On the occasion of this year’s World No Tobacco Day, the World Health Organization published a report entitled “Hooking the next Generation”. It contains a lot of information about e-cigarettes that have been around for years and are being vaped by millions of users. According to the report, major tobacco companies have reshaped their messages and products to target children and teenagers in an attempt to replace the millions of smokers who die from their products each year. Why children at these ages are excellent targets for these companies is because if they become addicted to nicotine before the age of 21, there is a high probability that they will remain addicted for the rest of their lives, the report states.

Specifically according to the WHO, around 37 million children and adolescents aged 13 to 15 already use tobacco worldwide and this is the fault of the tobacco and e-cigarette industry, which targets children by selling products with fruit and candy flavors and cartoon designs. Something, of course, that the companies deny.

“Public health crisis” due to vaping

Between 2018 and 2019 public health officials in the US identified a “public health crisis in vaping.” Since then, initiatives have been introduced around the world trying to curb the situation, but what was then called a “crisis” now appears to be a simple reality. It’s hard to walk down the street in a busy city without noticing someone blowing a large bubble of steam out of their nose or mouth. Many of the so-called Generation Z have spent their childhood sucking nicotine through plastic objects that, at first glance, look like popsicles or, more crudely, adult pacifiers. According to the report, major tobacco companies have tailored their messages and products to target children in an attempt to replace the millions of customers who die from their products every year.

According to the WHO report, children aged 13 to 15 use e-cigarettes at higher rates than “adults in all WHO regions. The authors wrote that 32% of 15-year-olds surveyed in Europe reported using e-cigarettes at some point, while 20% reported using in the past 30 days. Most of these children did not use vaporizers to quit smoking, the WHO report said. When one is not familiar with the world of vaping, one may wonder what the WHO is talking about when it uses words like “vape” or “e-cigarette”.

What does vaping mean?

E-cigarettes, or vapor – the WHO report uses the term interchangeably – first appeared on the US and European markets in the mid-2000s. These products, often designed to look like regular cigarettes, used “free-base” nicotine ». Freebase nicotine has been around since the 1960s, when tobacco companies realized that by adding ammonia to nicotine they could de-proton it to make it more potent when heated and inhaled. This form of nicotine is extracted directly from the tobacco plant. The problem with freebase nicotine, at least when it comes to appealing to children, is that it becomes physically painful to vape at high concentration levels and still produces the “throat burn” that former cigarette smokers “crave” but would unpleasant for people who have never smoked.

The first vapor cigarettes usually contained between 3mg and 12mg of nicotine. In 2016 the Juul company introduced a vaporizer that featured a new type of nicotine delivery: nicotine salts Nicotine salts have a solution with a lower pH, virtually eliminating the throat burn caused by free-base nicotine, even at very high concentration levels. These devices hit the US market at a highly addictive 50mg concentration. In Europe they cannot be sold in a concentration above 20mg. When it comes to attracting children, these devices are magical because they are subtle. They can be vaporized in bathrooms or on your sleeve or shirt, and the fruity smell only lingers in a room for a few minutes. Unlike cigarettes, which “betray” users with their pungent smell, vapor cigarettes can easily be hidden from prying parents. The WHO writes that in addition to giving millions of dollars to public health policy on vaping, tobacco companies are also trying to influence scientific research being conducted to measure the health effects of vaping devices.

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The long-term effects of vaping are unknown

The report’s authors said that in 2024 tobacco company Philip Morris International sponsored a smoking cessation course on Medscape, a US-based medical news website, that presented “nicotine products as relatively harmless.” The series was canceled after complaints. Scientific information about vaping is confusing, including advice on vaping during pregnancy or using vaping to quit smoking, and whether vaping causes cancer. Even to a journalist following the issue closely, public health messages from the UK, for example, suggest that vaping is safer than cigarettes and should be encouraged for smoking cessation, while messages from other countries, such as the US, refrain from recommending vaping under any circumstances. Which of these policies is correct, no one can imagine. Because these products are still so new, we simply don’t have the studies needed to truly understand the long-term health consequences of inhaling watermelon-flavored nicotine vapor dozens of times a day, every day for many years, and especially when it comes to children . “Children are excellent targets for these companies because if someone becomes addicted to nicotine before the age of 21, there is a high probability that they will remain addicted for life,” the report states. And it makes them more attractive by selling products with fruit and caramel flavors and cartoon designs.

We do know, however, that there is almost no health benefit from smoking nicotine or tobacco, and certainly no benefit for pre-adolescent children who have never smoked and started smoking. Some studies have shown that children who start vaping later are more likely to smoke cigarettes. Many studies have shown that nicotine has a negative impact on brain development and increases the risk of cancer. Smoking affects reproductive health, causes a reduced immune response, affects cell and tumor proliferation, and causes resistance to chemotherapeutic agents. We know all this. In recent decades, massive public health efforts have been launched around the world to get people to quit smoking. They were largely successful. According to WHO estimates, cigarette use has been steadily declining over the past two decades worldwide. The authorities thought they had caught up with the tobacco companies. And maybe they had, for a few years. But just like that, companies found a new generation of customers.

Editor: Irini Anastasopoulou