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Commentary: Trying to quit smoking? E-cigarettes may make things worse

Not only can e-cigarettes cause as much harm as normal cigarettes, research shows there is no conclusive or strong evidence for any beneficial outcome from e-cigarettes, say two academics.

Commentary: Trying to quit smoking? E-cigarettes may make things worse

A smoker is engulfed by vapours as he smokes an electronic vaping machine during lunchtime in central London on Aug 9, 2017. (Photo: AFP/Tolga Akmen)

SYDNEY: A major review on the health effects of e-cigarettes reflects what public health advocates have feared: Escalating use of e-cigarettes in school-aged children, early warning signs of increased smoking rates in young Australians and direct health harms of vaping in all ages.

The review, which was released on Thursday (Apr 7), was commissioned by the federal health department and conducted by researchers at the Australian National University. Overall, it found that the health risks from e-cigarettes significantly outweighed any potential benefits.

The review should silence lobbyists, who have long used data selectively to promote the sale of e-cigarettes. This is despite the fact that previous reports, none as comprehensive and rigorous as this latest review, have delivered similar findings.

The review looked at the evidence behind the health impacts of e-cigarettes or “vapes” – a diverse group of devices that aerosolise a liquid for inhalation. These are touted as a safer alternative to cigarettes and an aid to quit smoking.

USING E-CIGARETTES INCREASES LIKELIHOOD OF SMOKING

The review found conclusive clinical evidence that e-cigarettes cause acute (short-term) lung injury, poisoning, burns, seizures, and their use leads to addiction. They can also cause less serious harm, such as throat irritation and nausea.

Evidence that e-cigarettes produce airborne particles in indoor environments (potentially harming non-users) was also conclusive.

Among the evidence ranked as strong, the review confirms what has worried tobacco control experts since patterns of e-cigarette use first emerged: People who have never smoked or are non-smokers are three times as likely to smoke if they use e-cigarettes, compared with people who have never used e-cigarettes.

This is a dream for tobacco companies and their retail allies.

LIMITED EVIDENCE OF HELPING PEOPLE QUIT SMOKING

The review found limited evidence that e-cigarettes assist individuals to stop smoking. But this is no stronger than evidence showing that e-cigarette use might also cause former smokers to relapse and revert to tobacco.

There is no conclusive or strong evidence in the review for any beneficial outcome from e-cigarettes.

E-cigarettes might help some individuals stop smoking. So they should only be available via a prescription from authorised medical professionals trained in helping people to quit. Any access beyond this risks serious harm for no benefit.

Indonesian youth smoke clove cigarettes in Jakarta. (File photo: AFP/Oscar Siagian)

YOUNG PEOPLE MORE LIKELY TO USE E-CIGARETTES

Australian Institute of Health and Welfare data shows that the age group most likely to use e-cigarettes in their lifetime are 18 to 24-year-olds. This has risen from 19 per cent in 2016 to 26 per cent in 2019.

Of e-cigarette users who identify as smokers, the second largest user group is 14 to 17-year-olds. Dual-use is starting young, from the limited Australian Institute of Health and Welfare data we have.

The Australian Institute of Health and Welfare data precedes increasingly visible use of e-cigarettes in Australian schools, as reported in the media.

The review also shows young males are the leading e-cigarette user group by age and sex. Australian males aged 18 to 24 are also the only age group that, on the latest Australian Institute of Health and Welfare data, is smoking at greater rates than they were three years earlier.

Whatever benefits might be delivered by e-cigarettes, such as helping people to quit smoking, would, according to the review, be modest compared with the harms they are likely to cause.

LAWS TO LIMIT ACCESS NEED STRICTER ENFORCEMENT

Unfortunately, public policy on the regulation of e-cigarettes is at risk of being influenced by powerful commercial interests. In the interests of public health, these forces must be resisted.

Is it time to go after smokers who light up near the windows of their homes? Listen to CNA's Heart of the Matter:

Federal, state and territory governments have enacted policies aimed at providing e-cigarette access to individuals who might benefit from them to quit smoking while protecting everyone else.

But the evidence on how widely e-cigarettes are used shows these policies need to be more tightly enforced.

It’s still easy to buy e-cigarettes online, they are available without prescription from petrol stations, tobacconists and speciality “vape” stores, and are re-sold by entrepreneurs – all of them acting unlawfully. Heavy fines will end their cash incentive.

The review shows that the risks to public health posed by e-cigarettes will only grow unless governments enforce their laws. This is to protect young Australians from becoming the first generation since trend data was collected to smoke and use nicotine at higher rates than their predecessors.

Paul Grogan is an Adjunct Senior Lecturer at the Daffodil Centre of the University of Sydney and Guy Marks is a Professor of Respiratory Medicine at the South Western Sydney Clinical School of the University of New South Wales. This commentary first appeared in The Conversation.

Source: CNA/geh

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