Beijing Tobacco Control Association: strict e-cigarette measures have limited effect on minors

Based on the rapid entry of e-cigarettes into the youth trend, on March 15 last year, the 3.15 evening gala specifically named e-cigarettes and randomly monitored the nicotine content in certain brands of e-liquid and the components in e-cigarette vapor. It was found that the labeling of nicotine in e-liquids sold on the market misleads consumers, and the actual nicotine content is often much higher than the labeled values, making it easier for users to become addicted. The formaldehyde content in e-cigarette vapor is dozens or even hundreds of times higher than the maximum allowable concentration of formaldehyde in indoor air in China, which is 0.08mg/m. E-cigarettes are not as "healthier" as advertised; on the contrary, using e-cigarettes is not safe. E-cigarettes have come under intense scrutiny, and calls for strict regulation to protect the health of young people have been incessant. A year later, has the original intention of protecting minors really been achieved?

The Rapid Popularity of E-Cigarettes Among Youth

The Beijing Tobacco Control Association has found that the rapid popularity of e-cigarettes among youth has already led to negative consequences, with other countries serving as cautionary tales: for example, in the United States, the proportion of adolescents using e-cigarettes has increased by 135% over the past two years, with over 3.6 million middle school students using e-cigarettes, accounting for about one-third of all e-cigarette users in the U.S. The proportion of high school students using e-cigarettes rose by 78% in just one year, and e-cigarettes are spreading rapidly among youth like an infectious disease, worsening continuously. Between 2000 and 2018, the smoking rate among American youth decreased by more than 70%, but the surge in youth e-cigarette use threatens to undo the achievements made in tobacco control.

What is the situation regarding youth e-cigarette use in China? In recent years, the e-cigarette usage rate among youth in China has shown a significant upward trend. According to the "2018 China Adult Tobacco Survey Results" released by the Chinese Center for Disease Control and Prevention, the primary users of e-cigarettes are young people, with a usage rate of 1.5% among the 15-24 age group, up from 0.4% in 2015, an increase of 1.1 percentage points within three years.

Limited Protection for Minors Under Strict E-Cigarette Regulations

In China, relevant announcements and notifications have been continuously issued. On August 28, 2018, the State Administration for Market Regulation and the State Tobacco Monopoly Administration issued a notice prohibiting the sale of e-cigarettes to minors, stating that market entities must not sell e-cigarettes to minors. On October 31, 2019, the two departments issued another notice to further protect minors from e-cigarette harm, urging e-cigarette manufacturers and sellers to promptly shut down e-cigarette sales websites or apps; urging e-commerce platforms to promptly close e-cigarette shops and take e-cigarette products off the shelves; and urging e-cigarette manufacturers and sellers to withdraw e-cigarette advertisements published on the internet. In November 2019, to implement the "State Council's Opinions on Implementing the Healthy China Action" and promote the implementation of the "Healthy China Action (2019-2030)" tobacco control actions, further strengthening youth tobacco control work, the National Health Commission, the Publicity Department of the CPC Central Committee, the Ministry of Education, the State Administration for Market Regulation, the National Radio and Television Administration, the State Tobacco Administration, the Communist Youth League Central Committee, and the All-China Women's Federation jointly issued a notice on further strengthening youth tobacco control work, which mentioned that comprehensive publicity on the harms of e-cigarettes and standardized management should be carried out. The components of e-cigarette liquid and the secondhand smoke (including aerosol) produced are unsafe, and there is currently no conclusive evidence that e-cigarettes can effectively help quit smoking. Local authorities should actively strengthen publicity and education on the harms of e-cigarettes, not promote e-cigarettes as a smoking cessation method, and advocate for youth to stay away from e-cigarettes. In local tobacco control legislation, amendments, and enforcement, efforts should be made to promote the prohibition of e-cigarette use in public places. Special actions should be taken in conjunction with comprehensive governance around primary and secondary schools to warn all market entities not to sell e-cigarettes to minors, especially through the internet, effectively preventing youth from falling into the trap of e-cigarettes.

However, online sales still have loopholes. Volunteers from the Beijing Tobacco Control Association have found that, for example, on the JD platform, there are still loopholes, with some shops disguising themselves as clothing sellers while covertly selling e-cigarettes. For instance, a certain shop on the JD platform is categorized under men's clothing, and in addition to selling regular men's clothing, the first product on the shop's homepage is an e-cigarette product, which is labeled in a way that obscures the term "e-cigarette" using a combination of pinyin and Chinese characters. When clicking on the link, the product description section contains a large amount of text and images promoting the benefits of e-cigarettes.

The Beijing Tobacco Control Association has found that at some convenience stores and small shops, the requirement to prohibit the sale of e-cigarettes to minors is also largely ignored.

Urgent Need to Incorporate E-Cigarette Regulation into the Legal System

The Beijing Tobacco Control Association states that youth are the biggest victims of e-cigarettes. First, the nicotine in e-cigarettes can lead to addiction and has long-term effects on the developing brain. The World Health Organization states that adolescents who use e-cigarettes are twice as likely to become smokers compared to those who do not use e-cigarettes. E-cigarettes may become a pathway for youth to develop smoking habits or for smoking to become a social norm again.

Secondly, a large number of marketing tactics and various flavored e-cigarettes, such as those with sweet, candy, or fruit flavors, target youth, leading them to underestimate the health risks associated with these products and ultimately become addicted. E-cigarettes seriously harm the physical and mental health of youth, impair lung function, and the toxic and harmful substances in e-cigarettes, such as propylene glycol and formaldehyde, pose health risks to the respiratory system and lungs. Long-term use of e-cigarettes increases the risk of chronic obstructive pulmonary disease and lung cancer; a survey conducted by the University of Hong Kong's School of Public Health shows that students using e-cigarettes face additional risks of respiratory symptoms. The largest epidemiological survey on e-cigarettes to date, released at the end of 2019, shows a direct relationship between e-cigarette use and lung diseases (research indicates that the proportion of traditional cigarette smokers suffering from emphysema, asthma, and bronchitis is 2.6 times that of non-smokers. Those who only use e-cigarettes also have a 30% higher probability of developing lung diseases compared to non-smokers, and worse, less than 1% of smokers who switch to e-cigarettes completely quit traditional cigarettes; the vast majority use both e-cigarettes and traditional cigarettes, and the survey shows that this group has a threefold higher probability of developing lung diseases compared to non-smokers.

The Beijing Tobacco Control Association states that the theme of World No Tobacco Day 2020 is "Protecting Young People from Tobacco Industry Manipulation and Preventing Them from Using Tobacco and Nicotine." To effectively protect youth, e-cigarette regulation urgently needs to be elevated to the legal level. It is suggested that the ongoing revision of the "Minor Protection Law" explicitly prohibits the sale of e-cigarettes to minors, while also clarifying the enforcement entities, enforcement mechanisms, and strict enforcement. To prevent youth from being tempted by e-cigarettes, laws should prohibit e-cigarette advertisements and flavored e-cigarettes.