Cigarettes are bad, we get it. What about Vaping? Be ready to be shockingly underwhelmed!

I hate to break it to you, but smoking is bad for your health, and it isn’t going away anytime soon. Yes. Truly sad. Now that we got that out of the way, let’s talk about it. Last year, Philip Morris released an ad stating they are “Delivering a Smoke-Free Future,” promising to help people quit their nicotine habits. But the data, as we will see, shows that smokers worldwide are not decreasing. From the number of ad campaigns showing the damage done to your lungs by inhaling that nicotine to the lobbying efforts of NGOs, everyone is confronted with the reality of the consequences of smoking, but that doesn’t seem to deter people from reaching for that small cylindrical helper to get them through the next moment.

In a world of global commerce where everyone has the choice to decide any kind of cigarette they want, how to get it, when to get it, where to get it, and who to buy from, is it any surprise that 1-in-5 adults use tobacco? What may be surprising is that this report shows that some start smoking as early as 13 years old.

Addictions May Not Be Harmful

So, we are addicted to nicotine. We can be soothed at a moment’s notice by enjoying a cigarette. While there have been many global campaigns to quell public smoking habits, and the numbers provided by the WHO report show a decline in tobacco usage, the global public does not show signs of snuffing out its smoking habits.

Enter e-cigs (or vaping). A better alternative to the traditional tobacco cigarette. What has been touted as the safer alternative, you can smoke it practically anywhere without the lingering smell of tobacco smoke.

Magdolna McAlister, an addiction specialist at the Bonus Pastor Alapitvany, said, “Nicotine is difficult to give up – it is one of the hardest addictions to stop. One reason why I believe this is happening is that people are socialized into smoking. People like to hang out with one another and chat, and what do they do when they talk? They smoke.”

In a study from 2024, it was reported that 80% of smokers began before the age of 18 years. In a similar report from the CDC, it was noted in 2024 that around 1.63 million US middle school and high school students reported vaping, a decrease from 2023 when it was estimated that 2.13 million were reported vaping.

Meet Kirsten Moraru. Kirsten remembers smoking her first cigarette six years ago. It was when she was at her friend’s place that they decided to try her friend’s father’s cigarettes. Now, 21 years old, Kirsten admits she’s still addicted to cigarettes. And while she doesn’t smoke as much as she did before, she is trying to cut back by using IQOS, vapes, and SNUS.

Trends show smoking will increase in sales and users over the next five years, despite campaigns aimed at promoting a smoke-free lifestyle. This increase in usage will not only be from people older than 18 but also from users in middle school and high school. With such a growing usage across the globe, is it safer to vape?

The health impacts of traditional smoking and vape usage remain a pressing concern across Europe, including Romania. Smoking is a leading cause of premature death in the European Union, accounting for approximately 700,000 deaths annually, according to the European Commission. While in Romania, according to the Eurobarometer in 2021 regarding attitudes of Europeans towards tobacco and related products, tobacco use caused around 29,500 deaths per year, with a smoking prevalence of 27.5% among adults in 2022, significantly higher among men (37.4%) than women (18.5%).

Rareș Buiga, an Oncologist with 25 years of experience at the Ion Chiricuţă Oncology Institute, said, “Every day I see the devastating effects of this silent killer on people who are either ignorant, indifferent to their health, or simply too weak to fight an addiction acquired too easily in their youth. Globally, at least one in three cancer deaths is thought to be smoking-related. I have a feeling that this proportion is even higher in Romania, where it tends to affect a disproportionately large number of women and young people.

Does Negative Advertising Help?

To combat this pressure, Romania passed a law in 2024 banning all online and offline advertising of tobacco and nicotine products. This is in addition to an existing ban on the supply of such products to minors. 6.5% of Romania’s consumer spending in 2022 was spent on alcohol, tobacco, and drugs, one of the highest rates in the EU, according to Eurostat. The National Statistical Institute of Romania indicates that 18.7% of all adult Romanians are daily smokers, and among those aged 15 to 24, 10.16% are daily smokers, while 9.81% smoke occasionally. E-cigs are most common among the 25-34 age group at 3.3%. All these indicators show that those in power take young people seriously, but the success of bans remains dependent on inspections and compliance. Unfortunately, databases still provide little or no information about e-cigs. This is simply because they are a relatively new phenomenon, and global statistical systems have not yet had time to accumulate and update a large amount of information.

