[COLUMNIST] Vaping: Behind the smokescreen of smoking cessation and healthier alternative

E-cigarettes and by extension vape, have been around since the early 2000s. Their popularity surged in the late 2010s, not only becoming a global phenomenon but also establishing itself as a trend among the youth.

The latter development is particularly concerning.

In 2017, the prevalence of vaping among secondary school students was 9.8%. By 2022, this figure had risen to 14.9% (National Health & Morbidity Survey/NHMS, 2023).

Amid the increasing popularity of vaping, the government controversially removed liquid nicotine from the Poisons List in April 2023, despite opposition from the Poisons Board. This move was reportedly aimed at taxing the booming vape industry (CodeBlue, 2023).

The dangers of cigarettes are very well-documented. From cardiac disease to pulmonary complications, it is proven that cigarettes have prematurely claimed countless lives. Vaping, on the other hand, was touted as not only a safer and healthier alternative to smoking but also as a tool for smoking cessation.

There is a certain truth to this.

The NHMS 2022 reported a 6.2% prevalence of cigarette smoking among adolescents in 2022—a reduction of more than half compared to 13.8% in 2017. Overall, the prevalence of smokers aged 15 years and above decreased from 21.3% in 2019 to 19% in 2023 (NHMS, 2024). However, the safety of vaping remains questionable at best.

Following the deregulation of liquid nicotine, the National Poison Centre (NPC) of Universiti Sains Malaysia (USM) reported that e-cigarette exposure accounted for 30.6% of poison-related calls in 2023, a five-fold increase compared to 2019 (New Straits Times, 2024). The report also mentioned that more 15- to 19-year-old experienced poisoning due to deliberate use of vape, with 95% of these cases being symptomatic.

Although vaping is still relatively new compare to smoking, making long-term health impact assessment challenging, multiple studies have linked it to adverse health effects, including cardiovascular and lung-related diseases (Cao et al., 2020; Peruzzi et al., 2020; Bracken-Clarke et al., 2021; Jonas, 2022). This is without taking in account vaping-associated pulmonary injury (EVALI), which costs the government over RM150,000 per treatment (Free Malaysia Today, 2024).

Even as a tool for smoking cessation, vaping has not been proven effective in the long term.

Despite being an effective tool to motivate traditional cigarette smokers to quit, the long-term efficacy of vaping for smoking cessation remains limited (Ashour, 2023). Furthermore, while studies shown mixed result regarding smoking relapse among those who use e-cigarettes to quit, a systematic review of longitudinal studies found a greater risk of relapse in this group (Everard et al., 2020; Pierce et al., 2021; Barufaldi et al., 2021).

Although a significant number of people who vape report doing so to quit traditional smoking, a significant proportion are dual users—those who simultaneously use both traditional cigarette and e-cigarettes.

One recent study involving students from four universities in Malaysia (three public universities and one private university) found that dual users constituted the majority across all demographics, including age, ethnicity, income, or CGPA (Elsaieh et al., 2023). The only exception was among students with CGPA between 2.4 to 2.8, where vape-only users and dual user were evenly split at 50%.

Furthermore, vaping also has the potential to serve as a gateway for youth to start smoking traditional cigarettes (Chatterjee et al., 2016; Chan et al., 2020; Al-Hamdani & Manly, 2021). Friedman and Xu (2020) suggest that e-cigarettes are associated with both smoking initiation and smoking cessation. Levy et al. (2018), however, argued that although vaping might increase smoking initiation among youth, the effect appears negligible.

Nevertheless, Lim et al. (2022) found 62.5% of dual or poly users (poly users being those who use traditional cigarettes, e-cigarettes, and shisha) in Malaysia started with e-cigarettes before transitioning to traditional cigarettes and/or shisha.

Also, Salleh et al. (2023) discovered that while the majority of respondents reported vaping as a means to quit smoking, over 90% of Malaysian young adults show low motivation to quit vaping itself.

