Rassegna Stampa Scientifica Novembre 2022






Big Tobacco Heralds a Healthier World While Fighting Its Arrival

The industry continues to fight efforts to restrict certain products, like spending heavily to urge California voters to overturn a law banning tobacco flavors.

 The fight shaping up over government restrictions on menthol and nicotine highlights the longstanding resistance of the tobacco industry to regulations, despite corporate claims of support for a smokeless alternative. [Photo Cutline]

 By Julie Creswell and Matt Richtel


Nov. 6, 2022


For decades, public health advocates chipped away at the influence of Big Tobacco with measures aimed at discouraging cigarette use. But the bitter legal and political battles were just a prelude to the unfolding climactic clash that could determine the fate of smoking and whether these companies adapt or falter.

 U.S. health officials have launched the most aggressive attack by far on cigarettes: Twin government proposals would ban menthol-flavored cigarettes and would limit nicotine levels to make traditional smoking less addictive. At the same time, the government is slowly embracing vaping as an alternative by authorizing the sale of some e-cigarettes, which can provide smokers a nicotine fix without many of the carcinogens.

 The measures are the source of a clash expected to play out over the coming months and years in courtrooms, legislative hallways and regulatory hearings. For public health advocates, the steps are aimed at saving millions of lives and reducing the billions of dollars spent on smoking-related illnesses like cancer and heart disease.

 Big Tobacco has said it embraces the transition — sort of.

 “We have an unprecedented opportunity to move beyond smoking,” Billy Gifford, chief executive of Altria, one of the world’s biggest cigarette conglomerates and the parent company of Philip Morris USA, told Wall Street analysts and investors in late October. The opening slide of his presentation offered a company vision: “To responsibly lead the transition of adult smokers to a smoke-free future.”

 Major cigarette companies, like Altria and R.J. Reynolds, acknowledge that cigarettes are dangerous and addictive, and they are heralding their investments in electronic cigarettes and other less-harmful alternatives to cigarettes. But, with much less fanfare, they are taking steps to slow the very smokeless future they claim to want: The companies have submitted letters protesting the proposed menthol ban in traditional cigarettes, and they have signaled they will similarly resist any efforts to lower nicotine levels.

 And Big Tobacco isn’t just duking it out at the federal level, but fighting local initiatives. For example, in California, the industry has spent heavily to stop a 2020 law from taking effect that would ban the sale of flavored-tobacco products including menthol. Putting the law in place depends on a majority of state voters supporting a Nov. 8 ballot proposition favoring the law, and the industry has spent $22 million to to try to persuade voters to reject the measure and the flavor ban.

 The California Coalition for Fairness, the tobacco industry-funded group behind the campaign that succeeded in getting the referendum on the ballot, argues the flavor ban “benefits the wealthy and special interests while costing jobs and cutting funding for education and health care.”

 Mr. Gifford, in his late October call with investors, said of the flavor ban: We don’t believe science supports it.”

 In various statements, R.J. Reynolds, owned by British American Tobacco and the second-largest cigarette company in the United States after Altria, has said it also embraces less harm but continues to hew to a business model that critics say puts public health second to profits.

 In Reynolds’s filing against the menthol ban, it wrote that, broadly, it “fully supports F.D.A.’s goal of reducing tobacco-related disease.” But, it contended, “menthol smokers would simply switch to nonmenthol cigarettes or turn to riskier options such as illicit market cigarettes.” The company declined further comment beyond its filing.

 As the smoking population in the United States has fallen to 13 percent from 21 percent in 2005, far from a peak of about 45 percent of adults in 1954, and public opinion has turned against cigarettes, the legal and political might of Big Tobacco has shrunk, too. A Gallup survey conducted in July found that 74 percent of Americans favored “requiring tobacco companies to lower nicotine levels in cigarettes to make them less addictive.” About 42 percent favored banning menthol-flavored cigarettes. (Under the current proposal, menthol e-cigarettes could be sold.)

 But the industry still earns billions of dollars in revenues, and it hopes to use its remaining clout to stall these monumental proposals at the regulatory level and in court — or stop them altogether.

 “This spring and summer, I would say, we’ve seen the most significant period of proposed regulations by the F.D.A. ever. Full stop,” said Sarah Milov, an associate professor of history at the University of Virginia and author of “The Cigarette: A Political History.” “With this industry, it’s all about where they are making their money. We will see them fight the menthol and nicotine rules, and that will be another demonstration of their continued commitment to combustible cigarettes.”

 A broad group of allies has joined the tobacco industry in the fight against the menthol ban by. There are those with financial stakes in the outcome, like the National Association of Convenience Stores, which say they would lose billions of dollars in annual sales, and the New York City Newsstand Operators Association.

 The menthol ban has also drawn opposition from think tanks like the Tax Foundation, which said federal and state governments could lose a combined $6.6 billion in tax revenues the first year. The American Civil Liberties Union has also opposed the ban, saying it would disproportionately affect communities of color.

 Major cigarette companies, like Altria and R.J. Reynolds, submitted letters last summer protesting the proposed menthol ban in traditional cigarettes. [Photo Cutline]

 In particular, the proposed ban has divided Black leaders across the country, especially since companies heavily marketed menthol cigarettes to Black smokers, who now prefer them at a much higher rate than white smokers do. While some welcomed the proposal as a way to lower cancer and heart disease, others expressed concerns that enforcing such a ban would lead to unwarranted police interactions with Black Americans. Big Tobacco has heavily lobbied against the ban with Black political leaders and retained some to help sew doubt and fear about the ban in communities around the country.

 Many opponents have challenged the F.D.A.’s legal authority to regulate tobacco products in far-reaching ways. But no matter how the companies promote their position, industry critics say that their goal is to maintain the lucrative share of the cigarette market at all costs. No wonder: Sales in the U.S. totaled $65 billion in 2021 —- one-third of it from menthol — dwarfing sales of e-cigarettes.

 “It’s absolutely false that they want to have their smoking customers quit or shift to less harmful tobacco products,” said Eric Lindblom, a senior scholar at the O’Neill Institute for National and Global Health Law at Georgetown University and a former adviser to the F.D.A. “If they were serious about having smokers quit, they would stop opposing any efforts at the federal, state and local level to regulate and tax smoking tobacco products more sharply.”

 Traditional cigarettes have become more expensive, though. A study published this year in JAMA found that from 2015 to 2021, the number of packs of cigarettes sold in the United States fell to 9.1 billion a year from 12.5 billion, a 27 percent drop. To compensate, tobacco companies increased prices — rising 29.5 percent a pack during that period, to $7.22 from $5.57.

 Inflation plays a role, too. In the first nine months of this year, Altria reported a steep 9 percent decline in sales volumes, with executives noting that customers were changing behaviors to save money, like buying single packs of cigarettes, rather than cartons.

 Company share prices have also fallen.

 “Most investors knew new regulation was coming, but the threat seemed far into the future,” said Christopher Growe, an analyst at financial services firm Stifel Financial. “I think menthol has more immediacy, but nicotine regulation is a long, long way away.”


The transformation of tobacco

On some level, the battle over menthol and nicotine limits extends the government’s efforts to chip away at smoking, even as the industry resists at every turn. But this moment is also fundamentally different. For the first time, many public health officials have embraced a strategy of harm reduction, which is not just to curb the cigarette market but to accept and even advocate for an alternative with e-cigarettes.

