They are marketed as modern and clean. Oncologists say the reality is more complicated. Walk into any college campus in India right now and you will spot them: the sleek little devices, the flavoured puffs, the nicotine pouches tucked discreetly into a pocket. Vaping and e-cigarettes have arrived in India with serious marketing muscle behind them, and they have found their audience. Young Indians, many of whom would never have touched a cigarette, are using these products in numbers that are beginning to concern doctors across the country. The pitch is seductive: no smoke, better flavours, modern design. The medical picture, though, is considerably less clean than the branding.
Smoke-Free Is Not Risk-Free
That phrase comes from Dr. A.K. Dewan, Director of Surgical Oncology at Rajiv Gandhi Cancer Institute and Research Centre, and it is the most important thing to understand about this entire conversation. The assumption driving youth uptake of vapes and nicotine pouches is that the absence of smoke means the absence of harm. But the harm was never only about smoke. It is about nicotine, and every one of these products delivers it.
Dr. Dewan is direct about what nicotine does, particularly to young users: it adversely affects brain development, concentration, mood, and impulse control in teens and young adults. The brain is not fully developed until the mid-twenties. Introducing a highly addictive substance into that developmental window does not just create a habit; it can reshape how the brain responds to reward and impulse for years. And the risk does not stay contained to the product a teenager starts with. Dr. Dewan flags that nicotine addiction at an early stage can increase the risk of long-term tobacco dependency and may eventually push younger users toward cigarette smoking as well. So the vape that felt like a safe experiment can become the on-ramp to something much harder to leave behind.
What Is Actually in the Aerosol
Dr. Deepak Jha, Chief of Breast Surgery and Senior Consultant in Surgical Oncology at Artemis Hospitals, points to another layer of the problem: the chemicals. Many young people think vaping carries no risk because there is no combustion, no smoke. But e-cigarette aerosol can contain harmful chemicals, ultrafine particles, and irritants that affect the lungs and airways. The research is still accumulating, but mounting evidence already points to long-term impacts on respiratory and cardiovascular health.
Dr. Dewan's assessment from a clinical standpoint reinforces this: vaping and e-cigarette use can cause inflammation, respiratory irritation, and long-term health complications, some of which are still being studied. That last part matters. These products have not been around long enough for medicine to fully catalogue their long-term effects. Young Indians using them now are, in a very real sense, early participants in an experiment they did not sign up for.
Nicotine Pouches Are Not the Safe Alternative Either
Nicotine pouches have a particular appeal because they are entirely smokeless, discreet, and easy to use in settings where vaping might draw attention. But Dr. Jha is clear that removing the smoke does not remove the risk. Regular use can increase heart rate and blood pressure, irritate the gums, and create nicotine dependence just as effectively as any other delivery method. Dr. Dewan adds oral health concerns and heart disease to that list. The fact that you can use a nicotine pouch silently in a classroom does not make it harmless; it just makes it easier to hide.
The Marketing Problem
Both doctors flag something that is arguably as dangerous as the products themselves: the way they are sold. Fruity flavours, attractive packaging, influencer endorsements, social media presence – all of it is designed to make these products feel like lifestyle accessories rather than addictive substances. Dr. Jha notes this specifically: the branding can make them appear innocuous, particularly to new users who might otherwise never have considered tobacco use at all. That is the strategy: reach the people who would say no to a cigarette by making the product look nothing like one.
Dr. Dewan points to the aggressive marketing push around flavours and designs targeted directly at younger populations. This is not accidental. The tobacco and nicotine industries understand that lifelong customers are made young. And in India, where regulation of these products is still catching up, there is significant room to operate.
What Needs to Change
The doctors are aligned on this: prevention, regulation, and awareness need to move faster than the products themselves. Dr. Dewan calls for stronger regulation, parental guidance, and school-level education – the kind of systemic response that addresses nicotine marketing before it reaches teenagers. Dr. Jha's point is simpler but just as important: informed choices are the starting point. Young people need to actually know what is in these products and what the evidence says about them before they decide to use them, not after the habit is already formed.
The category is new. The addiction it creates is not.
