New study finds global adolescent vaping is low

Peer-Reviewed Publication

SOCIETY FOR THE STUDY OF ADDICTION

A new study published today in the scientific journal Addiction has found that approximately 8.6% of adolescents reported using e-cigarettes (vaping) in the past 30 days, but only 1.7% engaged in frequent vaping. This suggests most adolescents who vape are experimenting but not making it a habit.

Researchers from the University of Queensland (Australia) wanted to estimate as far as possible the global prevalence of adolescent vaping.  The researchers analysed data from 151,960 adolescents in 47 countries who participated in the World Health Organization’s (WHO’s) Global Youth Tobacco Survey between 2015 and 2018.  The overall weighted prevalence of adolescent vaping and frequent vaping in the past 30 days was 8.6% and 1.7% respectively.

Lead author Dr. Gary Chan says “There are two likely explanations for the low levels of frequent vaping among young people.  First, e-cigarettes are relatively new and are often sold in colourful packages with highly palatable flavours that could appeal to adolescents, thus leading to experimentation but not continued use. Second, while some e-cigarettes contain high levels of nicotine, adolescents can also vape non-nicotine or low nicotine e-cigarettes and avoid becoming addicted. Future WHO surveys should ask participants to disclose whether nicotine is in the vaping liquids they use.”

The researchers also wanted to test the association between the implementation of World Health Organization (WHO) tobacco control policies and adolescent vaping.  In 2008, WHO introduced the MPOWER policy package, with six policies to reduce tobacco use: monitoring, smoke-free environments, cessation programs, health warnings, advertising bans, and taxation.  Implementation of these policies has reduced tobacco use; however, it is unclear if these policies have had any impact on youth uptake of e-cigarettes.

Using data from the 44 countries where implementation data were available, the researchers found inconclusive evidence that implementation of five of the MPOWER policies was associated with lower adolescent vaping.  Implementation of the sixth policy – higher taxes on tobacco products – was curiously associated with more adolescent vaping. This suggests that some adolescents in countries with a higher tobacco tax may be substituting cigarettes with e-cigarettes.

-- Ends –

For editors:

This paper is free to read for one month after the embargo lifts from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.15892 or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Dr Gary Chan, please contact him at the The University of Queensland by telephone (+61 7 344 32533) or email (c.chan4@uq.edu.au).

Full citation for article: Chan GCK, Gartner C, Lim C, Sun T, Hall W, Connor J, Stjepanović D, and Leung J (2022) Association between the implementation of tobacco control policies and adolescent vaping in 44 lower-middle, upper-middle, and high-income countries. Addiction: doi: 10.1111/add.15892

Funding: GCKC was funded by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT1176137). CG was funded by NHMRC Centre of Research Excellence Grant. CL was funded by National Health and Medical Research Council Postgraduate Scholarship (GNT2005317). TS, WH and JC were funded by Department of Health, Australia. The funders have no role in any stage of this study.

Declaration of interests:  The authors declare no competing interest.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.

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JOURNAL

Addiction

DOI

10.1111/add.15892 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association between the implementation of tobacco control policies and adolescent vaping in 44 lower-middle, upper-middle, and high-income countries

ARTICLE PUBLICATION DATE

12-May-2022

COI STATEMENT

The authors declare no competing interest.

UK

Swap-to-stop’ but let us shop - say vapers

Peer-Reviewed Publication

UNIVERSITY OF EAST ANGLIA

A Government scheme to give out free vapes to smokers appeals to most but not all, according to new research from the University of East Anglia (UEA).

The 'Swap-to-Stop' scheme was announced earlier this year - providing a million e-cigarettes to disadvantaged people who smoke.

A new study published today supports the scheme, with people who vape saying that this type of approach might have helped them if it had been available when they attempted to quit.

But the research also shows that accessing vapes via the NHS might not be appealing to everyone, because some people don't see e-cigarettes as treatments but more as consumer products that they can shop for themselves.

The team says there is a place for both commercial and medical routes to vaping for quitting smoking to satisfy people's personal preferences.

Lead researcher Dr Emma Ward, from UEA’s Norwich Medical School, said: “The vast majority of people who have quit smoking via vaping will have done so without any support from healthcare professionals.

“However, using vapes to quit smoking has been supported by the NHS and there are guidelines for healthcare professionals to support patients looking to quit smoking with vaping.

“In April 2023, the Government announced a 'Swap-to-Stop' scheme – to help achieve its Smokefree 2030 target of less than 5 per cent of people smoking in England by 2030.

“The scheme will be the biggest Government supported stop smoking scheme to date using e-cigarettes. The scheme will use vaping products that are also available to buy commercially.

“We wanted to better-understand how well it might work.”

The team interviewed 136 people from across the UK – nearly all of whom had quit smoking via vaping.

They asked them how helpful they would have found e-cigarettes being provided by the NHS when they were attempting to quit. They also asked for their views on different ways to access vaping for quitting smoking.

Dr Ward said: “Our research shows that people who quit smoking using commercially purchased vapes believe they might have benefitted from the NHS providing e-cigarettes and support if it had been available to them when they were quitting.

“Vaping being available via healthcare professionals offers reassurance around the effectiveness of e-cigarettes in helping people quit smoking and potential harms.

“However, it is unlikely that one type of e-cigarette will suit everyone seeking to quit and our research highlights how important being able to choose vaping products in a commercial environment is for some quitters.

“People who vape believe they have benefited from being able to choose vaping products in shops to get the right mix of device and flavours to work best for them to help them to permanently stop smoking.

“Even those who do achieve success with vapes given to them by the NHS are likely to continue to use shops to buy ongoing vaping supplies.

“So, we argue that there is a place for both commercial and medical routes to vaping to help people stop smoking.”

This research was carried out in collaboration with London South Bank University. It was funded by Cancer Research UK.

‘Medicalisation of Vaping in the UK? E-cigarette users’ perspectives on the merging of commercial and medical routes to vaping’ is published in the journal Perspectives in Public Health.

