What Is the Biggest Risk of E-Cigarettes?

Recently, the San Francisco city government proposed new legislation to ban the sale of e-cigarettes in the city until the U.S. Food and Drug Administration (FDA) deems them to meet health standards. This marks the first time in the U.S. that the overall safety of e-cigarettes has been questioned, along with whether they are suitable for teenagers to try tobacco products for the first time through e-cigarettes.
 

In recent years, e-cigarette bans have quietly spread globally. Among the countries that restrict e-cigarettes, Singapore, Thailand, and Brazil are among the few that have completely banned them, while other countries either strictly control sales or prohibit the use of nicotine-based e-liquids.

Hong Kong is a region that has recently proposed strict regulations, now fully banning the sale, import, or promotion of e-cigarettes, although their use remains permitted. A Hong Kong official even suggested that the government view e-cigarettes as a "gateway that ultimately leads to the consumption of traditional cigarettes."

This proposal in San Francisco also responds to the Hong Kong official's "gateway" hypothesis, indicating that beyond potential safety risks, the biggest concern about e-cigarettes is that young people are developing a habit of using nicotine through them, which may lead to addiction and ultimately result in smoking traditional tobacco.

San Francisco Supervisor Shamann Walton recently stated: "E-cigarettes have consistently targeted teenagers with colors and flavors, attracting them and enticing them into nicotine dependence." He added, "Companies like Juul are drawing in those who have never smoked before, thus increasing the number of nicotine users." There should be a ban on e-cigarette products marketed towards young people.

Walton's mention of Juul is not coincidental. Juul is the leader in the U.S. e-cigarette industry, holding over 75% of the total U.S. e-cigarette market. This Silicon Valley startup, founded in 2015, has cultivated a market worth billions of dollars in just a few years.

At the end of 2018, a study concluded that over 20% of U.S. high school students were using e-cigarettes, a 78% increase from the previous year. A Stanford research team found that Juul specifically targeted teenagers in its marketing during the first six months after its launch, contributing to the rapid increase in e-cigarette use among teenagers in the U.S. over the past three years.

Should e-cigarettes be regulated?

The debate over whether e-cigarettes need regulation has two fundamental starting points. One is what health risks e-cigarettes pose. The second is whether teenage use of e-cigarettes increases the likelihood of them eventually smoking traditional cigarettes.

The first question regarding the health risks of e-cigarettes remains a focal point for scientists worldwide. It is becoming increasingly clear that while e-cigarettes may not be as harmful as combustible cigarettes, they are not completely harmless either.

The second question is quite tricky. There is growing evidence that young people who use e-cigarettes do indeed increase their risk of trying traditional cigarettes. However, we cannot overlook that e-cigarettes also allow smokers to quit smoking. The key issue is whether the health benefits of e-cigarettes for adult users outweigh the potential harm of enticing new users to consume nicotine and traditional tobacco.

"E-cigarettes cannot simply be classified as beneficial or harmful," summarized David Eaton, chair of the committee behind the 2018 report. "In some cases, such as when non-smoking teenagers and young people use them, their side effects are clearly concerning. In other cases, such as when adult smokers use them to quit smoking, they reduce the probability of diseases caused by smoking.

Therefore, it is currently difficult to draw clear causal relationships from existing research. E-cigarette advocates argue that looking at current teenage smoking rates can help determine the impact of e-cigarettes on teenagers. Although teenage smoking rates have sharply increased in recent years, the smoking rate among teenagers has been declining. In fact, the teenage smoking rate in the U.S. dropped from around 11% in 2015 to just over 7% in 2018. The emergence of e-cigarettes has actually led to a decrease in the overall smoking rate among teenagers.

Currently, countries around the world have completely different attitudes towards e-cigarettes, with some countries imposing total bans (Brazil, Singapore, Thailand) while others have completely open markets (Russia, Netherlands, Armenia). Between these extremes, there are various approaches. For example, Australia and Japan allow the use of e-cigarettes but prohibit the addition of nicotine.
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It is still too early to determine whether e-cigarettes are attracting a new generation to use nicotine or whether they will ultimately cause serious long-term health damage. Similarly, it is also too early to determine whether e-cigarettes can ultimately help traditional adult smokers quit smoking.

Perhaps the biggest risk of e-cigarettes now is the uncertainty of what risks they pose?