The Rise of E-Cigarette Use Amongst Young People: Health Risks and Government Response

According to the official website of the UK Parliament, electronic cigarettes are becoming increasingly popular among non-smoking young people. These young people typically use small disposable devices that can hold the maximum allowable concentration of nicotine. This article explores research into the potential negative health effects of electronic cigarettes on young people, as well as government efforts to prevent non-smokers and young people from using them.

Are there new products targeting young people?

Electronic cigarettes allow users to inhale vapor and nicotine, referred to as e-cigarettes. Nicotine is the primary addictive substance in tobacco. E-cigarettes work by heating a liquid that typically contains nicotine and flavorings among other chemicals. They do not burn tobacco nor produce tar or carbon monoxide, which are two of the most harmful elements found in tobacco smoke. There are several generations of e-cigarettes available, including refillable/rechargeable and disposable options.

A recent study by the University College London revealed an increase in the number of young people using electronic cigarettes. According to the research, 15% of 18-year-old respondents in the UK used e-cigarettes in January 2022, up from 11% in January 2021. In comparison, the percentage of all adults who use e-cigarettes is 8%. At the same time, the percentage of 18-year-olds using disposable e-cigarettes increased significantly from 1% to 57%.

People are concerned that electronic cigarette marketing targets non-smoking teenagers rather than those trying to quit smoking. Research shows that young people who have never smoked or used electronic cigarettes pay more attention to electronic cigarette marketing than adult smokers. The Times believes that the bright colors commonly used for electronic cigarettes and the various flavors, including "cotton candy" and "lemon pie," are attractive to young people. Deborah Arnott, CEO of the public health charity Action on Smoking and Health, expressed concern that electronic cigarettes are being promoted to children on social media platforms including TikTok.

It is prohibited to sell electronic cigarettes containing nicotine to individuals under the age of 18. However, commentators highlight examples of individuals under 18 using electronic cigarettes. Trade standard officials point out that electronic cigarettes are not always sold in shops that have sold alcohol or tobacco in the past, and staff may not always be aware of age verification requirements. Additionally, it is reported that electronic cigarettes can be purchased online from websites such as Amazon and eBay, which are sometimes incorrectly categorized as products that do not require age verification.

Does it pose a risk to health?

The use of e-cigarettes may have negative impacts on respiratory health, according to recent research. Young people who use e-cigarettes are twice as likely to suffer from chronic coughing compared to non-users. E-cigarettes can reduce lung function by interfering with gas exchange and causing tissue inflammation. They can also lower immunity and increase the risk of respiratory infections. Lung damage caused by e-cigarette use is referred to as e-cigarette or vaping-associated lung injury (EVALI). A public health investigation in Illinois and Wisconsin found that EVALI patients had a median age of 21.

Nicotine can also have harmful effects on health. Adolescents are more susceptible to nicotine dependence than adults. Long-term exposure to nicotine can affect brain development, leading to cognitive and attention deficits, as well as exacerbating emotional disorders such as depression and suicidal thoughts. Popular disposable e-cigarettes typically contain a maximum allowable nicotine strength of 20 milligrams per milliliter. One brand indicates that their disposable e-cigarette contains nicotine equivalent to about 40-50 cigarettes.

An increasing number of people who frequently use e-cigarettes are reporting oral health problems. A study in South Korea has found a significant correlation between using e-cigarettes and gum disease, suggesting that e-cigarettes may not be a safe alternative to smoking for oral health.

Some health experts are concerned that electronic cigarettes may be a gateway to smoking for young people. One study found that young people who use e-cigarettes are more than three times more likely to smoke than those who have never used e-cigarettes. However, other researchers believe that regardless, those who try e-cigarettes are more likely to try smoking. A study published in the academic journal "Addiction" found no statistically significant association between the prevalence of e-cigarette use and frequent smoking among those aged 16 to 24.

The British cancer research company suggests that electronic cigarettes can be beneficial to smokers, but non-smokers should not use them as the long-term health effects are still unclear. They are calling for "effective regulation" to ensure that "smokers only use them when quitting or preventing relapse," and stating that "non-smokers should never use electronic cigarettes.

How will the government respond?

In 2019, the UK government announced ambitious plans for England to become "smoke-free" by 2030, defined as only 5% of the population smoking. The government reportedly intends to release a new tobacco control plan for England, including measures related to smoking alternatives like e-cigarettes. In a written response to questions on June 23rd, 2022, Maggie Throup, Parliamentary Under-Secretary of State for Health and Social Care, stated that "the government's regulatory framework is aimed at maximizing the opportunity for smokers to use e-cigarettes as a smoking cessation tool". Throup added that the government seeks to prevent "non-smokers and young people" from using e-cigarette products.

In June 2022, the government released an independent review by Dr. Javed Khan of its "smoke-free" ambition. Khan's review stated that offering e-cigarettes as a substitute for smoking is a "must-do" in achieving a "smoke-free" society by 2030. The review also highlighted concerns from school leaders that e-cigarettes have become a problem in playgrounds and public restrooms. School and university leaders have expressed worry that e-cigarettes are "too easily accessible" to those under 18, with an increase in related disciplinary action observed. Professor Linda Bauld, a public health expert at the University of Edinburgh, emphasized the importance of striking the right balance between helping smokers quit and protecting young people from starting to use e-cigarettes.

The government has stated that it is considering the proposals put forward in the Khan review to prevent young people from accessing e-cigarettes. On June 28, 2022, Lord Kamal, the Parliamentary Under-Secretary of State for Health and Social Welfare, stated in written answers that the government will "monitor the evidence of young people's use and continually review e-cigarette regulations.

On April 29, 2022, the Scottish government initiated a review to tighten regulations on advertising and promotion of electronic cigarette products.

Other countries have implemented measures to restrict the use of electronic cigarettes. Juul, a brand of electronic cigarette popular among young people, has recently been banned in the United States. The Food and Drug Administration (FDA) stated that it did not have enough data to ensure that marketing the company's products "would be appropriate for protecting public health." However, a federal investigation found that three other brands were more popular than Juul among middle and high school students.

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