Stand Strong Against Vaping

Wander through any bustling hangout spot or busy area in major cities like Kathmandu, and you’ll quickly witness young people with sleek pods in hand. As they puff thick clouds of flavoured mist, you can’t help but wonder: what is it? Behind the allure of these captivating vapour bursts lies a chemical deception – a modern-day poison quietly ensnaring Nepal’s youth. This is the unsettling, yet alarming, reality of vaping.

 Vaping is more than an addiction. The aggressive marketing of e-cigarettes over the last few years as a nicotine-cessation device has lured youth into its mockery. Little did they know how nicotine-containing pods would help cease nicotine. It's a hoax. Instead, an e-cigarette, a device that generates nicotine vapour without smoke, comprises more harmful constituents. The mechanism is usually the heating of a liquid solution containing nicotine and other chemicals. As a result, the aerosol produced from e-cigarettes is vaped. 

The e-liquid solution formulated of nicotine, tetrahydrocannabinol, methamphetamine, methadone, metals, and flavouring additives exposes toxins and carcinogens. This leads to severe health effects like nicotine poisoning, injury to the gastrointestinal system, trauma from battery explosions, and cardiovascular and neurological systems. In 2019, the U.S. Centres for Disease Control (CDC) reported numerous cases of “EVALI” (E-Cigarette or Vaping Associated Acute Lung Injury). The symptoms included increased heart rate, shortness of breath, increased blood pressure, coughing, chest pain, and even death.

 This led to over 2,800 hospitalisations, including 68 deaths, raising questions about the risk and safety of vaping. Although clinical signs and symptoms of EVALI are not specific, they are similar to respiratory disease, where the major diagnostic criteria include a history of e-cigarettes and vaping 90 days before the onset of symptoms.

A new generation is hooked on this current trend. E-cigarettes, marketed as "safe" or "healthier" alternatives to tobacco, are now entangling non-smokers too. During an informal observation of vendors selling vaping devices, most acknowledged that consumers are youth, often high school and college students. Although some products were labelled indicating a minimum age of 21 for purchase, these warnings were ignored. 

Verification of age was rare. Instantly, a young buyer walked up, asked for flavour pods and left with a nicotine device in their pocket. "I vape far more than I ever smoked cigarettes. With cigarettes, I might light up once every couple of hours. But now, with my e-cigarette in hand, I find myself taking a puff every 10 minutes. Sometimes, I don’t even realise it. Unlike smoking, it smells sweet, and my clothes and breath do not stink, a young vape user said.

And, where are these products coming from? A majority hail from China, followed by imports from the United States and the Middle East. The market is flooded with shiny, sleek, colourful pods dangerously accessible. “A disposable pod boasts up to 2000-4000 puffs per device, and others are refillers depending on price,” said a retailer. Sold for as little as Rs. 1,000 and above, these devices are sold mostly on online platforms, while shops have mushroomed in the last few months, offering over 200 flavours. “First, we sold it online, seeing the market demand; we have recently just opened our physical store, said a seller.

One of the customers said, “You can buy an e-cigarette anytime, anywhere. It’s easy. Walk into a hookah shop, scroll through a few clicks on online platforms, and it’s yours. No questions asked. No age verification. It’s that simple."

Regardless of its form, nicotine is still nicotine. To make matters worse, many sellers have little understanding of the dangers associated with these products. Their misguided belief that e-cigarettes are tobacco-free, merely flavoured, and a less harmful alternative to smoking is deeply concerning. In the worst-case scenario, these flavoured pods are so addictive that users end up consuming higher doses of nicotine through vaping than they would through smoking. This, however, in no way implies that any of these products are safe.

Then the economics come into play: a double-edged sword. 

"A vape costs Rs. 3,000 and lasts a month. But cigarettes? 150 rupees a day, which adds up to Rs. 4500 a month. So, in a way, vaping feels cheaper," said a young user consuming both cigarettes and e-cigarettes.

When asked about health risks, the response is often indifferent.

"I know smoking causes cancer and infertility; everyone knows that. But with e-cigarettes? I’m not sure. Nobody talks about that. And honestly, it doesn’t feel as dangerous."

While the Tobacco Product Control and Regulation Act (2011) bans smoking in public places and restricts tobacco advertising, promotion, and sponsorship, it fails to explicitly regulate e-cigarettes and vaping products. There have not been any enforceable age restrictions, standardised packaging warnings, or advertising bans specifically aimed at these products. Lately, even influencers are seen promoting vaping on social media platforms. A legal loophole is observed that is profiteering sellers and distributors at the expense of our youth.

Who seems to be responsible for regulating and monitoring? Well, it's a shared responsibility that lies with multiple stakeholders. Stringent legislation with penalties should be introduced. Clear age restrictions, packaging guidelines, flavour bans (especially those targeting minors), and advertising prohibitions are essential. The regulatory authorities should step up for investigation of standards and quality control. While educational institutions have their part to educate, it is quintessential that parents and guardians stay informed on vaping risks and how their children are lured into the addiction. To debunk myths about vaping, testimonials from individuals affected by vaping-related illnesses can make the message truly resonate.

The biggest epidemic is on its way. It’s up to us to break the chain of addiction. Recent evidence suggests the short- and long-term cardiopulmonary and neurological impacts, particularly in flavoured products, highly addictive substances, and nicotine. Vaping is engineered to create addiction, trapping individuals through deceptive marketing. 

The sooner we recognise this manipulation of harm reduction, the sooner we can protect our future generation. All the stakeholders, including government, educators, advocates, legal institutions, parents, health workers and youth groups, have a role to play in creating awareness about the harmful impact of vaping. 

(The author is a public health practitioner at TAPAS, Nepal.)