Dr Catherine Conlon: We led the way on smoking laws, let’s do the same for vaping

Ireland has led the way globally with the introduction of legislation on smoking indoors. Now there is an opportunity to provide the same global leadership with legislation to protect teenagers and young people from recreational vaping

Older people might enjoy the menthol flavour whereas fruit and sweet flavours can be more attractive to younger people.

The Australian government has announced a decision to ban all disposable vapes, which often come in fruity flavours, to ban the import of non-prescription vapes, and to limit nicotine levels, with the intention that the sale of vapes will be confined to helping smokers quit.

The legislation is designed to tackle the surge in teenage vaping and includes minimum quality standards restricting flavours, colours and ingredients. Products will be required to have pharmaceutical-like packaging, and the concentration and volumes of nicotine will be controlled.

It is further proposed to end access to vapes in convenience stores and other retailers. Prescriptions for nicotine vaping products for smokers will be facilitated with stricter standards around vaping products that can be purchased in pharmacies.

Australian health minister, Mark Butler said he was determined to stamp out the public health menace that is vaping. "Just like they did with smoking, Big Tobacco has taken another addictive product, wrapped it in shiny packaging and added flavours to create a new generation of nicotine addicts," Butler stated.

"Vaping was sold to governments and communities around the world as a therapeutic product to help smokers quit. 

It was not sold as a recreational product — especially not one for our kids. But that is what it has become: the biggest loophole in Australian history.

The initiative includes $63m for an evidence-based, public health campaign to discourage people from taking up smoking and vaping and to encourage more people to quit. A further $30m will be invested in support programmes to help people quit; as well as funding to strengthen education and training in smoking and nicotine cessation for healthcare workers.

Last month, health experts in Ireland warned of serious risks associated with vaping and called for greater regulation to control the problem. Experts from the Royal College of Surgeons in Ireland (RCSI) said greater understanding is needed about the consequences of vaping and that delays in grasping the seriousness of the health risks will affect a whole generation of young people.

Head of the School of Medicine at RCSI and principal investigator in respiratory health, Professor Gerry McElvaney, has called for tighter regulations to support people to quit smoking, alerting them of the risks associated with the direct inhalation of the chemicals in vapes and the effects it has on the lungs.

"What’s even more concerning is that we know there are young people vaping who have never smoked tobacco," Professor McElvanny stated. On the ill effects of vaping, Professor McElvanny said there is reason to believe that it causes notable cardiovascular and respiratory damage while also being capable of affecting brain development in young people.

Department Head in the Department of Chemistry, RCSI, Professor Donal O’Shea criticised the marketing techniques used to sell vapes.

"Older people might enjoy the menthol flavour whereas fruit and sweet flavours can be more attractive to younger people," Prof. O’ Shea said, adding that the health effects of these harmful chemicals and additives in vapes are "unknown". 

Professor Des Cox, chair of the Royal College of Physicians of Ireland (RCPI) Policy Group on Tobacco suggested in March that Ireland should increase the age limit on buying tobacco and nicotine-inhaled products to 21. 

While adults may also enjoy flavours, the risks of nicotine-inhaled products initiation in adolescents and young adults outweigh the benefits of ex-smokers using flavoured products. File photo: Nick Ansell/PA

At an Oireachtas Health Committee in March, the RCPI advised that flavoured vapes should be banned and that the advertising restrictions on tobacco should be applied to vaping products.

"Adolescents are more likely to initiate nicotine-inhaled products through flavoured products relative to other age groups. While adults may also enjoy flavours, the risks of nicotine-inhaled products initiation in adolescents and young adults outweigh the benefits of ex-smokers using flavoured products," he stated.

Professor Cox added that he did not recommend vaping as a smoking cessation tool, adding that "nobody knows how harmful these products are".

"Studies also show that nicotine-inhaled products are a gateway to tobacco smoking. Adolescents who never use nicotine-inhaled products are between three and five times more likely to start smoking compared with adolescents who have never used nicotine-inhaled products," Professor Cox concluded.

What is the evidence around the health impacts of vaping?

Dr Michael Joseph Blaha, Director of Clinical Research at the John Hopkins Ciccarone Centre for the Prevention of Cardiovascular Disease in Baltimore summarises the evidence.

Vaping is less harmful than smoking but it is still not safe 

Regular cigarettes contain 7,000 chemicals, many of which are toxic. "While we don’t know exactly what chemicals are in e-cigarettes," Blaha says, "there’s almost no doubt that vaping exposes you to fewer toxic chemicals than smoking traditional cigarettes. 

"However, in 2020, the US Centres for Disease Control (CDC) confirmed almost 3,000 (2,807) cases of electronic or vaping use-associated lung injury (EVALI) and 68 attributed deaths." Blaha said this appears to predominantly affect people who modify their vaping device or use black-market modified e-liquids.

The research suggests that vaping is bad for your heart and lungs. Nicotine is the primary agent in regular cigarettes and vapes, and is highly addictive. "People need to understand that e-cigarettes are potentially dangerous to your health," says Blaha. 

"Emerging data suggests links to chronic lung disease and asthma, as well as associations between dual use of e-cigarettes and smoking with cardiovascular disease. You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe." 

Vapes are just as addictive as traditional cigarettes

Blaha states that many e-cigarette users get even more nicotine than they would from a combustible tobacco product: users can buy extra-strength cartridges, with a higher concentration of nicotine, or increase the e-cigarettes voltage to get a greater hit of the substance.

Vapes are not the best smoking cessation tool

A recent study found that most people who intended to use vapes to kick the nicotine habit ended up continuing to use traditional and e-cigarettes.

Among youth, vapes, especially the disposable kind, are more popular than any traditional tobacco product. According to a US 2021 National Youth Tobacco Survey, more than two million high school students reported using vapes in 2021, the majority (80%) using flavoured vapes.

Blaha said the reasons vapes may be particularly enticing to young people include: many consider them less harmful than smoking; they are cheaper than traditional cigarettes, and the lack of smoke appeals to many – with no smell, vapes reduce some of the stigma of smoking.

Blaha concludes:

What I find most concerning is that people who would have never smoked otherwise, especially youths, are taking up the habit.

Ireland has led the way globally with the introduction of legislation on smoking indoors, and limitations on cigarette packaging, providing a template for other countries to do the same.

Now there is an opportunity to provide the same global leadership with legislation to protect teenagers and young people from nicotine addiction and potential heart, lung and neurological damage from recreational vaping.

The last thing we need is yet another profit-driven global market impacting on the health of citizens.

• Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition, safefood.