approval does not mean it is safe
While the FDA’s approval permits tobacco pods and nicotine-filled devices to be sold in the U.S., it doesn’t mean the products are safe. They may be an alternative for heavy smokers, but all nicotine-containing products are still addictive and health-harming. They should most definitely not be adopted by young people or non-smokers; an addiction that was previously not a problem is likely to arise.
Nicotine is still nicotine, whether it’s in a paper tobacco cigarette or a battery-powered device. Moreover, people seem to neglect the cocktail of other cancer-causing chemicals present in vaping e-liquid. While there isn’t yet an abundance of scientific research on the connection between vaping and ill-health, vaping as a practice is significantly younger than smoking. Nonetheless, we still see the emerging consequences of vaping in the increasing prevalence of lung conditions such as EVALI.
The culture of vaping poses significant risks to young people, particularly because this is the age group that e-cigarette companies most vigorously target. Young people who begin vaping at an early age are more likely to get addicted to nicotine. While vapes were originally created to help smokers quit, they may have the opposite effect.
The FDA approved the marketing of products for the RJ Reynolds Vapour Company on the basis of ‘public health’. However, as backed by research, vaping is not safer than smoking. With teens having increased access to products through online purchases, the approval of these products heightens the likelihood that non-smokers will also adopt the vaping habit.