Introduction: Under the slogan of "smoking is harmful to health", e-cigarettes are becoming popular among young people through concepts such as "health" and "cool". But is it really as safe as marketing says? What harm does it do? Let's find out.
In recent years, e-cigarettes have been very popular in the market, especially among young people, who have smoked more e-cigarettes than traditional cigarettes. With the emergence of this phenomenon, the academic community is also worried about the long-term and short-term effects of vaping cigarettes on health. Some researchers said that the safety of e-cigarettes has not been fully confirmed, and for some people with underlying diseases, it is even more necessary to be vigilant about the harm of e-cigarettes. Moreover, e-cigarettes are extremely attractive to young people and need public attention.
16,000 flavors of e-cigarettes
It is becoming a "tide play" upstart for young people
Electronic cigarette, also known as "electronic nicotine delivery system", is an electronic device for users to inhale, mainly composed of smoke oil (containing nicotine, flavor, solvent propylene glycol, etc.), heating system, power supply and filter four parts, through heating atomization to produce an aerosol with a specific odor for smokers to use. With the quiet rise of flavored electronic cigarettes in the mainland, hanging an electronic cigarette on the chest has become a trend and fashion in the eyes of many young people, and they have become the main consumer group of electronic cigarettes.
In August 2021, according to a set of data released by the World Health Organization, there are currently about 16,000 flavors of e-cigarette products on the market, mainly divided into fruit flavor, candy flavor, sweet taste and so on. According to the "2021-2022 Global E-cigarette Industry Development Trend" report of Ai Media Consulting, 60.9% of Chinese consumers prefer e-cigarettes with fruits, food and other flavors, and these seasoned e-cigarettes attract many teenagers who are not deeply involved in the world to "enter the pit". Coupled with the fashion cloak it wears, e-cigarettes are becoming the "tide play" upstarts that young people are chasing.
Figure 1 Various flavors of electronic cigarettes (Source: Fudan Development Research Institute)
On October 22, 2021, the Institute of Health Communication of Fudan University released the "Research Report on E-cigarette Marketing and its Impact on Adolescent Health", which mainly found:
94.3% of teenagers have heard of e-cigarettes, and 4.5% of teenagers report that they have tried to use e-cigarettes;
26.2% of adolescents who have used both types of products use e-cigarettes first and then use cigarettes;
The age of the first use of e-cigarettes is overwhelmingly 10-15 years old;
About half of e-cigarette users reported having experienced adverse reactions;
Among teenagers who have tried to buy e-cigarettes in the past month, 2/3 have successfully purchased e-cigarettes;
The most attractive e-cigarette flavors for teenagers are fruit flavors, followed by food and beverage flavors;
15% of teens have seen e-cigarettes in stores near schools, and 1/3 of teens said they had seen e-cigarette ads in the last month.
Professor Zheng Pinpin, director of the Tobacco Control Research Center of the Institute of Health Communication of Fudan University, said that a number of studies have shown that curiosity about e-cigarettes is one of the risk factors for teenagers to use e-cigarettes, and adolescents' curiosity about e-cigarettes is closely related to the online and offline linkage marketing of e-cigarette companies [1].
"On top" e-cigarettes
It is a "new drug" that cannot be smoked.
One
E-cigarettes can cause inflammation of the brain, heart, lungs, etc
Recently, researchers at the University of California, San Diego School of Medicine reported that daily use of e-cigarettes can cause inflammation in multiple organ systems such as the brain, heart, lungs and colon, and can affect the organ's response to infection, such as SARS-CoV-2. The study, published in eLife entitled "Effects of mango and mint pod-based e-cigarette aerosol inhalation on inflammatory states of the brain, lung, heart, and colon in mice" (Figure 1), is the first study to evaluate e-cigarettes and their flavoring agents in a multi-organ manner. Ultimate research suggests that daily e-cigarette use may lead to neuroinflammation, which in turn leads to behavioral changes and mood disorders. In addition, e-cigarette use can cause inflammation of the intestines (associated with poor health throughout the body) and inflammation of the heart (which leads to cardiovascular disease) [2].
