Sometime around 2020, sleek, USB-designed electronic cigarettes entered the tobacco industry as an update to the smoking experience. These claimed to be akin tothe new iPhones on the block, with updates and bug fixes to the previous cigarette smoking experience that used to involve more nicotine, smell, and an unshakeable link to cancer. But the revolution e-cigarettes promised is built on deception and misinformation; limited research and awareness mean people believe that vapes might really be the healthy alternative to smoking when they aren’t.

Raising awareness regarding e-cigarettes’ health risks is increasingly becoming a central public health discussion. A new study published in JAMA Network speaks to the role of anti-vaping advertisements as a prevention strategy, illustrating that narratives focusing on how vaping can indeed be addictive led to reduced instances of vaping and even discouraged people from smoking normal cigarettes too.

Vaping and e-cigarettes are the trojan horse of nicotine addiction. They usually carry the label of “nicotine-free,” and the assumption is since their smell is masked, it might not harm the individual. But growing evidence shows that even e-cigarettes expose people to toxic chemicals known to cause health effects.

In a randomized clinical trial, the researchers asked some 1,541 participants to watch a series of prevention advertisements by the U.S. FDA’s Real Cost campaign, which is focused on ending tobacco use among adolescents. After four legs of the experiment, the participants were found to pay deeper attention to the ads showing vaping risks’, and even greater retention of these pitfalls. The ads “led to lower susceptibility to vaping, greater health harm and addiction risk beliefs about vaping, and less positive attitudes about vaping. We also found beneficial effects of vaping prevention advertisements on cigarette smoking outcomes, including lower susceptibility to smoking and less positive attitudes toward smoking,” the study noted.

According to one estimate, 80% of people surveyed in the U.S. say they do not see a great risk of harm from regular use of e-cigarettes — a sentiment that is echoed globally. Even in India, while e-cigarettes were banned in 2018, accessing them is not very difficult as young people and adolescents form a major demographic. Because even if companies like Juul or Vape were banned, cheap imports from other countries like China make it incredibly easy for young Indians to purchase vapes and e-cigarettes. This misinformation is perhaps the biggest threat to nicotine prevention; vaping is the new fad because it presents a “healthy” alternative to otherwise harmful smoking.

“Teens’ brains are still developing, making them especially vulnerable to nicotine addiction. In fact, nicotine can ‘rewire’ the brain to crave more nicotine, and some research suggests these changes could be permanent… more research is needed to understand the long-term consequences of using e-cigarettes,” the U.S. Food and Drug Administration noted on its website.

The question then is how to make young people most vulnerable to addiction care about a public health crisis. In the current study, what worked was the focus on addiction-themed narratives, as opposed to ones focusing only on health harms, as most smoking advertisements do. “…video advertisements can visually demonstrate the consequences of nicotine addiction, something youth tend to discount. In our trial, the consequences featured in the addiction advertisements included negative effects on mood and loss of autonomy, which may be particularly salient to youth” the study noted.

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Companies like Juul positioned themselves as saviors in this narrative, claiming to “protect” smokers with flavored vapes. “Vaping works by extracting nicotine from tobacco and turning it into a smokable liquid without setting it on fire,” wrote Vanessa Grigoriadis in Vanity Fair. But Grigoriadis pointed out how Juul leveraged this for profit, working in tandem with lobbyists to package a still-harmful product as a magic pill.

“Its crème brûlée–flavored vapor would save lives by satisfying nicotine cravings, yet not hastening one’s demise… [but] to make Juul as appealing to smokers as possible, and by that I mean delivering a nice buzz and head rush, Juul upped the percentage of nicotine in each vape over the potency of e-cigarettes authorized for sale in Europe,” Grigoriadis explained. “This head-buzzy Juul was pleasurable but also insanely addictive. And it proved to be a hit not only with smokers, the group of people Juul claimed it was trying to save, but also with a group of people known for chasing head buzzes, namely teenagers.”

This makes the role of prevention targeting e-cigarettes central in public health messaging. Another study from July 2021 found that when young people see anti-vaping advertisements, they are more likely to accurately understand the risks of e-cigarettes, which can further reduce tobacco use and lung cancer diagnoses.

A 2020 study showed that e-cigarettes and cigarette smoking become symbiotic habits; in that that “adolescents who did not intend to smoke cigarettes in the future, but had used e-cigarettes, were far more likely to start smoking one year later than teens who didn’t use e-cigarettes at all.” Today, vaping accounts for at least 2% of the larger tobacco category.

It raises important questions about why some smoking campaigns work, and why others don’t. Preventions that focus only on health harms, like big, bold pictures of blistered mouths and smoke-filled blackened lungs, have been found to have limited benefits. The fear-based narrative that uses an almost threatening tone has a contradictory effect. A 2011 research found that people “withdraw mental resources from processing the messages while simultaneously reducing the intensity of their emotional responses,” further tampering with the effect of public health communication. Moreover, some experts have also noted the ads have sort of a reinforcing effect among young people, presenting smoking as the cool, “rebellious” thing to do, inevitably making people more interested in smoking.

In May this year, a separate study found that anti-vaping advertisements targeted to teens were more effective when they were focused on information rather than infantilizing people; they worked when they emphasize the harms of vaping e-cigarettes or used negative imagery, but explicitly avoided “teen-centric” styles like memes and hashtags. Because when anti-vaping ads resort to trite memes and puppets mimicking the Breakfast Club, “their messages [become] ham-handed and overwrought,” Forbes noted.

“The most strenuous posturing, [adolescents] quickly realize, is usually the most spurious as well.”