In late December of last year, the Government of Canada announced a proposal to lower the allowable levels of nicotine in vaping products from 66 milligrams per millilitre to 20 mg/ml in an effort to curb youth vaping. The public consultation period would be in effect for 75 days, closing on Mar. 4, 2021.
Credit: Toptop54
The proposed reduction is a move vaping advocates say will minimize their value to adult smokers looking to transition away from cigarettes, according to the Morinville News.
However, the Canada-based Vaping Industry Trade Association (VITA) says smokers having access to sufficient nicotine levels in an alternate product is essential to the effectiveness of vaping as a harm reduction product. “A limit of 20mg/mL is simply too low for many smokers,” Allan Rewak executive director of VITA stated in a media release. “Adult smokers need access to higher nicotine vapor products at the beginning of their journey from smoking to vaping. Lowering this limit is just going to keep more smokers smoking.”
The Canadian government is following a move by Nova Scotia, who in April of this year, instituted a 20mg/mL nicotine cap as well as a flavor ban. VITA says that change in the rules saw a 25 percent increase in legal cigarette sales increase, an increase four times higher than surrounding provinces. The regulations also resulted in half of the province’s specialty vape shops closing their doors.
“Considering the disparity of harm between vaping and smoking, we don’t understand why the federal government would be using Health Canada resources during a global pandemic to explore making it harder for adult smokers to switch to a reduced risk product,” said VITA president Daniel David.
Enforcement the real problem
The Government of Canada has previously put some measures in place to address youth vaping. Those changes include public education campaigns and banning the advertising of vaping products in public spaces if the ads can be seen or heard by youth.
Thomas Kirsop, owner of Alternatives & Options, a vape store in Morinville and St. Albert said he believes the government is taking the wrong approach with the nicotine reduction to handle the rise in youth vaping.
“A 60 percent reduction in commercially available nicotine concentration will impede my ability to assist the heaviest smokers,” Kirsop said. “It is a federal offence to knowingly sell vapor products to minors or for members of the adult population to provide these products to underaged consumers. In practice, however, I find this law poorly enforced. I think enforcing the current law would yield more significant gains than destroying the efficacy of a less harmful solution.”
Health Canada says restricting flavors in vaping products, and requiring the vaping industry to provide information about their vaping products, including sales, ingredients, and research and development activities are under consideration.
VDX Distro announced today the launch of its e-liquid brand, Four Seasons Fine Tobacco. The brand was founded to give smokers a more authentic and pleasing replacement for traditional cigarettes, according to a press release.
Credit: Four Seasons
“Four Seasons’ e-liquids are designed to withstand flavor bans by being what they are and no more – pure, authentic tobacco flavors. Its flavors are all made from naturally extracted tobacco, with no artificial flavors, colors, additives, or sweeteners, giving consumers that pure tobacco taste,” the release states. “Each flavor is carefully crafted to emulate those of the most widely appreciated cigarette brands, resulting in a vaping experience that most closely resembles the mouth feel, throat hit, and taste.”
Four Seasons’ products have received an acceptance letter from the U.S. Food and Drug Administartion (FDA) for its premarket tobacco product application (PMTA) accepted, according to the release.
“At Four Seasons we seek to bring you a satisfying vaping experience that will give you the tools you need to make the switch away from combustible tobacco for good,” said Four Seasons CEO and Founder Ryan Chalmé. “Our mission from day one remains the same as it does today, helping adults discover an alternative to traditional tobacco.”
The FDA requires a product to have been on the market prior to Aug. 8, 2016 and have filed a PMTA in order to remain on the market after Sept. 9, 2020. There was no mention if Four Seasons was on the market prior to Aug. 8, 2016.
In late November, the City of Missoula, Montana banned flavored vaping products and not flavored combustible tobacco products. Now, Missoula County is considering using its extraterritorial powers to extend the city’s ban on the sale of flavored vapes and their display five miles outside city limits next week.
If approved, it would be the first time Missoula County applied its extraterritorial powers in four years. The last time it did was related to the city’s smoking ordinance.
“This initially started with the health board adopting a resolution and asking both the commission and City Council to do something to stop the epidemic of youth tobacco, especially using vape products,” said Shannon Therriault, county director of environmental health. “We were seeing a giant increase in the number of kids becoming addicted to nicotine, and a lot of that traces back to flavored tobacco products.”