 This strategy is not one that public health officials adopted lightly: For years, many were skeptical about legalizing e-cigarettes, worrying that the devices hooked a new generation on nicotine and lured young people into the vaping crisis.

 Twin government proposals involve outlawing menthol-flavored cigarettes and limiting nicotine in cigarettes. At the same time, the government is slowly embracing an alternative by legalizing the sale of some e-cigarettes. [Photo Cutline]

 While public health experts debated the merits of e-cigarettes, major companies argued that, absent that alternative or other products, there were no appealing options to help smokers quit.

 Mitch Zeller, who retired this year from his post as director of the F.D.A.’s Center for Tobacco Products, said that for all his experience with the companies, he wasn’t sure that they would accept a smokeless future. How they respond to the new proposals will be “a test of their sincerity,” he said.

 “It’s a day of reckoning for the industry,” Mr. Zeller said, adding of the tobacco companies. “They’ve got to make a decision.”

 He acknowledged that the tobacco companies were in a tough position, having widely deployed “rhetoric” supporting alternatives but, at the same time, having to answer to shareholders whose returns were still reliant on cigarette sales and profits.

 “They have a fiduciary duty to their shareholders,” he said. He added, however, that regulation might force the companies to adapt, no matter how hard they resisted.

 Still, tobacco giants are pushing back against any efforts to curb sales. The industry has persistently sued to stop the federal government from requiring larger, graphic warnings on packages about the deadly risk of cigarettes. And Big Tobacco companies have continued to ply a tactic they’ve used for years: poaching former F.D.A. employees, mostly recently with Philip Morris International hiring Matt Holman, who was the chief of the science office in the agency’s Center For Tobacco Products.

 The tobacco industry has been joined in the struggle against the menthol ban by broad group of allies, like the National Association of Convenience Stores and the NYC Newsstand Operators Association. [Photo Cutline]

 If the F.D.A. pushes through a menthol ban, the tobacco industry will “dig in” and go to court, said Marc Scheineson, a former associate commissioner at the agency who is now a partner at the law firm Alston & Bird, which represents some smaller tobacco companies. “If there are rules that are put in place with the F.D.A. sort of ignoring valid scientific objections or criticisms, it will end up in court again.”

 He noted a recent win for the Cigar Association of America, which challenged the F.D.A.’s regulation of premium cigars. In that case, U.S. District Judge Amit Mehta in Washington, D.C., said the F.D.A. had acted “arbitrarily and capriciously” and ignored or overlooked evidence provided by the industry. The case is still pending.

 In another blow to the F.D.A., the U.S. Court of Appeals for the 11th Circuit in late August set aside marketing denial orders for six e-cigarette companies, saying the agency there, too, had been arbitrary and capricious in its decisions.

 Mr. Scheineson said he hoped a compromise could be reached. He asked: Could nicotine be reduced in a slow, laddered way while allowing menthol cigarettes to be sold?

 In the interim, all e-cigarette companies have had to apply to the F.D.A. to remain on the market, now that the agency has received expanded authority to regulate vaping devices and e-cigarettes. The F.D.A. is wading through applications for 350 products, according to a letter published in Augustby Brian King, the director for the Center for Tobacco Products. In the last two years, the agency has authorized the sale of about two dozen vaping products.

 And the biggest tobacco companies are vying for their piece of the budding market. Last year, the F.D.A. approved several Vuse products by Reynolds. However, the agency has not yet ruled on the sale of Vuse Alto, the company’s biggest seller to date, which accounted for 95 percent of its e-cigarette sales last year and displaced Juul as the top-selling vaping product. Vuse Alto has gained in popularity in recent years for its small, sleek design, longer battery life and the fact that it wasn’t mired in the same teenage-use controversy as Juul.

 Altria’s strategy had long appeared to be pinned to its relationship with Juul Labs. In 2018, Altria paid $12.8 billion for a 35 percent stake in Juul. But even before Juul lost its initial bid in June for authorization to keep selling certain products on the U.S. market, the company’s products had been severely restricted by public pressure to pull flavored e-pods off the market out of concerns for their appeal to teenagers. The F.D.A. reversed itself this summer and is granting an additional review to Juul’s application for certain tobacco and menthol products to stay on the market.

 By late September, Altria had taken a more than $12 billion cumulative loss on Juul, valuing the investment at $350 million. Altria said it ended its noncompete agreement with Juul, opening up the possibility it could acquire another e-cigarette company to compete in the space, some analysts predict. Meanwhile, reports emerged in October that Juul might seek bankruptcy protection.

 Besides Juul, Altria also has stakes in companies that make nicotine pouches, a product that is placed between the cheek and jaw.

 Another category of cigarette alternatives are known as “heat-not-burn tobacco sticks.” In October, Altria announced that it sold the U.S. rights to sell IQOS, a heat-not-burn tobacco stick, for $2.7 billion to Philip Morris International.

 To fill the void, Altria promptly announced a new joint venture with Japan Tobacco to develop a heat-not-burn stick called Ploom for the U.S. market.

 On Altria’s call with investors in late October, Mr. Growe, the Wall Street analyst from Stifel, asked the company’s chief executive when a new Ploom product might be available. “Do you have a reasonable time frame for launching a product in the U.S.” he asked, and then added a few sentences later: “Or am I getting ahead of myself here?”

 “I think you’re getting ahead of yourself a little bit,” said Mr. Gifford, Altria’s chief executive.

 “Maybe underlying your question is: ‘why are you taking so long,” Mr. Gifford continued. “And I think it goes back to, look, we want to be disciplined.”

 Mr. Gifford said that Altria absolutely wants to create an alternative to the cigarette, but not in a hasty fashion. “We need to go about it in a thoughtful manner.”

 Julie Creswell is a New York-based reporter. She has covered banks, private equity, retail and health care. She previously worked for Fortune Magazine and also wrote about debt, monetary policy and mutual funds at Dow Jones. @julie_creswell

 Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter based in San Francisco. He joined The Times in 2000, and his work has focused on science, technology, business and narrative-driven storytelling around these issues. @mrichtel






Rassegna Stampa Scientifica Dicembre 2022




“New Zealand has introduced a steadily rising smoking age to stop those aged 14 and under from ever being able to legally buy cigarettes in world-first legislation to outlaw smoking for the next generation. Associate health minister Ayesha Verrall said at the law’s passing on Tuesday: “Thousands of people will live longer, healthier lives and the health system will be $5bn better off from not needing to treat the illnesses caused by smoking, such as numerous types of cancer, heart attacks, strokes, amputations.” New Zealand is believed to be the first country in the world to implement the annually rising smoking age, ensuring tobacco cannot be sold to anyone born on or after 1 January 2009. It will be accompanied by a slew of other measures to make smoking less affordable and accessible, including dramatically reducing the legal amount of nicotine in tobacco products and forcing them to be sold only through specialty tobacco stores, rather than corner stores and supermarkets.” [Tess McClure. New Zealand passes world-first tobacco law to ban smoking for next generation, The Guardian]


