Dr Shital Raval talks to Dr Prakash C. Gupta, Director of Healis-Sekhsaria Institute of Public Health on the risks and misconceptions associated with Vaping.
Vapes are the latest replacement for cigarettes that are gaining huge popularity amongst the millennials. Also called e-cigarettes, e-hookahs, mods or ENDS (electronic nicotine delivery systems), they are available in various sizes and shapes often disguised as regular cigarettes, pens or USB drives as seen in the popular brand products by JUULs. Vaping is the use of these e-cigarettes that allows inhalation of the nicotine via vapor produced by heating up a cartridge. They are often battery operated and along with liquid nicotine, contain various chemicals and attractive flavorings. These devices are gaining momentum with the youth and kids under the claims that they are safer than smoking as they do not contain tobacco or have zero nicotine or are less harmful.
Growing adoption of E-cigarettes among young children
In 2018, the US Surgeon general issued a public advisory regarding the harmful health risks associated with the epidemic of youth e-cigarette usage. E-cigarettes have become the most common tobacco product among the American youths since 2014 and it was estimated that more than 3.6 million youth were currently using e-cigarettes. This included numbers as high as 1 in 5 among high school children and 1 in 20 among middle school children. In addition to these alarming statistics, it was found that e-cigarettes can also be used as vehicles to deliver marijuana and other drugs. This puts children at risk for not only nicotine-dependency and tobacco-related harms but also for addiction via exposure to recreational drugs.
Legislation in Indian States
In India, e-cigarettes are an un-approved drug according to the State Drugs Controller. While the national laws remain cloudy on the sale of e-cigarettes, many state run FDAs have declared the sale of e-cigarettes to be illegal. In 2013, Punjab became the first state to declare ENDS unapproved under the Drugs and Cosmetics Act. More states have followed suit and currently 11 states have banned all ENDS including e-cigarettes, vape, e-sheesha, e-hookah etc These states include Maharashtra, Kerala, Karnataka, Tamil Nadu, Uttar Pradesh, Bihar, Jammu & Kashmir, Jharkhand, Puducherry, Mizoram and Himachal Pradesh3 In 2018, the Union Health Ministry issued the following advisory “As such, the states/Union Territories are advised, in larger public health interest and in order to prevent the initiation of ENDS by non-smokers and youth with special attention to vulnerable groups, to ensure that any Electronic Nicotine Delivery Systems (ENDS) including e-Cigarettes, Heat Not-Burn devices, Vape, e-Sheesha, e-Nicotine Flavoured Hookah.”4
Need for Regulations
We caught up with Dr Prakash Gupta, Director of Healis-Sekhsaria Institute of Public Health to find his views on vaping products. “E-cigarettes are marketed as a new technological product. The youth are particularly vulnerable because they are keen to try the latest gadgets. I believe that if we can prevent introduction of new tobacco-related products, then we will save our society from dealing with the harmful consequences later in the future. For any new product, regulations need to be put into place after assessing the safety of the product. Studies show that when vaping is done, the concentration of PM 2.5 or fine particles released in the air can be as high as or higher than that in sheesha or hookah bars. As we know PM 2.5 is the major parameter of measuring air pollution and toxicity.Wherever it is possible, we need to completely restrict availability to non-smokers and youth and if these products are made available, all tobacco policies should be applicable. This includes no form of advertising even at points of sale and ban on vaping in public places."
Perception of Vaping
The concerns raised by Dr Gupta are valid as our own dipstick survey on knowledge of vaping among the urban youth found that nearly 30% of the youngsters (average age of 18) currently vape often and socially and 22% admitted they are very likely to continue vaping in the future 48% of them have 2 or more friends who use vapes or e-cigarettes. 52% of the same youngsters think that vaping is safer and less addictive than cigarettes. 74% said that there was easy availability of vaping products in India.
The biggest challenge lies with the millennial generation taking up vaping and hence the nicotine habit, who would or else never have picked up a regular cigarette. Besides the growing appeal of vaping via fruity flavorings and sleek devices, there are also various myths that promote vaping is less harmful than smoking.
Can Vaping be a Cessation Aid?
For all those who feel that vaping can be an effective cessation aid or cigarette replacement, Dr Gupta disagrees. He says “According to the assessment of all research studies, the message is quite clear; that e-cigarettes are not the future! Supporters of ENDS or Vaping are likely to have personal or vested interest in promotion of these products unlike Public Health workers so one must not believe them. If one does wish to quit, there are already various NRTs (nicotine-replacement therapy) products available in the market.”
The efficacy of e-cigarettes as a smoking cessation tool is yet to be proven. More research is still underway to fully establish the constituents of e-cigarettes and all its hidden components, and their long-term effects. Be wary of websites, blogs and even studies that seem grossly favorable towards ENDS and seem to diminish their adverse effects on health. It would be pertinent to weigh the pros and cons before commencing use of any e-cigarettes or vaping products.
References:
- Smoking & Tobacco Use About Electronic cigarettes https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-ciga…
- Surgeon General’s Advisory on E-cigarette use among youth 2018 https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advi…
- E-cigarette is injurious to your health May 25, 2019 https://epaper.thehindubusinessline.com/Home/ShareArticle?OrgId=GI85TKS…
- Health Ministry asks states to ban sales and imports of e-cigarettes, vape, e-hookah to prevent health risks August 29, 2018
- https://www.india.com/news/india/health-ministry-asks-states-to-ban-sal…
Dr Prakash C. Gupta, Director of Healis-Sekhsaria Institute of Public Health, has researched public health in India extensively over decades and shares with us his valuable opinions on tobacco use and cessation.
Dr. Shital Raval is Medical Editor, PatientsEngage and a passionate anti-tobacco advocate
