In a report released sixty years ago, the U.S. surgeon general settled a long-standing debate about the dangers of cigarettes, leading to significant changes in smoking habits across America. Now, some public health experts are calling for a similar report to address the controversies surrounding vaping. Many adults in the U.S. believe that nicotine vaping is just as harmful, if not more dangerous, than smoking traditional cigarettes. However, the Food and Drug Administration (FDA) and most scientists agree that electronic cigarettes are far less dangerous than their combustible counterparts. Despite this, e-cigarettes are not considered harmless, and there is ongoing disagreement among public health experts regarding their overall impact.

Lawrence Gostin, a public health law expert at Georgetown University, emphasizes the urgent need for clarifying information, stating that there have been too many confusing messages about vaping. He suggests that a surgeon general's report could help clear up misconceptions and provide much-needed guidance. However, one major obstacle to studying the long-term effects of vaping is that e-cigarettes have not been around long enough for scientists to determine if vapers develop health problems like lung cancer and heart disease.

Cigarette smoking has long been recognized as the leading cause of preventable death in the United States, with an estimated annual toll of 480,000 lives, according to the Centers for Disease Control and Prevention. However, smoking rates have been declining since the 1960s, thanks in part to the implementation of warning labels on cigarette packs, the banning of cigarette commercials, increased tobacco taxes, and restrictions on smoking in public places. By 2022, the adult smoking rate had dropped to 11%, and some experts believe that e-cigarettes played a role in this decline.

E-cigarettes were initially marketed as a tool to help smokers quit, and the FDA has authorized a few e-cigarettes as less harmful alternatives for adult smokers. The popularity of vaping exploded in the 2010s, attracting both adults and teenagers. In 2014, e-cigarettes surpassed combustible cigarettes as the most commonly used tobacco product among youth. However, concerns arose about the potential for nicotine addiction leading young people to transition to traditional cigarettes. Surprisingly, the high school smoking rate dropped to less than 2% last year, a significant decrease from the 35% rate observed 25 years ago. Experts credit this decline to the rise of e-cigarettes, which have successfully deterred young people from smoking.

While e-cigarettes are considered safer than traditional cigarettes, they are not without risks. Cigarettes contain thousands of chemicals, at least 69 of which are known to cause cancer. E-cigarette vapor, on the other hand, is estimated to contain significantly fewer chemicals and carcinogens. Studies have shown that individuals who completely switch from smoking to vaping experience improved lung function and other health benefits. However, concerns arise when considering the impact of vaping on individuals who have never smoked. Research on vaping has produced mixed results, with limited evidence to separate the effects of vaping from previous cigarette smoking. Some studies have found bronchitis symptoms and aggravation of asthma in young people who vape, while others suggest potential effects on heart health. Nicotine, the addictive stimulant found in both cigarettes and e-cigarettes, has been linked to developmental issues in adolescents and potential connections to ADHD symptoms, depression, and stress. However, experts emphasize that more research is needed to establish clear conclusions.

The World Health Organization has raised concerns about the growing global market for e-cigarettes, especially due to the wide variety of appealing flavors that attract young people. In 2016, the then-U.S. Surgeon General Vivek Murthy called for efforts to prevent and reduce e-cigarette use among children and young adults, stating that nicotine in any form is unsafe for kids. The FDA began taking steps to regulate e-cigarettes in 2016, authorizing several products while rejecting over a million marketing applications. Critics argue that the FDA's regulation has been inconsistent and unfair. The number of e-cigarette devices available in the U.S. has increased significantly, largely due to disposable products imported from China that come in various fruit and candy flavors. However, youth vaping rates have recently started to decline, with 10% of high school students reporting e-cigarette use in the previous month in 2020, down from 14% the previous year.

The decline in youth vaping rates may be attributed to several factors, although it is challenging to pinpoint the exact reasons. One possible influence is the 2019 outbreak of severe lung illnesses and deaths associated with vaping products containing THC, a substance not found in commercial nicotine e-cigarettes. This outbreak raised concerns about the safety of e-cigarettes in the minds of many Americans. Sherri Mayfield, a 47-year-old postal worker, recalls the outbreak and reports of rapid illnesses and deaths among young people, leading her to believe that more research on vaping is necessary. Mayfield acknowledges that cigarettes are not safe, but she believes that they take longer to cause significant harm to one's health compared to vaping.

The surgeon general's office acknowledges the impact of the 1964 report on smoking and calls for similar action to address youth vaping. However, the current surgeon general's website does not list vaping or smoking as priority issues. The Associated Press Health and Science Department, supported by the Howard Hughes Medical Institute's Science and Educational Media Group, is responsible for this comprehensive coverage of the topic.