How E-Cigarette Use Threatens to Destroy a Decade of Public Health Progress

(Photo: via Flickr/Creative Commons)

By Paul Baresel

After widespread recognition of the health consequences of smoking, including respiratory disease, reproductive disease, diabetes, cardiovascular disease, and cancer, public health initiatives, and legislation have driven adult and student smoking prevalence to 19 and 18.1 percent, respectively, as of 2011 — the lowest rates in 50 years.

The most significant decline in smoking among students occurred after 1998, the same year the Tobacco Master Settlement Agreement dissolved unethical tobacco misinformation research organizations founded by cigarette manufacturers, reformed tobacco marketing regulation, and significantly increased anti-smoking advocacy smoking. With increased public clarity on the health consequences of smoking, absolute restriction on tobacco targeting to youth, and decreased outdoor advertising, cigarette use rates continued to decline for a decade.

Today, public health faces a new form of nicotine use- e-cigarettes. Smoking e-cigarettes, or vaping, has been promoted as a health conscious alternative to cigarette smoking that is gaining significant traction in youths and threatens to set back decades worth of progress.

E-cigarette Health Concerns

Tobacco use among youths is critically important to stemming the epidemic of smoking-related disease. Studies have shown that among adults who smoke, 90 percent started smoking by age 18, and 99 percent by age 26.

Data from the American Journal of Public Health indicates that younger adults have greater smoking cessation success rates than older adults (8.5 percent vs. 5 percent), yet overall cessation for more than six months by both groups achieved by fewer than 1 in 10 individuals. This means that not only are the most effective measures to reduce smoking-related disease likely to be those that target young adults and initial youth smoking, but youth smoking is likely a strong predictor of the smoking disease burden of the United States in the decades to come.

Unfortunately, vaping among youths is on the rise. Studies of U.S. middle and high school students in 2014 show that 4 of every 100 middle school students and 13 of 100 of high school students have used electronic cigarettes in the 30 days prior to polling, up from 0.6 percent and 1.5 percent, respectively, in 2011.

Concerns Surrounding Carcinogenic Compounds

The use of e-cigarettes in youths and adults also differs. Adults tend to use vaping as a smoking cessation tool, while youths are more likely to engage in vaping before or while developing initial smoking addiction.

Worse, e-cigarette use is likely to encourage traditional cigarette use among adolescents, and the dangers of vaping are unknown and potentially significant. Studies show that e-cigarettes, even without the harmful toxins and tar of traditional cigarettes, can still be carcinogenic.

E-cigarettes may also deliver higher doses of nicotine than traditional cigarettes, exacerbating both nicotine’s toxic and addictive properties. Additionally, e-cigarette vapor contains a variety of potential carcinogens and toxic compounds, including propylene oxide and easily volatilized phenolics.

Although they may present a powerful tool for smoking cessation that could ultimately be helpful to public health, a lack of knowledge and regulation surrounding their use and potential harms compounded with their growing use among youths make e-cigarettes a danger to progress against the smoking epidemic.

Youths, the most important target population for reducing smoking related deaths and disease, are the most vulnerable and are increasing in their use of vaping. In order to develop an effective strategy to address e-cigarettes, either as a tool or toxic agent, they must first be standardized and their contents regulated.

The successes of the Master Settlement Agreement, which regulated traditional tobacco research and marketing, ultimately being successful in reducing traditional smoking, should serve as a framework under which to design new legislation for e-cigarettes.

The reduction of national smoking-related disease and deaths is a landmark public health success. Let us continue that progress rather than see it undermined by the changing face of nicotine use.

Paul Baresel is a second year UVM medical student studying public health.

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  • BOC_Sciences

    E-cigarette is just a replacement of the conventional cigarette, as there is still much harm it can pose to health. So this new form of cigarette also should be regulated for a better public health.

    -BOC Sciences Inhibitors

    • castello

      E-cigs are easily 95% safer than smoking! Why would you mislead the public about that?

    • Alan Beard

      Totally invalid reply that just leads to a web page full of YOUR chemicals! You are a chancer,not bringing anything valid to this whatsoever…..shameful commercial exploitation to ‘push’ your product!

