When Parties to the WHO Framework Convention on Tobacco Control gather in October in Moscow for their biennial meeting they will discuss specific regulatory options for electronic cigarettes. E-cigarettes first appeared on the scene more than a decade ago, so why are they only being brought to the table now?
The answer is that business is booming for a product whose impact on public health is largely unknown. From one manufacturer in China in 2005, the industry has grown to an estimated $US3 billion market with 466 brands, many of them owned by tobacco companies. By 2017, it is predicted, the market will be worth $ 10 billion.
While there is still a lack of research around many aspects of e-cigarettes, what is known is that their key ingredient, nicotine, is highly addictive and can affect the brain development of foetuses and adolescents, and that the aerosol that is produced is not merely “water vapour”, as is often claimed in the marketing of the products. E-cigarettes usually contain some carcinogens such as formaldehyde which in some brands may attain levels similar to that of some conventional cigarettes.
Globally, there are now almost 8000 different flavours of e-cigarettes available and those few that have been analysed vary widely in the level of nicotine they deliver, and in the chemicals contained in the aerosol that is inhaled and then released into the environment. Given the many concerns around just what consumers are absorbing when they use e-cigarettes,and the health impacts they have on both users and those around them, many governments are understandably questioning not whether they should regulate, but rather how best to do this. The challenge is ensuring that young people and non-smokers are prevented from initiating the use of e-cigarettes, while at the same time minimizing the health risk for smokers, using these devices and still leaving the door open to the as yet unproven potential of the products in helping smokers to quit.
A new report from the World Health Organization sets the parameters to guide the discussion that will take place around these issues when the 179 Parties to the WHO FCTC meet two months from now. The findings of the report are clear. Regulation must be put in place to prevent e-cigarettes being promoted to non-smokers and to youth, and to reduce health risks for users and non-users, particularly for children, adolescents and pregnant women.
Regulation will protect public health in the same way that it does for numerous other products. In the European Union, for example, toothpaste regulation prohibits the use of more than 1300 chemical compounds for health reasons. At the moment, there is no equivalent regulation around the use of chemical compounds in e-cigarettes.
Manufacturers of e-cigarettes insist that they do not target youth, but there has been a rapid increase in the number of adolescents experimenting with the products, which are frequently marketed in a way that mimics successful tobacco advertising, aligning their use with celebrity culture and an independent and glamorous lifestyle.
Similarly, the industry says it does not market to children to attract new, young consumers. But sweet flavours with names such as “strawberry milkshake” and “gummy bears”belie this claim,and the fear is that youngsters who are attracted to these innocent-sounding products will become addicted to nicotine. Banning such flavours in e-cigarettes, as has been done in cigarettes in some countries, is necessary to protect children and adolescents from the potentially dangerous consequences of experimenting with these products.
E-cigarettes are frequently promoted as an aid to quit smoking. However, the small number of studies examining this claim has been unable to prove their effectiveness in helping people give up tobacco.
Evidence shows that while e-cigarettes do not emit traditional tobacco smoke, they do raise the level of nicotine in the air as well as tiny particles that carry toxicants. There is no safe level of exposure for bystanders to this ‘particulate matter’ and health risks rise with increasing concentration of the particles in the air.
While the debate around e-cigarettes is clearly in its infancy and while regulations will need to be adaptable to new evidence that emerges, the incredible progress that has been made in protecting public health through tobacco control must not be set back by the unfettered proliferation of a nicotine-containing product that is being marketed both as healthy and for use in smoke-free environments.
The tobacco industry is taking an ever-greater stake in the e-cigarette market and uses this fact to try and promote itself as part of the solution to the tobacco epidemic – a claim that must be soundly rebuffed. Manufacturers of cigarettes and other tobacco products are not legitimate partners in any public health discussion and it is only through providing governments with unbiased scientific evidence, that they can take the best regulatory steps to protect people.
Dr Douglas Bettcher
Director, Department for the Prevention of Noncommunicable Diseases
World Health Organization
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