Learn From US Cautionary Tale Of Youth Vaping Epidemic, Expert Tells Malaysia

Malaysia has higher current vape and cigarette use among teens than the United States. An American public health expert singles out youths as the biggest concern with vaping, saying that nicotine and vaping can harm the brain and lung development of young children and teens.

GENEVA, June 1 – A public health expert has urged Malaysia to heed the teen vaping epidemic in the United States, after Putrajaya legalised e-cigarettes without restrictions on sale to minors.

Dr Kelly Henning, who leads the public health programme at nonprofit Bloomberg Philanthropies based in New York, said the most important and urgent issue with vaping is youths taking up the habit.

“The concern is that, particularly with high concentrations of nicotine, the likelihood of youth becoming addicted to nicotine is very high,” Dr Henning told CodeBlue in a recent interview at the sidelines of the 76th World Health Assembly in Geneva, Switzerland.

“With young children and teens, there is some evidence of adverse effects of nicotine on the developing brain and even inhaling these substances through vaping devices may have long-term consequences on the developing lungs. So there are harms from nicotine and vaping to youth that need to be taken into consideration.

“Really, youths should not be using these products and therefore, they need to be regulated so that you cannot have access to these products,” added the epidemiologist trained in internal medicine, infectious diseases, and public health. 

Alarmingly, higher vape and cigarette use is reported among Malaysian youths than their American counterparts. 

The National Health and Morbidity Survey (NHMS): Adolescent Health Survey 2022 reported 14.9 per cent prevalence of current e-cigarette or vape use among secondary school students aged 13 to 17 in Malaysia last year, while 6.2 per cent are current cigarette smokers.

In the US, among middle and high school students, current use of e-cigarettes and cigarettes were reported at 9.4 per cent and 1.6 per cent respectively last year, according to the 2022 National Youth Tobacco Survey (NYTS) by the US’ Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

About 11.3 per cent of American middle and high school students reported current use of any tobacco product. 

Malaysia’s 2022 statistics on youth vaping or smoking preceded the declassification of liquid nicotine from the Poisons Act 1952 last March 31 that effectively legalised e-cigarettes and vape with nicotine, without any restrictions or regulations whatsoever on sale to minors; advertising, promotion and sponsorship; nicotine content; flavours; or required health warnings on product packaging.

“Electronic cigarettes came on the market in the US with no regulatory framework. And when that happened, teenage use shot up enormously, despite the fact that smoking has been declining among teens for a decade and a half,” Dr Henning said.

“So the use of electronic products surpassed that of combustible products and was enormously high. 

“And we started to hear calls for help from parents and schools. These kids were so addicted to nicotine, they couldn’t make it through a class without using the product. It was enormously disruptive to school. Then, of course, parents were alarmed because kids were getting up at night and using the product.”

Dr Henning said there is now much publicity in the US about the harms of vaping, as well as increased regulation, mostly at the state level, while the FDA is considering banning e-cigarette flavours.

She acknowledged that the US was struggling with a youth vaping epidemic, but that the country has also “begun to address it quite seriously”.

The public health expert added that countries in similar situations should address teen vaping as soon as possible. “Take a look at the US experience. It’s a cautionary tale.” 

UK Restricts Vape Nicotine Content, Has Robust Smoking Cessation Programme

Dr Henning said nicotine vape may have a role in harm reduction for adult smokers who cannot quit with available techniques and products.

“Vaping may be less harmful for those adult, highly addicted, smokers. I think the jury is out, but there is evidence accumulating, and we need to stay very closely in touch with that evidence.

“But the biggest concern right now is for kids.”

The US Surgeon General’s 2018 advisory on e-cigarette use among youth stated that e-cigarette aerosol is not harmless. Besides potential harm to the developing brain – which continues to develop until about age 25 – nicotine exposure during adolescence can impact learning, memory, and attention.

Both United Kingdom and New Zealand health authorities say that vaping is much less harmful than smoking cigarettes. 

Malaysia’s vape industry has repeatedly touted harm reduction, citing the UK and New Zealand, in its argument for separate regulations on e-cigarettes from other conventional tobacco products.

“The amount of nicotine in the products in the UK is much lower than the amount in the products in places like the United States, where we have very high nicotine [content] vape products,” Dr Henning noted.

The UK restricts e-liquids to a nicotine strength of no more than 20mg/ ml, or 2 per cent. In Malaysia, e-cigarettes and vape products available in the market have up to 5 per cent nicotine strength.

Dr Henning also pointed out that while the UK treats vape as a harm reduction tool for smokers, the country couples that with very extensive counselling in smoking cessation programmes that she described as “very robust, very old, and very excellent”.

“That combination of using these electronic cigarette products together with their ongoing cessation programme – the UK cites success with that – that doesn’t exist in many places in the world,” she said.

“It’s different than opening up the market to anything and everything.”

Vape Flavour Bans in US States Reduce Uptake

“Tobacco companies have been pushing the concept of reduced harm products for decades and in many ways, this is the same situation. Time and time again, those products have been proven to not be less harmful. So we need to have our guard up very carefully,” Dr Henning said.

She also stressed that while the vaping problem is being highlighted now in various countries, tobacco companies still predominantly sell tobacco products. “They would like to do both.”

“There is rhetoric from tobacco companies that they would like to stop selling combustibles, but they’ve done nothing to support that position. They oppose taxation. They oppose advertising bans. They oppose marketing bans. They oppose smoke-free public places. All the things that are needed to reduce use of combustible cigarettes are opposed by the tobacco industry.”

The public health expert suggested a complete ban on vape flavours to allow only tobacco flavour, citing the US’ NYTS 2022 that found almost 85 per cent of current youth e-cigarette users use flavoured e-cigarettes. Fruit flavours were the most popular, followed by candy, desserts, or other sweets.

“Many cities and states in the US have done that and have shown a decline in uptake of these products. Massachusetts and California both have comprehensive flavour bans in place now, and this is increasingly proven to be effective in reducing use,” said Dr Henning.

She also recommended similar regulations for vape as for conventional tobacco products, such as restrictions on sale to minors and advertising, as well as mandatory health warnings on product packaging, with additional restrictions on flavour and nicotine concentration for e-cigarettes.

CodeBlue reported Tuesday that voting and passage of the Control of Smoking Product for Public Health Bill 2023 would likely be delayed, as Cabinet has decided to have the bill sent to a parliamentary special select committee after it is tabled next week in the current Dewan Rakyat meeting that is scheduled to end on June 15.

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