Public Health at Risk as E-Cigarettes Gain Popularity Among Youth

There were approximately 8,000 illegal use of e-cigarette cases last year

The 40% increase in the number of illegal cases related to e-cigarettes last year, has gained attention. In response to inquiries from Members of Parliament, Mdm Rahayu Mahzam, Senior Parliamentary Secretary of the Ministry of Health and the Ministry of Law, stated in parliament that there were about 8,000 illegal cases related to e-cigarettes last year. This marks a 43% increase from around 5,600 cases in 2022. Approximately 7,900 of these cases involved the purchase, use or possession of e-cigarettes.

The illegal sale of e-cigarettes has surged in recent years, alongside the and the use of e-cigarettes among local youths. Despite knowing that e-cigarettes are illegal, why do more people risk going against the law just for a puff?

37 Countries, including Singapore, Ban the Sale and Distribution of E-Cigarettes

Globally, 37 countries ban the sale and distribution of e-cigarettes. Singapore is one of them.

According to the Health Hub website, around 37 countries have banned the sale or distribution of e-cigarettes and emerging tobacco products, such as heated tobacco products and other e-vaporisers. With growing awareness of the dangers of e-cigarettes, more countries are opting for stricter regulations or complete bans.

In the Asia Pacific, countries including Australia, Japan, South Korea, Bhutan, Brunei, Cambodia, India, Nepal, Sri Lanka, Thailand, and Singapore, have banned Electronic Nicotine Delivery System (ENDS). E-cigarettes are the most common type of ENDS.

Despite these bans, outlaws continue to distribute e-cigarettes recklessly, exploiting technology to gain reach. Our reporter discovered that a simple online search using relevant keywords lead to numerous local websites selling a wide variety of e-cigarettes, including disposable devices and cartridges, in various shapes and flavours. Each product is priced as low as $14.

After placing an order, customers provide their contact information and delivery address, and pay in person without any form of identity verification or age restriction. It is understood that to avoid police detection, e-cigarette transactions are usually conducted in person, with cash exchanged for goods. Electronic transfers or cashless payment methods are rarely used.

Besides the web, Shin Min also discovered that there were several Telegram group chats selling e-cigarettes. The smallest group chat had more than 8,000 members, and the largest boasted an astonishing 40,000 members.

These groups are usually created by multiple e-cigarette merchants. On average, “menus” listing hundreds of e-cigarette flavours from different merchants appear every two to three seconds.

Posing as a buyer, our reporter privately messaged a business owner asking for the “menu.” Some merchants simply told the reporter to visit their web pages directly as they offered too many flavours and varieties to list. They also stated that all transactions would be conducted in cash and in person.

Some merchants err on the side of caution. When this reporter pretended to be a minor, one merchant not only refused to sell, but also threatened to report the incident to the school. The merchant’s account was deleted shortly after.

Case Study

Eight years of e-cigarette addiction causes a health scare for one university student

Two years ago, a university student began experiencing symptoms such as the occasional cough and fever.

The 26-year-old, who had been vaping for eight years, shared three reasons for his addiction. Firstly, vapes leave a cooling effect. Secondly, the price of an e-cigarettes is a third of traditional cigarettes. Lastly, e-cigarettes leave only a mild odour and can be smoked discretely indoors.

However, at the age of 24 two years ago, the student grew more sensitive to e-cigarettes, which lead to adverse reactions.

“I coughed frequently and had a lot of phlegm. I would cough every half an hour. I developed fevers and inflammation. Once, I had a fever thrice in two months.”

To confirm that e-cigarettes were the cause, he stopped vaping for two weeks and noticed a significant reduction in his symptoms.

Despite knowing the health risks, he admitted that e-cigarettes are more addictive than traditional cigarettes.

“I tried to quit vaping, but many of my friends in university vaped too. In the end, I got more addicted and couldn’t quit.”

Another interviewee, a 42-year-old freelancer who chose to remain anonymous, revealed that he first tried a friend’s e-cigarette five years ago and has been hooked ever since. In addition to purchasing them online, he would implore friends travelling within Southeast Asia to bring back e-cigarettes as they are small and easy to conceal.

However, law enforcement efforts to crack down on e-cigarettes have intensified. Local measures now include joint operations at sea, land and air checkpoints. Inspection of incoming travellers have also been tightened to prevent the e-cigarette problem from worsening.

What are the Harmful Effects of E-Cigarettes?

In addition to the health harms that traditional cigarettes can bring, such as cardiovascular disease, e-cigarettes have also been linked to acute lung diseases.

