tag:theconversation.com,2011:/us/topics/nicotine-4806/articlesNicotine – The Conversation2024-03-05T16:03:57Ztag:theconversation.com,2011:article/2229462024-03-05T16:03:57Z2024-03-05T16:03:57ZTo stop teenagers vaping they need to see it as cringe, not cool<figure><img src="https://images.theconversation.com/files/579543/original/file-20240304-20-xtxrty.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5449%2C3788&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-sept-8-2019-man-1498869299">Amani A/Shutterstock</a></span></figcaption></figure><p>The proportion of young people who vape has grown significantly over the last year. According to charity <a href="https://ash.org.uk/resources/view/use-of-e-cigarettes-among-young-people-in-great-britain">Action on Smoking and Health</a>, the proportion of young people aged 11 to 17 in Great Britain who have experimented with vaping has risen from 15.8% in 2022 to 20.5% in 2023. </p>
<p>Vapes often come in gratifying and seemingly innocuous flavours, such as bubblegum, candy floss and sherbet, and in colourful and enticing packaging that is likely to <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/cb.362?saml_referrer">appeal to younger consumers</a>. </p>
<p>What’s more, young people may see vaping as a safe alternative to smoking. A 2015 review from Public Health England stated that e-cigarettes were <a href="https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review">“95% safer” than cigarettes</a>. This messaging was meant for adults addicted to cigarettes – but it has led to the perception that vaping is not harmful. </p>
<p>Nevertheless, vapes can contain <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html#:%7E:text=The%20e%2Dcigarette%20aerosol%20that,to%20a%20serious%20lung%20disease">potentially harmful and addictive substances</a>, such as nicotine and flavourings linked to lung disease.</p>
<p>In response, the <a href="https://www.gov.uk/government/news/disposable-vapes-banned-to-protect-childrens-health">government has announced</a> several measures which aim to stop vaping appealing to younger consumers. This includes a ban on the sale of disposable vapes, restrictions on appealing vape flavours, introducing plainer packaging and tighter restrictions on how retailers display vapes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/disposable-vape-ban-local-communities-voiced-their-concerns-and-the-government-has-listened-221906">Disposable vape ban: local communities voiced their concerns – and the government has listened</a>
</strong>
</em>
</p>
<hr>
<p>This a start, but more needs to be done. A public health awareness campaign that speaks directly to <a href="https://journals.sagepub.com/doi/full/10.1177/1179173X20945695">young people</a> who are currently vaping or more <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8270-3#:%7E:text=Vaping%20was%20more%20common%20overall,relatively%20low%20rates%20of%20vaping%20%2D">susceptible to vaping</a> and seeks to make it seem cringe, not cool, could help to break the connection between vaping and social approval. </p>
<h2>Why teens vape</h2>
<p>The popularity of vaping may be linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296881/">peer pressure</a> – young people might start vaping to fit in or to impress their peers by experimenting with new things. Young people are at a critical age where they are learning to <a href="https://www.nature.com/articles/nrn3313">assert their independence</a>, and place more value on the approval and support of their peers than their parents.</p>
<p>Teenagers’ brains are more sensitive to the feelings and excitement derived from taking risks than adults’ brains are. </p>
<p>When young people think their peers are observing them, they are more likely to take risks – the reward response is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075496/">amplified</a>. This has been linked with teenagers being more predisposed to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0273229721000368?casa_token=HiKmVsY9010AAAAA:z0t6E8qMRVSD9lWpwd-dvRiQbuqcX6C-iH0l_g7eKzLA3VMAbTrW3jFh0HEzfJsoxykHDJlfDJk">risky health behaviour</a>, like vaping. </p>
<figure class="align-center ">
<img alt="Person in hoodie seen from behind blowing smoke rings" src="https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teenagers are more predisposed to take risks with their health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-male-red-hoodie-vaping-smoking-1509908339">Chicken Strip/Shutterstock</a></span>
</figcaption>
</figure>
<p>There are huge numbers of posts on social media platforms that position vaping as exciting and fun to teenagers. Popular and trending hashtags include #vapetrick, #vapefam and #vapelife. These serve to create connections and draw teenagers into a community, feeding into their need for social approval among their peers. </p>
<p>To make vaping cringe among young people they need to see it as embarrassing, disgusting and culturally unacceptable – as young people are concerned with how others judge them. Role models who focus on the negative <a href="https://digitalcommons.wayne.edu/cgi/viewcontent.cgi?article=1781&context=oa_dissertations">social consequences</a> of vaping are likely be more effective in motivating young people to see vaping as cringe.</p>
<h2>Break the connection with cool</h2>
<p>One way to break the connection with social approval, in a way that would chime with young people, would be to to involve <a href="https://www.tandfonline.com/doi/full/10.1080/1553118X.2022.2042694">social media influencers</a>. Influencers carry significant credibility with teenagers, acting as <a href="https://wsj.westscience-press.com/index.php/wsshs/article/view/548">trendsetters</a> and affecting <a href="https://www.tandfonline.com/doi/full/10.1080/1553118X.2022.2042694">social norms</a>.</p>
<p>How vaping is depicted in <a href="https://journals.sagepub.com/doi/10.1177/10901981221086944">films and across media platforms</a>, such as online video channels, also requires careful monitoring. Limiting depictions of vaping and where it is present, presenting it as undesirable behaviour rather than as cool, may go some way to limit young people wanting to vape. </p>
<p>Stronger regulation of vaping content on social media platforms popular with younger people is essential, such as monitoring the use of popular hashtags. Some platforms have started to do this. TikTok displays a warning message stating “Be informed and aware” with a link to more information on <a href="https://www.tiktok.com/safety/en-gb/substance-support/">substance support</a> when anyone searches for vaping content. </p>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/20563051211008828">Education</a> programmes typically focus on teaching young people how to critically evaluate information they encounter online, not how social media algorithms affect the content pushed towards them. School education programmes should openly discuss the potential harmful impact algorithms can have on their consumption experiences.</p>
<p>Another measure to implement would be to raise the price of vapes. This has had a significant impact on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7147-9">reducing the rate</a> of young people smoking: they are likely to be more sensitive to changes in price than adults. A <a href="https://www.theguardian.com/uk-news/2024/feb/27/budget-2024-jeremy-hunt-vaping-tax-ni-cut-vapes-tax-cuts">planned tax increase</a> from the government on vaping in the 2024 budget could have a positive effect here. </p>
<p>But care also needs to be taken in limiting teenagers’ access to vaping products. When supply of the energy drink <a href="https://www.businessinsider.com/prime-ksi-logan-paul-drink-sparked-black-market-uk-2023-2?r=US&IR=T">Prime</a> – a product also popular among younger consumers – was limited, this led to a black market emerging. Young people went to great lengths to acquire the product as a status symbol to gain social approval. Making vapes difficult to acquire could lead to young people vaping to gain kudos among their peers.</p><img src="https://counter.theconversation.com/content/222946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Moorlock does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Influencers could play an important role in encouraging teenagers not to vape.Emily Moorlock, Senior Lecturer in Marketing, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230842024-02-25T19:05:37Z2024-02-25T19:05:37ZNicotine pouches are being marketed to young people on social media. But are they safe, or even legal?<figure><img src="https://images.theconversation.com/files/576964/original/file-20240221-30-zpsdc9.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5024%2C3357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-hands-hold-hand-box-snus-2134161211">Piskova Photo/Shutterstock</a></span></figcaption></figure><p>Flavoured nicotine pouches are <a href="https://www.theguardian.com/australia-news/2024/feb/07/all-good-to-take-to-school-australian-influencers-spruik-flavoured-nicotine-pouches-to-vape-addicted-youths">being promoted to young people</a> on social media platforms such as TikTok and Instagram. </p>
<p>Although some viral videos have been taken down following a series of reports in <a href="https://www.theguardian.com/australia-news/2024/feb/08/albanese-government-condemns-widespread-marketing-of-nicotine-pouches-to-young-people">The Guardian</a>, clips featuring <a href="https://www.tiktok.com/@anabolicgabe/video/7300486987331472641">Australian influencers</a> have claimed nicotine pouches are a safe and effective way to quit vaping. A number of the videos have included links to websites selling these products.</p>
<p>With the rapid rise in youth vaping and the subsequent <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">implementation of several reforms</a> to restrict access to vaping products, it’s not entirely surprising the tobacco industry is introducing more products to maintain its future revenue stream.</p>
<p>The major trans-national tobacco companies, including Philip Morris International and British American Tobacco, all manufacture nicotine pouches. British American Tobacco’s brand of nicotine pouches, Velo, is a leading sponsor of the <a href="https://www.formula1.com/en/latest/article.mclaren-new-livery-reveal-2024-f1-season.216OAbbqt6SWUjIio6GLqP.html">McLaren Formula 1 team</a>.</p>
<p>But what are nicotine pouches, and are they even legal in Australia?</p>
<h2>Like snus, but different</h2>
<p>Nicotine pouches are available in many countries around the world, and their sales are <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">increasing rapidly</a>, especially among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203764/">young people</a>.</p>
<p>Nicotine pouches look a bit like small tea bags and are placed between the lip and gum. They’re typically sold in small, colourful tins of about 15 to 20 pouches. While the pouches <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915420/">don’t contain tobacco</a>, they do contain nicotine that is either extracted from tobacco plants or made synthetically. The pouches come in a wide range of strengths. </p>
<p>As well as nicotine, the pouches commonly contain plant fibres (in place of tobacco, plant fibres serve as a filler and give the pouches shape), sweeteners and flavours. Just like for vaping products, there’s <a href="https://storage.googleapis.com/who-fctc-cop10-source/Supplementary%20information/nicotine_pouch_paper.pdf">a vast array</a> of pouch flavours available including different varieties of fruit, confectionery, spices and drinks.</p>
<p>The range of appealing flavours, as well as the fact they can be used discreetly, may make nicotine pouches particularity attractive to young people.</p>
<figure class="align-center ">
<img alt="Two teenage girls vaping on a blanket in a park." src="https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaping has recently been subject to tighter regulation in Australia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-lgbt-teenagers-bisexual-lesbian-young-1535887709">Aleksandr Yu/Shutterstock</a></span>
</figcaption>
</figure>
<p>Users absorb the nicotine in their mouths and simply replace the pouch when all the nicotine has been absorbed. Tobacco-free nicotine pouches are a relatively recent product, but similar style products that do contain tobacco, <a href="https://tobaccotactics.org/article/snus/">known as snus</a>, have been popular in Scandinavian countries, particularly Sweden, for decades.</p>
<p>Snus and nicotine pouches are however different products. And given snus contains tobacco and nicotine pouches don’t, the products are subject to quite different regulations in Australia.</p>
<h2>What does the law say?</h2>
<p>Pouches that contain tobacco, like snus, have been banned in Australia since 1991, as part of a <a href="https://www.productsafety.gov.au/products/health-lifestyle/personal/tobacco-related-products/smokeless-tobacco-products">consumer product ban</a> on all forms of smokeless tobacco products. This means other smokeless tobacco products such as chewing tobacco, snuff, and dissolvable tobacco sticks or tablets, are also banned from sale in Australia.</p>
<p>Tobacco-free nicotine pouches cannot legally be sold by general retailers, like tobacconists and convenience stores, in Australia either. But the reasons for this are more complex.</p>
<p>In Australia, under the <a href="https://www.legislation.gov.au/F2024L00095/latest/downloads">Poisons Standard</a>, nicotine is a prescription-only medicine, with two exceptions. Nicotine can be used in tobacco prepared and packed for smoking, such as cigarettes, roll-your-own tobacco, and cigars, as well as in preparations for therapeutic use as a smoking cessation aid, such as nicotine patches, gum, mouth spray and lozenges.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">From today, new regulations make it harder to access vapes. Here's what's changing</a>
</strong>
</em>
</p>
<hr>
<p>If a nicotine-containing product does not meet either of these two exceptions, it cannot be legally sold by general retailers. No nicotine pouches have currently been approved by the <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/nicotine-pouches">Therapeutic Goods Administration</a> as a therapeutic aid in smoking cessation, so in short they’re not legal to sell in Australia.</p>
<p>However, nicotine pouches can be legally imported for personal use only if users have a prescription from a medical professional who can assess if the product is appropriate for individual use.</p>
<p>We only have anecdotal reports of nicotine pouch use, not hard data, as these products are very new in Australia. But we do know authorities are increasingly <a href="https://www.9news.com.au/national/more-than-1-million-in-vapes-nicotine-products-seized-in-raids-across-sydney/e86beb9b-437f-4904-b0cc-d1c46bfb2ef3">seizing these products</a> from retailers. It’s highly unlikely any young people using nicotine pouches are accessing them through legal channels.</p>
<h2>Health concerns</h2>
<p>Nicotine exposure <a href="https://adf.org.au/drug-facts/nicotine/">may induce effects including</a> dizziness, headache, nausea and abdominal cramps, especially among people who don’t normally smoke or vape.</p>
<p>Although we don’t yet have much evidence on the long term health effects of nicotine pouches, we know nicotine is addictive and <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">harmful to health</a>. For example, it can cause problems in the cardiovascular system (such as heart arrhythmia), particularly at high doses. It may also have negative effects on <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/nicotine-pouches">adolescent brain development</a>.</p>
<p>The nicotine contents of some of the nicotine pouches on the market is alarmingly high. Certain brands offer pouches containing more than <a href="https://truthinitiative.org/research-resources/emerging-tobacco-products/what-zyn-and-what-are-oral-nicotine-pouches">10mg of nicotine</a>, which is similar to a cigarette. According to a World Health Organization (WHO) <a href="https://iris.who.int/bitstream/handle/10665/3724%20yes63/9789240079410-eng.pdf?sequence=1">report</a>, pouches deliver enough nicotine to induce and sustain nicotine addiction.</p>
<p>Pouches are also being marketed as a product to use when it’s not possible to vape or smoke, such as <a href="https://www.velo.com/gb/en/blog/post/flying-with-nicotine-products">on a plane</a>. So instead of helping a person quit they may be used in addition to smoking and vaping. And importantly, there’s <a href="https://factcheck.afp.com/doc.afp.com.34JC8Q2">no clear evidence</a> pouches are an effective smoking or vaping cessation aid.</p>
<figure class="align-center ">
<img alt="A Velo product display at Dubai airport in October 2022." src="https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Velo product display at Dubai airport in October 2022. Nicotine pouches are marketed as safe to use on planes.</span>
<span class="attribution"><span class="source">Becky Freeman</span></span>
</figcaption>
</figure>
<p>Further, some nicotine pouches, despite being tobacco-free, still contain <a href="https://tobaccocontrol.bmj.com/content/early/2022/08/05/tc-2022-057280.abstract">tobacco-specific nitrosamines</a>. These compounds can damage DNA, and with long term exposure, can cause cancer. </p>
<p>Overall, there’s limited data on the harms of nicotine pouches because they’ve been on the market for only a short time. But the WHO <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">recommends a cautious approach</a> given their similarities to smokeless tobacco products.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-missing-ingredient-australia-needs-to-kick-its-smoking-addiction-for-good-167973">The missing ingredient Australia needs to kick its smoking addiction for good</a>
</strong>
</em>
</p>
<hr>
<p>For anyone wanting advice and support to quit smoking or vaping, it’s best to talk to your doctor or pharmacist, or access trusted sources such as <a href="https://www.health.gov.au/contacts/quitline">Quitline</a> or the <a href="https://www.icanquit.com.au/">iCanQuit website</a>.</p><img src="https://counter.theconversation.com/content/223084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Cancer Institute Vaping Communications Advisory Panel. These are unpaid roles. She has received relevant competitive grants that include a focus on e-cigarettes/vaping from the NHMRC, MRFF, NSW Health, the Ian Potter Foundation, VicHealth, and Healthway WA; relevant research contracts from the Cancer Institute NSW and the Cancer Council NSW; relevant personal/consulting fees from the World Health Organization, the Hong Kong Special Administrative Region Department of Health, BMJ Tobacco Control, the Heart Foundation NSW, the US FDA, the NHMRC e-cigarette working committee, NSW Health, and Cancer Council NSW; and relevant travel expenses from the Oceania Tobacco Control Conference and the Australia Public Health Association preventive health conference.</span></em></p>Nicotine pouches are placed between the lip and gum, and users absorb the nicotine in their mouths. Although these products don’t contain tobacco, this doesn’t mean they’re safe.Becky Freeman, Associate Professor, School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214122024-01-23T19:00:02Z2024-01-23T19:00:02ZFor the new vape laws to succeed, these 3 things need to happen – or users may look to the illicit market<figure><img src="https://images.theconversation.com/files/570782/original/file-20240123-15-tpau1a.jpg?ixlib=rb-1.1.0&rect=17%2C511%2C5973%2C3476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-next-to-a-man-IktGJT61bG4">Ernst Gunther Krause/Unsplash</a></span></figcaption></figure><p>This year, the Australian government will progressively <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">ban</a> the retail sale of all e-cigarettes, known as vapes. Vapers will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">only be allowed</a> to use nicotine vapes that comply with <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/reforms-regulation-vapes">Therapeutic Goods Administration</a> (TGA) product requirements – and only to help them quit or manage their nicotine dependence, if prescribed by a doctor and dispensed by a pharmacy.</p>
<p>This will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">accompanied by</a> increased funding for law enforcement to prevent illegal importation of vapes, a public education campaign about the risks of vaping, and greater efforts to encourage smokers to only obtain their vapes on prescription.</p>
<p>But for the scheme to be successful, three things need to happen: vaping products that vapers will use need to be available, GPs need to be willing to write prescriptions, and pharmacies need to be able to meet the demand. None of these are guaranteed. </p>
<p>Failure to do so could see some people continue to use the illicit market for vapes, or to switch to traditional cigarettes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">From today, new regulations make it harder to access vapes. Here's what's changing</a>
</strong>
</em>
</p>
<hr>
<h2>The previous vape policy failed</h2>
<p>The new policy tightens the enforcement of a <a href="https://link.springer.com/chapter/10.1007/978-3-031-23658-7_1#Sec5">retail sales ban on vapes containing nicotine</a> first introduced in <a href="https://www.aph.gov.au/DocumentStore.ashx?id=b57abf1c-0e4f-49a5-a3a3-2bb02ea76bf3&subId=401164">2011</a>. This only allowed smokers to use nicotine vapes if they had been approved for smoking cessation (quitting) by the TGA and were prescribed by a doctor to help them quit smoking. </p>
<p>The TGA’s expectation was that nicotine vapes would eventually be produced that would be approved for prescription. When no vapes had been approved by 2021, the TGA <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-final/notice-final-decision-amend-current-poisons-standard-nicotine">reclassified nicotine</a> to allow doctors to prescribe unapproved nicotine vapes.</p>
<p>But these policies didn’t meet their objectives. <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">Fewer than 10% of vapers</a> obtained a prescription.</p>
<p>The TGA’s <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">impact assessment</a> of the 2021 policy shows it failed to prevent vaping among Australian youth or give smokers legal access to vapes. This was in large part because vape retailers illegally sold nicotine vapes as nicotine-free products (which were not banned) and sold colourful, flavoured disposable vapes that appealed to young people.</p>
<figure class="align-center ">
<img alt="Colourful vapes in a shop" src="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Retailers illegally sold nicotine vapes as ‘nicotine-free’ products.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-black-long-sleeve-shirt-holding-black-dslr-camera-hVcmxpYg1Gc">e Liquids UK/Unsplash</a></span>
</figcaption>
</figure>
<p>By the end of 2023, an <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">estimated</a> 1.3 million Australian adults were using vapes containing nicotine. The largest uptake was among young adults aged 18 to 24 and there was a worrying uptake among young people aged 14 to 17. More than <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">90% of vapes</a> were obtained illegally from retail vape stores and via internet sales.</p>
<h2>What are the new rules, and what are their aims?</h2>
<p>From January 1, the importation of disposable vapes <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">is banned</a>. </p>
<p>From March, there will be a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">complete ban</a> on the import of non-therapeutic vape products. Importers of therapeutic vapes will need a licence and permit from the government’s Office of Drug Control to import them. </p>
<p>The government will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">later set product standards</a> that limit flavours, reduce permissible nicotine concentrations and require pharmaceutical packaging of therapeutic vapes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
</strong>
</em>
</p>
<hr>
<p>The policy <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">aims</a> to reduce adolescent vaping by 2026 while allowing adult smokers to use vapes for quitting and managing nicotine dependence, by making them easier to access. </p>
<p>But there are major challenges in achieving these goals. </p>
<h2>1. Enough therapeutic products</h2>
<p>The TGA will need to ensure there are enough products that meet their product standards and that vapers will use. </p>
<p>It’s unclear how vape producers will be encouraged to notify the TGA that their device meets standards and whether vapers will be interested in using them. </p>
<p>However, vapes exist with specified nicotine levels that could be plain-packaged, if required.</p>
<h2>2. Doctors will need to prescribe them</h2>
<p>The new regulations allow any medical or nurse practitioner to prescribe nicotine vapes for smoking cessation and to manage nicotine addiction. </p>
<p>Given the existing <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">low uptake of vape prescribing</a> and strong discouragement from the <a href="https://www.ama.com.au/qld/news/Vaping-package-good-step-in-nicotine-control#:%7E:text=%E2%80%9CThere%20is%20little%20evidence%20to,use%20as%20a%20cessation%20aid">Australian Medical Association</a> and <a href="https://www.racp.edu.au/docs/default-source/advocacy-library/policy-on-electronic-cigarettes.pdf">medical colleges</a>, more medical practitioners will need to be persuaded to prescribe vapes. </p>
