Mitigating the Risks of Vaping: A Literature Review on Toxicity Awareness and Strategies to Curb Electronic Cigarette Use
Abstract
The rise in adolescent vaping, fueled by appealing flavors, targeted marketing, and a lack of awareness about health risks, is a growing public health concern. This study explores how mitigating vaping risks is linked to public awareness and adverse events like EVALI (e-cigarette or vaping product use-associated lung injury). Using a systematic review of literature from 2015–2025 via Scopus AI, the study found that public awareness campaigns significantly increase perceived risks and reduce vaping initiation among youth. Tailored programs, such as school-based initiatives and digital media campaigns, effectively foster informed decision-making. Despite these successes, challenges persist, including disparities in access to information and the rapidly evolving vaping market. Theoretical insights align with health behavior models, while practical recommendations emphasize combining education, regulation, and community outreach. Future research should focus on longitudinal studies to assess long-term health effects and explore technologies for disseminating accurate information. These findings provide a foundation for comprehensive strategies to mitigate vaping risks and protect public health.
Downloads
References
Al-Hamdani, M., Hopkins, D. B., & Park, T. (2020). Vaping among youth and young adults: A “red alert” state. Journal of Public Health Policy. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85074702408&origin=scopusAI
Asdigian, N. L., Riggs, N. R., Valverde, P. A., & Crane, L. A. (2023). Reducing youth vaping: A pilot test of the peer-led “Youth Engaged Strategies for Changing Adolescent Norms!” (YES-CAN!) program. Health Promotion Practice. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85131733390&origin=scopusAI
Barrington-Trimis, J. L., Leventhal, A. M., & Unger, J. B. (2019). Trends in e-cigarette use and associations with other tobacco product use: Findings from the PATH Study. American Journal of Preventive Medicine, 57 (4), 506–514. https://doi.org/10.1016/j.amepre.2019.05.012
Berg, C. J., Barker, D. C., Sussman, S., Getachew, B., Pulvers, K., Wagener, T. L., Hayes, R. B., & Henriksen, L. (2021). Vape Shop Owners/Managers' Opinions about FDA Regulation of E-Cigarettes. Nicotine and Tobacco Research. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85102211917&origin=scopusAI
Besaratinia, A. (2021). From Tobacco Cigarettes to Electronic Cigarettes: The Two Sides of a Nicotine Coin. Frontiers in Oral Health. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85125417429&origin=scopusAI
Bonner, E., Chang, Y., Christie, E., Colvin, V., Cunningham, B., Elson, D., Ghetu, C., Huizenga, J., Hutton, S. J., Kolluri, S. K., Maggio, S., Moran, I., Parker, B., Rericha, Y., Rivera, B. N., Samon, S., Schwichtenberg, T., Shankar, P., Simonich, M. T., Wilson, L. B., & Tanguay, R. L. (2021). The chemistry and toxicology of vaping. Pharmacology and Therapeutics. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85103372736&origin=scopusAI
Chadi, N., Vyver, E., & Bélanger, R. E. (2021). Protecting children and adolescents against the risks of vaping. Paediatrics and Child Health (Canada). https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85127477474&origin=scopusAI
Cheah, C. S. (2022, June 30). Misconceptions about vaping can lead to ineffective policy and regulations. Focus Malaysia. https://focusmalaysia.my/misconception-on-vape-can-lead-to-ineffective-policy-and-regulations/?utm_source
Cheng, T., Liu, Y., & Wang, X. (2021). Heavy metal exposure from e-cigarette aerosols: User awareness and health implications. Environmental Research, 198, 111234. https://doi.org/10.1016/j.envres.2021.111234
Choe, J., Chen, P., Falk, J. A., Nguyen, L., Ng, D., Parimon, T., & Ghandehari, S. (2020). A Case Series of Vaping-Associated Lung Injury Requiring Mechanical Ventilation. Critical Care Explorations. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85086512976&origin=scopusAI
Crane, L. A., Asdigian, N. L., & Fitzgerald, M. D. (2023). Looking cool, doing tricks, managing stress, and nicotine addiction: Youth perspectives on nicotine vaping and implications for prevention. American Journal of Health Promotion. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85165376219&origin=scopusAI
Darabseh, M. Z., Selfe, J., Morse, C. I., & Degens, H. (2021). Impact of vaping and smoking on maximum respiratory pressures and respiratory function. International Journal of Adolescence and Youth. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85114477595&origin=scopusAI
DiCasmirro, J., Tranmer, J., Davison, C., Woo, K., Toon, D., Hubeny, M., Ross-White, A., & Goldie, C. (2025). Public Health Interventions Targeting the Prevention of Adolescent Vaping: A Scoping Review. Public Health Nursing. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85207551753&origin=scopusAI
