E-cigarettes: it’s time for some regulation

They've become a familiar sight in public places: a cloud of smoke billowing into the air as a shopper, student or pedestrian uses an e-cigarette and releases “smoke” into the air.

There are two reasons why those who use e-cigarettes are currently able to do so in public.

Firstly, there is no legislation that regulates the use of e-cigarettes in South Africa. The current tobacco control law was introduced more than two decades ago, at a time when e-cigarettes were not available.

This is why e-cigarettes are being used inside restaurants and malls, in public transport and office buildings, as well as on the streets. There are no laws governing their use.

Secondly, there are no laws governing the advertising, marketing and sponsorship of e-cigarettes. This has meant that e-cigarette manufacturers have used the legislative vacuum to widely market and promote these devices.

They’ve also been able to make unsubstantiated claims about the impact they have on public health as well as on their efficacy as a quit tool.

And they’ve been able to position e-cigarettes as healthy, sexy and attractive, with a particular focus on getting young people to use the product.

This is all set to change as the Department of Health has proposed regulating the use and marketing of e-cigarettes in the Draft Control of Tobacco Products and Electronic Delivery Systems Bill, which restricts the use of e-cigarettes in public places and in all areas where combustible cigarettes are not allowed.

Marketing, advertising and the sponsorship of e-cigarettes will also be banned and their sale will be restricted to adults over 18.

Comments for the bill have closed; the department has received thousands of submissions. This process will continue for the next eight months at least.

But as this gets under way, there is a debate raging in the background about the harm attached to e-cigarettes, mostly suggesting that people switch to them. People should not believe the hype. The common argument from e-cigarette manufacturers and promoters is that they are not as harmful as combustible cigarettes because they contain less nicotine.

Yes, it’s true they contain less nicotine, but this does not equate with being less harmful than combustible cigarettes.

E-cigarette use has been linked to the development of lung diseases such as chronic obstructive pulmonary disease (bronchitis and emphesyma). And, if used during pregnancy, it can cause sudden infant death syndrome.

Studies have also linked the use of e-cigarettes to increased heart rate and high blood pressure, which are often precursors of heart disease.

The evidence shows that there can be up to 60 toxins in the e-liquid that is used to manufacture some e-cigarettes.

Despite claims from the tobacco industry that e-cigarettes help smokers to stop using combustible cigarettes, there is no data available to suggest that e-cigarettes are more effective as a quit tool than nicotine replacement therapy programmes, motivational counselling and/or support groups.

Instead there is evidence to show that e-cigarettes are most likely to be used in combination with combustible cigarettes.

Preliminary research into the use and effects of e-cigarettes raises cause for concern about their use among young people.

The US surgeon-general found that e-cigarette use among high school learners increased by 900% between 2011 and 2015.

It’s also the most commonly used form of tobacco among young people in the US, and has overtaken the use of combustible cigarettes, cigars, chewing tobacco, and water pipes.

The report also noted that the presence of nicotine in many e-cigarettes can cause addiction as well as harm the developing adolescent brain.

The report also noted other effects on adolescents, including addiction, priming for use of other addictive substances, reduced impulse control, deficits in attention, and mood disorders.

South Africa has not yet reached the US levels of consumption of e-cigarettes. However, alarm bells are ringing here, too. A survey of high school learners by the Bureau of Economic Research showed that nearly four in 10 learners in the survey had smoked cigarettes, and three out of 10 had used e-cigarettes.

Most had started smoking in their early high school years and had experimented with tobacco. The data shows similarities with findings from international research, which shows that e-cigarette use encourages young people to start smoking combustible cigarettes.

South Africa is not the first country to introduce regulation of e-cigarettes. We will join over 60 other countries.

Currently, just under 20% of the population smokes combustible cigarettes, a figure that has remained stagnant for almost a decade.

Sefako Makgatho Health Sciences University estimates that between 200 000 and 300 000 people currently use e-cigarettes, and believes that this number will increase if they are not regulated.

The proposed regulation of e-cigarettes to limit their use in public places, to ban all marketing, advertising and sponsorship, as well as to introduce health warnings on packaging, will send a clear message to South Africans that e-cigarettes are harmful to the health of both the users themselves as well as to those around them.

They will then make their own choice not to use e-cigarettes, exactly as millions of South Africans refuse to consume combustible

This article first appeared in The Star on August 13, 2018.