Proponents of e cigarettes say that it is a disruptive innovation and that smokers can quit smoking by using it as a nicotine delivery device, taking away the addictive craving of cigarettes.

Critics note that if one intentionally breathes in something other than clean air, it is a problem for the lungs. The chemicals placed in the cartridge and the long term consequences of inhaling the vapor still need further study. Others note that e cigarettes are expensive and can still be a gateway to actual cigarette use. To distance these new products from the old, some marketers are avoiding the term “cigarette,” renaming them “e hookahs” or “vape pens.”

In the last year alone, the use of e cigarettes has more than doubled, according to the New York Times, with sales at more than $1.7 billion. The number of e cigarette users in the United States reached 2.5 million last year and, at this rate, is expected to overtake conventional cigarette consumption within the next decade. The growth has come with almost no federal oversight or testing of the safety of the product, leaving it to local jurisdictions to regulate them.

Two bills are currently being proposed in City Council that relate to e cigarette use in Philadelphia. The first seeks to prevent the sale of e cigarette devices to minors, and the second would restrict the public spaces where a person could use the devices.

Teens are being targeted by e cigarette manufacturers. In order to find the next generation of addicted users, they have knowingly placed nicotine in these products and added sweet candy flavors with alluring names. There are now more than 400 brands available to American consumers. Some of these products are derived from tobacco extract some aren’t. The decades that have been spent persuading youths not to smoke are being undermined by clever marketing.

Second, although all e cigarettes are intended to deliver vaporized solutions deep into the body via inhalation, none are currently subjected to safety testing or labeling requirements. Would you knowingly let your kid inhale an untested product? Think about it. You have more information about the potential health impact of your mascara than you do about that of your e cigarette. The City Council bill clarifies that e cigarettes should not be sold to kids under age 18.

Since 2007, Philadelphia has had a highly successful public smoking ban. We simply should not confuse the public by allowing e cigarette vaping to pollute the air.

The safety of vaping remains untested, and the proper expectation of members of the public is that they should be able to enjoy a meal without wondering, “What is that smell in the air?” Major cities like New York, Chicago, and, most recently, Los Angeles have responded by banning the use of e cigarettes in public spaces, restaurants, bars, and nightclubs.

If these proposals seem familiar to you, there’s a reason. In the late 1990s, many municipalities in the United States were wrestling with the exact same questions regarding conventional cigarettes.

Though it’s probably safe to say that no municipal authorities were in favor of selling cigarettes to minors, there was little public appetite for enforcement of public smoking bans. Arguments at the time revolved around the anticipated negative economic impact and a desire for freedom from government regulations. Today, these laws are now so commonplace that it’s difficult to remember that their passage came only after decades of hard fought political battles.

Introducing these two ordinances on e cigarettes is the right thing for City Council to do. We should not repeat the awful mistakes of the past while the truth about the impact of these products on our lives is so uncertain.

Frank Leone is director of the Comprehensive Smoking Treatment Program at the University of Pennsylvania.

Walter Tsou is a former Philadelphia health commissioner.

Are e-cigarettes a ‘gateway to nicotine addiction’? – health news – nhs choices

V2 cigs review & coupon: complete v2 electronic cigarette brand review

On average tobacco smokers die significantly younger and spend more of their shorter lives ill. Because e cigarettes can be marketed to young people, there is a worry that if they did lead to more conventional smoking, they could have a potentially disastrous impact on public health.

This current study does suggest that e cigarettes may not be the harmless alternative some believe, and may be acting as a “gateway drug” to conventional smoking.

However, it does not prove that is the case. It is quite plausible that existing teenage smokers are also trying e cigarettes for a variety of reasons.

The debate about the safety and regulation of e cigarettes is likely to continue until more robust long term evidence emerges.

Where did the story come from?

The study was carried out by researchers from the Center for Tobacco Research and Education at the University of California, San Francisco, and was funded by the US National Cancer Institute.

It was published in the peer reviewed medical journal, JAMA Pediatrics.

The Mail Online coverage was balanced and discussed the pros and cons of e cigarettes. It also usefully brought in some wider research from 75,000 Korean adolescents “which also found that adolescents who used e cigarettes were less likely to have stopped smoking conventional cigarettes”.

What kind of research was this?

This was a cross sectional study looking at whether e cigarette use was linked to conventional cigarette smoking behaviour among US adolescents.

E cigarettes are devices that deliver a heated aerosol of nicotine in a way that mimics conventional cigarettes while delivering lower levels of toxins, such as tar, than a conventional combusted cigarette. They are often marketed as a safer alternative to regular smoking, or as a way of helping people quit traditional smoking.

The devices are not currently regulated in the US or the UK, meaning there are limited or vague rules concerning appropriate advertising. The researchers say e cigarettes are being aggressively marketed using the same messages and media channels that cigarette companies used to market conventional cigarettes in the 1950s and 1960s. These include targeting young people to get a new generation of smokers hooked on nicotine for life.

The researchers outline how studies have demonstrated that youth exposure to cigarette advertising causes youth smoking. Meanwhile, electronic cigarettes can be sold in flavours such as strawberry, liquorice or chocolate, which are banned in cigarettes in the US because they appeal to youths.

