Clear The Air News Tobacco Blog Rotating Header Image

Vaping Control

Young vapers are almost five times more likely to try real cigarettes

The study suggests that e-cigarettes could contribute to a new generation of real smokers

Younger people who have tried e-cigarettes but had never previously smoked are nearly five times more likely to try tobacco cigarettes, suggesting vaping may play a role in instigating smoking.

Researchers from the University of Bristol’s Tobacco and Alcohol Research Group (TARG) worked with the city’s Medical Research Council’s Integrative Epidemiology Unit and the National Institute for Health Research’s Bristol Biomedical Research Centre to combine 17 studies into whether e-cigarette smoking was associated with subsequent cigarette smoking.

While existing studies suggest that smoking e-cigarettes, also known as vaping, is less harmful than smoking cigarettes and can be an effective quitting tool, concerns have circulated over whether they can present a ‘gateway’ into smoking.

This latest study found that young people who had never previous smoked but had tried vaping were four-and-a-half times more likely to go on to smoke.

Lack of hard evidence

However, the researchers are reluctant to conclude that vaping is causing young people to start smoking, as the results rely on the participants’ self-reported smoking history.

Without biochemical verification, they would be unable to reliably check whether a participant had never previously smoked a cigarette.

“Policymakers have used the findings of studies, including the studies we reviewed in this research, to support the heavy regulation of e-cigarettes, including restrictions on flavours and even total bans, but the evidence that e-cigarette use might cause young people to take up smoking is not as strong as it might appear,” said Jasmine Khouja, a PhD student in TARG based in the School of Psychological Science.

None of the studies were able to provide stronger evidence whether the association of early vaping with later smoking was casual, and much of their evidence also failed to consider the nicotine content of e-liquids.

This makes it difficult to conclude whether nicotine was the mechanism driving the association, the report, published in journal Tobacco Control, claimed.

Derailing efforts to quit

A separate study from the Ohio State University College of Public Health in December warned that knee-jerk reaction bans on e-cigarettes could derail the efforts of millions of people trying to stop smoking traditional nicotine cigarettes.

The US Centres for Disease Control and Prevention (CDC) had reported 48 deaths and 2,291 cases of serious lung injury linked to smoking e-cigarettes, also known as vaping, as of 3 December, prompting the American Medical Association to call for a blanket ban.

Amy Fairchild, dean of The Ohio State University College of Public Health, said that while the alarm was justifiable, the response needed to acknowledge the “powerful evidence” supporting the availability of legal nicotine products.

Juul and the upsurge of e-cigarette use among college undergraduates


Objective: Examine trends in e-cigarette use, and Juul use specifically, among U.S. college students.

Participants: In 2016, we established a cohort of 529 incoming first-year students to a large Midwestern University. In 2018, these students (now third-years) were re-contacted, and a new sample of 611 incoming first-year students was enrolled.

Methods: First-year students in 2016 completed a survey assessing their e-cigarette use; in 2018, first- and second-year students reported on e-cigarette use, and use of Juul specifically.

Results: From 2016 to 2018, past 30-day e-cigarette use rose from 5.9% to 27.7%. In 2018, for Juul alone, ever use was above 35% and past 30-day use was above 20% for both cohorts. Juul use did not differ by gender, but was associated with higher socioeconomic status (SES) and being White.

Conclusions: Findings present disturbing possibilities for long-term nicotine addiction among the next generation, and underscore the need for a rapid public health response.

Neurotoxicity of e-cigarettes


•Electronic cigarettes (EC) are marketed as alternatives to conventional cigarette (CC) smoking.

•Recent accounts of EC- or vaping-associated lung injury (EVALI) have raised concerns regarding their adverse health effects.

•The increased popularity of EC among adolescents and pregnant women calls for further safety evaluation.

•EC may have neurotoxic effects due to nicotine and other chemicals inherent both to e-liquids and EC aerosols.


It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.

Prevalence of Electronic Cigarette Use and Its Determinants among 13-to-15-Year-Old Students in Greece

Download (PDF, 318KB)

Does the gateway theory justify a ban on nicotine vaping in Australia?


•The evidence does not provide strong support for the hypothesis that vaping is a significant gateway to smoking in young people.

•Regular vaping by young never-smokers is rare.

•Most young people who use e-cigarettes have already smoked combustible cigarettes.

•A ban on nicotine vaping prevents adult smokers from accessing a potentially lifesaving alternative to smoking.

•A more nuanced regulatory policy could restrict young nonsmokers’ access to vaping while allowing access for adult smokers.


Australia bans the sale, possession and use of liquid nicotine for vaping. One of the major arguments used to justify Australia’s policy is that the availability of nicotine vaping products will lead a substantial number of young people who would otherwise not have smoked cigarettes to take up regular smoking (the gateway theory). In this article, we provide a critical analysis of the use of the gateway theory to justify Australian policy. We argue first that the evidence that vaping serves as a gateway to smoking is unconvincing. Smoking more often precedes vaping than vice versa, regular vaping by never-smokers is rare and the association is more plausibly explained by a common liability model. Second, we argue that even if the evidence were stronger it would not justify a ban on the sale of nicotine to adult smokers because there are other ways of preventing adolescent vaping that do not require a ban. We describe an alternative regulatory model for Australia that would address legitimate concerns about preventing adolescent uptake while allowing adult smokers to access these products for cessation or as an alternative to smoking cigarettes.

Exploring the Point-of-Sale Among Vape Shops Across the United States

Audits Integrating a Mystery Shopper Approach



Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States.

Aims and Methods

This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents).


95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions.


Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.

The truth behind Philip Morris’ cigarette-free future

Download (PDF, 656KB)

The Secrets of Big Tobacco: Has Philip Morris Really Given Up Smoking?

Download (PDF, 136KB)

The Truth Behind Philip Morris International’s Smoke-Free Future

Download (PDF, 1.64MB)

Historical Perspective of Proactive and Reactive Regulations of E-cigarettes to Combat Nicotine Addiction


Cigarettes and electronic cigarettes (e-cigarettes) are major sources of exposure to nicotine, an addictive chemical. Although these products are being regulated by the Food and Drug Administration (FDA) under the Tobacco Control Act, specifications about the nicotine content in these products have not been established yet. In e-cigarettes, nicotine concentration ranges from 0 to > 50mg/mL, and the recent e-cigarette devices provide control to change nicotine flux for higher nicotine delivery. Due to the lack of robust regulations in manufacturing, distribution and marketing, e-cigarettes have already infiltrated the market with youth appealing flavors and devices. As a result, the country is facing a youth epidemic of e-cigarette use. The unregulated nicotine levels in both cigarettes and e-cigarettes can lead to repeated and overexposure of nicotine to youth which can lead to the addiction and detrimental effects on their cognitive functions. Over the past decade, the corrective measures being taken by the FDA for cigarette and e-cigarette regulations also should focus on nicotine exposure levels. Before it is too late to prevent youth from lifetime addiction to nicotine, it is important to address the issues of nicotine concentration, nicotine flux and the e-cigarette device regulations while offering adults with smoking disorder less harmful alternatives to cigarettes.