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JOURNAL

Perspectives in Public Health

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE PUBLICATION DATE

7-Aug-2023

THE WAR ON VAPING

Vaping just once raises oxidative stress levels in nonsmokers, increasing disease risk

New study findings ‘are clear, unambiguous and concerning,’ UCLA researcher says

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES

The risk that both tobacco and electronic cigarettes can pose to regular smokers’ health has been well documented, but a new UCLA study illustrates just how quickly vaping can affect the cells of even healthy younger nonsmokers.

The findings, published on Monday in JAMA Pediatrics, show that a single 30-minute vaping session can significantly increase cellular oxidative stress, which occurs when the body has an imbalance between free radicals — molecules that can cause damage to cells — and antioxidants, which fight free radicals.

“Over time, this imbalance can play a significant role in causing certain illnesses, including cardiovascular, pulmonary and neurological diseases, as well as cancer,” said the study’s senior author, Dr. Holly Middlekauff, a professor of cardiology and physiology at the David Geffen School of Medicine at UCLA.

E-cigarettes, devices that deliver nicotine with flavoring and other chemicals in a vapor rather than smoke, are seen by many as a safer alternative to regular cigarettes, but research by Middlekauff and others has demonstrated that vaping is associated with a number of adverse changes in the body that can presage future health problems. 

For the current study, 32 male and female study participants, who ranged in age from 21 to 33, were divided into three groups: 11 nonsmokers, nine regular tobacco cigarette smokers and 12 regular e-cigarette smokers. Middlekauff and her colleagues collected immune cells from each individual before and after a half-hour vaping session to measure and compare changes in oxidative stress among the groups.

The researchers performed the same process during a control session in which participants spent 30 minutes “sham-vaping,” or puffing on an empty straw.

They found that in nonsmokers, oxidative stress levels were two to four times higher after the vaping session than before. The same 30-minute exposure did not lead to an increase in oxidative stress among the regular cigarette and e-cigarette smokers, the researchers noted, most likely because their baseline levels of oxidative stress were already elevated.

“We were surprised by the gravity of the effect that one vaping session can have on healthy young people, “Middlekauff said. “This brief vaping session was not dissimilar to what they may experience at a party, yet the effects were dramatic.”

The results are especially troubling, the researchers say, because the popularity of vaping continues to increase, particularly among teens and young adults. According to a 2020 study, nearly 1 in 3 high school students reported that they had used an e-cigarette during the previous month.

There is still more to be understood about what exactly causes the changes in oxidative stress levels — whether it is the nicotine or non-nicotine elements in e-cigarettes — the researchers say. Middlekauff and her team will continue to explore this question in future research.

“While there’s a perception that e-cigarettes are safer than tobacco cigarettes, these findings show clearly and definitively that there is no safe level of vaping,” Middlekauff said. “The results are clear, unambiguous and concerning.”

Other authors of the study included Dr. Theodoros Kelesidis, Elizabeth Tran, Randy Nguyen, Yuyan Zhang and Grace Sosa, all of UCLA.

The research was supported in part by the Tobacco-Related Disease Research Program of California and the National Institutes of Health.

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JOURNAL

JAMA Pediatrics

METHOD OF RESEARCH

Randomized controlled/clinical trial

ARTICLE TITLE

One Vaping Session Increases Cellular Oxidative Stress in Otherwise Healthy, Young Non-smokers: A Randomized Controlled Crossover Trial

ARTICLE PUBLICATION DATE

9-Aug-2021

Depression & anxiety symptoms linked to vaping nicotine and THC in teens and young adults

American Heart Association Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, Abstract 602

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

• A study of more than 2,500 people ages 13-24 found that nicotine-only vapers, THC-only vapers and dual vapers (of nicotine and THC) were more likely to report anxiety symptoms, depressive symptoms and suicidal thoughts when compared with their peers who did not use electronic cigarettes or vape THC.
• Approximately 60% of the nicotine-only, THC-only and dual vapers self-reported that they experienced anxiety symptoms, versus about 40% of participants who never vaped. Anxiety symptoms were more frequently reported among THC-only vapers.
• Over half of the nicotine-only, THC-only and dual vapers self-reported that they experienced symptoms of depression versus 25% of non-vapers.

Embargoed until 3 p.m. CT/4 p.m. ET, Tuesday, February 28, 2023

DALLAS, February 28, 2023 — A survey of more than 2,500 teens and young adults led by the American Heart Association found that vaping nicotine and THC, the psychoactive component in marijuana, was associated with self-reported symptoms of depression and anxiety. The study’s preliminary findings will be presented at the Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, which will be held in Boston, February 28-March 3, 2023, and offers the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.

The use of pod-based e-cigarettes has surged among youth and young adults in recent years. Previous studies have identified links between vaping and symptoms of both anxiety and depression among young adults.

“Younger people have long been vulnerable to tobacco use, may experience greater harm from nicotine and other drugs and may be targeted by tobacco advertisers and marketers,” said study author Joy Hart, Ph.D., a professor of communication at the University of Louisville in Kentucky. “E-cigarette devices are still relatively new compared to other tobacco products, such as combustible cigarettes and pipes, so more research is needed to try to better understand the popularity of e-cigarettes, including reasons for vaping and the associated health risks among youth.”

The researchers, several of whom work for the Association, conducted an online survey among 2,505 teens and young adults, ages 13-24, to gauge mental health differences among nicotine-only vapers, THC-only vapers, dual vapers of both nicotine and THC and people who had never vaped any product. The study was focused on 1,921 people who had never vaped or were current vapers, defined as having vaped in the past 30 days. Of those participants, 562 individuals reported they had never vaped, 370 had vaped only nicotine, 159 had vaped only THC, and 830 were dual vapers of nicotine and THC.