<figure class="align-center ">
<img alt="Doctor writes prescription" src="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Uptake of vape prescribing has been low.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-patient-consulting-room-gp-surgery-2367985555">Stephen Barnes/Shutterstock</a></span>
</figcaption>
</figure>
<p>GP guidelines for quitting recommend prescribing nicotine gum and patches, and vapes only if these products are unsuccessful. However, a <a href="https://pubmed.ncbi.nlm.nih.gov/38189560/">Cochrane review</a> of clinical trials found vapes were more effective for smoking cessation than nicotine gum and patches.</p>
<h2>3. Pharmacies need to dispense them</h2>
<p>There must be enough pharmacies prepared to dispense vapes. Pharmacy organisations are <a href="https://www.psa.org.au/nicotine-vaping-product-access-changes-coming/">cautiously supportive of the new regulations</a> but it’s unclear how many pharmacies will provide vapes. This may depend, in part, on demand for these products. </p>
<h2>Risks of the illicit market</h2>
<p>All of these challenges need to be met in two years. Failure to achieve these aims will sustain the illicit market for vapes. </p>
<p>Vapers who are unconcerned about the possibility of arrest for possessing vapes without a prescription (a <a href="https://www.criminaldefencelawyers.com.au/blog/is-vaping-illegal-in-australia/?utm_source=Mondaq&utm_medium=syndication&utm_campaign=LinkedIn-integration">criminal offence</a> in most states) may continue to use the illicit market.</p>
<p>Australian Border Force officials <a href="https://www.smh.com.au/politics/federal/smoke-alarm-warning-to-border-force-it-won-t-stop-vape-black-market-20240101-p5eujs.html">have conceded</a> they will not be able to prevent the illicit importation of vaping devices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
</strong>
</em>
</p>
<hr>
<p>There is also a risk some vapers will switch to cigarettes which, while expensive, are readily available. Vapes are not without harm, but toxicological analyses <a href="https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01737-5">conclude</a> they are <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html">less harmful</a> than conventional cigarettes.</p>
<h2>What if the vape regulations fail?</h2>
<p>If the vape laws aren’t successful, regulators must find another way to meet the policy’s goals of minimising youth vaping and reducing the size of the illicit vaping market. </p>
<p>One way would be to allow the sale of approved vapes to adult smokers under much tighter regulations than apply to cigarettes. This could mean banning disposable vapes and restricting sales of other vapes to licensed tobacconists on the condition that they will lose their licence if they sell to youth. This could be enforced by requiring the installation of CCTV in stores, as occurs in US cannabis retail outlets. </p>
<p>This alternative model could include many of the other regulations proposed: only allowing approved vaping devices, plain packaging, flavour restrictions and no advertising. But this <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13663">model</a> wouldn’t require a doctor’s prescription or restrict dispensing to pharmacies.</p><img src="https://counter.theconversation.com/content/221412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wayne Hall has been a paid advisor to the Therapeutic Goods Administration on the safety and effectiveness of medical cannabis (2017-2019) and was a member of Australian Advisory Council on Medicinal Uses of Cannabis, Commonwealth Department of Health, February 2017-2021. He has advised the World Health Organization on the health effects of cannabis, 2019-2023. He has not received any funding from the alcohol, pharmaceutical, tobacco or e-cigarette industries. His past research on tobacco related topics was funded by the National Health and Medical Research Council. The opinions expressed in this article are those of the author and do not necessarily reflect the view of the organisation where he works or its funders.</span></em></p>If the scheme isn’t successful, some people may continue using illicit vapes, or to switch to traditional cigarettes.Wayne Hall, Emeritus Professor, The National Centre for Youth Substance Use Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2188162023-12-31T20:28:06Z2023-12-31T20:28:06ZFrom today, new regulations make it harder to access vapes. Here’s what’s changing<figure><img src="https://images.theconversation.com/files/565086/original/file-20231212-23-grq40b.jpg?ixlib=rb-1.1.0&rect=5%2C1988%2C3946%2C3443&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-gray-sweater-smoking-cigarette-sitting-on-bench-during-daytime-3athPFPd5rs">Ryan Grice/Unsplash</a></span></figcaption></figure><p>This year the Australian government is introducing a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">series of measures</a> to restrict the availability of vapes, starting today.</p>
<p>The new reforms address loopholes in the current laws that allow easy access to highly addictive, flavoured, cheap, and harmful vaping products that are <a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">marketed to kids</a>. </p>
<p>Vaping products will still be available through a prescription for anyone using them to quit smoking. But the Therapeutic Goods Administration will <a href="https://www.tga.gov.au/news/media-releases/new-regulations-place-stronger-controls-importation-manufacture-and-supply-vapes">tightly regulate</a> prescription-only vapes.</p>
<p>So what are the new regulations? And why are they needed? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-in-vapes-toxins-heavy-metals-maybe-radioactive-polonium-210462">What's in vapes? Toxins, heavy metals, maybe radioactive polonium</a>
</strong>
</em>
</p>
<hr>
<h2>What was wrong with the previous regulations?</h2>
<p>Before the 2024 rule changes, vaping products imported and sold in Australia were required to be nicotine-free, unless accessed through a pharmacy with a prescription from a qualified health professional. </p>
<p>Individual users were also allowed to import nicotine-vapes from overseas through the <a href="https://www.tga.gov.au/products/personal-importation-scheme">Personal Importation Scheme</a>, provided they had a valid prescription. </p>
<p>The vaping industry – including manufacturers, importers and retailers – exploited these loopholes and openly sold <a href="https://www.health.nsw.gov.au/tobacco/Publications/e-cigarette-analysis-project-summary-report.pdf">products containing nicotine</a> to young people by falsely claiming the products were “nicotine-free”. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1575083639586660353"}"></div></p>
<p>But the only way to tell the difference between a nicotine and nicotine-free vape is to test it in a lab – a time consuming and expensive endeavour, given the high volume of products imported. </p>
<p>So enforcing the nicotine/nicotine-free standards essentially proved <a href="https://www.theguardian.com/australia-news/2023/nov/29/nsw-vape-sales-retailers-increase-government-ban-2023">near impossible</a> against an industry determined to addict a new generation of users.</p>
<h2>So what’s changing?</h2>
<p>The new laws help tidy up the confusion and make the rules much clearer and easier to enforce. </p>
<p>They also address the ready access to vapes, which is the single <a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">biggest challenge</a> to preventing young people from vaping.</p>
<p>The regulatory changes will be rolled out in three phases:</p>
<h2>1. Importation ban</h2>
<p>The first phase, being implemented from today, includes a ban on the importation of all disposable, single-use vapes. These are the products that are <a href="https://www.cancercouncil.com.au/wp-content/uploads/2023/10/Gen-Vape-W4-Infographic-National.pdf">most popular with young people</a> and come in a variety of flavours, including fruit, confectionery, cocktails and tobacco. </p>
<p>Single-use, disposable vapes cannot be refilled, but <a href="https://www.health.nsw.gov.au/tobacco/Pages/vaping-types.aspx">come in a wide range</a> of sizes, from a few hundred of puffs, to upwards of 10,000 puffs. </p>
<p>Disposable vapes have flooded into Australia and fuelled the explosive rise in vape use among teens and young adults.</p>
<figure class="align-center ">
<img alt="Vape liquids in a shop" src="https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Disposable vapes come in a range of flavours that appeal to young people.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-in-black-shirt-standing-in-front-of-store-shelf-8RN9UZeL-fo">E-Liquids UK/Unsplash</a></span>
</figcaption>
</figure>
<p>The importation of all other vapes, including refillable products, will be banned from March 1 2024, unless importers hold a licence and permit from the <a href="https://www.odc.gov.au/">Office of Drug Control</a> to lawfully import vapes. These legally imported vapes will only be sold in pharmacies to users with a prescription. </p>
<p>The Personal Importation Scheme allowance for vapes will also end on March 1 2024, meaning all vape users must access vaping products from a pharmacy in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tga-review-strengthens-case-for-much-tighter-vape-restrictions-at-the-border-202506">TGA review strengthens case for much tighter vape restrictions at the border</a>
</strong>
</em>
</p>
<hr>
<p>This initial phase, while effectively stopping illegal vapes from coming in to Australia, doesn’t address the high volume of product that is already here. Retailers will be able to continue to sell their existing stock of “nicotine-free” vapes. But as we know, these products often <a href="https://www.tga.gov.au/news/media-releases/infringement-notices-totalling-588840-issued-three-sydney-based-tsg-stores-and-jaradat-and-sabbagh-group-pty-ltd">do contain nicotine</a>. </p>
<h2>2. Domestic manufacture and sales ban</h2>
<p>The next phase of reforms, expected to come into effect in late 2024, will eliminate the retail sale of all types of vaping products, regardless of their claimed nicotine content.</p>
<p>This second phase will include a ban on the manufacture, supply, advertising and commercial possession of vapes that fall outside of the prescription framework. </p>
<p>These changes will require amendments to the <a href="http://www6.austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/tga1989191/">Therapeutic Goods Act 1989</a>, and will likely be introduced in Autumn 2024 for federal Parliament’s consideration, but the exact date is yet to be set.</p>
<h2>3. Prescription access</h2>
<figure class="align-center ">
<img alt="GP listens to patient" src="https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vapes will only be available on prescription.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span>
</figcaption>
</figure>
<p>The prescription access to vapes for therapeutic purposes is also being changed to allow access to products that meet a quality standard. </p>
<p>From today, all medical and nurse practitioners will now be able to prescribe therapeutic vapes for quitting smoking or to manage nicotine dependence. </p>
<p>Further changes that strengthen the standards for therapeutic vapes are expected to be made by March 1 2024. For example, prescription vapes will have limits on the amount of nicotine, the types of flavours permitted, and be in standardised medical-style packaging. </p>
<h2>What do the changes mean for vape users?</h2>
<p>Vapes for therapeutic purposes will continue to be permitted in Australia and more medical professionals will be able to prescribe them. Prior to 2024, only select medical professionals could prescribe vapes (they had to register as an authorised prescriber). This is being widened to ensure the prescription model works as intended. </p>
<p>While vaping products will be available by prescription it’s important to know they <a href="https://www.tga.gov.au/resources/resource/guidance/nicotine-vaping-products-information-prescribers">remain unapproved medicines</a> that have not been subjected to the same rigorous safety and effectiveness testing as other evidence-based quit smoking aids. </p>
<p>If you’re thinking of quitting smoking (or quitting vaping), get support by talking to your doctor, calling the Quitline (13 7848), or accessing <a href="https://www.icanquit.com.au/">help online</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/218816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Cancer Institute Vaping Communications Advisory Panel. These are unpaid roles. She has received relevant competitive grants that include a focus on e-cigarettes/vaping from the NHMRC, MRFF, NSW Health, the Ian Potter Foundation, VicHealth, and Healthway WA; relevant research contracts from the Cancer Institute NSW and the Cancer Council NSW; relevant personal/consulting fees from the World Health Organization, the Hong Kong Special Administrative Region Department of Health, BMJ Tobacco Control, the Heart Foundation NSW, the US FDA, the NHMRC e-cigarette working committee, NSW Health, and Cancer Council NSW; and relevant travel expenses from the Oceania Tobacco Control Conference and the Australia Public Health Association preventive health conference.</span></em></p>Vapes will be harder to access from today, but the restrictions are staged, with some due to roll out later in the year. Here’s what’s changing.Becky Freeman, Associate Professor, School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041522023-04-25T14:07:02Z2023-04-25T14:07:02ZUK plan to encourage smokers to take up vaping means swapping one health risk with another<figure><img src="https://images.theconversation.com/files/522587/original/file-20230424-28-vyodce.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C3479%2C1938&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The scheme would offer smokers vape starter kits to help them quit.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-device-cigarettes-mans-hand-concept-1185129853">ducu59us/Shutterstock</a></span></figcaption></figure><p>The UK government set out ambitious plans in 2019 to make England smoke free by 2030. To achieve this, they <a href="https://www.gov.uk/government/news/smokers-urged-to-swap-cigarettes-for-vapes-in-world-first-scheme">recently announced</a> plans to offer free vape starter kits to one million smokers in a bid to help them quit. </p>
<p>While smoking cigarettes is associated with a <a href="https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking/">range of serious health problems</a>, mounting evidence shows that vaping is also not without harms and risks. Given that there is still a lot we do not know about the health effects of vaping, we argue it is potentially irresponsible to recommend smokers switch to vaping to quit – especially when other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/">medically proven methods to quit</a> smoking already exist. </p>
<p>E-cigarettes and vapes have only been around since the early 2000s. As such, there is still a lot we do not know about the harms that may be associated with their long-term use. But a growing body of evidence indicates vaping is not as harmless as many believe. </p>
<p>For example, studies have shown that vaping can <a href="https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP279754">induce bronchiolitis</a>, an infection which closes off the smaller airways in the lungs, making breathing more difficult. This can become irreversible with prolonged vaping, given how fragile our lungs are. </p>
<p>Research also shows vaping can cause similar cellular changes in the lungs as smoking does. <a href="https://www.atsjournals.org/doi/10.1164/rccm.201903-0615OC">One study</a> showed that people who vaped (including those who vaped nicotine) had similarly elevated levels of protease enzymes – harmful enzymes that may damage lung function – as smokers. Vaping may also increase mucus production in lung cells, <a href="https://link.springer.com/article/10.1007/s11882-017-0747-5">worsening asthma</a> and causing airways to become more sensitive and constrict more easily.</p>
<p>Long-term use of vaping products can affect the way blood vessels function as well, increasing the risk of cardiovascular disease. In <a href="https://journals.lww.com/jhypertension/Abstract/2018/06001/EFFECT_OF_ELECTRONIC_CIGARETTE_SMOKING_ON_BLOOD.12.aspx">one report</a> people who used nicotine e-cigarettes had increased blood pressure, heart rate and blood vessel constriction immediately after vaping nicotine. These effects were similar to those seen in people who smoke cigarettes, but are occurring at a much younger age. </p>
<p>Much of this harm is probably caused by the contents of the vaping liquids used. In addition to nicotine, vape liquids also contain a cocktail of <a href="https://www.sciencedirect.com/science/article/pii/S0731708520312504?via%3Dihub">flavour chemicals</a> and additives used in food products. </p>
<p>Most of these chemicals have not undergone testing to <a href="https://www.nature.com/articles/s41598-019-39550-2">check if they are safe</a> to be heated to high temperatures and inhaled into the lungs. To add to the already complex scenario, they can break down when heated in vaping devices, causing them to turn into more reactive chemicals. These reactive chemicals can <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1913069">cause damage to cells and tissues</a> in the lung.</p>
<figure class="align-center ">
<img alt="A young woman breathes out vapour from her vape pen." src="https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=328&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=328&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=328&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaping liquids can contain many chemicals alongside nicotine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-women-smoke-electronic-cigarette-street-2054025671">ilkov_igor/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In fact, in 2019 the <a href="https://theconversation.com/vaping-related-lung-disease-now-has-a-name-and-a-likely-cause-5-things-you-need-to-know-about-evali-125730">death of 68 people</a> was found to be caused by the thermal breakdown of a specific chemical (vitamin E acetate) that was being added to some vaping liquids. The condition was even given a name: Evali (e-cigarette or vaping use-associated lung injury). Although this additive is now banned in both the US and UK, it is an example of the damage that can happen when vape-heated chemicals are inhaled into the lungs. </p>
<p>While there are regulations on the <a href="https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products#:%7E:text=The%20requirements%3A,no%20more%20than%2020mg%2Fml">kinds of ingredients</a> vaping liquids can contain, research into how vaping causes them to convert into other chemicals is <a href="https://pubs.acs.org/doi/pdf/10.1021/acs.chemrestox.0c00412">only beginning</a>. As such, the health risks from these vape-generated chemicals could lead to similar health problems as vitamin E acetate did – though it’s likely to take years of accumulative damage before such problems emerge.</p>
<p>Alongside these health risks is the fact that vaping is not a guaranteed way to help smokers quit. In fact, vaping to quit may only lead to dual use – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0749379719303915?via%3Dihub">which is riskier</a> than using either product alone. One review also found that smokers who switched to e-cigarettes may <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078138/">relapse and use cigarettes</a> later on.</p>
<h2>Alternative solutions</h2>
<p>The <a href="https://www.fda.gov/tobacco-products/products-ingredients-components/e-cigarettes-vapes-and-other-electronic-nicotine-delivery-systems-ends#:%7E:text=Many%20studies%20suggest%20e%2Dcigarettes,effective%20tools%20for%20quitting%20smoking.">Food and Drug Administration</a> in the US, alongside <a href="https://www2.hse.ie/living-well/quit-smoking/vaping/">other agencies in Europe</a>, do not recommend vaping as a replacement for smoking. Most cite the lack of evidence supporting the use of vaping to help people quit smoking, alongside the lack of safety testing as reasons they do not recommend it. </p>
<p>It’s mystifying to us that there has been such little concern expressed about the UK’s proposal to encourage smokers to take up vaping since it was first put forward by an <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary">independent review</a> for the government in 2022.</p>
<p>Instead of recommending people switch from one risky habit to another, the government should instead recommend the use of <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013308/full">medically proven nicotine replacement therapies</a> (such as skin patches, gums and nasal or oral sprays) and <a href="https://www.cochrane.org/CD001292/TOBACCO_does-individually-delivered-counselling-help-people-stop-smoking#:%7E:text=Combining%20the%20results%20of%20the,%25%2C%20compared%20to%20minimal%20support">personalised counselling</a> to help smokers quit. The government also needs to put more onus on vaping companies to prove their products are safe before they can be sold to the public, following similar protocols that <a href="https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices">drug companies need to follow</a>. </p>
<p>Remember that it took much longer than it should have for the <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1440-1843.2003.00483.x">serious harm caused by tobacco</a> to be proven and accepted. The evidence that vaping can be harmful is mounting, and we cannot afford to take as long as it took with cigarettes to warn people about the potential risks it poses. Instead of encouraging people to vape in order to quit smoking, they should instead be encouraged to ask their GP or pharmacist for access to proven and safe nicotine replacement therapies.</p><img src="https://counter.theconversation.com/content/204152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A growing body of evidence shows vaping is not without harms.Donal O'Shea, Professor of Chemistry, RCSI University of Medicine and Health SciencesGerry McElvaney, Professor of Medicine, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015582023-04-10T20:02:12Z2023-04-10T20:02:12ZHow can I help my teen quit vaping?<figure><img src="https://images.theconversation.com/files/518067/original/file-20230328-18-s4t4vt.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C956&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-in-blue-shirt-talking-to-a-young-man-in-white-shirt-8550841/">Kindel Media/Pexels</a></span></figcaption></figure><p>You’re driving your teen home from school when they open up to you about their vaping. What started off as an occasional puff of an e-cigarette has turned into something more serious. </p>
<p>“I was curious and just wanted to try it,” they say. “All my friends were doing it and I wanted to do it too.”</p>
<p>But now they are vaping more often and getting anxious when they can’t access their vape. They want to quit but they aren’t sure how.</p>
<p>Here are some practical tips to help your teen stop vaping.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-and-lies-are-used-to-sell-vapes-online-even-we-were-surprised-at-the-marketing-tactics-we-found-200446">Sex and lies are used to sell vapes online. Even we were surprised at the marketing tactics we found</a>
</strong>
</em>
</p>
<hr>
<h2>I don’t want to lecture. But what can I do?</h2>
<p>You’ve seen <a href="https://www.abc.net.au/news/2023-03-29/qld-vaping-larger-vapes-enter-market-doctors-call-action-teens/102153474">the news</a> and you know e-cigarettes <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51890">are harmful</a>. </p>
<p>You might want to reprimand your child, or say “If your friends jumped off a cliff, would you do it?”. But you know criticism and <a href="https://www.psychologytoday.com/au/blog/growing-friendships/201809/want-your-child-listen-and-learn-don-t-lecture">lecturing</a> <a href="https://academic.oup.com/ntr/article-abstract/12/3/191/1041894?redirectedFrom=fulltext&login=true">don’t work</a>. So, what do you do?</p>
<p>First, acknowledge it’s a great sign your teen wants to quit and is asking for help. We know motivation is critical to behaviour change. </p>
<p>But if you’re a parent of a teen who isn’t ready to try quitting, you need to work on boosting their motivation to quit first.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teens-vaping-what-should-i-say-3-expert-tips-on-how-to-approach-the-talk-196205">My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'</a>
</strong>
</em>
</p>
<hr>
<h2>Boost their motivation to quit</h2>
<p>Talk with your teen about their vaping. Ask them what led to them wanting to quit and their reasons for wanting to give up. You can both use those reasons to help motivate quitting.</p>
<p>Use that knowledge to balance the benefits of quitting with the costs of not quitting. You can do this using <a href="https://www.nova.edu/gsc/forms/client_handout_3_1_decisional_balance_exercise.pdf">a practical exercise</a>.</p>
<p>Discuss potential barriers that might get in the way of quitting.
