User:QuackGuru/Sand E

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For over 50 years, there has been a compelling assemblance of irrefutable evidence demonstrating that smoking cigarettes leads to disease in nearly every human organ.[1] At least as early as the 1950s the tobacco industry has intentionally mislead the public regarding the health risks of smoking.[2] Big Tobacco has partnered with firms, including the Electronic Cigarette Association, Consumer Advocates for Smoke-Free Alternatives Association, and Vapers International, Inc., that were set up to promote the use of e-cigarettes.[3] These factions, coupled with other vested interested parties, have had taken steps to stall or abolish legislation targeted at curbing the sales and the use of e-cigarettes.[3]

Previous studies have identified several strategies used in tobacco and e-cigarette advertising that are particularly appealing to young individuals.[4] These include marketing flavors, especially fruity ones, offering price reductions and discounts, displaying product design, promoting harm reduction claims like e-cigarettes being less harmful than traditional cigarettes, incorporating activities and environments, highlighting sports events or bars, and utilizing emotional appeals and humor.[4]

While cigarettes have been the leading source of tobacco consumption, a diverse range and usage of more recently created products had been accelerating by 2021.[5] These newly created tobacco, nicotine, and other aerosolized products were perpetually being introduced into the marketplace and were vigorously being pushed both in affluent countries where cigarette consumption is descending and where people are able to pay for the latest products, in addition to less affluent countries, thus sidestepping laws prohibiting tobacco advertising or the importation of nicotine vaping devices.[5]

Their short as well as their long-term consequences, including their potential carcinogenicity, are actively being scientifically investigated.[6] Biased research paid for by the tobacco industry continues to be rampant in the e-cigarette topic area, as of 2019.[7] The tobacco companies have had an impact on research-based conclusions by providing funding for scientists.[8] The extent to which research related to e-cigarettes has ties to businesses and other special interests in this industry, is an area of concern.[9]

Tobacco industry strategies

External video
1994 - Tobacco Company CEOs Testify Before Congress

For over 50 years, there has been a compelling assemblance of irrefutable evidence demonstrating that smoking cigarettes leads to disease in nearly every human organ.[1] At least as early as the 1950s the tobacco industry has intentionally mislead the public regarding the health risks of smoking.[2] When more evidence demonstrating a link between smoking and cancer was starting to become more apparent, the tobacco industry created the Tobacco Industry Research Committee in 1953, which was a group devoted to attacking scholarly research.[2]

While millions of people were dying, it was hard to show in the early 1960s the true cost of tobacco on health worldwide, as the proof needed decades to arise fully.[1] Confronted with the undeniable evidence of the deaths caused by tobacco products, the tobacco industry devised an extensive and thorough approach to maintain and grow their market.[1] Fabricating uncertainty and controversy surrounding the health impacts of tobacco and pushing disingenuously less risky smoking products were bedrocks of this approach.[1]

Tobacco industry engaging in public deception

The top executives of the seven largest American tobacco companies testified in Congress today that they did not believe that cigarettes were addictive, but that they would rather their own children did not smoke.[10]

 —Philip J. Hilts, The New York Times[10]

Cigarette smoking accelerated in the late 19th and early 20th centuries in tandem with the growth of mass production technologies and advertising.[11] However, it was not until the 1930s that statisticians noted increased cancer mortality rates and thoracic surgeons reported an increase in pneumonectomy to remove lung cancers.[11]

Three decades later the landmark 1964 US Surgeon General's Report causally attributed lung cancer to cigarette smoking, and four decades after this the tobacco companies were defeated in the US court system on racketeering charges that they systematically deceived the public in the pursuit of profits.[11] The lesson from smoking in the 20th "cigarette" century is that it took decades to show that addictive, heavily marketed inhaled tobacco products caused lung disease.[11]

On April 15, 1994, senior executives of the seven major tobacco companies in the US spoke before the US Congress.[10] Each one testified that they believe nicotine is not addictive.[10] This was one of the more peculiar moments in the history of tobacco politics that occurred in Washington, D.C., Philip J. Hilts stated.[12]

Tobacco industry funded research

As they have done to influence tobacco control policies for conventional cigarettes, the large companies often try to stay out of sight and work through third parties that can obscure their links to the tobacco industry.[13]

 —Stanton A. Glantz and David W. Bareham, Annual Review of Public Health[13]