The analysis of the participants’ survey responses found:

• Approximately 70% of the THC-only vapers and 60% of the nicotine-only vapers and dual vapers reported experiencing anxiety symptoms — such as worries, flashbacks, panic attacks and situational anxieties— within the past week, compared to about 40% of participants who had never vaped.
• Over half of the nicotine-only vapers, THC-only vapers and dual vapers reported experiencing symptoms of depression — such as difficulty engaging in or being interested in activities normally enjoyed, whether they felt that depression interfered with their ability to do the things they needed to do at work, at school or at home and whether depression interfered with their social life and relationships — within the past week, compared to 25% of non-vapers.
• More than 50% of people in all vaping groups reported having suicidal thoughts within the past 12 months, compared to only one-third of the non-users.
• About a quarter of the dual vapers and nicotine-only vapers started vaping nicotine to calm down or feel less stressed, and one-third of participants in both groups reported that they currently vaped nicotine to cope with feelings of anxiety. In contrast, about half of THC-only vapers started vaping THC and currently vaped THC to relieve anxiety symptoms.
• Around 20% of nicotine-only vapers and dual vapers started vaping to help feel less depressed and currently vaped for this reason. About one-third of THC-only vapers started vaping THC and nearly half currently vaped TCH to feel less depressed.

Dual vapers were significantly more likely than nicotine-only vapers to indicate addiction to nicotine, which was defined in this study as behavior such as waking up at night to vape. Dual vapers of nicotine and THC were also significantly more likely to say they felt less depressed after they started vaping, whereas nicotine-only vapers were more likely to report that vaping had no impact on their feelings of depression. This may be related to dual users’ stronger addiction to these products, rather than the positive impacts of the products on their mental health, the researchers said.

“Although we knew that THC was commonly vaped, we were surprised to have so many dual vapers—more than double the nicotine-only vapers. Dual use may either compound the addictive nature of vaping or attract people who are more prone to addiction, as well as have an impact on symptoms of depression. These findings suggest the importance of addressing the use of THC and the need for building resilience and coping skills for teens and young adults,” Hart said.

The study had limitations: the use of cross-sectional data did not allow researchers to assess whether symptoms of anxiety and depression, as well as suicidal thoughts, were caused or exacerbated by the use of the THC and nicotine vapes, or whether the existence of those symptoms had an effect on the use of the vape products; collecting online data via a web-based panel meant that participants may not be representative of all U.S. teens and young adults; and the data were self-reported.

“When better coping skills are developed, there may be fewer temptations to try to manage anxiety symptoms and similar mental health challenges through vaping, as well as better refusal skills if offered an electronic cigarette. Increased priority on more positive behaviors to alleviate tension and manage anxiety symptoms may reduce the likelihood of vaping, possible addiction and the increased risk of negative health outcomes,” said Rose Marie Robertson, M.D., FAHA. Robertson is deputy chief science and medical officer of the American Heart Association, co-director of the Association’s National Institutes of Health/U.S. Food and Drug Administration-funded Tobacco Center of Regulatory Science and senior author on the study. “There is also an urgent need for effective communication campaigns and educational programs to increase understanding among youth and young adults of the risks of using e-cigarettes.”

Future research, Robertson said, is needed to examine the long-term connections between mental health and vaping, whether nicotine-only, THC-only or both nicotine and THC.

“This study showed the striking significance of issues with mental health in users of both nicotine vapes as well as THC vapes, and as new products continue to come on the market, I think that this is something that we will continue to see,” said Loren E. Wold, Ph.D., FAHA. Wold is assistant dean for biological health research in the College of Nursing, a professor in the Colleges of Nursing and Medicine (physiology and cell biology) at The Ohio State University and lead of the writing committee for the Association’s 2022 Statement on Cardiopulmonary Consequences of Vaping in Adolescents. “These products were developed as smoking cessation tools for those that use traditional cigarettes, so I’m very curious now what the implications are with mental health in users who are using these products to help stop smoking.”

Additional co-authors are Jeffrey Willett, Ph.D.; Allison Groom, M.A.; Robyn L. Landry; Angel Bassett, M.A.; Mary Dunn, Ph.D.; Kandi Walker, Ph.D.; Thomas Payne, Ph.D.; and Anshula Kesh, M.P.H., B.D.S. Authors’ disclosures are listed in the abstract.

The study was funded by a grant from the Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation. Through the American Heart Association Tobacco Center for Regulatory Science, the Association works closely with investigators at institutions across the country to pursue research that adds to the existing knowledge about the health impacts of smoking and nicotine-related products including e-cigarettes, findings that can help inform public health and the regulation of tobacco products.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/depression-anxiety-symptoms-linked-to-vaping-nicotine-and-thc-in-teens-and-young-adults?preview=c30b14f8eb24c1a3519f6e7e9e0d0513
  • Video interview: Rose Marie Robertson, M.D., FAHA, senior author on the study and deputy chief science and medical officer of the American Heart Association and co-director of the Association’s National Institutes of Health/U.S. Food and Drug Administration-funded Tobacco Center of Regulatory Science.
  • Video interview: American Heart Association volunteer expert, Loren E. Wold, Ph.D., FAHA, assistant dean for biological health research in the College of Nursing, a professor in the Colleges of Nursing and Medicine (physiology and cell biology) at The Ohio State University and lead of the writing committee for the Association’s 2022 Statement on Cardiopulmonary Consequences of Vaping in Adolescents.
• AHA news release: Use of e-cigarettes had negative cardiovascular effects similar to smoking cigarettes (October 2022)
• AHA news release: People who vape had worrisome changes in cardiovascular function, even as young adults (October 2022)
• AHA news release: No health benefits among adults who used both e-cigarettes and traditional cigarettes (May 2022)
• AHA health information: Quit Vaping – Quit Smoking – Quit Tobacco
• AHA health information: The Ugly Truth About Vaping
• For more news from AHA EPI Lifestyle Conference 2023, follow us on Twitter @HeartNews #EPILifestyle23.

The American Heart Association’s EPI/LIFESTYLE 2023 Scientific Sessions is the world’s premier meeting dedicated to the latest advances in population-based science. The meeting will be held Tuesday-Friday, February 28 – March 3, 2023, at the Omni Boston Seaport in Boston, Massachusetts. The primary goal of the meeting is to promote the development and application of translational and population science to prevent heart disease and stroke and foster cardiovascular health. The sessions focus on risk factors, obesity, nutrition, physical activity, genetics, metabolism, biomarkers, subclinical disease, clinical disease, healthy populations, global health and prevention-oriented clinical trials. The Councils on Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (Lifestyle) jointly planned the EPI/Lifestyle 2023 Scientific Sessions. Follow the conference on Twitter at #EPILifestyle23.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

New studies suggest vaping could cloud your thoughts

UNIVERSITY OF ROCHESTER MEDICAL CENTER

Research News

 

Two new studies from the University of Rochester Medical Center (URMC) have uncovered an association between vaping and mental fog. Both adults and kids who vape were more likely to report difficulty concentrating, remembering, or making decisions than their non-vaping, non-smoking peers. It also appeared that kids were more likely to experience mental fog if they started vaping before the age of 14.

