Smoking is declining in popularity around the world. According to the World Health Organisation (WHO), lighting up could decrease from 22.1 per cent of men and women in 2010 to 18.9 by 2025. In the US alone, the number of adult smokers is expected to plummet from 19 per cent in 2010 to 12.5 per cent within seven years. In my native France, where smoking is so endemic scientists once called it “the French paradox”, because smokers did not seem to suffer adverse effects at the same rate as the rest of the world, health minister Agnes Buzyn announced one million people had been persuaded to give up in the past year.
So what has contributed to this trend? In addition to price increases and countless public health prevention campaigns, there is evidence that the growth in smoking e-cigarettes, known as vaping, has played a significant role in decreasing tobacco consumption over the past decade, with the belief that it is less toxic. Last year the e-cigarettes market was valued at $10.24 billion and could reach $16.85bn by 2023, according to Mordor Intelligence.
A study published by the Drug and Alcohol Review last month claims former smokers who have quit and now vape are less likely to take up smoking cigarettes regularly again. Yet public health experts remain divided when it comes to their attitude towards vaping. A 2016 WHO report submitted before the Framework Convention on Tobacco Control, to which 180 countries have signed up, stated nations should consider cutting the use of e-cigarettes because there was not enough evidence to show they curbed smoking. It suggested countries should consider imposing restrictions on vaping, including tighter controls on sales and advertising. WHO argued while the long-term effects were largely unknown, these were reasonable measures. The UAE is among those countries which ban vaping amid fears of its impact on health.
What is beyond doubt is that both cigarettes and e-cigarettes contain addictive nicotine. According to the Centre for Disease Control, there has been a sharp increase in the number of school pupils taking up vaping. The US Food and Drug Administration has taken measures to fight this alarming rise by banning the sale of e-cigarettes in convenience stores. One of the e-cigarette manufacturers within the FDA's sights is Juul in San Francisco. Last month the US body seized thousands of documents from Juul's headquarters amid fears, according to FDA commissioner Scott Gottlieb, that teenage use of vaping devices is escalating into an "epidemic". Juul's sales reportedly increased by 783 per cent in the year to June 2018, making the company nearly $1bn. According to the Wall Street Journal, Altria Group, the parent company of Marlboro cigarettes, is in talks to "take a significant minority stake" in the firm.
But it is what has made the firm so popular, particularly among teenagers, that raises alarm bells: a dangerous combination of psychology, physiology and marketing.
Firstly, Juul has positioned itself as a way to give up smoking altogether. This psychological primer, together with the idea that vaping is less dangerous, is likely to have persuaded teenagers that it is a safer option than smoking.
Secondly, its innovative technology is appealing. The vaporisers look like USB flash drives and come in a vast range of flavours, enticing consumers to try new ones and smoke more.
The third factor is an unprecedented and aggressive use of social media for marketing and communication, especially on Facebook and Instagram. By making vaping appear “cool” and enticing consumers to share pictures of their “e-cigarette experience”, Juul’s strategists have created the vapers’ equivalent of Instagramming dishes in restaurants.
Several neuroscientific studies have revealed how seeing pictures of dishes triggers a reaction in the reward system of our brains, making us hungry. Pictures of people vaping not only triggers desire to vape in the brains of people seeing them, they say, but also reinforces herding behaviour.
Finally, most of their pods contain more nicotine than most of their competitors, something that contributes to neurophysiological addiction.
The FDA’s campaigning against e-cigarette consumption by teenagers has prompted Juul to withdraw most of its online content and launch prevention initiatives. However, if Altria takes a stake in the company, it would no doubt become harder for Juul to stick to its anti-smoking narrative.
The FDA is prioritising preventing under-18-year-olds from having access to e-cigarettes by making it more difficult for them to buy them. This key measure that was taken promptly, compared to a usually slow public policy timeline when dealing with health issues. But there are always unintended consequences, even to policy that is designed and implemented with the best of intentions. If e-cigarettes and pods are harder to buy, it should be the same for cigarettes - which is unfortunately not the case.
One invariant in human behaviour is that anything that requires little effort is more likely to be adopted than a costly action. If buying vaping material becomes difficult and buying cigarettes remains relatively easy, there is a chance that people might go back to smoking. A short-term objective of preventing teenagers from having access to e-smoking devices could lead to long-term consequences. With more than a billion people on the planet still smoking regular cigarettes, that is a worrying possibility.
Professor Olivier Oullier is the president of Emotiv, a neuroscientist and a DJ