    • Fergus Mason

      “this new form of cigarette”

      They’re not cigarettes, you brain donor.

      • BOC_Sciences

        Did you ever attend elementary school? You shouldn’t attack me like that though I said something inappropriate here.

        • Fergus Mason

          “Did you ever attend elementary school?”

          No. I’m British. And why the hell shouldn’t I attack you? You spewed this scientifically illiterate bilge all over the internet. If you want respect, try earning it.

    • Loud biker

      And water is just a replacement of conventional Vodka. What’s your point?

  • castello
  • castello

    Nicotine is not the enemy. You told us to quit smoking and we did! Now you want to move the goalposts?

  • EKeller

    What are the harmful elements in conventional cigarette smoke? To begin with, when organic matter is burned, tar is created. Nothing is burned in an e-cigarette, therefore there is no tar. Also when organic matter is burned, the process of combustion itself creates thousands of chemicals many of which are toxic and some of which are carcinogenic. Also many solid particles join the smoke as the combustion process partially consumes the tobacco and paper. E-cigarettes use the process of vaporization (heating a liquid solution to create a vapor). No chemicals of combustion are created unless the researcher chooses to overheat and burn the equipment to bias the experiment’s results. Also there are no solid particles in vapor because no ash is being created. It is these solid particles, tar, and the toxic chemicals in smoke that damage the body. If you want to know what effect on health nicotine has when it is not inhaled as smoke, look to Sweden where the use of smokeless tobacco is very high. Sweden has the lowest lung cancer mortality rate for males in the EU. The rate for females is not as low because many still smoke rather than use snus.

  • EKeller

    Have you failed to notice that while the rate of e-cigarette use was going up among middle- and high-school students, the smoking rates were plummeting? This trend can be reversed, driving kids to switch back to smoking, with a clever propaganda campaign falsely claiming that vapor is just as hazardous as smoke. But do you really want to see the smoking rates go up? Really? No? Then tell the truth.

  • Mehedi Hasan

    Great news by for all to us.
    Health blog can give us very effective health information.

  • CyZane

    E-cig foes are one of the two: Paid shills of Big Pharma who see their NRT sales shrink as people turn to e-cigs to replace conventional tobacco, or rabid anti-smokers who are against anything that remotely resembles smoking whether harmful or not. Risk is magnitudes less with e-cigs than conventional tobacco and that is the good news. Anti-smoker activists should be embracing the e-cig technology and happy kids are taking up vaping rather than smoking either tobacco or weed.

  • Alan Beard

    Marvelous spin -Paul Baresel you will progress quickly upon graduation with this type of inventive blogging that focusses on the hypothetical so called ‘concerns’ whilst totally ignoring the facts .

    Regular** non-smoking youth take up of e-cigs is well nigh non-existent ie <2% across the globe except in 1 rogue Polish study (Regular = used at least every other day!)

    Your provided links to a carcinogonenic concerns are hardly robust evidence of anything more than your failure to research the subject properly

    A list of ~200 studies is shown here I also suggest you may look up the following and search out work by him and his co-authors , also These are the world experts on smoking cessation who have spent a lifetime in the field of study not some lunatic from the West Coast

  • Kellie

    Mr. Paul Barsel,

    Please read this fully cited research paper write by a Canadian Registered Nurse:

    It should only take you 15 minutes to read & cites 52 credible references.

    As a medical student you have an ethical responsibility to use current credible evidence in your teaching. In regards to your article, please post your references citing:
    1) vaping produces more inhalable nicotine than tobacco smoke
    2) vapour toxicity levels are adverse to human health
    3) vaping leads to tobacco addiction
    4) vaping is as addictive as smoking

    Thank you in advance for your prompt response.
    Kellie Forbes BSCN RN

    • GustavoWoltman

      Great comment, wow! Gustavo Woltmann

  • Lisabelle

    I was pre-COPD, I was pre-emphysema and now I am not thanks to E-cigs. I smoked for 43 years and tried every method recommended to quit. I had limited success, only with E-Cigarettes have I maintained a SMOKE-FREE status and I AM PROUD OF MYSELF! I am proud of Millions of us ex-smoking vapers worldwide!