While other studies have found an association between vaping and mental impairment in animals, the URMC team is the first to draw this connection in people. Led by Dongmei Li, Ph.D., associate professor in the Clinical and Translational Science Institute at URMC, the team mined data from two major national surveys.

"Our studies add to growing evidence that vaping should not be considered a safe alternative to tobacco smoking," said study author Li.

The studies, published in the journals Tobacco Induced Diseases and Plos One, analyzed over 18,000 middle and high school student responses to the National Youth Tobacco Survey and more than 886,000 responses to the Behavioral Risk Factor Surveillance System phone survey from U.S. adults. Both surveys ask similar questions about smoking and vaping habits as well as issues with memory, attention and mental function.

Both studies show that people who smoke and vape - regardless of age - are most likely to report struggling with mental function. Behind that group, people who only vape or only smoke reported mental fog at similar rates, which were significantly higher than those reported by people who don't smoke or vape.

The youth study also found that students who reported starting to vape early - between eight and 13 years of age - were more likely to report difficulty concentrating, remembering, or making decisions than those who started vaping at 14 or older.

"With the recent rise in teen vaping, this is very concerning and suggests that we need to intervene even earlier," said Li. "Prevention programs that start in middle or high school might actually be too late."

Adolescence is a critical period for brain development, especially for higher-order mental function, which means tweens and teens may be more susceptible to nicotine-induced brain changes. While e-cigarettes lack many of the dangerous compounds found in tobacco cigarettes, they deliver the same amount or even more nicotine.

While the URMC studies clearly show an association between vaping and mental function, it's not clear which causes which. It is possible that nicotine exposure through vaping causes difficulty with mental function. But it is equally possible that people who report mental fog are simply more likely to smoke or vape - possibly to self-medicate.

Li and her team say that further studies that follow kids and adults over time are needed to parse the cause and effect of vaping and mental fog.

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In addition to Li, authors of the youth study include Catherine Xie, and Zidian Xie, Ph.D. For the adult study, Li was joined by co-authors Zidian Xie, Ph.D., Deborah J. Ossip, Ph.D. Irfan Rahman, Ph.D., and Richard J. O'Connor, Ph.D. Both studies were funded by the National Cancer Institute and the U.S. Food and Drug Administration's Center for Tobacco Products.

The long read
The great vape debate: are e-cigarettes saving smokers or creating new addicts? 

Photograph: Bloomberg via Getty Images


The US is cracking down on vaping while the UK is promoting e-cigarettes as an aid to giving up smoking. Where does the truth lie? By Sarah Boseley


Tue 18 Feb 2020

Gone With the Smoke is already no more than a distant whiff of bubblegum-flavoured vapour. The vape shop and lounge, one of many in San Francisco, has been forced to close. So have Vapor Den (“eclectic lounge & hipster go-to”) and Happy Vape. From late January, it became illegal to sell e-cigarettes and e-liquids in San Francisco. Even online sales to addresses within the city limits have been stopped. Stores outside the city that dispatch e-cigarettes to an SF postcode will face prosecution.

While vaping is banned, sales of legal marijuana and tobacco will continue as usual. San Francisco has often been considered more progressive than the rest of the US in its approach to drugs and unorthodox lifestyles: marijuana was legalised in California for medical use in 1996, after a campaign by Aids activists from the city, and for recreational use in 2016. Vaping, on the other hand, has crossed a line.

Behind the outright ban on sales of e-cigarettes in San Francisco is a panic about teenagers vaping. More than one in four American teens have tried vaping, according to the US Centers for Disease Control and Prevention. A study published in the New England Journal of Medicine reported that 12% of 16- and 17-year-olds were addicted to nicotine, and raised the alarm about the effect of nicotine on the adolescent brain. The Food and Drug Administration (FDA) recently described the use of e-cigarettes as a “crisis among America’s youth”.

“San Francisco has never been afraid to lead. That will always be the case when the health of our children is on the line,” announced the San Francisco city attorney Dennis Herrera in a statement after the ban was passed by the the city legislature last June. He was scathing about the FDA’s failure to control e-cigarette sales. “Now, youth vaping is an epidemic. If the federal government is not going to act to protect our kids, San Francisco will,” he said.


In the UK, meanwhile, the medical establishment is endorsing vaping as an aid to giving up smoking. My local vape shop in London is colourful, thriving, offers a panoply of flavours and displays a banner the length of its storefront proclaiming: “Vaping is 97% safer than smoking, according to NHS and Cancer Research UK.” (The correct figure is 95%, according to a report in August 2015 by Public Health England, PHE, the government executive agency and watchdog that offers guidelines on health protection issues.)

A transatlantic schism has opened up over vaping and health. In the US, the war on vaping is being pursued by activists, politicians and scientists who believe that tobacco companies are cynically promoting e-cigarettes as a means to get people addicted to nicotine, which will – sooner or later – lead them to cigarettes. In the UK, anti-smoking campaigners and health experts counter that for many adult smokers, vaping offers the best hope of avoiding a premature death.

The two sides periodically break into open hostilities. The claim by PHE that vaping is 95% safer than smoking tobacco, frequently quoted by e-cigarette manufacturers and sellers, has been criticised as misleading by anti-smoking campaigners in the US. Matt Myers, who heads the Campaign for Tobacco-Free Kids in Washington DC, the biggest anti-smoking organisation in the world, has called the 95%-safer figure “mere fiction”.