Echeagaray, O., Savko, C., Gallo, A., & Sussman, M. (2022). Cardiovascular consequences of vaping. Current Opinion in Cardiology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85131105773&origin=scopusAI
Esquer, C., Echeagaray, O., Firouzi, F., Savko, C., Shain, G., Bose, P., Rieder, A., Rokaw, S., Witon-Paulo, A., Gude, N., & Sussman, M. A. (2022). Fundamentals of vaping-associated pulmonary injury leading to severe respiratory distress. Life Science Alliance. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85120797906&origin=scopusAI
Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review. Therapeutic Advances in Drug Safety, 5 (2), 67–86. https://doi.org/10.1177/2042098614524430
Ferro, G. A., & Nicolosi, C. (2019). Vaping and the precautionary principle in EU law. In The Regulation of E-Cigarettes: International, European and National Challenges. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85137428703&origin=scopusAI
Fortier, J., Taillieu, T., Salmon, S., ..., & Afifi, T. O. (2022). Adverse childhood experiences and other risk factors associated with adolescent and young adult vaping over time: A longitudinal study. BMC Public Health. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85122989283&origin=scopusAI
Galimov, A., Galstyan, E., Yu, S., Smiley, S. L., Meza, L., Baezconde-Garbanati, L., Unger, J. B., & Sussman, S. (2020). Predictors of vape shops going out of business in Southern California. Tobacco Regulatory Science. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85084511985&origin=scopusAI
Gilmore, B., Reveles, K., & Frei, C. R. (2022). Electronic cigarette or vaping use among adolescents in the United States: A call for research and legislative action. Frontiers in Public Health. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85144587246&origin=scopusAI
Goniewicz, M. L., Smith, D. M., Edwards, K. C., & Blount, B. C. (2018). Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. JAMA Network Open, 1 (8), e185937. https://doi.org/10.1001/jamanetworkopen.2018.5937
Hajek, P., Etter, J. F., Benowitz, N., Eissenberg, T., & McRobbie, H. (2017). Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction, 112 (11), 1901–1910. https://doi.org/10.1111/add.13659
Hassan, M., Vinagolu-Baur, J., Li, V., FrT., & Rankin, E. (2024). E-cigarettes and arterial health: A review of the link between vaping and atherosclerosis progression. World Journal of Cardiology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85210772109&origin=scopusAI
Jackler, R. K., & Ramamurthi, D. (2019). Nicotine arms race: JUUL and the high-nicotine product market. Tobacco Control, 28 (6), 681–682. https://doi.org/10.1136/tobaccocontrol-2019-055063
Jiang, H., Ahmed, C. M. S., Martin, T. J., ..., & Lin, Y.-H. (2020). Chemical and Toxicological Characterization of Vaping Emission Products from Commonly Used Vape Juice Diluents. Chemical Research in Toxicology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85089712095&origin=scopusAI
Kim, S., Park, J., & Lee, H. (2022). Adolescent knowledge of e-cigarette toxicity: A longitudinal analysis. Journal of Adolescent Health, 70 (3), 412–418. https://doi.org/10.1016/j.jadohealth.2021.08.012
Kreslake, J. M., Diaz, M. C., Shinaba, M., Vallone, D. M., & Hair, E. C. (2022). Youth and young adult risk perceptions and behaviors in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA. Tobacco Control. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85099444966&origin=scopusAI
Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., Stone, M. D., Khoddam, R., Samet, J. M., & Audrain-McGovern, J. (2015). Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA, 314 (7), 700–707. https://doi.org/10.1001/jama.2015.8950
Levy, D. T., Gartner, C., Liber, A. C., Sánchez-Romero, L. M., Yuan, Z., Li, Y., Cummings, K. M., & Borland, R. (2023). The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products. Nicotine and Tobacco Research. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85145459501&origin=scopusAI
Levy, D. T., Warner, K. E., Michael Cummings, K., ..., & Borland, R. (2019). Examining the relationship of vaping to smoking initiation among US youth and young adults: A reality check. Tobacco Control. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85057123199&; origin= scopusAI
Lim, H. P. (2025, January 5). Step up efforts to curb cigarette addiction, an academician calls on the government. The Borneo Post Online. https://www.theborneopost.com/2025/01/05/step-up-efforts-to-curb-cigarette-addiction-academician-calls-on-govt/?utm_source
Lim, K. H., Heng, P. P., Lim, H. L., Cheong, Y. L., Kee, C. C., Mohd Ghazali, S., & Lim, J. H. (2021). Support of smoking restriction in public areas among adolescents in Malaysia: The findings from Tobacco and E-Cigarette Survey among adolescents in Malaysia (TECMA). International Journal of Public Health Research, 12 (1). https://spaj.ukm.my/ijphr/index.php/ijphr/article/view/315