It is well known the tobacco industry has funded research to call into question the evidence of the dangers of tobacco consumption.[14] Research paid for by the tobacco industry supports ideas sympathetic to the tobacco industry.[14] This includes tobacco industry affiliated studies in favor of nicotine's assistance with Alzheimer's disease, neuroenhancement, and ulcerative colitis.[14] In the late 1980s, researchers without ties to the tobacco industry gradually became increasingly critical of tobacco-affiliated investigators and their researchers.[15] This culminated in the critical analysis of the role of the tobacco industry as one of the forefront funders of medical research and the negatives of this in the 1990s.[15] At this time, tobacco-funded researchers were heavily scrutinized, as were their research proposals and conclusions.[15]

In the early 2000s, the tobacco industry cultivated a new image and proposed transparency in its involvement in scientific research in the context of an increasingly critical public.[15] Still, a major study of the time concluded that tobacco industry research revolved around projecting a positive corporate image above public health policies and that the escalation in transparency may be a part of this agenda.[15] Initial hopes that e-cigarettes would be both a less toxic competitor to conventional cigarettes and a help to people who attempt to quit smoking cigarettes have not translated into real-world positive effects.[13] Instead, e-cigarettes have simply become another class of tobacco products that are maintaining and expanding the tobacco epidemic.[13]

Partnerships and marketing

The vaping industry has been allowed a free rein to market, promote and sell their products in a way that is not proportionate to the potential harms.[16]

 —David White and colleagues, Breathe[16]

Big Tobacco has partnered with firms, including the Electronic Cigarette Association, Consumer Advocates for Smoke-Free Alternatives Association, and Vapers International, Inc., that were set up to promote the use of e-cigarettes.[3] These factions, coupled with other vested interested parties, have had taken steps to stall or abolish legislation targeted at curbing the sales and the use of e-cigarettes.[3] Methodical e-cigarette industry groups were partly responsible for the initial surge in the sales of these products.[17] Leading up to 2016, platforms like Twitter and YouTube have enabled the tobacco industry to reach broader audiences, a trend that e-cigarette companies have exploited.[18] This has spurred research into using these media channels as both advertising tools and information resources for e-cigarettes.[18]

Previous studies have identified several strategies used in tobacco and e-cigarette advertising that are particularly appealing to young individuals.[4] These include marketing flavors, especially fruity ones, offering price reductions and discounts, displaying product design, promoting harm reduction claims like e-cigarettes being less harmful than traditional cigarettes, incorporating activities and environments, highlighting sports events or bars, and utilizing emotional appeals and humor.[4]

Despite rising public and governmental scrutiny post-2018 in the US, popular e-cigarette brands persisted in utilizing youth-appealing features in their advertisements.[4] Predominantly, online and social media advertisements were the most commonly used formats.[4] Research has shown that e-cigarette advertising on social media has been widespread and vast and readily available.[4]

The tobacco industry, which is now nearly the same as the vaping industry, has long recognized that young people are a crucial market.[19] This has led to their advertising campaigns specifically targeting children and adolescents.[19] Research has uncovered that the vaping industry uses strategies akin to those of the tobacco industry to gain legitimacy and misrepresent the scientific data on the health risks of nicotine vaping products.[20] As these interests weaken vaping control measures, implementing safeguards is essential to counteract their influence, the journal Health Promotion International argues.[20] The significant intersection between the tobacco and vaping industries is alarming, as the tobacco industry has a well-documented history of manipulating the scientific debate on the harms of smoking and obstructing tobacco control efforts.[20]

Newly introduced products

While cigarettes have been the leading source of tobacco consumption, a diverse range and usage of more recently created products had been accelerating by 2021.[5] These newly created tobacco, nicotine, and other aerosolized products were perpetually being introduced into the marketplace and were vigorously being pushed both in affluent countries where cigarette consumption is descending and where people are able to pay for the latest products, in addition to less affluent countries, thus sidestepping laws prohibiting tobacco advertising or the importation of nicotine vaping devices.[5]

Modern advancements in nicotine delivery systems sparked the creation of e-cigarettes.[21] With the onset and rapid growth of e-cigarettes, this has challenged people in the scientific, and public health circles, because they have to make regulatory decisions in accordance with public health, in spite of the lack of evidence.[1] There has been an escalation in their use in the decade prior to 2020, which has spurred the medical community to examine their potential health effects.[22] As a consequence of past lessons learned from Big Tobacco companies, the medical community is suspicious of e-cigarettes and has routinely advised against their use.[23] Many physicians fear that patients who vape are merely substituting one form of nicotine addiction for another.[23]