Given the potential for a new generation to be hooked on nicotine and then tobacco smoking in this unregulated environment, the researchers wanted to investigate whether e cigarettes were associated with regular smoking behaviour in adolescents.

What did the research involve?

The researchers used existing smoking data collected from US middle and high school students in 2011 (17,353 students) and 2012 (22,529) during the large US National Youth Tobacco Survey. They analysed whether use of e cigarettes was linked with conventional tobacco smoking and smoking abstinence behaviour.

The National Youth Tobacco Survey was described as an anonymous, self administered, 81 item, pencil and paper questionnaire that included

  • indicators of tobacco use (cigarettes, cigars, smokeless tobacco, kreteks southeast Asian clove cigarettes , pipes, and “emerging” tobacco products)
  • tobacco related beliefs
  • attitudes about tobacco products
  • smoking cessation
  • exposure to secondhand smoke
  • ability to purchase tobacco products
  • exposure to pro tobacco and anti tobacco influences

Smoking behaviour was categorised as

  • conventional cigarette experimenters adolescents who responded “yes” to the question “Have you ever tried cigarette smoking, even one or two puffs?”
  • ever smokers of conventional cigarettes those who replied “100 or more cigarettes (five or more packs)” to the question “About how many cigarettes have you smoked in your entire life?”
  • current smokers of conventional cigarettes those who had smoked at least 100 cigarettes and smoked in the past 30 days
  • ever e cigarette users adolescents who responded “electronic cigarettes or e cigarettes, such as Ruyan or NJOY” to the question “Which of the following tobacco products have you ever tried, even just one time?”
  • current e cigarette users those who responded “e cigarettes” to the question “During the past 30 days, which of the following tobacco products did you use on at least one day?”

Data on intention to quit smoking in the next year, previous quit attempts and abstinence from conventional cigarettes was also collected. The analysis was adjusted for potential confounding factors such as race, gender and age.

What were the basic results?

The main analysis included 92.0% of respondents (17,353 of 18,866) in 2011 and 91.4% of respondents (22,529 of 24,658) in 2012 who had complete data on conventional cigarette use, e cigarette use, race, gender and age. The mean age was 14.7, and 5.6% of respondents reported ever or current conventional cigarette smoking (of these, 5% currently smoked).

In 2011, 3.1% of the study sample had tried e cigarettes (1.7% dual ever use, 1.5% only e cigarettes) and 1.1% were current e cigarette users (0.5% dual use, 0.6% only e cigarettes).

In 2012, the 6.5% of the sample had tried e cigarettes (2.6% dual use, 4.1% only e cigarettes) and 2.0% were current e cigarette users (1.0% dual use, 1.1% only e cigarettes).

Ever e cigarette users were significantly more likely to be male, white and older. The rates of ever tried e cigarettes and current e cigarette smoking approximately doubled between 2011 and 2012.

The main analysis found use of e cigarettes was significantly associated with

  • higher odds of ever or current cigarette smoking
  • higher odds of established smoking
  • higher odds of planning to quit smoking among current smokers
  • among e cigarette experimenters, lower odds of abstinence from conventional cigarettes

How did the researchers interpret the results?

The researchers’ interpretation was clear “Use of e cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.”

They added that, “In combination with the observations that e cigarette users are heavier smokers and less likely to have stopped smoking cigarettes, these results suggest that e cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths. These results call into question claims that e cigarettes are effective as smoking cessation aids.”


This study found US adolescents who use e cigarettes are more likely to smoke conventional cigarettes. They also have lower odds of abstaining from conventional cigarettes than those who don’t try e cigarettes. On the flip side, e cigarette users were more likely to report planning to quit conventional smoking.

The research sample was large, so is likely to provide a relatively accurate picture of the smoking behaviour of US adolescents.

These results suggest that e cigarettes may not discourage conventional cigarette smoking in US adolescents, and may encourage it. However, because of the cross sectional nature of the information, it cannot prove that trying e cigarettes causes adolescents to take up conventional smoking. There may be other factors at play.

And indeed, smoking tobacco cigarettes may cause teenagers to take up e cigarettes. For example, the type of person who may want to try smoking in the past could only try conventional smoking. Nowadays, they have e cigarettes as an option too.

Retrospectively trying to work out if they would have taken up conventional smoking had they not tried e cigarettes first is not possible. This question would require a cohort
study that tracks behaviour over time. You would then be able to see which smoking method they took up first and if one led to the other. This was not possible using the data the researchers had to hand in the current study.

Conventional smoking has been a public health priority for many decades because, on average, smokers die significantly younger (more than a decade in some groups) and they spend more of their shorter lives ill. Consequently, any product that may increase the rates of conventional smoking among the young such as e cigarettes has serious and widespread health consequences.

Currently, regulation around e cigarettes is minimal, but there are plans to introduce stricter rules in the UK. In the meantime, this study provides some evidence that e cigarettes may not be the harmless, safe alternative some believe, and may be acting as a gateway drug to conventional smoking.

The research stops short of proving this, so the debate on whether e cigarettes should be treated similarly to conventional cigarettes, through advertising and sales restrictions, is likely to continue.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.