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There is an ugly irony to the fact vaping began as a ‘healthy’ alternative to cigarettes but is now a global health epidemic with young people as the main casualties.
Introduced commercially in 2003, e-cigarettes, widely referred to as ‘vapes’, began to dominate global markets by 2006–2007.
The Asia Pacific e-cigarette market was worth $9.2 billion in 2023 and is forecast to grow more than six times to $59.4 billion by 2032.
There's no smoke without fire, and social media is fanning the flames.
E-stores and influencers
A recent study by researchers from the Public Health Foundation of India (PHFI) showed the rampant online sale and promotion of e-cigarettes via e-stores and influencers.
The study identified 83 e-stores selling e-cigarettes, including 49 in India and 34 overseas.
Not only are the manufacturers selling e-cigarettes, but 189 influencers are actively promoting these products on social media, portraying them as trendy and cool, flavourful, and inexpensive.
They're telling young people vapes can help end nicotine addiction. These promotions often target adolescents through Instagram and Facebook.
India's Global Adult Tobacco Survey-2 found awareness of e-cigarettes was highest (3.9%) among 15-24-year-olds.
The PHFI study also found that 66.6% of participants were aware of e-cigarettes through social media, with Instagram (46%) being the most popular platform.
The curiosity to experiment with innovative products, combined with exposure to deceptive claims, has heightened the risk of young people taking up the habit and becoming addicted.
This is further driven by attractive product design, a variety of youth-friendly flavours and the perception these products are less harmful than cigarettes.
Contrary to initial perceptions, e-cigarettes have proven ineffective in stopping people smoking or as nicotine replacement therapy.
Banned, but a growing market
India has banned vapes since 2019. Despite this, the Indian market for e-cigarettes was believed to be around $7.8 million in 2018. This was predicted to grow by 26% a year through to 2024.
Interestingly, no e-cigarette manufacturer has registered their product as nicotine replacement therapy in any country. The emerging evidence has raised concerns about the long-term safety and health implications associated with vaping.
Consequently, many health experts now advocate for a complete ban, citing the lack of substantial evidence supporting their effectiveness in stopping people from smoking.
A 2023 WHO report noted that 87 countries have implemented some form of restrictions on vapes, while 34 countries, including India, have completely banned their sale.
That means there are approximately 2 billion people in 74 countries where there are no regulations governing the sales of e-cigarettes.
India's position
India banned vapes after a 2019 white paper, developed by the Indian Council of Medical Research (ICMR) which presented a strong case for the move, stressing the risks they pose to foetal, infant, and child brain development.
The subsequent PECA Act dealt with e-cigarette promotion, consumption and new media.
In 2022, the government prohibited misleading advertising of banned products through the enforcement of guidelines. But that hasn't stopped e-cigarette companies from using social media and websites to promote e-cigarettes.
After the 2019 ban, youth-led research conducted by PHFI following a participatory approach design identified 148 pages engaged in selling tobacco products online (including e-cigarettes) in India, with Instagram being the most popular platform (62.7%), followed by Facebook (23.7%).
Youth participants in one study documented 1,412 hashtags, the majority of which were related to vaping, such as #vape (218 million).
Vape bans elsewhere
Other countries are considering vapes bans similar to India's. The UK government has proposed a ban on tobacco sales to individuals born on or after January 1, 2009.
In the United States, smoking tobacco use was in decline among adolescents until 2014, but with the introduction of e-cigarettes, this trend has changed.
In Australia, recent legislation on the availability of e-cigarettes means vapes will be available at pharmacies only and will not be available to people under 18 years without a prescription. However, vapes will be available to those over 18 without a prescription.
Evidence already exists that vapes do not stop people smoking and their availability over the counter for any age category can lead to nicotine addiction and other health harms.
So, rather than focusing on banning specific flavours, imposing age restrictions or requiring prescriptions, the case is being made for all vaping products to be banned.
According to the four rounds of the Global Youth Tobacco Survey from 2013 to 2019, smoking has been on the decline in India. But tobacco control experts are anticipating that with the rampant online sales of e-cigarettes, this trend may reverse during the next survey due to easy access and availability.
Urgent policy action banning all online promotions of these products can help protect the health of India's younger population.
(Monika Arora is vice president (research and health promotion), Public Health Foundation of India, New Delhi, India. Shalini Bassi is a public health specialist, health promotion division, Public Health Foundation of India, New Delhi, India. Shishirendu Ghosal is a research scientist at HRIDAY, New Delhi, India.)
This article was first published under Creative Commons by 360info.
Disclaimer: The views expressed here are the authors' own. They do not necessarily reflect the views of DH.