    • Chuck B

      I agree Lisabelle im using E-cigs and was told that i have COPD a Doc shamed me and said anyone smoking >20 yrs has it. This can maybe buy us a few years thats all i want in this day and age living and being a struggling artist and worker sucks. I been able to not smoke as much with E Cigs indeed. Take Care

  • Fergus Mason

    “e-cigarette use is likely to encourage traditional cigarette use among adolescents”

    Why? This is about the dumbest thing I’ve ever read. It’s like saying drinking fruit juice is likely to encourage drinking metal polish. Why would anyone switch from vaping to something that’s less pleasant, more expensive and highly dangerous?

  • dodderer1
  • Anonymous Vaper

    Where to begin with this..

    1) You do not “smoke” an e-cigarette. It is called “vaping” for a good reason. To mention “smoking” would naturally be associated with *combustion* of which there isn’t any in an electronic cigarette.

    2) If you look carefully at the raw data from *any* survey, you will note quite clearly that combustible tobacco use is falling substantially, which is exactly what those in tobacco control and the anti-smoking advocacy groups actually want. Instead of praising those who have chosen an unacknowledged *harm reduction* method (which may or may not lead to total cessation of recreational nicotine use; which is entirely up to the user), there are claims abound that the advent of e-cigarettes is undermining the last 50 or so years of anti-smoking advocacy.

    The statistics are blatantly clear, even from the CDC: that combustible tobacco use has substantially fallen ever since questions on e-cigarettes have been included.

    3) Yes smokers start young, always have and I dare say always will; *despite* the efforts of the advocacy groups. I do find it a little curious that the data cited ( is used to say that those using e-cigarettes are not effective as a means of cessation, simply because this study *does not include e-cigarettes* but rather includes data from “cold turkey” and pharmaceutical aids. Whilst in other areas, e-cigarettes *are* effective; some say “as effective as traditional NRT” ( whilst others rate e-cigarettes much higher (;jsessionid=A53234383572F5DCDBB9CCED547C654E.f04t01)

    4) The prevalence of vaping is increasing, but by the same token looking at any recent survey data traditional combustible tobacco use is in rapid decline.

    5) “while youths are more likely to engage in vaping before or while developing initial smoking addiction.” – sad to say, there is not a shred of evidence that supports this claim. One of the issues with surveys is their self-reporting nature which could feasibly result in many current smoking youths claiming they don’t smoke when in fact they do. Uptake of vaping by youths, globally is substantially less than those that take up traditional combustible tobacco. Those that do start vaping may “duel use” for a time before switching but in over %90 of cases, the individual *has smoked prior to vaping*; I would like to see the evidence of your specific claim on this.

    6) “Studies show that e-cigarettes, even without the harmful toxins and tar of traditional cigarettes, can still be carcinogenic.” The truly sad thing here, is that the researchers *do not understand* the users of e-cigarettes and are “testing” them as though they were traditional tobacco, ranging from applying high voltages to atomiser coils that *are not designed for those levels* to “8 second puffs” (the average user takes less than 4 second per puff). ( &

    under these conditions it is remarkably easy to generate “high levels of formaldehyde” and “other chemicals”, BUT these conditions are particularly harsh and unpleasant for the user themselves, otherwise known as the “dry puff” phenomenon.

    7) “Although they may present a powerful tool for smoking cessation that could ultimately be helpful to public health, a lack of knowledge and regulation surrounding their use and potential harms compounded with their growing use among youths make e-cigarettes a danger to progress against the smoking epidemic.”

    Perhaps the 20-25% of Stop Smoking Services in the UK have got it wrong by endorsing e-cigarettes as a valid option to aid cessation? Or the National Institute for Health & Care Excellence ( ? Or even the guidelines from the BSI PAS 54115:2015 ? Each of these details how e-cigarettes can successfully be used as a cessation method, covers the safety of the devices AND the liquids.

