The sale and promotion of e-cigarettes to young people must be banned by governments, the Australian Council on Smoking and Health says, following the most comprehensive review yet of vaping harms.
The review, led by researchers from the Australian National University Centre for Epidemiology and Population Health, found there was conclusive evidence that e-cigarettes caused poisoning, injuries, burns and immediate toxicity through inhalation, including seizures. Their use also led to addiction.
The review, funded by the federal health department, found there was also conclusive evidence e-cigarettes caused less serious health impacts such as throat irritation and nausea.
“E-cigarettes cause acute lung injury,” the review, which was published on Thursday, states. “Among smokers, there is moderate evidence that use of e-cigarettes increases heart rate, systolic blood pressure, diastolic blood pressure and arterial stiffness acutely after use.”
The review found there was strong evidence that e-cigarettes increased tobacco smoking uptake in non-smokers, particularly young people, while there was limited evidence that nicotine e-cigarettes help smokers quit cigarettes.
The 430-page review was led by the epidemiologist and public health physician Prof Emily Banks.
She and her team analysed evidence from 189 studies on the health impacts of e-cigarettes. Previously, there was no systematic review drawing together the existing evidence of the health effects of e-cigarettes.
The researchers were especially interested in whether nicotine and non-nicotine vaping products led to dependence, cardiovascular disease, cancer, respiratory disease, oral diseases, reproductive outcomes, injuries and poisonings, mental health conditions, and environmental hazards with human health implications.
“The evidence is there for some of the risks, but for most major health outcomes, like cancer, cardiovascular disease and mental illness, we don’t know what the impacts of e-cigarettes are,” Banks said. “Their safety for these outcomes hasn’t been established.”
Despite this, there were “myths” around e-cigarettes depicted in advertising and promotion of the products targeting young people, she said, including “the false ideas that vapes wouldn’t be widely available if they were dangerous and ‘it’s just water vapour’”.
“Vapes deliver hundreds of chemicals – some of them known to be toxic and many others with unknown effects,” Banks said.
“In Australia, over 2 million people have used e-cigarettes. Use is more common among youth, particularly young males, and among smokers and the majority is not for the purposes of smoking cessation. Vaping is causing addiction in a new generation of users.
“Young non-smokers who vape are around three times as likely to take up smoking than non-vapers. Nicotine use in children and adolescents can lead to lifelong addiction issues as well as difficulties in concentration and learning.
“Vaping is also illegal [in Australia] if it isn’t on prescription.”
Australia’s drug regulator, the Therapeutic Goods Administration (TGA), has been cracking down on the illegal advertising of vaping products in recent months. A health department spokesperson told Guardian Australia that since 1 October 2021, 49 infringement notices – totalling $450,216 – had been issued to companies and individuals.
That included 41 infringement notices for alleged breaches of the advertising requirements and eight infringement notices for alleged import offences.
“Whilst the TGA hasn’t seen companies explicitly marketing their products to children, disposable nicotine brands are using tactics that may attract children and young adults, such as the use of brightly coloured packaging or a range of flavours,” the spokesperson said.
“The TGA has received a small number of adverse event reports related to nicotine vaping products. To date, a pattern of increased reporting has not been identified; however, as an unapproved product, it is expected that many adverse events may not be reported to the TGA.”
The Australian Council on Smoking and Health chief executive, Maurice Swanson, said “schools across Australia are being swamped by e-cigarettes”.
“Relying solely on education programs for parents and children is a failed strategy,” he said. “A comprehensive approach including new legislation to prohibit the sale, supply and promotion of e-cigarettes on social media platforms is required.”
The Cancer Council’s public health committee chair, Anita Dessaix, said the ANU report was the most comprehensive study of the health impacts of e-cigarettes ever published. It should send an urgent message to Australian governments, she said.
“Every week we’re hearing growing community concern about e-cigarettes in schools, the health harms and the risks of smoking uptake among young people,” Dessaix said. “A public health crisis is rapidly unfolding before our eyes. These findings send a clear message to all governments: act now.”
