Published by
Stanford Medicine

Addiction, FDA, Health Policy, Podcasts, Public Health

E-Cigarettes: The explosion of vaping is about to be regulated

E-Cigarettes: The explosion of vaping is about to be regulated

E-cigarettes are about to get zapped. To date, across the globe, they’ve been largely unregulated – and their growth since they first came on the scene in 2007 has been exponential. Now, in the first big regulatory action that is sure to spur similar responses across the pond, the European Parliament approved rules last week to ban e-cigarette advertising in the 28 EU member nations beginning in mid-2016.  The strong action also requires the products to carry graphic health warnings, be childproof and contain no more than 20 milligrams of nicotine per milliliter. It’s expected that the U.S. Food and Drug Administration will soon follow suit and the days of great independence for e-cigarettes will come to a crashing halt. A few U.S. cities, Los Angeles most recently, have banned e-cigarettes in public spaces.

e-cigUntil recently, I was completely ignorant about the whole phenomenon of e-cigarettes. What is the delivery system? Where are they manufactured? Are they a safe alternative to smoking? And how are they being marketed and to whom? Well here’s an eye opener: According to the Centers for Disease Control and Prevention, e-cigarette usage more than doubled among middle and high school students users from 2011 to 2012. Altogether, nearly 1.8 million middle and high school students nationwide use e-cigarettes.

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, has long studied the effects of tobacco advertising, marketing, and promotion through his center, SRITA (Stanford Research Into the Impact of Tobacco Advertising). After years of detailing how tobacco use became ubiquitous in the U.S. he’s now tracking the marketing of e-cigarettes, and what he’s found probably won’t surprise you. The same sales techniques that brought about the explosive growth of tobacco use are being deployed again to make e-cigarettes look sexy, cool and defiant.

While there are claims by the e-cigarette industry that e-cigarettes are important tools to help people kick the tobacco habit, there’s little evidence to date to back up that claim. And Jackler isn’t completely sold on the notion that e-cigarettes will bring about a great cessation of tobacco smoking; he sees them more as a continuity product. He told me:

What the industry would like to see you do is when you go to a place that you can’t smoke, that you pick up your e‑cigarette and you vape, and you get your nicotine dose in the airport when waiting, or when you’re in your workplace, or when you’re even in school, and that way, when you leave school or the workplace, you go back to the combustible tobacco products.

Sorry if I’m a bit cynical, but as an ex-smoker I find it hard to believe that Big Tobacco – which is increasingly getting into the e-cigarette business – doesn’t also see vaping as a way to continue to keep smokers smoking. Bubble gum flavors and packaging designed to resemble lipstick containers! Who’s really being targeted here?

After my 1:2:1 podcast (above) with Jackler, I’m convinced we’ve been down this road before and it wasn’t pretty health-wise. More than 16 million Americans suffer from a disease caused by smoking. Listen to the podcast and you be the  judge about the true intentions of those promoting e-cigarettes.

Previously: Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labelsWhat’s being done about the way tobacco companies market and manufacture products and Image of the Week: Vintage Christmas cigarette advertisement
Photo by lindsay-fox

10 Responses to “ E-Cigarettes: The explosion of vaping is about to be regulated ”

  1. Matt Says:

    This makes me angry,

    Listen, Im not saying that e cigs are “safe” But I am saying that they are 100x less dangerous than actual tobacco.

    The actual vapor that is being inhaled consists of 4 ingredients

    Propelyne Glycol
    Vegetable Glycerin
    Nicotine Extract from tobacco
    and Flavoring (candy flavoring in 99 percent of cases0

    The only danger is from the nicotine as everything else is NON TOXIC to the human body.

    Where-as just about everything in a cigarette is toxic and dangerous to the human body.

  2. Darrin Gold Says:

    No one under the legal smoking age should ever use an electronic cigarette. Adults that do not smoke should not use an electronic cigarette. I was a smoker for 27 years. I made many attempts to quit during that time. I used the Nicotine patch, the Nicotine gum, the Nicotine lozenge, and will power. On December 17, 2010 I purchased an electronic cigarette and I have been a non smoker since that very first puff. My health has improved as well. I no longer suffer from sinus infections, ear infections or the constant chest congestion I became used to having. I can climb many flights of stairs without getting winded as well. I believe if it were not for the electronic cigarette, I would have been a smoker for the rest of my life. I have seen 100’s of people in my own community switch from cigarettes to electronic cigarettes with the same results.
    As to the idea that they are marketed to kids because of the colors and flavors and only kids would want that, I would direct you to the alcohol isle at most super markets where you can purchase birthday cake vodka. I would also send you to the Apple store where you can buy your new Iphone in many vibrant colors. Then there are the flavored coffee creamers like White Chocolate Raspberry, and even Girl Scout Cookie. Adults like flavors and colors. Are Coffee Mate and International Delight marketing to kids?

