Vape at your own risk

A woman smokes ana e-cigarette. [Gety Images] From supermarket shelves to online vendors of recreational products, the vape is marketed as an ordinary commodity in Kenya. Packaged in vibrant colours and available in different flavours, it could pass as a product that is meant to be consumed by children. However, the vape or e-cigarette is far from that. This electronic device simulates the act of tobacco smoking. Instead of smoke from lit tobacco, the user inhales vapour, which is why using the e-cigarette is called 'vaping'. The vape consists of an atomiser, a power source such as a battery, and a container such as a cartridge or a tank. The vapour from this device is produced when the atomiser, a heating element, turns the liquid inside the cartridge into vapour. This liquid, called the e-liquid, cools into an aerosol of tiny droplets, vapour and air. The e-liquid is also referred to as vape juice or vape oil, e-juice, juice, vapour juice, smoke juice, vaping fluid, vaping juice or e-fluid. It often contains all manner of formulations since it is not regulated in many countries. It is believed that the initial idea of vaping came from Joseph Robinson in 1927, an American who wanted to create a device that would make inhaling vapour with medicinal compounds easier without the possibility of being burned. His device would use medicinal compounds. In 1979, Phil Ray and Normal Jacobson coined the term vape from their invention of a device that could use evaporated nicotine instead of combusting tobacco like a conventional cigarette and this too, was not successfully commercialised. However, in 2003, a Chinese Pharmacist Hon Lik invented the first commercially successful e-cigarette after his father, a smoker, died of lung cancer. Initially marketed as an alternative to cigarettes that would help smokers quit, the shape was initially created to mimic cigarettes. However, they are now marketed as recreational devices and the designs are increasingly being made to look like everyday devices like pens, ear pods and flash drives. They are also sold in different flavours and colours. It is no surprise that this device started gaining popularity in Kenya shortly after the ban on shisha in 2017. Compared to shisha, which had to be consumed in establishments, the vape is portable and a user can consume it at their own convenience. According to a 2017 review by the Indian Journal of Psychological Medicine, the additives typically include nicotine, propylene glycol, glycerin, menthol and camphor. However, over 80 chemicals such as formaldehyde and metallic nanoparticles have been found in the e-liquid, according to a 2018 study published in the Official Journal of the Mexican Institutes of Health. A 2013 study published in the Journal of Addiction Medicine found the e-liquids tested had as high as five times the upper threshold permitted levels of impurities including low levels of some of the toxicants found in tobacco smoke, as well as small concentrations of carcinogens. Apart from health warnings displayed by some individual vendors who sell the vape, the device is not regulated in Kenya. However, medics are warning young people about the use of vape, the e-cigarette, saying it is more harmful than a normal cigarette. Dr Jumaa Bwika, a pulmonologist (specialises in lung conditions), believes that the biggest problem with vaping is that e-cigarettes have a higher content of nicotine than most cigarettes, according to research. This means that the e-cigarette is highly addictive as opposed to strategies where people are given nicotine replacement carefully and gradually to wean them off nicotine. "The fact that young buyers will vape with no supervision leads to addiction making them yearn for more and more over time," Dr Bwika says. He adds that there is no standardisation of the additional chemicals inside the e-cigarette therefore different companies have different things in them. There have been significant reports of lung diseases caused by the chemicals in e-cigarettes in North America and Western Europe that have led to legal battles in several states in the US. "There is evidence that shows causal effects to the relationship between the e-cigarettes and the very severe lung diseases that people got and some ended up in critical care for a long time so the e-cigarettes are very harmful especially for the young people since nicotine is very harmful to the developing mind," the expert added. The other problem with e-cigarettes is with the marketing that is meant to target the younger generation, "the young people who use it will get addicted to it and provide a steady customer base for many years to come because right now, it has been made to look very contemporary like it's the in-thing." Just recently, Juul Labs, a vape maker agreed to pay USD462m in claims settlement by six US states. This is after this firm was accused of targeting teenagers by marketing vapes as less addictive than cigarettes. This firm, however, denied targeting young people but critics have been pointing out its colourful packaging, variety of flavours, and use of young models in ad campaigns. He says that the pricing is also meant to get this captive customer base to make it easier to smoke the e-cigarette and it is just like building a customer base for future tobacco users. In Kenya, vape pens have been available from as low as Sh800 on online shops and other physical shops in towns where anyone can easily order and it gets delivered within a few hours to a few days from the day one ordered. "If you look at the people who are targeted and those who vape, the majority are people who have never smoked, to begin with, so the economics of it or the strategy is that they are looking for a long-term market," Dr Bwika says. He adds that vaping will have adverse effects on passive smokers as well as the environment brought about by the chemicals being released into the air. From various fronts of research, Dr Bwika says no evidence shows that e-cigarettes help people quit smoking especially when one compares the benefits to the risks, in that the risks outweigh the benefits if any. Healthcare providers in Kenya and the World Health Organization (WHO) are not convinced that e-cigarettes are the best way to help people stop smoking and that there are more and better-tried smoking cessation methods that can help people who are addicted to tobacco to quit smoking. Some of these may include pharmacotherapy which are medications that have nicotine that is used to replace the nicotine craving and whose dosage has been standardized. "For instance, we know that a particular patch delivers by slow release 21mg of nicotine over 24 hours while this other one delivers 14mg or 7mg and we can control their intake, meaning we have seen a breakthrough in their usage," says Dr Bwika. Additionally, he says there is cognitive-behavioural therapy; there is a psychological dependence on tobacco and cigarette that can be countered by cognitive-behavioural therapy. These methods can be done alongside group support such as is done with alcohol addiction and there is evidence that such people who have used these interventions have been able to quit smoking than trying to quit all by themselves. His plea to the government is to regulate or completely ban the sale and use of e-cigarettes owing to the overwhelming data and science against them. "This product that has a very addictive chemical inside it, the dosing of that chemical is a lot more than in standard cigarette and it's marketed to target young people and being shown to have harmful effects in addition to the nicotine," he says. "Any well-meaning health-conscious person will go towards regulation, banning access for younger people and this is something the government can do to reduce exposure to young people," Dr Bwika says.

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