Why Is the World Strictly Restricting E-Cigarettes?

Recently, e-cigarettes have faced strict restrictions worldwide.

On November 1, the State Administration for Market Regulation and the State Tobacco Monopoly Administration jointly issued a notice requiring all market entities to refrain from selling e-cigarettes to minors, urging e-commerce platforms to promptly shut down e-cigarette stores and take e-cigarette products off the shelves. Subsequently, major e-commerce platforms removed e-cigarette products.

The restrictions in the United States came even earlier than in China. On September 12, 2019, the White House announced a ban on flavored e-cigarettes—except for those with tobacco flavor—due to the increase in middle and high school students using e-cigarettes. On November 16, Apple announced the removal of all e-cigarette-related apps from its mobile app store.

A few days later, the Indian cabinet approved an emergency order banning the production, import, and sale of e-cigarettes.

So far, more than 20 countries, mainly in South America, the Middle East, and Southeast Asia, have banned the sale of e-cigarette products. Thailand has the strictest smoking laws, while countries like Australia, Canada, and Norway have implemented many restrictions.

Many people, upon seeing news about these e-cigarette bans, like me, are curious about why there is a global wave of restrictions on e-cigarettes. Initially, e-cigarettes were presented to the public as a harm-reduction product, seemingly beneficial to society. So, what are the actual harms of e-cigarettes? With these questions in mind, I did some research.

First, I wanted to know whether the health risks of e-cigarettes are lower than those of traditional cigarettes. If a person switches from smoking cigarettes to using e-cigarettes, will the health damage be reduced?

The answer to this question is quite clear. From the perspective of harm, e-cigarettes do pose less health risk than traditional cigarettes. Contrary to popular belief about the harmful components of cigarettes, the most harmful substance in cigarettes is not nicotine, but tar.

According to data from the U.S. National Cancer Institute, tobacco smoke contains over 7,000 chemicals, most of which are found in the tar produced by smoking. Among these, 250 chemicals, including carbon monoxide, ammonia, and hydrogen cyanide, can harm smokers and those exposed to secondhand smoke, with 69 of them being carcinogenic.

Of course, nicotine is not harmless; it causes addiction and can lead to birth defects in infants and may increase the risk of type 2 diabetes. However, existing research indicates that compared to the harm caused by tar, the harm from nicotine is relatively minor.

Thus, one of the most prominent indicators on cigarette packages is the tar content; the higher the tar content, the stronger the "smoky" flavor, and vice versa.

E-cigarette vapor does not contain tar, so its health risks are indeed significantly lower compared to traditional cigarettes. However, please remember that while the risks are reduced, they are still considerable.

The American Psychological Association points out that many particles in e-cigarettes contain varying amounts of toxic chemicals associated with heart disease, respiratory diseases, and cancer. According to a 2015 report by CBS, research by Professor Peyton from Portland State University showed that high-voltage e-cigarettes release compounds containing formaldehyde, which is classified as a carcinogen by the International Agency for Research on Cancer.

Additionally, some e-liquids in e-cigarettes contain diacetyl, which can lead to popcorn lung, medically known as "obstructive bronchiolitis." In December 2015, researchers from Harvard University’s School of Public Health announced that they found evidence suggesting that regular users of flavored e-cigarettes are at an increased risk of developing popcorn lung.

Since 2019, with the continuous innovation of e-cigarettes in the U.S. market, a new danger has emerged: a deadly lung injury. The CDC has named this condition EVALI (e-cigarette or vaping product use-associated lung injury), which refers to lung injuries that occur after using e-cigarettes or other vaping products. As the name suggests, this lung disease is directly linked to e-cigarettes.

EVALI has already resulted in a significant number of actual cases. As of November 13, 2019, the CDC had received reports of 2,172 cases of lung injury associated with e-cigarette use from 49 states (excluding Alaska), the District of Columbia, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands). 42 deaths have been confirmed in 24 states and the District of Columbia.

However, upon closely examining the CDC's report, I must be realistic and say that these cases in the U.S. cannot simply be extrapolated to suggest that the same lung injury risks exist in the Chinese market. This is because some e-cigarettes in the U.S. market contain a very specific substance that is strictly prohibited by law in China: tetrahydrocannabinol (THC) and cannabidiol (CBD) oil. THC is a cannabis compound that can induce euphoria. To be precise, this is no longer the conventional understanding of e-cigarettes but rather a new type of drug. The lung disease is caused by additives related to cannabis that are included in e-cigarettes containing cannabis, specifically vitamin E acetate used as a thickening agent.

The CDC tested fluid samples from 29 patients across 10 states and found that 100% of the samples contained vitamin E acetate, 82% contained THC, and 62% contained nicotine.

