Over the past couple of years, electronic cigarettes (also known as e-cigarettes, vapourisers or vapes) have grown in popularity despite the ban on their import, sale, distribution as well as purchase, use and possession in Singapore.

Part of its appeal, especially to youths, is the variety of interesting forms of vape devices such as pipes, and even nondescript everyday items such as USB memory sticks and watches. Furthermore, vaping is gamified on social media to produce bigger, better vape clouds; e-liquids (called "vape juices") are also offered in a variety of flavours, from apple to mint, thereby downplaying their health harms.  Youths are attracted to it, thinking that it is cool and safe. Advocates for vapourisers also claim that they can help smokers quit.  

However, e-cigarettes are still inherently harmful to health and those who do not use tobacco products should continue to avoid them.

How Do E-cigarettes Work?

Manufacturers of vaping products claim that the products do not expose users to lung disease or lung illness despite the lack of conclusive evidence. 

 

E-cigarettes are battery-operated devices that release nicotine by heating up  e-liquids and turning them into vapour, which users then inhale. The main difference between e-cigarettes and regular cigarettes is the absence of tobacco leaves in the former.

Related: Get the Facts Right About Tobacco Products

What Are the Harmful Effects of Vaping?

Woman feeling unwell, possibly as a result of using a vape device. 

Despite e-cigarettes'  playful marketing, close imitation of food packaging and flavours that subtly downplay health harms, the main function of e-cigarettes is essentially still to dispense nicotine, a highly addictive substance that keeps users nicotine- dependent and eventually long-term users of vapourisers. Nicotine is not only addictive but it also leads to  acute  side effects such as increased heart rate, increased blood pressure, and even sweating, nausea and diarrhoea in more extreme cases [1].

Besides health risks, nicotine exposure during adolescence also lower youths' impulse control permanently, negatively affects the developing brain's ability to focus and learn and leads to mood disorders. Impulse control issues refer to the failure to resist an urge or impulse that may harm oneself or others. Common examples include sudden physical or verbal outbursts, internet addiction etc [2]. 

Do E-Cigarettes Cause Cancer?

In addition to nicotine, e-cigarettes and vapourisers also contain other toxic substances like fine particulate matter (PM), cancer-causing agents such as carbonyls and volatile organic compounds such as formaldehyde, benzene as well as potentially toxic metal nanoparticles like tin, lead and nickel [3] derived from the e-cigarette, heating element or vapouriser device itself.

As these are relatively new products, the harms of using these products may only surface many years later.

Can E-Cigarettes Help Smokers Quit?

While many e-cigarette retailers market their products as a cessation aid that can help existing smokers to quit smoking cigarettes, the evidence on the role of e-cigarettes in aiding smoking cessation and reducing harms remains inconclusive. In some studies, an individual who stopped smoking cigarettes and shifted to using vapourisers would be considered to have successfully quit but there may be potential health implications associated with this long-term use of vapes. Other research suggested that vaping may prolong the addiction to nicotine and hinder cessation. [3] 

E-Cigarettes – A Gateway for Youths to Pick Up Smoking

In youths, e-cigarettes can serve as a gateway to pick up smoking. E-cigarettes are widely available online, albeit illegally (do note that penalties for purchasing e-cigarettes from overseas are harsh and can incur fines of up to $10,000) There is a growing number of studies from overseas such as Taiwan [4], UK [5], US [6] and Canada [7] that reported that never smoker youths who experiment with e-cigarettes at least double their chance of smoking cigarettes later in life. 

Related: Smoking — Habit or Addiction?

The Dangers of an Unregulated Industry

Both the U.S. Food and Drug Administration and the U.S. Centres for Disease Control and Prevention have begun to investigate incidents of lung injuries associated with vaping. 

 

Besides the known harmful effects of e-cigarettes, dabbling in an unregulated industry also exposes you to many other risks and long-term effects.

The list of ingredients, for example, can vary widely between different manufacturers. Without a regulatory body to monitor the ingredients that go into a vaping device, you cannot be certain what harmful, toxic chemicals might be contained within the e-liquids.

Furthermore, because e-liquids come in a concentrated form, users may expose themselves to potentially toxic levels of nicotine when refilling the e-cartridges [8]. Harms of vaping are not only limited to health harms, it has also been linked to physical injuries, with a growing number of cases of vapourisers and e-cigarettes exploding and catching fire as reported in the media [3].

While most e-cigarettes on the market today contain nicotine and flavoured chemicals, it is worrying to think that these same devices could potentially be used in the future to dispense harder and more harmful drugs.

In conclusion, because e-cigarettes have only been on the market for around 10 years, more long-term studies still need to be conducted. What you can be certain, however, is that e-cigarettes are illegal and come with a host of already identified negative effects, as well as further unknown ones.

Resources for Quitting

Join the I Quit Programme and remain smoke free for 28 days and you are 5 times more likely to quit smoking. You can nominate your loved ones as a supporter when you sign up for the programme. Validate your smoke-free status and redeem a HPB eVoucher* worth $50 at the 28th day milestone. Keep going and you'll also receive eVouchers* worth $30 and $20 at the 3rd month and 6th month milestone respectively!

*Terms and conditions apply.

Download the HealthHub app on Google Play or Apple Store to access more health and wellness advice at your fingertips.


References

  1. Mishra A et al. Harmful effects of nicotine. Indian J Med Paediatr Oncol, 2015. Jan; 36(1). Assessed on 1 Feb 2022: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846
  2. Centers for Disease Control and Prevention, 2016, https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm. Accessed 1 Feb 2022.
  3. WHO Report on the Global Tobacco Epidemic, Addressing new and emerging products, 2021. Geneva: World Health Organization; 2021. WHO Report on the Global Tobacco Epidemic, Addressing new and emerging products. World Health Organization, Geneva, 2021, https://www.who.int/publications/i/item/9789240032095. Accessed 1 Feb 2022.
  4. Chien Y et al.  Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia.  Int J Environ Res Public Health 2019. Apr; 16(7):1145.
  5. Conner M et al. Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-month prospective study. Tob Control 2019.
  6. Soneji S, Barrington-Trimis J, Wills T.A, et al.  Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults. JAMA Pediatrics 2017.
  7. Hammond D et al.  Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study.  CMAJ 2017.
  8. National Institute on Drug Abuse. 2016.  https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes Accessed 1 Feb 2022.

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