The city ordinance goes into effect this month.
The city ordinance bans the display of self-service tobacco products of any kind, except where children aren’t permitted. It also banned the sale of all flavored electronic tobacco products, and made it illegal to sell tobacco to anyone under the age of 18.
“The health board reviewed it and approved. Now, it’s coming to the commissioners to review and approve,” said Therriault, according to the Missoula Current. “If approved, it can be applied five miles outside the city limits. It’s great, because it takes in a large amount of the area – the urban area.”
The original city ordinance included a ban on all flavored tobacco, which had the support of health officials but was opposed by dozens of businesses and tobacco users.
The COVID-19 pandemic has changed the conventional wisdom about many things, and upended the world and our economy in ways we could not have imagined in January. The proliferation of misleading, conflicting and sometimes outright false information, coupled with the constantly changing norms brought on by the pandemic, have hit business owners particularly hard.
Dimitris Agrafiotis Credit: TSFA
The Tennessee Smoke Free Association is an advocacy group and trade organization with a focus on tobacco harm reduction through the use of personal vaporizers (electronic cigarettes) and other smokeless tobacco products shown to reduce the morbidity and mortality associated with smoking. While our primary focus is the prevention of tobacco harm, we are also a group of small business owners trying to stay afloat in these uncertain times.
In the summer and fall of 2019, mysterious lung injuries were making headlines in the United States. By October, the Centers for Disease Control and Prevention had taken notice and given it a name: EVALI, which stands for e-cigarette, or vaping, product use-associated lung injury. They began issuing warnings about vaping devices, and guidelines were issued on treating it. And then, in early November 2019, the CDC reversed course and issued a report naming the actual culprit as tainted vitamin E acetate cartridges in illicit marijuana vaporizers — not the vaporizers themselves.
However, the damage to our industry was already done, and stigma of the original incorrect conclusions persists. Standard vaporizers contain varying levels of nicotine (which can be controlled by the user) but don’t have many of the harmful carcinogens found in cigarettes. We are still fighting the battle of misinformation and working to get our message out that e-cigarettes and vape devices can be used by adults addicted to cigarettes in a responsible way that improves their health.
And then, in the wake of the confusion and misinformation surrounding EVALI, the pandemic hit. Cities and counties began shutting the economy down, separating businesses into categories of “essential” and “non-essential.” In many places, vape shops were designated non-essential and forced to close, while gas stations, grocery stores and convenience stores — all of which sell cigarettes — were permitted to stay open.
We were able to advocate for ourselves, and many cities and counties reversed course and allowed us to reopen with curbside services, which almost all of our members did, following strict safety protocols. We continue to be grateful to the elected officials who responded to our hardship and worked with us so we could operate in a responsible manner.
Prior to discovering vaping, I was a longtime heavy smoker with a family history of poor health and even death because of smoking cigarettes. I feel that e-cigarettes saved my life, and many members of the TSFA have had similar experiences. We are knowledgeable and honest about our products and are small-businesses owners who contribute to our communities.
However, as small-business owners, though, we are still struggling with the aftereffects of the EVALI fallout, which were compounded by the pandemic. At the Tennessee Smoke Free Association, we will continue our work to put out critical scientific information and bust myths surrounding the use of e-cigarettes.
Dimitris Agrafiotis is the executive director of the Tennessee Smoke Free Association.This article first appeared on Knoxnews.com.
Two California cities have become the only jurisdictions in the U.S. to eliminate the sale of all vaping and traditional tobacco products. On January 1st, Beverly Hills and Manhattan Beach, both in the Los Angeles area, began to enforce the strictest vaping rules in the country. The law also included a phase-out period for retailers to empty their shelves of e-cigarettes. Other cities are considering enacting similar bans.
The Beverly Hills City Council, the first to pass its ordinance, proposed the rule nearly three years ago during a meeting discussing the potential ban of flavored vaping products. Ultimately, the council settled on a total ban of all vaping and traditional tobacco products.
Credit: Haiberliu
“Somebody’s got to be first, so let it be us,” said then-Mayor, current Councilmember John Mirisch, who first proposed the concept in 2017, according to a press release. Mirisch recently joined the Board of Trustees of the advocacy group Action on Smoking & Health (ASH), which coordinates Project Sunset, an effort to phase out tobacco sales worldwide.
