Volume 13 Issues 11 November, 2023
Assistant Professor, Psychiatry, Subharti Medical College, Meerut
The landmark 1964 Surgeon General’s report on smoking and health was a pivotal moment in public health, linking cigarette smoking to increased mortality from diseases like lung cancer. In response, the tobacco industry sought to rebrand its products, reducing machine-tested yields of tar and nicotine to promote “healthier” cigarettes. This led to the development of alternative smoking devices, one of which was a “smokeless non-tobacco cigarette” patented in 1965. This early innovation aimed to offer a “safe and harmless means for and method of smoking.”
Fast forward to the early 2000s, the first modern e-cigarette devices began to emerge, and by the 2010s, various brands had flooded the market. Vaping, defined as using a handheld electronic device to inhale a mist (or “vapor”) into the lungs, became increasingly popular. E-cigarettes, vape pens, and other electronic nicotine delivery systems (ENDS) heat a liquid containing nicotine, flavourings, propylene glycol, and other additives into an aerosol inhaled through a mouthpiece. These devices, known as “e-cigs,” “vape pens,” and “tank systems,” were marketed not as smoking devices but as tech products—emphasising innovation and a supposed health advantage over traditional cigarettes.
Initially, vapes were promoted as nicotine-free and as tools for quitting smoking. However, this was misleading. Many vapes were loaded with multiple flavouring agents designed to appeal to young consumers, many of whom had never smoked cigarettes before. The marketing strategies used by vape companies targeted a younger demographic, leading to a surge in usage among youth.
The impact of vaping has been profound. From a near-zero prevalence in the early 2000s, vaping has skyrocketed. By 2021, an estimated 8.1% of adults in the U.S. were using e-cigarettes, with some reports indicating a lifetime prevalence of vaping as high as 23%. The harms associated with vaping are significant. Nicotine e-cigarettes can lead to addiction, even among non-smokers, and dual use of both vapes and traditional cigarettes is common among smokers. The increased delivery of nicotine in each puff heightens the risk of addiction. Additionally, the flavoring agents and other chemicals in vapes are not without harm, as evidenced by cases of EVALI (E-cigarette or Vaping Use-Associated Lung Injury). Furthermore, studies have shown that e-cigarette use is linked to detrimental effects on cardiac health, increasing the risk of severe cardiac conditions.
In response to these concerns, the Government of India took a proactive stance by banning the manufacture, importation, transport, sale, advertising, and distribution of e-cigarettes in September 2019, primarily to protect young people from the associated harms. Despite this ban, e-cigarettes remain widely available through various sources, including stores and online platforms.
As clinicians, it is crucial to recognise the rising trend of vaping and address the associated health risks. The first reported cases of EVALI involved patients who claimed they were not smoking but only vaping. Therefore, when assessing tobacco use, it is essential to ask not only about traditional smoking habits but also, “Do you vape?”
