The modern-day sweet shop has undergone a transformation, bidding farewell to screw-top glass jars filled with gobstoppers and lemon sherbets that once enticed children to spend their pocket money. In their place now stand sleek, colorful boxes bearing names like “Banana ice,” “pink lemonade,” “blueberry sour raspberry,” and “cotton candy ice.” These boxes contain Elf bars, disposable e-cigarettes that are ostensibly intended for adults only. The rules dictate that under-18s cannot purchase them, even when they wander in to peruse the confectionery also on display in these shops. However, the reality is that these alluring gadgets often end up in the hands of children, who may have learned about them from influencers on platforms like TikTok.

This situation is deeply troubling for parents of teenagers who catch a whiff of strawberry-scented vapor in their child’s bedroom. In the past, they might not have known that their child was experimenting with a scrounged cigarette behind the school bike sheds. Smoking was once so prevalent that it was rare to find a child who hadn’t tried it at some point, often leading to an unpleasant first experience that deterred further tobacco use.

Overall, smoking rates in the UK have plummeted dramatically, with fewer than 15% of adults today identifying as smokers, down from a peak of over 45% in the 1970s. This success can be attributed to the arduous and prolonged battle against tobacco. However, in recent years, the role of e-cigarettes in this victory has come under scrutiny. Many UK experts argue that e-cigarettes have contributed positively by providing nicotine addicts with a less harmful alternative, devoid of the carcinogenic tar found in traditional cigarettes.

In contrast, some voices in the United States, notably in government and health organizations, label e-cigarettes as the devil’s handiwork, alleging that they lure kids into nicotine addiction, expose them to harmful chemicals, and potentially lead them back to tobacco in the long run. Skepticism grows with the entry of Big Tobacco companies into e-cigarette production, indicating a troubling alignment of interests as these companies seek new markets in affluent countries.

The transatlantic divide over vaping and health, sparked by the introduction of overtly teen-friendly e-cigarettes by San Francisco startup Juul, still persists. The US government, through the Food and Drug Administration, and some states like California, have imposed legal and financial penalties on Juul, whose USB stick-sized e-cigarettes, launched in 2015, gained popularity among young people. Reports have even surfaced of high school epidemics characterized by flavored vapor emerging from bags in the back rows of classrooms. In September, Juul agreed to pay $440 million to 33 US states following investigations into its marketing practices, accused of intentionally targeting young people. Fruit and candy flavors had already been removed from its range.

In the UK, however, the government largely aligns with the guidance from Public Health England (now the Office for Health Improvement and Disparities), which asserts that vaping is significantly less harmful than smoking, with claims of it being 95% less harmful. The NHS encourages smokers to consider vaping as a quitting aid, although the absence of medically licensed e-cigarettes poses a challenge.

Health experts in the UK primarily concentrate on the sizable population of middle-aged smokers whose habit poses a severe health risk, particularly in deprived areas. Nearly 6 million people in England still smoke, and a quarter of all cancer-related deaths are attributed to smoking. Dr. Javed Khan, former head of Barnardo’s, published a review commissioned by the then-health secretary, Sajid Javid, emphasizing the promotion of vaping as a means to make smoking obsolete. According to campaign group ASH (Action on Smoking and Health), more than half (57%) of adult vapers in the UK are ex-smokers.

Nevertheless, the issue of underage kids using disposable vapes like Elf Bar and Geek Bar, manufactured in Shenzhen, China, and available both online and in stores, poses a distressing challenge. No one wants children to become addicted to nicotine, and addressing this issue diverts resources away from the critical fight against tobacco. ASH data indicates that 83% of 11-17-year-olds have never tried an e-cigarette, but in 2021, 7% said they were currently vaping, up from 4% in 2020. Recent analysis of US data suggests that children, on average, try e-cigarettes at the age of 13, with one in ten vaping shortly after waking up.

Solving this complex problem is a formidable task, compounded by entrenched opinions on vaping’s uses and misuses. Nonetheless, it is clear that action must be taken to restrict the advertising and marketing of e-cigarettes that appeal to young people. Just as cigarettes are now sold in plain packaging, a similar approach should be extended to all nicotine products. Eye-catching boxes and sweet flavors should be eliminated. Additionally, existing regulations regarding the sale and marketing of these products to children need to be diligently enforced. Local authorities, struggling with limited resources, require additional support in preventing under-18s from accessing these products. As advocated by organizations such as Action on Smoking and Health and Cancer Research UK, and recommended by Dr. Khan, it is time for a windfall tax on tobacco companies to ensure that those responsible for pollution contribute to the solution.