With countries such as the United Kingdom and New Zealand formerly touting vaping as the panacea for smoking, new research by the Australian National University’s (ANU) National Centre for Epidemiology and Population Health indicates that the habit is far from risk free.
The report, Electronic cigarettes and health outcomes: systematic review of global evidence, found that vaping is causing nicotine addiction in a new generation of users with young people who vape three times more likely to take up cigarette smoking.
Commissioned by the Health Department, ANU’s study shows that risks associated with vaping include addiction; intentional and unintentional poisoning; acute nicotine toxicity, including seizures; burns and injuries; lung injury; indoor air pollution; environmental waste and fires; dual use with cigarette smoking; and increased smoking uptake in non-smokers.
Less direct evidence indicates adverse effects of e-cigarettes on cardiovascular health markers, including blood pressure and heart rate, lung function and adolescent brain development and function.
Chief Executive of the Australian Council on Smoking and Health, Maurice Swanson, a committed tobacco campaigner for nearly four decades, welcomed the findings on vaping.
“It mimics smoking and that’s one of the real dangers of vaping to public health – it really normalises smoking. Because the evidence is that if you’re a young non-smoker and you take up vaping, you have at least three times possibly higher the risk of going on to smoking traditional cigarettes,” Mr Swanson said.
“But it’s not a finding that we’ve been naive about. We’ve known from other studies that have been done on young people that if you start off with vaping, you’re threefold more likely to go on to smoke.”
“You have kids being able to purchase vaping devices (online) shaped as a pen, or a thumb drive that delivers the nicotine equivalent of between nine and 15 packets of cigarettes – you can appreciate how quickly a 15-year-old would get addicted to nicotine if they were toggling on one of those vapes regularly because there’s an endless supply of nicotine.”
In 2019, 11% of the total Australian population aged 14 and over reported that they have used e-cigarettes, with nearly a quarter of people aged 18-24 saying that they have tried them.
Over one-third of current e-cigarette users in Australia were aged under 25, and half were aged under 30.
Mr Swanson said the findings bore serious consideration by people and GPs advocating the use of vaping as a safe alternative to smoking.
“The evidence is it may be less harmful than smoking in the longer term, but the emphasis I would put on it is ‘may’,” Mr Swanson said.
“And if you read (lead researcher) Emily Banks’s report, she’s basically saying there’s insufficient information to make that claim because we haven’t had the exposure period that we’ve had, for example, with smoking.
“Not anywhere near the extent that you would require to make judgements about long term health impacts.”
Toxicological analyses of non-nicotine e-cigarette emissions identified 243 unique chemicals, of which thirty-eight were listed poisons, one was not permitted in e-cigarette liquids, and three exceeded cut-off levels for the relevant standard.
Twenty-seven chemical reaction products were identified, including carbonyls such as acetaldehyde, acetone, acrolein and formaldehyde, which have been associated with adverse health outcomes in humans.
Health impacts result not just from the liquids, but also from the level of variation in the types of vaping devices used.
“Because the devices themselves contribute to the load of chemicals in the aerosol, depending on the element that’s used, the variable temperatures that are used to heat the liquid into an aerosol,” Mr Swanson explained.
Since the rescheduling of nicotine on the 1st of October 2021, Australians must obtain a prescription from a GP to legally purchase a vaping device, something that is not well known among the general population.
“The changes last year were basically to ensure that people who genuinely wished to use vaping to quit smoking would do so with the support of their general practitioner. That’s what that whole change was designed to do,” Mr Swanson said.
“The challenge for Health authorities now is that they’re relying on border force to screen all of these imports to detect the illegal importation of nicotine, and the illegal importation of vaping devices that contain nicotine”
At least 32 countries ban the sale of nicotine e-cigarettes, while 79 countries – including Australia – allow them to be sold under full or partial regulation.