Youth smoking continues to be a disturbing health issue in Sri Lanka despite a drop in numbers due to recent interventions by the Ministry of Health. As health officials strive to meet their goal of bringing tobacco smoking especially among youth to zero level , they now face new challenges linked to the hi tech world we live in. An emerging health problem still to be properly researched and not well understood in the country is E-smoking. Although the negative outcomes of this new trend is still to be properly documented, the possible health outcomes of this practice was recognised by health authorities in 2016, when E-smoking became a legal offence and the sale, manufacture or importation of e-cigarettes that contain tobacco was prohibited in accordance with the Prohibited Tobacco Products Regulations No 1 of 2016 .
Adding to their concerns was the fact that recent studies conducted elsewhere in the world are now showing a definite link to various health risks that young persons exposed to e-smoking are exposed to. The Sunday Observer spoke to Emeritus Prof. of Forensic Medicine and Toxicology, University of Colombo and Senior Prof. of Forensic Medicine, General Sir John Kotelawala Defence University, Prof. Ravindra Fernando to gain more insights into this new disturbing problem and its negative health impacts, while debunking the myths surrounding it.
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Q. While the wide ranging effects of tobacco smoking have been well documented and studies have shown its adverse effects on one’s health especially the lung, little attention seems to have been given to E-smoking. Still considered a recent trend mostly seen in the more affluent youth community, many young people in Sri Lanka are unaware of its health risks. Could you explain to our young readers what E-smoking is ?
A. E-smoking refers to Electronic cigarettes, or e-cigarettes. They include e-pens, e-pipes, e-hookah, and e-cigars, known collectively as ENDS—electronic nicotine delivery systems.
They’re also sometimes called JUULs, “vapes” and “vape pens.” E-cigarettes are the most commonly used tobacco products among kids where they have been sold for over a decade — the number reaching epidemic levels according to a study by the American Heart and Lung Association.
Q. Has there been a survey to find out how many young people engage in this practice in Sri Lanka?
A. As far as I am aware no studies have been performed in Sri Lanka. However, the number of young persons becoming addicted to smoking in general is still high despite the efforts being made by the Health Ministry to reduce this number.
Q. It has been said that e-cigarettes are a gateway to youth smoking. Do you agree?
A. There is concern with the possibility that non-smokers and children may start nicotine use with e-cigarettes at a rate higher than anticipated as it is highly additive. This is because of the possibility of nicotine addiction from e-cigarette use which may drive youngsters to start smoking cigarettes and become hooked to this habit which would undermine their health and put them at risk to many lung and heart diseases.
Q. What are the health implications of e-smoking as compared to smoking ordinary cigarettes?
A. E-cigarettes create vapour made of fine and ultrafine particles of particulate matter, which have been found to contain propylene glycol, glycerin, nicotine, flavours, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other substances.
Its exact composition varies, and depends on the contents of the liquid, the physical and electrical design of the device, and user behaviour, among other factors. E-cigarette vapour potentially contains harmful chemicals not found in tobacco smoke.
It contains fewer toxic chemicals, and lower concentrations of potential toxic chemicals than cigarette smoke. The vapour is probably much less harmful to users and bystanders than cigarette smoke, although concern exists that the exhaled vapour may be inhaled by non-users, particularly indoors. Vaping is generally believed to be safer than smoking, and e-cigarette users do not get exposed to the estimated 7,000 chemical constituents present in combustible cigarettes. The liquids do, however, contain nicotine, which has been studied for decades and is known to be highly addictive.
Q. Could you briefly outline the history of e-smoking in the medical world?
A. E-smoking is said to have started in China and today millions of young people aged 18 -24 use it globally, many of them university students.
Q. How have Health authorities in countries where it is increasingly becoming a problem, dealt with this issue? Give us some examples.
A. Due to their concerns over this disturbing health risk facing young persons in particular, in 2016 the US Administration took steps to curb this practice by increasing scrutiny and research on these products. China is planning to regulate e-cigarettes in an attempt to stave off a new gateway addiction in what is already the world’s largest smoking population.
China has more than 300 million tobacco smokers - nearly a third of the world’s total - but the battery-operated vaping trend has yet to explode as it has in the United States and elsewhere.
The Head of the National Health Commission’s (NHC) planning department in China is currently working with relevant departments to conduct research on electronic cigarette supervision and plans to regulate electronic cigarettes through legislation.
Q. Talking about legislation, have our own local health authorities taken any steps in that direction?
A. . Yes. The sale, manufacture or importation of e-cigarettes that contain tobacco has been prohibited in accordance with the Prohibited Tobacco Products Regulations No 1 of 2016.
Q. Yet according to news reports, there is a steady supply of E-cigarettes , smoking pipes etc being smuggled illegally from various countries which proves there are a growing number of takers in our country. Have there been any recent interventions by the Health Ministry and Tobacco Authorities to educate , raise awareness about its health implications among school kids, school leavers and the public in general about this emerging health risk?
A. Yes this risk is also included in our on going awareness programs directed at schoolchildren and youth.
Q. According to young users, they are freely advertised on several internet sites including Google where sites and locations from where they can be purchased are to be found. Do you think there should be more stringent laws or stricter enforcement of existing laws and monitoring of the movement of the entry points of e-cigarettes to the country to reduce the risk of young people being exposed to this health risk?
A. Most certainly. Stricter laws, heavier fines and careful monitoring of entry points where these illegal products are smuggled in is a high priority if we want our future citizens to stop smoking.
Q. Do you have a message for all young people out there who still don’t know the negative health implications of e-smoking?
A. Many young people still believe in myths about this new fad. What I want to tell them is that nicotine in e-cigarettes is addictive and can harm brain development. It is a myth to think that E –smoking can help one to quit tobacco smoking as many manufacturers and sellers falsely claim. E-cigarettes are not recommended as a way to quit smoking. There are instances when it has dangerous outcomes. In some cases, e-cigarette devices have exploded, causing burns or fires.
Q. Any other adverse effects that have been documented?
A. Second hand smoke/vapour from e-cigarettes is harmful to growing lungs. Long-term health effects on users and bystanders are still unknown. According to news reports by American public health officials, recently a patient in Illinois, USA, is the first to die of a mysterious lung illness linked to vaping.
This death occurred as doctors and hospitals nationwide report an increasing number of vaping-related respiratory illnesses in the past few months across several US states. Around 193 cases have now been reported in 22 states, including 22 cases in Illinois, according to latest hospital data in the US.
Q. Any guidelines for parents and adults on how to protect their children from this dangerous health risk ?
A. The best way to protect your children is to never smoke or vape near them. Talk to your doctor about quitting all tobacco. Never smoke indoors, in your car, or in places where children spend time.