    8) “The successes of the Master Settlement Agreement, which regulated traditional tobacco research and marketing, ultimately being successful in reducing traditional smoking, should serve as a framework under which to design new legislation for e-cigarettes.”

    The MSA served to do one thing, fill state funds. Yes it may have been relatively effective upon implementation, but only a small proportion of those funds make it to the anti-smoking advocacy groups, instead it’s used to subsidise other State efforts.

    9) “The reduction of national smoking-related disease and deaths is a landmark public health success. Let us continue that progress rather than see it undermined by the changing face of nicotine use.”

    Recreational nicotine use is not the issue here. The issues with smoking are well known, albeit with some questions over just how “harmful” environmental tobacco smoke actually is. The advent of the electronic cigarette is not undermining the progress in the decline of traditional cigarette use, it’s actually caused a rapid decline wherever vaping prevalence is high, the issue is wherever vaping is the target of increasingly strict regulation the decline in tobacco use is slowing dramatically, and in some cases tobacco prevalence is on the increase.

  • Melody Chard

    Sorry Paul Barsel but unless you can give us Current Unbiased Scientific Research results I am goint to look at you as yet another young whippersnapper being used as a hand puppet for the misinformation that is going to cause the deaths of smokers who believe your drivel. You have failed to substantiate any of the misinformation you have posted here. Do you seriously want to ruin your “professional” reputation before it even begins? You are on the wrong side of this equasion buddy! By the way I am a 6 year vaping veteran…..57 years old…..used tobacco for 43 years. It’s Harm Reduction…..not a cessation aid! Nicotine Does Not cause Cancer just in case you didn’t know this!

  • Deej Barens

    I feel sorry for your future patients, since as the first poster asked for citing your references. By not being thorough to back up your claims, all they are is repeating the anti-vaping misinformed rhetoric based on evidence produced by old studies under unrealistic vaping conditions.

  • Ray P. G.Yeates

    “……..the changing face of nicotine use”

    Being only a second year graduate student Paul Baresel certainly limits your qualification to suggest smokers; turned vapers are attempting to undermine years of work in tobacco control.
    Despite its dark side, nicotine hasn’t always been vilified; Native
    Americans, for example, smoked tobacco not only for ceremonial reasons
    but also considered it to have medicinal properties. And it may. Today’s research finds there may be some positive uses for nicotine through safer delivery methods than cigarettes, including evidence that it may reduce the risk of developing Parkinson’s disease and Alzheimer’s disease. It may also show promise as a treatment for depression, anxietyand schizophrenia, and could possibly even help with wound healing [source: Graham, Leary].

    …………and then there’s this:

  • VaEHp

    Headline “Vaping Saves Lives”

    It is estimated that around 50 Million people globally have been able to stop or reduce their tobacco smoking due to this revolutionary disruptive device, Now that’s Progress !

    I had continual failure trying to quit smoking with little or no hope… until Personal Vaporizers came along. Vaping quickly ended my 34 year Tobacco Smoke addition. Its been just over 2 years now.

    A plethora of supporting and compelling information is available now,

    I cant seem to post any links here without getting tagged as spam… so please take a moment to type these out and review, you wont be disappointed.

  • Bruce Nye

    It might be an important perspective to understand the background and relative risk in the teenage use of vapor products. To aid in understanding that perspective I put together a researched brief which will illustrate the proportionate risk and dispell some of the fear based assumptions that threaten the reduction in smoking prevalence. You can find the brief here:

    This is, again, a brief paper. There is far more research in support of the points made, and that research was aided by men and women such as yourself whom I regularly work with to bring their education to fruition. I hope this will open your mind to the tremendous opportunity to reach a world where the devastation that smoking causes so many will no longer distract us from our primary purpose, to provide aid and comfort to those who suffer.

    Godspeed on your quest to become a physician and public health advocate.

    -Bruce Nye, ASN, MSCS, RN
    Trauma/Surgical Unit
    Creighton University Medical Center

  • Daniel Walters

    Could you please post your reference material. We need to find out where the “idiots” are getting this false material and stop the spread of these outright lies and misinformation. You should be ashamed of yourself, calling yourself a health professional is making a mockery of real health professionals.

