Vaping: Respiratory Impacts and Public Health Challenges in the Americas.

The use of electronic nicotine delivery systems (ENDS), also known as electronic-cigarette (e-cig) or vaping, is a public health threat throughout the Americas. Teenagers and young adults have the highest rates of use of these tobacco products. However, vaping has a gateway effect, which has led to dual use of both combustible tobacco and nicotine vaping products, which is concerning given that greater adverse health effects of e-cigarettes are seen in the context of co-use with combustible tobacco. Multiple policy approaches have been used across North and South America, with varying success. Powerful anti-tobacco messaging in North America has contributed to decreased vaping in the adolescent population, while banning of all e-cigarettes in Brazil and Mexico has been associated with lower vaping rates compared to countries without bans. Great strides have been made to identify the health risks of vaping, and more work is needed, particularly longitudinal data, to fully understand both the risks of sole use of e-cigarettes and the risks of vaping in combination with other inhalants. Moreover, in some Latin American countries, basic surveillance data to define incidence and prevalence are lacking. This article describes a concerted view and shared experience from the Respiratory Societies of the Americas on how vaping is managed, regulated, and advocated against in this area of the world, with the goal to help shape the future of vaping-related product regulations, and to address public health challenges in the Americas.