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Argumentative Essay on Vaping

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Published: Mar 14, 2024

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a smoker and a person vaping in london, uk

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

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

G one 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.”

W hat 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.

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.

A number 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.”

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.”

I n 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.

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.”

I n 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 Hajek 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.

The long read
Health & wellbeing
Health policy

Vaping and Its Negative Aspects Essay

Introduction, attention-arousing and orienting material.

Vaping has become a curse of the recent decade. Vapes are better than nicotine-containing cigarettes. Vapes do not harm the health of a smoker. Vapes are about vaping, not smoking. As one popular vape-producing company puts it, “live long and vape strong”. It seems that vapes create a new reality in which smoking could be safe. Well, what if I say that, in the US, in one week 12 people died because of vaping and 805 people were diagnosed with the breathing illness related to vaping (Pesce par. 1). If these statistics are not enough to give up vaping, the goal of the current speaker is to persuade that vapes are not as warm and fuzzy as companies want us to believe.

Credibility

Vaping is regarded as an escape for smokers who try to give up their addiction since the latter could substitute the former. Still, there are numerous sources that vaping is a decent and safe habit. The argument against vaping is backed by the results of the researches, the viewpoints of medical experts, and the experience of vapers. The importance of this topic is undeniable since even underaged people become addicted to vapes.

Thesis Statement

Vaping has numerous devastating effects and did not worth doing.

Preview of main points

There are two major reasons to give up a habitude of vape. Firstly, vaping is addictive and undermines the ability to self-control. Secondly, usage of a vape, even if it is nicotine-free, poses a health hazard and leads to diseases of the respiratory system.

Vaping is addictive

It is a well-known fact that there are numerous kinds of vaping liquids. They have various chemical compositions, tastes, and smells. Some of them might contain nicotine, while others are free of it. The problem is that vaping causes addiction in any case.

One of the reasons for this is that vapes are regarded as tools to socialize and make new acquaintances (Levin par. 21).

In essence, new friends and a higher circle of socialization is positive outcome of vaping.

However, the issue lies in the fact that young people that are shy to make friends, for instance, during classes, start vaping to fit in with the team.

Vice versa, if an individual intends to give up vaping, he or she might postpone this idea because of the fear to distance herself from the friends who use vapes.
In the interview with the 21-years old man, Levin illustrates how strong the addiction might be (par. 16). Josh Evans avows that he inhales the vapors even though sometimes it makes him feel physically bad and fail to fight against vaping (Levin par.16).
The final point worth being mentioned is that addiction to vaping leads to more serious addictions in the long-term perspective.

In two years, the number of young adults using vaping cartridges with the flavor of cannabis or nicotine increased more than twice (Pesce para.2).

According to the President of the Campaign for Tobacco-Free Kids, Matthew Myers, people that become addicted to vapes or e-cigarettes at a young age, grow into heavily smoking adults (Lemons 17).

(Transition: The fact that vapes triggers addiction would not be that important if it were not for the health hazard.)

Vaping is dangerous for health

Blaha informs that all lung fluid samples of people ill with “e-cigarette, or vaping, product use associated lung injury (EVALI)” show the presence of vitamin E acetate (par 6.).

From this, it could be inferred that vaping liquids contain chemicals that cause diseases of the respiratory system. Thus, even nicotine-free vapes could have a devastating effect on health.

Another point of concern about vaping is that hitherto remains a lot of doubts about how certain chemicals in liquids affect health (Blaha par. 9). Nevertheless, some studies confirm that vaping leads not only to asthma but also to cardiovascular disease (Blaha par.9).

Therefore, it could be argued that vaping remains an insufficiently studied phenomenon. The absence of a clear understanding of the consequences of vaping, as well as PR campaigns of brands that produce vapes and liquids, give a reason to think that vaping does not affect health. At the same time, the growing number of young people with breathing diseases makes them think that vaping is not as good as it might seem at the first sight.

(Transition: As you can notice, vaping has a significant number of disadvantages that should motivate people either not to try it or give up the habit.)

Summary statement

Vaping is not only addictive but also challenges the well-being of a vaper. In the scientific community, there is no common opinion on the effect of the chemicals that are included in the composition of vaping liquids. Notwithstanding this fact, the example of people diagnosed with EVALI proves that vaping represents a threat and that life would be better without this addiction.

Concluding remarks

Still, it is important to remember that our health and quality of life depend on our own choices. Vapes were not created by nature and human beings survived for centuries without smoking and vaping. I will leave you with the question: if the necessity to vape was not put in our bodies and minds by nature, do we need it?

Works Cited

Blaha, Michael Joseph. “5 Vaping Facts You Need to Know.” Health Conditions and Diseases , 2020. Web.

Lemons, Jane Fullerton. E-Cigarette Dilemma . CQ Press, 2019. Web.

Levin, Dan. “Vaping on Campus: No Parents, No Principals, a Big Problem.” The New York Times , 2019. Web.

Pesce, Nicole Lyn. “These Charts Show the Shocking Number of High School and College Students Who Vape.” Market Watch , 2019. Web.

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IvyPanda. (2023, October 31). Vaping and Its Negative Aspects. https://ivypanda.com/essays/vaping-and-its-negative-aspects/

"Vaping and Its Negative Aspects." IvyPanda , 31 Oct. 2023, ivypanda.com/essays/vaping-and-its-negative-aspects/.

IvyPanda . (2023) 'Vaping and Its Negative Aspects'. 31 October.

IvyPanda . 2023. "Vaping and Its Negative Aspects." October 31, 2023. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

1. IvyPanda . "Vaping and Its Negative Aspects." October 31, 2023. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

Bibliography

IvyPanda . "Vaping and Its Negative Aspects." October 31, 2023. https://ivypanda.com/essays/vaping-and-its-negative-aspects/.

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Persuasive Essay on Vaping and E-cigarettes Should Be Banned

Nicotine is a highly addictive substance which is as hard to give up as heroin. 2.06 million teens are using nicotine on a daily basis across America. Nicotine is commonly used in vaping and e-cigarettes, and the dosage is either lower or the same as in cigarettes and tobacco products.Some believe vapes lead to drug addictions, while others say they do nothing wrong and have no effect. Vaping and E-cigarettes should be banned. Vaping is unbenefictial to a person’s health and rather targets their packaging towards young children and gives them a higher risk of developing a nicotine addiction.

