Vaping and the Redefinition of Nicotine Exposure: A Multisector Priority for Contemporary Public Health

The rapid expansion of electronic cigarette use represents a fundamental shift in global nicotine exposure, extending beyond its original framing as a harm-reduction tool for smokers. Emerging evidence indicates that vaping constitutes a distinct toxicological and behavioral exposure, characterized by aerosolized nicotine, solvents, metals, and flavoring compounds with potential respiratory, cardiovascular, immunological, and neurobiological effects. Of particular concern is the disproportionate uptake among adolescents and young adults, many of whom have no prior history of combustible tobacco use, raising implications for long-term dependence and neurodevelopmental vulnerability. Current evidence remains limited by device heterogeneity and short follow-up durations, underscoring the need for standardized research frameworks. This perspective synthesizes existing evidence, highlights key research gaps, and outlines clinical and policy priorities required to address vaping as an evolving public health challenge.