Prof Ann McNeill of King’s College London, a tobacco and addiction expert who advises PHE, defends its position. “We are battling against misinformation on a massive scale,” she says. McNeill acknowledges there has been a rise in vaping among kids in the US and Canada, but does not see it as a reason for panic. “I don’t think it merits discussion of an ‘epidemic’. That word is overblown,” she said.


The soaring popularity of vaping among the young in the US is largely down to Juul – a tiny black or chrome device that looks like a USB stick and fits into the palm of the hand. In 2004, two design graduate students came up with the idea for an electronic alternative to smoking. They launched Juul in 2015, which quickly defined the market; by July 2019, Juul accounted for 75% of US e-cigarette sales. Since then, its fortunes have taken a dive. The company is accused, in dozens of lawsuits from San Diego to New York City, of targeting young users via social media campaigns featuring youthful models. Opponents claim Juul pods are easier for novice vapers to inhale, since they contain nicotine salts instead of straight nicotine, further softened with teen-friendly flavourings such as mango, cool cucumber and creme brulee. Juul has repeatedly denied it has marketed to teens.

There was fresh alarm in the US last year when 2,500 cases of lung disease and 55 deaths were associated with vaping. E-cigarettes work by heating liquid containing nicotine to produce vapour, which is then inhaled. There is no smoke or tar involved, but there are small amounts of chemical flavourings, including diacetyl, which has been linked to lung disease, and propylene glycol or vegetable glycerin. If the e-liquid overheats, formaldehyde can be formed. In fact, none of these chemicals were to blame in these cases – it turned out that the people who fell ill were using bootleg devices containing cannabis – but the reputational damage was done.

In the wake of this alarming spate of hospitalisations and deaths, the New York state governor, Andrew Cuomo, took emergency action in September, attempting to ban flavoured e-cigarette products. President Trump entered the fray, telling the FDA to act and imposing a temporary ban on any flavours that might appeal to young people. In December, New York City mayor, Bill de Blasio, signed a law banning flavours. “Manufacturers of fruit and candy-flavoured e-cigarettes are intentionally and recklessly targeting young people,” said Cuomo, citing flavours including bubblegum, cotton candy and Captain Crunch. The state ban was overturned in January 2020 by Justice Catherine Cholakis, who said it was an overreach.

In the UK, the NHS continues to edge as close as it can to approving the use of e-cigarettes to quit smoking. NHS hospitals in the West Midlands have sanctioned vape stores on the premises, while PHE launched, via YouTube, a video showing two white-coated experts with bell jars demonstrating how e-cigarettes are free of all the disgusting and damaging tar in a conventional cigarette.

The science is furiously disputed. Academics on both sides are accused of cherry-picking data to suit their own prejudices. PHE is a global authority on health issues such as vaccination and obesity, but on vaping, it is looking increasingly isolated. Deborah Arnott, head of Action on Smoking and Health (Ash) in the UK, says that Britain is losing ground in the e-cigarette debate because of the virulent campaign in the US against vaping. “The noise is causing problems in how we are perceived,” Arnott said. “We’re being written off.”


What should be settled by science has become a clash of faiths. In the US, the debate is dominated by those who believe people should “just say no” to drugs. In the UK, there is more support for the idea of “harm reduction”, in which addicts take controlled amounts of their drug, be it alcohol, heroin or in this case, nicotine, to keep them stable.

PHE’s support for e-cigarettes as a tool to help people quit smoking is shared by other respected health bodies, such as the Royal College of Physicians and Cancer Research UK. They point out that the UK regulates smoking and vaping far more rigorously than the US. The UK has rules on age, and health warnings, and caps on the nicotine content. Marketing to young people is forbidden – e-cigarettes cannot be advertised on TV. There is less nicotine in Juul pods or e-cigarette cartridges sold in the UK: Juul in the US contains up to 59mg per ml, while nicotine levels in e-cigarettes across Europe are capped at 20mg per ml by an EU directive enshrined in British law. In the US, at this point, there is no middle ground between unrestricted sales and an outright ban. 

A still from PHE’s video demonstrating how vapes are free from the tar and damaging substances found in cigarettes. Photograph: PHE

All sides agree that vaping nicotine is safer than getting it from cigarettes. Nicotine by itself is “relatively harmless”, according to the NHS, while the harm from cigarettes is in the smoke produced by burning tobacco and the residue of tar it leaves, which damages the airways, causing lung disease and cancer.

“People smoke for nicotine but they die from the tar,” wrote Michael Russell, a professor in addiction at the Institute of Psychiatry in London and a pioneer of harm reduction, in 1976. His work laid the foundations for the introduction of nicotine replacement therapy – the nicotine patches and gum the NHS hands out today.


Russell, who died in 2009, wanted to develop a low-tar cigarette that would be high in nicotine, to give smokers the hit they wanted without inhaling more deeply. His research on the low tar product was funded by the tobacco company RJ Reynolds, now owned by British American Tobacco (BAT). This relationship with a tobacco company, which Russell later claimed was normal practice at the time, is now seen as fatally compromising. It has since been used to undermine his research and attack his reputation.

Ann McNeill, who worked with Russell as a young researcher, believes he was ahead of his time. “His pioneering research improved the quality of life of smokers and saved the lives of many more,” she said in a paper celebrating Russell, co-written with Debbie Robson of the UK Centre for Tobacco & Alcohol Studies. “It is a sad indictment of our community that his work is still not recognised adequately by all those working in tobacco control, some of whom still fail to recognise the centrality of nicotine in tobacco use and the implications of this.”

Anti-tobacco activists – whether they are for or against e-cigarettes – believe they are defending the gains they have made in the battle against smoking. Vaping’s defenders say the tobacco firms are diversifying into a product that won’t kill their customer base. Hardline opponents are convinced e-cigarette sales will keep the hated tobacco companies in business.

The major tobacco companies – Philip Morris, Imperial, British American Tobacco and Japan Tobacco – did not take long to realise the potential of e-cigarettes, and all are now players in the vaping business. Blu, launched in the US in 2009 by an Australian entrepreneur, was bought by Lorillard Tobacco, and later acquired by the British company Imperial. In 2013, BAT launched Vype. In 2015, RJ Reynolds, makers of Camel and Lucky Strike, produced Vuse, which was the most popular brand in the US before Juul came along. Altria, the parent company of Philip Morris USA, acquired a 35% stake in Juul.