    A comprehensive review conducted by Dr. Igor Burstyn of Drexel University School of Public Health based on over 9,000 observations of e-cigarette liquid and vapor found “no apparent concern” for bystanders exposed to e-cigarette vapor, even under “worst case” assumptions about exposure.

    Link to study:

  3. David Says:

    What Matt says is right, but I want to add something. Nation wide we are seeing movements for legalization of marijuana, but instead of accepting that people want to use nicotine people want to ban it all together? We tried that with marijuana. That is failing. Instead of banning them lets regulate them instead. Either way people are going to use them legal or not. Teen and adults alike. Banning them will just move them into an unregulated distribution method, or having people just make the devices and juice at home. People do diy e-cigs and juice already. Overall regulation would be best, and ban combustible tobacco products all together.

  4. Niall Says:

    Joy, more ignorance about the actual facts.

    Vaping has done the exact opposite of what this article seems to be getting at, and is the reason thousands of people have STOPPED smoking.

    It’s healthier, those of us who have actually done our research know beyond a shadow of a doubt it’s safer, and yet this fear mongering continues.

    And as for flavours, they’ve certainly been a decisive factor in getting me to stick with vaping and drop smoking from my life. Because an adult can’t possibly enjoy sweet flavours right? Utterly preposterous.

    So let’s admit the truth shall we? The government is losing too much money because people are stopping smoking, logical step is ignore the scientific facts that are already there and make them sound bad. Politics disgusts me.

  5. Ted Says:

    I’m actually a vape use who quit smoking. Matt correctly listed the ingredients commonly found in vape fluid. While it is healthier as far as chemicals present it also feels a world better than smoking. I can feel a difference in my breathing. If I smoke a ciggarette, after months of not using them, my lungs get congested.

    I should mention propylene glycol is present in many cigarettes as a preservative. The nicotine, of course, is toxic as hell. Propylene glycol is a food grade solvent used to decrease the vape temp point. This fluid is trivial to make at home if you can follow a recipe, and for this point alone it will be challenged as it is difficult to tax.

    I’ve been slowly decreasing the mg level of nicotine. This assists the process of completely quitting by separating the two points of addiction; chemical and oral fixation. Allowing me to fight each separately. The chemical addiction prior to the fixation in an order reversed from from that of patches. I have no desire to ever smoke cigarettes again already, and I hope to finish the process this year as the addiction slowly fades away.

    Thank you Paul, I enjoyed your report on this matter.

  6. Ben Says:

    My partner smoked two packs a day for over ten years. He tried everything to quit: patches, gum, lozenges, multiple attempts at cold turkey, not to mention my incessant nagging. None of those worked for more than a couple of weeks at best even with his sincere desire to quit. Once he found e-cigarettes the effect was immediate, and he hasn’t smoked since (over two years) except for one relapse of a few weeks when we couldn’t find a place that sells e-cigarettes. We’ve taken to ordering them online and his addiction has gone from costing us hundreds of dollars a month to less than $30 a month, and he can walk up a flight of stairs again. To ban e-cigarettes would basically force him back to cigarettes, and kill him.

    Sure, this is anecdotal evidence. There are probably some stories out there of people who tried e-cigarettes and went back to smoking. And it’s not a cure to nicotine addiction, just a different vector for nicotine. Also some e-cigarettes taste worse than others and so wouldn’t be as effective. The best ones are actually made by small businesses not the big tobacco companies. But the claim that because there’s not yet any scientific evidence for its effectiveness at reducing tobacco use, so therefore they are not effective, is pretty fallacious. Also, the Lancet study you link to doesn’t say they aren’t effective, it says they just aren’t more effective than nicotine patches (and no more dangerous either).

    As far as danger to others, if you have even once sprayed a can of glade aerosol air freshener, then you’ve released more secondhand toxins into the air than every e-cigarette put together. Just compare to .

    Best thing to do would be to raise the purchasing age of ecigs and cigarettes to 21 (plenty of minors know 18 year olds, but much fewer know 21 year olds) and to take away the license of any shopkeeper caught selling them to minors.

  7. Anonymous Says:

    Author, you are fear mongering, either intentionally or unintentionally.