“The Supreme Court [this past] Monday refused to block a California law banning flavored tobacco, clearing the way for the ban to take effect next week… R.J. Reynolds, the maker of Newport menthol cigarettes, had asked the justices to intervene before next Wednesday, when the law is set to go into effect. The company, joined by several smaller ones, argued that a federal law, the Tobacco Control Act of 2009, allows states to regulate tobacco products but prohibits banning them… Last week, the Justice Department announced an agreement for 200,000 retailers to display eye-catching signs in their stores about the dangers of cigarette smoking. The order goes into effect in July and gives retailers three months to post the signs. The agreement settles the terms of a 1999 racketeering lawsuit filed by the U.S. government against tobacco companies, including Reynolds.” [Adam Liptak. Supreme Court Refuses to Block California’s Ban on Flavored Tobacco, NY TimesSee also: U.S. Supreme Court lets California ban flavored tobacco products, Reuters]


“Juul Labs, the e-cigarette manufacturer, announced [last] Tuesday that it has reached settlements covering more than 5,000 cases with nearly 10,000 plaintiffs. The sweeping resolutions, which litigators say will address youth e-cigarette usage, come after more than three years of legal battles. The settlements include compensation for those suffering from nicotine addiction and other health problems as well as reimbursement for those who purchased Juul products... Juul did not disclose the settlement amount… But Robert Jackler, a Stanford medical school professor who researches the impact of tobacco advertising and served as an expert witness in the proceedings, was less optimistic. “Time and again, tobacco companies absorb sizable legal settlements as a cost of doing business, only [to] reemerge as highly profitable purveyors [of] nicotine products, which they market to youth.”” [Kelsey Ables. E-cigarette firm Juul settles 5,000 lawsuits amid teen vaping concerns, Washington PostSee also: Juul settles more than 5,000 lawsuits over its vaping products, NPR]


“Using e-cigarettes to quit was associated with significantly lower odds of having stopped smoking cigarettes (odds ratio, 0.62; 95% confidence interval, 0.45–0.85), controlling for nicotine dependence and demographics… Ever-smoking youth who used e-cigarettes “to try to quit using other tobacco products, such as cigarettes” had lower odds of having stopped smoking cigarettes than those who did not use e-cigarettes as to try to quit. Physicians, regulators, and educators should discourage youth from attempting to use e-cigarettes as a way to stop smoking cigarettes.”


e-Cigarettes Used by Adolescents to Try to Quit Smoking Are Associated With Less Quitting: A Cross-Sectional Analysis of the National Youth Tobacco Survey

Journal of Adolescent Health

Available online 5 December 2022

In Press, Corrected Proof

Stanton A. Glantz.



“The growing use of e-cigarettes has been condemned as a significant health crisis by some and welcomed as an unprecedented opportunity to eliminate combustible tobacco by others. Seeking to better understand the contestation and range of perspectives on this issue, this article employs an interpretivist approach to identify how experts communicate their perspectives on these issues…  Throughout, experts struggled and disagreed with precisely where and how to define “harm reduction." Overall, this study significantly expands on past literature by delving more deeply into the broader ideological contexts in which these policy disagreements occur, and the argumentative strategies employed within them.”


Understanding experts’ conflicting perspectives on tobacco harm reduction and e-cigarettes: An interpretive policy analysis

SSM - Qualitative Research in Health, 2, 100197.

Available online 24 November 2022, Version of Record 2 December 2022.

Daniel Eisenkraft Klein, Benjamin Hawkins, Robert Schwartz



Note: Open Access.


[Kenyan farmer] Siprone Chacha “was tempted into tobacco cultivation by the prospect of increasing her income. However, she found that by the time she had cut down trees, cleared land, planted the crop, paid for the pesticides and the fertilizer, and then carefully nurtured the crop to maturity it was hard to make a profit. On top of everything else, the buyer with whom she had a contract did not accept all of her leaves. “If the leaf was not perfect, he would not take it which meant that I had to dump the unsold crop on my land which was poisoned by the nicotine.”


Cultivating tobacco-free farms

Bull World Health Organ. 2022 Dec 1; 100(12): 754–755.

Gary Humphreys



Note: Open Access.



Rassegna Stampa Scientifica Febbraio 2023




 Lancet: Global cancer: overcoming the narrative of despondency

“It is easy to become despondent about global cancer. Feb 4 marks World Cancer Day, and renewed calls to “close the cancer care gap”. But the worldwide inequities in cancer care and control are deeply rooted… Robust taxation and regulation to tackle the commercial determinants of health that drive cancer burden—primarily related to tobacco, alcohol, and junk food—is essential. Health promotion and education can prevent illness and raise awareness to help catch disease early… Following a 2005 World Health Assembly resolution, each country has been encouraged to prepare a national plan for cancer control… But while more than 150 countries now have such plans, an analysis from 2018 shows that quality varies wildly. 10% had no strategy for tobacco control… The impact of cancer on societies is unavoidable. NCDs [non-communicable diseases] are becoming the increasingly dominant health challenge for many low-income and middle-income countries, with cancer a rising priority. The urgency will only accelerate… Political legacies and reputations will depend on how the question of cancer is answered.”



Global cancer: overcoming the narrative of despondency

The Lancet

VOLUME 401, ISSUE 10374, P319, FEBRUARY 04, 2023




Editor’s Note: Your work matters. Open Access.



Spain: Deceptive THR Summit in Peril; UK: Tighter Vape Regulations

“A "congress" scheduled for King Juan Carlos University that aims to position electronic cigarettes at the center of academic and scientific debate about the weapons used in the fight against smoking has led to a crisis behind the scenes in recent days in which the World Health Organization (WHO) and the Ministry of Health have gotten involved, and which has put the future of the event at risk, as confirmed to EL PAÍS by the parties involved. The THR [Tobacco Harm Reduction] Summit Spain 2023 is scheduled for February 23rd in Madrid with the title ‘Opportunities in the fight against smoking: a global scientific vision’… King Juan Carlos University has decided to distance itself from the event. The rector will no longer attend and has asked the rest of the organizers to withdraw their logo from all documentation and is studying whether he can prevent the congress from being held on University premises.” [Oriol Guell. Sanidad y la OMS ponen en jaque un gran congreso favorable a los cigarrillos electrónicos previsto en Madrid (Health Ministry and WHO place in peril a major pro e-cigarette conference scheduled for Madrid), El País. Ed. Note: I’ve lightly edited some sections of the El País article but recommend the Google Translate full text as the piece gives a good and detailed overview of the THR crowd machinations not reflected above.]


“Vapes should be taxed and displayed in plain packaging behind the counter to reduce their popularity among children, health campaigners and councils have warned. To tackle the rapidly growing popularity among children and young people, Action on Smoking and Health (Ash) is calling on Jeremy Hunt, the chancellor, to set out a £4 excise tax on single disposable vapes on top of the usual £4.99 price. The Local Government Association (LGA) is also requesting action, urging ministers to tighten regulation on the display and marketing of vaping products to match tobacco.” [Rachel Hall. UK campaigners call for tighter regulations on vapes to match tobacco, The Guardian. See also: Disposable Electronic Cigarettes (Prohibition of Sale). First Reading, Hansard. Ed. Note: Given the outlier, pro-vaping past positions from ASH (London) and many UK authorities, this is welcome news, however belated.]


