Smokers trying to quit say they feel like they're giving up a friend."

Scott Leishow, professor at the College of Health Solutions, Arizona State University

Even since the 1950s, when the link between smoking and lung cancer was firmly established (despite the protestations from Big Tobacco), there's been no question about the harmful effects of cigarettes. You didn't have to take it on faith — just one look at a macrophotograph of a tarred-up lung surface was proof enough for most of us. Today in the U.S. and most other developed countries, there are more ex-smokers than current smokers, thanks to public health measures such as aggressive anti-smoking campaigns, high taxes and laws against smoking in public places. However, smoking is still responsible for more than one in 10 deaths globally, according to a recent study published in the British medical journal The Lancet. Not to mention the economic cost, nearly half a trillion dollars annually in direct health care and lost earnings in the U.S. alone, according to the same publication. 

Although cigarette smoking has declined in the U.S., more and more people — especially adolescents — are vaping, that is, ingesting nicotine vapor without the harmful effects of all the other chemicals in cigarettes such as tar, polycyclic aromatic hydrocarbons (PAHs), arsenic and 70-odd other carcinogens. Nicotine is what delivers the pleasure, releasing the feel-good neurotransmitter dopamine and, like caffeine, stimulating one's energy and focusing concentration. So if a smoker trades in cigarettes for vaping, what's the problem? She's getting the hit without the harm, right?

Yes and no, mainly no. Turns out, nicotine isn't as benign as once thought and has been implicated in a host of harmful effects on the body. No wonder: As an alkaloid synthesized by plants to deter herbivores, it's a powerful, naturally occurring insecticide. When inhaled, nicotine changes the conductivity of heart muscles, leading to arrhythmia. That's uncontested but the other potentially dangerous effects are harder to pin down; researchers have established connections in animal studies but not so much in humans. "Nicotine is definitely harmful to the developing adolescent brain in animals; in humans, it's harder to establish," according to Neal Benowitz, a nicotine researcher at University of California at San Francisco. However, there's strong evidence nicotine can really damage developing brains in utero: Don't smoke or vape if you're pregnant.

Big Tobacco has been quick to adapt to all this, successfully countering many public health attempts to curb smoking in developing economies while promoting the "coolness" of e-cigarettes — vapes — in the U.S. and other affluent countries. Their major demographic targets are teens and young adults. Of course, we were all young once, vulnerable to peer pressure and believing we'd live forever (see above photo from my youth). I just hope young people today are smarter and more skeptical than I was when I was a kid.

Barry Evans (he/him, [email protected]) was not always the model citizen he is today.