Cloud on the horizon: Should we worry about teen vaping?

Not only will The Public Health (Tobacco Products and Nicotine Inhaling Products) Bill prohibit the sale of ‘vapes’ — tobacco- and nicotine-inhaling products — to persons under the age of 18, it will also make it illegal for under-18s to sell such products. Furthermore, the legislation will introduce a new licensing system for the retail sale of these items.

It will come as a relief to many families, as concern about the potential health effects of e-cigarettes grows — last month a 17-year-old boy in New York became the youngest person in the US to have died due to a vaping-related illness.

It’s believed at least five people have died in the US from vaping-related illnesses, while hundreds of cases of severe pulmonary disease have been linked to vaping in recent months. It’s estimated there may be more than 450 possible cases of pulmonary illness associated with vaping in the USA.

Last week Health Minister Simon Harris said the “jury was out” on whether vaping actually helps people to give up smoking, adding there was a “very big difference” between an adult in their 40s who had been smoking for 20 years switching from tobacco to an e-cigarette and a child who has never smoked, beginning to smoke e-cigarettes.

We should all be concerned, he warned, “about the cynical behaviour of big tobacco companies” in trying to “hook” the next generation onto nicotine products.

“The law I got approval for will ban the sale of e-cigarettes to anyone under the age of 18, will ban the sale of tobacco from vending machines because we know it’s easier for kids to access tobacco through vending machines,” he said, adding that it would also bring in a new licensing regime.

Vaping effects unknown

News of the proposed changes comes amid growing concern about the epidemic of e-cigarette use by children particularly in the US where the Surgeon General last year labelled the craze for vaping a “teen vaping epidemic”.

Last February, the US Centre for Disease Control and Prevention found almost five million teenagers in the country used e-cigarettes.

E-cigarettes contain very little nicotine — for example, Juul pods contain 20mg/ml nicotine or a level of just 1.7% — so why all the fuss?

Although generally thought to be safer than traditional cigarettes which kill up to half of all lifetime users, according to the World Health Organisation, the long-term health effects of vaping are still largely unknown.

In Ireland — while specific up-to-date research on vaping trends among children and young people is not available — the 2018 Health Ireland Survey indicates low e-cigarette usage among young people in Ireland, showing that 99% of people who use vaping products are former smokers.

In Britain also, teens don’t appear to have fallen for the vaping craze to the same extent as their US contemporaries — earlier this year, the Public Health England organisation reported that less than 2% of 11-18-year-olds vape weekly.

Flavoured vapes

E-cigarettes are widely available in Ireland. The popular Juul brand launched its sleek, flash-drive- style e-cigarettes in Ireland a few months ago.

Research published earlier this year in Science News warned teenagers are more likely than adults to use fruit-flavoured and sweet cigarettes, believing that sweet flavours — mango, apple and berry-flavoured options — are less harmful than tobacco flavours.

A recent US study led by Dr Samir Soneji at Dartmouth College, New Hampshire, found teen and young adult vapers were not only more likely than older adult vapers to use fruit- and candy-flavoured e-cigarettes, but were also more likely to concurrently use multiple flavour types.

Research has also found that fruit and sweet e-cigarette flavours may be particularly toxic because of the chemicals included in these flavours.

Common components of fruit- and sweet-flavoured e-cigarettes may have negative impacts on lung function and may contribute to respiratory cell inflammation, respiratory disease, and irritation when inhaled.

In addition, 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”.

More research needed

Chief executive of the Irish Cancer Society Averil Power, says the organisation was “pleased that the Government is acting to prohibit the sale of e-cigarettes to children,” but she warns, “far more” needs to be done to prevent an explosion in childhood nicotine addiction in this country.

“We also need to see an extension of tobacco advertising restrictions to e-cigarettes, along with a ban on e-cigarette flavouring.”

Irish Heart Foundation head of advocacy Chris Macey says the organisation is “petrified” that a whole new generation of children is at risk of becoming addicted to nicotine, attracted by the sweet and fruit-flavoured e-cigarettes.

“In the US, figures show 37% of high school students there used e-cigarettes in 2018 and that that figure was up from 28% in 2017. We’re worried that this is going to come here,” he says.

He points to a 2015 study by the Tobacco-free Research Institute which found that among 15-17 year olds here, just under 25% had tried e-cigarettes at least once.

The IHF’s stance, he says, is to urge caution in terms of e-cigarette use. “There is insufficient research to date on their long-term impact on users.“Research from the University of Pennsylvania has found that vaping once can damage a person’s blood vessels and that there is a potential link with cardiovascular disease.

“We’re not saying that they are as damaging as cigarettes but we’re saying there are some risks attached and that more research needs to be carried out into them.

“E-cigarettes could be an effective harm reduction but we’re not recommending their use. There are other methods for giving up smoking that have been shown to be more effective.”