The number of kids who vape is increasing, addicting new generations to nicotine and cigarettes, and introducing them to smoking. The percentage of kids who vape has gone up throughout the years, For example, "As of 2020, 19.6% of high school students used e-cigarettes, the most-used tobacco product among the age group, followed by cigars (5%)" (ProCon 1). 19.6% of high school students rely on nicotine. The nicotine in the vapes is the same as the one in cigarettes that can lead to them turning to cigarettes. Many of the students can get their friends addicted to nicotine as well, increasing the number of students who use e-cigarettes. The site also mentions that "One JUULpod contains as much nicotine as a pack of cigarettes, both of which last for about 200 puffs" (ProCon 1). Vaping can be just as bad and addictive as cigarettes. It may take longer to use the whole vape rather than a pack of cigarettes, but it's still the same amount of nicotine consumed. It is not a healthier option if it's not as different as cigarettes. Matthew Myers, who campaigns against tobacco, stated, "Like cigarette companies, e-cigarette makers claim they don’t market to kids. But they’re using the same themes and tactics tobacco companies have long used to market regular cigarettes to kids (Exploring Issues 1). E-cigarettes and vape companies tend to rely on the same marketing used to get kids into cigarettes. They use the same techniques as tobacco companies that try to get kids to buy their products. They use a confident and good looking person to say vaping is cool and desirable. Vaping attracts many new people into smoking and opens many opportunities for health issues.

Nicotine can lead to many problems regarding health. Nicotine is a very addictive substance and can damage a person's body. One way it can affect a person is "Nicotine used by young people may increase the risk of addiction to other drugs and impair prefrontal brain development, which can lead to ADD and disrupt impulse control"(ProCon 1). Nicotine can cause cravings and cause impulsive behavior if a person becomes addicted. Nicotine can lead to more drugs and can cause brain damage to a person. Brain damage can lead to disorders like ADD. Not only does it lead to brain disorders, but also long-term diseases and strokes. The article states, "People who use e-cigarettes have a 71% increased risk of stroke and a 40% higher risk of heart disease, as compared to nonusers" (ProCon 1). People who use e-cigarettes or vapes have a higher chance of having a stroke or heart disease, which could kill them. The chemicals in the products can expose a person to life-long struggles because of a stroke. Heart disease is a long-term disease that can result from vaping and is the leading cause of death in America. A main contributor to these injuries and illnesses is the chemicals inside the vape. An example of what the chemicals can do is "Some ingredients in the liquids used in e-cigarettes change composition when they are heated, leading to inhalation of harmful compounds such as formaldehyde, which is carcinogenic" (ProCon 1). The liquids can change when heated, changing the compounds in the liquid. The liquid compounds could become dangerous and turn into chemicals like formaldehyde, which can lead to irritations all over the body and sometimes even cancer. Some health conditions and problems can cause problems for the rest of a person's life, but some argue it helps people with smoking.

E-cigarettes help people stop smoking. Studies have been done many times on this topic. One study states, "A July 2019 study found that cigarette smokers who picked up vaping were 67% more likely to quit smoking" (ProCon 1). That may be true, but people can still face health issues and still ingest an equal amount of nicotine found in a pack of cigarettes. Vapes can be safer than cigarettes because of the fact that they use vapor, not smoke. The website says, "However, most scientists agree that ESDs are much less harmful to health than tobacco cigarettes" (Exploring Issues). Vapes can be much safer than tobacco with items inside, but they can also expose a person to the same health problems as tobacco. Vaping can even heat up and change the liquid compound inside of it, creating formaldehyde, which can lead to cancer and irritations. The heat in the vapes can burn holes in the lungs as well, just like cigarettes.

Vaping can cause many problems regarding health and contributes to attracting more children to turn to vaping. Vapes can be marketed the same as cigarettes and can be just as harmful. Vaping can lead to a gateway of health issues like strokes, heart attacks, ADD, nausea, and more. The liquid in the vapes can create dangerous compounds when heated up and can burn holes into the lungs. It may be different than smoking and a healthier option, but the risks are still present.

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Personal Health

The Risks of Another Epidemic: Teenage Vaping

“We’re stepping backward from all the advances we’ve made in tobacco control,” one investigator said.

By Jane E. Brody

While most of us strive to avoid inhaling aerosols that could harbor a deadly virus, millions of teens and young adults are deliberately bathing their lungs in aerosols rich in chemicals with known or suspected health hazards.

I’m referring to vaping (or “ juuling ”): the use of e-cigarettes that is hooking young people on a highly addictive drug — nicotine — and will be likely to keep them hooked for decades. Meanwhile, e-cigarettes and other vaping devices are legally sold with few restrictions while producers and sellers reap the monetary rewards. Although many states prohibit e-cigarette sales to persons younger than 18 or 21, youngsters have little trouble accessing the products online or from friends and relatives.

In just one year, from 2017 to 2018, vaping by high school seniors increased more than “for any substance we’ve ever monitored in 45 years, and the next year it rose again almost as much,” said Richard Miech, principal investigator for the national survey Monitoring the Future.

By 2019, a quarter of 12th graders were vaping nicotine, nearly half of them daily. Daily vaping rose in all three grades surveyed — eighth, 10th and 12th — “with accompanying increases in the proportions of youth who are physically addicted to nicotine,” Dr. Miech and colleagues reported in The New England Journal of Medicine last year.

Although self-reported use of e-cigarettes by high school and middle school students decreased over the past year, Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, cautioned, “Youth e-cigarette use remains an epidemic.”

“We’re stepping backward from all the advances we’ve made in tobacco control,” Dr. Miech, professor at the Institute for Social Research at the University of Michigan, said in an interview. “I’m worried that we will eventually return to the tobacco situation of yore. There’s evidence that kids who vape are four to five times more likely the next year to experiment with cigarettes for the first time.”

As someone who witnessed the persuasive tactics the tobacco industry used to get nearly half of American adults hooked on regular cigarettes in the 1950s, I see similar efforts being used today to promote these new delivery systems for nicotine: sex, glamour, endorsements by celebrities and doctors, and sponsorship of popular sports and musical events. Only now there are even more pervasive avenues of influence through websites and social media.

In 2016, ads for e-cigarettes reached nearly four in five middle and high school students in the United States, Dr. Ellen S. Rome noted.

