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While some women themselves argue that it is "dirty and ugly", social stigma also surrounds their taking up the practice, with many men citing it as "too unhealthy, dangerous and bad"

In an interview with The New York Times , Thomas Glynn, former cancer science director at the American Cancer Society, called the dramatic decline in adolescent smoking since the late 1990s "an astounding accomplishment in public health." But he added that "I think we have to have alarms out" about adolescent vaping, which may yet lead to a surge in smoking

Output increased and markets expanded, which meant that a product that was no longer sold loose, but already packaged, needed to be recognisable