Although vitamin E acetate is associated with EVALI, there is still insufficient evidence to rule out the possibility of other chemicals causing the illness. Therefore, the CDC recommends not using e-cigarettes containing THC, and during the investigation, the only way to avoid illness is to refrain from using all e-cigarettes or vaping products.

Next, let’s discuss another concern: can e-cigarettes help with quitting smoking?

My answer is: there is no evidence that e-cigarettes genuinely help with quitting smoking. On the contrary, there is evidence that e-cigarettes make it easier for non-smokers, especially young people, to become addicted to nicotine.

Whether e-cigarettes help with quitting smoking is a key factor in assessing their legitimacy. I found some data regarding the effectiveness of e-cigarettes for quitting smoking. According to a smoking cessation study conducted in Auckland, New Zealand, from 2011 to 2013, 657 adults participated in the cessation experiment. The cessation rate for those using nicotine e-cigarettes was 7.3%, while the cessation rate for those using placebo e-cigarettes (which contained no nicotine) was 4.1%, and the cessation rate for those using nicotine patches was 5.8%. It can be said that nicotine e-cigarettes did not perform significantly better than nicotine patches in terms of quitting smoking, and those using non-nicotine e-cigarettes performed even worse than patches. In a study by the National Institutes of Health in the U.S., although 85% of e-cigarette users reported wanting to quit smoking entirely, their actual success rate was not higher than that of non-e-cigarette users, and in some cases, the quitting rate among e-cigarette users was even lower than that of non-users. From this data, you can see that in Australia and the U.S., those who use e-cigarettes are generally those who also smoke traditional cigarettes; for them, e-cigarettes are merely an additional toy.

The U.S. Food and Drug Administration (FDA) also believes there is no evidence that e-cigarettes are safe and effective in helping addicts quit smoking. The American Heart Association believes that e-cigarettes should only be used as a last resort for those who are addicted.

E-cigarette manufacturers always loudly proclaim: "Our e-cigarettes can help long-term smokers quit smoking." However, more evidence is needed to determine whether e-cigarettes are an effective means of quitting smoking; simply listening to the merchants' claims is not enough. The American Heart Association recommends that smokers adopt other more traditional cessation methods, such as nicotine patches, rather than e-cigarettes.

The American Heart Association states: "Tobacco companies want to get the new generation addicted to nicotine and smoking. In 2017 alone, they spent $8.6 billion on aggressive marketing. That’s over $23 million a day, nearly $7 million an hour! E-cigarettes are now the most common form of tobacco use among children and adolescents. Many young people say part of the reason they try e-cigarettes is that the flavors are enticing. Over 80% of young users say their first e-cigarette product was flavored." "E-cigarettes are becoming increasingly popular among adolescents, with over 3,500 young people starting to vape every day. The official website states: This is an emergency; join the fight! Indeed, they have regarded the resistance against e-cigarettes as a 'battle' to protect the health of young people."

According to a report released by the CDC in February 2019, the proportion of high school students using tobacco products increased by 38.3% from 2017 to 2018, while the proportion of middle school students using tobacco products increased by 28.6%. This offset the decline in youth tobacco product use in previous years.

The greatest threat to public health posed by e-cigarettes may be that their increasing popularity could "normalize" smoking again, making it fashionable. For many years, global anti-smoking efforts have led to a decline in the number of smokers, and e-cigarettes could undermine the results of these efforts.

In conclusion, why is the world imposing strict restrictions on e-cigarettes? First, the most urgent reason is that the outbreak of EVALI lung disease has resulted in 42 deaths directly related to e-cigarettes. Secondly, there are three important reasons: e-cigarettes have led to an increase in young smokers; even without adding cannabis to e-cigarettes, they still pose health risks; and there is no evidence that e-cigarettes genuinely help with quitting smoking.

For individuals, my advice is: if you are someone who does not smoke, do not start using e-cigarettes just because they are less harmful; the first step is using e-cigarettes, and the next step is often switching to traditional cigarettes; if you are using e-cigarettes to quit smoking, do not have overly high expectations. The success rate is almost equivalent to simply deciding to quit smoking or using other more traditional cessation methods, and quitting smoking directly can save you money.

When considering the issue of e-cigarettes, I hope everyone learns to view it from a statistical perspective rather than being swayed by a single story. We can easily be attracted by the overwhelming advertisements for e-cigarettes and inspired by success stories of quitting smoking. E-cigarette manufacturers can tell you a real story of someone who successfully quit smoking using e-cigarettes, and I can tell you a story of someone who suffered greatly due to e-cigarettes, which is also true. If our understanding of the world remains limited to enjoying colorful stories and we are not accustomed to looking at black-and-white data, it will be difficult to uncover the truth. Statistical data from authoritative sources may seem cold, but they are closer to the truth than those warm stories.