“Maternal snuff use was associated with increased risks of post neonatal mortality, SIDS [Sudden Infant Death Syndrome], and SUID [Sudden Unexpected Infant Death]. Nicotine is the common substance in cigarette smoke and snuff. These findings support the hypothesis that nicotine contributes to an elevated risk of SIDS… Snuff use in early pregnancy was associated with a more than tripled risk of SIDS, aOR 3.70 (95% CI: 2.06–6.65) compared to that of nonuse. Maternal smoking was also associated with higher risk of SIDS, aORs were 4.31 (95% CI: 3.26–5.70) and 7.03 (95% CI: 5.04–9.79) for moderate and heavy smoking, respectively. Maternal snuff use was associated with an almost tripled risk of SUID, aOR 2.90 (95% CI: 1.75–4.80). Maternal smoking was also associated with higher risk of SUID, with aORs 3.20 (95% CI: 2.53–4.05) and 5.44 (95% CI: 4.10–7.22) for moderate and heavy smoking, respectively.”


Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study

Pediatric Research

Published: 09 February 2023

Anna Gunnerbeck, Cecilia Lundholm, Samuel Rhedin, Ayoub Mitha, Ruoqing Chen, Brian M. D’Onofrio & Catarina Almqvist



Note: Open Access.


Related PR:


Nicotine exposure during pregnancy may increase risk of sudden infant death



“Overall, 62.3% of adults [6,455 survey participants] supported a policy to prohibit the sale of menthol cigarettes… Nearly two-thirds of adults supported prohibiting menthol cigarette sales, while more than half of adults [57.3% of respondents] supported prohibiting all tobacco product sales. Support for these policies was similar, which may be explained by general support for tobacco retail policies. Policy support varied by certain demographic characteristics and current tobacco product use… Although support for both policies was lower among people who reported current tobacco product use compared with those who did not, more than one-third of respondents who currently smoked cigarettes or menthol cigarettes still supported prohibiting menthol cigarette sales, and more than one-quarter of these respondents supported prohibiting all tobacco product sales.”



Prev Chronic Dis 2023;20:22Support for Policies to Prohibit the Sale of Menthol Cigarettes and All Tobacco Products Among Adults, 20210128.

Volume 20 — February 2, 2023

Al-Shawaf M, Grooms KN, Mahoney M, Buchanan Lunsford N, Lawrence Kittner D.




Note: Open Access.




Rassegna Stampa Scientifica Marzo 2023




“Most experts agree that vaping carries far lower health risks than smoking, says Ann McNeill, professor of tobacco addiction at King’s College London. “Nicotine is an addictive substance but not the one that kills,” she says. But nuance is important: “If you’ve got something very dangerous and something much less dangerous, it doesn’t mean it’s harmless.”… The rise of the disposable vape has been meteoric. In 2021, just 7.7% of teenage vapers used them; by 2022, this figure had jumped to 52%... McNeill acknowledges that “disposables seem to be more attractive to the younger audience”. “I think that is something we need to look at – if we are seeing ‘never smokers’ taking up disposables, we need to make sure we’re enforcing the law so that these products can’t be sold quite so readily as they clearly are at the moment.”” [Clea Skopeliti. ‘Beside himself with craving’: the teenagers hooked on vaping, The Guardian]


“Sydney councils are looking at updating their “no smoking” signs to explicitly mention e-cigarettes after concerns that vapers do not know that the prohibitions apply to them too. A legislative amendment in 2018 expanded all NSW [New South Wales] non-smoking legislation – such as rules banning the use of cigarettes in indoor public areas, cars and outdoor dining areas – to include the smoking of e-cigarettes… The number of people who smoke cigarettes in NSW has dropped to record levels, although vaping is increasingly popular. The latest NSW Population Health Survey showed the number of people aged 16 to 24 who were current vape users more than doubled to 11 per cent in 2021.” [Mary Ward. Why vapers don’t know they are also banned from non-smoking areas, Sydney Morning Herald]


“This Black History Month [in February], I have a simple message for nonprofit organizations in the United States: If you have accepted money from the tobacco industry, send it back. For hundreds of years, from enslaved people working on tobacco plantations to today’s menthol smokers, Black people have died for the tobacco industry’s profit. Today, the makers of Marlboro, Camel and Newport are using cash donations to polish their images and influence policy while approximately 45,000 Black Americans die of smoking-related illness every year… Tobacco’s shameful chapter in that story [through the lens of African American history and culture] is forever connected to the slave trade and tobacco plantations, where forced labor formed part of the foundations of the United States — and what is now a global tobacco industry.” [Phillip Gardiner. Black history has taught us that Big Tobacco is not an ally, Washington Post]


“In their articles critiquing the US Food and Drugs Administration’s (FDA) first marketing order to allow the legal marketing of any e-cigarette, for Vuse Solo tobacco-flavoured e-cigarettes, Glantz and Lempert and Meshnick et al discuss a range of serious procedural, technical and substantive problems with FDA’s publicly released explanation of how its evaluation of the Vuse application supports that order as appropriate for the protection of the public health. …Glantz and Lempert and Meshnick et al reasonably conclude that FDA should withdraw its order allowing the marketing of the Vuse Solo e-cigarettes because the agency did not adequately evaluate the Vuse Solo application, did not establish that allowing its marketing was ‘appropriate for the protection of the public health’, and did not structure its final pre-market tobacco product application (PMTA) order to avoid increases in youth product use or unnecessary new health harms and risks.”



How might FDA fix this e-cigarette PMTA mess? Commentary on Glantz and Lempert and Meshnick et al

Tobacco Control Published Online First: 09 February 2023.

Eric N Lindblom



Note: Open Access.


Referenced Tob Control studies:


Vuse Solo e-cigarettes do not provide net benefits to public health: a scientific analysis of FDA’s marketing authorisation


Analysis of FDA’s Vuse market authorisation: limitations and opportunities





Rapid-response surveillance of the first US test market for VLN cigarettes


Industry marketing of tobacco products on social media: case study of Philip Morris International’s IQOS


JUUL and its ‘Action Network’ attempt to prevent a local flavour ban


Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK



Note: UK Multistate paper Open Access.


“In this study comprising 2 surveys conducted among 2469 youths (aged 11-18 years) and 12 046 adults (aged ≥18 years) from Great Britain, youths had higher odds of reporting no interest in trying e-cigarettes in standardized green packaging than e-cigarettes in branded packaging, but adults had lower odds of reporting no interest in trying e-cigarettes in standardized green packaging than e-cigarettes in branded packaging.”


Association of Fully Branded and Standardized e-Cigarette Packaging With Interest in Trying Products Among Youths and Adults in Great Britain

JAMA Netw Open. 2023;6(3):e231799.

March 14, 2023

Eve Taylor, Deborah Arnott, Hazel Cheeseman, David Hammond, Jessica L. Reid, Ann McNeill, Pete Driezen, Katherine East



Note: Open Access.


Related coverage:


Putting vapes in plain packaging ‘reduces their appeal to children’



"Vaping of most newer-generation e-cigarettes results in the delivery of nicotine to the lungs in a manner similar to that of cigarettes. These e-cigarettes pose a risk of nicotine addiction for some young people, but for adults already addicted to cigarettes — the single deadliest consumer product ever invented — they also serve as an important, less-hazardous alternative to continued smoking. Considerable evidence indicates that e-cigarettes help some adults to quit smoking."


