Alia, 23, vaper, has breathing difficulty: Are e-cigarettes turning young people more nicotine-dependent and causing heart disease?

Twenty-five-year-old Niti Abraham has had no problems with availability either. “If you know the right people in the city, a call is all it takes to get your e-cigarette delivered wherever required. I think what works for me is that regular smoking causes a longer-lasting smell and is easily identifiable but vaping causes a more pleasant smell that also dissipates faster. For me, it’s mainly the smell, the taste in the mouth (smoking leaves a foul aftertaste), convenience and budget-friendliness.” Both of them are addicts but not yet as serious as Izzy Esposito, the 18-year-old vaping addict from the UK, who made news. She had become so nicotine-dependent that she always had a vape in her hand. Her gums started bleeding and she got sores in her mouth and lips.

E-cigarettes are banned in India but available for use through online and point of sale outlets, according to a new study by the Public Health Foundation of India (PHFI) and WHO-India.“Surreptitious use among adolescents is now not just common in private schools but also in government schools. Our study shows several e-stores (national and international) selling electronic cigarettes in India and 189 prominent social media influencers, who are promoting electronic cigarettes. Another study published in 2020 in the International Journal of Public Health observed that internet electronic cigarette vendors (IEVs) continued to sell vaping devices in India despite the ban. Sixteen out of 45 identified IEVs were not compliant with the legislation of 2019. Demands are now being raised in some quarters to make the sale of e-cigarettes legal on the grounds that these are safer than cigarettes,” says Prof Monika Arora, Vice President, PHFI, Gurgaon.

The risk of bronchitis symptoms increases almost two-fold among adolescents, who have used e-cigarettes in the past and more than two-fold among current users compared to non-users. (Source: Freepik)

There is irrefutable evidence on the negative attributes of Electronic Nicotine Delivery Systems (ENDS) on human health. “While not containing tobacco per se, ENDS contain nicotine which is a toxic chemical and the principal ingredient of tobacco causing addiction among users. ENDS use at younger ages (due to targeted marketing and misleading harm reduction messaging) has been shown to increase the risk of the subsequent initiation of cigarette smoking. Also, nicotine dependence levels in young e-cigarette users have been reported to be over two times higher compared to traditional tobacco smokers.The myriad flavours available in e-cigarettes/ENDS are especially selected to target adolescents and youth. Nicotine also interferes with brain functions among youth, impacting parts of the brain responsible for attention, learning and memory. Use of e-cigarettes worsens anxiety and irritability while triggering or aggravating impulsive behaviours. Unregulated nicotine levels in e-cigarettes (varying between 14.8 to 87.2 mg/ml) constitute a serious threat to established tobacco control policies,” says Dr Prakash C. Gupta, director, Healis Sekhsaria Institute for Public Health, Mumbai.

Prof K. Srinath Reddy, founding president (past) and distinguished professor, Public Health Foundation of India, Gurgaon, further adds, “E-cigarettes are not harmless. They cause dysfunction in the lining of blood vessels, restricting the development of new blood vessels and stoking inflammation. Daily use of e-cigarettes has been found to be independently associated with an increased risk of heart attacks. There are numerous other ingredients in e-cigarettes, apart from nicotine, that are dangerous and make the product unsafe for use. These include Glycol Mist, Diacetyl, metals (like nickel, tin and lead), Acrolein, Acetyl Propylene and other carcinogenic chemicals. Repeated exposure to Acrolein causes chronic pulmonary inflammation and reduction of host defence. The risk of bronchitic symptoms increases almost two-fold among adolescents, who have used e-cigarettes in the past and more than two-fold among current users compared to non-users. Vapourised e-cigarette fluid has been found to be cytotoxic, pro-inflammatory and an inhibitor of defence mechanisms in the cells that clear invading organisms.”

The misplaced argument that ENDS decrease rates of traditional smoking is weak. “Evidence highlights that youth cigarette use was on the decline in the United States but with the introduction of e- cigarettes, consumption of nicotine delivery products doubled or tripled every year between 2011 and 2014, with e-cigarette use surpassing conventional cigarette use in youth. A higher prevalence of e-cigarette use is also associated with ‘dual use’ (both cigarette smoking and e-cigarettes). Such dual use is on the rise among youth in countries that allow ENDS use,” says Prof Pankaj Chaturvedi, deputy director, Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai.

According to these experts, “companies manufacturing e-cigarettes or other so-called electronic harm reduction nicotine products have not even applied to any drug controller anywhere in the world to register them as cessation products. Worldwide, 109 countries have completely banned e-cigarettes and India enforced this evidence-based decision in the interest of public health especially to protect vulnerable groups, including adolescents and youth, pregnant women and women in the reproductive age group. The ENDS ban in India does not allow for similar new nicotine and tobacco products to enter the Indian markets. Online sales and some point-of-sale outlets need to be urgently checked to restrict experimentation with and addicted use of ENDS. Social media influencers promoting vaping as a behaviour and ENDS as a product should be penalised under PECA 2019.”

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