A crucial part of tobacco control policy is stopping young people from starting to use tobacco products — eight out of 10 adult smokers start smoking as teenagers and are likely to become lifetime smokers. Evidence from tobacco industry documents shows that tobacco companies also target this age group, seeking to find “replacement” smokers to maintain their market share and profits.
Advertising, use of flavoured tobacco, and point-of-sale marketing that reaches children are some of the well-known tactics employed by tobacco companies to manipulate young children. Over decades, strides have been made to shield children who are also very vulnerable to these tactics. Comprehensive restrictions on these marketing avenues have been imposed on tobacco products, but the introduction of e-cigarettes or vape products threatens to undo this progress.
The e-cigarette industry, which is still largely dominated by the tobacco industry, has been lobbying for differential or better treatment, but the government would do well to ignore the lobbying by an industry whose interests are irreconcilable with public health interests. The top four e-cigarette manufacturers are major tobacco companies, showing an industry desperate to maximise profits from both new and old products.
Amid the conversation on regulating e-cigarettes products, it is important to remember that children’s best interests are of paramount importance. The government should protect the health and well-being of children and this includes protection against the harmful effects of tobacco and e-cigarette use and adopting appropriate measures to discourage youngsters from initiating the use of these products.
Failure to regulate electronic cigarettes ignores the harmful effects of these products which are linked to severe health conditions, including cancers, respiratory and cardiovascular diseases, chest pains, mouth ulcers, asthma, and increased risk of stroke. We also risk the creation of a new generation of nicotine addicts, with research showing that young people who use e-cigarettes are more likely to go on to use tobacco products.
While the industry calls for better treatment, the opposite is needed; e-cigarette products actually require stricter or a step up in regulation to match the sophistication and diversity of the products and ensure that other innovations the industry might come up with in the future are covered.
Unregulated, e-cigarettes products are patently marketed to South African children. In shopping malls, colourful e-cigarette kiosks are in plain sight of children. The sleek and youthful designs, which capitalise on the world’s move towards gadgets and technology, coupled with thousands of youth-friendly flavours promote these products. Flavours like “gummy bear” increase product appeal and create a perception that these products are safe. Some US states have banned flavoured e-cigarettes, which have been fuelling a youth e-cigarette epidemic.
Placing children at the centre of this conversation and imposing strict regulation does not mean adult tobacco users or non-smokers are being neglected. Regulation is beneficial for public health.
Social media platforms such as Instagram, Twitter and Facebook are also used to promote these products in South Africa. In some posts, the manufacturers ask users to suggest new flavours that they would want to try and they also host competitions for people to send in videos using the products and win prizes. Phone applications that promote these e-cigarette products are also available on Google Play and App stores. The self-age verification online platforms and websites provide another marketing channel. With no regulation, the e-cigarette market is fast becoming a minefield and the Control of Tobacco and Electronic Delivery Systems Bill must be finalised to address this crisis.
The industry will argue that it wants to join hands in “addressing the global public health issue of smoking” but we must always remember to judge the industry by its deeds, not by its words. The industry says it does not target children, but instead it violates child rights by marketing and designing products which are blatantly attractive to children.
As early as 1954, the tobacco industry published the “Frank Statement to Cigarette Smokers”, declaring that they “accept an interest in people’s health as a basic responsibility, paramount to every other consideration in our business… [and to always] cooperate closely… to safeguard the public health”. Of course, this was just a charade, since the tobacco industry continuously tries to subvert tobacco control policies globally, including in South Africa.
The tobacco and e-cigarette industries cannot be trusted to self-regulate and public health policy must be protected from the industry’s influence, as spelt out in Article 5.3 of the WHO Framework Convention on Tobacco Control. The companies “themselves have become desperately addicted to the profits their products generate” and will not stop interfering with tobacco-control efforts.
Placing children at the centre of this conversation and imposing strict regulation does not mean adult tobacco users or non-smokers are being neglected. Regulation is beneficial for public health. Adults will still have access to e-cigarettes products as South Africa does not intend to join countries that ban e-cigarette products, such as Uganda and India. The government of South Africa only seeks to regulate these products and this is also in line with the World Health Organisation’s recommendation that e-cigarettes be regulated and should not benefit from differential or preferential treatment.
The Control for Tobacco and Electronic Delivery Systems Bill seeks to regulate electronic e-cigarette products as cigarettes, considering also the adverse risks of aerosols to non-users and the weak evidence of effectiveness in smoking cessation. The bill will prohibit use of e-cigarette products in public indoor areas and impose comprehensive bans on all forms of advertising, including social media and point-of-sale marketing that reaches children. Graphic health warnings and standardised packaging applied to e-cigarette products would also reduce the ability of the sleek designs to promote the products and to create an erroneous perception about their safety.
We agree that e-cigarettes are different from traditional tobacco products and that this difference could require different approaches for certain aspects, such as how to disclose ingredients or which ingredients to prohibit or concentrations allowed, but no preferential treatment needs to be given to e-cigarettes that would compromise public health. Children must be protected while adult users can still choose to use them. DM
Dr Sharon Nyatsanza is project and communications manager at the National Council Against Smoking, and Dr Catherine Egbe (specialist scientist) is with the Alcohol, Tobacco and Other Drug Research Unit at the South African Medical Research Council.
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