Nicotine e-cigarettes as a tool for smoking cessation

Nature Medicine (2023)

Published: 13 February 2023

Kenneth E. Warner, Neal L. Benowitz, Ann McNeill & Nancy A. Rigotti



Ed. Note: No footnote provided to support the claim of "Considerable evidence".


“The Statement [by Australia's National Health and Medical Research Council (NHMRC) on e-cigarettes] exaggerates the risks of vaping and fails to compare them to smoking; incorrectly claims that the association between adolescent vaping and subsequent smoking is causal and discounts evidence of the benefits of e-cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect, and misapplies the precautionary principle.”


A critique of the Australian National Health and Medical Research Council CEO statement on electronic cigarettes


First published: 20 February 2023

Colin P. Mendelsohn, Wayne Hall, Ron Borland, Alex Wodak, Robert Beaglehole, Neal L. Benowitz, John Britton, Chris Bullen, Jean-François Etter, Ann McNeill, Nancy A. Rigotti


C.P.M. was an unpaid board member of the Australian Tobacco Harm Reduction Association (ATHRA), a registered health promotion charity, from October 2017 to January 2021. ATHRA accepted unconditional seed funding from the vape retail industry to become established. Funding ceased in March 2019. C.P.M. was a Director of ATHRA in March 2018 when it received a donation from KAC Communications. The donation was sourced from a surplus arising from the Global Forum on Nicotine conference in May 2017... A.W. has been an unpaid board member of the Australian Tobacco Harm Reduction Association (ATHRA), a health promotion charity, since October 2017. ATHRA received unconditional funding for establishment costs from small Australian vape businesses. Vape industry funding has not been accepted since March 2019. A.W. was a Director of ATHRA in March 2018 when it received a donation from KAC Communications. The donation was sourced from a surplus arising from the Global Forum on Nicotine conference in May 2017…



Note: Open Access.


“An overall mean of 22.7% of the samples (n = 13,804; males: n = 11,099; females: n = 2705) showed nicotine intake, with male samples also displaying higher positivity rates than female (24.1% vs 18.5%). Sample positivity was higher during 2012–2014 (25–33%) than 2015–2020 (15–20%). Samples from team sports displayed a higher positivity rate than those from individual sports (31.4 vs 14.1%)… WADA [World Anti-Doping Agency], international and national sports federations should consider these findings with concern, proactively investigate this phenomenon and act in order to protect the health and welfare of its athletes.”


Should We be Concerned with Nicotine in Sport? Analysis from 60,802 Doping Control Tests in Italy

Sports Medicine (2023)

Published: 24 February 2023

Thomas Zandonai, Francesco Botrè, Maria Gabriella Abate, Ana María Peiró & Toby Mündel



Note: Open Access.


Related PR & coverage:

Study finds ‘alarming’ rates of nicotine in sport, says Brock researcher


Les sportifs, consommateurs insoupçonnés de nicotine [Athletes, unsuspecting consumers of nicotine]




“Earlier this week, the man who runs the vape shop took me through the new flavours he’d just got in, like I am a connoisseur of fine whisky. I’m not that. I am a silly little girl who likes her dummy [pacifier]. I have had my brain well and truly fried over the past nine months or so by vapes. Not the old-style vapes: unflavoured, nerdy-looking objects that were for a long time the preserve of morose ex-smokers… Until recently I liked to kid myself that at least vaping, unlike smoking, wasn’t damaging my health… Vapes might be better for you than smoking but this isn’t a great starting point. Anything that is addictive enough to have you shelling out hundreds of pounds a month against your better judgment can’t be good for society… Making these things pricier, or more difficult to get hold of, would make it easier [to quit]. Or maybe uglier, like cigarette packets are now, and not presented at eye-level in all their rainbow appeal in every corner shop and at every supermarket checkout.” [Imogen West-Knights. My vaping addiction came out of nowhere – and I’m finding it impossible to quit, The Guardian]


“America's vaping epidemic is being fueled by people who never smoked before — in more evidence the devices are not simply a cessation aid. The number of US adults who use the devices increased 16 percent from 2019 to 2021, according to a report by the American Cancer Society (ACS), from 8.8 to 10.2 percent of the population. But the rates among people who have never smoked traditional cigarettes are rising twice as fast. Over that three-year period, those numbers jumped 31 percent.” [, Daily Mail]


“E-cigarette use prevalence increased among younger adults between 2019 and 2021 (8.8%−10.2%, adjusted prevalence difference=1.7% points, 95% CI=0.1, 3.3), primarily owing to an increase among those who never smoked cigarettes (4.9%−6.4%, adjusted prevalence difference=1.7% points, 95% CI=0.3, 3.1). People who never smoked cigarettes constituted 53% (2.68 million) of younger adults who used E-cigarettes in 2021, increasing by 0.71 million from 2019… Conclusions: Efforts must address the rise in E-cigarette use among younger adults who never smoked cigarettes. At the same time, assistance is needed to help those who switched to E-cigarettes to stop smoking to transition to non-use of all products.”


Changes in E-Cigarette Use Among U.S. Adults, 2019–2021

American Journal of Preventive Medicine

Published: April 18, 2023

Priti Bandi, Jessica Star, Adair K. Minihan, Minal Patel, Nigar Nargis, Ahmedin Jemal




Note: Open Access.


“Teenagers who smoke and vape are up to twice as likely to be heavy smokers by the time they leave school than those who only use tobacco, research suggests. Experts said using the devices to supplement cigarettes was more likely to 'entrench' tobacco use amongst adolescents… Researchers said it showed the devices, billed as quitting-aids for adult smokers, could be especially damaging among the young, adding that 'comprehensive steps must be taken to reduce adolescent access to e-cigarettes'… The findings come after the [UK] government announced free vape kits will be offered on the NHS [National Health Service] to help smokers to give up tobacco, in a world first.” [Kate Pickles. Vapes 'do NOT help young smokers ditch habit': Gadgets might actually 'entrench' cigarette use among kids, study claims, Daily Mail]


“Youth who smoked tobacco cigarettes by early adolescence (before age 15) were selected from the ongoing UK Millennium Cohort Study (n=1090) and the US Population Assessment of Tobacco and Health (n=803) study… Among youth who were early cigarette smokers, 57% of UK and 58% of US youth also used e-cigarettes. The odds of later adolescent smoking among early smoking youth were significantly higher among e-cigarette users relative to those who had not used e-cigarettes (adjusted OR (AOR UK)=1.45; AOR USA=2.19)… Conclusions: Despite national differences in e-cigarette regulation and marketing, there is evidence e-cigarette use among early adolescent smokers in the UK and USA leads to higher odds of any smoking and more frequent tobacco cigarette use later in adolescence.”


E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts

Tobacco Control Published Online First: 18 April 2023.

Brian C Kelly, Mike Vuolo, Jennifer Maggs, Jeremy Staff




Note: Open Access.


