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The Cancer Association of Namibia's take on 'vaping'

This is a very interesting article written by Rolf Hansen, the CEO of the Cancer Association of Namibia on the topic of e-cigarettes and 'vaping':

The tobacco industry remains pursuant in finding “grey areas” to infiltrate the market with “smart” and “healthier” ways to sell their products and promote smoking.
 
An electronic cigarette/ E-cigarette is a handheld electronic device that tries to create the feeling of tobacco smoking. It works by heating a liquid to generate an aerosol, commonly called a "vapour” that the user inhales. Using e-cigarettes is sometimes called vaping. The liquid in the e-cigarette is usually made of nicotine, propylene glycol, glycerine, and flavourings.
Most E-cigarettes contain zero tobacco products, or heat as opposed to combust tobacco, or does not contain e-liquids with nicotine at all. Vapour from an electronic cigarette simulates tobacco smoke, but the process of burning tobacco does not occur.
 
The health risks of e-cigarettes are uncertain at current, as this is new technology flooding the market. But, because of the contents of the e-liquid (i.e. toxicants and traces of heavy metals at levels permissible in inhalation medicines, and potentially harmful chemicals not found in tobacco smoke at concentrations permissible by workplace safety standards. However, chemical concentrations may exceed the stricter public safety limits), the Cancer Association of Namibia has been inundated with calls from the public on weather “vaping” is allowed in public places, restaurants, schools and enclosed areas.
 
Vaping is still dangerous, and many vaporizers employ e-liquid or e-juice that contains nicotine, but usually not in the high concentrations that represent in cigarettes. Overall, it remains a very unhealthy situation, and the combustion process to produces the vape creates a lot of the carcinogens present in cigarette smoke as well.
 
E-cigarettes are likely safer than tobacco cigarettes, but the long-term health effects when used by non-smokers (including second hand inhalation) can lead to nicotine addiction, and there is concern that children could start smoking after using e-cigarettes. So far, no serious adverse effects have been reported in trials globally we have learnt, but definite less serious adverse effects include throat and mouth irritation, vomiting, nausea, and coughing.
 
Given all the information presented on the topic, the Cancer Association of Namibia cannot condone the use of e-cigarettes/vaping, especially in public places and around children due to the adverse effects it may have. No smoking remains in our opinion the best option.
 
How does the electronic cigarette work?
 
An electronic cigarette or e-cigarette is a handheld electronic device that creates an aerosol by heating a liquid. The user then inhales the aerosol. Using e-cigarettes is sometimes called vaping. The liquid in the e-cigarette, called e-liquid or “e-juice”, is usually made of nicotine, propylene glycol, glycerine, and flavourings.
 
Where does the nicotine in “e-juice” come from?
 
The main ingredients in the e-liquid usually are propylene glycol, glycerine, nicotine, and flavourings. However, there are e-liquids sold without propylene glycol, nicotine, or flavours. The liquid typically contains 95% propylene glycol and glycerine. The nicotine in e-liquid is the same as that used in pharmaceutical nicotine replacement therapy (NRT). It is extracted from a member of the tobacco family but not the same plant as used for smoking tobacco as that has much less nicotine in the leaves than the rustic type of tobacco plant.
 
Is tobacco used in electronic cigarettes?
 
Although they do not produce tobacco smoke, e-cigarettes still contain nicotine and other potentially harmful chemicals. Nicotine is a highly addictive drug, and recent research suggests nicotine exposure may also prime the brain to become addicted to other substances.
 
How addictive are Vapes?
 
When you start smoking, vaping or supplying nicotine to your receptors, they multiply. If you stop smoking or vaping, the receptors don't go away. Nicotine use very quickly escalates into addiction, even when dealing with tobacco-free, odourless “vaping” associated with e-cigarettes.
 
What are the known health factors on E-Cigarettes / Vapes?
 
A 2014 World Health Report (WHO) report found e-cigarettes release a lower level of particles than traditional cigarettes. Comparable to a traditional cigarette, e-cigarette particles are tiny enough to enter the alveoli of the lung, enabling nicotine absorption. E-cigarettes companies assert that the particulates produced by an e-cigarette are too tiny to be deposited in the alveoli.  Exactly what comprises the vapour varies in composition and concentration across and within manufacturers. Different devices generate different particle sizes and cause different depositions in the respiratory tract, even from the same nicotine liquid. Reports in the literature have shown respiratory and cardiovascular effects by these smaller size particles, suggesting a possible health concern.
 