Buiga said, “The increase in taxes above 70% of the price (OECD) has had a clear diminishing effect. Also, the ban on smoking in public spaces, warning labels [on the packs], and the ban on advertising have played a clear role in reducing smoking. All this translates into a significant decrease in the incidences of lung cancer in countries with strict policies.”

While e-cigs are often marketed as a less harmful alternative to traditional smoking, evidence shows that both methods pose significant health risks. A 2022 review by the European Commission’s Scientific Committee on Health concluded that vape usage can negatively impact cardiovascular and respiratory health. However, traditional smoking remains more damaging overall due to its stronger association with lung cancer, chronic obstructive pulmonary disease, and heart disease.

According to a fact sheet released by WHO in 2023, around 1.3 million non-smokers die just from second-hand tobacco smoke. Meanwhile, in an article published by Nicotine & Tobacco Research in 2014, the study’s findings on using e-cigs indoors concluded that while it may involuntarily expose non-users to nicotine, it does not expose them to toxic tobacco-specific combustion products.

E-cigs are still relatively new in terms of exposure to humans, and so more research is needed, particularly on long-term health effects. According to Buiga, “High voltage (“tank-style”) devices produce higher amounts of toxic decomposition products, such as carbonyls (formaldehyde, etc.). The patterns also vary, reaching different decomposition temperatures, generating different levels of carcinogens. Therefore, the risk also varies depending on the type or model.”

The amount of chemicals found in e-cigs is interesting since many of them have not been approved by governmental and international health institutions. A study released in 2020 showed that while vaping does not necessarily cause lung disease, doing so was associated with the possibility of having the disease.

So, is vaping safer than smoking tobacco for youth? The answer is not that simple. What we do know is that in government studies, nicotine has been shown to be addictive and detrimental to one’s health. Exposure to nicotine in cigarettes and e-cigs has already been reported to produce adverse effects in the brains of young people, hampering their cognitive functions, either through learning or attention.

With all this being said, researchers say that more research is needed to see what other possible adverse effects nicotine has on the adolescent brain. Another problem that has not been paid attention to is the advertising of e-cigs to young people all over the world as fashionable or “chic.”

“One other problem I see in Romania,” says Magdolna McAlister, “is the fact that parents do not see their children smoking as a big problem. Elfbars, which are marketed as ‘child-friendly,’ are one of the latest ways in which the tobacco industry has begun to infiltrate the lives of kids.”

A report published by the European Commission stated that young people are being directly exposed to advertising campaigns. The advertising of tobacco products has taken place outside of colleges and schools, like in Italy, where Apple Store-like stores generate interest in the product by emphasizing technology and prestigious marketing. The Frontiers in Public Health in 2024 study found that 56% of Polish adolescents were exposed to e-cig advertising, especially online and in clubs.

For our current study, the figures from Romania are notably compelling. Eurostat data indicates a rise in smoking prevalence among Romanians aged 15 and older, from 30% in 2020 to 34% in 2023.

While the tobacco industry has declined in Romania, tobacco consumption is still among the highest rates in the EU. In 2014, according to Eurostat data, 19.8% of people in Romania were daily smokers, while in 2019, only 18.7% reported smoking daily. After the drop in 2019, the rate of traditional tobacco smokers in Romania continued to grow again to a current 34%, according to the latest data presented by WHO.

According to the Eurobarometer published in 2024 regarding attitudes of Europeans towards tobacco and related products, 14.94% of women and 18.91% of men smoke traditional tobacco products in Romania. This is an overall decrease in the 23% gap between male and female smokers registered in 2019. Although the gender gap has become smaller, the number of overall smokers in Romania has increased over the years, especially in the youth category, with 15.7% of the population between 15 and 29 years old smoking daily, as registered in the 2019 Eurostat.

