The 2017 Florida Youth Tobacco Survey found that kids and teens are using e-cigs more than any other tobacco product. Florida high school students used e-cigs at nearly four times the rate of conventional cigarettes, and at least one in three reported trying an e-cig.
Surprisingly, the American Cancer Society has ramped up its support for vaping as a smoking cessation tool this year, declaring in a June health statement that "although many [electronic devices] deliver nicotine, flavor additives, and other chemicals, they do not burn tobacco, a process that yields an estimated 7,000 chemicals, including at least 70 carcinogens."
While that may be true, the American Lung Association says it is more worried about the long-term effects of vaping, the fact that it has not been heavily regulated and the possibility that it may be a gateway to smoking for young people. The ALA still sticks to a strict message of encouraging only approved smoking cessation products like nicotine patches or Chantix to aid efforts to quit.
"Although the tobacco industry markets e-cigarettes as a tool to help adult smokers quit smoking, e-cigarette use actually only marginally increases the number of adult cigarette smokers who are able to successfully quit," says Samir Soneji, the principal investigator on a recent report from Dartmouth College's Geisel School of Medicine that adds empirical heft to the ALA's concerns. "On the other hand, e-cigarettes may facilitate cigarette smoking initiation and confer substantial harm to adolescents and young adults once they are introduced to nicotine."
Besides nicotine, the ALA is concerned about the other elements that have been found in e-cigs. For a while, vaping juice contained diacetyl, which some have claimed can cause a bronchitis-like condition known as popcorn lung (because it can also be caused by inhaling the chemicals found in microwave popcorn flavoring). But Kleizo points out that the big players in the industry eliminated that problem as soon as it was identified.
Still, Sward says, the effects of inhaling the other chemicals in vape juice are unknown. The two biggest ingredients are glycerin, which is also used in stage production to make fog, and propylene glycol, which supports the flavor.
"Ingesting those two substances is OK," Sward says. "But the effect of inhaling them, especially together and over time, is unknown altogether."
At the same time, states are grappling with new vaping regulations. Many municipalities aren't waiting around for FDA regulation – for instance, in June, San Francisco voters decisively voted in a ban on fruity- or candy-flavored vape juices, some of which are sold under names like "lollipop," "chicken and waffles" and "unicorn milk."
This fall, voters in Florida will be asked to approve Amendment 9, a statewide ban on vaping indoors, as part of a package of new constitutional amendments. The ballot measure would simply add "vapor generating electronic devices" to the existing ban on smoking tobacco indoors. Like the existing smoking ban, the new restrictions would not apply to retail tobacco shops, vapor-generating electronic device retailers, designated smoking guest rooms at hotels and other public lodging establishments, or stand-alone bars.
But because the Constitution Revision Commission bundled several of the proposed amendments – for instance, the proposed vaping ban is bundled with a proposal to ban offshore drilling and fracking in one yes-or-no question – a pair of ex-public officials, former Supreme Court Justice Harry Lee Anstead and former Florida Elections Commissioner Robert Barnas, have sued the state to toss them out. They argue that six of the ballot questions will illegally require voters to "pay a price" for one thing if they want the other.