“Cigarettes have become so normalized that to some this might seem like a drastic step,” said Chris Bostic, ASH Policy Director. “But if another product emerged tomorrow that was highly addictive and killed when used as intended, of course we’d ban its sale. We’d probably charge the people who marketed it with manslaughter too.”
Total vaping and tobacco bans have been gaining traction more recently, within the public health community and more broadly. The Danish Institute for Human Rights, after concluding a human rights assessment of Philip Morris International in 2017, concluded that “there can be no doubt that the production and marketing of tobacco is irreconcilable with the human right to health. For the tobacco industry, the UNGPs [United Nations Guiding Principles on Business and Human Rights] therefore require the cessation of the production and marketing of tobacco.”
Vapor industry advocates say that banning e-cigarettes only pushes former combustible cigarettes smokers back to combustibles. They also say that vaping bans increase the size of the black market. Black market THC vaping products were the cause of a lung disease that sickened and killed numerous youth in 2019.
RLX Technology, parent to the RELX brand of vaping products, has filed with the Security Exchange Commission (SEC) in the U.S. to raise up to $100 million in an initial public offering (IPO).
Credit: RELX Technology
The $100 million request is well below the $1 billion the company said it expected to raise when it announced Citigroup as the bank of record for its planned initial public offering in the U.S., people with knowledge of the matter said.
The Shenzhen-based company, which counts Sequoia Capital among its backers, boasts a 62.6 percent market share in China for closed-system vaping products in terms of retail sales, according to a press release.
“The company has partnered with 110 authorized distributors to supply its products to over 5,000 RELX Branded Partner Stores, and over 100,000 other retail outlets nationwide, covering over 250 cities in China,” the release states.
Revenue for the company nearly doubled in the nine months ended September 30, 2020 to $324 million, with net income of $16 million.
The Beijing, China-based company was founded in 2018 and booked $400 million in sales for the 12 months ended September 30, 2020. It plans to list on the NYSE under the symbol RLX. RLX Technology filed confidentially on October 26, 2020. Citi is the sole bookrunner on the deal. No pricing terms were disclosed.
Uwell accomplished the impossible by improving on the success of Caliburn with the new Caliburn G.
Mike Huml
Uwell’s follow-up to the sleeper hit, the Caliburn, is every bit as good as its predecessor and more. The Caliburn G builds upon the success of the original Caliburn and represents the culmination of all the best pod system innovations to date. In terms of both features and performance, the Caliburn G does not lack in any respect.
The Caliburn G is a lightweight pod system that features both an automatic draw and a manual, button-activated draw. The battery is rated at 690 mAh, which is surprisingly adequate for all-day vaping, and it’s quickly charged via a USB-C cable. Each 2 mL pod is refillable and replaceable, and the 0.8 ohm mesh coil can be replaced as well.
Additionally, the Caliburn G has two airflow options depending on how the pod is inserted, one for mouth-to-lung vaping and the other for direct-lung vaping. The pod can be refilled quickly and easily from the top, and the Caliburn G is free of any leaks, gurgling and spitback of any kind. All in all, the Caliburn G might very well be the most consistent, easy-to-use, convenient and well-performing pod system on the market.
The original Caliburn was surely ahead of its time, and the Caliburn G offers some key refinements that really give it the edge. The Caliburn G incorporates a single button that can be used to fire the device or toggle the power with five quick clicks. Whether utilizing the button or the automatic draw, a multicolored LED will illuminate at the tip to indicate that the coil is receiving power. This LED will cycle between red, blue and green depending on the remaining battery life.
When above 60 percent power, the light will display green. When between a 30 percent and 60 percent charge, the light will illuminate blue, and when below 30 percent, the LED will be red. When charging, the LED will pulse or breathe in the same color corresponding to battery life until fully charged when the light will illuminate as solid green. A full charge can be achieved in under one hour, and the device can continue to be used while it is charging.
At 690 mAH, the battery lasts a surprisingly long time and should be capable of a full day of use. If not, charging is extremely quick, and downtime is kept to a minimum since it can be used while charging. Additionally, by using the increasingly popular USB-C port, there is a good chance that the Caliburn G can be charged with the same cable as most any modern mobile phone or device, further increasing convenience.