What is your teen worried will happen if they try to quit? Have they been using vaping to relax and are worried they will become more anxious? Are they worried about losing friends? Do they think they won’t be able to quit?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1640117707084566528"}"></div></p>
<p>Once you have an idea of the costs and benefits your child perceives, you’ll be in a better position to help them. For example, if they have been using vapes to relax, help them find other ways of reducing stress. </p>
<p>It might also help to tap into their values and use these to highlight that their vaping isn’t aligned with who they want to be. </p>
<p>For example, if they are skipping class to vape but are usually a diligent student, discuss this discrepancy and the longer-term impact of their dependence (for example, not getting into uni).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-parents-guide-to-why-teens-make-bad-decisions-88246">A parent's guide to why teens make bad decisions</a>
</strong>
</em>
</p>
<hr>
<h2>Set a goal</h2>
<p>Once your child is motivated, it’s time to set a goal to quit. Work with your teen to develop a SMART goal that is <strong>S</strong>pecific, <strong>M</strong>easurable, <strong>A</strong>chievable, <strong>R</strong>elevant, with a <strong>T</strong>imeframe.</p>
<p>That goal might be to quit vaping by a certain date. But your teen may need to set smaller goals first. This might mean “This week, I will only vape on Monday, Wednesday and Friday.”</p>
<p>Once achieved, these goals can be made more challenging until gradually, your teen has succeeded in quitting vaping. </p>
<p>Make sure you reward your teen or they reward themselves for achieving their goals, even the small ones.</p>
<p>Next, if your teen has been using nicotine vapes – and many vapes <a href="https://www.mja.com.au/journal/2019/210/3/nicotine-and-other-potentially-harmful-compounds-nicotine-free-e-cigarette">contain nicotine</a> even if they are not labelled as such – they may be addicted. </p>
<p>Contact the Quitline (details below) or see your GP to discuss support for your teen. They may need extra help weaning off e-cigarettes. A nicotine tapering plan may help.</p>
<h2>How to handle the setbacks</h2>
<p>Your teen will likely have some trouble quitting. Remember those barriers from earlier? Create coping plans. What will your teen do if they are feeling stressed and want to reach for their vape? What will your teen do if they are at a party and are offered a puff?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1557622847920635905"}"></div></p>
<p>These strategies may help your teen:</p>
<ul>
<li><p>keeping busy by doing puzzles, drawing, or playing games on the phone</p></li>
<li><p>changing locations. Encourage your teen to get out and about. They can go to the gym, outside for a walk, or head to the footy</p></li>
<li><p>reminding your teen about the reasons they want to quit and the costs of not quitting</p></li>
<li><p>helping them practise saying “no” to a vape</p></li>
<li><p>having snacks or gum they can grab when they have the urge to vape. </p></li>
</ul>
<h2>Show compassion</h2>
<p>There are many reasons people vape. Among them is a vaping industry, <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-1-the-ecigarettemarket">with deep pockets</a>, that’s expert at <a href="https://theconversation.com/sex-and-lies-are-used-to-sell-vapes-online-even-we-were-surprised-at-the-marketing-tactics-we-found-200446">manipulating</a> young people to start and continue vaping.</p>
<p>So be compassionate and try not to judge your teen. Lecturing, criticising and being punitive won’t help them quit. Position yourself as someone they can rely on.</p>
<hr>
<p><em>More support and information about quitting vaping is available from
<a href="https://lungfoundation.com.au/lung-health/protecting-your-lungs/e-cigarettes-and-vaping/for-parents/">Lung Foundation Australia</a> and
<a href="https://www.quit.org.au/articles/teenvaping/">Quitline</a> (ph: 13 7848).</em></p><img src="https://counter.theconversation.com/content/201558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Michelle Jongenelis receives funding from the National Health and Medical Research Council. She is affiliated with the Australian Council on Smoking and Health, the Public Health Association of Australia, and the World Federation of Public Health Associations' Tobacco Control Working Group.</span></em></p>Criticism and lecturing won’t help. This will.Michelle Jongenelis, Associate Professor, Melbourne Centre for Behaviour Change, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995572023-02-14T21:05:23Z2023-02-14T21:05:23ZLearning about the health risks of vaping can encourage young vapers to rethink their habit<figure><img src="https://images.theconversation.com/files/510008/original/file-20230214-14-oczc6l.jpg?ixlib=rb-1.1.0&rect=741%2C0%2C5009%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than one-third of teenagers between the ages of 15 and 19 have tried vaping.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/learning-about-the-health-risks-of-vaping-can-encourage-young-vapers-to-rethink-their-habit" width="100%" height="400"></iframe>
<p>Vaping is most prevalent in Canada <a href="https://www.doi.org/10.25318/82-003-x202200700003-eng">among 15- to 24-year-olds</a>, and has significantly increased since e-cigarettes with nicotine were <a href="https://www.publichealthontario.ca/-/media/Documents/T/2019/tobacco-ecigarettes.pdf?rev=00f54b6bd95f432fb407fd314f2d000d&sc_lang=en">legalized in 2018</a>. Ensuring that young people understand the health risks involved may help encourage them to steer clear of vaping.</p>
<p><a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2020-summary.html">Recent data from Statistics Canada</a> show that more than one-third of teenagers between the ages of 15 and 19 have tried vaping, and 15 per cent report having done so within the last 30 days. Of those who reported vaping in last 30 days, approximately 80 per cent had vaped nicotine. </p>
<p>Unfortunately, teens may underestimate the amount of nicotine in the vaping products they use, while one in 10 users reported having tried vaping without knowing whether it contained <a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2020-summary/2020-detailed-tables.html">nicotine</a>. </p>
<p>There is evidence that vaping among young people may be a “<a href="https://doi.org/10.1136/bmjopen-2017-021080">gateway behaviour</a>” to cigarette use — another smoking behaviour that contains nicotine. By extension, we may be seeing a new generation of tobacco smokers who will likely have serious health problems.</p>
<h2>Health risks</h2>
<p>Vaping is not without health risks. Some studies suggest that it could lead to <a href="https://doi.org/10.1371/journal.pone.0272475">lung damage</a> or even <a href="https://healthcare.utah.edu/healthfeed/postings/2019/07/vaping-pneumonia.php">pneumonia</a>. Many vaping products in Canada and the United States have also been made with <a href="https://www.ctvnews.ca/health/health-canada-proposes-ban-on-most-vaping-flavours-it-says-appeal-to-youth-1.5476736">fruit-flavoured aerosols</a>, leading to concern from some advocates about how these products are marketed and their potential appeal to young people.</p>
<p>In response, Health Canada and advocates have called for more measures beyond <a href="https://www.ctvnews.ca/canada/feds-must-enforce-vaping-penalties-to-protect-kids-advocates-1.6221289">warning labels</a> on e-cigarette products, including ways to make them less accessible to youths, particularly when it comes to online sales which can be difficult to regulate for teens. </p>
<p>Working in the area of behavioural medicine with expertise in health behaviour change, our research suggests ways to help university students steer away from vaping. Providing health risk information about vaping through expert advice and personal testimonies is an effective strategy. This is important because it tells us how information can be presented to have a strong impact on how young adults think about the consequences of vaping.</p>
<figure class="align-center ">
<img alt="A hand holding a vaping device surrounded by smoke against a black background" src="https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510009/original/file-20230214-22-qzpb6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaping in young people may be a gateway behaviour to cigarette use.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In January 2021, we <a href="https://doi.org/10.1177/13591053221144977">conducted a 45-day study</a> on undergraduate students from six provinces, all of whom consistently vaped e-cigarettes. Most vaped at least five to 15 times a month. </p>
<p>Our goal was to investigate whether young adults can refrain from vaping using an informational video about the potential health risks of vaping told by health experts and other e-cigarette users. Participants were randomized into two groups: one watched the vaping information video, and a control group watched a more general nutrition and healthy lifestyle video that did not offer in-depth information on the health effects of vaping.</p>
<h2>Health risk information and vaping</h2>
<p>Over the course of 45 days, we followed the students to see how their feelings about vaping changed. We found that those who viewed the informational video were more likely to express intentions to stop or reduce their vaping habits. </p>
<p>Those feelings remained strong over the study period, including three follow-up sessions when participants were asked to report how they felt about the perceived severity of the threats posed by vaping and their vulnerability to them. </p>
<p>The study showed vaping intentions — and, to a lesser degree, vaping behaviour itself — can be reduced after learning about the potential consequences in this way. The students’ intentions were significantly altered after learning about possible health effects, but those intentions to reduce vaping were not seen in the control group. The emphasis on intention formation is crucial because it drives the necessary actions (such as goal setting and motivation) towards achieving the desired change. </p>
<p>Overall, vaping use in both groups dropped over the study, however this drop was more pronounced in the intervention group, specifically towards the end of the study. This intervention does underline a successful strategy to reach young people engaged in harmful behaviours.</p>
<h2>What’s next?</h2>
<p>Curbing vaping remains the ultimate goal. While health risk information can lead regular vapers in university to form intentions to vape less, more research is needed on how to convert those intentions into convincing behaviour change. For now, to reduce harmful habits like vaping, we encourage others to educate themselves on the potential harms of these behaviours. </p>
<p>Evidence of health risks associated with the use of e-cigarettes continues to grow. However, there is limited evidence to illustrate health benefits of <a href="https://davidhammond.ca/wp-content/uploads/2018/03/2019-ITC-Youth-Vaping-BMJ-Hammond-et-al.pdf">stopping vaping</a>. Research is needed to address this knowledge gap.</p>
<p>Similar to tobacco and cigarettes in the past, a full understanding of the harm from using vaping products, and how reducing their use affects one’s health, may take several decades. Current evidence suggests e-cigarette use may follow the trend of tobacco cigarettes: multiple <a href="https://doi.org/10.1136/tobaccocontrol-2013-051470">long-term health risks</a> with continued use. </p>
<p>As the literature on the short-term health consequences of <a href="https://www.canada.ca/en/health-canada/services/smoking-tobacco/surveys-statistics-research/vaping-what-we-know.html">vaping behaviour</a> continues to mount, and as the vaping <a href="https://doi.org/10.1007/s40138-020-00219-0">market continues to grow</a>, research identifying effective <a href="https://doi.org/10.18332%2Ftid%2F95218">health behaviour change strategies</a> to curb intentions to vape and vaping use are paramount. </p>
<p>We envision provincial and federal health agencies will implement evidence-based interventions like our study in settings like schools, clinics and community centres to help clear the “smoke” around the true health effects and harms of vaping to motivate them to steer away.</p><img src="https://counter.theconversation.com/content/199557/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Babac Salmani does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p><p class="fine-print"><em><span>Harry Prapavessis receives funding from the Canadian Foundation for Innovation (CFI); Canadian Cancer Society (CCS); Canadian Institutes of Health Research (CIHR); Social Sciences and Humanities Research Council (SSHRC).</span></em></p>How providing information on the health risks of vaping through expert advice and personal testimonies can help steer students away from using e-cigarettes.Babac Salmani, PhD Candidate, Faculty of Health Sciences, Western UniversityHarry Prapavessis, Professor, Kinesiology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962052023-01-22T19:02:29Z2023-01-22T19:02:29ZMy teen’s vaping. What should I say? 3 expert tips on how to approach ‘the talk’<figure><img src="https://images.theconversation.com/files/501212/original/file-20221215-12-ffyghb.jpg?ixlib=rb-1.1.0&rect=0%2C546%2C1920%2C1563&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-holding-logic-vape-pens-in-hands-11587598/">Olena Bohovyk/Pexels</a></span></figcaption></figure><p>You’ve dropped your daughter off at her friend’s house and while cleaning the car, you find what looks like a USB drive on the passenger seat. It’s a disposable vape. </p>
<p>You’ve seen the news. Vapes or e-cigarettes are <a href="https://nceph.anu.edu.au/research/projects/health-impacts-electronic-cigarettes#health_outcomes">harmful</a> yet increasingly <a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">popular</a> with people her age.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1574496365970829312"}"></div></p>
<p>You call to ask if the vape’s hers. It is and she’s been vaping occasionally for a few weeks. You say you’ll talk about it later. </p>
<p>But what will you actually say?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-give-my-teen-alcohol-just-a-sip-the-whole-can-or-none-at-all-190234">Should I give my teen alcohol? Just a sip, the whole can, or none at all?</a>
</strong>
</em>
</p>
<hr>
<h2>1. Know your facts</h2>
<p>It’s important to be across accurate and up-to-date information about vaping. Evidence-based resources for parents and carers in Australia include:</p>
<ul>
<li><p>the Lung Foundation’s <a href="https://lungfoundation.com.au/resources/vaping-and-young-people-parents-and-carers/">evidence-based resources</a></p></li>
<li><p><a href="https://www.health.nsw.gov.au/tobacco/pages/vaping-parents.aspx">factsheets, videos</a> and <a href="https://www.pandc.org.au/vaping-webinar-recording/">webinars</a> from NSW Health that help dispel any misconceptions parents might have about vaping. This includes whether vapes are likely to contain nicotine and the accuracy of labelling</p></li>
<li><p>Quit Victoria’s resources for parents and teens, including <a href="https://www.quit.org.au/articles/teenvaping/#anchor-name-4">brief guides</a> that cover the essentials on vaping, including busting a few myths.</p></li>
</ul>
<p>A common theme across such resources for parents is to bring home the reality of vaping in terms of how many teens are actually doing it, what current health evidence shows, and why it’s more than just media coverage of incidents at schools.</p>
<p>In a nutshell, vapes are <a href="https://doi.org/10.1111/1753-6405.13316">easy to access</a>, teen vaping is <a href="https://doi.org/10.1111/1753-6405.13316">common</a> and it’s becoming <a href="https://doi.org/10.1016/j.drugalcdep.2021.108712">normalised</a> in this age group.</p>
<p>Our own unpublished research with young people aged 16-26, provides some insights. We’ve heard vaping called a “clean alternative” to smoking (it’s not), and a “social activity” at school or parties. One young participant has seen others “nic sick”, or nauseous from <a href="https://www.jmir.org/2022/3/e34050">vaped nicotine</a>.</p>
<p>There’s mounting evidence pointing to <a href="https://nceph.anu.edu.au/research/projects/health-impacts-electronic-cigarettes#health_outcomes">physical health harms</a> and unknown <a href="https://doi.org/10.1093/ntr/ntaa171">mental health risks</a> from vaping. There’s no reason for a teen to be vaping, even if adults might take this approach in <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub6/full">quitting smoking</a>. Many vapes <a href="https://www.health.nsw.gov.au/tobacco/Pages/enforcement-nicotine-containing-e-cigarettes.aspx">contain nicotine</a>, whatever the label says, with the potential for dependence or addiction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-we-reverse-the-vaping-crisis-among-young-australians-enforce-the-rules-185867">How can we reverse the vaping crisis among young Australians? Enforce the rules</a>
</strong>
</em>
</p>
<hr>
<h2>2. Listen more than speak</h2>
<p>It might be tempting to deliver a lecture on the dangers of vaping. But conversations are <a href="https://doi.org/10.1080/14659891.2018.1436601">more likely</a> <a href="https://doi.org/10.1080/09687637.2016.1221060">to be effective</a> if they are clear, open, and constructive, with thought about how to focus on discussing health harms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mother discussing tricky topic with disinterested teenage son" src="https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500922/original/file-20221214-16-136aqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It might be tempting to deliver a lecture. But other approaches are more likely to work.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-mother-and-son-having-a-conversation-8550840/">Kindel Media/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>So use some of these tips, based on ones from the <a href="https://adf.org.au/talking-about-drugs/vaping/vaping-youth/talking-about-vaping/">Alcohol and Drug Foundation</a>:</p>
<ul>
<li><p>approach the conversation calmly, during a shared activity, such as walking the dog</p></li>
<li><p>consider questions your teen may ask, and how you want to respond</p></li>
<li><p>don’t assume, avoid accusations, show trust</p></li>
<li><p>no judging; really listen to their perspective (listen more than speak) and respect they have a different and unique worldview and opinions. <a href="https://doi.org/10.1177/08901171211061941">Understand their social life</a> and create an environment where they can discuss this with you</p></li>
<li><p>don’t exaggerate, just stick to the facts. Remember, your teen may have already received vaping and health resources <a href="https://myresources.education.wa.edu.au/programs/vaping">from school</a> and be aware of the health impacts and uncertainties about long-term health risks of vaping</p></li>
<li><p>tailor your discussion based on whether your teen vapes occasionally, is addicted and/or wants support to quit</p></li>
<li><p>respect their privacy</p></li>
<li><p>show that their health is your focus.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-parents-guide-to-why-teens-make-bad-decisions-88246">A parent's guide to why teens make bad decisions</a>
</strong>
</em>
</p>
<hr>
<h2>3. Support quitting</h2>
<p>But what if it’s gone beyond trying vaping, and your teen feels they have a dependency or addiction? </p>
<p>Services such as <a href="https://www.quit.org.au/articles/about-quitline-13-7848/">Quitline</a>, which traditionally provide counselling for people wanting to stop smoking, are increasingly receiving <a href="https://www.theguardian.com/australia-news/2022/oct/27/unprecedented-teens-as-young-as-13-calling-quitline-for-help-with-their-vaping-addiction">calls from teens</a> struggling with vaping-related nicotine dependence. </p>
<p>Parents can also call Quitline (phone: 13 78 48) to plan the conversation with a teenager about vaping. They can also contact a GP to help their teen treat nicotine dependence and related effects.</p>
<hr>
<p><em>Extra resources about vaping for parents and teens are available in <a href="https://www.health.nsw.gov.au/vaping#:%7E:text=Support%20to%20quit%20vaping&text=Quitline%20counsellors%20are%20available%20to,service%20offering%20information%20and%20advice">New South Wales</a>, <a href="https://www.vic.gov.au/smoking-and-vaping-advice-parents">Victoria</a>, <a href="https://quithq.initiatives.qld.gov.au/quit-support/quitline/get-help-from-quitline/">Queensland</a>, <a href="https://www.education.sa.gov.au/students/health-safety-and-wellbeing/alcohol-tobacco-and-other-drugs-schools">South Australia</a>, <a href="https://www.healthywa.wa.gov.au/vaping#:%7E:text=If%20your%20child%20is%20vaping,13%207848%20(13%20QUIT)">Western Australia</a>, <a href="https://www.health.tas.gov.au/health-topics/smoking/smoking-topics/e-cigarettes">Tasmania</a>, <a href="https://www.health.act.gov.au/about-our-health-system/population-health/smoke-free-environments/electronic-cigarettes">Australia Capital Territory</a> and <a href="https://www.quit.org.au/articles/about-nt-quitline-13-7848/#:%7E:text=Quitline%20(13%207848)%20is%20a,Friday%2C%208am%20to%208pm%20ACST">Northern Territory</a>.</em></p><img src="https://counter.theconversation.com/content/196205/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Trigg receives funding from the Medical Research Future Fund, Flinders Foundation and The Australian Prevention Partnership Centre. He is a member of the Australasian Professional Society on Alcohol and other Drugs and Public Health Association of Australia. He has previously worked for Cancer Council South Australia.</span></em></p><p class="fine-print"><em><span>Billie Bonevski receives funding from the National Health and Medical Research Council, the Medical Research Future Fund, NSW Ministry of Health, the Hospital Research Foundation SA, Flinders Foundation. She is currently on the Executive Board of the Society for Research on Nicotine and Tobacco (SRNT) as Member Delegate for Asia, Africa, Oceania and Latin America.</span></em></p>It might be tempting to fly off the handle and deliver a lecture on the dangers of vaping. But here’s what might actually work.Joshua Trigg, Research Fellow in Public Health, Flinders UniversityBillie Bonevski, Professor of Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921982022-10-12T10:06:31Z2022-10-12T10:06:31ZFrom e-cigarettes to hookah pipes, South Africa aims to tighten tobacco laws<figure><img src="https://images.theconversation.com/files/489026/original/file-20221010-22-5b5ku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"> It's estimated that tobacco use kills half of it's consumers.</span> <span class="attribution"><span class="source">Alexander Joe/AFP via Getty Images</span></span></figcaption></figure><p><em>Tobacco is a <a href="https://www.afro.who.int/health-topics/tobacco-control">leading cause of disease</a>. It is estimated that it kills half of its consumers. Over a million additional deaths result from exposure to second hand smoke. Countries around the world are moving towards stricter regulation of tobacco products in compliance with their obligation to the World Health Organisation’s (WHO) <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a>. In <a href="https://www.afro.who.int/news/who-supports-south-africas-draft-bill-control-tobacco-products-and-electronic-delivery-systems">2018</a> South Africa published a tobacco control bill that sought to better regulate the sale of cigarettes and other tobacco products. It’s been revised as the <a href="https://www.youtube.com/watch?v=mXjRz9f2lts">Tobacco Products and Electronic Delivery Systems Control Bill 2021</a> and has been approved for submission to parliament. Ina Skosana speaks to Catherine Egbe, a lead researcher on <a href="https://www.samrc.ac.za/sites/default/files/attachments/2022-05-31/GATSFactsheet.pdf">South Africa’s Global Adult Smoking Survey</a>, about the latest developments.</em></p>
<hr>
<h2>Why has it taken so long to bring the bill before parliament?</h2>
<p>The bill was first released for public comments <a href="https://theconversation.com/how-south-africa-is-tightening-its-tobacco-rules-97382">in 2018</a>. After reviewing all the comments, the Department of Health had to do more consultations and update the 2018 version.</p>
<p>Under normal circumstances the process would not take this long. Introducing a law that is focused on protecting people’s health, and impacts on the big industries that make money off the products, will always be a challenge, no matter how harmful the products are.</p>
<p>Bills that have a wider impact on society usually take longer to pass because the consultation process takes time, but a delay of four years is not ideal. </p>
<p>We are happy that the bill is back on track. </p>
<h2>What are the major changes to the 2018 version of the bill?</h2>
<p>The first improvement is that it takes care of novel products – these now go beyond just e-cigarettes to include oral nicotine pouches, and other novel products related to tobacco or nicotine. It also includes future innovations that the industry may come up with.</p>
<p>The tobacco control landscape is very dynamic in terms of product types. One of the key problems we’re having today in South Africa is that the existing law doesn’t regulate electronic cigarettes or other novel products. </p>
<p>So you need a law that takes into account that there could be changes even tomorrow. The current bill, therefore, takes care of future innovations so that such products can fall within the tobacco regulatory framework in South Africa.</p>
<h2>What are the chances of this bill being passed?</h2>
<p>The administrative and political leadership of the Department of Health is committed to, and passionate about protecting South Africans from tobacco related harms. But it’s not in their hands anymore. They’ve done their part. It’s now left to the members of parliament and the public to make this bill become law. This is where citizens’ action will make impact. They must put pressure on parliament to pass this bill. The health of the nation should take precedence over profit from tobacco. </p>
<h2>Why is it important to update restrictions on tobacco use?</h2>
<p>South Africa introduced the very first <a href="https://www.gov.za/documents/tobacco-products-control-act#:%7E:text=The%20Tobacco%20Products%20Control%20Act,provide%20for%20matters%20connected%20therewith">Tobacco Control Act</a> in the 1990s. That law has been updated three times – in 1999, 2007, 2008. </p>
<p>The initial law came into place way before the WHO treaty and before many of these novel products were available. As a signatory to the WHO tobacco control framework, South Africa must make its laws align with the WHO treaty. </p>
<p>In the 1990s the country was a regional leader in tobacco control. It had some of the most stringent tobacco control laws. But the tobacco industry has since come up with new products and ways around the restrictions. South Africa has now fallen behind the rest of the world. As a result, South Africa has regressed and smoking prevalence has steadily increased over the past couple of years.</p>
<p>When the country first introduced tobacco control legislation, it had a smoking prevalence of over <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758983/pdf/v001p00272.pdf">30%</a>. This subsequently fell to as low as 16% in 2010. But is has began to increase.</p>
<p>We’ve been monitoring the trends of tobacco use. One of the surveys I have been using is the <a href="https://hsrc.ac.za/special-projects/sasas/">South African Social Attitudes Survey</a>. </p>
<p>The global adult tobacco survey, which we conducted <a href="https://www.samrc.ac.za/sites/default/files/attachments/2022-05-31/GATSFactsheet.pdf">last year</a>, shows that 29.4% of South Africans use various tobacco products. And 25.8% smoke tobacco. This is proof that the current law is obsolete. It’s not doing what it’s supposed to do – which is to drive down the tobacco use prevalence. </p>
<h2>What are the main drivers of increase in smoking prevalence?</h2>
<p>The industry is using many tactics to get young people to start smoking. In the global adult tobacco survey, we found that the average age of initiation of smoking in South Africa was 17.6 years. About 74% of current smokers started when they were teenagers. So what does the industry do? It employs what I call the “catch them young” approach. It tries to target these young people to get them hooked on nicotine.</p>
<p>Nicotine is one of the most <a href="https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive">addictive</a> drugs. Once hooked, the smoker keeps looking for the product. That’s why the industry targets young people by using celebrities on social media, and new products that contain exotic flavours. Exotic flavours <a href="https://tobaccocontrol.bmj.com/content/25/Suppl_2/ii32">appeal more</a> to children than adults. </p>
<p>Then electronic cigarettes came on board. Nicotine is one of the common components between electronic cigarettes and traditional tobacco products. </p>