As in decades past, the nation’s regulatory agencies have been slow — some say negligent — to recognize this fast-growing threat to the health and development of young Americans. Dr. Rome, a pediatrician who heads the Center for Adolescent Medicine at the Cleveland Clinic, explained that nicotine forms addictive pathways in the brain that can increase a youngster’s susceptibility to addiction throughout life. The adolescent brain is still developing, she told me, and e-cigarette use is often a gateway to vaping of marijuana, which can affect the brain centers responsible for attention, memory, learning, cognition, self-control and decision-making.

In a review published last December in the Cleveland Clinic Journal of Medicine, Dr. Rome and her co-author, Perry Dinardo, challenged the public perception that vaping is harmless, or “at least less harmful than cigarette smoking.”

While it’s likely to be true that vaping may be less hazardous than tobacco cigarettes, since the vaped aerosols that reach the lungs are devoid of the thousands of tobacco-derived toxic and carcinogenic substances inhaled by cigarette smokers, vaping still introduces a fair share of potentially harmful chemicals. In addition to nicotine, some of the chemicals, like the carcinogen formaldehyde, are created when the nicotine-rich liquid in some vaping devices is heated to high temperatures.

“E-cigarettes might have their own unique health effects we haven’t discovered yet,” said Theodore L. Wagener, director of the Center for Tobacco Research at Ohio State University. “Although compared to tobacco cigarettes, e-cigarettes without a doubt expose users to much lower levels of harmful chemicals , we still don’t know how the body handles them and what their long-term effects might be.”

Remember, it took many decades of smoking by tens of millions of people before the deadly hazards of tobacco cigarettes were recognized.

The surge in the use of electronic cigarettes was tied to a game-changing product, Juul, a cartridge device introduced in 2017 in a slew of enticing flavors. Flavors especially attractive to youngsters are now banned from use in closed-system devices like Juul , which now is sold only in tobacco and menthol flavors, but can still be used in the open-system products sold in vape shops. And now, taking advantage of a loophole in regulations, a disposable product called Puff Bar , which comes in more than 20 flavors, has replaced Juul as the vape of choice among young people.

Concerns about vaping grew after a 2019 outbreak of severe lung injuries , which were subsequently linked to vitamin E acetate, an additive found in some vaping devices that deliver THC, the psychoactive ingredient in marijuana. Juul pods are not designed to be refillable with substances like THC or other chemicals.

Producers of Juul introduced changes that enhanced the palatability and safety of vaping, but at the same time “made it easier for kids to start using nicotine,” Dr. Wagener said. Instead of freebase nicotine that is very harsh to inhale, Juul contains a nicotine salt, “a very palatable form of nicotine that makes inhaling high doses of nicotine easy,” he explained. And Juul doesn’t require the high temperatures that produce toxic substances like formaldehyde. A single pod contains the nicotine equivalent of a pack of conventional cigarettes.

“Juul made it cool, and young people who had never smoked cigarettes are becoming addicted to nicotine ,” said Erika R. Cheng, a public health epidemiologist at Indiana University School of Medicine. In addition to nicotine, Juul pods contain a mix of glycerol, propylene glycol, benzoic acid and flavoring agents, the long-term health effects of which have yet to be determined , she said.

“E-cigarettes were initially advertised as a means to help people transition from harmful tobacco smoking,” Dr. Cheng said. “A lot of early users didn’t even know they contained nicotine.” Although a small minority of smokers have used e-cigarettes to help them quit or reduce their dependence on tobacco, most who use the devices vape to get their nicotine fix when they can’t smoke regular cigarettes.

Although there have been calls for bans on e-cigarettes, Abigail S. Friedman, a health economist at Yale University School of Public Health, cautioned that “bans can push people into the black market looking for something that can be acutely dangerous.”

Dr. Friedman said that rather than outright bans that can have unanticipated costs, she favors better regulations. Currently, other than flavors, what is inhaled from e-cigarettes is unregulated. Still, she and other experts are very concerned about the explosive uptake of vaping by young people. In the 2019 Youth Risk Behavior Survey of 4.9 million high school students, she said, 6 percent reported smoking conventional cigarettes while 33 percent puffed e-cigarettes in the past 30 days. In December 2018, the U.S. Surgeon General, Dr. Jerome Adams, declared e-cigarette use by youth an epidemic .

Jane Brody is the Personal Health columnist, a position she has held since 1976. She has written more than a dozen books including the best sellers “Jane Brody’s Nutrition Book” and “Jane Brody’s Good Food Book.” More about Jane E. Brody

Jane Brody’s Personal Health Advice

After joining the new york times in 1965, she was its personal health columnist from 1976 to 2022. revisit some of her most memorable writing:.

Brody’s first column, on jogging , ran on Nov. 10, 1976. Her last, on Feb. 21. In it, she highlighted the evolution of health advice throughout her career.

Personal Health has often offered useful advice and a refreshing perspective. Declutter? This is why you must . Cup of coffee? Yes, please.

As a columnist, she has never been afraid to try out, and write about, new things — from intermittent fasting to knitting groups .

How do you put into words the pain of losing a spouse of 43 years? It is “nothing like losing a parent,” she wrote of her own experience with grieving .

Need advice on aging? She has explored how to do it gracefully , building muscle strength and knee replacements .

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Tob Use Insights

The Vaping Teenager: Understanding the Psychographics and Interests of Adolescent Vape Users to Inform Health Communication Campaigns

Associated data.

Supplemental material, Supplemental_material for The Vaping Teenager: Understanding the Psychographics and Interests of Adolescent Vape Users to Inform Health Communication Campaigns by Carolyn Ann Stalgaitis, Mayo Djakaria and Jeffrey Washington Jordan in Tobacco Use Insights

Background:

Adolescent vaping continues to rise, yet little is known about teen vape users beyond demographics. Effective intervention requires a deeper understanding of the psychographics and interests of adolescent vape users to facilitate targeted communication campaigns.

We analyzed the 2017-2018 weighted cross-sectional online survey data from Virginia high school students (N = 1594) to identify and describe subgroups of adolescents who vaped. Participants reported 30-day vape use, identification with 5 peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular), social prioritization, agreement with personal values statements, social media and smartphone use, and television and event preferences. We compared vaping rates and frequency by peer crowd using a chi-square analysis with follow-up testing to identify higher-risk crowds and confirmed associations using binary and multinomial logistic regression models with peer crowd scores predicting vaping, controlling for demographics. We then used chi-square and t tests to describe the psychographics, media use, and interests of higher-risk peer crowds and current vape users within those crowds.