    The CDC report you link to states clearly ” an estimated 1.78 million students having ever used e-cigarettes as of 2012. Moreover, in 2012, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes.”

    1.78 million students have *tried* an e-cig. This behavior ranges from taking one puff off someone elses, to using one all day every day.

    Also note where it says, of those 1.78 million students, only 160,000 have never tried a conventional cigarette. This means that 91% of the 1.78 million kids “who have tried an ecig at least once” have also tried a conventional cigarette at least once.

    In your article you state “Altogether, nearly 1.8 million middle and high school students nationwide use e-cigarettes.” This is a false statement, either intentional, or unintentional. It’s complete bullshit.

    Please refrain from freak outs and panics over your own personal imagined fears that result from your own personal inability to understand a subject somewhere other than a university level medical text.

    The truth is, electronic cigarettes are reducing the harm caused by conventional cigarettes on a serious scale, and if 91% of kids who smoke cigarettes switch to electronic cigarettes, this is a good thing.

    “The state must declare the child to be the most precious treasure of the people. As long as the government is perceived as working for the benefit of the children, the people will happily endure almost any curtailment of liberty and almost any deprivation.” — Adolf Hitler, Mein Kampf

  8. Anonymous Says:


    You state “After years of detailing how tobacco use became ubiquitous in the U.S. he’s now tracking the marketing of e-cigarettes, and what he’s found probably won’t surprise you. The same sales techniques that brought about the explosive growth of tobacco use are being deployed again to make e-cigarettes look sexy, cool and defiant.”

    Big surprise. This could be said of new cars and fast food. Marketing is marketing, and the same marketing tactics that work for cigs, work for ecigs, bubble gum, soda, fast food, and underwear. Conflation.

    Also, you state “While there are claims by the e-cigarette industry that e-cigarettes are important tools to help people kick the tobacco habit, there’s little evidence to date to back up that claim.”

    A link to a WebMD fud piece ? Really ? Why didn’t you link to the other WebMD article titled “Survey: E-Cigarettes May Help Smokers Quit” where of the people who responded “31% of these smokers said they’d quit cigarettes and two-thirds of them said they’d cut back on the number of cigarettes they smoked. A third of those who’d quit smoking also quit using e-cigarettes.”

    And FYI, “Big Tobacco” is not an evil monster. It’s an industry, made of corporations, which in turn are made up of people, who are doing their job, which is to sell product. You really should try to prevent your emotions from tainting policy which should be driven by valid scientific data.

    Also, you state “Bubble gum flavors and packaging designed to resemble lipstick containers! Who’s really being targeted here?” People. Consumers with disposable income. Same group thats targeted by every other form of product advertising. You should visit website, and see where they offer to flavor medications, including oxycodone and phenobarbital for your grandmother and your dog. The flavor argument is bunk, because everyone likes flavors, everyone with a tongue, no matter what age said tongue happens to be.

    The only content in this article, is your fragile emotional state. No data or science here to see people. Please move along.

  9. Dr Hugo Oliver Bentner Says:

    I shall keep my comments short and to the point.
    I have had many patients die due to related inhaling of smoke and chemicals from cigarettes

    My practice welcomes e cigarettes for those who have tried and failed to stop smoking. My colleges in chemistry and in the medical field Believe after many hours of deliberation and taking all factors into consideration the only way forward in the near future is to allow e. cigarettes.

    We have found the health of are patients who have changed from smoking cigarettes to vaping is much improved

  10. Tina Says:

    Put ME on the panel that will determine whether vaping is banned or not. After smoking full flavored menthol cigarettes for 46 years, I took a hit off off of a tank with 2.4mg cappuccino flavored ejuice. I have not had a cigarette since,(Over a year).. Nor have I been tempted to have one or felt a craving for one. My clothes do not smell like cigarettes, my house no longer smells like cigarettes, my health has improved greatly, no more congestion or coughing in the mornings, clearing my throat constantly while trying to talk to people or bronchitis, my teeth are whiter, my breath is fresher, no more yellow fingers… and I am off all medications.My Dr. considers me a non smoker and when asked by a friend when I was going to quit the nicotine, I told her when she stopped guzzling coffee and Mountain Dews all day. The difference between nicotine and caffeine as far as how it affects the body is that nicotine becomes more dangerous when combined with tobacco and other poisons like the ones that come in regular tobacco cigarettes. Im a healthier person, thanks to vaping. We need to stop letting big corporations determine our fates just because they are greedy.


Please read our comments policy before posting

Stanford Medicine Resources: