Vaping: A Growing Global Health Concern

Abstract

The epidemic of teen vaping [1National Institute of Drug AbuseMonitoring the future survey: high school and youth trends.Adv Addict Sci. 2018; https://www.drugabuse.gov/publications/drugfacts/monitoring-future-survey-high-school-youth-trendsGoogle Scholar, 2National Institute of Drug Abuse. Teens using vaping devices in record numbersAdv Addict Sci. 2018; https://www.drugabuse.gov/news-events/news-releases/2018/12/teens-using-vaping-devices-in-record-numbersGoogle Scholar, 3U.S. Food & Drug Administration. Youth tobacco use: results from the national youth tobacco survey - 2018 E-Cigarette data 2018. https://www.fda.gov/tobacco-products/youth-and-tobacco/youth-tobacco-use-results-national-youth-tobacco-survey.Google Scholar] and the outbreak of vaping-related lung injuries and deaths in the U.S. [[4]Centers for Disease Control and Prevention. Outbreak of lung injury associated with E-Cigarette use, or vaping. 2019. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.Google Scholar] underscore the urgent need to systematically regulate electronic cigarette manufacturing, marketing, and distribution. However, development of plausible and effective vaping regulations and most importantly, their enforcement are likely to present unique challenges to countries across the globe. The challenges may vary depending on the legal, regulatory, economic, and sociopolitical contexts of each nation. History has taught us that simply banning a product may not fully or properly address a ‘complex’ problem, and often times, comprehensive and carefully considered plans are needed to resolve such problems. Following the ratification of the 18th Amendment in 1919, which banned the production, importation, transportation, and sale of alcoholic beverages in the U.S., alcoholism rates soared during the 1920s [[5]Blum D. The chemist's war: the little-told story of how the U.S. government poisoned alcohol during Prohibition with deadly consequences. 2010. https://slate.com/technology/2010/02/the-little-told-story-of-how-the-u-s-government-poisoned-alcohol-during-prohibition.html.Google Scholar]. Whilst strict enforcement of the law resulted in a substantial drop in smuggling alcohol from Canada and other countries, organized crime gangs responded by stealing tens of millions of gallons of industrial alcohol — used in paints and solvents, fuels, and medical supplies — and redistilling it to make it potable. However, the bootlegged whiskies and gins often made people sick because the liquor produced in hidden stills frequently came tainted with metals and other impurities. Frustrated with the people's defiant response and continued consumption of banned, yet, tainted booze, the federal government ordered poisoning of the industrial alcohol manufactured in the U.S. to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the government poisoning program had killed, by some estimates, at least 10,000 people [[5]Blum D. The chemist's war: the little-told story of how the U.S. government poisoned alcohol during Prohibition with deadly consequences. 2010. https://slate.com/technology/2010/02/the-little-told-story-of-how-the-u-s-government-poisoned-alcohol-during-prohibition.html.Google Scholar]. Philosopher, George Santayana, famously said: "Those who cannot remember the past are condemned to repeat it." Reflecting on historical examples, opponents of ban on electronic cigarettes argue that outlawing vaping would not only deprive smokers of a potentially less harmful alternative but it would also lead to creation of a black market with counterfeit products whose safety, at best, might be as questionable (if not dangerous) as those currently available in the market. More likely, black-marketed unregulated vaping products might be even more problematic than the existing electronic cigarette products. The overall effects would likely be much similar to those that drove people to imbibe tainted alcohol during Prohibition. It should, however, be noted that alcohol was widely used in well-established markets before Prohibition, whereas the electronic cigarette market is still developing and mostly focused on youth and young adults. So, it is unclear whether teens and young adults would respond to vaping bans in ways similar to that observed during alcohol prohibition. In addition, in Brazil, which is one of the first countries to ban electronic cigarettes in 2009, the prevalence of vaping is considerably low, around 0.43%, and has remained steadily low for the past years [[6]World Health Organization (WHO) WHO. WHO report on the global tobacco epidemic 2019: offer help to quit tobacco use. 2019.Google Scholar]. It should also be acknowledged that the continued exposure of teens and young adults in other countries to aggressive marketing and alluring electronic cigarette products for more than a decade varies from the relatively limited experience of the Brazilian population