Most scientists and health campaigners in the US will have no dealings with the tobacco industry, because of its history of devious marketing practices and underhand tactics. Under the terms of a World Health Organization (WHO) treaty in the early 00s, governments agree not to have any discussions with tobacco industry representatives (over trade terms, for example, taxation, regulation or investment). But anti-smoking campaigners now fear that, by promoting the benefit of their e-cigarettes as an alternative to smoking, tobacco companies are acquiring respectability. WHO shares that anxiety and has advised measures to control e-cigarettes. Many countries, including Brazil, Thailand, Singapore, the Seychelles and Uruguay, have banned e-cigarettes as a result, while others have imposed regulations limiting their use.


Anumber of health professionals and academics have dedicated their careers to exposing lies about the safety of tobacco products and stopping the promotion of cigarettes around the world. Recent hard-won victories include smoking bans in public spaces and plain packaging with severe health warnings. Despite their efforts, there are still over 1 billion smokers in the world. The global cigarette market was worth $888bn (£682bn) in 2018 and forecast to rise to $1,124bn by 2024.

Stanton Glantz, professor of medicine at the Center for Tobacco Control, Research and Education at the University of California San Francisco, is the loudest of the anti-tobacco lobbyists – in his choice of Hawaiian shirts as well as his pronouncements. Glantz claims he was agnostic when e-cigarettes first appeared. He isn’t now. In December, he tweeted: “Using e-cigs increases exposure to toxic chemicals for most users; they would be better off just smoking.”

This was a new extreme, even for Glantz. Alex Berezow, vice-president of scientific affairs at the American Council on Science and Health, described the tweet as “mind-boggling”. “Unfortunately, Dr Glantz has become something of an ideologue. His (justifiable) animosity toward the tobacco industry has been turned (unjustifiably) to other industries, such as vaping,” he wrote on his blog. The research paper that had prompted Glantz’s tweet, Berezow pointed out, actually shows that e-cigarette users get less exposure to toxic chemicals than tobacco smokers – not more.

Glantz, who you have to interrupt if you want to ask a question, told me that in the tweet, he was talking about dual-users – people who are both smoking and vaping. “Maybe it was worded inarticulately,” he conceded. But he won’t back down. He claims the evidence suggests that most people are dual users (in the UK, about a third of vapers are still smoking as well, according to a survey by YouGov).

A giant in the anti-tobacco lobby, Glantz does not understand how researchers he respects can support vaping. Glantz claims that confidence in e-cigarettes, at PHE and among the UK scientists who condone it, is starting to crack. He is convinced the “95% safer” figure is wrong. It came from a paper published in 2014 by a group of experts led by David Nutt – the former government drugs adviser famous in the UK for declaring that ecstasy and LSD were safer than alcohol, which led to his sacking.

“The Nutt paper had no evidence whatsoever. It was 12 guys who sat around and pulled that number out of the air,” said Glantz. “The most generous thing you can say about that paper is that it was much earlier in the process and there wasn’t a lot of evidence out there.” He believes the credibility of Nutt’s group has been undermined by revelations that they were part-funded by a consultancy called EuroSwiss Health, run by Delon Human, a South African doctor who has accepted funding from BAT for some of his ventures.


Nutt says that’s nonsense. The group comprised 12 world experts. “Has [Glantz] ever read the paper?” he said. “There are 14 variables in that paper [possible harms, such as death from cancer]. It looks at the effect of 12 different forms of nicotine on 14 variables. And I bet he wouldn’t actually disagree with any of them.” He gives an example. “Does he actually think that tobacco is not much more harmful than vaping on the likelihood of lung cancer?” The paper, he said, “comes up with an answer he doesn’t want. That’s why he thinks it’s bad science.”Get the Guardian’s award-winning long reads sent direct to you every Saturday morning

Nutt, a professor in neuropsychopharmacology at Imperial College London, says he is “saddened” by Glantz’s attacks. “He was a hero of mine. He was one of the pioneers in demolishing the myth that tobacco wasn’t addictive and opposing the fraud and misinformation and lies of the tobacco industry. But the problem is he is still basically playing the same tune and we’re now in a different era.” It’s proven impossible to stop people selling tobacco, Nutt said. “So the anti-tobacco people have got to attack something else, because that’s what they do – they attack and they ban. So basically they’ve fixed their wagons against vaping because it is one thing they can ban, and they’re very successful. It’s laughable that in India people go to prison for selling vaping when the government allows advertising of tobacco.”

Glantz became an icon of the anti-tobacco movement after he received 4,000 leaked documents from Brown and Williamson, then the US’s third-biggest tobacco company, in 1994. They proved the industry knew that smoking caused cancer and had hidden it. Since then, Glantz has always objected vigorously to any compromise with the industry. In 1997, a deal was broached with the tobacco industry by Matt Myers of the Campaign for Tobacco-Free Kids. It would have brought in tight federal regulatory control of cigarettes, prohibiting the sort of advertising and marketing that is still ubiquitous in the US, as well as sales to children. But Glantz was opposed to any deal that would allow cigarette manufacturers to continue in business. His goal was to close them down altogether. Myers was stymied by his own allies, and the US still does not have the anti-tobacco regulations that are common in Europe.

Myers is calm and quietly authoritative. He is not against harm reduction, he says. Nor are other public health bodies such as the American Cancer Society or the American Heart Association. “All of us have said that under appropriate circumstances, if e-cigarettes are shown to actually significantly help smokers quit or switch completely, and that there are rules in place to prevent them being marketed in a way that doesn’t unduly impact youth, we would be supportive,” he said.

Up until now, on a national level, the US has had no regulatory control of e-cigarette sales, marketing, minimum age, or limits on nicotine content. “It’s the wild west,” said Myers. Tobacco-Free Kids has brought legal action against the FDA over its failure to regulate e-cigarette use and last year won a ruling from a federal judge that there was no excuse for further delay. The e-cigarette companies are irresponsible too, Myers added.