    • melawyth

      I did check a couple of his links. It’s old stuff done on older equipment, or the flawed “studies” that were debunked almost immediately last year.

  • melawyth

    I’m appalled that a magazine or journal issued by a university would accept and publish an article with arguments as unsubstantiated as these. There is a wealth of easily-accessible research on the efficacy and safety of personal vaporizers (please see the links offered by others on this thread) and I would expect any graduate student to make himself familiar with it before writing something on the subject. This is all at the tabloid level and totally irresponsible journalism.

  • Mitch Fewer

    I sent Mr. Baresel a PM requesting he come back here and provide his sources. There has been no response. Mr. Baresel if you are reading this the people here have DONE the research and we know better. If you can’t back up your article it is nothing more than a baseless opinion piece. We’ll put our knowledge of the facts against yours and see where the truth lies.

  • gotsteam

    DO as I SAY! NOT as you wish to do! You are not capable of living your own life therefore WE must tell you how to live. If WE say vapor is just as bad as smoking, you MUST believe us. Never-mind that other research says something contrary.

    In reality, E-Cigarette Use Threatens to Destroy a Decade of Milking and Bilking the Public Health CASH COW.

  • Venus Timberlake

    To reduce the rate of teenage smokers is a big problem. If it work, the rate of cigarette related disease will decline.

  • Neal Arrendo

    Vaporizers, on the other hand, are bigger and don’t resemble traditional cigarettes quite as much, but can deliver more consistent nicotine delivery, battery longevity and a much larger variety of flavors and features. You have to decide what is most important to you and make your choice.


  • john Walker

    Paul Hi,
    Wondering, do you understand the inherent , very large qualitative differences in the complex compounds produced by : slow burning virtually any complex organic compound, with insufficient oxygen present; i.e smoke. Versus the compounds produced by boiling a organic liquid ,at well below its ignition temp, i.e vapor ?

    In terms of risk comparisons smoke is intrinsically an ‘elephant’ whereas vapor is a ‘sparrow’ ; even if the sparrow turns out to be largish as sparrows go, it will still be minuscule when compared to the elephant.

  • Maria Jonshan

    E-cigarettes are frequently referred to as E-cigs, e-hookahs, vapes, vape among other names.

  • john

    Nicotine is addictive and also harmful for health, with normal cigarettes we inhale nicotine and thousand of chemicals but if we talk about electronic cigarettes then we see that we have an option to choose the level of nicotine which is not possible with normal cigarettes.

  • Vape Beat

    E-Cigarette is less harmful then the normal cigarette…

  • Vape Beat

    e cigarette is less harmful then the normal cigarette..

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  • Lisabelle

    The dose makes the poison, I suggest you might want to stop eating tomatoes, potatoes, peppers and eggplant since all contain nicotine. Compared to real smoking which whallops one with a fast and heavy amount of Nicotine plus 3000 or more chemicals that combustion creates. Methods of delivery of nicotine, even the Nicorette gum has more chemicals than Electronic Cigarettes which are used almost entirely according to safety standards which are in place. There are over 15 Million Americans that vape to reduce or quit smoking entirely. We are proud to be ex-smokers and find vaping more enjoyable than smoking ever was. Nice to have your sense of smell and taste again. Nice not to smell like an ashtray, Nice not to have burns in clothing or furnishings. Nice to not wheeze oneself to sleep each night. Nice to not hack up a lung in the morning. Nice to not be out of breath climbing a flight of stairs. So many positives really exist, yet so much Pharma sponsored propaganda does as well

  • Martins Beltens

    Vaping is much more better than smoking.
    I used to smoke for 10 years and felt terrible. Then I started to vape and after 3 months of vaping I finally quit. Vaping is super gateway to quit smoking

  • computechguide

    The rise of eCigs and vaping is only due to it’s technology and mostly it attracts youth. As per my experience and reading, ecigs is as harmful as smoking but due to new product, people simply try it.