Charged Affairs

By Nsikakabasi George | Rising Expert for Global Health | February 12, 2024 | Photo Credit: iStock

The detrimental effects of tobacco smoking have been profound, with resultant global efforts made to curb these effects. The move towards an emphasis on tobacco harm reduction is a practical measure to reduce the morbidity and mortality from tobacco use among smokers. The move has seen the emergence of a variety of tobacco and nicotine products for consumers, which may actually introduce new forms of harm.

Electronic nicotine delivery systems (ENDS) are products of tobacco harm reduction efforts and are devices that heat liquids to create aerosols inhaled by users.  E-cigarettes, also known as vapes, are the most common form of ENDS. These e-liquids may contain nicotine, additives, and chemicals that can harm people’s health. The products are aromatic and flavored to appeal to users who are mostly adolescents and young adults, and they are easy to access. 

Considering that many e-cigarettes contain nicotine, this should spark a lot of concern regarding the health of the population. Nicotine is highly addictive, and some evidence suggests that minors who use ENDS can double their chance of starting to smoke tobacco cigarettes later in life, depending on factors such as the ENDS product type, usage frequency, manufacturing, user behavior, and post-sale manipulation. For kids and teens, using nicotine hurts brain development, which can have long-lasting effects and could lead to learning and anxiety problems. The role of ENDS as a tobacco cessation strategy for large populations is still considered unclear. The World Health Organization says that there is not enough evidence to say for sure that ENDS can help people quit smoking.

The Unintended Consequences

The world is experiencing what can be described as a vaping epidemic, which is indeed a state of emergency. In the United States, over 3,500 young people initiate vaping daily. The 2022 National Youth Tobacco Survey revealed that the youth e-cigarette epidemic remains a serious public health threat due to the tobacco industry’s flood of cheap, youth-appealing-flavored e-cigarettes without FDA authorization. Over 2.1 million middle and high school students in the US reported e-cigarette use in 2022, with nearly half of high schoolers vaping nearly daily. This makes a new generation more likely to become addicted to nicotine and other substances in the future.  A lot of teens are also vaping in Europe. In 2023, four times as many 11–17-year-olds in the UK used an e-cigarette compared to the rate in 2013. In France, more than half of 17-year-olds have tried vaping, according to the ESCAPAD 2022 survey. In Georgia, Italy, and Latvia, the percentage of 11–17-year-old students using e-cigarettes has doubled in the past 4-6 years.

As the world goes through a realization of climate change and planetary health, it is worthy of note that e-cigarettes also pose significant environmental harm. Vapes typically contain lithium-ion batteries, heavy metals, plastic, and residue from liquid nicotine, which is hazardous waste. Disposable vapes are harmful to the environment due to their single-use nature, involving plastic production, mining, shipping, and packaging. In the UK alone, nearly 5 million vapes are thrown away weekly, causing significant waste. Disposable vapes are difficult to recycle due to their mixed materials and design. To this end, waste management systems globally may become insufficient to handle the large quantities of disposable vapes being thrown away daily.

Moving Forward

In recent years, efforts have been made to reduce the harm posed by e-cigarettes to adolescents and young people, especially by making them less appealing. The French National Committee Against Smoking plans to ban all flavors and tastes of e-cigarettes. The sale of ENDS is currently banned in 34 countries globally. In countries where vapes are not banned, regulation of product circulation, taxes on products, restrictions on sales to minors, and limiting market access have been recommended. These regulations, especially on advertising and market access, are also meant to stop non-smokers and children from starting to use ENDS, lower the health risks for users, keep non-users safe, stop health claims that have not been proven, and protect public health policies from the commercial and vested interests of the ENDS-producing industry.

Traditional methods of smoking cessation should also not be forgotten and are thus encouraged for smokers, including cognitive behavior therapy (CBT) and social support. A pilot study with 99 people found that helping people quit vaping using a smartphone app for cognitive behavioral therapy (CBT), along with human-led coaching and nicotine replacement therapy (NRT), is a possible, acceptable, and possibly effective way to deal with e-cigarette use. About 87% of participants quit vaping, and the days of vaping by participants decreased from 24.7 days to 3.9 days in a 30-day period. 

To help people who smoke quit and make global tobacco control stronger, the WHO recommends that countries implement policies and programs that include short advice from health experts, national toll-free quit lines, and text message-based interventions for quitting sent to cell phones. This also highlights the need to increase awareness about the harmful effects of tobacco and vaping. Governments and health organizations should launch campaigns to educate the public about the dangers of smoking and vaping, targeted at teenagers and young adults who are most vulnerable to the harmful effects of these products. 

In light of the complexity of the debate on this issue, addressing the current vaping pandemic will require a multifaceted approach involving governments, health organizations, healthcare professionals, legislators, and the public. These actors need to regulate the sale and marketing of these products, provide support to individuals who are trying to quit, invest in research, and promote healthy lifestyles and alternatives to smoking and vaping. By implementing these recommendations, we can reduce the potential harm from vaping and improve the health of individuals and communities around the world.

Nsikakabasi George (he/him) is YPFP’s Rising Expert for Global Health. He is a Public Health Practitioner with over 4 years cross-cutting experience across Health Policy and Management, Epidemiology, Health Financing, and Global Public Health, working with local and international organizations which targets sustainable development. You can find him on LinkedIn, Twitter, Facebook, and Instagram.