E-cigarettes: mounting evidence shows the dangers of these new devices

South Africa’s public health community has been gathering evidence that shows e-cigarettes are more dangerous than first thought and that their use may have widespread effects.

E-cigarettes – or electronic cigarettes -- are battery-operated devices that emit doses of vaporised nicotine, or non-nicotine solutions for the users to inhale.

Speaking at a scientific evidence sharing round table, a panel of researchers, doctors and professors explained why the current promotion of e-cigarettes by tobacco manufacturers is extremely dangerous and problematic in South Africa.

The round table was organised by the National Council Against Smoking in conjunction with the University of Cape Town, the University of the Western Cape and the Chronic Disease Initiative for Africa. It discussed the latest evidence around e-cigarettes.

The evidence has strengthened calls for these new devices to be regulated just as conventional cigarettes are regulated and pointed out areas for further research to clarify the range of potentially harmful effects of these devices.

About 20% -- or about 8 million South Africans over the age of 15 -- smoke. Studies done on the use of e-cigarettes in South Africa suggest that about 300 000 people use these devices.

Currently e-cigarettes are not regulated in South Africa. As a result, e-cigarettes can be used in both indoor and outdoor public spaces freely.

Manufacturers and retailers of these products have been able to falsely market these products as safer alternatives to conventional cigarettes and as a method to assist one to quit smoking.

However, findings from peer-reviewed journals show that e-cigarettes carry their own health risks. This is because fine and ultrafine particles released in the vapour of these products can easily be deposited in deeper parts of the respiratory system. This leads to increased risk of multiple health outcomes, including cardiovascular diseases, harms to the unborn foetus and respiratory disease.

The evidence shows that electronic cigarettes are considered a gateway to the use of other tobacco products especially among adolescents.

Wits University pulmonologist Dr Erica Shaddock said that studies in the US showed that cigarette use among young people was on the decrease. But e-cigarette use had dramatically increased.

This was concerning, particularly because the trend could be repeated in South Africa.

Although e-cigarettes have been mooted as an aid to help quit smoking, Shaddock said the evidence showed that when people used e-cigarettes to quit they replaced the cigarette with an e-cigarette. “But when they use other nicotine replacement therapies they are more likely to quit completely,” said Shaddock. This means that, far from helping people to quit smoking, e-cigarettes are able to establish nicotine addiction in young people who did not formerly smoke.

Dr Catherine Egbe, specialist scientist in the South African Medical Research Council said that the use of nicotine in e-cigarettes was deadly. “Nicotine is known to be one of the hazardous components of tobacco products and is highly addictive,” said Egbe.

She said that manufacturers marketed the devices as 95% less harmful than cigarettes.

“But there is no scientific backing to this,” said Egbe, who added that the claim of 95% protection was derived from a method of questionable scientific validity. E-cigarettes could introduce a new strain on South Africa’s already overburdened health care system.

Commenting on the effect of e-cigarettes on children, Professor Anthony Westwood, paediatric and child health specialist from the University of Cape Town, said it was critical that e-cigarette use is regulated by the South African government as soon as possible.

“Nicotine has highly addictive properties and it has the ability to alter the function of young brains permanently. Given the propensity of adolescents to experiment, these controls are needed,” said Westwood.

When the Draft Tobacco Control Bill is passed later this year, the use of and marketing around e-cigarettes will be regulated.

Savera Kalideen, executive director from the National Council Against Smoking said it was important that the round table discussion dispelled the myths around e-cigarettes which the tobacco industry were consistently spreading.