In terms of second hand smoke, emissions from electronic cigarettes are not comparable to environmental pollution or cigarette smoke as their nature and chemical composition are completely different. The particles are larger, with the mean size being 600 nm in inhaled aerosol and 300 nm in exhaled vapour. The exhaled aerosol particle concentration is 5 times lower from an e-cigarette than from a combustible tobacco cigarette. The density of particles in the vapour is lower than in cigarette smoke by a factor of between 6 and 880 times lower.
 
For particulate matter emissions, e-cigarettes slightly exceed the WHO guidelines, but emissions were 15 times less than traditional cigarette use. In January 2014, the International Union Against Tuberculosis and Lung Disease stated "Adverse health effects for exposed third parties (second-hand exposure) cannot be excluded because the use of electronic cigarettes leads to emission of fine and ultrafine inhalable liquid particles, nicotine and cancer-causing substances into indoor air."
 
Since e-cigarettes have not been widely used long enough for evaluation, the long-term health effects from the second-hand vapour are not known. There is insufficient data to determine the impact on public health from e-cigarettes. The potential harm to bystanders from e-cigarettes is unknown, because no long-term data is available at current.
 
E-cigarettes used in indoor environments can put at risk non-smokers to elevated levels of nicotine and aerosol emissions. Non-smokers exposed to e-cigarette aerosol produced by a machine and pumped into a room were found to have detectable levels of the nicotine metabolite cotinine in their blood. The same study stated that 80% of nicotine is normally absorbed by the user, so these results may be higher than in actual second hand exposure. In 2015 a report commissioned by Public Health England concluded that e-cigarettes "release negligible levels of nicotine into ambient air with no identified health risks to bystanders".
 
E-cigarette use by a parent might lead to inadvertent health risks to offspring. E-cigarettes pose many safety concerns to children. For example, indoor surfaces can accumulate nicotine where e-cigarettes were used, which may be inhaled by children, particularly youngsters, long after they were used. A policy statement by the American Association for Cancer Research and the American Society of Clinical Oncology has reported that "Third-hand exposure occurs when nicotine and other chemicals from second-hand aerosol deposit on surfaces, exposing people through touch, ingestion, and inhalation"
 
Do smoking laws apply to vaping?
 
Many jurisdictions worldwide have recently begun enacting laws (by amending tobacco control laws already in place) that prohibit e-cigarette usage everywhere that smoking is banned, although some countries with comprehensive smoke-free laws will still allow for vaping to be permitted in bars and restaurants while prohibiting e-cigarettes in other indoor places.
 
In Namibia, our current Tobacco Control Act of 2010 does not make provision for e-cigarettes / vaping in direct context. This is, because the Act is primarily focussed on tobacco products. In the event that an e-cigarette contains any form of tobacco product, the Act then comes into play.
 
The onus thus rests on the owner / management per venue to, on the basis of “right of admission”, prohibit the use of e-cigarettes / vaping in their respective institutions.
 
What about Hubbly Bubbly?
 
A hubbly bubbly – also called a hub, hookah, water pipe, or shisha – is an instrument for smoking tobacco, which is often flavoured. It consists of a base container, usually made of glass, attached to one or many smoking tubes. While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. Just like regular tobacco, shisha contains nicotine. In fact, in a 60-minute Hookah session, smokers are exposed to 100 to 200 times the volume of smoke inhaled from a single cigarette.
 
Smoking a hookah doesn't have to mean smoking tobacco or taking in nicotine, which are common substances associated with smoking. But hookah smoking has its own demon — combusted charcoal — which carries health risks even when non-tobacco shisha is used!
 
As tobacco molasses is primarily used in this product, it falls directly under the Tobacco Control Act of 2010. It is illegal to smoke under the age of 16 years, in public and enclosed spaces and is punishable by enactment of the law.
 
Is vaping still smoking?
 
Vaping is still dangerous, and many vaporizers employ e-liquid or e-juice that contains nicotine, but usually not in the high concentrations that represent in cigarettes. Overall, it remains a very unhealthy situation, and the combustion process to produces the vape creates a lot of the carcinogens present in cigarette smoke as well.
 
E-cigarettes are likely safer than tobacco cigarettes, but the long-term health effects when used by non-smokers (including second hand inhalation) can lead to nicotine addiction, and there is concern that children could start smoking after using e-cigarettes. So far, no serious adverse effects have been reported in trials globally we have learnt, but definite less serious adverse effects include throat and mouth irritation, vomiting, nausea, and coughing.
 
Given all the information presented on the topic, the Cancer Association of Namibia cannot condone the use of e-cigarettes/vaping, especially in public places and around children due to the adverse effects it may have. No smoking remains in our opinion the best option.