<p><a href="https://tobacco.ucsf.edu/convincing-analysis-e-cigs-are-gateway-cigarette-smoking-studies-around-world">Studies </a> from around the world show that some people who may not have smoked, ended up smoking traditional products after starting with electronic cigarettes.</p>
<h2>What are the risks of not regulating tobacco products?</h2>
<p>Any delay in controlling tobacco will cause a lot of deaths from tobacco related diseases. Tobacco is one of the leading causes of noncommunicable diseases. These conditions are the leading cause of death in South Africa and in many parts of the world. If the legislation is delayed further, more young people are at risk of getting hooked on nicotine, with dire consequences.</p>
<p>In 2016, the healthcare <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822111/">cost</a> of tobacco use was R14.48 billion in South Africa. The tobacco industry only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822111/">contributed</a> about R12 billion in taxes. So at the end of the day, who is benefiting more from tobacco?</p><img src="https://counter.theconversation.com/content/192198/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine O. Egbe, PhD has received research grant from the Campaign For Tobacco-Free Kids. </span></em></p>South Africa was once a leader in tobacco use control but has since fallen behind, and smoking prevalence has steadily increased.Catherine O. Egbe, PhD, Specialist Scientist, Alcohol Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1903992022-09-14T12:24:05Z2022-09-14T12:24:05ZE-cigarette maker Juul settled a lawsuit over its practice of targeting teens through social media, parties and models – here’s why the company is paying $438.5 million to dozens of states<figure><img src="https://images.theconversation.com/files/484125/original/file-20220912-12-chvajy.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C4493%2C2970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A 2021 survey revealed that more than 2 million youths in the U.S. were using e-cigarettes. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vape-teenager-young-pretty-white-girl-smoking-an-royalty-free-image/1153463721?adppopup=true">Aleksandr Yu/iStock via Getty Images Plus</a></span></figcaption></figure><p>In early September 2022, electronic cigarette maker Juul Labs – the face of the <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/surgeon-general-advisory/index.html">vaping epidemic among teenagers</a> – <a href="https://portal.ct.gov/AG/Press-Releases/2022-Press-Releases/AG-Tong-Leads-Multistate-Agreement-With-JUUL-Labs">agreed to pay US$438.5 million</a> to 33 states. </p>
<p>The settlement concludes a two-year bipartisan investigation into the e-cigarette maker’s marketing and sales practices for its vaping products. Those states claimed that Juul <a href="https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive#">marketed its addictive nicotine products</a> to adolescents. The company had <a href="https://www.statnews.com/2022/09/06/juul-to-pay-nearly-440m-to-settle-states-teen-vaping-probe/">previously settled suits with four other states</a>. </p>
<p>As part of the settlement, Juul has also agreed to limit marketing and sales practices that may appeal to adolescents. In addition, the company faces pending lawsuits by <a href="https://www.npr.org/2022/09/06/1121304870/juul-vaping-settles-states-teen-nicotine">nine other states and hundreds of claims</a> on behalf of teenagers who want to hold Juul responsible for their nicotine addiction.</p>
<p>In 2018, the Food and Drug Administration stated that e-cigarette use, or “vaping,” among youths had reached “<a href="https://www.fda.gov/news-events/press-announcements/fda-takes-new-steps-address-epidemic-youth-e-cigarette-use-including-historic-action-against-more">epidemic proportions</a>.” Juul’s arrival coincided with massive <a href="https://www.tobaccofreekids.org/assets/factsheets/0394.pdf">increases in vaping among teenagers</a>. </p>
<p>Though Juul is just one type of e-cigarette in a field of vaping products, its sales comprised <a href="https://www.tobaccofreekids.org/assets/factsheets/0394.pdf">70% of the market at the end of 2017</a>. Juul quickly dominated after its launch in 2015 because of its discreet design – it is small, concealable and resembles a USB thumb drive device – as well as its high-nicotine concentration and range of flavors. The 33 states that are party to the suit claimed that the company’s aggressive and targeted marketing and sales practices have fueled the uptake in vaping among adolescents. </p>
<p><a href="https://somalab.usc.edu/current-research/">As a researcher in tobacco control</a>, I use publicly accessible data from social media platforms like Twitter, Instagram, TikTok and YouTube to capture and describe the marketing practices of companies whose products may directly affect public health. I’ve <a href="https://scholar.google.com/citations?user=zAFlXaQAAAAJ&hl=en">conducted studies</a> that examined the impact of tobacco marketing on <a href="https://doi.org/10.1016/j.addbeh.2022.107312">adolescents</a> and <a href="https://doi.org/10.1016/j.addbeh.2022.107307">young adults</a>. </p>
<p>Juul use among kids has been a research focus of mine since 2016. It was during this time when my colleagues and I <a href="https://doi.org/10.1016/j.drugalcdep.2018.05.018">found hundreds of Twitter posts</a> describing students sneaking Juul products onto school grounds to use <a href="https://theconversation.com/is-juul-making-it-easy-for-kids-to-vape-in-school-new-study-suggests-yes-98987">during school hours</a>. The latest settlement marks a small victory for those working to curb Juul use among teenagers. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3ofEzRdUNus?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A North Carolina teen discusses how vaping and e-cigarettes turned his world upside down.</span></figcaption>
</figure>
<h2>Nicotine’s effects on the developing brain</h2>
<p>In 2021, a survey by the FDA and the Centers for Disease Control and Prevention found that some 2.55 million high school and middle school students – or 9.3% of U.S. students in that age range – said they had <a href="https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey">used a tobacco product in the previous 30 days</a>. E-cigarettes were the most commonly used tobacco product; according to the 2021 survey, 2.06 million high school and middle school students reported having used e-cigarettes. </p>
<p>E-cigarettes like Juul often contain nicotine, which has been shown by a vast body of research to be an <a href="https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive#">addictive substance</a>. Extended exposure to nicotine can have a <a href="https://www.ajpmonline.org/article/S0749-3797(15)00035-5/fulltext">detrimental impact on brain development</a> during adolescence.</p>
<p>Adolescent brains continue to develop into early adulthood, particularly in the prefrontal cortex. This brain region is involved in higher cognitive development, including cognitive functions related to <a href="https://doi.org/10.2174/1570159X15666171103152136">attention, memory and cognitive flexibility</a>. Human neuroimaging studies have revealed that nicotine exposure results in <a href="https://doi.org/10.1016/j.neuropharm.2013.02.015">long-term functional and structural changes in the brain </a>. </p>
<h2>How Juul use took off among teenagers</h2>
<p>The two-year <a href="https://portal.ct.gov/AG/Press-Releases/2022-Press-Releases/AG-Tong-Leads-Multistate-Agreement-With-JUUL-Labs">investigation into Juul</a> revealed that the company grew quickly in popularity in part by marketing to underage users by organizing launch parties. Juul also <a href="https://www.vox.com/2019/1/25/18194953/vape-juul-e-cigarette-marketing">hired young and trendy-looking models</a> to appear in advertisements and relied on social media posts to raise brand awareness. </p>
<p><a href="https://www.cnn.com/2018/11/13/health/juul-flavor-social-media-fda-bn">Juul’s use of social media</a> to appeal to young people was a <a href="https://www.jahonline.org/article/S1054-139X(18)30358-6/fulltext">concern that my colleagues and I raised in 2018</a>. We examined whether adolescents – defined in our study as people under age 18 – were <a href="https://doi.org/10.1016/j.jadohealth.2018.08.002">following Juul’s official Twitter account</a> and the extent to which adolescents shared Juul’s posts to their own followers – other adolescents. </p>
<p>To accomplish this, we collected all tweets from Juul’s official Twitter account from February 2017 to January 2018. We then identified Juul’s tweets that were retweeted, meaning shared by others on Twitter. We found that there were 721 unique users who shared Juul’s tweets during that time. We then determined whether those unique users were adolescents or adults based on a systematic classification procedure. </p>
<p>Our study showed that <a href="https://doi.org/10.1016/j.jadohealth.2018.08.002">25% of users following Juul were adolescents</a>. We also found that an adolescent could be exposed to Juul’s posts without directly following Juul’s official account, as a result of retweeting. </p>
<p>Our findings have clear implications for public health. For example, a meta-analysis – or study that synthesizes the pertinent and available data on a topic from prior research – found that exposure to online e-cigarette marketing <a href="https://doi.org/10.1001/jamapediatrics.2022.2223">increases an adolescent’s risk of trying e-cigarettes</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LIyzUVfJpN4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A teen who nearly died after smoking e-cigarettes starts a no-vaping campaign.</span></figcaption>
</figure>
<h2>Targeted strategies aimed at youth</h2>
<p>While Juul <a href="https://www.nytimes.com/2022/09/06/health/juul-settlement-vaping-crisis.html">has not admitted any wrongdoing</a>, as part of the settlement it has agreed to refrain from marketing aimed at youth and from depicting persons under age 35 in any marketing. Juul also agreed to forgo the use of paid influencers – <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056828">public figures with sizable followings</a> on social media platforms who promote products on behalf of brands for monetary compensation or other benefits. And as part of the settlement, the company agreed to refrain from product placement, use of cartoons and other marketing practices that appeal to adolescents. </p>
<p>I’m cautiously optimistic that the settlement reached between Juul and the states will help curb e-cigarette use among adolescents. However, Juul’s share of the e-cigarette market <a href="https://www.nytimes.com/2020/06/02/health/puff-bar-teens.html">has decreased</a> in recent years, replaced <a href="https://truthinitiative.org/sites/default/files/media/files/2021/06/Truth_E-Cigarette%20Factsheet%20update%20JUNE%202021_FINAL.pdf">by disposable, one-time-use e-cigarettes</a> like the newly popular PuffBar. PuffBar offers its <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056780">products in a variety of flavors</a>, which is important because flavored e-cigarettes are <a href="https://doi.org/10.15585/mmwr.mm7039a4">trendy among U.S. middle school and high school students</a>.</p>
<p>Juul is just one e-cigarette company that has employed marketing practices that appeal to adolescents. For example, our team’s research found that e-cigarette companies were <a href="https://doi.org/10.1001/jamapediatrics.2020.1987">using cartoons as company logos</a> and in other promotional material. <a href="https://doi.org/10.1093/ntr/ntaa093">We’ve documented</a> 106 companies that have used cartoons to help establish their brand identities. </p>
<p>In 2021, we examined the associations between recognition of <a href="https://doi.org/10.1016/j.addbeh.2022.107312">e-cigarette packaging with cartoons and e-cigarette use</a>. We also studied adolescents’ susceptibility to e-cigarette use and their expectations of benefits and risks from use. To assess the degree to which adolescents recognize cartoon images on product labels, we presented adolescents in our study with 40 images of e-cigarette packages – 20 with cartoons and 20 without. We then asked each adolescent whether they recognized the products. </p>
<p>We found a positive association between recognition of cartoon images and e-cigarette use, susceptibility to use and a perceived social benefit of use. In other words, we determined that adolescents recognized e-cigarette-related cartoon marketing, and that these adolescents were using e-cigarettes.</p>
<h2>A step in the right direction</h2>
<p>The settlement comes at a time when the public outcry against teen vaping has reached a <a href="https://www.heart.org/en/news/2022/09/06/educators-other-experts-aim-to-build-momentum-in-fight-against-youth-vaping">fever pitch</a>. Although the settlement is an important step forward, research from the tobacco control community shows that marketing practices from tobacco companies can and will influence young people to consider trying tobacco products, including e-cigarettes.</p>
<p>As Juul’s popularity wanes and new e-cigarette companies begin to capture more of the market share, strict measures to curb additional marketing practices will be critical in the efforts to keep more young people from becoming addicted to nicotine.</p><img src="https://counter.theconversation.com/content/190399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jon-Patrick Allem receives funding from Tobacco-Related Disease Research Program (TRDRP), California Tobacco Control Program, and the National Institutes of Health (NIH).</span></em></p>The nearly half-billion-dollar settlement orders Juul to tamp down its targeting of the teen market.Jon-Patrick Allem, Assistant Professor of Research in Population and Public Health Sciences, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1866282022-08-10T12:16:32Z2022-08-10T12:16:32ZCigarette advertising aggressively targets kids in low- and middle-income countries, a new study finds<figure><img src="https://images.theconversation.com/files/477722/original/file-20220804-1334-m15q4r.jpg?ixlib=rb-1.1.0&rect=42%2C30%2C4046%2C2642&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In some countries, cigarettes are prominently displayed at children's eye level.</span> <span class="attribution"><span class="source">Campaign for Tobacco-Free Kids</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The world’s largest multinational tobacco companies are advertising cigarettes to kids near playgrounds and schools in 42 majority low- and middle-income countries. That’s the key finding of our <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-057095">recently published paper</a>. </p>
<p>Through our on-the-ground data collection at 19,500 points of sale, we identified tobacco industry advertising and promotions demonstrating four common tactics. These include displaying cigarettes near snacks, sweets and sugary drinks; placing cigarette advertisements near children’s eye level; marketing flavored cigarettes through ads and/or product displays; and selling single cigarette sticks. </p>
<p>We collected data on how cigarettes are marketed and sold within 250 meters, or about 820 feet, of one or more schools and/or playgrounds in more than 100 cities around the globe. The locations included most capital cities and spanned Africa, Asia, Central America, Europe, North America and South America.</p>
<p>Our findings correspond with <a href="http://dx.doi.org/10.1136/tc.2003.006577">similar research conducted in high-income countries</a>. Taken together, our research and that of others suggests that in the absence of strong restrictions and enforcement, the tobacco industry is employing similar marketing strategies all around the world with what we believe is <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-057026">the specific intention to attract</a> <a href="http://dx.doi.org/10.1136/tobaccocontrol-2015-052586">and addict</a> children and youth.</p>
<h2>Why it matters</h2>
<p>Many jurisdictions throughout the world have implemented laws <a href="https://truthinitiative.org/research-resources/tobacco-industry-marketing/what-do-tobacco-advertising-restrictions-look-today">prohibiting advertising of tobacco products</a> on radio, television and billboards. As a result, <a href="https://apps.who.int/iris/handle/10665/178574">comparably less restricted</a> point-of-sale opportunities have become a critical component of tobacco company marketing strategies. This includes the <a href="http://dx.doi.org/10.1136/tobaccocontrol-2011-050395">“Big Four” global giants</a>: Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Tobacco. </p>
<p>Previous research has established that in the face of advertising restrictions, the tobacco industry will <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.92.6.937">refocus its marketing efforts – and dollars</a> – on unregulated channels such as the point of sale. Tobacco companies themselves have <a href="http://dx.doi.org/10.1136/tc.2006.018978">acknowledged the effectiveness</a> of the point-of-sale channel, developing effective marketing strategies and resources geared toward maximizing potential sales. Tobacco companies <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-057026">provide incentives to retailers to market their products</a> in this manner.</p>
<p>Our findings, summarized below, show that the tobacco industry uses point-of-sale advertising widely, and consistently targets youth. </p>
<p>• In 90% of the countries we studied, cigarettes were displayed near junk food or sugary drinks, including some self-serve displays within children’s reach. </p>
<p>• We found ads or displays promoting flavored cigarettes, which are <a href="http://dx.doi.org/10.1136/tobaccocontrol-2016-053196">known to appeal to minors</a>, in 76% of the countries we studied.</p>
<p>• Stores selling tobacco in 78% of countries sold single cigarettes, <a href="https://doi.org/10.1007%2Fs11524-013-9854-3">making the product more affordable</a>. </p>
<p>• Points of sale in all 42 majority low- and middle-income countries displayed cigarette advertising at kids’ eye level, featuring “Big Four” tobacco products or ads.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/booe1PLkdGY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The study identified four common tactics that tobacco companies use to target kids.</span></figcaption>
</figure>
<p>Research is clear that kids who are frequently exposed to tobacco advertising and promotion at points of sale have <a href="http://dx.doi.org/10.1136/tobaccocontrol-2015-052586">higher odds of trying smoking and are more likely to be susceptible</a> to smoking in the future compared to those who are less frequently exposed. Smoking kills <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">8 million people worldwide each year</a> and is the leading cause of preventable death.</p>
<p>Experts have also established links between point-of-sale advertising and smoking-related behaviors and beliefs, like misperceptions that smoking is less harmful than it really is and a <a href="https://doi.org/10.1093/ntr/ntn002">lower likelihood of quitting smoking</a>.</p>
<h2>What’s next</h2>
<p>Our work focused on what consumers see and did not differentiate between products that were on sale legally versus those sold illicitly. </p>
<p>The World Health Organization <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a>, an international treaty ratified by 182 parties and covering more than 90% of the world’s population, recommends a variety of evidence-based strategies to counteract these marketing tactics. These include comprehensive bans on tobacco advertisement, promotion and sponsorship, plain tobacco packaging, large graphic health warnings on tobacco packs, bans on single-stick cigarette sales, and regulation of flavors.</p><img src="https://counter.theconversation.com/content/186628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was supported with funding from Bloomberg Philanthropies' Bloomberg Initiative to Reduce Tobacco Use (bloomberg.org). Jennifer Brown consults with the Campaign for Tobacco-Free Kids. </span></em></p>In places around the world that lack restrictions to combat the problem, tobacco companies are using marketing strategies aimed at children, like displaying tobacco products at kids’ eye level.Jennifer Brown, Researcher in Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867042022-08-04T12:21:07Z2022-08-04T12:21:07ZThe US government’s call for deep nicotine reduction in cigarettes could save millions of lives – an expert who studies tobacco addiction explains<figure><img src="https://images.theconversation.com/files/476774/original/file-20220730-28629-fb4hod.jpg?ixlib=rb-1.1.0&rect=246%2C49%2C5223%2C3572&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A 95% reduction in the nicotine content of cigars and cigarettes would make these tobacco products largely nonaddictive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/foto/cigarette-butts-overflowing-outdoor-ashtray-imagen-libre-de-derechos/520644430?adppopup=true">Robert Recker/The Image Bank via Getty Images</a></span></figcaption></figure><p>The cigarette is the only legal consumer product that – when used as intended – causes the premature death of half of long-term users. </p>
<p>To address this long-standing health threat, in late June 2022, the Biden-Harris administration <a href="https://www.fda.gov/news-events/press-announcements/fda-announces-plans-proposed-rule-reduce-addictiveness-cigarettes-and-other-combusted-tobacco">announced a plan</a> to move forward with a new standard for cigarettes and other combusted tobacco products that would make them minimally or nonaddictive. </p>
<p>A similar nicotine-reduction strategy has also recently been announced by the government of New Zealand and was <a href="https://blogs.otago.ac.nz/pubhealthexpert/removing-the-nicotine-from-tobacco-the-key-component-of-the-current-smokefree-bill/">described as the key component</a> of the country’s new smoke-free plan.</p>
<p>The Biden-Harris proposal was predated by <a href="https://doi.org/10.1056/NEJMp1707409">an earlier plan</a> in 2017 during Trump’s presidency to reduce the permissible nicotine content in cigarettes. <a href="https://www.ted.com/talks/mitch_zeller_the_past_present_and_future_of_nicotine_addiction?language=en">Mitch Zeller</a>, the director of the Food and Drug Administration’s Center for Tobacco Products from 2013 to April 2022, stated in 2019 that “this one rule could have the greatest impact on public health in the history of public health.”</p>
<p>So what does the proposal mean in practice? When implemented – likely not for at least another three years – it would mean that all cigarettes and cigars sold in the United States will have to contain approximately 95% less nicotine than they currently do. As nicotine is the addictive substance in tobacco, this would mean that these tobacco products would become pretty much nonaddictive. No more young people would become addicted to cigarettes and current smokers would find it much easier to quit. </p>
<p>As a <a href="https://scholar.google.com/citations?user=oYyjpUUAAAAJ&hl=en">professor of public health sciences</a> who has been doing research on smoking cessation for over 30 years, I am impressed by any intervention that increases the quit rate among smokers with no plans to quit. In one of our recent randomized clinical trials of very low-nicotine cigarettes, my research team at Penn State, along with colleagues at Harvard, found that those assigned to use them were more than <a href="https://doi.org/10.1101/2022.05.24.22275536">four times as likely to quit smoking</a> as those who smoked normal nicotine cigarettes. </p>
<p>Research suggests that the full public health benefits of a successfully implemented reduced nicotine standard for cigarettes could be enormous. </p>
<p>A 2018 FDA study projected that by the year 2060, a reduced nicotine standard for cigarettes <a href="https://doi.org/10.1056/NEJMsr1714617">could reduce the smoking rate dramatically</a> – from around 13% now to below 2%, preventing 16 million people from becoming regular smokers and preventing more than 2.8 million tobacco-caused deaths. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/vUx-b89laPU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Along with heart disease, stroke and cancer, smoking can cause infertility, erectile dysfunction, cataracts, premature aging, hair loss and tooth loss.</span></figcaption>
</figure>
<h2>Not just a ‘light’ or ‘low-tar’ cigarette</h2>
<p>The proposed standard would not simply result in something akin to a “light” cigarette. Light cigarettes, which have been marketed for decades, contain <a href="https://doi.org/10.1136/tc.7.4.369">about the same amount of nicotine</a> as regular cigarettes – about 10 to 15 milligrams per cigarette. To comply with the new standard, a cigarette will likely be required to contain <a href="https://doi.org/10.1093%2Fntr%2Fntz045">less than 0.5 milligrams of nicotine</a>. </p>
<p>So-called “light” or “low-tar” cigarettes have tiny holes in the filter that allow air flow into the filter to dilute the smoke. When smoked by a machine, light cigarettes deliver lower levels of tar and nicotine per puff. However, when held by a human, the holes are often blocked by the fingers, and smokers can easily puff a bit harder to <a href="https://doi.org/10.1158/1055-9965.epi-04-0667">inhale the same amount</a> of nicotine and tar.</p>
<p>Some skeptics of the proposed nicotine reductions have raised the concern that smokers might just smoke reduced-nicotine-content cigarettes more intensely, as they do with “light” cigarettes. However, dozens of research studies have shown that with very low-nicotine-content cigarettes, smokers <a href="https://doi.org/10.1016%2Fj.drugpo.2021.103436">do not increase their smoke intake</a>. </p>
<p>Instead, over a short period of time, smokers learn that the very low-nicotine cigarette is not very satisfying, and <a href="https://doi.org/10.1001/jama.2018.11473">they gradually reduce their smoking</a>. In randomized trials, those using very low-nicotine-content cigarettes are also <a href="https://doi.org/10.1101/2022.05.24.22275536">more likely to quit</a>. </p>
<h2>A role for e-cigarettes</h2>
<p>When nicotine reduction in cigarettes was initially proposed under the Trump administration, Zeller and former FDA director Scott Gottlieb recognized that one of the main challenges to the success of this plan was the possibility that the regulation might give rise to an illicit market for high-nicotine cigarettes. </p>
<p>Zeller and Gottlieb understood that one critical way to keep that from happening is to allow nonsmoked nicotine products – like electronic cigarettes – to remain on the market. E-cigarettes deliver a satisfying amount of nicotine for smokers while exposing the user to significantly <a href="https://nap.nationalacademies.org/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf">lower amounts of toxic substances</a> than regular cigarettes. As a result, e-cigarettes are likely to be significantly less harmful. </p>
<p>New research by our team, along with colleagues at Virginia Commonwealth University, recently found that when smokers with no plans to quit use <a href="https://doi.org/10.1093/ntr/ntab247">electronic cigarettes</a> with cigarettelike nicotine delivery, a greater proportion completely quit smoking than those using zero-nicotine e-cigarettes or no e-cigarette.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/6OZehKDHsj0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Exercise and support from family and friends – along with the nicotine patch – are a few of the strategies this smoker used to quit.</span></figcaption>
</figure>
<h2>The controversy over e-cigarettes</h2>
<p>The potential for e-cigarettes to help replace smoking explains why it came as a surprise to many when – two days after the Biden-Harris announcement in June to drastically reduce the permissible nicotine content in cigarettes – the FDA then announced that it was <a href="https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products">effectively banning all sales</a> of Juul, the enormously popular e-cigarette that has been the biggest selling e-cigarette brand over the past five years. When Juul appealed the decision, the <a href="https://www.statnews.com/2022/06/24/court-rules-juul-can-sell-e-cig-while-challenges-fda-ban/">FDA suspended the denial order until an additional review is completed</a>, which is expected to take months. </p>
<p>And Juul is not the only e-cigarette to be threatened with a ban. Of the millions of e-cigarette applications submitted to the FDA by the deadline in September 2020, more than 99% <a href="https://www.fda.gov/tobacco-products/ctp-newsroom/fda-issues-marketing-denial-orders-fontem-us-myblu-products">have been denied</a>. </p>
<p>The reason the FDA’s e-cigarette ban is so puzzling and counterintuitive in the context of the FDA’s nicotine-reduction efforts in cigarettes is that the availability of e-cigarettes is critical to the feasibility of that plan.
