Harmful effects of using electronic cigarettes and heated tobacco products

In recent years, in addition to cigarettes, cigars, and tobacco products (pipe tobacco) that are being managed under the provisions of the Law on Prevention and Control of Tobacco Harms, new products have appeared on the market, the most popular of which are electronic cigarettes (Electronic Nicotine Delivery - ENDs) and heated tobacco products (Heated Tobacco Products - HTPs).

Currently, the Law on Prevention and Control of Tobacco Harms does not regulate “electronic cigarettes” and “heated tobacco products”. Therefore, these products are not yet allowed to be legally imported, traded and circulated in Vietnam.

New "cigarettes" - new harms

Electronic cigarettes (ENDs) are devices that use a battery to heat an e-liquid to produce an aerosol/smoke for the user to inhale, containing flavorings, dissolved in Propylene Glycol or/and Glycerin. The main ingredients of e-liquid, besides nicotine, are propylene glycol and flavorings.

At least 60 chemical compounds have been found in e-cigarette liquid (also known as e-liquid) and many more are present in the aerosol/smoke produced by e-cigarettes. Nicotine is a highly addictive substance that increases heart rate, constricts blood vessels in the heart, increases pulse and blood pressure. Nicotine also affects tumor growth and metastasis and has the ability to promote and form tumors.

The e-cigarette liquid also contains glycerin and propylene glycol. Propylene glycol can form propylene oxide, a carcinogen, when heated and vaporized. Glycerin, when heated and vaporized, forms acrolein, which irritates the upper respiratory tract.

Toxic substances found in e-cigarette aerosols include Ethylene Glycol, Diethylene Glycol, aldehydes, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) such as toluene, nitrosamines, polycyclic aromatic hydrocarbons, carcinogenic nitrosamines, acrolein, Formaldehyde, Hydrooxycarbonyls, Acetaldehyde, Polycyclic Aromatic Hydrocarbons, Ultrafine molecules... Some metals such as lead, silver, chromium, nickel, formaldehyde have levels equivalent to or higher than those of conventional cigarettes.

To create attractive flavors to attract users, especially young people, manufacturers also use many types of flavorings such as mint, apple, orange, lemon... in electronic cigarettes. According to the World Health Organization, there are currently about 20,000 types of flavorings, many of which have not been fully evaluated for their harmfulness to health.

These flavors can mask the harshness of nicotine, making the product more pleasant and easier to inhale. Some flavorings used in ENDS have been shown to increase the toxicity of the product. Additionally, heating the metal coils in ENDS creates a number of heavy metals in the ENDS aerosol, including cadmium, lead, nickel, tin, manganese, selenium, zinc, and copper.

Heated tobacco products (HTPs) are products that use an electronic device to heat a tobacco stick to a temperature high enough to create an inhalable aerosol containing nicotine, a highly addictive substance, and other chemicals, non-tobacco additives, and often a variety of flavors.

The World Health Organization has issued a warning: Heated tobacco produces toxic gases, containing many of the same toxins as those found in regular cigarette smoke. Although heated at lower temperatures, it still produces chemicals similar to those found in cigarette smoke, such as: Acrolein (a strong respiratory irritant), glycidol, formaldehyde and acetaldehyde (carcinogens), carbon monoxide, polycyclic aromatic hydrocarbons and metals (aluminum, titanium, strontium, molybdenum, tin and antimony).

Some health effects of using electronic cigarettes and heated tobacco products

E-cigarettes and heated tobacco products are new products that have only appeared in the last 10 years, and scientific evidence on the toxicity and long-term health effects of these products is still being studied. However, many initial studies have shown the health consequences of using and passive exposure to the “aerosols”/smoke of these products.

There is growing evidence that ENDS use affects the respiratory and cardiovascular systems and increases the risk of cancer, dental disease, and other health problems including gastrointestinal symptoms, most commonly epigastric pain, nausea and vomiting, diarrhea, and gastrointestinal bleeding.

The most prominent consequence of ENDS is EVALI. In the United States, at least 2,807 hospitalizations and 68 deaths have been confirmed due to EVALI as of February 2020. Some specific health effects of e-cigarettes and heated tobacco products have been documented through reports, specifically:

The impact of ENDS on lung function has been reported. Lung function decreased and respiratory resistance increased in e-cigarette users compared to non-users. Another cross-sectional study of 44,817 Canadian adults found that e-cigarette use was associated with a higher rate of obstructive pulmonary disease. The rate was more than twice as high in ENDS users compared to non-smokers and non-e-cigarette users.

E-cigarette use has been linked to severe acute lung injury (EVALI). In 2019, a series of cases of severe lung injury in e-cigarette users with no history of lung disease were reported in the United States.

Cases continued to rise, peaking at 2,807 hospitalizations in February 2020, including 68 deaths. In addition to EVALI, studies have shown that ENDS may be associated with increased severity of respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD), particularly in people who use both cigarettes and e-cigarettes.

Like adults, children and adolescents are at risk for respiratory illnesses linked to e-cigarettes. A study based on five large surveys of high school students in South Korea, Hong Kong, and the United States reported higher rates of asthma, chronic cough, or chronic bronchitis among students who had used e-cigarettes than among students who had never used them.

Because they have only been around for about 10 years, the long-term health effects of e-cigarettes have not been fully evaluated, however, there is growing evidence that e-cigarette use affects cardiovascular function.

E-cigarettes may cause vascular dysfunction, even with short-term inhalation. Several studies have shown that ENDS use is associated with an increased risk of vascular stiffness, thrombosis, atherosclerosis, myocardial infarction, coronary artery disease, hypertension, and a history of stroke.

Recent evidence suggests that e-cigarettes may also pose a cancer risk. Aerosols produced by e-cigarettes may enhance the activity of cancer-causing enzymes, leading to DNA damage and cancer after long-term use.

Not only aerosols, but also exposure to metals in e-cigarette liquids increases the risk of cancer. Recent evidence has shown that ENDs cause DNA damage, increasing the risk of cancer. In addition, the use of ENDS may increase chemotherapy resistance, increase cancer cell survival, and require higher chemotherapy doses.

For oral health, recent studies show that people who use e-cigarettes are at much higher risk of gum disease, tooth decay, bone loss around the teeth, other periodontal diseases, oral mucosal damage, and infections than those who never use them.

E-cigarettes can cause gastrointestinal symptoms, most commonly epigastric pain, nausea and vomiting, followed by diarrhea and gastrointestinal bleeding. Some cases of ulcerative colitis have been reported. Electronic devices can fail, cause fire, injury, and endanger the safety of users. Serious injuries have been reported to the mouth, face, neck, eyes, nose, jaw, etc.

Waste from electronic equipment parts and solution containers affects the environment because of the amount of solid waste released into the environment after use, especially with single-use devices.

An Khang

(According to documents of the Provincial People's Committee)

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