Generation at risk

The organisation is “absolutely petrified that a whole new generation of children is at risk of becoming addicted to nicotine through the use of e-cigarettes,” he says, pointing to figures that the percentage of young people using e-cigarettes who had never smoked before doubled to more than 8% in 2015.

“We’re very concerned about the fact that vaping may be a gateway to smoking. There is mixed research on this, but the EU Tobacco Product Directive says e- cigarettes can develop into a gateway to nicotine addiction and, ultimately, traditional tobacco consumption.”

He adds that the organisation is aware of US studies which claim that youth e-cigarette use has “migrated into conventional cigarette use.”

Along with the introduction of a new licensing system for the retail sale of tobacco products and nicotine-inhaling products, the legislation is expected to prohibit the sale of nicotine-inhaling products by and to persons under the age of 18 years.

The government is planning to introduce legislation banning the sale of e-cigarettes to under 18s “before the end of the year,” says Macey, adding that the organisation also wants a complete ban, particularly in terms of social media, on the marketing of e-cigarettes to young people.

“We talk to the young people on our youth panel and what we are hearing is that e-cigarettes are being marketed to them very heavily on social media. E-cigarettes are hugely addictive because nicotine is hugely addictive and that is why we are so worried.”

It’s feared, he says, that e-cigarettes could have a devastating effect on the progress made over the decades in terms of discouraging smoking in young people.

“In 1996, 41% of 15- and 16-year-olds were smoking cigarettes. That was down to 12% by 2016,” he says. “We’ve achieved so much in terms of breaking young people’s addiction to nicotine, we don’t want that to be put at risk by e-cigarettes.”

Preventing underage use

In response to the new Irish legislation, Joe Dunne of Vaping Business Ireland says the organisation fully supports the government measures ensuring that e-cigarettes could be sold to over 18s only.

“VBI has long campaigned for this overdue measure to be enacted by Minister Harris and the government. The legislation is yet to be published, however VBI wrote to all members of the Oireachtas in August and again in October (2019) urging action on legislative measures to ensure the sale of e-cigarettes to over 18s only, “ says Dunne.

“The Minister has indicated changes to the licensing regime for retailers who sell vaping products, however VBI await further details to assess the specific proposals proposed by the government.”

The organisation has also urged the government to carry out substantive research into the effects of vaping.

Robin Kiely, Communication and Government Affairs Director of Juul in Ireland says that globally, the company has “taken the most stringent actions of anyone in the industry to proactively prevent any potential underage use.”

In Ireland, like in every market where Juul operates, he says, the company has “industry-leading protocols, not only adhering to local regulations but also going above and beyond to curb youth access to our product.”

JUUL products are only for adult smokers looking to switch and no non-nicotine users, most especially youth, should ever try JUUL, he says. “JUUL Labs’ Irish operations are underpinned by our industry-leading code of practice, to ensure responsible and restrictive advertising, marketing and age-gated product access.

“All retail partners must comply with JUUL Labs’ Challenge 25 policy, whereby any customer who looks under the age of 25 must produce ID to prove they are over the age of 18, and retailers are regularly monitored through a mystery shopper auditing programme to ensure adherence, while we operate double-age verification for online purchases.

“All JUUL product packaging includes labelling that indicates JUUL is a nicotine product intended for adult smokers only.”

Furthermore, adds Kiely, JUUL supported the need for legislation in Ireland to prevent the sale of e-cigarettes to minors.

“We do not want non-nicotine users, especially youth, to buy JUUL products, and we are committed to restricting youth access, limiting appeal, and decreasing youth use while still serving the adult smoking community. We have never marketed to youth and never will.

Protecting children’s health

Averil Power says we must act quickly to protect children’s health.

“In the United States, youth e-cigarette addiction has been described as an ‘epidemic’ and we need to respond to ensure this isn’t replicated in Ireland.

“Already, we know that about one in four 15-17 year olds in Ireland have tried e-cigarettes at least once, with six in 10 saying they tried them ‘out of curiosity’.”

Between 2017 and 2018, she points out, there has been an increase of 1.5 million teenagers using e-cigarettes in the US.

“Flavouring has proven one of the main attractions for teens to use e-cigarettes with over 15,000 flavours on the market there.

“Recent studies have shown that adolescents were more likely to report interest in trying an e-cigarette offered by a friend if it were flavoured like menthol, candy, or fruit compared to tobacco. In the US, among teens who have ever tried an e-cigarette, 96% used a flavoured product their first time.”

New e-cigarette products which have recently arrived on the Irish market, had helped precipitate the surge in teen addiction in the US, she warns.

“The Government must take a stand against the same old tobacco industry tactics being used to get another generation of children addicted to nicotine.”