Any current vaping was the highest among those with Hip Hop peer crowd identification (25.4%), then Popular (21.3%). Stronger peer crowd identification was associated with increased odds of any current vaping for both crowds, vaping on 1 to 19 days for both crowds, and vaping on 20 to 30 days for Hip Hop only. Compared with other peer crowds and non-users, Hip Hop and Popular youth and current vape users reported greater social prioritization and agreement with values related to being social and fashionable. Hip Hop and Popular youth and current vape users reported heavy Instagram and Snapchat use, as well as unique television show and event preferences.

Conclusions:

Hip Hop and Popular adolescents are most likely to vape and should be priority audiences for vaping prevention campaigns. Findings should guide the development of targeted health communication campaigns delivered via carefully designed media strategies.

Introduction

Current (past 30-day) vaping among U.S. adolescents has increased dramatically in recent years. 1 , 2 Rates almost doubled from 2017 (11.0% of 12th graders) to 2018 (20.9%), the largest substance use increase ever observed in the 44-year history of the national Monitoring the Future study. 1 Vapes have been the most commonly used tobacco product among adolescents since 2014, 2 and more than 5 million middle and high school students were current vape users in 2019. 3 These dramatic increases have offset reductions in cigarette smoking, fueling an overall increase in adolescent current tobacco use. 1 , 4

This explosion of vaping is concerning because of the risks associated with adolescent vape use. Adolescents who vape are more likely than non-users to initiate cigarette smoking and escalate smoking among those who have already experimented with cigarettes, 5 - 11 though this association may be due to shared risk factors for vaping and smoking. 12 Researchers are beginning to understand the chemical constituents and health implications of vape juice and aerosols, which include carcinogens and irritants. 8 , 13 - 17 Although long-term health effects are unknown, vaping may be associated with short-term risks including respiratory symptoms, asthma, and bronchitis among adolescents. 8 , 18 , 19 In addition, nicotine exposure affects adolescent brain development, leading to long-term cognitive issues including memory and attention impairment. 20 - 22

Despite the alarming increase, teens who vape remain a minority of the adolescent population. 3 Little is known about which youth are at the greatest risk beyond demographic descriptions, leaving public health interventionists with a limited understanding of who should be prioritized in prevention efforts. Current vaping is more prevalent among male, non-Hispanic White, higher socioeconomic status, and lesbian, gay, and bisexual adolescents and young adults. 23 - 27 In addition, young current vape users often have friends and family members who vape or who accept vaping, 28 and use other substances including cigarettes and marijuana. 29 - 31

Audience psychographics move beyond demographics to provide health communicators with critical insights about values, identities, and interests that can inform effective messaging and campaign strategies. 32 - 35 In addition, these insights are critical for the effective planning and execution of modern digital media campaigns that rely on interest-based targeting to deliver digital advertisements to the intended audience. 36 Past studies describing ever and current vape users have typically focused on vaping attitudes and beliefs, 37 - 40 or have used psychographics and motivations to segment adult, but not adolescent, vape users into discrete subgroups. 41 , 42 Only a few studies have examined the psychographics of adolescent or young adult vape users, revealing that novelty-seeking, sensation-seeking, and lower social conservatism are generally associated with ever and current vaping in these populations. 27 , 43 , 44 From this basis, we seek to expand health communicators’ understanding of the psychographics, identities, media use, and interests of adolescent current vape users to inform the development of effective vaping prevention campaigns.

Knowing which adolescents vape, what other substances they use, what they care about, and what influences them is crucial to addressing adolescent vaping. Commercial marketing, including vape marketing, relies on audience segmentation to identify population subgroups with shared desires and needs for whom a tailored brand can be built and marketed via targeted media channels. 45 In health communications, a similar approach is necessary to counter industry marketing by identifying adolescent subgroups at the greatest risk for vaping, developing targeted campaigns that appeal to their shared values, beliefs, and interests, and delivering campaign content via specific media channels and strategies to ensure the target audience is reached. 45 Health campaigns designed around the psychographics of their target audiences are effective, 45 - 47 but this approach requires a clearly defined audience with unique characteristics for whom appealing content can be tailored. Importantly, campaigns must both tailor messaging (by selecting messaging that caters to audience preferences, values, and interests to capture attention and increase persuasion) and target media delivery (by selecting highly specialized media channels and using state-of-the-art ad-targeting technologies) to effectively reach their target audiences in the modern, cluttered media environment. 47 Although much is known about the demographics of adolescent vape users, health educators lack crucial information about their values, influences, and interests that is necessary to define an audience and deliver effective, targeted communications.

To fill this gap, we used online survey data to describe the risk profile, psychographic characteristics, and interests of adolescent current vape users in a single U.S. state. We had 2 primary objectives: to identify potential target audiences for adolescent vaping prevention campaigns and to describe the psychographics, media use, and interests of these higher-risk youth to inform campaign planning. First, we sought to define potential target audiences by applying a peer crowd audience segmentation approach. Peer crowds are macro-level subcultures with shared interests, values, and norms 47 , 48 which are associated with adolescent and young adult health behaviors 49 - 57 and have served as the basis for targeted health interventions. 58 - 64 For example, the Commune campaign targeting Hipster peer crowd young adults resulted in reductions in cigarette smoking associated with stronger anti-tobacco attitudes among those recalling the campaign, 58 , 62 whereas engagement with the Down and Dirty campaign was associated with stronger anti-chewing tobacco attitudes and lower odds of current use among Country peer crowd teens. 61 In this study, we examined vaping behavior for 5 adolescent peer crowds previously established in the literature: Alternative (counterculture, value creativity and uniqueness), Country (patriotic, value hard work and being outdoors), Hip Hop (confident, value overcoming struggles and proving themselves), Mainstream (future-oriented, value organization and stability), and Popular (extroverted, value socializing and excitement). 47 , 49 , 50 , 52 , 54 , 55 , 61 After identifying the highest risk peer crowds, we sought to create a profile of these audiences by examining their broader health risk profiles, psychographics (social prioritization and personal values), digital behaviors (social media and smartphone use), and interests (television shows and events). With this information, we aimed to identify and describe segments of adolescents most in need of targeted vaping interventions to provide clear guidance for health message development and media targeting.