Many researchers, including me, believe that having a variety of legal, regulated high-nicotine e-cigarettes on the market is a critical element in <a href="https://doi.org/10.2105%2FAJPH.2019.305067">reducing consumer demand</a> for illegal high-nicotine smoked products. </p>
<p>Health authorities in other parts of the world, including <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary">the United Kingdom</a> and New Zealand, have recognized the important role that e-cigarettes can play in reducing cigarette smoking. New Zealand’s <a href="https://blogs.otago.ac.nz/pubhealthexpert/removing-the-nicotine-from-tobacco-the-key-component-of-the-current-smokefree-bill/">nicotine-reduction plan</a> explicitly includes providing access to alternative nicotine products like e-cigarettes. </p>
<p>Research shows that e-cigarettes are <a href="https://nap.nationalacademies.org/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf">much less harmful</a> than cigarettes, and they are proved to <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">help smokers transition</a> from highly toxic cigarettes. It is therefore highly likely to be appropriate for the protection of public health to keep a variety of e-cigarette brands on the market until after the nicotine reduction plan for cigarettes has been successfully implemented. </p>
<p>As we pass <a href="https://lcfamerica.org/get-involved/events/world-lung-cancer-day/">World Lung Cancer Day</a>, quietly as usual, I believe we now have a plan that could do more than anything else to reduce the number of deaths each year from that horrible disease. It is a plan that has been proposed by Republican and Democratic administrations alike and is supported by the best available science. In my view, implementation of a reduced-nicotine standard for combustible tobacco represents the possibility of finally bringing an end to cigarette addiction within our lifetimes.</p><img src="https://counter.theconversation.com/content/186704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Foulds receives research funding from the U.S. National Institutes of Health, and has previously done consulting for pharmaceutical companies that manufacture smoking cessation medicines.</span></em></p>The proposed standard would lower the nicotine content in cigarettes and cigars by 95% – a public health proposal that could prevent millions from becoming smokers in the first place.Jonathan Foulds, Professor of Public Health Sciences and Psychiatry, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1858362022-06-29T12:05:04Z2022-06-29T12:05:04ZThe FDA and Juul are fighting over a vape ban, but the role of e-cigarettes in the world of tobacco abuse is not clear-cut<figure><img src="https://images.theconversation.com/files/471462/original/file-20220628-14487-w1q3rk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3862%2C2058&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is illegal for people under 21 to smoke e-cigarettes like Juuls, but adult use has come under scrutiny, too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/labs-inc-virginia-tobacco-and-menthol-flavored-vaping-e-news-photo/1241480667?adppopup=true">Patrick T. Fallon/AFP via Getty Images</a></span></figcaption></figure><p><em>On June 23, 2022, the U.S. Food and Drug Administration announced that all Juul products must be removed from U.S. markets. This decision essentially broadened an existing ban on teen use of the company’s nicotine e-cigarettes to include adults as well. The next day, Juul asked a federal appeals court to temporarily block the ban while Juul challenged the decision. The court agreed to the pause, and for now, Juul products are still for sale in the U.S.</em> </p>
<p><em><a href="https://scholar.google.com/citations?user=0xNYzqcAAAAJ&hl=en&oi=ao">Lynn Kozlowski</a> of the University at Buffalo has been studying nicotine and cigarette addiction for decades. He explains how the recent fight over Juul products fits into the larger discussion of e-cigarettes, tobacco use and public health among adults and teens.</em> </p>
<h2>Why does the FDA want to stop the sale of Juul products?</h2>
<p>According to the FDA, <a href="https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products">the decision</a> was a precautionary response due to a lack of “sufficient evidence regarding the toxicological profile of the products” to ensure protection of public health. The FDA also noted that it hadn’t received any information suggesting Juul products were an “immediate hazard.” </p>
<p>In the announcement, FDA commissioner Robert M. Califf commented on the effects Juul products have had on youth vaping. And this decision comes at a time when some have hoped that a new ban on Juul products and other e-cigarettes for adults would <a href="https://thehill.com/policy/healthcare/3533490-advocates-cautiously-optimistic-over-report-of-juul-ban/">help reduce vaping by teens</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman exhaling a cloud of vapor while holding a Juul e-cigarette." src="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">E-cigarettes are not without health concerns, but evidence suggests they are much less harmful to health than tobacco cigarettes.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/JuulUnprovenAds/9385f3bb9b4b430db36127fb491c34b3/photo?Query=19129612472205&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=1&currentItemNo=0">AP Photo/Craig Mitchelldyer</a></span>
</figcaption>
</figure>
<h2>How do the health risks of vaping compare to smoking?</h2>
<p>Cigarettes kill at least 1-in-2 smokers prematurely and <a href="https://doi.org/10.7554%2FeLife.49979">cut smoker’s lives short by an average of 10 years</a> due to cancer, obstructive lung disease and cardiovascular disease. </p>
<p>There is not yet any long-term epidemiological data available on e-cigarettes. But <a href="https://nap.nationalacademies.org/catalog/24952/public-health-consequences-of-e-cigarettes">U.S.</a> and <a href="https://www.rcplondon.ac.uk/projects/outputs/rcp-advice-vaping-following-reported-cases-deaths-and-lung-disease-us">British</a> assessments have concluded that while vaping is likely to be substantially less harmful than cigarettes, it is not risk-free. Potential harms include nicotine addiction as well as <a href="https://doi.org/10.1038%2Fnrcardio.2017.36">some cardiovascular risks</a>, though these are estimated to be lower than risks from cigarettes.</p>
<h2>Could e-cigarettes reduce harm of normal smoking?</h2>
<p>I do not encourage that anyone vape if they do not need to. But if someone would otherwise smoke cigarettes, and vaping helps them stop smoking completely, e-cigarettes <a href="https://doi.org/10.2105/AJPH.2021.306416">can be a useful tool for reducing the smoking and health problem</a>. Quitting cigarettes is unequivocally good for your health. Research shows that if a person stops using cigarettes by age 40, they on average avoid 90% of the increased risk of death compared to if they continued smoking. If a person stops smoking cigarettes by age 30, their health risks are <a href="https://doi.org/10.7554%2FeLife.49979">nearly the same as a person who never smoked</a>. </p>
<p>The CDC says that there is <a href="https://www.cdc.gov/tobacco/sgr/2020-smoking-cessation/fact-sheets/pdfs/adult-smoking-cessation-e-cigarettes-use-h.pdf">limited evidence</a> that vaping <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub4/full">helps people quit smoking cigarettes</a>. The FDA, in <a href="https://www.fda.gov/tobacco-products/premarket-tobacco-product-applications/premarket-tobacco-product-marketing-granted-orders">approving some e-cigarettes for sale</a>, expresses the view that e-cigarettes can be a beneficial tool for smokers who significantly reduce their cigarette use or stop smoking by switching to e-cigarettes.</p>
<p>Recent studies have also shown that e-cigarettes are <a href="https://doi.org/10.1056/NEJMoa1808779">more effective</a> than <a href="https://doi.org/10.1002/14651858.CD010216.pub4">nicotine replacement medicines</a> in helping people who want to quit smoking. The <a href="https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/">National Health Service</a> in the United Kingdom includes vaping as an approved way to quit smoking.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Numerous types of vapes on a desk." src="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaping is popular with high school students – as shown in this photo of vapes confiscated at a New York high school – but it is on the decline.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/NewYork-E-Cigarettes/4112231cb80f43afbaef95f1cc537c05/photo?Query=e-cigarette&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=515&currentItemNo=29">AP Photo/Steven Senne,</a></span>
</figcaption>
</figure>
<h2>Is vaping among teens as popular as it once was?</h2>
<p>Teen vaping is on <a href="https://www.nytimes.com/2021/09/30/health/youth-vaping-decline.html#">a downward trend</a>. Data from the CDC showed that in 2019, 27.5% of high school students reported vaping at least once in the previous month. That number fell to 19.6% in 2020 and to 11.3% in 2022. Just over a one-quarter of monthly users – or about 3% of high school students in 2022 – report vaping on a daily basis.</p>
<p>Some of these decreases were likely due to COVID-19, enforcement of restrictions on youth access and <a href="https://doi.org/10.3389%2Ffcomm.2019.00075">government anti-vaping campaigns</a>. </p>
<p><a href="https://doi.org/10.1093/ntr/ntac088">Widespread publicity</a> about a <a href="https://theconversation.com/vaping-likely-has-dangers-that-could-take-years-for-scientists-to-even-know-about-123051">serious lung disease caused by vaping</a>, called EVALI, very likely turned many away from vaping. This was despite the fact that research eventually showed the disease was mostly <a href="https://doi.org/10.1111/add.15108">caused by black market cannabis vaping products</a>. </p>
<h2>Does teen vaping increase teen tobacco use?</h2>
<p>Despite the encouraging drop in teen vaping, an important question to ask is whether vaping directly leads to later cigarette smoking.</p>
<p>Parents are justly concerned that vaping could be a gateway to smoking. But <a href="https://theconversation.com/vaping-as-a-gateway-to-smoking-is-still-more-hype-than-hazard-47399">research doesn’t seem to support a strong causal connection</a>. While vaping surged nationally in recent years, <a href="https://doi.org/10.1001%2Fjamanetworkopen.2020.27465">smoking rates fell</a>.</p>
<p>Using several years of U.S. data from the National Youth Tobacco Survey on almost 40,000 participants, researchers found that less than 1% of those who first used e-cigarettes <a href="https://doi.org/10.1136%2Ftobaccocontrol-2019-055283">went on the become established cigarette smokers</a>. People who vaped first were also less likely to become smokers than those who had tried cigarettes or other tobacco products first.</p>
<p>Another large study of U.S. youth found that a history of e-cigarette use was associated with only <a href="https://doi.org/10.1093%2Fntr%2Fntab243">modest or nonsignificant increases in cigarette smoking</a> once the researchers controlled for general risk-taking behavior.</p>
<h2>How do you balance adult use with teen safety?</h2>
<p>Even if vaping is not a big factor in causing teens to become smokers, teen use of vaping products is a concern despite a ban on the sales of e-cigarettes to people under 21 in 2019. </p>
<p>Completely banning a product that is useful for adult smokers who are looking to quit is not the only way to help reduce youth access. <a href="https://doi.org/10.1056/NEJMp2119107">One proposal</a>, for example, suggests moving the sales of all nicotine and tobacco products to stores that are only accessible to those 21 or older.</p>
<p>While products like Juul deserve study and regulation, it is important to keep in mind the proven deadliness and easy availability of cigarettes – both to adults today and to the many teens who start smoking every year and will become adult smokers. Getting as many smokers as possible off tobacco cigarettes will save lives.</p><img src="https://counter.theconversation.com/content/185836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynn T. Kozlowski receives no external funding at the present time.</span></em></p>E-cigarettes are facing calls for complete bans on their sale. A tobacco addiction researcher explores the balance between vaping’s harm to teens and potential use as a tool for quitting smoking.Lynn T. Kozlowski, Professor of Community Health and Health Behavior, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722182022-02-02T18:52:15Z2022-02-02T18:52:15ZFish on acid? Microdosing zebrafish with LSD shows its potential benefits for humans<figure><img src="https://images.theconversation.com/files/443433/original/file-20220131-126279-j84hlf.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C2600%2C1650&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because of their social nature and the fact that they share 70 per cent of their DNA with humans, zebrafish make ideal test subjects.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/fish-on-acid-microdosing-zebrafish-with-lsd-shows-its-potential-benefits-for-humans" width="100%" height="400"></iframe>
<p>Microdosing — <a href="https://www.theguardian.com/society/2021/dec/02/people-microdosing-on-psychedelics-to-improve-wellbeing-during-pandemic">regularly ingesting small amounts of a psychedelic substance</a> — has gone mainstream.</p>
<p>Believed to increase productivity, spark creativity or improve open-mindedness, the microdosing of psychedelic drugs is gaining popularity with both academic researchers and those interested in experimenting.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/microdosers-of-lsd-and-magic-mushrooms-are-wiser-and-more-creative-101302">'Microdosers' of LSD and magic mushrooms are wiser and more creative</a>
</strong>
</em>
</p>
<hr>
<p>But microdosing may offer more beyond its mood-boosting abilities.</p>
<p>Using zebrafish and our new method for precise and repeated drug administration, my colleagues and I are studying LSD and terpenes (chemicals in plants responsible for their scent, among other things) in a series of projects exploring potential novel treatments for mental illness and alcohol use disorder.</p>
<p>Zebrafish might seem an odd choice in studying human health, but <a href="https://doi.org/10.1038/nature12111">they share 70 per cent of their genes with us</a> and are a popular nonhuman organism used by scientists to study biological processes. They are also incredibly social, making them <a href="https://dx.doi.org/10.1038/s12276-021-00571-5">well-suited for behavioural studies into psychiatric disorders</a> and <a href="https://doi.org/10.1038/nrd46277">drug discovery</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/animals-in-research-zebrafish-13804">Animals in research: zebrafish</a>
</strong>
</em>
</p>
<hr>
<p>However, past drug research using zebrafish has studied “chronic” administration — putting fish in a drug solution for weeks. Since humans require (at the very least) some sleep, this administration can’t accurately reflect human consumption patterns.</p>
<h2>Dose control</h2>
<p>To address this limitation, we developed a new method to dose multiple fish accurately and efficiently for exact exposure times. By placing an insert into the housing tank, we can move groups of fish from their housing tank into a dosing tank for a precise dosing period, more closely mimicking the way that a person might consume drugs or alcohol.</p>
<p>To verify that this new dosing procedure could have behavioural and neurochemical effects, we completed a series of projects using our new method to examine the effects of alcohol and nicotine.</p>
<p>First, we tested the zebrafish with a daily moderate dose or a weekly binge-level dose of ethanol for three weeks. We found a significant difference in <a href="https://doi.org/10.1371/journal.pone.0063319">location preference in the daily moderate group</a> compared to controls during a withdrawal period, which implies there were neurological changes. </p>
<p>Then we followed up with a study using <a href="https://doi.org/10.7717/peerj.6551">lower doses for shorter periods of time</a>. Here, we saw decreased boldness and increased anxiety-like behaviour during withdrawal from the highest dose (<a href="http://dx.doi.org/10.7717/peerj.2994">opposite to what is seen after an acute single-dose</a>). </p>
<p>Similarly, testing the model <a href="https://doi.org/10.1038/s41598-020-65382-6">using nicotine</a>, we found again that acute doses decreased anxiety-like behaviour while repeated dosing led to an increase of anxiety-like behaviour during withdrawal.</p>
<p>For humans, having an alcoholic drink or a cigarette <a href="https://doi.org/10.1176/ajp.147.6.685">can decrease anxiety, and the inverse is observed in withdrawal</a>. Our zebrafish model is consistent with this, which has given us confidence that we can test novel compounds with potential therapeutic effects in humans.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a short glass drink with alcohol next to an ashtray with a smoldering cigarette in it. in the background, out of focus, a man wearing a blue shirt and surgical mask" src="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researchers have been finding that cigarette and alcohol consumption has increased during the pandemic. These substances can reduce anxiety, but withdrawal from them can increase it.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Potential therapies</h2>
<p>Terpenes are a large and diverse group of aromatic compounds. They are responsible for the smell, taste and pigmentation of plants. Many terpenes — like those found in tea, lemongrass, cannabis and citrus fruits — <a href="https://dx.doi.org/10.1007/978-3-030-31269-5_15">have medical benefits</a>.</p>
<p>We found that zebrafish acutely dosed with the terpene limonene (found in citrus fruit peels and cannabis) and myrcene (found in cannabis and hops), showed a significant reduction in anxiety-like behaviour. One observation that may be clinically significant is that — contrary to nicotine or alcohol — no negative effects were seen after repeated dosing for seven days, <a href="https://doi.org/10.1038/s41598-021-98768-1">suggesting minimal to no addictive potential</a>. </p>
<p><a href="https://doi.org/10.1038/s41598-021-98768-1">This study</a>, alongside <a href="https://doi.org/10.1078/094471102321621304">previous research</a>, suggests that the terpenes limonene and beta-myrcene possess sedative and anti-anxiety effects that have potential as valuable therapeutic compounds for the treatment of a variety of mental health conditions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="close-up of a hand holding tweezers handling small squares of cardboard that are microdose tabs" src="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is a growing interest in microdosing psychedelics to increase productivity and spark creativity.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Prairie psychedelic research</h2>
<p>Some of the most influential research into psychedelics <a href="https://www.thecanadianencyclopedia.ca/en/article/psychedelic-research-in-1950s-saskatchewan">began in Saskatchewan in the 1950s</a>. British-born psychiatrist Humphry Osmond <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381240/">used LSD and mescaline to treat alcoholism</a>, with single doses showing a 50 to 90 per cent recovery rate over two years.</p>
<p>However, while Osmond saw success in large single-dose treatments, the acute administrations required continuous monitoring of the patient over the seven- to 15-hour “trip” to prevent any <a href="https://dx.doi.org/10.1124/pr.115.011478">harm arising from impaired judgment</a>. From a therapeutic perspective, this would be very time-intensive for clinicians, and is not feasible. </p>
<p>This is where microdosing comes in. With the potential to be <a href="https://doi.org/10.1007/s00213-019-05417-7">easy and safe</a>, we believe this pattern of exposure to be more therapeutically relevant, as doses are small enough to be safely self-administered with the proper guidance of a clinician.</p>
<h2>Future knowledge</h2>
<p>In our first study, we repeatedly microdosed our zebrafish with LSD. Using behavioural neuroscience tests to quantify locomotion, boldness and anxiety-like behaviour, we observed no impact on behaviour after 10 days of repeated dosing. Like with terpenes, this may suggest a lack of withdrawal symptoms or addictive potential, which is encouraging for clinically viability for use in humans.</p>
<p>Our current study examines the effects of LSD microdosing on the symptoms of alcohol withdrawal, <a href="https://policyoptions.irpp.org/magazines/april-2021/covid-19-shows-us-why-canada-needs-a-federal-alcohol-act/">which is a growing issue in Canadian health care</a>.</p>
<p>In Canada, the negative effects of alcohol are widely felt. Fetal alcohol spectrum disorder remains the leading developmental disability in Canada, and alcohol harm is a top <a href="https://www.cihi.ca/sites/default/files/document/report-alcohol-hospitalizations-en-web.pdf">cause of injury and death</a>. It costs Canadians <a href="https://csuch.ca/publications/CSUCH-Canadian-Substance-Use-Costs-Harms-Infographic-2020-en.pdf">billions of dollars in lost productivity, and is a burden on the health-care and judicial systems</a>. Treatment and rehabilitation can be costly, time consuming and bogged down in lengthy wait times — if accessible at all.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fetal-alcohol-spectrum-disorder-amid-covid-19-fewer-services-potential-boost-in-rates-145593">Fetal alcohol spectrum disorder amid COVID-19: Fewer services, potential boost in rates</a>
</strong>
</em>
</p>
<hr>
<p>Further research into other psychedelics, like psilocin (the psychoactive compound in psilocybin, or “magic mushrooms”), are also planned with the goal of providing scientific evidence to help determine whether these substances should be used in larger clinical trials in humans.</p>
<p>Psychedelics may provide assistance, but despite increasing evidence that LSD and psilocin <a href="https://doi.org/10.1016/j.pharmthera.2003.11.002">are non-addictive and low risk</a>, they remain highly restricted. Perhaps with more research and the continuing shift in public perception, we might yet again see LSD being used as a radical treatment for mental health and addiction.</p><img src="https://counter.theconversation.com/content/172218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trevor James Hamilton receives funding from the Natural Sciences and Engineering Research Council of Canada (NSERC). </span></em></p>Growing interest in psychedelics has spurred new research decades after hallucinogenics were tested in Saskatchewan in the 1950s. And an unassuming common fish is proving a useful test subject.Trevor James Hamilton, Associate Professor in Neuroscience (Department of Psychology), MacEwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731102022-01-06T11:14:27Z2022-01-06T11:14:27ZHeated tobacco: a new review looks at the risks and benefits<p>Heated tobacco products are designed to heat tobacco without burning it or producing smoke. The popularity of these products soared in Japan after the release of an electronic device called IQOS in 2016. Heated tobacco products are now available in many countries, but questions remained about their effect on cigarette smoking and health, so we set out to review the evidence.</p>
<p>Our <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013790.pub2/full">new review</a> covers data from 11 studies with over 2,600 people. The headline finding is that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who kept smoking, but higher levels of these toxins than those who stopped using tobacco altogether.</p>
<p>This lower exposure was found across a number of harmful substances linked to cancers, heart disease and respiratory problems. This means it is possible that switching from cigarettes to heated tobacco could reduce the odds of developing these diseases, but we don’t have enough data yet to be sure. The studies were all of short duration, and it typically takes a while for people to develop tobacco-related diseases. </p>
<p>That said, the evidence so far is consistent with how uniquely dangerous smoking is. We know that most of the harmful effects of cigarettes — which <a href="https://www2.hse.ie/wellbeing/quit-smoking/reasons-to-quit-smoking/smoking-facts-and-figures.html">kill half of all regular smokers</a> — come from inhaling <a href="https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction">toxic chemicals made by burning tobacco</a>. As heated tobacco products are designed to avoid burning tobacco, we’d expect them to pose a lower risk. </p>
<p>Heated tobacco products could benefit public health if they reduce risk and help people stop smoking normal cigarettes, without attracting people who would otherwise avoid tobacco entirely. </p>
<p>We didn’t find any studies looking at whether giving smokers heated tobacco products helped them stop smoking. But we found two Japanese studies looking at how cigarette sales changed after IQOS entered the market. Both found that falls in cigarette sales sped up after the IQOS launch, suggesting that heated tobacco products might replace rather than complement cigarettes. </p>
<p>On the other hand, it is possible that sales of cigarettes fell because most people cut down without stopping altogether. The greatest improvements in health come from stopping smoking altogether rather than smoking fewer cigarettes.</p>
<h2>How they compare with e-cigarettes</h2>
<p>E-cigarettes, or vapes, are another group of nicotine products that have become <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2765159">very popular</a> in recent years. Heated tobacco products heat tobacco leaf, whereas e-cigarettes heat a liquid, typically containing nicotine. There are large differences in the science and regulation of these products. E-cigarettes have been on the market for longer than heated tobacco, so we have more evidence about their benefits and harms.</p>
<p>Unlike heated tobacco, e-cigarettes have been shown to help people stop smoking normal cigarettes. In the not-too-distant future, the UK may even <a href="https://www.gov.uk/government/news/e-cigarettes-could-be-prescribed-on-the-nhs-in-world-first">offer e-cigarettes</a> to those who wish to quit smoking, as long as the products pass the necessary regulatory hurdles.</p>
<p>Yet some countries, including Japan, have imposed restrictions that have essentially banned the sale of nicotine e-cigarettes, while heated tobacco products remain widely available. This may explain why heated tobacco has taken off in Japan; it’s the only potentially lower-risk alternative to cigarettes available. Heated tobacco use remains rare in countries like the UK and US, where the e-cigarette market was already well-established by the time IQOS launched.</p>
<p>The heated tobacco market is dominated by products from the cigarette industry, which has historically acted to <a href="https://doi.org/10.1146/annurev.publhealth.24.100901.140813">distort science</a> into the harm of cigarettes. Conversely, many e-cigarette manufacturers are unaffiliated with cigarette companies. All safety studies in our review of heated tobacco were conducted by cigarette manufacturers, whereas there are <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">many independent studies of e-cigarettes</a>. </p>
<h2>The search for a less harmful cigarette</h2>
<p>Tobacco companies have claimed to be searching for decades for a less harmful cigarette. Some attempts, including adding <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/">ventilation holes to cigarette filters</a>, have caused more harm.</p>
<p>The e-cigarette was the first non-medical nicotine alternative to cigarettes that appealed widely to smokers around the globe. But e-cigarettes don’t contain tobacco and many manufacturers are unconnected to cigarette companies. Many tobacco companies instead focused on developing heated tobacco devices, a market over which they could maintain greater control <a href="https://academic.oup.com/jcle/article/17/2/458/6109742?login=true">through patents</a>. </p>
<figure class="align-center ">
<img alt="E-cigarettes" src="https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439509/original/file-20220105-21-1e8842.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">E-cigarettes were the first non-medical alternatives to cigarettes to become popular globally.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/big-electronic-cigarettes-isolated-on-white-116632465">gmstockstudio/Shutterstock</a></span>
</figcaption>
</figure>
<p>In 2014, with the introduction of IQOS to test markets by Philip Morris International, sales increased quickly in Japan and South Korea, and other tobacco companies introduced their own electronic heated tobacco devices. Some of the most popular today are glo by British American Tobacco and Ploom by Japan Tobacco International.</p>
<p>Much of the research into the safety of heated tobacco comes from Philip Morris International, which applied for IQOS to be sold as a “reduced exposure” and “reduced risk” tobacco product in the US. In 2019, <a href="https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-iqos-tobacco-heating-system-reduced-exposure-information">the US allowed IQOS</a> to be marketed as a reduced exposure product. Their review concluded that “switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals”. </p>
<p>The <a href="https://www.fda.gov/media/139796/download">reduced risk application failed</a>, because “the evidence is not sufficient to demonstrate substantiation of either of the claims about the reduced risk of tobacco-related disease or harm”. We need more evidence to be sure about how using heated tobacco affects people’s health.</p><img src="https://counter.theconversation.com/content/173110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Tattan-Birch receives studentship funding from Public Health England, now the Office for Health Improvement and Disparities. </span></em></p><p class="fine-print"><em><span>Jamie Brown has received funding to study smoking cessation from Pfizer and J&J, who manufacture smoking cessation medications.</span></em></p><p class="fine-print"><em><span>Jamie Hartmann-Boyce receives research funding to her organisation from Cancer Research UK, outside the submitted work. </span></em></p>Is heated tobacco a lower-risk alternative to cigarettes?Harry Tattan-Birch, PhD Candidate, Behavioural Science and Health, UCLJamie Brown, Professor, Behavioural Science and Health, UCLJamie Hartmann-Boyce, Associate Professor and Director of Evidence-Based Healthcare DPhil Programme, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1679732021-09-29T20:09:07Z2021-09-29T20:09:07ZThe missing ingredient Australia needs to kick its smoking addiction for good<figure><img src="https://images.theconversation.com/files/423268/original/file-20210927-124938-10b5yv6.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6096%2C4055&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-refusing-cigarettes-concept-quitting-smoking-1724010937">Shutterstock</a></span></figcaption></figure><p>From October 1, Australians who use e-cigarettes and other vaping products containing nicotine <a href="https://www.tga.gov.au/blogs/tga-topics/nicotine-vaping-laws-are-changing">will need a doctor’s prescription</a> to buy them from a local pharmacy or to order them from overseas.</p>
