After decades of relentless effort by health activists and political pressure groups, tobacco control saw significant progress at the start of the new millennium. Smoking in public was discouraged, health warnings were prominently featured on packs, some nations removed all branding, and advertising was tightly controlled. Physical shops and hawkers were regulated and located away from schools and residential areas. Most importantly, cigarettes lost their status as a fashionable activity in popular culture, turning the tide against this dangerous and addictive substance.

However, the emergence of heated tobacco products (HTPs) like electric cigarettes and other vapor-based devices has reversed much of that progress. Marketed as a healthier alternative to traditional cigarettes, HTPs bypass many of the advertising regulations applied to tobacco, spreading their claim widely despite limited scientific evidence to support it. Organizations such as the Centers for Disease Control and Prevention (CDC) warn that while more research is needed, the use of any type of tobacco product, including HTPs, is harmful. Similarly, in 2018, the US Tobacco Products Scientific Advisory Committee of the FDA voted against endorsing HTPs as less harmful than conventional cigarettes.

The World Health Organization has also raised alarms, adding to the criticism of this new trend. The difficulty now lies in the fact that e-cigarette culture has become embedded among younger people, regaining its “fashionable” status due to aggressive marketing by tobacco companies. The activism of the past must be revived to combat this new threat.