E-cigarettes and vaping: what we know so far
Around the world and in Australia, parents and teachers are alarmed about increasing youth vaping and e-cigarette use. News and media stories have labelled it as the ‘vaping epidemic’ that creates a cohort of nicotine-addicted youth. UQ's Dr Janni Leung, Emerging Leadership Fellow of the National Centre for Youth Substance Use Research (NCYSUR), explains what we know from the research so far?
E-cigarettes help people quit smoking
E-cigarettes were originally developed by a pharmacist to help people quit smoking.
The highest level of scientific evidence shown in systematic reviews and meta-analyses indicates that people who use nicotine e-cigarettes to help them quit are two times more likely to be successful at remaining smoke-free than placebo vaping, and one and a half times more effective than NRT.”
Australians who used e-cigarettes every day were more likely to quit, or reduce smoking cigarettes, based on findings from national representative population surveys.
In response to the Australian Government’s ban on the personal use of nicotine-containing e-cigarette products without a prescription, many people took to social media to express concerns about smoking relapse with the barrier to accessing e-cigarettes. Many users indicated that it does not make sense why a potentially less harmful product is banned while the most harmful product to human health, traditional cigarettes, are not.
Are e-cigarettes less harmful than smoking?
E-cigarettes are not completely harmless, but they are considerably less harmful than smoking because the carcinogens and toxins produced by burning tobacco in traditional cigarettes are the major causes of harm. The smoke from cigarettes causes lung diseases, cancer, heart diseases, and stroke, which account for the bulk of the burden of disease attributable to tobacco use.
The long-term health impacts of e-cigarette use, however, are yet to be known.
Mathematical modelling studies commonly assume that the risk of vaping relative to smoking is at 5 per cent (range 1–40 per cent). The models often predicted that population use of vaping, instead of (or in dual use with) smoking, would lead to improved population health outcomes, including decreases in smoking-attributable deaths and financial impacts to the health system.
Oral irritation, cough, and headaches or migraines are most often reported by people who use e-cigarettes. It is unclear, however, whether e-cigarettes cause these symptoms, because some studies showed e-cigarette users reported fewer symptoms than people using NRT samples.
An outbreak of 'e-cigarette, or vaping product use associated lung injury' (EVALI) is often attributed to the use of e-cigarettes. EVALI was linked to the vaping of cannabis oils contaminated by vitamin E acetate.
E-cigarettes that contain nicotine can lead to nicotine addiction. Nicotine is a highly addictive substance, and vapes – particularly non-regulated products – may contain high levels of nicotine along with toxic and harmful chemicals that cause serious health problems. Vapes that contain cannabis with high Tetrahydrocannabinol (THC) – the psychoactive compound in cannabis – levels may increase the risk of mental health problems and affect brain development, particularly in adolescents.
Prevalence is lower than the media suggest
In the World Health Organization’s Global Youth Tobacco Surveys, 1 in 60 adolescents vaped regularly in the past month across 47 countries between 2015 and 2018.
The Australian Institute of Health and Welfare’s most recent national figures showed that 1.1 per cent of the population vaped daily in 2019. This was 10 times lower than the 11 per cent of the population who are still smoking traditional cigarettes daily.
South East Queensland’s Adolescent Aware study of independent schools found that 72 per cent of Year 12 students in 2020 reported that they had never used an e-cigarette or vaped, even once or twice. Up to 12 per cent reported that they had in the past month. Among those who have used an e-cigarette, 75 per cent reported that they have tried flavouring-only vapes, 44 per cent tried nicotine vapes, 31 per cent tried cannabis vapes, and 7 per cent reported trying one that they do not know what was in it. E-cigarette use was more common in males and students with a history of truancy and who also used other substances, engaged in binge drinking, smoked traditional cigarettes, and used cannabis.
A UQ study of residential student colleges found that 62 per cent of students reported that they had used an e-cigarette or a vaping device. What did they contain? The most popular was flavour with nicotine or tobacco (73 per cent used it), 29 per cent reported using flavour only, 5 per cent reported vaping cannabis or THC, and another 5 per cent reported that they did not know what the vaping device contained.
Equivocal evidence that youth who vape will go on to smoke cigarettes
Some studies have shown that adolescents who vaped were more likely to also smoke traditional cigarettes, and those who did not smoke but vaped were more likely to initiate smoking. The two behaviours are associated, but correlation does not equal causation.
In the United States, the increasing trend of vaping in adolescents has occurred while smoking rates among young people have continued to fall. Among young people, self-reported intentions to smoke cigarettes have also continued to drop, including among adolescents who have vaped.
We should reduce e-cigarette use among youth, even if e-cigarettes do not increase cigarette smoking. In countries where these products are legal, governments can minimise e-cigarette uptake among non-smoking youth by enforcing age restrictions on e-cigarette purchases and limiting the number and density of licensed e-cigarette sales outlets.
Be careful of positive and marketing content on social media
A major challenge is minimising e-cigarette and pro-vaping-related videos that have been trending on social media. On TikTok, a study conducted in 2020 found that e-cigarette-related videos were already viewed over 1.5 billion times. The majority of these videos portrayed e-cigarette use positively (for example showing funny, ‘cool’ or creative tricks), and those were also the ones with the most views and likes. A follow-up study one year later in 2021 found that most of those videos were still available without age restrictions, and views and likes have increased.
Young people who are exposed to tobacco marketing, and who had lower perceptions of the risks of tobacco, are more likely to use a variety of tobacco products, including vapes and traditional cigarettes.
Marketing through social media has been glamorising and making e-cigarettes attractive to youth. In Australia, it’s illegal to officially publish messages that encourage people to smoke, but it is unclear how we could regulate e-cigarette-related content posted on social media.
We need strategies to regulate the advertising and promotion of e-cigarettes, particularly those targeting youth, for any purpose other than to help quit or reduce cigarette smoking.
About the author
Dr Janni Leung is an NHMRC Emerging Leadership Fellow of the National Centre for Youth Substance Use Research (NCYSUR) at UQ. NCYSUR continues a vision to protect young people by conducting high-quality research on contemporary issues in addiction, including alcohol, drug use, video gaming, social media, and crypto-market addiction. NCYSUR welcome partners, philanthropists, and funders to get in touch and collaborate with us to prevent substance use and addiction in our youth together for a better future.
Dr Leung will give a free talk about what is known from the research so far on vaping at the Back To UQ day on Sunday 7 August.
This article was reciveved from The University of Queensland, Australia. Link here