This highlights a troubling reality: the existence of e-cigarettes seems to have merely shifted users from one addiction to another—from traditional cigarettes to e-cigarettes.

Even worse, the e-cigarette and vaping industry has a history of targeting children and adolescents through appealing packaging and flavours.

Although the Control of Smoking Products for Public Health Act 2024 (Act 852) finally came into effect on 1st October 2024—10 months after being passed by Parliament and 18 months after the deregulation of liquid nicotine—it may prove too little, too late, and almost certainly too ineffective.

Even though Act 852 explicitly prohibits the sales of smoking products online, purchasing them on the internet remains alarmingly easy. A simple “Malaysia vape online” Google search reveals dozens of online stores offering vaping products, some of which are listed on popular e-commerce platforms like Lazada, or even foodpanda, a food delivery service (Google, n.d.; foodpanda, n.d.; Lazada, n.d.).

As the Member of Parliament of Kota Melaka recently stated, even if one cannot find anything directly labelled as “vape” on e-commerce platform, sellers can easily circumvent this by using alternative terms (Free Malaysia Today, 2024a).

This is evident on Shopee, another popular e-commerce platform. A search for “vape” yields no results; however, typing “vap” into the search bar immediately brings up various slangs terms and alternative key words that ultimately lead to vaping products. Alarmingly, some of these listings appear to specifically target children and adolescents, as evidenced by the excessive use of characters popular among these groups in their product design (Shopee, n.d.).

While open advertisements for vaping products have supposably diminished or become non-existent since Act 852 came into effect, it hardly makes a difference. The user base of children and adolescents has grown so large that word-of-mouth marketing, driven by customers themselves, is proven more effective than conventional advertising.

So, what can be done—and what must be done—to protect public health, most importantly the health of our children and future generations?

The enforcement of the law, obviously, needs much improvement. The government must collaborate with e-commerce platforms to halt the listing of smoking and vaping products and identify those who persist in violating the law.

Additionally, there is a need to change the narrative surrounding the perceived safety vaping products. Dangerously, more and more youths view vaping as a hobby rather than a harmful activity. To counter this trend, the implementation of Act 852’s regulations on packaging and labelling should be expediated. Currently, these regulations are only set to take effect on 1st October, 2025—an unnecessary delay that undermines public health efforts.

Beyond fast-tracking the packaging and labelling regulations, the requirement for tobacco products registration must also be prioritise. This would enable tighter control over the materials and substances used in manufacture vaping liquid or devices, which is another major concern.

Earlier, rumours circulated that vape pens containing hallucinogenic compounds were being sold. Although the NPC found no evidence of such substances in the sampled vape pens, they did discover the presence of synthetic drugs instead (Malay Mail, 2024).

The requirement for smoking products to be registered will be enforce on 1st April 2025. However, if the years of unregulated vaping products have taught us anything, it is that time is of the essence.

While various sectors, including the Sultan of Pahang, Al-Sultan Abdullah Sultan Ahmad Shah, have called for a ban on vaping products—and Johor has already banned them since 2016—a total ban may not be the best approach (Free Malaysia Today, 2024b).

Despite their obvious flaws, vaping products remain a tool for a relative harm reduction among smokers. Therefore, rather than banning them outright, a more targeted restriction on sales and tighter regulation should be considered.

The current ban on online sales, although largely ineffective due to poor enforcement, is a step in the right direction. However, it is crucial to clearly reframe vaping products not as recreational or hobbyist items but as harm reduction tools specifically for current smokers, and they should be regulated accordingly.

Restricting the sale of vaping product to pharmacies only—similar to what the Australian government has implemented—should be seriously considered (The Straits Times, 2024). Additional restrictions, such as purchase limits, could further address issues like adolescents asking adults for help in buying vaping products. A time-based purchase limit, rather than a visit-based one, could also greatly help control consumption and support smoking cessation efforts.

Finally, it is imperative for the government to revisit Generational Endgame (GEG) policy to ensure we are on a clear path towards becoming a smoke-free society.

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Chia Chu Hang is a Research Assistant at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.

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