Figure 2 Research results (Source: eLife)
Senior study author Dr. Laura Crotty Alexander, director of the Department of Pulmonary Intensive Care at the San Diego Health Care System for Medicine and Veterans Affairs at the University of California, San Diego School of Medicine, said: "E-cigarettes have only become popular in the last five years or so, so we know very little about their negative impacts." In this study, Crotty Alexander's team focused on JUUL, the most well-known e-cigarette brand of the moment, and its most popular flavors – mint and mango. To simulate e-cigarette use, the researchers exposed young mice to e-cigarette aerosols 3 times a day for 3 months, and then looked for various signs of inflammation in these mice. The researchers found that:
Daily exposure to e-cigarettes may induce neuroinflammation in the brain regions responsible for behavioral changes, drug rewards, and the formation of anxious or depressive behaviors, particularly in the nasac shell and core area of the NAc;
Inhalation of e-cigarette aerosols for 3 months can alter inflammatory status and fibrosis-related gene expression in heart tissue, and these changes are likely to lead to changes in human susceptibility to diseases and incidence;
Inhalation of e-cigarette aerosol for 3 months changes pro-inflammatory markers in the colon;
Exposure to e-cigarette aerosols for 1 and 3 months may not lead to significant changes in airway physiology, but this does not rule out the possibility of changes in prolonged exposure;
Inhalation of e-cigarette aerosols alters the inflammatory state of the lungs at the level of gene expression under steady-state conditions for 3 months;
The inflammatory response of each organ varies depending on the taste of the e-cigarette used, and the hearts of mice inhaling the peppermint-flavored e-cigarette aerosol are more sensitive to the effects of bacterial pneumonia than mice that inhale mango-flavored e-cigarette aerosol.
Therefore, this study proves that the use of e-cigarettes is related to cardiovascular and immune responses, with significant neuroinflammation in the brains of mice exposed to e-cigarette aerosol, as well as inflammatory regulatory changes in the heart, lungs and gastrointestinal tract, which are highly correlated with organ health levels and overall health levels.
Two
E-cigarette inhalation can trigger erectile dysfunction in men
A joint study conducted by New York University and Johns Hopkins University found that men who smoke e-cigarettes are 2.4 times more likely to develop erectile dysfunction (ED) than men who do not smoke e-cigarettes [3]. The study was published in the American Journal of Preventive Medicine in a paper titled "Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study" (Figure 3).
Figure 3 Research results (Source: [2])
Omar Shahawi, one of the researchers, said: "Given that many people use e-cigarettes as a form of reducing the harm of smoking or helping them quit smoking, we need to fully investigate the relationship between e-cigarette products and erectile dysfunction. ”
The study analyzed the health of 11,207 men aged 20-65 years with no history of cardiovascular disease, based on data from the 2016-2018 U.S. Tobacco and Health Demographic Assessment Study. They found that 10.2% of the participants had ED, and the number of participants who used e-cigarettes reached 5.6%.
After adjusting for multiple risk factors, the researchers found:
People who regularly use e-cigarettes are more than 2 times more likely to have ED than those who have never smoked e-cigarettes;
In people with a normal body mass index and no history of cardiovascular disease, there was a significant association between inhalation of e-cigarettes and ED, indicating that e-cigarettes are likely to directly cause ED.
Although the data of this study has certain limitations, the results of this study are still reference, and the large use of e-cigarettes will have a series of negative effects on men's sexual health, and it is hoped that the majority of men can take this as a warning.
The state has introduced relevant control policies
The National Health Commission released the "China Smoking Hazards To Health Report 2020", which pointed out that "there is sufficient evidence that e-cigarettes are unsafe and will cause harm to health." For adolescents, e-cigarettes can have adverse consequences for their physical and mental health and growth, and can induce adolescents to use cigarettes" [4]. A global systematic survey showed that adolescents under the age of 20 who use e-cigarettes are more than twice as likely to smoke in the future as adolescents without e-cigarette use habits. Therefore, the mandatory supervision of e-cigarettes is important and necessary.
One
The "Measures for the Administration of Electronic Cigarettes" make clear provisions
On March 11, 2022, the State Tobacco Monopoly Administration formulated and issued the Administrative Measures for Electronic Cigarettes, which clearly stipulates: the sale of flavored electronic cigarettes other than tobacco flavors and electronic cigarettes that can add atomizations by themselves is prohibited; the sale of electronic cigarette products to minors is prohibited; the use of self-service vending machines and other self-service sales methods to sell or covertly sell electronic cigarette products is prohibited; ordinary primary and secondary schools, special education schools, secondary vocational schools, specialized schools, kindergartens must not set up e-cigarette product sales outlets, etc.
