The vaping scam to quit smoking: “If It Were A Drug, No Agency Would Approve It”
It is increasingly common to walk through areas near institutes or universities and see young people exhaling large clouds of white smoke. In their hands, a device similar to a traditional cigarette, a pipe or a small box with a mouthpiece. It is what is known as an electronic cigarette, also called by the anglicism vaper .
In 2021, 44.3% of young people between the ages of 14 and 18 claimed to have tried electronic cigarettes at some time, compared to 17% in 2014, according to the National Plan on Drugs in its survey on drug use in secondary education in Spain. (YOU STUDY). As the years go by, the figures show that more young people have ever tried electronic cigarettes than have tried tobacco. In 2014, 30.4% of adolescents had tried tobacco, a figure that rises to 38.2% in 2021, although habitual consumption has decreased between these ages. This change, which could be considered positive or progress from a medical point of view, brings with it a series of problems that experts put on the table.
Since its appearance in 2003 with the Hon Lik patent in China, the Vaping has spread throughout the world, especially in developed countries. Little by little, its presence in marketing and advertising is being noticed. In 2017, according to a Eurobarometer survey, 31% of Spaniards said they had seen advertisements or promotions related to this device in the last year. Just four years later, this figure rose to 47%, eight points above the European Union average. “The tobacco industry is trying to sell us again on an old tactic that they already used with the menthol filter in cigarettes, in other words, sowing doubt in order to gain time,” says Andrés Zamorano Tapia, coordinator of the smoking group of the Spanish Society of General and Family Doctors (SEMG) and president of the National Committee for the Prevention of Smoking (CNPT).
Read: What Happens When You Quit Smoking And Start Vaping
Its emergence does not seem to be a general problem, but rather one that focuses on younger age groups and their social and consumer habits. Zamorano Tapia describes the process this way: “Tobacco companies and influencers appear. They advertise, especially to children and adolescents, making it attractive because of its flavors and aromas. It looks like something out of a candy store, and since its sale is not regulated, it can be sold in any type of establishment”. Specialists distinguish three reasons why it is attractive to young people: the availability of flavors, its low price, and the social function of belonging to a group.
These devices are perceived by much of society as something harmless. The major manufacturers and advertisers have taken it upon themselves to convey a message of calm, presenting the electronic cigarette as a healthy alternative to conventional tobacco. The very term “vaping” suggests this. The American Cancer Association warns that e-cigarettes do not produce what is commonly understood as a vapor, but rather aerosols. The president of the CNPT agrees, saying that “what is exhaled from electronic cigarettes is not water vapor, as they would have us believe. This term is misleading. It is aerosols, solid and liquid products in suspension that contain substances harmful to health”.
NICOTINE IS NOT THE ONLY ADDICTIVE FACTOR
The presence of nicotine is not necessary to develop a smoking habit, as psychological therapies have shown the enormous influence that this practice has on behavior. The act itself can be an invitation to use again and again, especially when it is considered that it does not cause any harm to the body. In fact, when young people start using electronic cigarettes, this addictive substance “does not play a big role”, as explained by Sergio Morchón Ramos, the doctor in charge of the Tobacco Treatment Unit at the Bellvitge University Hospital. “This is what happens to young people. They start smoking, with or without nicotine, and little by little they get psychologically hooked and there comes a point where they have already established all the addictions,” explains Morchón Ramos.
Surveys show an upward trend in the presence of nicotine in electronic cigarettes among young Spanish students between the ages of 14 and 18. In 2018, 67.1% used cartridges without nicotine, 11.3% with nicotine and 21.6% both. The latest available data, for the year 2021, show that 60.7% smoke cartridges without nicotine, 14.9% with nicotine and 24.4% both.
Due to its recent appearance, there are no conclusive long-term studies on the health effects of vaping, but in the short term, adverse physiological effects on the respiratory tract similar to those associated with tobacco smoke have been found, according to the report on electronic cigarettes published by the General Directorate of Public Health in 2022. The liquids used in the devices are mainly composed of glycerin, propylene glycol, volatile organic compounds flavorings and nicotine. Zamorano Tapia warns that “ingesting propylene glycol and glycerin orally is not harmful. The problem is when they get hot, because they release acrolein, which can cause chronic inflammation, increased mucus secretion…and if they contain nicotine, that’s the last straw.”
