It's hardly news. The WHO warns vaping gives tobacco companies a way to replace dead smokers. What are health experts doing about it? To mark 2024's World No-Tobacco Day, the World Health Organization (WHO) published a report called Hooking the next generation. It outlined a lot of information about e-cigarettes that we've known for years. According to the report, big tobacco companies have arranged their messaging and products to target kids in an attempt to replace the millions of customers who die from their products each year.

Kids are excellent targets for these companies because if you pick up a nicotine addiction before the age of 21, there's a good chance you will be addicted for life, the report said. The WHO said the industry targets children by selling products with fruit and candy flavors and cartoonish designs. The companies, meanwhile, deny that they explicitly target children.  

In a 'vaping public health crisis'

In 2018-2019, public health officials in the US acknowledged a “vaping public health crisis.” Since then, initiatives have been introduced worldwide attempting to rein in the situation, but what was a "crisis" then now appears to be a mere fact of life. It is hard to walk down the street in a busy city without noticing someone blowing a large puff of vapor out their nose.

Many members of Gen Z have spent their formative years sucking on highly addictive plastic objects that, at first glance, look like flash drives or, more crudely, adult pacifiers. According to the WHO report, children between 13 and 15 years old use e-cigarettes at higher rates than "adults in all WHO regions."

The authors wrote that 32% of 15-year-olds surveyed in the European region reported using e-cigarettes at some point, with 20% reporting use in the past 30 days. Most of these children were not using the vapes to wean themselves off cigarettes, states the WHO report.

What is a vape?

If you are unfamiliar with the world of vaping, you may be wondering what the WHO is talking about when they use words like "vape" or “e-cigarette.” E-cigarettes, or vapes — the WHO report and this article use the term interchangeably — first hit the American and European markets in the mid-2000s. These products, which were often designed to resemble regular cigarettes, used "free-base" nicotine.

Free-base nicotine has existed since the 1960s when tobacco companies realized that by adding ammonia to nicotine, they could strip it of its protons to make it more intense when heated and inhaled. This form of nicotine is extracted directly from the tobacco plant. The problem with free-base nicotine, at least when it comes to attracting children, is the fact that it becomes physically painful to vape at high levels of concentration and still provides a "throat burn" that former cigarette smokers crave but would be uncomfortable for people who have never smoked.

These early iterations of vapes typically contained between 3 to 12 milligrams of nicotine. In 2016, the company Juul introduced a vape that featured a new kind of nicotine delivery: nicotine salts. Nicotine salts have a lower pH solution, essentially eliminating the throat burn caused by free-base nicotine, even at very high concentration levels.

These devices hit the US market at a highly addictive concentration of 50 milligrams. In Europe, these vapes cannot be sold at a concentration higher than 20 milligrams. When it comes to attracting kids, these devices are magic, because they are discrete. They can be smoked in bathrooms or into your sleeve or shirt, and the fruity smell of a hit only lingers in a room for a few minutes. Unlike cigarettes, which mark users with their acrid smell, vapes can be easily hidden from nosy parents.

Long-term health effects of vaping are unknown

The WHO suggests that along with sticking their hands and millions of dollars into public health policy on vaping, tobacco industries also try to influence the scientific research that is conducted to measure the health effects of vaping devices. The authors noted that in 2024, the tobacco company Philip Morris International funded a series of courses about smoking cessation on Medscape, a US-based medical news website, that portrayed "nicotine products as relatively harmless." The series was canceled following complaints.

Science communication on vapes is confusing, including for advice about vaping while pregnant or using vapes to get off cigarettes and whether vaping causes cancer — even for a journalist who follows the issue closely. For example, public health messaging out of the UK suggests that vaping is safer than cigarettes and should be encouraged for smoking cessation, while messaging out of other countries, like the US, abstains from recommending vapes under any circumstances.

Which of these policies is correct is anyone's guess. Because these products are still so new, we simply don't have the studies needed to truly understand the long-term health consequences of inhaling watermelon-flavored nicotine vapor dozens of times a day, every day for multiple years, and particularly not when it comes to the impact on kids.

We do know, however, that there is virtually no health benefit to smoking nicotine or tobacco, and there is certainly no benefit to prepubescent never-smokers taking up the habit. Some studies have indicated that children who start vaping later are more likely to smoke cigarettes.

Numerous studies have shown that nicotine has a negative impact on brain development and increases the risk of cancer. Smoking impacts reproductive health, causes a decreased immune response, affects cell and tumor proliferation and causes resistance to chemotherapeutic agents. We know all this.

Over the past few decades, enormous public health efforts were initiated worldwide to get people off cigarettes. They were largely successful. According to WHO estimates, cigarette use has been steadily decreasing for the past two decades across the globe. Authorities thought they had gotten ahead of the tobacco companies. And perhaps they had, for a few years. But just like that, the companies found a new generation of customers.

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