<p>But there’s another evidence-based way to help more smokers quit, which Australia is yet to act on: reducing the nicotine in cigarettes to non-addictive levels. And e-cigarettes could play an important role in this policy. </p>
<p>If you know someone who’s ever tried to stop smoking and failed, nicotine addiction is likely the reason they found it so hard. While nicotine itself is not a significant direct cause of the health harms from smoking, it makes tobacco products highly addictive. In 1963, <a href="https://www.who.int/tobacco/media/en/TobaccoExplained.pdf">tobacco industry lawyers wrote</a>:</p>
<blockquote>
<p>We are […] in the business of selling nicotine, an addictive drug.</p>
</blockquote>
<p>So what are other countries doing to reduce nicotine addiction? What role could alternative nicotine products including e-cigarettes play, and how could reducing nicotine in cigarettes backfire if not managed well? And how much potential does a new very low nicotine standard for cigarettes have to end Australians’ addiction to smoking?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-october-it-will-be-all-but-impossible-for-most-australians-to-vape-largely-because-of-canberras-little-known-homework-police-167376">From October, it will be all but impossible for most Australians to vape — largely because of Canberra's little-known 'homework police'</a>
</strong>
</em>
</p>
<hr>
<h2>How other countries are tackling a global killer</h2>
<p>Most people know someone who has died or developed serious health problems from smoking. </p>
<p>Even today, smoking remains the <a href="https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx">leading preventable cause of early death</a> in Australia, causing the deaths of more than <a href="https://www.aihw.gov.au/getmedia/d2a1886d-c673-44aa-9eb6-857e9696fd83/aihw-bod-30.pdf.aspx?inline=true">20,000 Australians</a> every year. It also costs the Australian economy <a href="https://ndri.curtin.edu.au/NDRI/media/documents/publications/T273.pdf">$136.9 billion annually</a>.</p>
<p>That’s why many countries, including Australia, are setting targets to reduce smoking to very low levels. But new approaches are needed to achieve this goal. </p>
<p>Reducing the nicotine levels in cigarettes to non-addictive levels was <a href="https://www.nejm.org/doi/10.1056/NEJM199407143310212?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">first proposed</a> by the US Food and Drug Administration in 1994. While it was not implemented at that time, there has been renewed interest in this policy. </p>
<p>New Zealand recently proposed a nicotine reduction strategy as an option for its <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">Smokefree Aotearoa 2025 Action Plan</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WGAXjziXFuc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">When you smoke around your pets, they’re twice as likely to get cancer: Quitline New Zealand.</span></figcaption>
</figure>
<p>US President Joe Biden’s administration is also <a href="https://thehill.com/policy/healthcare/public-global-health/549156-biden-administration-eyes-reducing-nicotine-in">considering</a> the US Food and Drug Administration’s <a href="https://www.federalregister.gov/documents/2018/03/16/2018-05345/tobacco-product-standard-for-nicotine-level-of-combusted-cigarettes">proposal</a> to reduce nicotine levels to “give addicted users the choice and ability to quit more easily”. </p>
<p>The World Health Organization supports a <a href="https://apps.who.int/iris/handle/10665/189651">global nicotine reduction strategy</a> and has provided recommendations for implementing it. </p>
<p>The good news is that it’s possible to reduce nicotine levels in cigarettes, and such cigarettes have already been tested in clinical trials. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0955395921003418">Results show</a> people smoke fewer cigarettes when given ones where the nicotine level has been reduced by 95% or more compared to regular cigarettes. They are also more likely to quit smoking. This is because those who smoke regularly find cigarettes with very low levels of nicotine less enjoyable and rewarding. </p>
<p>While it is not ethical to conduct similar studies with young people who do not already smoke, reducing nicotine levels is also expected to reduce the number of adolescents who become addicted to smoking, with promising results from <a href="https://academic.oup.com/ntr/article/18/9/1861/2584023">animal studies</a>. </p>
<h2>How could alternative nicotine products help?</h2>
<p>Allowing only very low nicotine content cigarettes to be sold would require increased investment in smoking cessation services and support, such as nicotine replacement therapies (including patches and gum), prescription medicines, and behavioural support from health professionals. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaping devices.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-device-742830484">Shutterstock</a></span>
</figcaption>
</figure>
<p>A nicotine reduction policy for tobacco products has also been made more feasible by the Australian government’s changes to how smokers can <a href="https://www.tga.gov.au/blogs/tga-topics/nicotine-vaping-laws-are-changing">access nicotine-containing e-cigarettes</a> from October 1 2021.</p>
<p>While not harmless, e-cigarettes are <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2021.306416">likely to be significantly less harmful</a> than smoked tobacco products. They can provide an alternative source of nicotine for those who are nicotine dependent, and have been shown to <a href="https://doi.org/10.1016/j.addbeh.2021.106912">increase quitting</a> compared to nicotine replacement therapy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/e-cigarettes-misconceptions-about-their-dangers-may-be-preventing-people-from-quitting-smoking-166846">E-cigarettes: misconceptions about their dangers may be preventing people from quitting smoking</a>
</strong>
</em>
</p>
<hr>
<p>Ensuring access to lower risk forms of nicotine is central to the policies being considered by both New Zealand and the <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1707409">USA</a>. </p>
<p>But there are possible unintended consequences of a nicotine reduction policy. Many people hold <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939783/">misconceptions about nicotine</a> and one risk is that people may believe reduced nicotine cigarettes are less harmful than regular cigarettes. This could reduce motivation to quit smoking.</p>
<p>That’s why we would also need a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114736/">health education campaign</a> encouraging people to quit tobacco smoking, and warning of the harms of continued smoking regardless of nicotine content. </p>
<p>Another risk is a growth in the illicit tobacco market, which would need to be monitored with increased enforcement effort. </p>
<p>Policymakers may also be concerned about the tobacco industry mounting legal challenges. However, Australia’s successful defence of <a href="http://www.tobaccoinduceddiseases.org/Plain-packaging-of-tobacco-products-lessons-for-the-next-round-of-implementing-countries,130378,0,2.html">tobacco plain packaging laws</a> show that such industry challenges can be overcome.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6674%2C4436&q=45&auto=format&w=1000&fit=clip"><img alt="A cigarette butt stubbed out." src="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6674%2C4436&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/quit-smoking-world-no-tobacco-day-1934934752">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Making it easier to quit — and stop kids ever getting hooked</h2>
<p>Michael Russell, a founder of medical approaches to help people quit smoking, famously said if nicotine was removed from cigarettes, people would “be little more inclined to smoke cigarettes than they are to blow bubbles or light sparklers”.</p>
<p>Modelling suggests that mandating very low nicotine levels for cigarettes would give New Zealand a <a href="https://www.medrxiv.org/content/10.1101/2021.08.13.21262035v1.full">“realistic chance”</a> of reaching its target of less than 5% of the population smoking. It has been estimated that <a href="https://academic.oup.com/ntr/article/23/3/438/5868042">24 million deaths in the USA would have been prevented</a> if nicotine in cigarettes had been reduced decades ago. </p>
<p>If we make tobacco smoking less addictive, we could prevent a new generation becoming addicted to smoking and help people who currently smoke to quit. And that’s a good thing, given the high cost of cigarettes and their contribution to health inequalities in Australia. </p>
<p>Australia led the world in tobacco policy by introducing tobacco plain packaging laws. Taking a leading role in new tobacco control policies, such as reducing the addictiveness of tobacco products, could help us achieve a smoke-free Australia. </p>
<p>But does Australia have the critical ingredient — political will — to finish the task?</p><img src="https://counter.theconversation.com/content/167973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Morphett is an affiliate of the NHMRC funded Centre for Research Excellence on Achieving the Tobacco Endgame. Her research has been funded by ARC and NHMRC grants. She is a member of The Society for Research on Nicotine and Tobacco. </span></em></p><p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research Council and the Australian Research Council. She is a member of the Society for Research on Nicotine and Tobacco, and is a member of Project Sunset, which is a network of tobacco control researchers and advocates who support phasing out the general retailing of commercial combustible tobacco products. </span></em></p>From October 1, Australians will only be able to buy e-cigarettes containing nicotine if they have a prescription from a doctor. But there’s another evidence-based way to help more smokers quit.Kylie Morphett, Research Fellow, School of Public Health, The University of QueenslandCoral Gartner, Associate Professor, School of Public Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1594362021-05-23T20:15:56Z2021-05-23T20:15:56ZVaping is glamourised on social media, putting youth in harm’s way<p>Despite their widespread reputation as a “safer” alternative to cigarettes, e-cigarettes (also known as electronic cigarettes or vapes) are <a href="https://moqc.org/wp-content/uploads/2017/08/Surgeon-General-Report_Use-of-E-cigarettes-Among-Youth-and-Young-Adults-2016.pdf">far from harmless</a>, particularly for adolescents, whose developing brains may suffer lifelong adverse effects from nicotine-containing products.</p>
<p>Yet vaping and e-cigarettes are <a href="https://www.jmir.org/2019/2/e11953/">widely promoted on social media</a> by the industry and influencers, using advertising tactics that were outlawed for tobacco in Australia in the 1980s for traditional media. This blatant promotion is not tolerated offline, so why is it happening on social media?</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=699&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=699&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=699&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=879&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=879&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=879&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Twitter image.</span>
</figcaption>
</figure>
<p>On Twitter, YouTube and Instagram, <a href="https://www.jmir.org/2019/2/e11953/">e-cigarettes</a> are frequently depicted as a safe and healthy alternative to cigarettes. This is at odds with the opinion of health authorities such as the <a href="https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf">Office of the Surgeon General</a>, the <a href="https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/about-e-cigarettes">Federal Health Department</a>
and the <a href="https://www.who.int/news-room/q-a-detail/tobacco-e-cigarettes">World Health Organization (WHO)</a>. There is substantial evidence e-cigarettes have <a href="https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes#toc">adverse health effects</a> but because they are relatively new (they were first introduced to the US market in 2007) their long-term effects are less clear.</p>
<p>Yet e-cigarettes are <a href="https://www.jmir.org/2019/2/e11953/">touted online</a> as a harmless recreational activity. Vape juice (which may or may not contain nicotine) is available in flavours such as gummy bear, chocolate treat and cherry crush, while social media influencers demonstrate fun vaping tricks or ways to customise e-cigarette devices. There are even online <a href="https://www.sciencedirect.com/science/article/pii/S095539592100075X">vaping communities</a> offering social support and connectedness.</p>
<p>There is no Australian federal legislation that directly applies to e-cigarettes. Instead, several laws relating to poisons, therapeutic goods and tobacco apply. Across Australian states and territories, it is illegal to sell nicotine-containing e-cigarettes but users can legally import them through a “personal importation scheme” if they have a doctor’s prescription. </p>
<p>Those that do not contain nicotine can be sold in some parts of Australia, provided there are no therapeutic claims. Our research found that despite Australia’s restrictions, the internet is <a href="https://www.sciencedirect.com/science/article/pii/S095539592100075X?via%3Dihub#bib0051">facilitating peoples’ access</a> to nicotine and vaping products. An estimated three-quarters of e-cigarette <a href="https://www.euromonitor.com/smokeless-tobacco-and-vapour-products-in-australia/report">purchases are done online</a>.</p>
<h2>Where on the web is vaping promoted?</h2>
<p>To find this content, all you need is a smart phone and a few relevant hashtags such as product names, or related terms such as: #vape, #vapelife, #vapesale and #ejuice.</p>
<p>Images from Instagram, Twitter and TikTok display a mixture of modern advertising techniques and advertising tropes used for decades by the <a href="https://www.tandfonline.com/doi/full/10.1080/07359683.2011.623087">tobacco industry</a>. There are images of scantily dressed women with e-cigarettes, details of tempting vape juice flavours, and discount offers. The scope of this content is alarming. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Old-school advertising tactics on Twitter.</span>
</figcaption>
</figure>
<p>This promotion, coupled with the product diversity and allure, ease of online purchase and lack of appropriate age verification, supports the <a href="https://www.mordorintelligence.com/industry-reports/global-e-cigarettes-market-industry">growth of e-cigarettes</a>, particularly among young people. Young people are the biggest users of social media, and they are being directly targeted. </p>
<p>E-cigarette use has been described as an “<a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/surgeon-general-advisory/index.html">epidemic among youth</a>”. In Australia, since 2013, the lifetime use of e-cigarettes has <a href="https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes/18b-3-extent">significantly increased</a> — doubling in 14-17 year olds (4.3% to 9.6%) and almost tripling in those aged 18-24 (7.9% to 26.1%), while rates of cigarette smoking have declined. </p>
<p>This increased e-cigarette uptake by young Australians is particularly worrying. While promotion and advertising of this product are tightly regulated offline, with age restrictions that are relatively easy to enforce, posing as an adult online is often simply a matter of ticking a box.</p>
<p>Despite the dangers of e-cigarettes, many adolescents have <a href="https://www.sciencedirect.com/science/article/pii/S0749379721000659?via%3Dihub#bib0001">positive opinions</a> about them. Surveys have revealed young people consider e-cigarettes to be a healthier and less addictive alternative to cigarettes, with fewer harmful chemicals and fewer health risks from second-hand vapour. </p>
<p>Tobacco companies have a tradition of infiltrating youth-friendly media. Almost all Australians aged between 18 and 29 <a href="https://www.sensis.com.au/about/our-reports/sensis-social-media-report">use social media</a>, for more than 100 minutes a day on average. The <a href="https://publichealth.jmir.org/2020/4/e15577/">high visibility of e-cigarettes</a> available on social media can foster awareness, encourage experimentation and uptake, and change social norms around vaping.</p>
<p>Social media platforms do have their own policies on tobacco advertising. Facebook and its subsidiary Instagram <a href="https://www.facebook.com/policies/ads/prohibited_content/tobacco">stipulate</a>:</p>
<blockquote>
<p>Advertisements must not promote electronic cigarettes, vaporizers, or any other products that simulate smoking. </p>
</blockquote>
<p>This policy has now been extended to all private sales, trades, transfers or gifting of tobacco products. Any brand that posts content related to the sale or transfer of these products must <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-11-internet-promotion">restrict it</a> to adults 18 years or older. Whether this is even possible on social media is still open to question. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=589&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=589&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=589&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=741&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=741&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=741&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Twitter image promotion.</span>
</figcaption>
</figure>
<p>Twitter’s <a href="https://business.twitter.com/en/help/ads-policies/ads-content-policies/tobacco-and-tobacco-accessories.html">policy on paid advertising</a> “prohibits the promotion of tobacco products, accessories and brands globally”. But this does not extend to the content of individual accounts. </p>
<p>TikTok’s <a href="https://ads.tiktok.com/help/article?aid=9552">advertising policy</a> states: </p>
<blockquote>
<p>Ad creatives and landing page must not display or promote tobacco, tobacco-related products such as cigars, tobacco pipes, rolling papers, or e-cigarettes.</p>
</blockquote>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=837&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=837&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=837&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1052&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1052&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1052&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vape juice advertising on TikTok.</span>
</figcaption>
</figure>
<p>But on social media, where “influencer” content is king, the boundaries between truly organic content and paid product placements is <a href="https://publichealth.jmir.org/2020/4/e15577">blurred</a>.</p>
<p>In 2012, Australia tried to counter this emerging online situation by introducing <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-11-internet-promotion">legislation</a> making it an offence to advertise or promote tobacco products on the internet, unless compliant with existing advertising laws. But that legislation doesn’t ban online sales of tobacco products, including vaping products, and can do very little about advertisements from overseas websites. </p>
<p>It is unclear whether health authorities and regulators are aware of the scale and explicitness of e-cigarette content on social media. It seems clear that more should be done to counter it.</p>
<p>Australia, along with close to 170 other countries, is a signatory to the WHO’s <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a> , which <a href="https://www.who.int/tobacco/control/measures_art_13/en/">calls on nations</a> to outlaw all advertising for tobacco products, including e-cigarettes.</p>
<p>Action is required. Australia, and other nations from which this content originates, need to prioritise public health. There needs to be improved surveillance, monitoring and the curtailing of content that glamourises e-cigarettes, as well as improved age verification practices.</p><img src="https://counter.theconversation.com/content/159436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonine Jancey has received funding from Healthway</span></em></p>Despite being widely viewed as a safer alternative to tobacco, e-cigarettes aren’t harmless, especially to adolescents. But social media is rife with glossy content that makes vaping look fun and cool.Jonine Jancey, Academic and Director Collaboration for Evidence, Research and Impact in Public Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1413652020-06-29T20:07:42Z2020-06-29T20:07:42ZWhy the ban on nicotine vape fluid will do more harm than good<figure><img src="https://images.theconversation.com/files/344228/original/file-20200626-104489-1rz02b.jpg?ixlib=rb-1.1.0&rect=34%2C25%2C5691%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Last week the federal government’s Office of Drug Control announced changes to the importation of <a href="https://www.odc.gov.au/news-media/news/australian-government-proposes-strengthening-its-stance-against-e-cigarettes">nicotine-containing electronic cigarette fluids</a> that will seriously affect the estimated 227,000 regular e-cigarette <a href="https://doi.org/10.1016/j.addbeh.2019.02.012">users in Australia</a>. </p>
<p>From January 1, 2021, users will no longer be allowed to import nicotine-containing fluids for use in e-cigarettes, even if they have a prescription. The measures, which were initially set to come into force on July 1, 2020, are in addition to the existing domestic ban on sales of these products.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/twelve-myths-about-e-cigarettes-that-failed-to-impress-the-tga-72408">Twelve myths about e-cigarettes that failed to impress the TGA</a>
</strong>
</em>
</p>
<hr>
<p>When <a href="https://www.2gb.com/health-minister-defends-decision-to-ban-e-cigarette-imports/">quizzed last week on the new rules</a>, Health Minister Greg Hunt claimed “people can still bring them in if they have a prescription from their doctor”. But this is not strictly the case. </p>
<h2>What do the new rules actually say?</h2>
<p>From January 1, e-cigarette users will not only need a prescription from their doctor, they will also need a doctor who is willing and able to import the products on their behalf. This will require the doctor to have a permit to import nicotine as an <a href="https://www.tga.gov.au/authorised-prescriber-scheme">unauthorised therapeutic</a>.</p>
<p>It is hard to imagine many doctors will to go to these lengths to provide access to nicotine so their patients can continue vaping. As these regulations have only just been announced, there are currently no medical professionals in Australia with these permits already in place. </p>
<p>With doctors already hesitant to prescribe nicotine for vaping (there are only nine GPs on the Australian Tobacco Health Reduction Association’s <a href="https://www.athra.org.au/doctors/">list of known prescribers</a>), it is unlikely there will be any who are willing to add the additional burden of applying for permits and organising importation.</p>
<p>So, come January 1, what are Australians who use nicotine-containing e-cigarette fluids going to do? </p>
<p>Option one: vapers go “cold turkey” and give up nicotine altogether. Many vapers use e-cigarettes because they were unable to quit smoking using any other method, including nicotine replacement therapy. One <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1808779">study</a> found 18% of ex-smokers who had switched to e-cigarettes were still smoke-free at the one-year mark, compared with 9.9% of those who had switched to nicotine patches.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-safest-to-avoid-e-cigarettes-altogether-unless-vaping-is-helping-you-quit-smoking-123274">It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking</a>
</strong>
</em>
</p>
<hr>
<p>Option two: vapers ignore the new regulations and attempt to continue importing their e-cigarette fluids. Besides risking a <a href="https://www.tga.gov.au/behind-news/prohibition-importing-e-cigarettes-containing-vaporiser-nicotine">A$222,000 fine</a> if caught, there are significant risks to buying e-fluids on the black market. There will be no warning labels or instructions for safe usage; nicotine levels may be unknown or inconsistent; and samples might be cut with dangerous substances, as in the case of the bootleg cannabis vape refills contaminated with vitamin E acetate that <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1915314">killed 60 people and hospitalised a further 2,558</a> in the United States last year.</p>
<p>Option three: vapers go back to smoking cigarettes, as a legal and more easily accessible source of nicotine. Current estimates are that e-cigarette use is <a href="https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction">95% less harmful than smoking</a>. There are <a href="https://twitter.com/HumanHeadline/status/1275723238618943488">fears among the vaping community</a> that this will be the default option for many users, despite the increased health risks of smoking over vaping. Vapers who are worried they may turn back to cigarettes should consider asking their GP to help them devise a plan to stay away from smoking.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1275723238618943488"}"></div></p>
<h2>Why is the government doing this anyway?</h2>
<p>The government’s rationale is twofold. First, it points to the <a href="https://www.premier.vic.gov.au/wp-content/uploads/2019/11/191126-E-Cigarette-Liquids-Are-Deadly-For-Kids-.pdf">increase in nicotine poisonings</a> associated with e-cigarette fluids in the past few years in Australia, including the <a href="https://www.coronerscourt.vic.gov.au/liquid-nicotine-awareness-needed">death of a toddler</a> in Victoria in 2018.</p>
<p>But these cases, including the toddler’s tragic death, involved highly concentrated imported nicotine-containing fluids, purchased from overseas because of the existing domestic ban. Cracking down on legitimate imports would arguably make it more likely, not less, that users may end up accessing illicit e-cigarette fluids with little or no safety labelling.</p>
<p>The government’s second argument is the <a href="https://www.fda.gov/tobacco-products/youth-and-tobacco/2018-nyts-data-startling-rise-youth-e-cigarette-use">increasing use of e-cigarettes among US school students aged 14-18</a>. But while there has indeed been an increase in vaping, smoking has declined among these age groups, so it is likely a case of experimentation, rather than vaping being a gateway to smoking. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-e-cigarettes-a-gateway-to-smoking-in-14-year-olds-new-us-data-46468">Are e-cigarettes a gateway to smoking in 14-year-olds? New US data</a>
</strong>
</em>
</p>
<hr>
<p>There is a crucial distinction to draw here: if the new rule change is intended to restrict youngsters’ access to vaping, it is unlikely to succeed. E-cigarettes and e-fluids without nicotine will still be available at any tobacconist or vape store. The only banned products will be nicotine-containing e-fluids.</p>
<p>The rule change may be framed partly as a preventative move to protect young people from vaping. But the people most likely to be affected are those who have successfully used e-cigarettes to quit smoking.</p>
<p>For that reason, it’s my view the new rules will do more harm than good. I would urge the government to consider regulating nicotine-containing products rather than banning them. </p>
<p>A regulated e-cigarette fluid market should consider: limiting the maximum concentration of nicotine to 24 milligrams per ml; childproof packaging for all products, with dropper-style tops to prevent accidental exposure through spillage; and appropriate warning labels and ingredient lists.</p><img src="https://counter.theconversation.com/content/141365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jody Morgan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From 2021, Australians will no longer be able to buy nicotine-containing e-fluids, without both a prescription and someone licensed to import it for them, raising fears many will go back to smoking.Jody Morgan, Associate Research Fellow, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1405792020-06-24T16:03:17Z2020-06-24T16:03:17ZE-cigarettes found to cause change in mouth bacteria – which could lead to gum disease or oral cancer<figure><img src="https://images.theconversation.com/files/343731/original/file-20200624-132951-1gk2sv6.jpg?ixlib=rb-1.1.0&rect=6%2C6%2C4642%2C3080&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bacterial changes could lead to serious diseases.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-smoking-ecigarette-399274873">vchal/ Shutterstock</a></span></figcaption></figure><p>E-cigarettes are a popular alternative to smoking, but we still know very little about the effects of them on our health. While numerous studies have explored the effect of e-cigarettes on our lungs, heart, and overall health, one important and often overlooked consideration is what effect they have on our microbiome. But a recent study has found e-cigarettes <a href="https://advances.sciencemag.org/content/6/22/eaaz0108">change the bacteria</a> in our mouths. These bacterial changes can <a href="https://link.springer.com/article/10.1007/s10552-008-9163-4">lead to disease</a>, if left unchecked.</p>