As far as appearances go, the Caliburn G features vertical lines machined into the matte, anodized aluminum body that give the device an attractive and unique but not over-the-top aesthetic. It’s also strangely satisfying to hold as the texture of the lines feels good under one’s finger. It’s a small thing and one that goes about largely unspoken, but it can be important that a vapor device feels good to hold. And as a bonus, the Caliburn G’s finish is virtually impervious to fingerprints. Save for any blemishes caused by dropping the device, the Caliburn G will look like new indefinitely.
Both the Caliburn G pods and coils are replaceable; however, each new pod will not actually include a pre-installed coil. One could feasibly never purchase new pods and only ever replace coils on a regular basis. However, replacing pods as well as coils allows the user to swap e-liquids more easily with no overlap in flavor. The coil is very easily replaced by removing the pod, flipping it upside down, sliding out the coil and inserting a new one.
The base of the coil and the corresponding area on the bottom of the pod are asymmetrical so that it can only be inserted one way. While the coil is replaced from the bottom, it is refilled from the top, and as such, it can be done without removing the pod. By simply applying leverage to the broad side of the mouthpiece, the tip can be popped off to reveal the fill port.
The fill port is kept sealed with a silicone flap to eliminate leaking due to a lack of pressure, which gives way when a bottle is inserted for filling. The opposite side features a pinhole to release the pressure when the pod is filled so that e-liquid does not get backed up and cause a mess. The tip snaps on and off, and a clear window on the narrow side of the battery section reveals how much e-liquid is remaining.
The pod also snaps into the battery section without magnets, using grooves and protrusions in the inside of the battery and the outside of the pod, respectively, to hold everything together securely. It doesn’t have the same satisfaction as the smoothness of a magnet, but the pod is held in place much more securely and won’t weaken over time.
The pod’s airflow inlet lies on the bottom of the pod on only one side and receives airflow via a small hole in the side of the battery section. This simple system is what allows the user to choose between open airflow for restricted lung hits and tighter airflow for mouth-to-lung drags. If the hole in the pod and the hole in the battery are on the same side, this allows for open airflow.
By reversing the direction of the pod, the pod’s air hole is now on the opposite side of the battery’s air hole, which introduces more resistance and therefore a tighter draw. The difference between the two airflow settings is admittedly small, but combined with the actual vaping performance as a whole, it ends up being a perfect system.
Performance is generally the most important aspect of any vapor device, and the Caliburn G makes large strides in a very subtle way in this regard. It’s been known since the inception of vaping that most devices are not to be used in the same way as traditional analog cigarettes. Smoking generally involves fast, sharp drags followed by a fast inhale.
Conversely, vaping, particularly mouth-to-lung vaping, requires long and slow pulls to give the coil time to heat up and start producing vapor. That is not the case when it comes to the Caliburn G. This device can be used exactly like an analog cigarette, and other than the physical shape, it feels nearly identical to smoking.
The airflow is similar, but the airflow turbulence is dead-on accurate. The 0.8 ohm mesh coil heats up instantly, and drags can be sharp and quick. Every pod system feels different, but for anyone looking for the best vaping experience to simulate smoking, this is it. The vapor production is more than adequate, the throat hit is significant yet smooth and the overall feel is spot on.
As for the direct-lung airflow setting, this is very good as well. Naturally, it can’t be compared to smoking, but it works just as well as anyone could expect. Even with the increased airflow, e-liquid never backs up or leaks into the mouthpiece. Full inhales aren’t feasibly possible like with any device that allows for restricted lung hits but also aren’t necessarily due to the almost nonexistent ramp-up time.
If necessary, using the manual switch is always an option both for direct-lung and mouth-to-lung vaping styles. To top it all off, no matter which way the Caliburn G is vaped, flavor representation is just about perfect as well. The Caliburn G is fantastic for any vaper, from first-time users to veterans. Usage is just about as simple as it can possibly get, and performance is perfect all around. Battery life is adequate, charging is fast, refilling is clean and easy, swapping coils is a snap, and the whole package is very intuitive.
In all fairness, if there were to be one negative aspect attributed to the Caliburn G, it would be that the button protrudes slightly, which could lead to the occasional accidental firing of the coil if the battery is not powered off. Even to say that this is a minor gripe would be an overstatement, but in the interest of safety, it could be argued that a button that sits flush to the rest of the body would be preferable.