Sample and design

We collected cross-sectional online survey data from high school students ages 13 to 19 living in the U.S. state of Virginia (N = 1594). Participants were recruited from November 2017 to January 2018 using paid Instagram and Facebook advertisements that directed interested individuals to a screener to determine eligibility (13-19 years old, current high school student, and Virginia resident). Eligible youth were invited to participate in the full survey and provided electronic assent (ages 13-17) or consent (ages 18-19). We delivered a parental opt-out form via email for participants ages 13 to 17. Qualified participants who completed the full survey received a US$10 electronic gift card incentive. We implemented numerous fraud prevention and detection measures to maximize data integrity, including concealing eligibility criteria during screening, collecting email addresses to prevent duplicate completions, and reviewing responses for inconsistencies. Chesapeake IRB approved the study (No. Pro00023204).

To address our research objectives, we examined participant demographics; current vaping, tobacco, and other substance use; peer crowd identification; 2 psychographic measures, namely, social prioritization 65 and personal values; social media and smartphone use; and television show and event preferences.

Demographics

Participants provided their birthdate, from which we calculated their age. Participants also indicated their gender (male, female) and race/ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian-Pacific Islander, and non-Hispanic other including multiracial and American Indian or Alaska Native).

Past 30-day vape use

Participants reported the number of days in the past 30 days on which they used e-cigarettes or vapes, with response options of 0, 1 or 2, 3 to 5, 6 to 9, 10 to 19, 20 to 29, and all 30 days. To mirror commonly reported statistics, we examined both any current vaping (1-30 days) and frequency of vaping defined as occasional use (1-19 days) or frequent use (20-30 days). 66

Past 30-day tobacco and substance use

Participants also reported the number of days in the past 30 days on which they used cigarettes; cigars, cigarillos, and little cigars (cigar products); smokeless tobacco; hookah; alcohol; marijuana; and prescription medication without a prescription. Those who reported any past 30-day use were considered current users of that item.

Peer crowd identification

Participants completed Rescue Agency’s I-Base Survey®, a photo-based tool that measured identification with 5 peer crowds: Alternative, Country, Hip Hop, Mainstream, and Popular. The I-Base Survey has identified consistent patterns of peer crowd prevalence and health risks in adolescents across the United States. 49 - 52 , 55 , 57 , 61 , 64 In brief, participants viewed a grid of 40 photos of unknown female adolescents and selected 3 who would best and 3 who would least fit with their main group of friends; they then repeated the process with male photos. Photos were presented in random order to each participant to reduce order effects, and represented a mix of races/ethnicities and peer crowds determined through prior qualitative research. Participants earned positive points for the peer crowds of photos selected as the best fit and negative points for those selected as the least fit, resulting in a score ranging from −12 to 12 for each of the 5 crowds. For analyses, we assigned participants to each crowd with which they had at least some identification, defined as a score of 1 or more on the I-Base Survey for that crowd. Participants could be assigned to more than 1 peer crowd as they could score positively for multiple crowds.

Social prioritization index

Participants completed the social prioritization index (SPI), a validated measure of the degree to which an individual places importance on their social life that is associated with young adult cigarette use. 58 , 59 , 65 The SPI included 13 questions: 8 items wherein participants selected 1 response that best described them from a pair (up for anything/pick and choose what to do, outgoing/low-key, center of attention/lay low, street smart/book smart, partier/studier, wing it/plan it out, the carefree one/the responsible one, in a picture I . . . strike a pose/smile big); 3 true or false items (In groups of people, I am rarely the center of attention; I have considered being an entertainer or actor; I can look anyone in the eye and tell a lie with a straight face); 1 item asking how many nights they went out for fun in the past week (0-1, 2-3, 4-5, 6-7 nights); and 1 item asking how late they typically stayed out when they went out for fun (9:59-10:59 pm , 11:00 pm -12:59 am , 1:00-2:59 am , 3:00 am or later). To calculate the SPI score (range: 0-17), participants received 1 point for each socially oriented selection for the 8 descriptive pairs and 3 true/false questions, and received 0 points for selecting 0-1 nights per week or 9:59-10:59 pm , 1 point for 2-3 nights per week or 11:00 pm -12:59 am , 2 points for 4-5 nights per week or 1:00-2:59 am , and 3 points for 6-7 nights per week or 3:00 am or later.

Personal values

Participants viewed 26 personal values statements (e.g., I think it is more important to live in the moment than focus on the future) and rated each on a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree).

Past 7-day social media use

Participants reported if they had consumed or created content on 6 social media platforms in the past 7 days: Facebook, Instagram, Twitter, Tumblr, Snapchat, and Pinterest.

Lifetime smartphone use

Participants were asked if they had a smartphone, and if so, if they had ever used their smartphone to engage in 9 different activities (e.g., listen to an online radio or a music service such as Pandora or Spotify; watch movies or TV shows through a paid subscription service like Netflix).

Television show preferences

Participants selected all television shows they regularly watched from a list of 24 broadcast and streaming shows popular with youth (e.g., 13 Reasons Why, Ridiculousness ).

Event preferences

Participants selected all events they regularly attended from a list of 25 leisure time events youth might attend (e.g., sports games, high school dances).

Statistical analysis

Respondents were required to complete the survey, so no data were missing. Data were weighted to the gender, race/ethnicity, and urban/rural demographics of Virginia teens for all analyses. As a first step, we ran weighted and unweighted frequencies and means for demographic measures.

To address our first objective of identifying which adolescents were at the greatest risk, we used chi-square tests to compare the rates of current vaping and vaping frequency among those who did and did not identify with each crowd, using follow-up z tests with Bonferroni correction to identify specific significant differences. To confirm that associations persisted while controlling for demographics, we ran separate binary and multinomial logistic regression models for each peer crowd, with a single peer crowd’s score (range: –12 to 12) predicting odds of current vaping, or of occasional or frequent vaping, while controlling for age, gender, and race/ethnicity. We also ran binary logistic regression models for each crowd to predict odds of any current cigarette, cigar product, smokeless tobacco, hookah, alcohol, and marijuana use, and any current prescription medication misuse, to understand the broader risk profile of the peer crowds. We ran separate models for each peer crowd to avoid multicollinearity associated with including all 5 scores in a single model.