<p>Our microbiome is the living community of bacteria, fungi, and viruses that keep us healthy. We often hear a lot about our gut microbiome, but our oral microbiome is probably just as important to our overall health. It’s the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503789/">second and most diverse microbiota</a> next to the gut, home to over <a href="https://jb.asm.org/content/jb/192/19/5002.full.pdf,%20https://www.sciencedirect.com/science/article/pii/S1043661812002277">1,000 species</a> of microbes. It’s the gateway to the rest of our digestive system and plays a key role in helping us break down foods. </p>
<p>Our oral microbiome also wards off <a href="https://www.nature.com/articles/s41368-018-0043-9">potentially harmful microbes</a> by <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1601-0825.2011.01851.x">preventing them from reproducing</a>. A healthy oral microbiome reduces the chances of developing <a href="https://www.researchgate.net/profile/Shree_Dhotre2/publication/312378702_Periodontitis_Bacteremia_and_Infective_Endocarditis_A_Review_Study/links/5a5700230f7e9bf2a5374727/Periodontitis-Bacteremia-and-Infective-Endocarditis-A-Review-Study.pdf">infections or disease</a>. </p>
<p>A <a href="https://advances.sciencemag.org/content/6/22/eaaz0108">recent study</a> investigating the effect of e-cigarettes on our oral microbiome found that e-cigarettes have a negative impact on the diversity of the bacteria present. They also cause an immune response from cells, which can lead to long-term damage to the surrounding cells.</p>
<p>Our oral microbes are not only the first to experience e-cigarette vapour, they’re also exposed to higher concentrations of the chemicals. This arguably makes them most likely of any of the body’s microbes to experience the negative effects of e-cigarettes. Changes in the balance of our mouth microbes can lead to some severe diseases, such as tooth decay and gum disease, or leave us <a href="https://www.sciencedirect.com/science/article/pii/S0065216416301095">susceptible to infections</a> from localised gum disease that can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023521">trigger heart disease or respiratory infections</a> or <a href="https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1113/JP272427">systemic infections like sepsis</a>, which can be fatal. Some of these infections and diseases have also been associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079586">oral cancers</a>.</p>
<p>For this particular study, 123 participants were recruited and split into five groups: smokers, non-smokers, e-cigarette users, former smokers currently using e-cigarettes, and those that use both. The team collected dental plaque samples to find out more about the microbes present and the genes they have, as well as fluid from the gums to know how the human body has reacted to these microbes. They also grew bacteria in the lab after exposing them to cigarette smoke and e-cigarette vapour.</p>
<h2>Bacteria changes</h2>
<p>The study found that those who used e-cigarettes had very similar species of microbes, suggesting e-cigarettes played a role in how the microbial community forms and exists. However, there were some significant differences in the smokers group, non-smoker group and e-cigarette groups, all of which had unique oral microbiomes.</p>
<p>When they looked at groups of people that switched from smoking to e-cigarettes and former smokers, they found their microbiota to be very similar – but they were still very different compared to non-smokers. Although this study didn’t specify which bacterial species were affected, even small changes from the healthy bacteria would likely result in negative effects overall. Gram negative bacteria, which are typically considered the “bad microbes”, were common between smokers and e-cigarette users. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343733/original/file-20200624-132988-imv3b2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Both smokers and e-cigarette users had more ‘bad’ microbes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-holding-vape-tobacco-cigarette-over-1252774594">Andrey_Popov/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This was also the case when the team did lab studies to see what effects e-cigarette vapour and cigarette smoke had on how bacteria grow. They found that the e-cigarette vapour (with or without nicotine) was able to change the way the bacteria grow, by increasing volume and the area covered by the bacteria, which can lead to infections if untreated. </p>
<p>The researchers also found that the microbes in the e-cigarette group had genes that lead to biofilm growth (such as dental plaque). Biofilms make microbes more resilient to the effects of drugs, toxic compounds and the immune system. This suggests that e-cigarettes vapours cause a stress response in the mouth’s microbes. </p>
<p>When stressed, microbes switch on their fight-or-flight genes, making them better able to survive in harsh environments. They do this by producing special enzymes that cause damage to other cells in order for the microbes to use their nutrients and get more space to reproduce. This leads to a cycle of more inflammation, causing a stronger stress response from other cells. However, if we can’t remove these stressed microbes, this sustained, long-term inflammation can lead to <a href="https://www.sciencedirect.com/science/article/pii/S1368837513006349">severe diseases</a>.</p>
<p>It was also found that when e-cigarette users were compared with non-smokers, e-cigarette users had significantly higher levels of immune cell response chemicals than non-smokers. E-cigarettes users also had lower levels of chemicals that stop this stress response happening. This shows that the body is trying to fight off microbes present, much more so than in non-smokers.</p>
<p>The presence of a diverse microbiota is essential for healthy mouths, healthy bodies, and healthy people. But based on this study’s findings, the use of e-cigarettes has a negative impact on not only the number and types of oral microbes, but on how the microbes behave and how our body responds. <a href="https://advances.sciencemag.org/content/advances/6/22/eaaz0108.full.pdf,%20https://peerj.com/articles/4693/">Other studies</a> have had <a href="https://www.sciencedirect.com/science/article/pii/S2589004220300687">similar findings</a>. Though more research into the health effects of e-cigarettes is needed, current evidence suggests ditching them may be best for our overall health.</p><img src="https://counter.theconversation.com/content/140579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Morse does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our oral microbiome is the second most diverse and equally important microbiota in the body.Daniel Morse, Postdoctoral Research Associate, Cellular and Molecular Medicine, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1389052020-06-02T13:51:12Z2020-06-02T13:51:12ZNicotine therapy for coronavirus: the evidence is weak and contradictory<figure><img src="https://images.theconversation.com/files/338883/original/file-20200601-95049-1v30ztp.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5599%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nicotine patch.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smoking-treatment-elderly-person-174163421">Image Point Fr/Shutterstock</a></span></figcaption></figure><p>France recently put <a href="https://www.independent.co.uk/news/world/europe/coronavirus-france-nicotine-patch-gum-research-covid-19-a9484696.html">limits on the purchase nicotine-replacement products</a>, stopping online sales and restricting buyers to a one-month supply of gums, patches and inhalers bought at pharmacies. The limits have nothing to do with the products’ usefulness or safety – these are well established. They have been put in place to stop people stockpiling them following news that nicotine may play a role in combating COVID-19. </p>
<p>There are a <a href="https://www.cebm.net/covid-19/nicotine-replacement-therapy/">number of reasons</a> nicotine is beginning to be explored in this context, but as with everything about the new coronavirus, much remains unknown.</p>
<p>At the outset of the pandemic, <a href="http://www.emro.who.int/tfi/know-the-truth/tobacco-and-waterpipe-users-are-at-increased-risk-of-covid-19-infection.html">smoking was identified as a risk factor</a> for COVID-19, with the expectation that the same pattern would be seen <a href="https://www.cebm.net/covid-19/smoking-in-acute-respiratory-infections/">as with other respiratory illnesses</a>, namely, that smoking would increase the chance of getting infected and of having worse outcomes once infected. But <a href="https://www.qeios.com/read/UJR2AW.3">some studies</a> have suggested that people who smoke may be at less risk from COVID-19. </p>
<p>So far, no one is sure if this is true. Different studies find conflicting patterns. And in those that find less COVID-19 infection in people who smoke, it is unclear if this is because of a genuine effect or because of issues with analyses or reporting. </p>
<p>We need better quality studies to investigate whether people who smoke are less likely to contract COVID-19. Some of these are underway, but the search for COVID-19 medications is urgent. While we wait for more definitive results, scientists are pressing ahead, following all possible leads in the hunt for a treatment. </p>
<h2>Uniquely deadly</h2>
<p>Tobacco cigarettes are uniquely deadly, killing <a href="https://www2.hse.ie/wellbeing/quit-smoking/reasons-to-quit-smoking/smoking-facts-and-figures.html">one in two</a> regular users. This means it is much more likely that a person who smokes will die from smoking than from COVID-19. </p>
<p>Even if smoking proves protective against COVID-19, no one would ever suggest starting smoking or continuing to smoke to reduce risk. But if something in cigarettes could be protecting people who smoke against COVID-19, there would be a reason to explore this further to see if the useful component could be delivered more safely. The most talked-about candidate so far is nicotine.</p>
<p><a href="https://theconversation.com/nicotine-replacement-when-quitting-cigarettes-consider-using-more-nicotine-not-less-115008">Nicotine</a> is what makes cigarettes addictive, but it doesn’t directly cause the many diseases that affect people who smoke and those around them. </p>
<p>Nicotine has a bad name, which is warranted when considering that more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">8 million people die</a> because of tobacco addiction each year. Yet this bad name is not warranted when it comes to nicotine replacement therapy, which delivers nicotine without all of the other harmful components of cigarette smoke. </p>
<p><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000146.pub5/full">More than a hundred randomised controlled trials</a> have tested nicotine replacement therapy as a way to help people quit smoking, and there is strong evidence that it is safe when used as intended. In fact, the World Health Organization considers nicotine replacement therapy an <a href="https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1">essential medicine</a>.</p>
<p>Nicotine has been shown to be <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004722/full">protective</a> in a handful of other diseases, and laboratory studies suggest it may play a part in regulating an enzyme called <a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntaa077/5834599">ACE2</a>, which is thought to be involved in COVID-19. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192087/">cell receptors</a> that nicotine binds to are ones that SARS-CoV-2 is also thought to affect. Some scientists speculate these links mean <a href="https://erj.ersjournals.com/content/erj/early/2020/04/20/13993003.01116-2020.full.pdf">nicotine would lead to worse COVID-19 outcomes</a>. <a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntaa077/5834599">Others speculate the opposite</a>. Until tests are done in humans, it’s impossible to know for sure.</p>
<p>Early studies in <a href="http://theguardian.com/world/2020/may/17/plan-study-nicotine-patches-potential-coronavirus-treatment-covid-19">Wales</a> and <a href="https://theconversation.com/does-nicotine-protect-us-against-coronavirus-137488">France</a> are testing nicotine replacement therapy as a potential treatment for COVID-19, and more trials may soon be underway. </p>
<p>It has also been suggested that studies <a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntaa077/5834599">currently testing nicotine replacement therapy for other conditions</a>, such as a US study looking at nicotine replacement for reducing cognitive impairment, could look at COVID-19 outcomes as well. </p>
<p>If <a href="https://www.cebm.net/covid-19/nicotine-replacement-therapy/">the evidence</a> begins to suggest that nicotine replacement therapy does improve COVID-19 outcomes, there would be a reason to rejoice. We need treatments urgently and nicotine replacement therapy is considered safe, is widely available, and is relatively cheap as it’s not protected by patent. But we are unlikely to know whether nicotine replacement has a role in COVID-19 any time soon. </p>
<p>In the meantime, there is no value in people purchasing nicotine replacement to help protect themselves against COVID-19. Such a move could cause harm by reducing the availability of nicotine replacement therapy for people who wish to quit smoking. For now, nicotine supplies must be preserved for the people who need them.</p><img src="https://counter.theconversation.com/content/138905/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hartmann-Boyce receives funding from the UK National Institute for Health Research (NIHR), British Heart Foundation (BHF), and Cancer Research UK (CRUK) to do research into smoking cessation and weight management. </span></em></p><p class="fine-print"><em><span>Nicola Lindson receives funding from the UK National Institute for Health Research (NIHR) and Cancer Research UK (CRUK) to do research into smoking cessation. </span></em></p>Eight million people die from smoking each year. Let’s not stockpile the therapy that can help them quit.Jamie Hartmann-Boyce, Departmental Lecturer and Co-Director of Evidence-Based Healthcare DPhil programme, Centre for Evidence-Based Medicine, University of OxfordNicola Lindson, Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1307842020-05-07T12:23:56Z2020-05-07T12:23:56ZJuuling among US youth is about the cool factor, new study suggests<figure><img src="https://images.theconversation.com/files/332579/original/file-20200505-83725-fdwne.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3440&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Millions of U.S. high school students have used e-cigarettes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-smokes-an-electronic-cigarette-in-town-royalty-free-image/1177486908?adppopup=true">Getty Images / Kiszon Pascal</a></span></figcaption></figure><p>In less than a decade, e-cigarette use among high schoolers in the U.S. has <a href="https://jamanetwork.com/journals/jama/fullarticle/2755265?appId=scweb">skyrocketed</a>, from almost none in 2011 (1.5%) to more than one-fourth in 2019 (27.5%). <a href="https://time.com/5680988/juul-vaping-health-crisis/">Alarm bells</a> have sounded for <a href="https://www.washingtonpost.com/local/education/helpless-to-the-draw-of-nicotine-doctors-parents-and-schools-grapple-with-teens-addicted-to-e-cigarettes/2019/07/25/e1e8ac9c-830a-11e9-933d-7501070ee669_story.html">doctors, parents and schools</a>; lawmakers have created policies to combat this epidemic.</p>
<p>That includes <a href="https://www.fda.gov/tobacco-products/ctp-newsroom/newly-signed-legislation-raises-federal-minimum-age-sale-tobacco-products-21">legislation</a> signed by President Trump on Dec. 20, 2019, which raised the minimum age from 18 to 21 on the sale of tobacco products. </p>
<p>E-cigarettes like Juul were covered in the legislation. And even though <a href="https://www.washingtonpost.com/opinions/the-vaping-ban-is-here-and-its-already-out-of-date/2020/02/07/c73e7c3a-492c-11ea-b4d9-29cc419287eb_story.html">politics</a> and <a href="https://www.nytimes.com/2020/01/02/health/flavor-ban-e-cigarettes.html">ambiguity</a> shrouded the move, the <a href="https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children">U.S. Food and Drug Administration</a> prioritized enforcement against some e-cigarette products that particularly appeal to kids. </p>
<p>Will these efforts work? <a href="https://medicine.umich.edu/dept/family-medicine/tammy-chang-md-mph-ms">As an assistant professor</a> of family medicine and researcher at the University of Michigan who specialize in adolescent health, we can tell you what we <a href="https://jamanetwork.com/journals/jama/fullarticle/2755265?appId=scweb">know</a>: Youth are using e-cigarettes, mostly Juul, in high numbers; most use the flavored kind; and the most popular flavors are fruit, menthol, mint, candy and dessert.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332581/original/file-20200505-83751-er0gv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For teens, the cool factor outweighs the taste factor.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-man-smoking-electronic-cigarette-while-royalty-free-image/1129450310?adppopup=true">Getty Images/Khaffizzul Hakim Al-Jalil Abdullah/EyeEm</a></span>
</figcaption>
</figure>
<h2>It’s not just about taste</h2>
<p>We can also tell you what we don’t know: why young people use Juul in the first place. And if we don’t know that, how can we be sure what policies and programs will work?</p>
<p>Because legislative action is about banning flavors, you might think that’s why kids are using Juul – for the taste. However, our recently published <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2765158?guestAccessKey=3969997a-4aa5-45c6-9aec-c795f1ff9827&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=050420">research</a>, shows something different. Our team surveyed over 1,000 diverse youth, age 14 to 24 years, from all across the U.S. We heard, in their own words, why they think people their age Juul. The answers? Social pressures, the desire to experiment and “the buzz” from the product. Very few (5%) mentioned flavors as a reason for why youth use Juul. </p>
<p>As researchers who work with youth, this made sense to us. After all, they have easy access to candies, snacks, and sodas if they crave something tasty. Why smoke an e-cigarette? True, a Juul with a good taste makes it more fun. But flavor is not the primary driver. </p>
<p>We also found most respondents (79%) believed e-cigarettes were dangerous. They knew Juul had “harmful cancer causing chemicals” and that a single pod “has enough nicotine for 20 cigarettes.” This is opposed to <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html">past studies</a> that report most youth didn’t know Juul contained nicotine. </p>
<p>We also asked our participants if they thought using Juul led to use of other substances, like alcohol, cigarettes, or other drugs. 72% believe that it does. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332583/original/file-20200505-83779-14rp0nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people know more about the dangers of vaping than you might think.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-smoking-electronic-cigarette-while-hanging-royalty-free-image/1135148202?adppopup=true">Getty Images / Thomas Barwick</a></span>
</figcaption>
</figure>
<h2>Preaching to the choir</h2>
<p>Those findings suggest that programs based on warnings of the dangers of Juul may be preaching to the choir. Young people already know, but many still do it to fit in. This insight into the lives of American youth is critical to designing public health messaging and policies that work. </p>
<p>As scientists, we’re not good at making things cool. But what we can do, with help from policymakers, is to use evidence to influence behaviors. And from decades of efforts to curb smoking, we’re aware of two things we can do to decrease e-cigarette use: restriction and enforcement. </p>
<p>The new federal legislation theoretically restricts the purchase of nicotine-laden products. Yet it’s still easy for youth to get <a href="https://truthinitiative.org/research-resources/emerging-tobacco-products/where-are-kids-getting-juul">Juul</a>. And <a href="https://www.nytimes.com/2020/01/31/health/vaping-flavors-disposable.html">loopholes</a> in the ban on flavors allow them to keep buying those products. </p>
<p>This means greater efforts in effective enforcement <a href="https://www.ketv.com/article/legal-tobacco-smoking-age-confusion-nebraska-does-not-comply-with-federal-law-of-21/30375500#">are needed</a>. Without a clear plan, businesses and potential customers around the country <a href="https://www.mankatofreepress.com/news/local_news/federal-tobacco-law-sparks-confusion/article_635839c6-3492-11ea-94d4-bf012c49081e.html">will remain confused</a>. </p>
<p>Among the <a href="https://tobacco21.org/tobacco-21-model-policy/">best practices</a> for enforcement, <a href="https://tobacco21.org/enforcement-is-critical/">say experts</a>: treating violations as a civil, not criminal, offense. Sales to minors shouldn’t involve arrests or police stings, but rather a notice to the owner of the business establishment. Repeated violations would mean larger penalties.</p>
<p>There’s no question that juuling and e-cigarette use is an epidemic among youth. Even if they do it to be cool, there are still things adults can do to protect them. But a law without enforcement effectively means we don’t have a law. In that scenario, the clear winners are adults making money off the sales of these dangerous products. The clear losers are youth.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/130784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Current legislation focuses on the flavor of e-cigarettes. But the latest research shows the attraction isn’t about taste.Tammy Chang, Assistant Professor of Family Medicine, University of MichiganMarika Waselewski, Research Specialist, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1374882020-05-06T05:47:28Z2020-05-06T05:47:28ZDoes nicotine protect us against coronavirus?<figure><img src="https://images.theconversation.com/files/332568/original/file-20200505-83730-31qf5t.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you noticed headlines recently suggesting smoking <a href="https://www.moroccoworldnews.com/2020/04/299012/french-doctor-suggests-smoking-may-protect-against-covid-19-infection/">could protect against COVID-19</a>, you might have been surprised.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1257405553162293249"}"></div></p>
<p>After all, we know smoking is bad for our health. It’s a leading risk factor for <a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/smoking-and-heart-disease">heart disease</a>, <a href="https://www.who.int/news-room/detail/29-05-2019-who-highlights-huge-scale-of-tobacco-related-lung-disease-deaths">lung disease</a> and <a href="https://wiki.cancer.org.au/policy/Tobacco_control/Link_between_smoking_and_cancer">many cancers</a>. Smoking also reduces our <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/smoking-effects-on-your-body">immunity</a>, and makes us more susceptible to respiratory infections including pneumonia.</p>
<p>And smokers touch their mouth and face more, a risk for COVID-19 infection. </p>
<p>Initial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083240/">observational findings</a> suggested a history of smoking increased the risk of poor outcomes in COVID-19 patients, as the <a href="https://www.who.int/news-room/q-a-detail/q-a-on-smoking-and-covid-19">World Health Organisation</a> and <a href="https://www.quit.org.au/articles/faqs-coronavirus-covid-19-and-smoking/">other bodies</a> have identified.</p>
<p>But <a href="https://www.qeios.com/read/WPP19W.3">a recent paper</a> which examined smoking rates among COVID-19 patients in a French hospital hypothesised smoking might make people less susceptible to COVID-19 infection.</p>
<p>So what can we make of this?</p>
<p><a href="https://theconversation.com/newsletter"><img src="https://images.theconversation.com/files/320030/original/file-20200312-116261-a6ugi0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" alt="Sign up to The Conversation" width="100%"></a></p>
<h2>What the study did</h2>
<p>This study was a cross-sectional survey where the researchers assessed the exposure (smoking) and the outcome (COVID-19) at the same time. This type of research design can’t prove the exposure causes the outcome – only that there may be an association.</p>
<p>There were two groups included in the study – 343 inpatients treated for COVID-19 from February 28 to March 30, and 139 outpatients treated from March 23 to April 9. Among other data collected, participants were asked whether they were current smokers.</p>
<p>The researchers compared smoking rates in both groups with smoking rates in the general French population.</p>
<h2>The results</h2>
<p>The study found 4.4% of inpatients and 5.3% of outpatients with COVID-19 were smokers, after adjusting for differences in age and sex.</p>
<p>This was only a fraction of the prevalence seen in the general French population. Some <a href="http://beh.santepubliquefrance.fr/beh/2019/15/2019_15_1.html">25.4%</a> reportedly smoked daily in 2018.</p>
<p>The authors asserted:</p>
<blockquote>
<p>current smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population.</p>
</blockquote>
<p>The finding of lower rates of smokers among COVID-19 cases has been more recently described elsewhere, in <a href="https://www.qeios.com/read/UJR2AW.2">a rapid review</a> of 28 studies on smoking in COVID-19 patients from various countries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-more-men-die-from-coronavirus-than-women-136038">Why do more men die from coronavirus than women?</a>
</strong>
</em>
</p>
<hr>
<p>The authors of the French study suggest the mechanism behind the protective effects of smoking could be found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192087/">nicotine</a>.</p>
<p>SARS-CoV-2, the virus that causes COVID-19, gains entry into human cells by latching onto protein receptors called ACE2, which are found on certain cells’ surfaces.</p>
<p>The researchers have proposed <a href="https://www.dw.com/en/does-nicotine-help-against-the-new-coronavirus/a-53260336">nicotine attaches</a> to the ACE2 receptors, thereby preventing the virus from attaching and potentially reducing the amount of virus that can get into a person’s lung cells.</p>
<p>The researchers are now planning to test their hypothesis in a randomised trial involving nicotine patches; though the trial is still <a href="https://www.theguardian.com/world/2020/apr/22/french-study-suggests-smokers-at-lower-risk-of-getting-coronavirus">awaiting approval</a> from French health authorities.</p>
<h2>So how should we interpret the results?</h2>
<p>These counterintuitive results may be due to several biases, so let’s explore some alternative explanations.</p>
<p>First is what we call “selection bias”. The hospital patients may be less likely to be daily smokers than the general population. For example, health-care workers and those with existing chronic conditions were disproportionately represented in the inpatient sample – both of these groups usually show lower prevalence of current smoking.</p>
<p>Further, around 60% of the hospitalised patients in the study were ex-smokers (similar to the national prevalence). Some may have <a href="https://amp.theguardian.com/society/2020/may/04/more-than-300000-uk-smokers-may-have-quit-owing-to-covid-19-fears?CMP=share_btn_tw&__twitter_impression=true">given up smoking very recently</a> in response to the WHO declaring smoking as a risk factor for COVID-19. But they were classified as non-daily smokers in the study. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332606/original/file-20200505-83775-9f95fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We can identify several biases in the study.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Second is what we call “social desirability bias”. COVID-19 patients may be more likely to deny smoking when asked about their smoking status in hospital, wanting to be seen by medical professionals as doing the right thing.</p>
<p>And data collection <a href="https://www.qeios.com/read/UJR2AW.2">may have been incomplete</a> for behavioural questions in busy hospitals overwhelmed by COVID-19 cases.</p>
<p>Finally, it’s important to note this paper has not yet been peer-reviewed.</p>
<p>Taken together, although there appears to be an association between smoking and COVID-19 in these hospital-based samples, there’s no evidence of a causal relationship – that is, that smoking prevents COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-use-may-increase-the-risk-of-coronavirus-heres-how-to-reduce-the-harms-135556">Drug use may increase the risk of coronavirus. Here's how to reduce the harms</a>
</strong>
</em>
</p>
<hr>
<h2>Lots of research at pandemic speed</h2>
<p>We must acknowledge this research has been conducted at “pandemic speed”, much faster than usual research time frames. </p>
<p>Normally <a href="https://www.nature.com/news/does-it-take-too-long-to-publish-research-1.19320">it would be months</a> between submission and publication – but in this case the researchers completed their observations and had the research published online within the same month.</p>
<p>An unintended consequence of the early release of research is that it may provoke undue community hope or belief in unproven treatments. </p>
<p>French authorities had to <a href="https://www.sbs.com.au/news/france-limits-nicotine-product-sales-after-research-suggests-could-protect-from-coronavirus">limit sales of nicotine treatments</a> to avoid stockpiling after this study was published. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-smoke-from-autumn-burn-offs-could-make-coronavirus-symptoms-worse-its-not-worth-the-risk-136230">The smoke from autumn burn-offs could make coronavirus symptoms worse. It’s not worth the risk</a>
</strong>
</em>
</p>
<hr>
<p>We saw a similar phenomenon recently with the drug <a href="https://www.theguardian.com/world/2020/mar/27/vital-drug-people-lupus-coronavirus-covid-19-link-hydroxychloroquine">hydroxychloroquine</a>, where supplies ran out for those who needed them after politicians proclaimed it as a cure for COVID-19.</p>
<p>So right now we need to put in extra effort to make sure early evidence is not misinterpreted or overstated.</p>
<p>As for the role of smoking in COVID-19 – this link requires substantially more research and critical appraisal. Because overall, smoking still kills. <strong>– Adrian Bauman, Melody Ding and Leah Shepherd</strong></p>
<h2>Blind peer review</h2>
