From Smoke to Vapor: Unmasking the Risks of New Nicotine Products

As the world observes World No Tobacco Day on May 31st, the conversation around nicotine and tobacco consumption is more complex than ever. While traditional cigarette smoking rates have seen declines in many regions, the rise of alternative nicotine delivery systems – e-cigarettes (vapes), heated tobacco products (HTPs), and oral nicotine pouches – presents new challenges and trends, especially among young people. These products are often marketed with an allure of modernity, lower harm, and appealing flavors, yet they carry their own set of risks and contribute to new forms of nicotine dependence. This World No Tobacco Day, themed “Unmasking the Appeal,” it’s crucial to look beyond the marketing, understand what’s really in these products, and promote a culture of health, particularly for the younger generation.

The Evolving Tobacco and Nicotine Market

The landscape of nicotine consumption has dramatically shifted. Alongside conventional cigarettes, a diverse array of alternative products has gained significant traction:

E-cigarettes (Vapes): These battery-operated devices vaporize a liquid (e-liquid) for inhalation. They come in various forms, from simple, convenient disposable “puffs” and pre-filled pod mods to more powerful, customizable systems for experienced users.
Heated Tobacco Products (HTPs): Devices like IQOS heat specially designed tobacco sticks to a lower temperature than traditional cigarettes, generating an aerosol containing nicotine and other chemicals, without combustion.
Oral Nicotine Pouches: Small, tobacco-leaf-free pouches containing nicotine powder and flavorings, placed between the gum and lip for nicotine absorption.

These alternatives are frequently promoted as more modern, potentially less harmful, and even more economical options than smoking. Their appeal is often amplified by sweet or fruity aromas, attractive designs, and sophisticated digital marketing strategies that resonate strongly with younger demographics. This has led to concerns about the development of new forms of nicotine addiction and unique health risks.

Deconstructing E-Cigarettes: What’s in the Vapor?

An e-cigarette is an electronic device that aerosolizes an e-liquid for inhalation. The e-liquid typically forms the core of the vaping experience.

E-Liquid Composition:

Base Liquids: The foundation is usually a mixture of propylene glycol (PG) and vegetable glycerin (VG). PG is a good carrier for flavor and provides a “throat hit,” while VG is thicker and produces more vapor.
Nicotine: Variable concentrations of nicotine, often in the form of nicotine salts in newer products (especially disposables and pod systems), which allow for higher nicotine delivery with less throat irritation, potentially increasing addiction risk.
Flavorings: A vast array of food-grade flavorings are used, but their chemical composition is rarely fully specified on labels, and their safety when inhaled after heating is not always well-established.

When this e-liquid is vaporized, the resulting aerosol is not just harmless water vapor. It contains nicotine (if present in the liquid) and can also include various toxic and irritating compounds. Studies have detected substances like formaldehyde (a known carcinogen), acetaldehyde, acrolein, heavy metals (e.g., nickel, tin, lead, potentially leaching from the device components), and fine particulate matter similar to that found in traditional cigarette smoke, albeit often at lower levels¹.

Understanding Heated Tobacco Products (HTPs)

Heated tobacco products, such as IQOS, Glo, and Ploom, operate by heating processed tobacco sticks or capsules to temperatures below combustion (typically around 350°C, compared to over 600°C in a burning cigarette). This process generates an aerosol containing nicotine, flavorings, and other tobacco-derived compounds. While manufacturers claim HTPs reduce exposure to harmful and potentially harmful constituents (HPHCs) compared to cigarette smoke, the aerosol still contains nicotine (which is addictive), irritants, and various toxic compounds, including heavy metals and polycyclic aromatic hydrocarbons (PAHs). The World Health Organization (WHO) states that HTPs are not harmless and that reducing exposure to HPHCs does not necessarily translate to reduced harm to health.

Is Vaping Truly “Less Harmful” Than Smoking? A Critical Look

The claim that vaping is significantly less harmful than smoking is a cornerstone of its promotion, particularly as a smoking cessation tool. While it is true that vaping avoids the combustion process and thus eliminates many of the most dangerous components of cigarette smoke like tar and carbon monoxide, it is crucial to understand that “less harmful” does not mean “harmless,” especially for individuals who have never smoked, and particularly for young people.

