They’ve become so common a sight – and smell – on streets around the world that it’s hard to believe electronic cigarettes have been around a little more than a decade.
From seemingly nowhere, the vaping market is now an estimated $19 billion industry with more than 40 million global users. But a cloud is forming around its reputation.
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Hundreds of people have fallen ill in the US with lung problems that health officials have linked to e-cigarettes. And now India has banned them, warning their use among young people has reached “epidemic” levels.
It’s the latest move against a practice that many endorse as a way to help people quit smoking – and debate about its safety is growing.
India’s ban, which prohibits the import, production and sale of e-cigarettes and could see offenders fined and jailed for up to three years, isn’t the first.
Other countries, including Mexico, Brazil, Singapore and Thailand, have introduced bans or restrictions due to safety concerns or fears about young people being drawn into nicotine addiction.
The US states of New York, Rhode Island and Michigan have already prohibited the sale of flavoured vapes, while Massachusetts has imposed a four-month ban on all vaping products. And the US is now planning a nationwide ban on flavoured products as a spate of vaping-related sickness sweeps the country.
More than 800 lung-illness cases have been linked to vaping across more than 40 states, according to the latest figures from the Centers for Disease Control and Prevention (CDC). At the time of writing, 12 people have died.
While officials haven’t yet identified the cause of the outbreak, the CDC says all reported cases feature a history of e-cigarette or vaping product use.
And a significant number of those products contained THC, a psychoactive ingredient found in cannabis. Many of the patients using these products reported obtaining them from informal or illicit sources.
One driver of its rapid success has been people vaping to help them manage nicotine cravings and quit smoking. E-cigarettes contain nicotine, but don’t burn tobacco or produce tar or carbon monoxide – two of the most damaging elements in tobacco smoke.
A clinical trial in the UK found people who use e-cigarettes along with expert support to quit smoking are twice as likely to succeed as people using other nicotine replacement products, such as patches or chewing gum.
And the UK government body Public Health England says vaping is 95% less harmful than smoking. Independent research it commissioned suggests e-cigarettes are contributing to falling smoking rates.
But other bodies aren’t so sure. The World Health Organization says it “does not endorse e-cigarettes as cessation aids”, and that there “remains a great deal of uncertainty” surrounding their toxicity.
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Many e-cigarette users are young adults – the median age of the patients with vaping-related lung problems in the US is 23 years old.
Two in 10 Americans between the ages of 18 and 29 use e-cigarettes, according to US think-tank Pew Research Center, compared to 8% of those aged 30 to 64. And a quarter of US high school students vape, according to the CDC.
Critics say the sweet flavours added to many vaping products entice young people and could lead to them becoming addicted to nicotine or moving on to tobacco products. And a report from the Office of the US Surgeon General warns nicotine exposure during adolescence can harm the brain during a critical time for its development.
Bodies including Public Health England, meanwhile, say there is no evidence e-cigarettes act as a route to smoking for children and non-smokers.
While the health effects remain unclear, the challenges continue to mount for the industry.
Amid the current crisis in the US, TV networks have pulled advertising from vaping brands, retail chain Walmart has stopped selling e-cigarettes, and a host of e-cigarette makers are being sued by the state of North Carolina.
There have also been reports of vape pens exploding in people’s faces and pockets, causing injury, burns and – in one case – death.
So e-cigarettes are undoubtedly facing tough questions. But many are concerned bans will do more harm than good, driving people to tobacco or the black market, and call instead for more regulation.
As Public Health England says: “Vaping isn’t completely risk free, but is far less harmful than smoking tobacco. There is no situation where it would be better for your health to continue smoking rather than switching completely to vaping.”
Whatever the future holds for vaping, with about 1 billion smokers and more than 8 million smoking-related deaths every year, it’s clear the world needs to find some way to tackle the problem.