Myers says both sides in the argument interpret scientific studies according to their prior beliefs. He describes PHE’s “95% safer” figure as worthless, because not enough research has been done. “I have very little doubt that e-cigarettes under appropriate circumstances are significantly less harmful to a smoker. Do we know exactly how much less harmful? The answer is no, because we have no clue how much nicotine it is delivering, how pure they are, what else they’re putting in them. Comparing it to the most lethal product ever created, for public relations purposes, is not helpful.”

In March 2018, Myers and Glantz, as well as representatives of PHE and almost every other influential anti-smoking scientist or campaigner, attended the World Conference on Tobacco or Health in Cape Town – just up the road from BAT’s South Africa HQ. At this meeting, held every two years, activists can discuss the perfidy of the industry, celebrate their successes and plan for the future.

Nobody connected with the tobacco industry is allowed in the building. The WHO’s Framework Convention for Tobacco Control, which came into force in 2005, lays down recommended anti-smoking measures for governments, from taxing cigarettes to marketing controls and smoking bans in enclosed public places. It has been signed by 168 countries (the US is a notable exception). The Framework document says governments “need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts” and must limit their contact to the absolute minimum. Activists now take this to mean there must be an impenetrable wall between themselves and anyone in any way connected with tobacco.

The man who did as much as anyone to establish the Framework Convention while an executive director of WHO, Derek Yach – originally from Cape Town but now based in the US – finds himself on the wrong side of that wall. Yach was pointedly excluded from the conference in his home city – and yet much of the conversation was about him. Yach had done the unthinkable: accepting almost $1bn over 12 years from Philip Morris, makers of Marlboro and other leading brands, to set up his Foundation for a Smokefree World in New York in 2017 to fund research into alternatives to tobacco.

As part of its commitment to a “smokefree future”, Philip Morris International is heavily promoting its e-cigarettes and Iqos, a cigar-shaped electronic device designed to heat, rather than burn, tobacco. “These products will one day replace cigarettes,” it says on its website, claiming to be moving on from tobacco products because “society expects us to act responsibly”. Iqos has taken off in Japan, where 3 million people regularly use them. Smoking there was declining by 2% a year before Iqos arrived, and is now dropping by 10% per year, for which Philip Morris International claims the credit.

Yach believes it’s in the tobacco companies’ interests to develop products that will leave conventional cigarettes behind. His erstwhile colleagues believe he is working for the devil. Why, they ask, does Philip Morris still sell cigarettes if it cares about the world’s health?

As rumours circulated that Yach was in the building or lurking outside, Michael Bloomberg, the billionaire former mayor of New York and funder of vast amounts of anti-tobacco science and programmes, was launching his own campaign. Striding down the hallway, flanked by purple banners emblazoned with the words Bloomberg Philanthropies, the financial backer of the conference and his entourage made their way to the TV cameras to discuss his Stop initiative. Bloomberg announced he has set aside $20m to counter the lies of the tobacco industry. Top of the watch list was Yach’s Foundation. 

Attorney general Letitia James announces 

a lawsuit by the state of New York against 

e-cigarette maker Juul.

 Photograph: Lucas Jackson/Reuters

Bloomberg helps pay for WHO’s work on tobacco. I was offered a five-minute audience – just long enough to ask if he thinks there’s a role for e-cigarettes in combating smoking. “It is like marijuana: one of the stupid things we’re doing is legalising it,” he said. “I think there’s no place for e-cigarettes. I think it’s a terrible idea.”

Yach claims that “A-grade scientists and researchers around the world” are picking up grants from his foundation and doing useful work, but few believe he can succeed. He admits he was taken aback by the strength of feeling. “I wasn’t completely naive about it, but I didn’t actually appreciate how harsh it would be, particularly from a pretty small bunch of people who have incredible influence at WHO,” he says.

Clive Bates, the former head of the UK’s Ash, who blogs and campaigns for e-cigarettes from his home in Nigeria – he is married to the British High Commissioner – said he was amazed by the anti-vaping anger in Cape Town. “It was like a cult, almost,” he said. “Particularly the attacks on the foundation. It’s quite an achievement for Derek to create an institution that has a worse reputation than Philip Morris.”

However, Robert West, a professor of health psychology and director of tobacco studies at UCL, says: “It is playing out beautifully [for Philip Morris]. [The Foundation] has got the tobacco control community arguing among itself and divided. Result.”

In the UK, a small number of prominent public health academics vehemently oppose e-cigarettes. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, and Simon Capewell, professor of clinical epidemiology at Liverpool, believe the tobacco companies are using e-cigarettes as a route back to respectability. Sally Davies, until recently the UK’s chief medical officer (the most senior government adviser on public health matters), backs a ban on flavours that might attract children. She’s worried that we don’t know the long-term health effects of vaping, which she described as a “ticking time bomb”.

Ann McNeill says there is not much growth in vaping among kids in the UK. Her key concern would be a rise in vaping among young people who have never smoked, but there’s no sign of that. She thinks the key to reducing youth uptake is “getting adult smoking down”, because young people tend to imitate their elders’ behaviour.

She feels she and her colleagues at PHE have been unfairly attacked for saying vaping is 95% safer than smoking tobacco. She points out that they never said it was harmless. A 5% risk of harm, she insisted, “is not an insubstantial number”. She feels that the statement has been twisted as if PHE had said vaping was completely safe.

There is evidence that smoking is going down as e-cigarette use goes up, both in the UK and in the US. In 1942, 82% of British men smoked. By 2006, when e-cigarettes first appeared, 22% of adults in England smoked. The number of smokers is now at an all-time low of 14.7%, while 7% of the UK population are vaping regularly. Bans on smoking in public places, no-logo cigarette packaging with gruesome pictures of tumours, and the removal of cigarettes from sight in shops have all had an impact, but, McNeill says: “All the evidence, I believe, points to e-cigarettes playing a role.”

