Despite health evidence against e-cigarettes, use among teens surge

While the risks and merits of e-cigarettes – or vaping – continue to be fiercely contested, medical evidence is stacking up to suggest that vaping could be as harmful as cigarette smoking. Researchers at the Harvard School of Public Health recently published findings that indicate bacterial and fungal toxins harmful to humans were found in leading e-cigarette brands. Dr David Christiani, study author and professor of environmental genetics at the Harvard School of Public Health says that people should not assume e-cigarettes are safe, calling for better education and more regulation.  “There needs to be much stronger regulation of the production and purity of the compounds used in e-cigarettes.”

The research included the examination of 75 popular e-cigarette products, including 37 single-use cartridges and 38 e-liquids from the top 10 selling United States brands.  Seventeen products out of the 75 analysed were found to contain traces of endotoxin, a potent inflammatory molecule found in bacteria.  61 products contained traces of glucan; a toxic substance found in the cell walls of most fungi. Exposure to these microbial toxins has been associated with a myriad of health problems including reduced lung function, asthma and inflammation.

The emerging facts are alarming given that the popularity of vaping is growing around the world, especially among young people.  Last year e-cigarette usage by United States high school students dramatically increased to 20.8% (3.05 million students) from 1.5% in 2011, and a World Bank report places e-cigarettes as the most commonly used tobacco product among young people in that country.  In Canada, e-cigarette use was the highest in the 15-19 and 20-24 age groups, and in the EU, 25% of people aged 15-24 years had tried e-cigarettes.  Of the latter group, most people (77%) opted for non-tobacco flavours such as fruit, candy, mint or alcohol – which the Harvard research shows have the highest endotoxin concentrations.

Closer to home, the e-cigarette market is growing steadily and while anecdotal evidence suggests that South African children and teens are as attracted to vaping as their global counterparts, research on the local e-cigarette youth market is lagging.  According to Zanele Mthembu, Development and Public Health consultant for the Campaign for Tobacco-Free Kids (CTFK), the country may be sitting on a silent epidemic which could worsen given the fact that major e-cigarette companies are eyeing the continent for market expansion opportunities.   “In South Africa, we’re seeing e-cigarettes marketed in upmarket malls as an aspirational product and the colourful packaging is made very desirable to the youth. In addition, there a worrying trend of marketing on social media and we’ve just seen Philip Morris International caught red-handed marketing IQOS to young people on social media using influencers.”

According to Mthembu, the growing market of teenage users also shows a significant lack of knowledge about e-cigarettes. The results of a US-based annual survey of 45 000 teenagers announced in December last year by the National Institute on Drug Abuse (NIDA) indicated that teens are attracted to the marketable technology and flavourings of e-cigarettes but appear unaware of whether or not they are using a nicotine-free option.   This means that many teens are unknowingly inhaling highly addictive nicotine when they vape, often taking in high levels.

E-cigarette makers such as Juul Labs have come under fire for the popularity of their products that are attracting teens with sweet flavours. In America, the US Food and Drug Administration announced curbs last year on sales of flavoured e-cigarette products, responding to concerns of underage use reaching epidemic proportion.  Juul takes this in its stride.  According to Juul EMEA president, Grant Winterton, the company will launch this year in multiple Asian locations with the Middle East and Africa planned for 2020 and 2021:  “There is no one who is not on our radar if you look forward over the next 4 to 5 years.”

However, Mthembu says that companies such as Juul might be in for a surprise in South Africa due to the pending Control of Tobacco and Electronic Delivery Systems Bill. “When the Bill is passed, e-cigarettes will fall under the same regulation as cigarettes and South Africa will join 83 other countries in controlling their use. Like cigarette regulation, under the proposed new Bill, the areas where you can vape will be restricted and more stringent rules on marketing and packaging will apply.  Furthermore, no advertising at point of sale will be allowed.”

Mthembu concludes, “We have long been aware of the health hazards of tobacco, which kills over 42 100 South Africans each year. Now, emerging research shows that the health hazards of e-cigarettes could also be significant. Without robust regulation, are we comfortable to sit back and let our children be the test dummies for the long-term health impact of e-cigarettes?  This would be a cruel legacy indeed for South Africa’s youth. We must remember – less harm does not mean harmless. We are urging government to process the new bill with speed in order to protect the health of the nation.”

Zanele Mthembu is an Advocacy Consultant for Campaign for Tobacco Free Kids.