Various tobacco control measures and challenges

In the years before the advent of electronic nicotine delivery systems technology, various public health measures made significant progress in tobacco control yielding a 6.9% reduction in smoking across the US population from 2005 to 2017.[24] Smoking among high-school students in the US had started to decline significantly, from 28% in 1996–1997 to 15.8% in 2011 to 7.6% in 2017.[25] This decline—a true public health triumph—may be attributed to multiple tobacco control measures, including restrictions on tobacco company advertising, promotions and sponsorship, taxation of tobacco products, clean indoor air laws, banning of flavorings in cigarettes (except menthol), and decreased access of cigarettes to teenagers through the adoption of local and statewide Tobacco 21 legislation (raising the legal age of sale from 18 to 21).[25]

Keeping in mind the economic and social burden exacted by smoking-related diseases, the US federal government had enacted various laws to make the sale of conventional tobacco products more difficult especially for the younger generation.[24] However, rapid and unchecked increase in e-cigarette use has once again threatened to endanger the health of youth through nicotine addiction and vaping-related disease.[24] The National Youth Tobacco Survey held jointly by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention shows that around 3.6 million students (both middle and high school) were using e-cigarettes in 2018, up from 2.1 million in 2017.[24] In the past decades, attitudes have changed: teenagers recognize the dangers of smoking and no longer find it attractive or "cool."[25] By contrast, e-cigarettes, now used by over 20% of high-school students as of 2018, are not viewed by adolescents as dangerous or even comparable to cigarettes.[25]

Promotion of e-cigarettes may encourage non-smokers, particularly young people, to initiate use, facilitate experimentation with traditional tobacco products, and undermine tobacco control efforts.[26] Marketing that accentuates that e-cigarettes can be used anywhere may undermine enforcement of smoke-free policies and tobacco control efforts.[26]

Tobacco industry market dominance

Although their initial inception dates back to 1963, the design of e-cigarettes in 2003 by Hon Lik, has spurred increasing global sales, which now show profits worth billions of dollars.[27] Traditionally dominated by small start-up companies, the e-cigarette market has experienced rapid growth and transition, and more recently as of 2019, large manufacturers and transnational tobacco companies have come to dominate the market.[26] Major tobacco companies have entered the vaping industry by either acquiring e-cigarette companies and brands or developing their own products.[26]

As the major tobacco companies have moved into, and increasingly dominated, the e-cigarette market, they are dominating the political and policy-making environments just as they have in conventional cigarette policy making.[13] Major tobacco companies now involved in the vaping industry include British American Tobacco, Imperial Brands, the Altria Group, Reynolds American, Philip Morris International, and Japan Tobacco International.[26] These companies have benefited from large advertising and marketing budgets, which enable promotion across the World Wide Web.[26]

Heavily promoted by the industry, with fierce marketing campaigns targeted mainly at the most socially vulnerable and easily influenced populations, such as adolescents and young adults, they are growing fast in popularity, as of 2019.[28] One of the selling arguments for using e-cigarettes that they provide assistance for people to stop smoking and abolish nicotine addiction may be a lie.[29] This is because the starting age for e-cigarette use is typically lower than that of traditional cigarettes and may result in more regular use.[29]

As cigarette companies have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction.[30] This raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry.[30] Regardless of their industry ownership, e-cigarette companies have a vested interest in maximizing the number of long-term product users.[30] Thus, the ethical onus falls on governments to restrict the influence of industry through appropriate regulations targeting product manufacturing, availability, and use, devised in light of public health interests.[30]

Tobacco industry pushing the narrative of potentially reduced-harm products

In recent years leading up to 2022, the tobacco industry has been pushing a narrative that their newer lines of products-including electronic nicotine delivery devices-are offered in part to meet a social responsibility of providing potentially reduced-harm choices to their consumers.[31] While some of the newer tobacco products might potentially be less harmful than combustible tobacco products, there is also significant deviation from the very concept of harm reduction when it is used for such a conspicuously commercialized purpose.[31] The framing of commercialized tobacco harm reduction as a mere consumer preference by the industry is not clearly consistent with the core principles of harm reduction, let alone the human right to health and the highest attainable level of health.[31]

The industry's continued marketing of combustible products alongside their "potentially less harmful" products, and preference that their non-combustible products be regulated less strictly than cigarettes and cigars, adulterates the public health principles of harm reduction and undermines the right to health.[31] The tobacco industry itself has made clear that whatever benefit its "next-generation" products may provide, it coexists with the continued profit-making from manufacture, distribution, and sale of combustible tobacco products to consumers, with minimal if any marketing restrictions including on who may purchase these allegedly less harmful goods (e.g., non-smokers and first-time users).[31] The tobacco industry wants to continue to sell harmful products directly to consumers while enjoying the social and political capital that may accrue from also selling potentially less—but still—harmful products directly to those same, and new, consumers.[31]