HIGHER CONCENTRATION OF METALS THAN TOBACCO
Both propylene glycol and glycerin have been linked to aggravating conditions such as asthma, cystic fibrosis and COPD. The compounds they release (formaldehyde, acetaldehyde and acrolein) are mutagenic and carcinogenic. Nicotine, for its part, is not only the main cause of addiction, but also carcinogenic and a cause of cardiac problems such as arrhythmias, angina and myocardial infarction. It has particularly negative effects on adolescent brain development and can affect behavior, concentration and learning ability.
E-cigarettes often contain toxic metals in very low concentrations. The presence of chromium, copper, zinc and tin can lead to numerous diseases, respiratory problems and mutagenic effects. “The metals are found in higher concentrations than in tobacco. This is probably due to the system used to heat and vaporize the liquid through the atomizer,” explains the coordinator of the smoking section of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). ), Carlos Rábade. In addition, a study published in Scientific Reports in 2019 shows preliminary results that point to flavors and aromas as a focus of respiratory problems.
The influence of attractive flavors in attracting young consumers should be highlighted, especially if we take into account the information provided by the 2020 Eurobarometer surveys, which show a significantly higher presence of consumption of the softest and most appetizing flavors among citizens of this age group. Among the general group of the European population using electronic cigarettes, 48% used cartridges with a fruit flavor, 30% with a menthol flavor and 20% with a sweet chocolate, vanilla or similar flavor. These percentages rose to 75%, 46% and 30% respectively in the 15–24 age group.
A QUESTIONABLE METHOD TO STOP SMOKING
One of the most common arguments used to promote the use of electronic cigarettes is their usefulness in quitting smoking conventional tobacco. It is not uncommon for advertisers and vendors to claim this supposed benefit, sometimes relying on surveys or studies to prove it. However, the vast majority of scientific evidence available to date refutes this property. For the doctor in charge of the Tobacco Treatment Unit at the University Hospital of Bellvitge, “the electronic cigarette is not recommended at all, but it could be useful in certain cases of patients who cannot quit smoking by other means. We recommend a strategy of harm reduction, taking into account that it can cause certain pathologies, but much less than traditional cigarettes”.
The coordinator of SEPAR’s smoking section is more skeptical: “If we take all the studies that exist on the use of electronic cigarettes, we can say, from an objective point of view and with solid scientific evidence, that at the moment they are not an effective method to quit smoking or to reduce the harm of tobacco.It is even more common to keep the smoker in tobacco and avoid a serious attempt to quit with the treatment that has proven to be effective: the combination of psychological counseling with pharmacological treatment “.
The coordinator of the SEMG smoking group thinks similarly, recalling that “the 2014 Jama Pediatrics study shows that minors who vape are six times more likely to be smokers when they grow up. Reports show that most smokers are dual smokers. More than 83% of studies conclude that they are not effective for smoking cessation. They quit 28% less than the control group. If it were a drug, no authority would approve it. According to Eurobarometer data, only 8% of people who tried to quit smoking in Spain in 2020 used electronic cigarettes for this purpose, five points below the European average.
MORE RESTRICTIVE REGULATIONS ON THE HORIZON
On April 3, 2014, the European Union adopted Directive 2014/40 on the regulation of tobacco and related products. This legislation sets the guidelines and minimum requirements in each member state of the European Union. Individually, each country has the power to include additional requirements in its legislation. At the national level, on June 9, 2017, Spain approved its own regulations, Royal Decree 579/2017 of June 9, which regulates certain aspects related to the manufacture, presentation and marketing of tobacco and related products. Similarly, on November 17, 2017, Law 28/2005 was amended, which regulates the places of consumption of nicotine-releasing devices and their advertising.
Some European countries have stricter regulations on electronic cigarettes. In fact, a large majority of the member states of the European Union have put on the table the decision to ban flavored liquids. Hungary and Finland were the first to take this step and have already implemented it in their legislation. In addition, Norway, Finland and Sweden have regulated them as medicines.
Outside the European Union, regulations vary widely. Kuwait and Arabia prohibit the sale of DSLN. Japan and Australia only market nicotine e-liquids as therapeutic products. Argentina, Brazil, Costa Rica, Georgia, Paraguay and Panama have legislation similar to that for tobacco products. The United States has a unique situation. So far, it regulates e-liquids more laxly than the EU, but it plans to ban the marketing of flavored liquids because of several cases of consumers with severe respiratory diseases that have caused the death of several people.
