President Donald Trump announced this week that all e-cigarette flavours apart from tobacco will be removed from the US market. But the popularity of vaping continues to grow globally, with the UK and France among the biggest users in Europe.

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After a sixth confirmed death and more than 450 cases of respiratory problems connected to e-cigarettes reported across the United States, Washington has stated its intention to take action by banning the flavours that appear designed to appeal to young people.

E-cigarettes are battery-powered devices that heat a liquid – which typically contains nicotine, propylene glycol, glycerin, flavourings and other chemicals – into an aerosol that the user inhales. No single device or substance has been linked to all the US deaths or lung problems. But in 80 percent of the cases, people admitted they were smoking a cannabis oil that e-cigarettes are not designed to vapourise. It also appears that many bought their devices on the black market instead of from official retailers.

American anti-tobacco groups applauded Trump’s announcement but said the restrictions must be “immediate”.

“It has taken far too long to stop e-cigarettes companies from targeting our nation’s kids with sweet-flavored, nicotine-loaded products,” said Matthew Myers, of the Campaign for Tobacco-Free Kids, in a statement.

We appreciate @POTUS, @FLOTUS & @SecAzar’s ongoing support of our efforts to prevent youth use of e-cigs, including the bold approach we announced today. We must act swiftly against flavored e-cigarette products that are especially attractive to children. https://t.co/nKfqLp7GfY Dr. Ned Sharpless (@FDACommissioner) September 11, 2019

The former mayor of New York, Michael Bloomberg, has pledged $160 million to combat the rise of vaping. But the popularity of the cigarette alternatives continues to rise.

Growing e-cigarette markets in Europe

France has one of the largest e-cigarette markets in Europe, with over 1.2 million “vapoteurs” partaking every day. Sales are growing at a rate of 5-10 percent every year and is already valued at €350 million.

But what are the real risks of e-cigarettes? “This is the big question. We are still investigating the long-term effects of vaping,” said addiction and smoking expert Dr. Philippe Arvers of SOS Addictions in comments to FRANCE 24.

“What we do have concrete evidence for is the real and positive role e-cigarettes play in giving up smoking for so many people in France.”

French support for vaping appears to be growing. Instead of restricting e-cigarettes, France continues to encourage vaping as a means of fighting tobacco addiction. According to an Odoxa-Dentsu Consulting survey conducted in 2018, for more than two-thirds of those surveyed, the e-cigarette is indeed an aid to smoking cessation.

A 2019 report by France’s Economic, Social and Environmental Council on tobacco and alcohol addiction highlights a significant drop in smoking rates in recent months but stops short of drawing a specific link with vaping.

The report also advised excluding tobacco lobbyists from discussions about vaping.

What is vaping?

Vaping has been around since 2003, when a Chinese pharmacist, Hon Lik, is credited with creating the first vapourising e-cigarette. Its purpose was to wean a smoker off traditional tobacco-filled cigarettes without forcing them to go cold turkey.

E-cigarettes promise a healthier alternative to cigarettes as they do not contain tobacco and provide a lower level of nicotine. They also provide smokers with something physical to hold in their hands as they wean themselves off the cigarette habit. There is no known link between vaping and cancer.

While the long-term health effects remain unknown, some say governments should make an effort to prevent e-cigarette use by young people merely due to their nicotine content. Nicotine can harm developing brains, the development of which continues until at least the age of 25. When children expose their brains to nicotine they become vulnerable to addiction, may have trouble paying attention, and can experience mood disorders and reduced impulse control.

Smoking culture

Smoking has long been more tolerated in France than on the other side of the Atlantic. But changing attitudes and public pressure led to a 2006 ban on smoking in enclosed public places such as restaurants, bars, government buildings and schools.

In May 2013, then health minister Marisol Touraine announced that the ban would be extended to include e-cigarettes. She also banned their purchase by minors.

Touraine’s Article 28 prohibited the use of e-cigarettes in certain public spaces, including educational establishments and establishments intended for the reception, training and accommodation of minors; in closed public transport (bus, train, metro, tramway...); and inside enclosed or covered workplaces that are used by more than just one individual.

In principle, it is not forbidden to vape in other places open to the public (restaurants and bars, for example). However, establishments are free to implement a ban on their premises.

Trump’s proposed ban specifically focuses on the appeal of e-cigarettes to young people. In America, e-cigarette use by teenagers increased by 78 percent in the year from 2017 to 2018. And, according to a 2014 survey, 81 percent of young e-cigarette users cited the availability of appealing flavours as a primary reason for use. Fruity flavours mask the bitterness of nicotine, making it a lot more palatable for younger smokers.

“We do not have the research on how many young people start with e-cigarettes and then progress to cigarettes,” says Arvers. “But in France, the numbers show that between 2016 and 2018 the number of smokers had hugely diminished, both for men and women. More than 1 million people gave up smoking. This is very significant.”

The most recent figures in France show that there were 17 million smokers in 2018 compared to 18 million in 2017 (of a total population of 66 million).

Arvers believes that any risks from vaping are manageable given the well-known health hazards of cigarettes.

“Vaping is not completely risk-free but the risks are much much smaller than with cigarettes,” he said.

“We know that one smoker out of every two will die from cigarette use. We cannot ignore this figure. Our main drive has to be towards a new generation of non-smokers. And we believe that e-cigarettes serve a crucial purpose in getting us towards this goal.”

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