Vaping: An Emerging Public Health Crisis

“In the case of cigarettes and e-cigarettes, history will judge us harshly as to how we answer this billion-person question. It may also look back in anger at policy-making amounting to institutionalized manslaughter.”- Professor Julian Kinderlerer- President of the European Group on Ethics in Science and New Technologies (EGE). Vaping is a relatively new phenomenon. However, this practice has caught on like wild fire in many parts of the world. Vaping devices are popular among pre-teens and teenagers. According to the National Institute on Drug Abuse vaping devices are the most commonly used form of nicotine among youth in the United States. Some research shows that many teens do not even realize that vaping cartridges contain nicotine, and assume the pods contain only flavoring. The attractiveness of vaping is rooted in: the easy availability of these devices, appealing advertisements, various e-liquid flavours, and the belief that vaping devices are safer than cigarettes. Additionally, vaping devices are easy to hide from teachers and parents because they do not leave behind the stench of tobacco cigarettes, and are often disguised as flash drives. The National Institute on Drug Abuse states that a study of high school students found that one in four teens reported using e-cigarettes for dripping, a practice in which people produce and inhale vapors by placing e-liquid drops directly onto heated atomizer coils. Teenagers reported the following reasons for dripping: to create thicker vapor (63.5 percent), to improve flavors (38.7 percent), and to produce a stronger throat hit a pleasurable feeling that the vapor creates when it causes the throat to contract (27.7 percent). According to National Council on Drug Abuse (NCDA) vaping is almost like a trend among primary and high school students. The NCDA study found that the risk perception of vaping is very low among students as they fall prey to the marketing of these products that come in a range of flavours and which the tobacco industry claims can help reduce the harm of smoking tobacco products. Vaping in the Caribbean. Currently, 11.3% of adolescents between 13 and 15 years of age in the region use tobacco, compared to the world average of 10.3%. The Healthy Caribbean Coalition (HCC) and the Pan American Health Organization (PAHO) delivered a webinar in June 2023 on “Clearing the Air – Vaping and Youth in The Caribbean” to launch HCC’s new report, “Vaping among Adolescents and Youth in The Caribbean: Situation, Policy Responses, and Recommended Actions” where the panelists emphasized the urgency of taking action to combat youth vaping given its high prevalence use among adolescents in the Caribbean. Smoking prevalence in the region has been reduced in the last few decades as a result of the regional tobacco control efforts. The Pan-American Health Organization, which is the Americas regional office of the World Health Organization (WHO), estimates that “between 2007 and 2015, the prevalence of tobacco smoking dropped from 22.1% to 17.4%, a greater drop than that recorded globally”. This trend is expected to continue, with the region being the “only WHO region expected to achieve a 30% relative reduction in the prevalence of current tobacco use by 2025.” Jamaica has the highest rate in youth consumption in the region, with 28.7%, followed by Colombia with 22% and Chile with 19.7%. Brazil has the lowest rate of tobacco consumption amongst the youth, as a result of the efforts of the country to introduce tobacco control measures as advertising ban, health warnings, and flavouring ban. What Are Vaping Devices?. A typical vaping device costs between $10-50 USD. Vapes also have recurring costs such as e-liquid and replacement pods or coils. Vaping devices are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. They can resemble traditional tobacco cigarettes (cig-a-likes), cigars, or pipes, or even everyday items like pens or USB memory sticks. Other devices, such as those with fillable tanks, may look different. Regardless of their design and appearance, these devices generally operate in a similar manner and are made of similar components. Alarmingly, more than 460 different e-cigarette brands are currently on the market. In addition to the unknown health effects, early evidence suggests that vaping might serve as an introductory product for preteens and teens who then go on to use other nicotine products, including cigarettes, which are known to cause disease and premature death. A study showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year. Another study supports these findings, showing that high school students who used e-cigarettes in the last month were about 7 times more likely to report that they smoked cigarettes when asked approximately 6 months later, as compared to students who said they did not use e-cigarettes. It is clear that the tobacco industry has done their work in creating and marketing vaping devices. Given how impressionable teenagers are there is no doubt that the marketing strategies of the tobacco industry has worked.