Nicotine itself, regardless of the delivery system, is highly addictive and has detrimental effects on the body. As highlighted in previous SIF Magazine articles, nicotine impacts cardiovascular health (increasing heart rate and blood pressure), can impair adolescent brain development, and may have negative effects on the immune system¹. The inhaled aerosol from e-cigarettes, even without considering nicotine, contains various potentially toxic substances that, with regular exposure, can cause inflammation of the respiratory tract and may contribute to cardiovascular damage. Some flavoring chemicals and other e-liquid constituents have also been shown to potentially interfere with the hormonal system².

The Dangers of Secondhand Aerosol and Environmental Impact

The impact of vaping isn’t limited to the user. While vape aerosol may have less odor than cigarette smoke, it still releases substances into the environment that can be inhaled by bystanders. This secondhand aerosol can contain nicotine, particulate matter, and other potentially toxic chemicals, posing risks to children, pregnant women, individuals with respiratory conditions, and even pets. Furthermore, the waste generated by vaping products – particularly disposable vapes with their plastic casings, lithium-ion batteries, heavy metals, and residual nicotine – presents a significant environmental hazard. Improper disposal contributes to e-waste and chemical pollution, posing risks to public health and ecosystems.

Why Are Young People Particularly at Risk?

Adolescence is a critical period for brain development, and the brain continues to develop until about age 25. Nicotine exposure during this time can disrupt normal brain maturation processes, leading to long-term consequences such as^{(Part 5 Source – JAMA Pediatr.)3}:

Deficits in attention and memory.
Alterations in emotional regulation and impulse control.
Increased susceptibility to nicotine addiction and potentially other substance use disorders.

Many disposable vapes and pod mods utilize nicotine salts, which deliver high concentrations of nicotine with reduced throat irritation. This makes it easier for young, inexperienced users to inhale large amounts of nicotine quickly, leading to rapid and strong addiction. There is also evidence suggesting that e-cigarette use among youth may increase the likelihood of them subsequently trying traditional cigarettes and engaging in polysubstance use (using multiple tobacco/nicotine products)^3,5.

Are E-Cigarettes an Effective Smoking Cessation Tool?

The role of e-cigarettes in smoking cessation is complex and debated. While some individuals report successfully quitting smoking with the help of vapes, the broader scientific evidence is mixed. The article cites studies indicating that e-cigarette use may not necessarily facilitate smoking cessation and could, in some cases, increase the risk of initiating or relapsing to traditional cigarette smoking or lead to dual use (using both cigarettes and e-cigarettes)⁵. Many public health bodies recommend that smokers seeking to quit should first try FDA-approved nicotine replacement therapies (NRTs) and counseling, which have a strong evidence base for efficacy and safety. In Italy, the National Health Service offers personalized programs through Anti-Smoking Centers, including medical and psychological assistance, and supportive pharmacological therapies.

Combating Tobacco and Vaping: An Integrated Approach

Addressing the challenges posed by both traditional tobacco and newer nicotine products requires a multifaceted strategy. This includes:

Information and Awareness: Comprehensive public health campaigns, particularly targeting youth, to educate about the risks of all nicotine products. Initiatives like Sapienza University’s “Respira Sapienza” aim to engage young people directly in promoting a smoke-free and vape-free culture.
Strong Control Policies: Implementing and enforcing robust regulations on the sale, marketing, packaging (e.g., plain packaging), and flavoring of all tobacco and nicotine products to reduce their appeal and accessibility, especially to minors.
Support for Cessation: Providing accessible and evidence-based support for individuals who want to quit smoking or vaping. This includes quitlines (like the Italian National Institute of Health’s toll-free number 800 554088), specialized cessation centers, and approved pharmacological aids. While smartphone apps for quitting are available and may appeal to younger users, their effectiveness is still being evaluated⁴.

World No Tobacco Day 2025: “Unmasking the Appeal”

The WHO’s theme for World No Tobacco Day 2025, “[Unmasking the appeal](https://www.who.int/campaigns/world-no-tobacco-day/2025),” directly addresses the tactics used by the tobacco and nicotine industries to make their products attractive, especially to young people. The campaign aims to shed light on these strategies, promote counter-awareness campaigns, and incentivize policies that protect public health and the environment. Opening our eyes to these realities today is the first crucial step towards a healthier future for all.

Pharmacology is also about understanding these emerging public health challenges and advocating for evidence-based solutions.