To what extent have electronic cigarettes (e-cigarettes) replaced traditional tobacco smoking, particularly among adolescents?

From the Guidelines

Vaping has become a significant replacement for traditional smoking among teens, with e-cigarette use now more prevalent than conventional cigarette smoking in this age group, posing a clear threat to public health. The most recent and highest quality study, published in 2021 in the Journal of the American College of Cardiology 1, highlights the growing evidence that e-cigarettes and their aerosol constituents can have deleterious effects on the cardiovascular system, respiratory system, and brain. Key points to consider include:

• E-cigarette use among young people is unprecedented, with millions of young people who would never have used cigarettes or other tobacco products now using e-cigarettes 1.
• The introduction of high-nicotine delivery systems such as JUUL has increased the addiction potential for young people 1.
• E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 1.
• There is limited evidence regarding the efficacy of e-cigarettes as a smoking cessation aid, and many e-cigarette users also continue to smoke cigarettes 1.
• Dual use of e-cigarettes while continuing to smoke traditional cigarettes is not associated with higher rates of quitting 1.

The shift towards vaping among teens is concerning, as it introduces nicotine addiction to a new generation, with many teens who might never have smoked cigarettes now using e-cigarettes. The health impacts remain concerning, as vaping can cause respiratory issues, cardiovascular problems, and contains harmful chemicals, though generally fewer than traditional cigarettes. Additionally, there's evidence that teens who vape are more likely to transition to traditional cigarettes later, suggesting vaping may serve as a gateway to smoking rather than just a replacement. A previous study published in 2015 in Pediatrics 1 also found that current e-cigarette users were much less likely to have stopped using cigarettes compared with smokers who never used e-cigarettes. Overall, the current evidence suggests that vaping has replaced traditional smoking among teens to a significant extent, and this replacement is concerning due to the potential health risks and the introduction of nicotine addiction to a new generation.

From the Research

Extent of Vaping/E-Cigarettes Replacement for Smoking

• The World Health Organization estimates that there are 1.1 billion cigarette smokers globally, with tobacco-related deaths numbering 7 million per year 2.
• Electronic nicotine delivery systems (ENDS), including e-cigarettes, have become a popular alternative to traditional smoking, with their use growing dramatically in the US and globally 2.
• However, the evidence suggests that e-cigarettes are not without risks and harms, including varying amounts of toxicants, nicotine, and carcinogens, which can put users at risk for lung diseases and COVID-19 similar to smokers 2, 3, 4.

Vaping/E-Cigarettes and Teenagers

• There is substantial evidence that nicotine e-cigarettes can cause dependence or addiction in non-smokers, and strong evidence that young non-smokers who use e-cigarettes are more likely to initiate smoking and become regular smokers 3.
• The use of e-cigarettes among teenagers has raised concerns, with prevention efforts and policy needed to avoid adolescents and other vulnerable populations from initiating tobacco or e-cigarette use 2.
• The long-term effects of e-cigarette consumption on human health, particularly among teenagers, have been scarcely investigated, highlighting the need for more research in this area 4.

Effectiveness of Vaping/E-Cigarettes for Smoking Cessation

• Nicotine replacement therapy (NRT), including gum, patches, and inhalers, has been shown to be effective in helping people quit smoking, with an overall efficacy of 50-70% 5, 6.
• However, the effectiveness of e-cigarettes as a smoking cessation tool is still uncertain, with limited evidence suggesting that they may be beneficial for smokers who use them to completely and promptly quit smoking 2, 3.
• More studies and long-term data are needed to assess the potential benefits and harms of e-cigarettes as a harm reduction tool and their effectiveness as a smoking cessation aid 2, 3.