Scholarly research and findings

Overview

Their short as well as their long-term consequences, including their potential carcinogenicity, are actively being scientifically investigated.[6] As of 2020, comprehensive in-depth analysis on the health implications of e-cigarettes have not been conducted.[32] Due to the relative novelty and continuously evolving landscape of these products, conducting long-term studies in this field presents a challenge.[33]

In recent years leading up to 2020, numerous studies have been published on nicotine-laden e-cigarettes, which demonstrated their addictive nature and their potential to cause respiratory injury.[33] As of 2020, the majority of studies have concentrated on the short-term effects of vaping.[34] As a result, the long-term effects of using e-cigarettes may remain unclear for years to come.[34] Adding to the complexity is the possibility of additive or synergistic toxicity when using two or more different tobacco products.[34]

The US FDA in 2009 analyzed e-liquid cartridge samples[35] from two brands of e-cigarettes,[36] which were NJOY and Smoking Everywhere.[37] Their analysis of the e-cigarette samples showed that the products contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.[38] Diethylene glycol was detected in one cartridge at approximately 1%.[38] Diethylene glycol, an ingredient used in antifreeze, is toxic to humans.[38] The source of the diethylene glycol contamination is not clear but could reflect the use of non-pharmaceutical grade propylene glycol.[23]

On July 22, 2009,[36] the FDA warned that e-cigarettes may present a health risk.[3] On October 6, 2022 in a press release, the US FDA Commissioner Robert M. Califf stated, "The FDA remains deeply concerned about e-cigarette use among our nation’s youth. It’s clear that we still have a serious public health problem that threatens the years of progress we have made combatting youth tobacco product use. We cannot and will not let our guard down on this issue. The FDA remains steadfast in its commitment to using the full range of our authorities to address youth e-cigarette use head-on."[39]

Positions of professional organizations

In October 2012, the World Medical Association stated, "Manufacturers and marketers of e-cigarettes often claim that use of their products is a safe alternative to smoking, particularly since they do not produce carcinogenic smoke. However, no studies have been conducted to determine that the vapor is not carcinogenic, and there are other potential risks associated with these devices."[40] In May 2014, Cancer Research UK stated that there are "very preliminary unpublished results that suggest that e-cigarettes promote tumour growth in human cells."[41]

In 2014, the World Lung Foundation (now known as Vital Strategies) stated that "Researchers find that many e-cigarettes contain toxins [toxicants], contaminants and carcinogens that conflict with the industry's portrayal of its products as purer, healthier alternatives. They also find considerable variations in the amount of nicotine delivered by different brands. None of this information is made available to consumers so they really don't know what they are ingesting, or how much."[42] In 2025, the American Cancer Society stated that "There is evidence that nicotine harms the brain development of teenagers. If nicotine is used during pregnancy, it can also cause premature births and low birthweight babies."[43]

Sponsorship of e-cigarette research

Biased research paid for by the tobacco industry continues to be rampant in the e-cigarette topic area, as of 2019.[7] The tobacco companies have had an impact on research-based conclusions by providing funding for scientists.[8] The extent to which research related to e-cigarettes has ties to businesses and other special interests in this industry, is an area of concern.[9]

In 2021, Juul provided $51,000 to allocate the full May/June issue of the American Journal of Health Behavior to publish 11 studies paid for by the company to present evidence that its products assist smokers to cease smoking.[44] All the studies were co-authored by people who were current or former Juul employees or somehow affiliated to or under contract with Juul.[45] Elbert Glover, the owner of the American Journal of Health Behavior journal at that time, did not tell the peer reviewers allocated to the studies that Juul bought the whole issue.[46] Several stopped reviewing the studies when they found out.[46] Glover recruited other people to review the studies for a cost of $75, which is not normally done..[46] Nearly all the articles did not acknowledge that Juul and other e-cigarette companies profit off of luring an untold number of new users to nicotine addiction.[45]

Research that divulged monetary support from the tobacco industry had increased rates of endorsing e-cigarette use as a quitting smoking-aid.[47] Moreover, industry funding is strongly associated with finding no harm of e-cigarettes, compared with studies without a potential conflict of interest.[11] Researchers who had ties to the tobacco industry or were funded by tobacco companies were less likely to report the harmful effects of using e-cigarettes.[48]

See also

References

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