Related coverage:


Research examines whether vaping can ‘entrench’ smoking habits in teenagers


E-Cigs in Early Adolescence Tied to Heavier Smoking Later On




Rassegna Stampa Scientifica Maggio 2023




“The Australian government said it wanted to crack down on the use of e-cigarettes in an effort to “reduce smoking and stamp out vaping” in one of the most sweeping tobacco regulatory moves in the country in years. The proposal, announced on Tuesday, would ban all single-use, disposable vapes; stop the importation of nonprescription vapes; require “pharmaceutical-like packaging”; reduce nicotine concentrations and amounts; and restrict certain flavors, colors and ingredients. The federal government would also work with states and territories to end the sale of vapes in convenience stores and other retail settings “while also making it easier to get a prescription for legitimate therapeutic use,” the Department of Health and Aged Care said in a statement


“Mark Butler, the health minister, said [the federal government’s] long-term intentions were clear. “I want vaping to return to the purpose that we were told it was invented for, that is a therapeutic product to help long-term smokers quit… We were promised this was a pathway out of smoking, not a pathway into smoking. That is what it has become.”” [Remy Tumin. Australia Aims to ‘Stamp Out’ Vaping With Sweeping Regulations, New York Times. See also: Federal government to unveil $234 million crackdown on vaping, Sydney Morning Herald; National Tobacco Strategy 2023–2030, Australian Government, Department of Health and Aged Care]


“Australians already pay some of the highest tobacco tax in the world but a pack of cigarettes will become even dearer as the government aims to reduce the number of daily smokers to below 10% of the population by 2025 and below 5% by 2030. According to data collected by the Cancer Council of Victoria, the cost of a pack of 25 or 30 cigarettes has increased from a few dollars in the early 1990s to well over $40. Taxes on tobacco are already pegged to rises in the average wage but there will be a further 5% rise a year over the next three years.” [Josh Nicholas, Cait Kelly. Australia’s tobacco tax is among the highest in the world – and it’s about to get higher, The Guardian]


“Health Canada is "missing in action" on the regulation of e-cigarette flavours in Canada as youth vaping rates rise, health advocates say, and at a time when the vaping industry is expanding into highly addictive new devices that experts warn appeal directly to kids… Vaping has been marketed as an effective way to quit smoking, but e-cigarettes have never been approved as smoking cessation aids in Canada… David Hammond, a public health professor at the University of Waterloo and a leading Canadian youth vaping researcher, said the federal government implied they were either going to, or were considering, banning flavours, but "they've not done anything."…


“Meanwhile, the vaping industry has dramatically expanded its availability of flavours and recently shifted to new discrete, disposable e-cigarettes that hold thousands of pre-loaded puffs, don't require refilling or cartridges and are linked to a surge in youth vaping… "Over the last 15 years, there's been a growing divide [on regulating flavours] and Health Canada is not in the middle and is definitely on the pro-vaping side," said Cynthia Callard, the executive director of Physicians for a Smoke-Free Canada. "And the provincial governments, by and large, are on the more cautious side."” [Adam Miller. Health Canada 'missing in action' on youth vaping crisis, experts say, CBC News]


“There was no clue on the packaging of the vape about how to properly dispose of it. A tiny white symbol of a crossed-out bin is the only indication that the device shouldn’t just be placed with the rest of your rubbish… Currently 1.3m single-use vapes are thrown away every week in the UK, according to recycling group Material Focus. When littered, they can leach dangerous metals, battery acid, and nicotine into the environment. Plus, each vape contains on average 0.15g of lithium, which equates to 10 tonnes thrown away over a year in the UK – enough to make around 1,200 electric car batteries. Producing this metal is an environmentally costly process that uses huge amounts of energy and water.” [Emma Snaith. I tried to properly recycle a disposable vape. It did not go well, The Guardian]


“Although the full spectrum of cardiovascular and cardiometabolic consequences of e-cig use is not fully appreciated, data is beginning to show that e-cigs can cause both short- and long-term issues on cardiac function, vascular integrity and cardiometabolic issues… A cross-sectional analysis has shown that daily e-cig use was independently associated with higher odds of myocardial infarction (odds ratio, 1.79 [95% CI, 1.20–2.66]), as was daily conventional cigarette smoking (odds ratio, 2.29 [95% CI, 2.29–3.24])… Acute exposures (2 weeks) to e-cigs showed cardiac function changes via echocardiography… [E]-cig effects on the cardiovascular and metabolic outcomes of individuals with comorbidities are of paramount concern when considering the relative and absolute risks of e-cig use in these individuals.”


Electronic Nicotine Delivery Systems and Cardiovascular/Cardiometabolic Health

Circ Res. 2023 Apr 28;132(9):1168-1180. Epub 2023 Apr 27.

Matthew J Mears, Harrison L Hookfin, Priya Bandaru, Pablo Vidal, Kristin I Stanford, Loren E Wold




Note: Open Access.


“Our results demonstrate that smoking EC [electronic cigarettes] is associated with a significant increase in cardiovascular hemodynamic measures and biomarkers. Our findings can aid policymakers in making informed decisions regarding the regulation of EC to ensure public safety.”


Association of Electronic Cigarette Exposure on Cardiovascular Health: A Systematic Review and Meta-Analysis

Current Problems in Cardiology

Available online 22 April 2023, 101748

Tariq Jamal Siddiqi, Ahmed Mustafa Rashid, Ahmed Kamal Siddiqi, Anusha Anwer, Muhammad Shariq Usman, Hifza Sakhi, Aruni Bhatnagar, Naomi M. Hamburg, Glenn A. Hirsch, Carlos J. Rodriguez, Michael J. Blaha, Andrew P DeFilippis, Emelia J. Benjamin, Michael E. Hall



“Overall, 38.8% of the sample reported intent to discontinue using their e-cigarette if tobacco and menthol-flavored e-liquid were the only options available, whereas 70.8% would discontinue under a tobacco-only product standard… Conclusions: Results indicate potential for flavor restrictions to reduce use of e-cigarettes among AYAs [adolescents and young adults] and suggest that a tobacco flavor product standard may result in the greatest discontinuation of use.”


Adolescent and Young Adult Response to Hypothetical E-Liquid Flavor Restrictions

Journal of Studies on Alcohol and Drugs, 84(2), 303–308 (2023).

Published Online: May 03, 2023

Natasha K. Sidhu, William V. Lechner, Sam N. Cwalina, Lauren Whitted, Sabrina L. Smiley, Jessica L. Barrington-Trimis, Junhan Cho, Theodore L. Wagener, Adam M. Leventhal, & Alayna P. Tackett




Note: Open Access.


