Can e-cigarettes really help people quit smoking? Behind the multi-billion-dollar business

Fresh grapefruit, peach oolong, banana milkshake—these sound more like items on a bubble tea menu. Space gray, deep sea blue, rose gold—these sound like new phone case colors. But if you open the top-selling e-cigarette starter kit on a major e-commerce platform, you’ll find that these are actually pod flavors and device color options.

Recently, two major developments involving e-cigarettes have drawn attention. Suspected vaping-related deaths were reported in Illinois and Oregon in the United States. Meanwhile, the e-cigarette brand launched by Luo Yonghao brought in Edison Chen as a spokesperson, marking a commercial collaboration between two early internet celebrity icons.

You may still wonder why anyone would puff away on something that looks like a USB drive, but in fact, this has already become a multi-billion-dollar business.

According to World Health Organization statistics, of the world’s 7.7 billion people, 1.1 billion are smokers. More than 8 million people die from tobacco every year, including over 7 million from direct tobacco use and about 1.2 million non-smokers exposed to secondhand smoke.

Some smokers seem to take the view that they would rather die than quit. The writer Lao She once declared, “I’d hang myself before I quit smoking.” To him, quitting was like wrestling with himself.

Others have been thinking about how to reduce the harm caused by smoking. As the saying goes, people smoke for nicotine but die from tar. That is how e-cigarettes came into being.

In 2003, Chinese pharmacist and longtime smoker Han Li invented the world’s first e-cigarette. E-cigarettes mainly consist of a battery, a heating and vaporization device, and a tube containing e-liquid. Through atomization, nicotine-containing e-liquid is turned into vapor for users to inhale, reducing the health risks associated with the incomplete combustion of tobacco.

Around 1600, sailors and merchants from Fujian brought tobacco into China from the Philippines, about 100 years after Columbus’s voyages first encountered tobacco through Indigenous peoples in 1492. By 2018, the global e-cigarette market had reached US$14.5 billion—just 15 years after the invention of the e-cigarette.

Not only was the first e-cigarette born in China, but in fact, more than 90% of the world’s e-cigarettes are currently made there. According to media reports, Shenzhen is the largest e-cigarette production hub, with more than 500 e-cigarette companies densely concentrated in the city.

Benefiting from the tobacco industry’s enormous profit margins, seven A-share listed companies related to e-cigarettes generated RMB 21.8 billion in revenue last year, with net profit approaching RMB 3.6 billion.

China has also remained at the forefront of e-cigarette technology. As of August 2018, there were 25,979 e-cigarette patents worldwide, of which China held 22,825, accounting for nearly 87.9%.

In 2018, US e-cigarette sales reached US$5.6 billion, making it the world’s largest consumer market for e-cigarettes. The United Kingdom ranked second with US$2.43 billion in sales, while Italy, Germany, and France were also major consumer markets.

People in the e-cigarette business say that e-cigarettes are alternatives to traditional cigarettes and can help smokers quit. In reality, however, there is currently no data proving that their popularity has reduced the number of smokers, and because they contain nicotine, most e-cigarettes are also addictive.

Nicotine enters the brain through the lungs. If you take 20 puffs from a cigarette, your brain receives 20 nicotine stimuli. Nicotine is also metabolized quickly in the human body: half an hour after smoking, nicotine levels drop by 50%, and after another half hour, they fall to 25%. You keep needing more to fill that sense of emptiness—but that emptiness is caused by nicotine itself.

A UK study found that although e-cigarettes were more effective than nicotine replacement therapy for smoking cessation, one year after successfully quitting, 80% of those who had used e-cigarettes to quit were still using e-cigarettes, while only 9% of those who used nicotine replacement products were still using those substitutes.

In response to the recent suspected vaping-related death cases, the US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) said in a statement that they were investigating 215 cases of severe lung illness linked to e-cigarettes, though whether the two are causally related remained unknown.

Some studies have shown that secondhand aerosol from e-cigarettes, like secondhand smoke from traditional tobacco products, is also a source of air pollution. Although levels of PM 1.0, PM 2.5, formaldehyde, acetaldehyde, and nicotine in secondhand aerosol are lower than in secondhand smoke from conventional cigarettes, some metals, such as nickel and chromium, are present at higher levels.

Data released by the CDC show that e-cigarettes are currently the most commonly used tobacco product among US middle and high school students. In 2018, 3.6 million middle and high school students in the US used e-cigarettes, and nearly 30% of high school students who vaped said they had used e-cigarettes on at least 20 days in the past month. #p#Page Break Title#e#

China’s e-cigarette market is also largely driven by young people. Recent survey results from the Chinese Center for Disease Control and Prevention show that e-cigarette users in China are also mainly young people. The e-cigarette usage rate among those aged 15 to 24 was 1.5%, and 45.4% of users purchased e-cigarettes through online channels.

According to media reports, in July this year, China’s National Health Commission stated at a press conference that the harms of e-cigarettes should be taken seriously. It is currently working with relevant departments to study e-cigarette regulation and plans to regulate e-cigarettes through legislation.