Hidden hands behind youth vaping surge

KUALA LUMPUR: The tobacco industry in Malaysia is very influential.

Their influence extends beyond health policies. In Malaysia, they have always been seen as a legitimate stakeholder in tobacco control, granting them participation in policy development.

This is perhaps why Malaysia placed 76 out of 100 countries in the Global Tobacco Industry Interference Index 2023.

The global survey looks at how governments are responding to tobacco industry interference and protecting their public health policies from commercial and vested interests, as required under the World Health Organisation Framework Convention on Tobacco Control.

Concerningly, the survey's finding is echoed in the Asian Tobacco Industry Interference Index 2023, where Malaysia ranked at the bottom in terms of deterioration.

The findings attributed Malaysia's low ranking to policy decisions like the delisting of nicotine as a poison from the Poison Act in March 2023, a move that left the e-cigarette and vape industry unregulated and free to target minors.

This is perhaps why the theme for this year's World No Tobacco Day 'Protecting Children from Tobacco Industry Interference', resonated deeply in Malaysia, a nation currently battling the dual challenges of traditional smoking and the rising use of e-cigarettes and vape among youth.

Malaysia's Troubling Ranking

According to the report, the absence of constraints against the tobacco industry's involvement in policy development and implementation vividly exposes its pervasive influence.

"The industry exerts its influence to shape government attitudes in favour of weak tobacco control measures. Their reach extends to shaping the landscape of regulations on electronic smoking devices.

"This new arm of influence is evident in Indonesia, Malaysia, and the Philippines, where regulations often align with the strong presence and influence of the tobacco industry," the report states.

To improve public image, these tobacco companies launch environmental corporate social responsibility (CSR) activities, such as installing 200 cigarette butt canisters in tourist areas.

Some tobacco companies' CSR programmes have resulted in the establishment of community garden farms and even a collaboration with a local public university for coastal cleanup. Their presence is also felt in career fairs, where the target market is youth.

Additionally, Malaysia has not increased tobacco taxes for eight consecutive years, missing critical opportunities to reduce consumption through fiscal measures.

Perhaps this scenario will improve once the Control of Smoking Products for Public Health Act 2024 (Act 852), announced by Health Minister Dr Dzulkefly Ahmad.

The Act, initially said to be approved in June, is Malaysia's first standalone legislation for tobacco and vape control. It was gazetted last February after receiving royal assent but is not yet in force.

Control of Smoking Products for Public Health Act 2024 (Act 852)

What is enshrined in the Act? First, the Act will cover matters relating to the "registration, advertisement, control of the sale and purchase of a tobacco product, smoking substance, and substitute tobacco product, and to provide for related matters."

It clearly spells out that a "smoking substance" means "any substance or any combination of substances used for smoking, including nicotine, propylene glycol, glycerol, and triethylene glycol."

Meanwhile, the term "smoking" is defined as "inhaling and expelling the smoke or vapour of any tobacco product or substitute tobacco product, and includes the holding of or control over any tobacco product or substitute tobacco product which is ignited, heated or vaporised, or used in any other method."

This means that once the law is enforced, vapes and e-cigarettes will fall under the purview of this legislation.

This is a significant move, as there have not been any specific regulations governing vapes and e-cigarettes until now.

Surge Among Youths

E-cigarettes and vapes are now the most popular nicotine products among youth, with a prevalence of 14.9 percent, significantly outpacing other products.

This finding, published in the National Health and Morbidity Survey 2022: Adolescent Health Survey by the Institute for Public Health, reveals a concerning shift in smoking trends among youth.

While traditional cigarette smoking has decreased from 13.8 percent in 2017 to 6.2 percent in 2022, e-cigarette use has surged from 9.8 percent to 14.9 percent over the same period.

This shift highlights the increasing attraction of these new tobacco industry innovations to young people.

This data underscores the urgent need for the enforcement of the Control of Smoking Products for Public Health Act 2024 (Act 852) to curb the appeal and accessibility of e-cigarettes to young people.

When it came to e-cigarette and vape usage among adolescents in Malaysia, Sarawak, Labuan, Sabah, and Kelantan took the top spots.

The prevalence in these states is about five percent higher compared to the national average of 14.9 percent.

A concerning aspect is how easily youth can obtain e-cigarettes and vapes.

Data shows that about 35 percent of them purchased these products from specific e-cigarette and vape shops, while 38 percent acquired them from friends.

More recently, a vape vending machine was set up in a mall in Kuala Lumpur where users need only pay with a card or e-wallet to complete a purchase. No age verification method was employed to prevent potentially underage customers from buying.

Poisoning Cases and Concerning New Trends

During the rise of e-cigarettes in 2015, particularly vaping in Malaysia, several incidents involving young children were reported.

The National Poison Centre (NPC) chief pharmacist, Sulastri Samsudin, recalls a case involving a 9-year-old suspected of vape poisoning.

"The child wanted to try out the uncle's mango milk-flavoured vape product. The flavour and the device, which often looks attractive to young children, were left out in the open within easy reach of the child with no safety precautions in place.

"The child then discreetly tried the vape for the mango flavour. When the doctor from the hospital called us, it was to report the case of the child being suspected of nicotine poisoning," she told Bernama.

While the trend of accidental vape poisoning among young children has decreased, there is a rising concern over substance abuse using vape products.

Sulastri noted that accidental poisonings from children drinking e-liquid refills peaked during the pandemic, but since 2022, substance abuse cases have become more prevalent.

In 2024, the NPC received calls linked to 14 cases of vape poisoning exposure.

Ten of these cases involved suspected substance abuse, with most involving youth and claims of using magic mushrooms.

This trend has worryingly continued over the past two years.

According to Sulastri, most cases referred to NPC exhibit symptoms of altered and aggressive behaviour, hallucinations, and strange conduct from vaping.

Reports suggest that youths might be inhaling drug-laced e-liquids.

"This substance of abuse can cause a number of psychiatric effects. One historical case reported to us is of a 14-year-old patient who confessed to inserting 'mushroom' into a vaping device to inhale it," she explained.

ENFORCEMENT IS KEY

Sulastri expressed hope regarding the Control of Smoking Products for Public Health Act 2024 (Act 852), which covers e-cigarettes and vapes. The previous legislation had many loopholes.

However, she stressed that the act must be strictly enforced and should monitor the design and flavouring of vaping devices, which often target younger audiences.

"The act needs to look into flavour, shape, nicotine concentration, and formulation. There is a new formulation of nicotine called nicotine salt, which is becoming a new addiction.

"Nicotine salt formulation has a higher nicotine concentration than the freebase one. The freebase ones are usually up to 20mg. It carries a bitter and harsh characteristic," she said.

In Europe, the content of nicotine in e-cigarette is regulated.

According to the European Union's Tobacco Products Directive, the directive controls the maximum sizes of the liquid bottles to 2ml for cartridges and 10ml for refill containers.

While the maximum nicotine level they can contain is not more than 20mg.

In Malaysia, the nicotine salt found here can range from 30mg to 70mg per ml.

Sulastri cautioned that a disposable nicotine salt packaging stating 5 percent nicotine can mean 50mg per ml of the product.

Therefore, a 5ml liquid will contain 250mg of nicotine.

She pointed out that new users can tolerate this formulation, making it appealing to those who have never smoked before.

The new formulation masks the bitterness and harshness typical of freebase nicotine, making it more attractive to youth.

"It is an innovation that the tobacco industry has developed so that more people will use it. This new formulation makes it attractive for youth to try.

"However, I do hope the act that will be enforced will address this as well, to control the nicotine formulation and concentration in vapes," Sulastri concluded.

-- BERNAMA

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