<p>On the whole, this Research Check represents a fair and balanced account of the study. The alternative explanations for the observation of low smoking status prevalence among the French hospital sample provided are possible. </p>
<p>One plausible explanation is error in recording smoking status. There is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977725/">evidence</a> of under-reporting and inaccurate reporting of smoking status within hospital samples, in general. </p>
<p>It’s unclear from the study what method was used to collect smoking status data. The authors simply state patients were “asked” and “data were collected in the context of care”. It’s important to know who asked the smoking status questions, what questions were asked, when they were asked, and what record keeping system was used.</p>
<p>Given clinical smoking status record keeping may not capture all smokers accurately, a better comparison would be to compare the 2020 data with pre-COVID-19 hospital patient data, rather than general population data which may have asked different questions. <strong>– Billie Bonevski</strong></p>
<hr>
<p><em>Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.</em></p><img src="https://counter.theconversation.com/content/137488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Bauman receives funding from the National Health and Medical Research Council and the Heart Foundation.</span></em></p><p class="fine-print"><em><span>Melody Ding receives funding from Heart Foundation Australia and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Billie Bonevski receives funding from the National Health and Medical Research Council, Heart Foundation, Cancer Council NSW, NSW Ministry of Health, VicHealth.</span></em></p><p class="fine-print"><em><span>Leah Shepherd does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study from France concluded smoking might protect against coronavirus. But particularly now, in the midst of a pandemic, it’s critical we don’t take headlines at face value.Adrian Bauman, Sesquicentenary Professor, Public Health, University of SydneyLeah Shepherd, Biostatistician, Sydney School of Public Health, University of SydneyMelody Ding, Associate Professor of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1344672020-04-13T14:12:52Z2020-04-13T14:12:52ZMore young people vaping, despite growing evidence of risks<figure><img src="https://images.theconversation.com/files/324628/original/file-20200401-23115-191rb8g.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2967%2C2020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many young people are unaware of the health risks of e-cigarettes.</span> <span class="attribution"><span class="source">(AP Photo/Kin Cheung)</span></span></figcaption></figure><p>Vaping use is on the rise in young people, with as many as <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">one in five junior and secondary school students reporting use of vaping products in 2019</a>. </p>
<p>Vaping has been associated with <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">severe respiratory health injuries and untimely deaths</a>, and there is now the <a href="https://www.cps.ca/en/blog-blogue/covid-youth-and-substance-use-critical-messages-for-youth-and-families">possibility that vaping may increase the risk of severe symptoms and complications in people infected with SARS-CoV-2, the virus that causes COVID-19</a>. These emerging risks raise serious concerns that vaping’s real consequences — either to individuals or broader society — are not yet known. </p>
<p>As public health researchers at the University of Saskatchewan, we have been tracking the use of vaping products since 2014 using the <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">Canadian Student Tobacco, Alcohol and Drugs Survey</a> (CSTADS). As negative consequences emerge, more work must be done to prevent the growing use of vaping products.</p>
<h2>Vaping use continues to increase among youth</h2>
<p>The <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2014-2015-supplementary-tables.html">first collection of data about e-cigarette use among Canadian youth in 2014</a> showed that six per cent of students in grades 6 through 12 reported they had used e-cigarettes in the previous 30 days. By 2017, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2016-2017-summary.html">in the same national survey</a>, that number had climbed to 10 per cent.</p>
<p>By 2019, e-cigarette use among youth had <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">doubled compared to 2017</a>. In the 2019 survey, 20 per cent of young people had used an e-cigarette in the previous 30 days, and 40 per cent of that group reported daily or nearly daily use of the products.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=828&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=828&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=828&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1041&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1041&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1041&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A selection of e-cigarettes.</span>
<span class="attribution"><span class="source">(AP Photo/Ben Margot)</span></span>
</figcaption>
</figure>
<p>Although the popularity and the use of e-cigarettes have increased, the perceived risk of harm remains low. On the 2018-19 CSTADS, only 42 per cent of Canadian youth reported that they believe regular use of e-cigarettes containing nicotine posed a “great risk of harm,” and only 14 per cent believed e-cigarettes without nicotine posed such a risk. </p>
<p>With the <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">legalization of marijuana</a> use in Canada in October 2018, there is a concern that we have yet to see how new behaviours like e-cigarette use, and their consequences, will become entrenched among youth.</p>
<h2>Initial intention backfires</h2>
<p>E-cigarettes were initially invented with the goal of creating a more effective smoking cessation tool to <a href="https://dx.doi.org/10.3978%2Fj.issn.2072-1439.2015.07.37">assist individuals experiencing challenges quitting tobacco smoking</a>. Despite this intention, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">42 per cent of e-cigarette users indicated that they had never smoked a cigarette, not even a drag</a>. </p>
<p>The device has the potential to normalize smoking behaviour among youth rather than provide an incentive for smokers to quit.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A vape kit, available for authorized retailers, is displayed at the Ontario Cannabis Store in Toronto in January 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Tijana Martin</span></span>
</figcaption>
</figure>
<p>Expert opinion is divided as to the value of e-cigarettes as a smoking cessation tool. Despite offering a vehicle for nicotine replacement, e-cigarettes present their own health risks, and the devices may not encourage individuals to quit smoking because they <a href="https://www.sciencedaily.com/releases/2014/01/140129164653.htm">do not break the link between their oral fixation and nicotine</a>.</p>
<h2>Nicotine: New look, more danger</h2>
<p>Another concern is that increased vaping could reverse the <a href="https://www.cps.ca/en/documents/position/e-cigarettes">advances made over decades by anti-smoking campaigns by Canadian organizations</a>. </p>
<p>A single e-cigarette pod can contain <a href="https://www.aafp.org/patient-care/public-health/tobacco-nicotine/tools/e-cigs.html">as much nicotine as an entire pack of cigarettes</a>. Approximately 90 per cent of students who use e-cigarettes said they used products containing nicotine on the 2018-19 CSTADS. </p>
<p>In <a href="http://dx.doi.org/10.1136/tobaccocontrol-2018-054565">a study published in <em>BMJ Tobacco Control</em> that compared nicotine levels</a> in young people who regularly smoked pod-style e-cigarettes (such as the very popular Juul) to those who regularly smoked conventional cigarettes, the e-cigarette smokers had higher nicotine levels. Additionally, e-cigarettes carry a greater risk of addiction, among youth, than smoking tobacco products, <a href="https://dx.doi.org/10.3390%2Fijerph16132279">according to new research published in the <em>International Journal of Environmental Research and Public Health</em></a>.</p>
<p>Nicotine is a powerful drug when it is delivered efficiently. This new delivery device was designed to accomplish that, and is additionally enticing because <a href="https://globalnews.ca/news/2830789/teens-use-e-cigarettes-because-they-are-cool-fun-and-new-study/">it is seen as novel and trendy</a>.</p>
<h2>Cannabis: Easy access, quicker high</h2>
<p>With the evolution of <a href="https://www.drugabuse.gov/publications/drugfacts/marijuana">new types of cannabis concentrates</a> (extracts such as shatter, crumble, budder and wax), greater risk of harm to youth has been created because these derivatives allow larger concentrations of compounds, like THC, to be inhaled very quickly. </p>
<p>Concentrate vaping is rapidly gaining in popularity and further expanding the room for experimentation with vaping among youth. Recent data suggest that <a href="https://doi.org/10.1542/peds.2019-0338">youth are using highly potent cannabis concentrates in the form of oil, wax or liquid preparations</a>, the health effects of which are yet to be well-researched, tested and standardized.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=344&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=344&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=344&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=432&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=432&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=432&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A dab of marijuana resin.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Joe Mahoney</span></span>
</figcaption>
</figure>
<p>Furthermore, the impact of these highly concentrated products on brain development is unknown and may place youth at <a href="https://www.drugfreekidscanada.org/prevention/drug-info/cannabis/">risk of cannabis use disorder and psychosis</a>. These risks are further compounded by the emergence of vaping-related illnesses, such as e-cigarette or vaping use associated lung injury (EVALI), which to date has <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">resulted in 68 deaths and over 2,807 cases</a> in the United States.</p>
<p>In terms of substance use by youth, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">cannabis was second only to alcohol in 2019</a>. In the same time period, cannabis vaping was reported by 42 per cent of youth, compared to 30 per cent the previous year. </p>
<p>With changing marijuana legislation, use and access to cannabis products by youth has increased, with <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">four per cent of youth reporting that it has become easier for them to get cannabis for themselves</a>. This increased access to such products may alter how cannabis is consumed by the over one million youth currently consuming cannabis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/british-columbias-vaping-crackdown-could-offer-a-roadmap-for-the-rest-of-the-world-128378">British Columbia's vaping crackdown could offer a roadmap for the rest of the world</a>
</strong>
</em>
</p>
<hr>
<p>Increased vaping and its unknown consequences threaten the health of our youth; it has been linked to <a href="https://doi.org/10.1542/peds.2016-0379">higher risk of progression to cigarette smoking</a>. Higher concentrations of <a href="https://doi.org/10.1371/journal.pone.0220300">nicotine</a> and <a href="https://www.drugabuse.gov/publications/drugfacts/marijuana">THC</a> are becoming available to the youth consumer, with unknown prevalence and effects that warrant further research.</p>
<p>It took <a href="https://www.ncbi.nlm.nih.gov/books/NBK222369/">decades to understand the lethal health effects of smoking tobacco</a>, which still <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">kills over eight million people annually</a>. We should not ignore those crucial lessons. We need to be vigilant and take all steps necessary to avert a public health catastrophe, now and in the future.</p><img src="https://counter.theconversation.com/content/134467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracey-Ann Stitchell is a former secondary and post-secondary biology teacher and currently is a PhD candidate in Community Health and Epidemiology at the University of Saskatchewan. She receives funding from the College of Medicine Graduate Student funding initiative.</span></em></p><p class="fine-print"><em><span>Nazeem Muhajarine works for the University of Saskatchewan. He receives funding from Global Affairs Canada, Canadian Institutes of Health Research, and Saskatchewan Health Research Foundation.</span></em></p>Even as evidence of its adverse effects emerges, vaping is growing more popular among young people.Tracey-Ann Stitchell, PHD Student, Community Health and Epidemiology, University of SaskatchewanNazeem Muhajarine, Professor, Department of Community Health and Epidemiology and Director, Saskatchewan Population Health and Evaluation Research Unit, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1321212020-02-24T12:50:52Z2020-02-24T12:50:52ZVaping and heart disease: setting the record straight<figure><img src="https://images.theconversation.com/files/316720/original/file-20200223-92493-1e02jc4.jpg?ixlib=rb-1.1.0&rect=0%2C902%2C5088%2C3060&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad science is clouding the issue.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-electronic-cigarette-over-dark-237371161">Oleg GawriloFF/Shutterstock</a></span></figcaption></figure><p>In June 2019, <a href="https://www.ahajournals.org/doi/10.1161/JAHA.119.012317">a paper</a> by prominent US academics found that people who used e-cigarettes were at greater risk of a heart attack. The authors concluded that <a href="https://tobacco.ucsf.edu/more-evidence-e-cigs-cause-heart-attacks-time-path">e-cigarettes were</a> just as risky <a href="https://www.bhf.org.uk/informationsupport/risk-factors/smoking">as tobacco</a> in provoking heart attacks, and that using e-cigarettes and traditional cigarettes at the same time was even riskier. Unsurprisingly, this caused a stir in the media – <a href="https://ahajournals.altmetric.com/details/61635069/news">in the form of 35 news stories</a>, to be exact. Also unsurprisingly, it provoked <a href="https://eu.usatoday.com/story/news/health/2019/07/17/vaping-heart-attacks-false-claims-sexual-harassment-allegations/1676473001/">vigorous scientific debate</a>. Eight months later, the paper was <a href="https://www.ahajournals.org/doi/10.1161/JAHA.119.014519">retracted</a>. </p>
<p>When a paper is retracted it means we can’t trust its results. It’s like being unpublished. The problem is, the paper still exists – it’s in news stories, it’s on social media, it’s in documentaries. Smokers see these stories and <a href="https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf">increasingly think e-cigarettes are as harmful as smoking</a>. That’s a problem because smoking is deadly. </p>
<p>In the study, the authors used a large set of information from adults in the US. In particular, they looked at people who smoked and people who used e-cigarettes and at whether those people had heart attacks. </p>
<p>A major problem with studies like this is which came first: if people who use e-cigarettes are also more likely to have heart attacks, what does this tell us? Does it mean that e-cigarettes cause heart attacks? Or that people who have heart attacks are more likely to try vaping? You can test for this by looking at which came first – the heart attack or the e-cigarette. </p>
<p>The <a href="https://www.ahajournals.org/doi/10.1161/JAHA.119.014519">journal states</a> that the authors were asked to look at this during the peer-review process. In response, they provided some extra information, which doesn’t appear to be what the reviewers had asked for. This information was not confirmed by the journal, and the paper was published. Concerns were raised after publication, at which point the journal asked the authors to re-evaluate the information. The authors replied that they could no longer access the data. This means <a href="https://retractionwatch.com/2020/02/18/journal-retracts-hotly-contested-paper-on-vaping-and-heart-attacks/">we can’t trust the paper</a>.</p>
<p>We can try to learn from this, and it takes several forms. For researchers and the people who fund and publish research, it means not just doing more research, but doing good research, subject to rigorous, critical review. It also means doing open research; it is possible that if the initial data was publicly available, the flawed analysis may not have made it to publication in the first place. </p>
<p>It means being aware of “<a href="https://catalogofbias.org/biases/hot-stuff-bias/">hot stuff bias</a>” where topics that get a lot of media attention attract more bad science than those that are less on the radar. As readers, it means thinking about what we read and looking to trusted sources for information on health topics. As responsible scientists, it also means sticking to the evidence we have and sharing that information whenever we can. </p>
<h2>What we know</h2>
<p>There’s so much we don’t know about e-cigarettes, but there are some things we do know:</p>
<p>• We need more research. E-cigarettes are relatively new to the market and the devices are changing all the time.</p>
<p>• Expert consensus is that regulated, nicotine-containing e-cigarettes are considerably less risky than smoking traditional cigarettes.</p>
<p>• That said, e-cigarettes are not risk free. For people who don’t smoke, vaping will probably introduce health risks.</p>
<p>• Not all e-cigarettes are the same. The outbreaks of <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">vaping-related illness in the US</a> over the past year have been largely attributed to vaping cannabis. E-cigarettes that contain cannabis sometimes also contain an additive called vitamin E acetate, which is known to be harmful to lungs. Vitamin E acetate is banned from e-cigarettes in Europe. </p>
<p>• Nicotine is <a href="https://theconversation.com/nicotine-replacement-when-quitting-cigarettes-consider-using-more-nicotine-not-less-115008">not the harmful ingredient in cigarettes</a>, or in e-cigarettes. It is addictive, so it gets its bad name because it’s part of what makes people keep smoking. But it’s the other ingredients in cigarettes that cause the increased risk of death and disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316721/original/file-20200223-92551-1cpt0wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Much of the vaping-related illness in the US is attributed to vaping cannabis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/marijuana-buds-closeup-cannabis-oil-vape-1296943213">Shannon Laura/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Misinformation can be deadly</h2>
<p>It is difficult to talk about retractions and their lasting impact without going back to the infamous – and since retracted – <a href="https://www.bmj.com/content/342/bmj.c7452">paper linking autism to MMR vaccines</a>. Though withdrawn in 2010, the impact of this long discredited article still looms large, with <a href="https://wellcome.ac.uk/reports/wellcome-global-monitor/2018/chapter-5-attitudes-vaccines">vaccine scepticism</a> linked to <a href="https://www.bmj.com/content/364/bmj.l739">recent outbreaks of diseases</a>, such as measles. </p>
<p>We must all do better to make sure we don’t repeat history when it comes to e-cigarettes. That includes being open and critical about science and thinking twice when we read stories about hotly contested topics in healthcare. With <a href="https://catalogofbias.org/biases/hot-stuff-bias/">topics that attract a lot of attention</a>, journals may be more likely to publish research with inappropriate methods or conclusions, and investigators may take a less critical approach than they would have otherwise. Alarming headlines are catchy, but misinformation might actually kill us.</p><img src="https://counter.theconversation.com/content/132121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hartmann-Boyce does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A prominent paper on vaping and heart disease has been retracted.Jamie Hartmann-Boyce, Senior Researcher, Health Behaviours, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1293182020-01-29T13:20:28Z2020-01-29T13:20:28ZE-cig flavors may be more than alluring; they could cause damage themselves<figure><img src="https://images.theconversation.com/files/312168/original/file-20200128-81336-phd8ra.jpg?ixlib=rb-1.1.0&rect=63%2C120%2C4669%2C2963&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A vape shop in New York City shows a line of flavorings on Jan. 2, 2020.</span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/129424/edit">Mary Altaffer/AP Photo</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="https://news.gallup.com/poll/267413/percentage-americans-vape.aspx">Millions of Americans</a> are vaping, and some are getting sick. Since June 2019, <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">2,711 have been hospitalized and 60 have died</a> due to <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">EVALI</a> (e-cigarette-associated lung injury), the devastating lung disease linked to e-cigarettes.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/31688912">Five million</a> users are middle and high school students. Some are as young as 11, although it’s illegal to sell vaping products to anyone under 21. </p>
<p>Especially for kids, much of the lure is <a href="https://doi.org/10.1371/journal.pone.0194145">flavor</a>. E-cigarettes offer attractive smells and tastes. Fruit, mint, candy and dessert flavors are the favorites, and <a href="https://doi.org/10.1001/jama.2019.18387">studies suggest</a> they ignite the desire to vape. That’s why the Trump administration <a href="https://www.fda.gov/consumers/consumer-updates/facts-fdas-new-tobacco-rule">just banned</a> the sale of those sweet flavors from cartridge-based e-cigs, the delivery method most popular with teens. </p>
<p>One of us (<a href="https://biology.umbc.edu/directory/faculty/person/SA20601/">Weihong</a>) is a chemosensory neurobiologist, and the other (Rakaia) is a research assistant in <a href="https://linlab.umbc.edu/">my lab</a>. Put simply, we study how the sensory systems and brain react to chemical stimulation. With e-cigarettes, we are focusing on how the enticing flavors ensnare our children. </p>
<p>But our studies have shown that the effect of flavor goes beyond the pleasure they may bring – the flavorings themselves may actually harm tissue. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/uyCl3BdlICY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">These ads extol the virtues of flavored cigarettes.</span></figcaption>
</figure>
<h2>Flavors enhance e-cig appeal</h2>
<p>The tobacco industry <a href="http://dx.doi.org/10.1136/tobaccocontrol-2014-051830">has long been using</a> flavorings make their products more palatable; it <a href="https://www.ncbi.nlm.nih.gov/pubmed/14507484">added menthol</a> to cigarettes nearly a century ago. </p>
<p>Today, the allure of flavors in e-cigarettes bring potential health consequences, and kids are particularly vulnerable. E-cigarettes can put adolescents at risk for respiratory, cardiopulmonary diseases, brain disorders and cancers.</p>
<p>About <a href="http://dx.doi.org/10.1136/tobaccocontrol-2019-055303">20,000 flavored e-liquids</a> are on the market – countless combinations of hundreds of flavoring molecules extracted from natural ingredients or artificially made. The vast majority are volatile odor chemicals, perceived not by taste, but by smell.</p>
<p>Your olfactory system, with far more sensitivity than your taste buds, can distinguish more than 10,000 smells. During vaping, a flavoring enters our nose, and like any agreeable scent, immediately evokes the <a href="https://doi.org/10.3758/BF03193837">fond memories</a> and <a href="https://www.livescience.com/why-smells-trigger-memories.html">pleasant emotions</a> associated with the aroma. Vanillin, a popular e-cigarette flavoring, smells like dessert; <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Ethyl-maltol">ethyl maltol</a>, a flavoring used in many foods, has a candy-like odor. The user, comforted and calmed, savors the moment – then goes back for more. </p>
<p>But e-cigarette vapor also contains nicotine, heavy metals and formaldehyde, as pungent as they are <a href="https://www.ncbi.nlm.nih.gov/books/NBK507184/">harmful</a>. Mixing in delectable flavorings disguises their unpleasantness, much like the cherry additive that camouflages the otherwise medicinal taste of children’s cough syrup. </p>
<p>Yet perceptions of irritation and pain in the nose, mouth, and throat serve as warning signals, the body’s cautionary bells and whistles evolved over millions of years. A <a href="https://scholarblogs.emory.edu/evolutionshorts/2014/05/01/the-evolution-of-bitter-taste/">bitter taste</a> might originate from a toxic plant; irritation in the nose or respiratory tract indicates the inhaled substance is potentially harmful. </p>
<p>But now that flavorings in e-cigarette mask the warning signals, many consumers have been lulled into believing vaping is benign. They rate <a href="https://doi.org/10.18001/TRS.5.6.4:10.18001/">mint flavors as safer</a>, though they are not. And instead of irritation from the e-cigarette prompting a cough – an action that removes harmful stimuli from the airway – the flavorings instead dampen the user’s sensory alarms and protective reactions. The risk of chemically induced injury, along with nicotine abuse, is increased.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=609&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=609&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312349/original/file-20200128-81362-i84vlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=609&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Flavorings themselves, and not just e-cigarettes, could lead to chronic coughing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coughing-senior-man-sitting-on-sofa-615311849">Africa Studios/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>How flavors themselves may be toxic</h2>
<p>Although the U.S. Food and Drug Administration has acknowledged some flavorings as “safe for consumption,” its label dodges a critical distinction. Safe for consumption does not mean safe for inhalation. While scientists still haven’t confirmed the <a href="https://doi.org/10.1016/j.jaci.2019.11.001">inhalation toxicity</a> for all flavorings, the latest research reveals some disturbing evidence.</p>
<p>Many of the most common flavorings when present at high levels can cause <a href="https://doi.org/10.1016/j.toxlet.2018.02.025">inflammation</a>, cell death, <a href="https://doi.org/10.1016/j.toxlet.2018.02.025">free radical formation</a> and DNA damage. One class of compounds, known as furfurals, trigger <a href="https://doi.org/10.1016/j.toxlet.2018.02.025">tumor growth in mice</a>. </p>
<p>Flavor molecules, reacting <a href="https://doi.org/10.1093/ntr/nty192">with the propylene glycol</a> in the e-liquid, can produce <a href="https://www.news-medical.net/life-sciences/What-are-Metabolites.aspx">metabolites</a>, or intermediate substances that are part of metabolic reactions, that are irritating to the respiratory system. Long-term exposure to irritants can lead to chronic cough; inflammation; hyper-reactive airway (wheezing, shortness of breath); edema (swelling in the arms, hands, legs or feet); and acute lung damage.</p>
<p>Some flavorings, inhaled chronically or at high levels, are already known to cause serious and sometimes deadly respiratory illnesses. Diacetyl, a buttery flavor used in processed foods – notably some popcorn products – causes “<a href="https://www.lung.org/about-us/blog/2016/07/popcorn-lung-risk-ecigs.html">popcorn lung,</a>” an irreversible disease that affects factory workers exposed daily to the compound. </p>
<p>Many e-liquids contain diacetyl; <a href="https://www.ncbi.nlm.nih.gov/pubmed/26642857#">an analysis</a> found the substance in 39 out of 51 tested e-cigarette samples. In about half the samples, the estimated daily consumption was above safety limits. </p>
<p>Patients with EVALI exhibit a significant number of these symptoms, and all were attributed to vaping. <a href="https://doi.org/10.1016/j.drugalcdep.2018.11.030">In one survey</a>, users reported cough (40.0%); dry or irritated mouth or throat (31.0%); dizziness or lightheadedness (27.1%); headache or migraine (21.9%); or shortness of breath (18.1%). </p>
<p>Similar health problems have been reported by patients with chemically induced <a href="https://doi.org/10.1016/0378-4274(96)03673-9">sick building syndrome</a>. This implies that e-cigarette users share common health problems with those suffering from chemical exposure.</p>
<h2>What about long-term vaping?</h2>
<p>Ongoing chemical exposure, especially at high doses, can cause olfactory dysfunction, including a reduced sense of smell. This encourages chronic e-cigarette users to choose stronger-flavored e-liquids to receive a sufficient buzz. In turn, more potent e-liquids generate more irritation and damage to the nose, lungs and lower airway. </p>
<p>The health effects of e-cigarette exposure go beyond the sensory and respiratory systems. Mint and candy flavors are more than chemical accessories that enhance a harmless experience. They shape our behavior, perhaps for a lifetime. </p>
<p>Our government is making progress towards keeping teens away from e-cigarettes. Now, long-term research is needed to fully comprehend the adverse health effects and toxicity of flavorings and other chemical substances in the e-cigarette vapor to prevent the potentially catastrophic effects of vaping.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/129318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Weihong Lin receives research funding from NIH NIDA/TRSP.</span></em></p><p class="fine-print"><em><span>Rakaia Kenney does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The FDA has banned flavored e-cigarettes that appeal to kids. But new research shows that the danger of flavors could go beyond their appeal to kids. The flavorings themselves could cause damage.Weihong Lin, Professor of Biological Sciences, University of Maryland, Baltimore CountyRakaia Kenney, Research assistant, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.