According to Eurobarometer in 2024, 28% of respondents aged between 15 and 24 and 46% of respondents between 25 and 39 smoked traditional tobacco products (eg, cigarettes). In comparison, in the rest of the EU, 22% of respondents aged between 15 and 24 and 32% between 25 and 39 smoked traditional tobacco products.

The most popular products used by smokers on a global level are traditional tobacco products. According to the data registered between 2010 and 2020 by WHO, 91% of tobacco smokers smoke traditional cigarettes.

Traditional tobacco products seem much more popular in Romania than vaping. Among Romanian respondents to the survey, 93% say they never even tried vaping, and only 1% answered they were currently using them.

While e-cigs aren’t very popular among current active smokers, they also seem not to be Romanians’ first choice when it comes to quitting either. In 2011, one of the first clinical trials published in the journal BMC Public Health suggested that e-cigs may be more effective than traditional Nicotine Replacement Therapy (NRT) products for quitting smoking, especially among smokers who aren’t motivated to quit.

While these are the tendencies of the general Romanian population, among the youth, especially among the teenage population, vaping is gaining in popularity, but not by much. According to a study published in 2016 in the International Journal of Public Health, 38.5% of teenage respondents said their most frequently tried alternative tobacco product was e-cigs. In a study published in 2016 in the journal Gaceta Sanitaria, 67.1% of students between 16 and 18 reported that a friend had tried e-cigs. Among the respondents, 54.3% also think that e-cigs are less dangerous, and 52.6% believe they can help smokers quit. Among the students participating in the study, 28.9% admit to having used e-cigs at least once, and 3% responded they have used them in the last month.

Smoking Among the Youth

“I started smoking as soon as I was legally allowed to smoke,” said Calin Simon. “I choose to vape instead of smoke tobacco because the smell bothered me. I could choose to quit, but why do that when I have the money?” Social influence is an important factor among students. Among ex-smokers and never-smokers, experimentation with e-cigs was associated with influence from their peers, while among smokers, experimentation with e-cigs was mostly influenced by parents trying them.

Despite various influences, they do have a main reason in common for experimenting with alternative tobacco products. For over 50% of the respondents, curiosity was the main reason for trying e-cigs, but 68% answered that they had no intention of using e-cigs the next year. 

Vaping, even among high school students, isn’t very popular in Romania. In the end, it seems that traditional smoking is the more popular choice among youth in Romania, with e-cigs being, more often than not, more of a curiosity than a habit.

“I remember smoking for the first time when I was 15; I stole [a cigarette] since everyone was doing it,” said Tudor. The 23-year-old recounts how, at first, he rarely smoked. Now, he rolls enough of his own cigarettes that it amounts to a pack a day, stating that he knows he is addicted. When asked if he was curious about vaping, he stated flatly, “No.”

In 2024, the international e-cig industry took in $3.56 billion. While we are on the topic of convenience, e-cigs such as vapes and heated tobacco products have one privilege over either manufactured or hand-rolled cigarettes, that is, being allowed to be consumed indoors. It looks like this has been a selling point to smokers, in a population survey in England in the results had 18.4% of people who exclusively smoked and 12.2% who used both cigarettes and e-cigs; those who used both reported that they were more likely to vape indoors.

There is a trend going on with vaporized nicotine products as in refillable and disposable vapes. This alternative started with the refillable vapes, a small investment you must make on the vape itself, then it’s all about buying the flavored liquid with or without nicotine.

“On the topic of vaping,” says Magdolna McAlister, “I find that there is not enough longitudinal data available on the adverse effects of it on the body. But if someone wants to stop smoking, I recommend they quit outright. Do not use gum, patches, or taper off. Just quit. Or use a diary and jot down when you have a craving. It will give you perspective.”

So, while vaping has not changed people’s smoking behavior, saying that it helps them quit smoking or have a better lifestyle has not yet been proven. For now, the data needs to be recorded, studied, and understood.

This article was constructed by Andrei Iura, Loriana Apahidean, Lucia Petrescu, Yeva Yukhnova, and Nicholas Pokorny

Sources for datasets used in Tableau: dashboard #1 and dashboard #2.