After identifying 2 peer crowds at elevated risk for vaping, we addressed our second objective of developing interest-based profiles of these potential target audiences by describing their psychographics (SPI and personal values), social media and smartphone use, and television and event preferences. We first compared frequencies and means for those who did and did not identify with the 2 crowds of interest, using chi-square tests and t tests to identify significant differences. Then, within the 2 peer crowds, we compared frequencies and means between current vape users and non-users, using chi-square tests and t tests to identify significant differences. This approach allowed us to identify the characteristics of the 2 peer crowds of interest to inform campaign content and media targeting, as well as to hone in on psychographics and interests that specifically characterized current vape users within the higher-risk crowds. Due to the relatively small subset of participants who were frequent vape users, we focused on any current use to improve the reliability of results. Tables present items that differed significantly between groups in at least 1 analysis and had endorsement rates above 5.0%.

The weighted mean age of the sample was 16.47 years, and about half identified as female (50.8%) and as non-Hispanic White (55.3%) ( Table 1 ). The most common peer crowd identifications were Popular (63.1%) and Mainstream (62.6%). Race/ethnicity and gender breakdowns differed by crowd ( Supplemental Appendix Table 1 ).

Unweighted and weighted sample descriptive statistics.

Consistent with 2018 National Youth Tobacco Survey results, 2 20.6% of Virginia high school students in our sample currently vaped ( Table 2 ). A significantly greater proportion of those with any Hip Hop peer crowd identification currently vaped (25.4%) than those with no Hip Hop identification (18.0%, P < .001). In binary logistic regression models using each peer crowd score (–12 to 12) to predict odds of current vaping while controlling for demographics, a 1-point increase in the Popular score was associated with a 4% increase in odds of current vaping, whereas a 1-point increase in the Hip Hop score was associated with a 10% increase.

Weighted frequencies and adjusted odds ratios for peer crowd risk behaviors.

Abbreviation: AOR, adjusted odds ratio.

Percentages represent the use rate for those with and without identification with a given peer crowd; asterisks indicate a statistically significant difference between “in crowd” and “not in crowd” for each peer crowd. Regression models use the peer crowd score (range: –12 to 12) to predict odds while controlling for age, gender, and race/ethnicity. Boldface indicates statistical significance ( P < .05).

Further differentiating current vape users in the sample, 17.0% were occasional vape users (1-19 days in the past 30 days) and 3.7% were frequent users (20-30 days). Those with any Hip Hop identification reported higher rates of occasional vaping (21.2%) than others (14.6%, P < .05). Although rates of frequent vaping did not differ significantly for any peer crowd, stronger Hip Hop identification was associated with greater odds of both occasional and frequent vaping. Stronger Popular identification was associated with greater odds of occasional vaping only. In addition, stronger Hip Hop identification was associated with greater odds of current cigarette, cigar product, hookah, alcohol, and marijuana use, whereas stronger Popular identification was associated with lower odds of use for many products.

Based on the chi-square tests and logistic regression results, we identified the Hip Hop and Popular peer crowds as being at elevated risk for vaping. We then characterized the psychographics ( Table 3 ), social media and smartphone use ( Table 4 ), and interests ( Table 5 ) of Hip Hop and Popular youth in general, as well as Hip Hop and Popular current vape users in particular.

Weighted frequencies for psychographic measures by peer crowd and current vaping status.

Abbreviation: SPI, social prioritization index.

Boldface indicates statistical significance ( P < .05).

Weighted frequencies for past 7-day social media and lifetime smartphone use by peer crowd and current vaping status.

Boldface indicates statistical significance (P < .05).

Weighted frequencies for television show and event preferences by peer crowd and current vaping status.

Overall, Hip Hop participants were social, trendy individuals interested in hip hop/rap music and sports. Compared with those with no Hip Hop identification, Hip Hop youth had higher SPI scores, in particular describing themselves as partiers, street smart, and carefree ( Table 3 ). Hip Hop youth more often agreed that they make decisions quickly, are fashionable, are social people with lots of friends, and are tougher than most people. In contrast, they less often agreed that they are patriotic, good students, care what others think about them, care about keeping their bodies free from toxins, and follow the rules. A greater proportion of Hip Hop youth used Snapchat in the past week and used their smartphones to look up sports scores or analyses than those with no Hip Hop identification ( Table 4 ). Many TV shows more often endorsed by Hip Hop youth revolved around hip hop/rap musical interests, such as Love & Hip Hop, The Rap Game , and Wild ’N Out ( Table 5 ). Similarly, Hip Hop youth more often indicated that they regularly attend hip hop concerts and dance clubs than others, as well as basketball and football games.

Characteristics of vape users within the Hip Hop peer crowd largely reflected an amplification of the broader crowd’s profile. Hip Hop vape users had higher SPI scores than non-users within the crowd, and they described themselves as partiers, street smart, carefree, and up for anything ( Table 3 ). They more often agreed that they are fashionable, use their clothes to express their identity, and are tough, and less often agreed that they follow the rules, follow tradition, and care about keeping their bodies free from toxins than non-users. A greater proportion of Hip Hop vape users reported using Snapchat, Instagram, and Twitter in the past week than non-users ( Table 4 ). Hip Hop vape users also more often reported using their smartphones to look up sports scores and analyses, stream music, and make video calls than non-users. Hip Hop vape users more often reported watching 2 cartoon shows, The Boondocks and Bob’s Burgers , than non-users ( Table 5 ). Similar to the overall crowd, a greater proportion of Hip Hop vape users indicated that they attend dance clubs, hip hop concerts, basketball games, and football games than non-users.

Popular youth shared some characteristics with Hip Hop youth, but also differed in key ways. Although Popular and Hip Hop youth both reported higher SPI scores than others, the specific SPI items they endorsed often differed ( Table 3 ). Though both Hip Hop and Popular youth described themselves as partiers, Popular youth also described themselves as the center of attention, outgoing, and up for anything, which were not significant in Hip Hop analyses. Similar to Hip Hop youth, Popular youth more often agreed that they are fashionable and are social people with lots of friends. However, Popular youth also more often agreed that they care about being good students, keeping their bodies free from toxins, and being patriotic, items with which Hip Hop youth less often agreed. Popular youth also more often agreed that family is important, that they try to follow tradition, and that they are religious than other youth. Popular youth more often reported using Instagram, Snapchat, and Twitter than other youth and more often used their smartphones to look up sports scores or analyses and to stream music or video content ( Table 4 ). Compared with others, Popular youth more often reported watching teen dramas, including 13 Reasons Why, Jane the Virgin, Pretty Little Liars , and Riverdale ( Table 5 ). Sports were favored by Popular youth, as they more often reported attending basketball, football, baseball, and soccer games than others. They also more often reported attending church events, community service events, high school dances, and pop and country music concerts.