There is absolutely no good reason to pass on the Caliburn G. Uwell is a reputable company with a history of supporting its products long-term, and the device itself is nearly perfect. For as well received and appreciated as the original Caliburn was among vapers, it’s truly a feat that it could be improved upon at all, but the Caliburn G stands as evidence that it was possible. A series of small changes and tweaks only served to enhance the Caliburn design, and vapers are left with a pod system that will be hard to beat for the foreseeable future.
Regulation, taxation and fighting bad science is all on the agenda for the tobacco and vapor industries over the next 12 months.
By VV staff
During the final session of the Global Tobacco & Nicotine Forum (GTNF), the future of the vapor industry was put on center stage. The panel of experts suggested that regulation, taxation and confronting misinformation are going to be the major challenges that the tobacco and vapor industries battle over the next 12 months.
In the U.S., the premarket tobacco product application (PMTA) process is going to be a major legal and regulatory focus, according to Stacy Ehrlich, partner at Kleinfeld Kaplan & Becker LLP. She said that while companies need to file PMTAs or standard equivalency (SE) reports, it is unknown how the U.S. Food and Drug Administration (FDA) will review these new products and enforce its rules.
“How wide will the FDA enforcement be over these products? Another regulatory key issue over the coming 12 months will be flavors in vapor and cigar products at all levels of government,” she said. “Flavors may increase initiation in youth … but they may also help move adults to lower risk products.”
So far, the only action toward flavors by the FDA has been to remove all flavors except tobacco flavors for closed pod systems. The absence of federal rulemaking has motivated some local and state entities to enact their own flavor bans.
“What are unintended consequences of flavor ban?” Ehrlich asked. “A push towards the black market—push people back to smoking? What are the long-term impacts on public health? These are significant regulatory issues to watch in the coming year.”
The fight against misinformation will also be a major issue. David O’Reilly, director of scientific research for British American Tobacco, told attendees that the industry is still suffering from the effects of the e-cigarette or vaping product use-associated lung injury (EVALI) that began in mid-2019. That crisis was later found to be caused by vitamin E acetate in black market THC products and not any nicotine-based vapor products.
“What the pandemic might do, and the jury is still out on this, but it has brought science and evidence into everyone’s lives,” said O’Reilly. “There is an opportunity for this industry to use that science to promote harm reduction and bring this information to consumers and make them more savvy, and maybe they will look at the different products and brands [and move to a less-harmful product].”
Another effect on the industry caused by the pandemic may be on packaging. Omar Rahmanadi, CEO of BMJ, said that before the pandemic, there was a pressure through social media and from political groups to lessen the use of single-use plastics. The pandemic, however, has caused a major increase in the use of such plastics because of the massive need for gloves and masks.
When the pandemic ends, there could be a major pushback toward removing single-use plastics from the market completely, Rahmanadi speculated. “It’s only a matter of time before the vapor and tobacco industries are pressured to use less single-use plastics,” he said.
Sally Satel, resident scholar at the American Enterprise Institute and psychiatry lecturer at Yale University, said that for any innovation or regulation to be implemented properly, the industry needs “a massive public reckoning of the truth” about the advantages of switching to vaping from combustible cigarettes. For example, there has been a move toward negative science and studies in recent months, she says.
The World Health Organization (WHO) endorsed a vaping study centered on heart disease that was later retracted. The study, which appeared in the Journal of the American Heart Association (JAHA), was written by Dharma Bhatta and Stanton Glantz of the University of California, San Francisco, and concluded that “Someday and everyday e‐cigarette use are associated with increased risk of having had a myocardial infarction, adjusted for combustible cigarette smoking.”
Another study from Rutgers University found that 80 percent of doctors wrongly believe nicotine causes cancer. It also took the Centers for Disease Control months to clarify that EVALI was caused by black market THC vapor products. “This paints a fairly grim picture of what we are up against,” said Satel. “And all of this while allowing cigarette sales to go undisturbed while putting barriers on devices that are a great benefit to public health.”
Whatever the challenges facing the tobacco and vapor industries, answers are out there, according to David Sweanor, adjunct professor of law at the University of Ottawa. He said several countries have lessened restrictions on next-generation tobacco products in recent years, and that has had a ripple effect in the tobacco industry. Cigarette sales have slumped.
“We have seen what happens in other countries when we see a slight lessening of restrictions on these [next-generation] products like we have seen in Japan … Norway, Iceland, Sweden. These aren’t places that are actively trying to see how rapidly ending smoking is happening; it was just the effect of lessening restrictions,” explains Sweanor.
