by Dr Helmy Haja Mydin. First published in The News Straits Times 21 September 2015

CHILDREN are great imitators. My toddler recently starting “praying” — not quite the full version, but she would imitate the rituals and say “Allahu akbar”.

Although one hopes that she would eventually develop a proper understanding of worship, I am fully aware that she is going through this phase because she has observed her parents and the act appears to be something that we condone.

Unfortunately, imitation and the need for social approval can also extend to less savoury behaviour and activities.

It is in this context that the burgeoning use of electronic nicotine delivery systems (ENDS) or e-cigarettes is worrying.

Malaysia, as a signatory of the World Health Organisation’s Framework Convention on Tobacco Control, has taken significant steps to denormalising nicotine use. This includes the banning of smoking in public places and imposing restrictions at work.

Such measures are aimed primarily at protecting non-users and preventing initiation by our youth. The long-term aim is to make Malaysia a “smoke-free” country, defined as having a prevalence rate of less than five per cent.

E-cigarettes threaten to undermine these efforts. Vaping, the verb for e-cigarette use, has been taking off to the tune of US$6 billion (RM25 billion) globally. This figure will continue to increase exponentially.

E-cigarettes are being portrayed as a lifestyle choice, an “in-thing” that is safe for consumption. This belies the fact that its primary ingredient, nicotine, is addictive and contains other chemicals, such as the cancer-causing acetaldehyde.

Although there is little doubt that e-cigarettes are relatively safer than normal cigarettes, the wide variation in their contents preclude them being used medically for the purpose of quitting smoking.

Furthermore, the data supporting its use as a method to quit smoking is sparse. Should future research provide convincing evidence that e-cigarettes have a role in smoking cessation, then the Ministry of Health should look into using e-cigarettes as part of its smoking cessation programmes. Until then, policy should be based on current evidence.

Unfortunately, data from the United States (the world’s largest e-cigarette market) has demonstrated the negative public health effects of e-cigarettes among youth.

The Centers for Disease Control and Prevention reported that youth use of e-cigarettes tripled from 2013 to 2014, including those who were not cigarette smokers.

A recent study in The Journal of the American Medical Association provided evidence that high school students in Los Angeles were more likely to use tobacco products if they were users of e-cigarettes.

As the journal Chest noted in the article published in September 2015: “What all of these studies tell us collectively is that the cohort of e-cigarette users is growing, young, and open to using both e-cigarettes and traditional tobacco products: not a group of seasoned smokers trying to quit or looking for an alternative to the traditional cigarette”.

The use of e-cigarettes is undesirable in youth as it is not only addictive (and thus providing companies with a source of long-term revenue), but acts as a gateway to more dangerous substances.

Besides leading to the use of normal cigarettes and shisha, there have also been reports of e-cigarettes being used to inhale cannabis and other illicit drugs such as crystal meth.

The argument that e-cigarettes are sold primarily for the use of current smokers is further undermined by the increasingly aggressive marketing that is very reminiscent of tactics used by the tobacco industry in the past. This includes glamorising the product and lacing it with sexual connotations.

According to the United Kingdom’s Advertising Standards Authority, the most complained-about advertisement of 2013 was of one by the e-cigarette company VIP, whose product advert featured a young woman suggestively saying: “I want you to get it out. I want to see it. Feel it. Hold it. Put it in my mouth.” Quite understandably, it was viewed as both sexist and degrading whilst embellishing the act of smoking.

Closer to home, we have products with colours and flavours (e.g. strawberry) that are aimed at both male and female youth. Once again, the more sexualised products are particularly disturbing. Flavours such as “breast milk” have been confiscated from school-going children.

Given the public health concerns surrounding youth, it is unsurprising that our neighbours in Singapore, Brunei and Thailand have opted to completely ban the use of e-cigarettes.

Allowing public use of e-cigarettes sends a message to our youth that society condones this addiction, which will lead to greater peer pressure to conform to expectations.

Given their inability to make informed decisions and the risk of them becoming addicts to a harmful product, it is only appropriate that the ministry puts forward proposals for a similar ban in Malaysia.

It is too late to ban cigarettes given the entrenched interests, but preventing an epidemic of e-cigarette use is still feasible and should be done to safeguard the nation’s future.

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The writer is an associate professor at Universiti Malaya and a founding associate of the Institute for Democracy and Economic Affairs

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