Popular vape users shared many traits with the broader Popular crowd as well as with Hip Hop vape users. Similar to Hip Hop vape users, Popular vape users reported higher SPI scores than non-users, describing themselves as outgoing, partiers, street smart, carefree, and up for anything ( Table 3 ). Popular vape users also more often agreed that they care about being fashionable, social, and tough than non-users and less often agreed that they care about keeping their bodies free from toxins and following the rules, similar to Hip Hop vape users. Although, overall, Popular youth more often agreed that they value family, tradition, and religion than other youth, Popular vape users less often agreed with these items than non-users. Similar to the broader Popular peer crowd and to Hip Hop vape users, Popular vape users more often reported using Instagram and Snapchat, and using their smartphones to look up sports scores and place video calls ( Table 4 ). Popular vape users, like Hip Hop vape users, more often reported watching The Boondocks and Bob’s Burgers than non-users ( Table 5 ). Similar to the broader Popular crowd, Popular vape users more often reported attending sports games, high school dances, and concerts than non-users, though they less often reported attending church events.

This study identified a subset of adolescents at the greatest risk for vaping, and the psychographic characteristics and interests that should inform the creation of targeted health communications messages and media delivery strategies for these youth. The Hip Hop and Popular peer crowds were at the greatest risk for current vaping, aligning with earlier representative data from Virginia and similar studies of young adults. 52 , 53 , 56 Interestingly, although both crowds were at increased risk for current vaping, their broader risk profiles diverged, indicating a need for differentiated health messaging for the 2 crowds. Hip Hop youth had greater odds of vaping frequently, which may indicate an escalation to nicotine addiction, and were more likely to use other tobacco products and substances. Popular youth, however, were at increased risk for occasional vaping only, with reduced risk for several other substances including cigarettes.

Understanding the psychographics and interests of Hip Hop and Popular youth, and Hip Hop and Popular current vape users in particular, provides insights for health communications campaign development and hints at possible explanations for differential risk by crowd. Hip Hop and Popular youth and current vape users reported higher mean SPI scores than other youth, and endorsed personal values related to being fashionable and sociable. These findings paint a psychographic portrait of Hip Hop and Popular youth and current vape users as individuals who care about their social lives, are trend sensitive, and are strongly influenced by their social environments. This portrait aligns with vape marketing campaigns, which often feature celebrities, associate vaping with socializing and partying, and use sleek, modern designs reminiscent of trendy technology such as iPhones, 37 , 67 - 69 all of which likely appeal to the youth described here. To effectively counter industry marketing and media depictions that may appeal to Hip Hop and Popular adolescents, health educators must create relevant messaging that breaks the connection between vaping and social status or trendiness, and motivates youth to reconsider vaping as a key feature of their social lives. Furthermore, as current vape users in this study cared less about following rules and protecting their bodies from toxins than non-users, campaign messaging must look beyond authoritative tones and typical scare tactic messaging to cultivate a socially influential brand that can persuade higher-risk youth to avoid vaping by speaking directly to their priorities and values.

Hip Hop and Popular adolescents and current vape users also reported extensive smartphone and social media use, in particular the use of Instagram, Snapchat, sports analysis sites, and video/music streaming services. Heavy social media use may contribute to adolescent vaping as user- and industry-generated vaping content abounds across platforms, 70 - 74 and early research suggests that heavier social media use and exposure to vape advertisements on social media are associated with willingness and intentions to vape. 75 Given the known association between exposure to online tobacco marketing and adolescent tobacco initiation and progression, 76 , 77 heavy social media use among Hip Hop and Popular adolescents may further explain why these youth vape. At the same time, these findings can guide health communicators in selecting relevant campaign channels and delivering content via targeted advertisements. Vaping prevention campaigns must meet higher-risk adolescents where they are to deliver messaging to the target audience using the cutting-edge ad-targeting technology employed by commercial advertisers. Although not yet ubiquitous in public health, the targeted placement of paid campaign advertising has been successfully applied to deliver health communications to intended audiences for initiatives including the U.S. Food and Drug Administration’s The Real Cost general market and Fresh Empire Hip Hop adolescent tobacco education campaigns. 35 , 61 , 78 , 79 In addition, to counter the abundance of pro-vaping content youth encounter online, health communication campaigns must cultivate active, appealing social media presences to establish themselves as relatable and trustworthy social influencers and interject tailored prevention messaging into the pro-vaping social media environments of higher-risk youth. 80 , 81

Finally, Hip Hop and Popular youth and current vape users reported specific television and event preferences. Although vaping is currently rare in television programming, 82 , 83 exposure to vape advertisements on television and to vaping in other forms of media including music videos is common and may promote positive attitudes toward vaping among youth. 84 - 89 Although it is unclear if Hip Hop and Popular adolescents are disproportionately exposed to vape advertisements or onscreen vaping, continued monitoring is warranted to track how vaping is depicted over time and if exposure to vaping in media is associated with risks similar to that of exposure to cigarette smoking in movies. 90 In addition, little is known about vape industry sponsorship or promotion at events, an important topic for future work given the tobacco industry’s historical use of events for product promotion. 91 , 92 Although less is known about how television and event preferences may influence vaping risk, this information is incredibly useful to health educators for campaign tailoring and media targeting. Interests can be used to build media targeting profiles that concentrate message delivery and dosage on those most at risk, increasing chances for successful attention and persuasion. Television preference data can inform media buys, 93 identify potential influencer partnerships, and reveal opportunities to engage with the target audience about relevant televised events. 81 Event preference data can inform the selection of relevant settings for advertisements and identify opportunities for in-person engagement with the target audience. With this wealth of information, health educators can develop targeted health communication interventions that effectively reach and persuade higher-risk adolescents.