Figure 4 Announcement page of the "E-cigarette Management Measures" (Source: The official website of the State Tobacco Administration)
The "E-cigarette Management Measures" will be officially implemented on May 1 this year, and the Measures also propose that "e-cigarette products should comply with the mandatory national standards for e-cigarettes". In this regard, the relevant person in charge of the State Administration of Market Supervision said that the formulation of mandatory standards for e-cigarettes is an important means to implement the relevant laws and regulations of the "E-cigarette Management Measures", and it is also an important technical support for the establishment of an e-cigarette regulatory system.
Two
The mandatory national standard of "electronic cigarettes" was approved
On April 12, the State Administration for Market Regulation and the Standardization Administration of the People's Republic of China approved the release of the mandatory national standard for "electronic cigarettes", which will be officially implemented from October 1, 2022. The release of the mandatory national standard of "electronic cigarettes" means that the end of the production stage of China's electronic cigarettes without national standards for a long time is of great significance to the industry.
Figure 5 Announcement release page (Source: Standardization Administration of the People's Republic of China)
The mandatory national standards for electronic cigarettes officially released this time have formulated comprehensive and standardized standards for electronic cigarette products, and put forward strict requirements in terms of electronic cigarette smoking equipment and materials, atomides, additives and releases. For example, in terms of nebulizer-related standards, there are the following provisions: 1) the nebulizer should contain nicotine, and the concentration of nicotine in the nebulizer should not be higher than 20mg/g, and the total amount of nicotinoid should not be less than 200mg; 2) the list of substances temporarily licensed for use of nebulizer additives is 101, and the maximum amount of use is also stipulated accordingly; 3) the characteristic flavor of the product should not be made to show other flavors other than tobacco, and minors should not be induced, and market popular seasonings, including fruit flavors, are prohibited [5].
The official release of the mandatory national standard of "electronic cigarette" will help to increase the marginal entry threshold of the industry, and the products of the electronic cigarette equipment/smoke bomb production enterprises need to be transformed from the original internal standards to the production according to the national standards, and the production capacity and technical reserves of the enterprises are put forward higher requirements, and certain requirements are also put forward for the middle and lower reaches of the brand and sellers, and the industrial threshold is increased marginally [6]. At the same time, because the national standard also includes relevant provisions such as e-cigarettes should not induce minors, it will also reduce the use rate of minors' e-cigarettes to a corresponding extent.
According to relevant regulations, products and services that do not meet mandatory standards shall not be produced, sold, imported or provided. After the release of the standard, the e-cigarette products sold on the market must meet the national standard. With the continuous landing of regulatory policies, the e-cigarette industry will gradually get rid of the situation of wanton growth, and then achieve orderly development. And because the production and management of e-cigarettes are more standardized, it will inevitably reduce the use of e-cigarettes, thereby reducing the harm caused by e-cigarettes to the human body.
Written by | Muzijiu
Typography | Luna
End
Resources:
[1] Fudan released a research report: e-cigarette marketing momentum is fierce, targeting young people, and market supervision should be strengthened. https://fddi.fudan.edu.cn/5d/e3/c21257a417251/page.htm
[2] Moshensky A, Brand CS, Alhaddad H, et al. Effects of mango and mint pod-based e-cigarette aerosol inhalation on inflammatory states of the brain, lung, heart, and colon in mice. Elife. 2022 Apr 12;11:e67621. doi: 10.7554/eLife.67621. PMID: 35411847.
[3] El-Shahawy O, Shah T, Obisesan OH, et al. Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study. Am J Prev Med. 2022 Jan;62(1):26-38. doi: 10.1016/j.amepre.2021.08.004. Epub 2021 Nov 30. PMID: 34922653.
[4] The National Health Commission released the "Report on the Dangers of Smoking in China 2020"
http://www.gov.cn/xinwen/2021-05/30/content_5613994.htm
[5] National standard "Electronic Cigarette"
http://c.gb688.cn/bzgk/gb/showGb?type=online&hcno=ABB028BCBF0391D0039E80FDAB8D3AF7
[6] E-cigarette industry review report: "E-cigarette" international boots landed, the industry entered the stage of standardized development https://www.djyanbao.com/report/detail?id=3037505&from=search_list
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