When e-cigarettes were first introduced, they were mooted as a tool that could help people stop smoking.
The industry pushed them as a product that could replace cigarettes and other tobacco products because they were supposed to be less harmful.
But as more research into the effects of these new devices becomes available globally, there is increasing evidence that shows that these devices are actually more detrimental than they were first thought to be.
E-cigarettes – or electronic cigarettes -- are battery-operated devices. It heats a fluid so that a dose of vaporised nicotine is emitted which the user inhales.
Unlike with cigarettes, smoke does not go into the lungs. And many proponents will argue, there is also non-nicotine variations of these devices. So surely that makes them less harmful?
Let’s have a look at what the research says.
One of the most significant research findings is that 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 into the deeper parts of the respiratory system. This leads to an increased risk of a user developing a cardiovascular disease.
There is also research that shows that e-cigarette users are exposed to as much nicotine as those who smoke cigarettes. Nicotine is one of the most dangerous components of cigarettes and is highly addictive.
Also, the e-cigarette aerosol and e-liquid have been found to produce trace elements like cadmium, lead, and nickel, which are known carcinogens.
And when it comes to children, Professor Anthony Westwood, paediatric and child health specialist at the University of Cape Town, says the global evidence shows that electronic cigarettes are considered a gateway to the use of other tobacco products, especially among adolescents.
“What many people do not realise is that the highly addictive properties in nicotine
have the ability to alter the function of young brains permanently. And while the toxicity of the fumes from these products is still unclear, there is increasing evidence showing that both nicotine and the aerosols from these products result in significant health harm. This includes pulmonary inflammation, impaired immunity and reduced lung function,” says Westwood.
Wits University pumlonologist, Dr Erica Shaddock, says she cannot support the use of e-cigarettes as a tool to quit smoking.
She highlights the view of the forum of International Respiratory Societies which points out that the health and safety claims of e-cigarettes still needs to be put through evidentiary review or tested so that the health impact of using them can be clearly understood.
The society says the benefit of e-cigarettes needs to be considered against the harm that it would cause by making smoking and nicotine use more socially acceptable.
South Africa’s health practitioners need to ban these devices until information about their safety is available, says Shaddock.
Taken holistically, the research ultimately shows that e-cigarettes have a distinct and new risk associated with its use. And, according to Dr Catherine Egbe, specialist scientist at the South African Medical Research Council, these risks could introduce more ill-health in the population. This would potentially add to the strain on the already overburdened South African health care system.
South Africa has been hard at work to reduce the number of smokers in the country.
About 20% -- or about 8 million South Africans over the age of 15 -- smoke. And in some provinces, and among some population groupings, this figure is much higher.
Over the last 20 years, various measures have been introduced to reduce these figures. We’ve introduced designated smoking areas in restaurants and other public places. And we’ve removed the advertising, sponsorship and marketing of cigarettes and other tobacco products to mention a few.
So, the question is, will e-cigarettes help us cut down the number of smokers or will it introduce a new public health problem?
There are two problems with e-cigarettes as they stand..
The first is that there is much that remains unknown about the harmful effects of using e-cigarettes, both in the short-term and long term. Here the solution is a raft of global studies that are evaluating the effects of e-cigarettes in all their forms but the long term impacts will only be known a decade from now.
The other is perception. Studies that have shown that generally, e-cigarettes are regarded as a safer tobacco product by both smokers and non-smokers. This means that people (and even some doctors) promote their use. This happens when there are no regulations that guide how they should be used or promoted.
And this has been the case in South Africa, where there is no regulation. As a result, e-cigarettes are currently being 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.
The challenge with this scenario is that it also makes consumers of these devices vulnerable to misinformation about the risks and perceived benefits of using these devices.
And it’s the reason why their use needs to be regulated as soon as possible.
When South Africa passes the Draft Tobacco Control Bill later this year, e-cigarettes will be regulated comprehensively.
The regulation be in line with the World Health Organisation recommendation to regulate these devices. The global health body argues that there is, as yet, no harmless tobacco product, and research on e-cigarette use have provided enough data to show that these products cause significant health harm, necessitating regulation.
Already in the developed world e-cigarettes have become extremely popular. Statistics released by the US’ Centres for Disease Control and Prevention, show that there are more than 3.6million minors in the US that use e-cigarettes. This is an increase of more than 1.5million students since 2017.
According to the research there are more than 7000 e-cigarette liquid flavours in the public domain, varying from fruit flavours to “exotic” flavours like “popcorn” and candy, designed with younger people in mind.
Already in SA, there are more than 300 000 users of e-cigarettes, if research conducted by the African Tobacco Industry Monitoring and Policy Research Centre, situated at Sefako Makgatho Health Sciences University is to be believed.
And the reality is that this is a growing number which will only increase as they become more popular and the price decreases.
There are many studies underway to examine potential harms. These may eventually yield additional evidence showing the health harms linked to e-cigarettes. But these may take several years.
Until more of that research makes it into the public domain, there is a need for the tobacco control community to continually remind the public that there is already enough evidence to show that e-cigarettes are not harmless to health.
* Savera Kalideen is the executive director of the National Council Against Smoking.
This article first appeared in The Saturday Star on April 25, 2019.