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In recent months, the issue of vaping and its marketing practices in the United States has been overshadowed by a cloud of uncertainty and regulatory challenges. Vape manufacturers in the country must obtain authorization from the Food and Drug Administration (FDA) to market and sell their products. However, the vaping industry faced a setback when the FDA ordered popular vape manufacturer JUUL to cease selling its products due to a lack of toxicological evidence regarding their safety. This decision prompted JUUL to file an appeal with the U.S. Court of Appeals for the District of Columbia, leading to a temporary stay that allowed their products to remain available to consumers. As the legal battle unfolded, the FDA temporarily suspended the marketing denial, citing the need for additional scientific review. Furthermore, JUUL sued the FDA for its refusal to disclose the documents justifying the initial ban, adding another layer of complexity to the issue.

In this article, we will delve into the intricate landscape of the vaping industry, shedding light on its marketing strategies and the challenges it poses to public health. By consulting experts in the field, we will explore what is known about vaping, what is still being researched, and the potential long-term health effects associated with its use.

What we know: How vape products are marketed
Vape products have often been positioned as a safer alternative to traditional cigarettes, providing a source of nicotine with supposedly fewer health risks. However, experts warn that these products appeal to more than just individuals attempting to quit smoking. Carsten Prasse, an assistant professor in the Whiting School of Engineering, highlights that the e-cigarette industry actively targets young people, utilizing enticing flavors like fruit and candy.

Joanna Cohen, the director of the Institute for Global Tobacco Control at the Bloomberg School of Public Health, explains that in the United States, companies are prohibited from making health-related claims unless they receive FDA approval. To market vape products as a safer alternative to cigarettes, manufacturers would require Modified Risk Tobacco Product (MRTP) approval. Surprisingly, while 15 MRTP orders have been granted for low nicotine or smokeless tobacco products, no MRTP orders have been granted for vaping products.

Although the risks of vaping in comparison to traditional cigarettes are not yet fully understood, J. Michael Collaco, a professor of pediatrics at the Johns Hopkins School of Medicine, points out a significant difference. Vaping solutions contain carrier agents and flavorings that cigarettes do not have, which introduces additional chemicals and compounds that carry their own risks. Despite being marketed as a safe alternative, the use of vape products among adolescents has been associated with a 350% increased likelihood of starting tobacco cigarette smoking.

What we're working to understand: The chemicals' effects on users and the environment
Vaping products are often touted as offering a healthier alternative to cigarettes, with claims based on assessments of toxic chemicals found in traditional cigarettes. While the concentration of chemicals may be lower in vape products, this does not eliminate the presence of other potentially harmful contaminants for users and the environment.

Numerous studies, including those conducted by Prasse, have revealed the presence of numerous unidentified chemicals in e-cigarette aerosols. Insufficient oversight exists regarding the chemicals used by vape companies, both in terms of their nature and the quality of ingredients. Vitamin E acetate, for instance, is one compound that has been strongly linked to lung injuries associated with e-cigarette use or vaping.

Consumers may assume that having vitamins in e-cigarettes is healthy. However, Prasse highlights the critical distinction between ingesting vitamins and inhaling them, as inhalation can have significant health implications.

What will take a while to understand: The long-term health effects
Given the relative novelty of vape products, it remains challenging to fully comprehend the long-term health effects on users. Nonetheless, studies conducted on mice suggest that prenatal and neonatal exposure to electronic cigarettes can result in lasting changes to lung structure. While data on the impact of adolescent use on lung function into adulthood is limited, Collaco notes other known respiratory health effects such as increased cough, bronchitis, asthma attacks, respiratory infections, and lung injuries.

Furthermore, exposure to secondhand vape smoke can potentially reach nicotine cigarette levels. Animal studies have demonstrated that fetal and infant exposure to vape smoke leads to decreased growth and eventual adult behavioral changes, including short-term memory deficits, increased hyperactivity, and anxiety.

"It's just not safe—whether you vape or are near someone who is vaping," cautions Collaco. "And it's definitely not water vapor."

The issue of vaping and its marketing practices in the United States remains enshrouded in uncertainty and regulatory challenges. While e-cigarette manufacturers must obtain authorization from the FDA, recent legal disputes, such as the case of JUUL, highlight the complexities surrounding this issue. It is evident that there are still many unknowns regarding the impact of e-cigarettes on health, including the risks associated with their ingredients and marketing strategies.

In an effort to ensure public health standards, the FDA aims to regulate the vaping industry. However, the intricate nature of vape products, along with the lack of comprehensive understanding of their long-term effects, poses significant challenges. Ongoing research seeks to shed light on the impact of vaping on users and the environment, providing valuable insights into the potential risks involved.
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