Explainer: Why India is banning e-cigarettes


Unlike in the case of cigarette smoking the actual and full-scale adverse health effects are not yet know. But much like traditional cigarettes, e-cigarettes too deliver ultrafine particles and nicotine deep into the lungs, where they get absorbed by the blood.

On September 18, the Union Cabinet approved the promulgation of the Prohibition of Electronic Cigarettes (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) Ordinance, 2019 with immediate effect. As a result, anyone violating it will be imprisoned for up to one year or fined up to Rs.1,00,000 or both for the first offence. Storage of electronic-cigarettes shall also be punishable. Besides health concerns, the government is concerned that e-cigarettes can “seriously undermine and derail the government’s efforts to reduce the prevalence of tobacco use”. The ordinance will need to be approved by Parliament when it meets in November. 

What are e-cigarettes and how do they work?

Electronic nicotine delivery systems (ENDS) or non-combustible tobacco products are known by many names — vapes, e-hookahs, electronic cigarettes and e-pipes. E-cigarettes may be manufactured to look like traditional cigarettes and are marketed as tobacco-free nicotine delivery devices.

Instead of burning tobacco leaves like in traditional cigarettes, an e-cigarette, which is a battery-operated device, produces aerosol by heating a solution containing nicotine among other things. The device contains nicotine and flavours in the form of liquid which is primarily composed of solvents such as glycerol and/or propylene glycol. The aerosol containing a suspension of fine particles and gases simulates cigarette smoke. Following a puff, the aerosol is delivered to the user’s mouth and lungs and the rest is exhaled.

What are the harmful effects of e-cigarettes?

Unlike in the case of cigarette smoking the actual and full-scale adverse health effects are not yet know. But much like traditional cigarettes, e-cigarettes too deliver ultrafine particles and nicotine deep into the lungs, where they get absorbed by the blood. A 2018 study found the use of e-cigarette daily was associated with a 79% increase in heart attack risk after other variables were taken into account.

According to ICMR’s white paper on e-cigarettes, depending on the battery output voltage used, nicotine solvents can release in varying amounts potential carcinogens such as acetaldehyde, formaldehyde and acetone. The liquid-vapourising solutions also contain “toxic chemicals and metals that can cause several adverse health effects including cancers and diseases of the heart, lungs and brain”. At the population-level the “adverse health impact will outweigh any presumed benefit to individual cigarette smokers” the ICMR report says.

Flavours such as diacetyl used in e-cigarettes are linked to serious lung disease. E-cigarettes also contain volatile organic compounds, heavy metals, such as nickel, tin, and lead.

In 2016, the U.S. Surgeon General had concluded that “e-cigarette use among youths and young adults is of public health concern; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain”.

Nicotine “harms parts of the brain that control attention, learning, mood, and impulse control”. Nicotine also changes the way synapses — connections between brain cells — are formed. This is of concern as more synapses are formed in younger brains.

In animals, aerosol exposure was found to increase “secretion of inflammatory markers, induced airway hyper-reactivity and caused lung tissue degradation in chronic exposure”.

But in 2018, the Public Health England, England’s public health agency, reiterated its claim that vaping is at least 95% safer than smoking.

Do e-cigarettes serve as tobacco cessation aid? 

Manufacturers have promoted e-cigarettes as a harm-reducing product. But at present, compared with nicotine patches and nicotine gum, there is limited evidence to support the claim that e-cigarettes help people stop smoking. On the other hand, the delivery of nicotine is variable and difficult to assess as they come in different sizes, the amount of nicotine in each vial varies, and the amount of nicotine consumed in each puff varies. Finally, nicotine content mentioned in the label and the actual amount has been found to vary.

The U.S. Food and Drug Administration (FDA) has not approved e- cigarettes for smoking cessation. One study found that though e-cigarettes led to higher percentage of people quitting smoking, nearly 80% of quitters were still vaping. “Given that most e-cigarette users continue to smoke cigarettes, the answer is not clear [that e-cigarettes aid quitting],” says Dr. Ned Sharpless, Acting Commissioner of FDA.

2015 survey cited by The Truth Initiative (an anti-tobacco organization) found that almost 60% of those who used e-cigarette also smoked cigarettes, called as dual users. A meta analysis of 25 studies found that smokers who used e-cigarettes as a cessation aid were 27% less likely to quit smoking.

Are more youth getting addicted to e-cigarettes?

According to a National Youth Tobacco Survey 2018 carried out by Centers fro Disease Control and Prevention (CDC), over 3.6 million kids in the U.S. currently using e-cigarettes in 2018. High school students in the U.S who used e-cigarettes at least once in the last 30 days increased from 11.7% in 2017 to 20.8% in 2018; the increase was 48% for middle school children.

Flavours in e-cigarettes have been cited as one of the top three reasons for children to use them. The misconception that “e-cigarettes are less harmful than other forms of tobacco such as cigarettes” is another main reason. Youth who use e-cigarettes may be more likely to go on to smoke conventional cigarettes.

Published in The Hindu on September 22, 2019