Nicotiana tabacum,or tobacco, is a herbal plant containing nicotine. It was first cultivated in America around 6,000 BC and had symbolic roles in native culture, was smoked to bind trade deals and used for spiritual connection. Centuries later (C16th), the plant began to colonise the world: the tobacco industry became entangled in the slave trade, and often an integral part of colonial economies of Europe who conquered the globe. Brought to England in the Elizabethan era, Sir Walter Raleigh made smoking tobacco a fashionable trend.

Today the tobacco industry’s annual net worth is £59 billion - making huge profits despite being heavily taxed. In the past the industry challenged any health claims and used celebrity endorsements. Doctors often featured on cigarette advertising encouraging people to buy brands like The Lucky Strike that offered ‘throat protection against irritation cough.’ In 1948, the actor Ronald Reagan, later U.S President, featured on a campaign: “I’m sending Chesterfields to all my friends. That’s the merriest Christmas any smoker can have.” Iconic brands came to embed themselves within popular culture, by the 1940s over 80% of men in the UK were smokers. The public was aware of the addictive qualities of smoking but less so about the most serious hidden health harms. A direct causal link to lung cancer was first established in the 1950s. As time evolved the anti-smoking campaigns of the 70s would warn the public of tobacco the “manmade killer.”

Distancing themselves from the past, international tobacco groups like British American Tobacco, portrays an overhauled industry that promotes “growth, diversity and entrepreneurial spirit” and delivers “sustainable products” that have evolved to complement technological innovations. The mass production of cigarettes was followed by the “next generation of products” known as the electronic cigarette (e-cigarette) - a device designed to imitate the experience of smoking, instead it contains liquid nicotine that is vaporised and inhaled. This new method of ingesting nicotine is advertised on billboards with brands like Vype marketing ‘vaping rocks.’

Nicotine is the psychoactive chemical found in the tobacco leaf, it is also produced synthetically and used for e-cigarette refills. In either form, it is ingested to stimulate the central nervous system. This drug has a mild ‘psychoactive effect’, changing the way people think, feel and behave, causing impulsive behavior and “distress in smokers who withdraw” according to the World Health Organisation. Despite its addictive qualities, nicotine-containing products remain legal and readily available.Bhutan is the only country to make the sale of tobacco illegal, this measure attempts to prevent unhealthy habits, which go against Buddhism.

Regulations have tightened on nicotine containing products over recent years: the minimum age to purchase and consume nicotine-containing products in the UK to anyone under 18 years. The retail strategy ‘Challenge 25’ requires those under 25 to produce a valid form of identification (driving license, passport or citizen card) when buying cigarettes of vaping products. The WHO Framework Convention on Tobacco Control (FCTC) has tightened control around tobacco - all EU member states are legally obliged to follow a new directive that bans promotional or misleading cigarette packaging, now all packets are one standard color with 65% dedicated to health warnings. Since 20 May 2016, electronic cigarettes are regulated by the revised EU Tobacco Products Directive that bans almost all advertising even though many see them as a much healthier choice.

Despite the name, 'e-cigarette,' these devices contain no tobacco and produce no smoke so the public perceive them to be less harmful as no tar gets into the lungs. The public health charity Action on Smoking and Health (ASH) estimates there are currently 2.9 million adults in Great Britain using e-cigarettes. Of these, approximately, 1.5 million are ex-smokers while the remainder continue to smoke tobacco alongside an e-cigarette or vape.

In recent years, the perception of harm from e-cigarettes has changed. A growing proportion of the public does not see e-cigarettes as less harmful. In addition, the proportion of the adult population thinking that e-cigs are as harmful, or more harmful, than smoking nearly quadrupled from 2013 to 2017 from 7% to 26%.

Today people are more aware than ever that smoking tobacco is harmful. Gruesome images of throat cancer, black lungs and open-heart surgery are printed on non-branded cigarette packets in an attempt to shock the public into quitting. The World Health Organisation applied pressure to regulators who tightened control around the tobacco industry after coining the term ‘tobacco epidemic’ to describe the 7 million people annually who die annually from smoking, a figure predicted to rise to 8 million by 2030.

Organisations such as Cancer Research UK make evident the link between smoking and premature mortality. The chemicals in tobacco products are a leading cause of many types of cancers, including cancer of the lung, larynx (voice box), mouth, esophagus and throat. Information is in the public domain to prevent tobacco use; what isn’t yet known is the impact e-cigarettes are having on national health.

Those who use e-cigarettes are often unaware the refills contain a liquid solution known as glycerol as well as nicotine and sometimes flavored chemicals. There have been reports when a person takes a drag on the device, the contents of the refill chemically reacts to produce formaldehyde which is carcinogenic. The significance of this chemical reaction is under-researched,with little known on the wider health effects. In the New England Journal of Medicine, Jensen et al (2015) wrote on the ‘hidden formaldehyde in e-cigarettes’ and the potential association with cancer risks.

Various public health and regulatory bodies agree that non-tobacco nicotine containing products are less harmful than smoking tobacco. Public Health England (PHE) published an independent evidence review on electronic cigarettes in 2015, which concluded that “e-cigarettes are around 95% safer than smoked tobacco and they can help smokers to quit”. So, is the e-cigarette definitely a healthier alternative to smoking? The tobacco industry certainly thinks so; they promote the e-cigarette as ‘a less risky alternative to smoking’ (British American Tobacco).

In 2013, researchers gathered anecdotal evidence from an online forum on the harms of e-cigarettes. Hua et al (2013) reported that of the 312 negative symptoms experienced by e-cigarette users, the most common complaints were: dehydration,headaches and dizziness, a metal taste in the mouth and a choking feeling after use. Researchers concluded “it will be many years before the long-term health consequences of e-cigarettes use are known.”

Policy-makers only recently accepted the notion of second- hand smoke (SHS) having potential fatal consequences on non-smokers. A prominent case to lift the smoke screen was Roy Castle, a TV personality who died of lung cancer in 1992 after performing for many years in smoky pubs and clubs. In the UK (2007), the Journal of Public Health reported on the effect of SHS: “tobacco smoke is a mixture of 3800 gaseous and particulate components, including more than 50 unknown or suspected carcinogens and 100 toxic chemicals.” Scientists further evidenced SHS to be, at the time, associated with “10,000 deaths a year, including 617 in the workplace.” Mounting pressure from the scientific community, as well as public pressure from Roy Castle’s widow, led to an indoor smoking ban in public spaces in July 2007.