Physiological Impact. The nicotine in e-liquids is readily absorbed from the lungs into the bloodstream when a person vapes an e-cigarette. Upon entering the blood, nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with most addictive substances, nicotine activates the brain’s reward circuits and also increases levels of a chemical messenger in the brain called dopamine, which reinforces rewarding behaviors. Pleasure caused by nicotine’s interaction with the reward circuit motivates some people to use nicotine again and again, despite risks to their health and well-being. The National Institute on Drug Abuse adds, e-cigarette use exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process. A study of some e-cigarette products found the vapor contains known carcinogens and toxic chemicals, as well as potentially toxic metal nanoparticles from the device itself. The study showed that the e-liquids of certain cig-a-like brands contain high levels of nickel and chromium, which may come from the nichrome heating coils of the vaporizing device. Cig-a-likes may also contain low levels of cadmium, a toxic metal also found in cigarette smoke that can cause breathing problems and disease. More research is needed on the health consequences of repeated exposure to these chemicals. There are also reports of lung illnesses and deaths related to inhalation of certain vaping oils into the lungs, which have no way to filter out toxic ingredients. Urgent Action Required. The World Health Organization (WHO) has clearly identified vaping as problematic. In fact the WHO says urgent action is needed to control e-cigarettes to protect children, as well as non-smokers and minimize health harms to the population. E-cigarettes as consumer products are not shown to be effective for quitting tobacco use at the population level. Instead, alarming evidence has emerged on adverse population health effects. E-cigarettes have been allowed on the open market and aggressively marketed to young people. Thirty-four countries ban the sale of e-cigarettes, 88 countries have no minimum age at which e-cigarettes can be bought and 74 countries have no regulations in place for these harmful products. E-cigarettes target children through social media and influencers, with at least 16 000 flavours. Some of these products use cartoon characters and have sleek designs, which appeal to the younger generation. There is an alarming increase in the use of e-cigarettes among children and young people with rates exceeding adult use in many countries. The WHO argues that even brief exposure to e-cigarette content on social media can be associated with increased intention to use these products, as well as more positive attitudes toward e-cigarettes. Studies consistently show that young people that use e-cigarettes are almost three times more likely to use cigarettes later in life. The WHO concludes that the tobacco industry profits from destroying health and is using these newer products to get a seat at the policy-making table with governments to lobby against health policies. The tobacco industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily promoting these products to children and non-smokers and continuing to sell billions of cigarettes. Workable Solutions. With the recent ban on the use and marketing of electronic cigarettes in Venezuela, more countries in the Americas are adopting measures in line with the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) to protect the health of their populations from novel tobacco products. Currently, 21 countries in the Americas regulate electronic nicotine delivery systems (ENDS), such as e-cigarettes and vapes, in some way. Eight of them (Argentina, Brazil, Mexico, Nicaragua, Panama, Suriname, Uruguay and Venezuela) prohibit their sale altogether, and the other 13 have partially or totally adopted one or more regulatory measures. Meanwhile, 14 countries lack any regulation of these products. Perhaps, CARICOM could seize the moment and speak as one body regarding its position on e-cigarettes and vapes. What is most troubling is that many parents have no idea that their child or children are involved. Vaping allows for a sense of secrecy. In addition the activity also has an air of sophistication. Vaping has become sexy. Our teenagers see vaping on the silver screens involving their role models and idols; this makes the practice more alluring. When this reality is juxtaposed with the fact that there is not an anti-vaping campaign locally this makes for a match made in vaping heaven. It is evident that our children have been targeted by the creativity of the tobacco industry. The truth is any anti-vaping campaign must be as equally creative in order to reach our pre-teens and teenagers who are primarily the targeted customers. Governments as well as non-governmental organizations must now 'heed the call' from bodies such as the World Health Organization and the National Institute on Drug Abuse in tackling vaping which has now become a social problem in many if not all societies. Our educational institutions are critical stakeholders in the fight against vaping. As a consequence, any anti-vaping campaign must bear this in mind. Our schools especially those at the primary and secondary levels must also adjust their school policies to include vaping and vaping devices. Our parent teachers’ associations must also be part of this conversation regarding anti-vaping measures. Interestingly, some jurisdictions have also placed a special tax on vaping devices. Perhaps such a measure should be explored and the proceeds used to fund anti-vaping campaigns. The time for stakeholders to act is now. In the words of Dr Tedros Adhanom Ghebreyesus, kids are being recruited and trapped at an early age to use e-cigarettes and may get hooked to nicotine. Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues. waykam@yahoo.com @WayneCamo © #vaping #ecigarettes