Although the Hip Hop and Popular peer crowds shared some psychographics and preferences, differences between the crowds indicate that separate campaigns are necessary. In particular, different messaging approaches are needed to appropriately address the more frequent, established nature of vaping among Hip Hop youth, who may require cessation resources, and the less frequent, possibly social nature of vaping among Popular youth. Experimental studies have demonstrated the promise of peer crowd-targeted smoking prevention messaging, 94 - 96 and evaluation studies of peer-crowd-targeted campaigns reveal success in addressing cigarette and smokeless tobacco use. 58 - 62 , 64 Peer crowd targeting may also be a means of more effectively addressing tobacco use disparities. Previous literature suggests that non-Hispanic White youth are at the greatest risk for vaping, 23 - 25 , 27 but this study indicates that the Hip Hop peer crowd, which overrepresents racial/ethnic minorities ( Supplemental Appendix Table 1 ), 50 - 52 , 54 is at the greatest risk for frequent vaping, identifying a higher-risk group that might otherwise be missed by campaigns using demographic segmentation. This study provides a preliminary insight into who these youth are, what they care about, and the media they consume; future research must test potential campaign messages with youth from the targeted peer crowd to ensure that tailored content resonates and motivates positive behavior change.

Limitations

It is important to note several limitations of this study. Generalizability is unclear as we surveyed a convenience sample recruited via social media from a single state, although peer crowd risk findings did align with previous observations from varied samples and locations. 52 , 53 , 55 , 56 We did not collect vape brand preferences, and did not distinguish between vaping nicotine, tetrahydrocannabinol (THC) or marijuana products, and flavors only, which should be explored to determine if users of different products have unique characteristics and interests. We also cannot discern causality, such as whether any of these psychographic characteristics or interests predisposed teens to increased interest in vaping, or if targeted industry marketing or other factors may have contributed to disparities.

Conclusions

Tackling adolescent vaping requires understanding who is at the greatest risk and how to reach them with relevant, persuasive messaging. Although current vaping is increasingly common among U.S. adolescents, risk is not evenly distributed, and prevention efforts should rely on psychographic segmentation, audience tailoring, and media targeting to effectively and efficiently reach higher-risk adolescents. 45 Although establishing a deeper understanding of the psychographics and interests of higher-risk adolescents may appear burdensome, in fact it is necessary to ensure that limited public health funds are spent on the populations facing the greatest challenges, 46 particularly in today’s online media environment where platform targeting tools cater toward advertisers who know the interests of their audiences. Our findings provide a detailed portrait of adolescents who are at increased risk for current vaping, information which should directly inform health communication campaign planning. Future campaigns should incorporate our findings to create messages relevant to the psychographics and risk profiles of these youth, which are delivered using carefully selected media strategies reflecting the greatest opportunities to reach the target audience efficiently. Addressing the urgent adolescent vaping crisis requires looking deeper than demographics to understand and leverage knowledge about who adolescent vape users are and what they care about, to create health communications campaigns that appeal to and persuade those at the greatest risk.

Supplemental Material

Acknowledgments.

The authors would like to thank Rebeca Mahr, Molly Moran, and Jon Benko for their assistance with data collection; Jensen Saintilien and Gwenyth Crise for their assistance with reviewing the literature; and Sharyn Rundle-Thiele for her feedback on a draft of the manuscript.

Author Contributions: CAS conducted analyses and drafted the manuscript. MD and JWJ contributed to study conception/design and manuscript revisions.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Supplemental Material: Supplemental material for this article is available online.

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Conclusions about the effects of electronic cigarettes remain the same

Conclusions about effects of electronic cigarettes remain unchanged

An updated Cochrane Review provides an independent, rigorous assessment of the best available evidence to date about electronic cigarettes for quitting smoking.

Scroll to the bottom of this article for a round-up of media coverage

The conclusions of this updated Review are unchanged since the last review was published two years ago: electronic cigarettes may help smokers stop their smoking, and the included studies did not find any serious side effects associated with their use for up to two years.

Many studies are now underway which may help us understand more about their effects in the future.

The first Cochrane Review, published in the Cochrane Library in December 2014, showed that electronic cigarettes may be an aid to smokers in stopping their smoking. The updated Review did not find any new randomized controlled trials (RCTs) with long-term outcomes looking at the effectiveness of electronic cigarettes in helping people to stop smoking. However, this is an active area of research, with a large number of ongoing studies that will add to the evidence in the next few years.

Smoking is a significant global health problem. Despite many smokers wanting to stop, they often find it difficult to succeed in the long term. One of the most effective and widely used strategies to help combat the cravings associated with nicotine addiction is to deliver nicotine by patches and chewing gum.

Electronic cigarettes have been around in some form for a number of years, but over the past few years their popularity has increased significantly, and they have begun to look and feel less like conventional cigarettes. Unlike chewing gum and patches, they mimic the experience of cigarette smoking because they are hand-held and generate a smoke-like vapour when used. They help to recreate similar sensations of smoking without exposing users or others to the smoke from conventional cigarettes, and can be used to provide smokers with nicotine. Though they are used by many smokers, little is still known about how effective they are at helping people stop smoking.

This version of the updated Cochrane Review includes no new RCTs. The original Review included two RCTs involving more than 600 participants, and found that electronic cigarettes containing nicotine may increase the chances of stopping smoking within six to 12 months, compared to using an electronic cigarette without nicotine. The researchers could not determine whether using electronic cigarettes was better than a nicotine patch in helping people stop smoking, because there were not enough people taking part in the study.

This updated Review now includes observational data from an additional 11 studies. Of the studies which measured side effects, none found any serious side effects of using electronic cigarettes for up to two years. The studies showed that throat and mouth irritation are the most commonly reported side effects in the short to medium term (up to two years).

The lead author of this Cochrane Review, Jamie Hartmann-Boyce from the Cochrane Tobacco Addiction Group, said, “The randomized evidence on smoking cessation is unchanged since the last version of the Review. We are encouraged to find many studies are now underway, particularly as electronic cigarettes are an evolving technology. Since the last version of the Review, 11 new observational and uncontrolled studies have been published. In terms of quitting, these can’t provide the same information we get from randomized controlled trials, but they contribute further information on the side effects of using electronic cigarettes to quit smoking. None detected any serious side effects, but longer term data are needed.”

Read this Press Release in French, Spanish or Polish .

Editor’s notes Full citation: Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation . Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3.

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E-cigarettes can help smokers quit, says study in The Guardian . Why can't scientists agree on e-cigarettes? blog post in The Guardian . E-Cigs Might Help Some Quit Smoking, New Study Reveals on Consumer Reports .

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