The best evidence that vaping helps people stop smoking comes from a study showing that e-cigarettes double the quitting success rate compared to gum or other aids. Peter Hayek from Queen Mary University of London and colleagues carried out the trial among more than 880 people who went to the NHS for help to give up smoking. Half were given nicotine replacement therapy in whatever form they wanted, such as patches or gum. The other half were given a starter e-cigarette kit and encouraged to buy their own when it ran out. The results, published in the New England Journal of Medicine in January 2019, showed that, at a year, the quit rate in the e-cigarette group was twice that of the nicotine replacement group, 18% versus 9.9%.

Of course, it did not satisfy the critics. When the researchers went back to the subjects after a year, most of the e-cigarette group were still vaping, whereas few of the ex-smokers in the other group were still chewing gum. So, they insisted, the study showed just how addictive e-cigarettes are.

Juul, once the leading e-cigarette, is struggling against public outrage and bad press. Sales have dropped and hundreds of staff have been laid off. The company said to be worth $38bn in 2018 was written down to $24bn by Altria in October last year, and valued at just $19bn by one of its major investors, Tiger Global Management, in December.

In the storm over child users, and anticipating an FDA ban, Juul stopped selling its fruit medley and mango flavours in the US in October and even dropped mint the following month. In January, the FDA acted, banning all flavours except tobacco and menthol from e-cigarettes that use a cartridge – as the Juul devices do. These are the devices kids use, said the FDA: flavours will not be banned from the refillable e-cigarettes that are more popular with adults. The FDA is also finally getting going on regulation, and has instructed manufacturers of e-cigarettes to apply for a right to trade by May.

The WHO, taking its cue from the US and from Bloomberg, has advised countries to control vaping, warning about the unknown impact on health and stating that e-cigarettes are risky for teenage brains, as well as for the foetus. That may leave the UK isolated, a lone bastion where (highly regulated) vaping is actually encouraged in the hopes of cutting smoking rates. Many public health experts in the UK believe they are witnessing an unnecessary tragedy, and that failure to promote the most promising method of helping people quit smoking is endangering the lives of millions.

McNeill insists public health experts in the UK do care about young people. But those whose lives are at risk are adults living in disadvantaged communities, who cannot kick their smoking habit. “I have lived with smokers and watched smokers die. You want them to do anything they can to prevent them from smoking.”

• This article was amended on 19 February 2020: to clarify that Altria is the parent company of Philip Morris USA and that Iqos is a product of Philip Morris International and to correct an error in attributing a quote from the WHO’s Framework Convention for Tobacco Control.

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Frequent teen vaping might boost risk of toxic lead and uranium exposure

Potentially harmful to brain and organ development, suggest researchers. Findings underscore need for implementation of regulations and targeted prevention

BMJ

Frequent teen vaping might boost the risk of exposure to lead and uranium, potentially harming brain and organ development, suggests research published online in the journal Tobacco Control.

 

The findings underscore the need for implementation of regulations and prevention efforts targeting teens, emphasise the researchers.

Vaping is popular with teens. In 2022, an estimated 14% of US high school students—around 2.14 million—and more than 3% of middle school students—around 380,000—reported vaping in the preceding month, note the researchers.

Certain metals have been identified in e-cigarette aerosols and liquids. Their absorption is especially harmful during periods of development, say the researchers, citing research showing that increased levels of exposure are linked to cognitive impairment, behavioural disturbances, respiratory complications, cancer, and cardiovascular disease in children.

The researchers wanted to find out whether potentially toxic metal levels might be associated with vaping frequency and whether flavour might be influential.

They drew on responses to the nationally representative Wave 5 (December 2018 to November 2019) of the PATH Youth Study, involving 1607 teens between the ages of 13 and 17. After exclusions, 200 vapers were included in the final analysis. 

Their urine samples were tested for the presence of cadmium, lead, and uranium, and vaping frequency was designated as occasional (1–5 days/month), intermittent (6–19 days), and frequent (20+ days).

Vape flavours were grouped into four mutually exclusive categories: menthol or mint; fruit; sweet, such as chocolate or desserts; and others, such as tobacco, clove or spice, and alcoholic or non-alcoholic drinks.

Among the 200 exclusive vapers (63% female), 65 reported occasional use, 45 intermittent, and 81 frequent use; vaping frequency information was missing for 9. 

The average number of recent puffs per day increased in tandem with vaping frequency: occasional = 0.9 puffs; intermittent = 7.9 puffs; frequent = 27 puffs.

In the preceding 30 days 1 in 3 (33%) vapers said they used menthol/mint flavours; half (50%) favoured fruit flavours; just over 15% opted for sweet flavours; and 2% used other flavours.

Analysis of the urine samples showed that lead levels were 40% higher among intermittent vapers, and 30% higher among frequent vapers than they were among occasional vapers. Urinary uranium levels were also twice as high among frequent vapers than among occasional vapers 

Comparison of flavour types indicated 90% higher uranium levels among vapers who preferred sweet flavours than among those opting for menthol/mint. 

No statistically significant differences were found in urinary cadmium levels between vaping frequency or flavour types.

This is an observational study, and as such no definitive conclusions can be drawn about toxic metal levels and vaping frequency/flavours, acknowledge the researchers, who also caution that the levels of toxic metals in vapes will vary by brand and type of vaporiser used (tank, pod, mod).

Although urinary levels indicate chronic exposure, they were assessed at just one point in time, added to which the presence of uranium in the urine may be attributable to various sources including environmental exposure from natural deposits, industrial activities, and dietary intake, they add.

“None the less,these compounds are known to cause harm in humans,” they write. Of particular concern were the increased uranium levels found within the sweet flavour category, they add. 

“Candy-flavoured e-cigarette products make up a substantial proportion of adolescent vapers, and sweet taste in e-cigarettes can suppress the harsh effects of nicotine and enhance its reinforcing effects, resulting in heightened brain cue-reactivity.” 

And they conclude: “E-cigarette use during adolescence may increase the likelihood of metal exposure, which could adversely affect brain and organ development.

“These findings call for further research, vaping regulation, and targeted public health interventions to mitigate the potential harms of e-cigarette use, particularly among adolescents.”

 

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JOURNAL

Tobacco Control

DOI

10.1136/tc-2023-058554 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring

ARTICLE PUBLICATION DATE

29-Apr-2024

COI STATEMENT