Friday 23 August 2019

Is youth vaping creating a new generation of nicotine addicts?

E-cigarettes have seen a rapid growth in the last number of years in Ireland, most recently among younger people. In the US there has been a regulatory backlash amid concerns about youth vaping - but will Europe follow suit? By Kathy Donaghy

In December 2018, the US Surgeon General issued an advisory calling youth vaping an
In December 2018, the US Surgeon General issued an advisory calling youth vaping an "epidemic"

Kathy Donaghy

E-CIGARETTES are being touted by their makers and some global public health figures as tools to help adult smokers kick the habit. But as vaping increases among young people, there are serious concerns that the devices will create a new generation of nicotine addicts.

A draft scheme of legislation to provide for measures in relation to tobacco products and nicotine-inhaling products such as e-cigarettes is currently being developed. In addition to the introduction of a new licensing system for the retail sale of tobacco products and nicotine-inhaling products the legislation will prohibit the sale of nicotine-inhaling products by and to persons under 18 years. It is intended that a Memorandum for Government seeking approval to publish the General Scheme of the Bill and to proceed to formal drafting will be submitted in the coming months.

E-cigarettes are widely considered safer than traditional cigarettes, but they are too new for researchers to understand the long-term health effects, making today's youth what public health experts call a "guinea pig generation."

In the US, it's reported that one in five high school students use e-cigarettes. Schools say the problem sneaked up on then at the start of the new term last September when students arrived back to school taking their easily concealed devices with them.

The figures stateside are eye-watering - almost five million American teens used an e-cigarette last year. US Surgeon General Jerome Adams has declared e-cigarettes an epidemic among youth, stressing that e-cigarette aerosols containing nicotine increase the risk of addiction to nicotine and other drugs, and impact brain development which can induce mood disorders and lower impulse control.

And now the fightback has begun. Last month San Francisco, home to American's most popular e-cigarette brand, Juul, voted to ban sales of e-cigarettes. The ban will be the first of its kind to go into effect in the US. The ban comes as Juul Labs enters the Irish market for the first time. Juul says its products are aimed at adult smokers trying to kick the habit. Here the Government is working on new legislation which will ban the sale of e-cigarettes to anyone under the age of 18.

The Irish Cancer Society and the Irish Heart Foundation have both raised serious concerns about the risks to young people from e-cigarettes.

In a joint policy document published in May, the two organisations said that while the companies making e-cigarettes claim their products are intended for adult use only, these claims cannot be trusted given the heavy presence of the tobacco industry behind these companies. Tobacco company, Altria, the company behind Marlboro cigarettes invested $12.8 billion into Juul to take a 35pc stake in the company in 2018.

And both organisations are worried that e-cigarette use among youths can act as a potential gateway to smoking. They also say there's a risk that we may follow the pattern seen in the US where daily e-cigarette use among teenagers has risen a startling 78pc from 11.7pc in 2017 to 20.8pc last year.

"While short-term evidence has found that e-cigarettes are less harmful than combustible cigarettes, e-cigarettes are not harm free, and more longitudinal evidence is required to assess long-term risk," the joint position paper states.

"We cannot categorically say that e-cigarette use increases cancer risk, but e-cigarette use may cause precursor events to cancer, such as lung inflammation and DNA damage in the lungs. While e-cigarettes cause less harm to the cardiovascular system than smoking, research suggests that these products can alter vital signs such as heart rate and blood pressure," it states.

The research on e-cigarette use among young people here is limited. According to one study, e-cigarette use among young people aged 15-17 is relatively high with 24.7pc of respondents saying they had tried them at least once.

The Irish Cancer Society and the Irish Heart Foundation have both raised concerns about the fact that e-cigarette companies have been investigated for using marketing techniques on social media that intentionally advertise their products in a way that appeals to young people.

According to Chris Macey, head of advocacy with the Irish Heart Foundation, new research on the number of young people vaping due to be published before the end of the year is likely to show the numbers have increased rapidly in a short space of time.

And he says after successfully reducing the number of people smoking, the risk is that a whole new generation will become addicted to nicotine.

While he says the e-cigarette manufacturing companies claim their products are less harmful than cigarettes, virtually anything is less harmful than lighting up a cigarette. But he says the jury is still out on exactly what harm e-cigarettes can cause.

Macey says it's time the Government stepped in to ban advertising of e-cigarettes in the same way cigarette advertising is banned otherwise we run the risk of "normalising" vaping.

"I think there is a complacency about vaping. I don't think parents would know if their children were vaping. Research coming out later this year will show that a lot more kids are vaping than anyone realised," he says.

Claims by e-cigarette companies that they don't market their products at children and just want to help existing smokers move to a safer alternative must be treated with scepticism, according to Irish Cancer Society chief executive Averil Power.

"They're being marketed as a lifestyle choice in much the same way the cigarette companies marketed cigarettes decades ago. One of the reasons they're so attractive to young people is that they come in cool flavours like berry flavour. Of course it's going to taste nicer than your first cigarette," says Power.

She's also concerned about the figures for young people using e-cigarettes. "If in 2015 we had 11pc of young people saying they had used an e-cigarette in the last 20 days, the figures today could be multiples of that."

"I don't think parents are aware of the damage. It may not be obvious to parents if their kids are using e-cigarettes. We believe they must be banned for sale to anyone under the age of 18 and they must be subject to the same rules of advertising as cigarettes," says Power.

Dr Paul Kavanagh, Consultant in Public Health Medicine and Advisor to the HSE Tobacco Free Ireland Programme, told the Irish Independent this week in Ireland, over 100 people will die and over 1,000 people will be hospitalised from illness caused by smoking. Protecting people from the harms of smoking is one of the single greatest steps any country can make for to improve the health of the public, he said.

"The evidence-base regarding the safety of e-cigarettes, their effectiveness as a stop smoking support, their impact on population prevalence of smoking and their relationship with youth smoking initiation is evolving rapidly. Some countries are adopting a 'watchful waiting' position before determining how their tobacco control efforts should respond; others are adopting various positions, reflecting the value they place on "harm reduction" versus 'precautionary principle' based approaches to tobacco control," says Dr Kavanagh.

"At one end of the spectrum, the UK, for example, has identified a role for e-cigarettes in its tobacco control efforts. At the other end of the spectrum, Australia, which has one of the lowest prevalence of smoking globally, has noted that e-cigarettes are not harmless, currently prohibits the sale of e-cigarettes and continues to watch emerging evidence," he says.

Dr Kavanagh points out that to date no specific role for e-cigarettes in tobacco control in Ireland has been identified in government policy. He adds that a health technology assessment of stop smoking interventions, including e-cigarettes, carried out by HIQA in 2017 found that there was "insufficient evidence at present to reliably demonstrate their effectiveness as an aid to stop smoking". It also identified various concerns regarding long-term safety profile and potential implications for youth initiation of smoking.

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