Ma, H., Kieu, T. K.-T., Ribisl, K. M., & Noar, S. M. (2023). Do vaping prevention messages impact adolescents and young adults? A meta-analysis of experimental studies. Health Communication. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85150428302&origin=scopusAI
Martin, A., Tempra, C., Yu, Y., Liekkinen, J., Thakker, R., Lee, H., Moreno, B. S., Vattulainen, I., Rossios, C., Javanainen, M., & Bernardino de la Serna, J. (2024). Exposure to Aldehyde Cherry e-Liquid Flavoring and Its Vaping Byproduct Disrupts Pulmonary Surfactant Biophysical Function. Environmental Science and Technology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85183312380&origin
Martinez, R., & Smith, L. (2024). Misinformation and toxicity awareness: The role of social media in shaping e-cigarette perceptions. Health Communication, 39 (5), 789–798. https://doi.org/10.1080/10410236.2023.2254321
Mendelsohn, C. P., Hall, W., Borland, R., Wodak, A., Beaglehole, R., Benowitz, N. L., Britton, J., Bullen, C., Etter, J.-F., McNeill, A., & Rigotti, N. A. (2023). A critique of the Australian National Health and Medical Research Council CEO's statement on electronic cigarettes. Addiction. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85148613143&origin=scopusAI
Mok, O. (2024, March 27). National Poison Centre calls for control measures after recording a five-fold hike in e-cigarette poisoning. The Malay Mail. https://www.malaymail.com/news/malaysia/2024/03/27/national-poison-centre-calls-for-control-measures-after-recording-five-fold-hike-in-e-cigarette-poisoning/125812?utm_source
National Academies of Sciences, Engineering, and Medicine (NASEM). (2018). Public Health Consequences of E-Cigarettes. The National Academies Press. https://doi.org/10.17226/24952
Pepper, J. K., Ribisl, K. M., Emery, S. L., & Brewer, N. T. (2016). Adolescents’ interest in trying flavored e-cigarettes. Tobacco Control, 25 (Suppl 2), ii62–ii66. https://doi.org/10.1136/tobaccocontrol-2016-053260
Reiter, A., Hébert-Losier, A., Mylocopos, G., Filion, K. B., Windle, S. B., O’Loughlin, J. L., Grad, R., & Eisenberg, M. J. (2024). Regulatory Strategies for Preventing and Reducing Nicotine Vaping Among Youth: A Systematic Review. American Journal of Preventive Medicine. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85171355349&origin=scopusAI
Son, Y., Mishin, V., Laskin, J. D., Mainelis, G., Wackowski, O. A., Delnevo, C., Schwander, S., Khlystov, A., Samburova, V., & Meng, Q. (2019). Hydroxyl radicals in E-cigarette vapor and E-vapor oxidative potentials under different vaping patterns. Chemical Research in Toxicology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85067393064&origin=scopusAI
Tøttenborg, S. S., Holm, A. L., Wibholm, N. C., & Lange, P. (2014). The health consequences of smoking electronic cigarettes are poorly described. Ugeskrift for Laeger. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-84987942684&origin=scopusAI
Venkata, A. N., Palagiri, R. D. R., & Vaithilingam, S. (2021). Vaping epidemic in US teens: Problem and solutions. Current Opinion in Pulmonary Medicine. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85101728906&origin=scopusAI
Wee, L. H., Tee, G. H., Chan, C. M. H., et al. (2022). The role of media and retailer message recall on Malaysian male perceptions of e-cigarette use: The 2016 National Study of E-Cigarettes Prevalence. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 1–9. https://doi.org/10.1177/00469580221079683
Woo, W., Tian, L., Lum, M., Canchola, A., Chen, K., & Lin, Y.-H. (2024). Ozonolysis of Terpene Flavor Additives in Vaping Emissions: Elevated Production of Reactive Oxygen Species and Oxidative Stress. Chemical Research in Toxicology. https://www-scopus-com.uitm.idm.oclc.org/record/display.uri?eid=2-s2.0-85193857024&origin=scopusAI
Zhang, L., Chen, H., & Wu, Q. (2023). Effectiveness of educational campaigns on e-cigarette toxicity awareness among young adults. Preventive Medicine Reports, 31, 102145. https://doi.org/10.1016/j.pmedr.2023.102145
Copyright (c) 2025 Samsiah Bidin
This work is licensed under a Creative Commons Attribution 4.0 International License.
Author (s) should affirm that the material has not been published previously. It has not been submitted and it is not under consideration by any other journal. At the same time author (s) need to execute a publication permission agreement to assume the responsibility of the submitted content and any omissions and errors therein. After submission of revised paper in the light of suggestions of the reviewers, the editorial team edits and formats manuscripts to bring uniformity and standardization in published material.
This work will be licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) and under condition of the license, users are free to read, copy, remix, transform, redistribute, download, print, search or link to the full texts of articles and even build upon their work as long as they credit the author for the original work. Moreover, as per journal policy author (s) hold and retain copyrights without any restrictions.