“What would happen if any jurisdiction in the world wanted to see how rapidly they could get rid of cigarettes? … Good policy is contagious. It would be very hard to resist if we saw something like that happen on a major scale to end smoking. Any country that gets that right—backs new technology—could save hundreds of millions of lives and possibly even create a new technology sector for its economy.”
Vaping studies often contain a lot of modal verbs like can, could, may and might. For example, an updated study on e-cigarettes for smoking cessation by the Cochrane Review suggest that vaping “could” help smokers quit using deadly combustible cigarettes.
The Cochrane study looked at 50 studies that took place in the US, the UK, Italy, Australia, New Zealand, Greece, Belgium, Canada, Poland, South Korea, South Africa, Switzerland and Turkey. The review found that e-cigarettes “could” be the answer many smokers are looking for according to an article in The New Strait Times.
Among the key findings were that smokers were likely to stop smoking for at least six months by switching to a vaping device with a nicotine e-liquid as compared to nicotine replacement therapy (such as gum and patches), nicotine-free vaporizers or behavioural support.
The researchers, made up of multiple independent and internationally-renowned healthcare experts, found that vaping with a nicotine e-liquid can help 10 in 100 people to stop smoking, compared to only 6 in 100 people who have tried using nicotine-replacement therapy or vaping nicotine-free e-liquids. Only an estimated 4 in 100 who try to quit without support, or those who rely only on behavioural support, are likely to succeed.
They also did not detect any clear evidence of serious harm from vaping a nicotine e-liquid.
Jamie Hartmann-Boyce from the Cochrane Tobacco Addiction Group said there is an increase in evidence of smoking cessation through the use of e-cigarettes compared to the last review in 2016.
“The randomised evidence on smoking cessation has increased since the last version of the review and there is now evidence that electronic cigarettes with nicotine are likely to increase the chances of quitting successfully compared to nicotine gum or patches,” said Hartmann-Boyce, the lead author of the review. “While there is currently no clear evidence of any serious side effects, there is considerable uncertainty about the harms of electronic cigarettes and longer-term data are needed. Scientific consensus holds that electronic cigarettes are considerably less harmful than traditional cigarettes, but not risk-free.”
In contrast, a recent study from the University of California San Francisco (UCSF), led by Richard Wang, determined that that e-cigarettes do not lead smokers away from addiction. Wang also claims that e-cigarettes “could” increase a users risk of disease. “If the use of consumer device products is not associated with increased smoking cessation, there is no health benefit,” he said. “Also, as people who smoke add e-cigarettes to their smoking, their risk of disease could increase.”
Wang worked with fellow UCSF researcher Sudhamiyi Bhadriraju and disgraced former UCSF researcher Stanton Glantz, who has recently had multiple studies retracted for what has been labeled by fellow scientists as “explicit dishonesty.”
This latest study was based on the collection of 64 trials in which participants were examined. All of them are e-cigarette users, according to an article on Explica.com.
“In observational studies you are asking people about the use of the devices they bought themselves. But they did it without specific guidance to quit smoking,” says Wang. “In a randomized trial, you test a product, treating it as a therapy or drug to quit.”
Wang then goes on to say there “may” be a cessation effect. “When certain electronic devices are treated as medicines, there may actually be a smoking cessation effect,” explains Wang. “But it has to be balanced against the risks of using cigarettes.”
Vaping can have a negative effect on memory, thinking skills and the ability to focus, particularly for young people, according to a recent study by researchers at the University of Rochester (New York) Medical Center.
“Our studies add to growing evidence that vaping should not be considered a safe alternative to tobacco smoking,” said Head researcher Dongmei Li.
The study is based on data analyzed from the over 886,000 participants involved in the Behavioral Risk Factor Surveillance System Survey and the more than 18,000 responses from the National Youth Tobacco Survey.
The researchers concluded that those who vaped or smoked cigarettes were more likely to struggle with cognitive function than those who had never smoked in any capacity. Also, the researchers noted that age played a large role in the participants’ cognitive abilities as they found that when participants were younger than 14 when they started vaping or smoking, they were even more likely to have cognitive struggles as adults.
“With the recent rise in teen vaping, this is very concerning and suggests that we need to intervene even earlier. Prevention programs that start in middle or high school might actually be too late,” Li added.
