Commentary: Youth smoking is a problem, so is youth vaping
Instead of focusing on the potential harms or benefits of vaping versus smoking in debates on e-cigarettes, we should look more closely at the industry’s preying on youth, say NUS Saw Swee Hock School of Public Health's Dr Yvette van der Eijk and Dr Jeong Kyu Lee.
SINGAPORE: Most scientists will agree that smoking is addictive, causes all sorts of health issues, and can kill. But when it comes to vaping there is no consensus.
Vapes, also known as e-cigarettes, are electronic devices that heat up a vapour solution (“e-liquid”) and send it into the lungs much like a regular cigarette. Some look like regular cigarettes while others look more like fancy pens, flash drives or high-end tech gadgets.
Sales of imitation tobacco products, including e-cigarettes, have been banned in Singapore since 1993. In February 2018, Singapore also made it illegal to buy, use or possess these.
NOT SAFE AND ADDICTIVE
In general, e-liquids contain far less chemicals than tobacco, but the long-term health impact of most these chemicals is unknown.
Some studies suggest vaping is almost as dangerous as smoking, while others suggest it is near harmless. Some studies say vaping among youth is a gateway to smoking, while others say it is not. Some studies suggest e-cigarettes help people quit smoking, while others suggest they actually prevent people from quitting.
The harms of e-cigarettes are difficult to assess, partly because there is so much variation between different e-cigarettes and the e-liquids they contain. As these products are also newly developed, we cannot make fair conclusions about their long-term health impact. This is a challenge because most diseases linked to smoking have a late onset, some 40 over years after the person starts smoking.
But based on the body of research, it seems fair to assume meanwhile that e-cigarettes containing nicotine are addictive, much like regular cigarettes. We can also assume that vaping is not safe, but safer than smoking. But to say something is “safer than smoking” does not say much, since the odds of dying from a smoking-related disease are more than one in two.
READ: Flavoured e-cigarettes fuelling a dangerous increase in tobacco use, a commentary
Due to the addictiveness and unknown health risk of e-cigarettes, a sensible policy should, at the minimum, prevent youths from using them.
But teen e-cigarette use has proliferated in some places. In the United States, 3.6 million teens are now using e-cigarettes, up from 2.1 million a year ago.
READ: US to restrict e-cigarette flavors to fight teenage vaping 'epidemic
Some e-cigarette companies have been quick to make their products and brands as appealing as possible to the tech-savvy, fun-loving younger generation.
Juul, the most popular e-cigarette brand in the United States, is sold in a sleek, colourful device which resembles a flash drive and comes in flavours such as mint, mango, and creme brulee. Research studies have shown that flavours of vapour solutions are especially appealing to young people.
Juul also use brightly coloured ad campaigns that feature attractive young models and associate the brand with having fun, freedom, relationships, and sex appeal.
NEW PRODUCT, SAME INDUSTRY
Tobacco companies, which own most of the e-cigarette market, have a well-documented history of preying on youth.
For decades before the 21st century, smoking used to be ubiquitous on the big screen. Even after countries started banning cigarette advertising on radio and television, tobacco companies found other ways to glamourise smoking – by putting them in movies.
Ever wonder why James Bond smokes so much? Or why he chose Larks in License to Kill? Larks paid the filmmakers US$350,000 (S$474,000). But tobacco companies also placed their products in movies such as Who Framed Roger Rabbit and The Muppet Movie.
READ: Smoking is lowering your productivity and killing the economy, a commentary
Leaked internal industry documents from the 1970s reveal that tobacco companies intentionally target youths as they are more vulnerable to addiction, and more impressionable. A 1973 tobacco industry report notes:
The fragile, developing self-image of the young person needs all of the support and enhancement it can get … this self-image enhancement effect has traditionally been a strong promotional theme for cigarette brands.
And it is still a strong promotional theme for cigarettes today.
In 2011, Marlboro launched a “Be Marlboro” campaign, which ran across more than 60 countries. It featured images of rebellious, fun-loving youth - one advertisement even feature a young leather-clad couple kissing in a dark street, with the tagline “maybe never fell in love” right next to a pack of Marlboro cigarettes.
READ: The year Singapore attempts to snuff out tobacco, a commentary
More recently, tobacco companies are turning their attention to social media. A recent investigation by the Campaign for Tobacco-Free Kids found that tobacco companies pay influencers to promote cigarettes, with specific instructions on which brands to promote, when to post the content for maximum exposure, and how to avoid making the photos look staged.
The report which investigated more than 100 social media campaigns found big Tobacco companies, such British American Tobacco and Philip Morris International/Altria, to be behind several high-profile influencer marketing campaigns.
The latter rolled out a campaign in Indonesia for their brand Marlboro which has been viewed more than 47 million times online.
But due to the borderless nature of social media, youth all over the world were exposed to this advertising. Singapore NMP Professor Lim Sun Sun, in her recent commentary, warned that in Singapore, too, there is nothing to stop young people from being exposed to these adverts
READ: Shady tactics in influencer campaigns make social media the new frontier for stubbing out smoking, a commentary
E-cigarettes are also aggressively promoted on social media. Juul, for its launch in 2015, spent over US$1 million on internet marketing.
Their products were promoted on Twitter, Instagram and YouTube, and social media influencers were recruited to promote it to their followers. This had quite an impact on teen experimentation with Juul.
The number of Juul-related tweets per month shot up from 765 in 2015 to over 30,500 in 2017, and by 2017, Juul had captured most of the e-cigarette market in the US.
The advertising platforms are changing, but the industry’s target remains the same. The gadgets are evolving, but the nicotine remains the same.
Whether they vape or smoke, the tobacco industry’s goal is simple: To create loyal customers. And to do that, they must hook the younger generations onto nicotine.
Debates on e-cigarettes often focus on the potential harms or benefits of vaping versus smoking. But perhaps it’s the industry’s preying on youth we should be more worried about.
Dr Yvette van der Eijk is Senior Research Fellow at the Saw Swee Hock School of Public Health, National University of Singapore, and Dr Jeong Kyu Lee is Assistant Professor at the same school.