There’s nothing harmless about e-cigarettes, hookah pipes

Cape Town - The use of tobacco was diffused widely before its health effects were well understood and over decades scientists have made known to the world its devastating effects on health.


While stronger policies are being implemented to curb the tobacco epidemic; the tobacco industry, desperate to maintain its market, continues to introduce new ways of consuming tobacco and nicotine.


“Safer” cigarettes did not start today, “light” and “low-tar” cigarettes were marketed as having lower health risks, and these descriptors have since been prohibited in South Africa and all over the world, after it was shown that these were not “safer”.


Menthol cigarettes have also been marketed as fresh, refreshing and “safer”. The use of flavours only makes it easier and smoother to smoke, masking the harshness of tobacco, but it does not make it less harmful.


Today’s youth and young adults in South Africa are increasingly using hookah pipes or shisha. Despite the colourful packaging and flavours, this is still tobacco; users are exposed to toxic chemicals. In fact, some harmful substances are found in higher concentrations and shisha users may absorb more toxic substances than cigarette smokers do.


Hookah pipes contain the same harmful chemicals found in cigarettes, including lead, nicotine, nickel, formaldehyde and benzene.


More recently there has been the emergence of electronic nicotine delivery and non-nicotine systems, commonly known as e-cigarettes or vape products. They are not tobacco products but they contain some of the toxic substances present in cigarettes and hookah pipes. They also share the same manufacturers, the top four producers of e-cigarettes are major tobacco companies.


E-cigarettes have been widely marketed as “safer” alternatives to tobacco products, but the World Health Organization (WHO) cautions that there is no adequate science to substantiate this claim.

A major debate has been that e-cigarettes have fewer toxins - the fundamental problem is that fewer toxins do not automatically equate to reduced health risks or tangible health benefits; especially considering that e-cigarettes have a unique toxicity profile.

Another complexity is that the harm in e-cigarettes also varies across brands, ingredients, hardware, the heating temperatures and amount of nicotine.


The long-term health effects of e-cigarettes are still unknown but short-term use has been linked to lung damage, cardiovascular diseases, cancers, chest pains, mouth ulcers, asthma, and a high risk of stroke; conditions which are also closely associated with cigarette use.

This shows that these products are not harmless and that we ought to be worried about their long-term health effects.

In 2019, the US witnessed an outbreak of lung injuries associated with e-cigarettes, resulting in 2 807 hospitalisations and 68 deaths.


Like cigarettes and hookah pipes, most e-cigarettes contain nicotine, an addictive and harmful substance. Nicotine levels in e-cigarettes are highly variable, with some having higher concentrations than in cigarettes. There are also instances of mislabelling with other “non-nicotine” e-cigarettes actually containing nicotine. Nicotine has been found to play a role in both the induction and progression of heart disease, hypertension and strokes.

Nicotine is also dangerous for the developing adolescent brain, potentially causing lasting severe consequences on cognition, attention and moods.


Formaldehyde is also common to cigarettes, hookah pipes and e-cigarettes. This substance is commonly used to preserve dead bodies. It is cancerous and continued exposure increases the risk of developing leukaemia. The amounts of formaldehyde in e-cigarettes can be equal or higher than the amounts found in cigarettes.


Toxic heavy metals such as cadmium and lead, which appears in the WHO list of 10 chemicals of major public concern due to potential toxicity; are also found in cigarettes and e-cigarettes alike.

Industrially, cadmium is used in making batteries and plastics. It damages lung tissue and can cause kidney, liver, bone and blood damage.


Lead is capable of causing negative effects on the brain, the nervous system and on red blood cells. Nickel in e-cigarettes can be 2 to 100 times higher than found in cigarettes.


Nickel is a skin and respiratory irritant, and high and prolonged exposure can affect lung function.

Tobacco-specific nitrosamines (TSNAs) have been regarded as one of the most important compounds associated with the negative health effects of tobacco. Although TSNAs are present at lower levels in e-cigarettes than in cigarettes, they are sufficiently high to give an elevated risk of tumour development.


Cancer-causing benzene can also be found in all these products. Benzene is a flammable liquid commonly used in producing detergents, explosives and pesticides. Long-term exposure can result in increased risk of excessive bleeding, leukaemia and a weakened immune system.

These are just some of the toxins present across hookah pipes, cigarettes and e-cigarette or vape products.


While we continue to discourage the use of cigarettes and improve the enforcement of laws to make certain that hookah pipes are treated as the tobacco products that they are; the government must act quickly to pass the Control of Tobacco Products and Electronic Delivery Systems Bill which will strictly regulate e-cigarettes.


Nyatsanza is project and communications manager at the National Council Against Smoking.

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