Canada will soon require health warnings to be printed directly on individual cigarettes, making it the first country to implement this kind of measure aimed at reducing tobacco usage. Details of the new regulations were announced on Wednesday, which was World No Tobacco Day. The regulations take effect on Aug. 1 and will be implemented through a phased approach over the next year… King size cigarettes are set to be the first to feature the warnings and will be sold by Canadian retailers by the end of July 2024, followed by regular size cigarettes and little cigars with tipping paper and tubes by the end of April 2025. The government said the new regulations are part of its strategy to reach a target of less than five per cent tobacco use in the country by 2035…


“Other measures the government is taking include strengthening and updating health-related messages on tobacco product packages, extending the requirement for health-related messaging to all tobacco product packages, and implementing the periodic rotation of messages.” [Noushin Ziafati. Video: Canada is first to require health warnings printed on individual cigarettes, CTV News. See also: Every Canadian cigarette will soon carry a health warning, BBC News; Canada becomes first country to require health warnings on individual cigarettes, Toronto Star; Cigarette warning labels are about to get even harder to ignore in Canada, CBC News; Des avertissements liés au tabagisme bientôt imprimés sur chaque cigarette, Radio-Canada; Canada to become first country in the world to require health warnings on individual cigarettes, Health Canada]




Rassegna Stampa Scientifica Giugno 2023




“The children’s commissioner for England has urged ministers to crack down on the “insidious” marketing of vapes to young people, which is leaving them so addicted to nicotine they can’t concentrate on lessons. Rachel de Souza said the government would be “failing a generation” if these “highly addictive and sometimes dangerous products” were allowed to become mainstream. Her comments are underpinned by research into the experiences of 3,500 young people across the UK, which found “deeply worrying” evidence that children feel pressured to vape, with addictions preventing some from concentrating for whole lessons, while others are avoiding school toilets for fear of peer pressure to vape.” [Rachel Hall. Ministers urged to restrict marketing of vapes to children in England, The Guardian]


“There is no reason to produce flavoured vapes with bright packaging designs, unless it is to appeal to children. Highly addictive, nicotine-based products should not be marketed to anyone, let alone the young. In 2020, menthol cigarettes were banned in legislation focused on discouraging young people from smoking. But at that time, it was perfectly legal for companies to offer children free samples of flavoured, single-use vapes to entice them. That these “starter packs” are nicotine-free is little consolation — they can act as a gateway to long-term nicotine use… E-cigarettes must have proper health warnings. Vaping is not risk free. At the very least, we know nicotine is highly addictive. It has been shown to impair attention, learning, mood and impulse control in children and young adults. Many of the flavourings, while safe for oral consumption, have an unknown impact when inhaled deep into the lungs. Some legal products contain nickel, tin and lead at very small doses: long term, when inhaled, this may be associated with lung disease.” [David Strain. Vaping as a cure for smoking has brought its own ills, Financial Times]


“Ministers looking to refresh Scotland’s policies on tobacco are being urged by campaigners to add warnings to individual cigarettes. The country has set a bold aim to create a tobacco-free generation by 2034. Sheila Duffy, chief executive of charity Action on Smoking and Health (Ash) Scotland, said the action plan, which will be updated later this year, could “re-establish” the country as a “world-leading public health nation”. Campaigners from Ash are now urging the Scottish Government to follow countries including Canada and New Zealand in reforming its anti-smoking plans.” [Lucy Skoulding. Calls for health warning labels to be put on individual cigarettes, Metro]


“Scottish Government ministers are being told it is time to tackle the “true scandal” of products such as elf bars to help protect both children’s health and the environment. The Royal College of Paediatrics and Child Health (RCPCH) wants to see an outright ban on single use e-cigarettes, which come in bright colours and a range of “exotic flavours”. First Minister Humza Yousaf has already said a complete ban is not off the table, with an expert group looking at the issue. But the RCPCH said paediatricians were “increasingly concerned” about the growing popularity of vapes.” [No author. Scots paediatricians join calls for total ban on single use vapes, PA Media/STV News; See also: Children's doctors call for single-use vape ban in Scotland, BBC News; Scottish children’s doctors call for an outright ban on disposable e-cigarettes, RCPCH]


“The government has been criticised for its “completely inappropriate” endorsement of an e-cigarette manufacturer blamed for fuelling an “epidemic” of underage vaping in the US. Juul Labs was promoted in an official briefing circulated by the Department of Health and Social Care about the prime minister’s plan to close a loophole allowing free samples to be given to children… It also included a quote from Joe Murillo, a former tobacco executive and chief regulatory officer at Juul Labs, in which he praised the UK government’s policy and called for more to be done “to combat underage use of these products”… But it failed to mention that the company has been blamed more than any other for fuelling an “epidemic” of youth vaping in the US, and in recent months has agreed to pay out more than $1bn to settle claims it unlawfully promoted its products to children.” [Shanti Das. UK government endorsed e-cigarette firm accused of fuelling underage vaping, The Observer]


“Plans to introduce a ban on selling e-cigarettes to under-18 has secured approval from the Republic of Ireland's cabinet. New laws, due to be enacted this summer, will limit which retailers can sell nicotine-inhaling products in the Republic of Ireland. Earlier, the tánaiste (Irish deputy PM) described vaping as "very dangerous, particularly for young people", according to Irish broadcaster RTÉ. Micheál Martin said… "In many ways, I see vaping as the revenge of the tobacco industry in terms of getting people hooked on nicotine again."” [No author. Vaping 'the revenge of tobacco industry' – Martin, BBC News]


“It’s now mandatory for over-the-top (OTT) streaming platforms to display anti-tobacco warnings as seen in movies screened in theatres and TV, as per a Union Health Ministry notification on May 31 amending the rules under the Cigarettes and Other Tobacco Products Act, 2004… Meanwhile, as per the notification, released on World No Tobacco Day, publishers of online curated content displaying tobacco products, or their use will be required to display anti-tobacco health spots at the beginning and middle of the programme.” [Bindu Shajan Perappadan, Aroon Deep. OTT platforms mandated to show anti-tobacco warnings, The Hindu; See also: Netflix, Disney, Amazon to challenge India's tobacco rules for streaming, Reuters; India first country to address tobacco promotions in streaming content, Stanton Glantz Blog]


“The chief executive of Philip Morris International says the maker of Marlboro cigarettes is charting a path to becoming an ESG [environmental, social, and governance] stock as part of a push to win back investors that have shunned the stock because of tobacco exclusion policies. PMI’s pivot away from cigarettes towards less harmful vapour-based nicotine alternatives, which accounted for about a third of its revenues last year, placed the tobacco group’s new product line “on the podium” when it came to environmental, social and governance impact, argued Jacek Olczak.” [Oliver Barnes, Harriet Agnew. Philip Morris on path to becoming an ESG stock, says chief executive, Financial Times]

"Before the advent of e-cigarettes, there was less interest in finding an answer to this question [of nicotine's harm to the human brain] — there are already more than enough good reasons to not take up smoking. The growing popularity of vaping has provided fresh impetus, but also represents an opportunity for scientists. Research into the impact of nicotine on people’s health has long been held back by difficulties in isolating the effects of this one molecule from all the other components of cigarette smoke. “We never had a clean nicotine delivery product that would be used recreationally for long periods,” [Roswell Park nicotine pharmacologist Maciej] Goniewicz says. Now, thanks to e-cigarettes, researchers do."


Is nicotine bad for long-term health? Scientists aren’t sure yet

Nature 07 June 2023

Anthony King


Note: Open Access.


“Marked similarities between FSFW’s [Foundation for a Smoke-Free World’s] practices and previous corporate attempts to influence science were observed, including: producing tobacco industry-friendly research and opinion; obscuring industry involvement in science; funding third parties which denigrate science and scientists that may threaten industry profitability; and promoting tobacco industry credibility.”


Document analysis of the Foundation for a Smoke-Free World’s scientific outputs and activities: a case study in contemporary tobacco industry agnogenesis

Tobacco Control Published Online First: 03 May 2023

Tess Legg, Bryan Clift, Anna B Gilmore



Note: Open Access.


“The study demonstrates a significant association between psychosocial stressors and adolescent e-cigarette use, highlighting the potential importance of interventions, such as targeted school-based programs that address stressors and promote stress management, as possible means of reducing adolescent e-cigarette use.”


Psychosocial stressors and current e-cigarette use in the youth risk behavior survey

BMC Public Health volume 23, Article number: 1080 (2023)

Published: 06 June 2023

John Erhabor, Ellen Boakye, Ngozi Osuji, Olufunmilayo Obisesan, Albert D. Osei, Hassan Mirbolouk, Andrew C. Stokes, Omar Dzaye, Omar El-Shahawy, Carlos J. Rodriguez, Glenn A. Hirsch, Emelia J. Benjamin, Andrew P. DeFilippis, Rose Marie Robertson, Aruni Bhatnagar & Michael J. Blaha



Note: Open Access.


“Compared with never e-cigarette users, current and former e-cigarette users were 30% (95% CI: 1.13, 1.50) and 15% (95% CI: 1.03, 1.28) more likely to have MetS [metabolic syndrome]. Current e-cigarette use was also associated with elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol and former e-cigarette use was associated with elevated triglycerides, elevated fasting glucose, and elevated blood pressure (AOR ranged from 1.15 to 1.42, all P<0.05). The prevalence of MetS for dual users were 1.35-fold (95% CI: 1.15, 1.58) higher than that for never smokers and 1.21-fold (95% CI: 1.00, 1.46) higher than that for combustible cigarette-only users.”


Associations between e-cigarette use or dual use of e-cigarette and combustible cigarette and metabolic syndrome: Results from the National Health and Nutrition Examination Survey (NHANES)

Ann Epidemiol. 2023 May 16;S1047-2797(23)00094-7. Online ahead of print.

Jiahui Cai, Aurelian Bidulescu




“A total of 7,043 reports [of calls to poison centres gathered by the National Poison Data System] were fielded due to potential poisonings by e-cigarettes, with nearly 9 in 10 cases concerning children under 5 years old. Most had either inhaled or ingested vape liquid. The number of total reports is around double the 2,901 that were reported during 2018, when around two-thirds involved children under 5 years old.” [Alexander Tin. E-cigarette sales surge — and so do calls to poison control, health officials say, CBS News. See also: MMWR reports highlighted below.]


"While e-cigarette use rose a bit, from 4.9% in 2021 to 6% in 2022, visually, it may lack the star power of cigarettes. “I’m not sure if it ever looked cool to vape, but it definitely doesn’t look cool now,” [Brock] Colyar [a New York magazine writer who covers nightlife] said. Culturally, “vaping has entered its death phase. There’s just something about cigarettes.”... Tyler McCall, a writer and the former editor-in-chief of Fashionista, blames the boon in celebrities lighting up on the Ozempic craze. While the obesity drug reportedly curbs addictions like smoking and drinking, it has become most synonymous with weight loss, and fashion media has cited it as a reason for the return of “thin is in”. Since cigarettes have long been used to curb appetite and reduce hunger, McCall sees a connection." [Alaina Demopoulos. Celebrities are smoking again: ‘Things are grungier, edgier, sleazier’, The Guardian]


“A series of “grassroots” campaigns telling UK e-cigarette users they are under attack and urging them to “stand up for their rights” by opposing new vaping regulations are being run by secretive lobby groups with links to Big Tobacco. The campaigns – pushed to millions of Facebook and Twitter users in the past few weeks – have names such as #BackVapingSaveLives and Save My Vape, and are styled to look like they are coordinated by members of the public. But in reality they are run and promoted by rightwing thinktanks and lobbyists that oppose stricter regulation and want to influence government policy. They include a movement called We Vape UK, which claims to be run by an “independent” organisation “for vapers by vapers”, but was set up by a fellow at the Adam Smith Institute, a free market lobby group that does not disclose its funders and has long-running ties to the tobacco industry.” [Shanti Das, Jon Ungoed-Thomas. Lobbyists with links to Big Tobacco fund pro-vaping Facebook campaigns, The Guardian]


“E-cigarette unit sales increased by 46.6% during January 2020–December 2022. After January 2020, sales of mint and other flavored prefilled cartridges ceased, and disposable e-cigarettes in fruit, sweet, and other flavors increased. Disposable e-cigarettes in youth-appealing flavors are now more commonly sold than prefilled units… Comprehensive restrictions on the sale of all flavored tobacco products that include e-cigarettes, menthol cigarettes, and flavored cigars are warranted in all jurisdictions. These strategies, when coupled with longstanding evidence-based strategies to prevent youth tobacco use such as price increases, comprehensive smokefree policies that include e-cigarettes, and counter-marketing campaigns, are expected to reduce youth initiation and use as well as reduce disparities in tobacco product use.”


E-cigarette Unit Sales by Product and Flavor Type, and Top-Selling Brands, United States, 2020–2022

MMWR Weekly / June 23, 2023 / 72(25);672–677

Fatma Romeh M. Ali, Andrew B. Seidenberg, Elisha Crane, Elizabeth Seaman, Michael A. Tynan, Kristy Marynak






Notes from the Field: E-Cigarette–Associated Cases Reported to Poison Centers — United States, April 1, 2022–March 31, 2023




Note: Open Access.


Related coverage:


E-cigarette sales surge — and so do calls to poison control, health officials say


Number of children under-5 being poisoned by vaping has TRIPLED since 2018



“Susceptibility to e-cigarette use was apparent among 54% of respondents from Australia, 61% from India, 62% from the UK, and 82% from China. Factors positively associated with susceptibility were tobacco use, exposure to advertising, higher income, and having friends and family members who vape. Factors negatively associated with susceptibility were perceptions of harmfulness and education.”


Short communication

Short report: Factors contributing to young people’s susceptibility to e-cigarettes in four countries

Drug and Alcohol Dependence

Available online 13 June 2023, 109944

In Press, Corrected Proof

Simone Pettigrew, Joseph Alvin Santos, Yuan Li, Min Jun, Craig Anderson, Alexandra Jones



Note: Open Access.


Related PR:


Many young people who have never vaped may be susceptible to starting, study suggests



“We used the cross-sectional 2019 European School Survey Project on Alcohol and Other Drugs data from 32 countries with 98 758 students aged 15-16 years and the 2020 WHO's assessment of the e-cigarette regulations… Of the respondents, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both… Conclusions: More comprehensive e-cigarette regulations and enforcement of age-of-sale laws may be protective of e-cigarette and dual use among adolescents.”


Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes

Tob Control. 2023 Apr 25;tc-2022-057749. Online ahead of print.

Hanna Ollila, Yelena Tarasenko, Angela Ciobanu, Elizaveta Lebedeva, Kirsimarja Raitasalo




Note: Open Access.


“Approximately 22% of Californians were subject to a partial or comprehensive FTSR [flavored tobacco sales restriction] by December 31, 2020. Accounting for potential confounders, residents of jurisdictions with a comprehensive FTSR (vs. no ban) had 30% lower odds of using any flavored tobacco… Conclusion: Recent passage of a statewide ban in California will close gaps from the patchwork of local policies and eliminate most partial FTSR exemptions.”


Variation in adults' use of flavored tobacco products by sales restrictions in California jurisdictionsInt J Drug Policy. 2023 Jun;116:104041. Epub 2023 Apr 27.

David S Timberlake, Julian Aviles, Denise Diaz Payán