In an interview with Professor Tan Huay Cheem, Chairman of the Singapore Heart Foundation, he shared that e-cigarettes are similar to traditional cigarettes, and can cause cardiovascular disease. This includes heart attacks, irregular heart rate and even heart failure.

Moreover, e-cigarettes contain harmful chemicals. The Health Sciences Authority pointed out that e-cigarettes contain particulate matter, carcinogens such as carbonyl compounds, and organic volatile mixtures. Common carcinogens in e-cigarettes include formaldehyde and benzene, among which formaldehyde can cause infertility. E-vaporisers such as e-cigarettes and heated tobacco products also contain tiny particles of toxic metals such as tin, lead and nickel.

E-cigarettes, like traditional cigarettes, can cause nicotine addiction. Nicotine affects a teen’s brain development. It impairs their attention span and learning abilities, permanently weakens the teen’s ability to control impulses, and could lead to mood disorders. Signs of a weakened ability to control impulses include sudden emotional outbursts, Internet addiction, compulsive eating, and other issues.

Prof Tan also highlighted reports of some e-cigarette users developing severe lung conditions including lesions, sometimes resulting in intensive care unit admission or even death.

“Vaping is not a method to quit traditional cigarettes, and they cannot be used as a substitute,” he emphasised.

Teacher: Students as Young as 13 Smoke E-Cigarettes

Teachers report that an increasing number of students, some as young as 10 years old, are smoking e-cigarettes. They urge schools to impose stricter penalties to serve as a deterrent. A male teacher mentioned that students were vaping in school toilets, and some were even making e-cigarette transactions on campus.

“Schools should conduct more surprise inspections and increase education efforts,” he said.

Another female secondary school teacher revealed that many students between the ages of 13 and 17 have been caught vaping, with a majority of them from secondary three. Besides the toilets, students also vape off-campus at camps.

“Perhaps it’s because e-cigarettes are easier to buy and hide as compared to the past. Students now have more pocket money too,” she suggested.

She said that although there have been surprise inspections at schools, some parents are not only aware of their children’s e-cigarette use, but they are users themselves.

A teacher at a private school told Shinmin that his students, aged 16 to 18, would vape whenever they were alone, in corridors and toilets.

“There have been several punishments, including warnings and confiscation of e-cigarettes, but as far as I know, no one has been expelled.”

The authorities recently announced that from March this year, all offenders who are caught for the purchase, use and possession offences for e-vaporisers, including offenders in schools and institutions of higher learning, will be referred to the Health Sciences Authority. First-time offenders face fines of up to $2,000.

Counsellor: It Takes Four Weeks to Six Months to Quit Smoking

Founder of Success Alliance Enrichment, pharmacist, and smoking cessation counsellor Mr Sean Ang, has been in the industry for 14 years. His clients who seek help are between 10 to 70 years old. Since 2014, he has noticed a worrying trend in the rising number of young e-cigarette smokers in Singapore.

He emphasised that e-cigarettes are neither safe nor healthy. Nicotine increases blood pressure, narrows blood vessels and can cause serious heart problems. There have also been reports linking e-cigarettes to lung disease. Moreover, the long-term effects of e-cigarettes remain unknown.

Mr Ang pointed out that the process to quit smoking varies from person to person. He starts by understanding their smoking patterns, motivations, and potential obstacles that hinder him/her from quitting. He then tailors a plan with clear steps his client can take.

“Some individuals may be suitable for nicotine replacement therapy (e.g., nicotine sprays, nicotine gums, etc.),” he said. “As a pharmacist, I can fill their prescriptions.”

Recommendation for Corporate Sector to Join Forces in Inspection and Banning

How long does it take for a smoker to quit? According to Mr Ang, the process could take 4 weeks (for low-frequency smokers) to 6 months (for regular smokers). The duration is also dependent on factors such as age, medical condition, and the duration of vaping.

Experts suggest that the authorities should collaborate with the corporate sector to monitor and ban e-cigarettes.

Mr Ang believes that the government should cooperate with private organisations to proactively prevent the formation of e-cigarette chat groups or platforms. These private organisations could provide moderating services to help identify and ban these online sales channels.

“In light of the rise in young e-cigarette users, our country must tighten its control measures. This includes taking a proactive stance to limit the supply of e-cigarettes to youths, coupled with more straightforward and open education efforts,” he said.

The Ministry of Health is Reviewing Penalties for Illegal E-cigarette Activities

The Ministry of Health is reviewing the penalties for e-cigarette-related violations. At the Ministry of Health Committee of Supply Debate 2024 on March 6, Senior Parliamentary Secretary of the Ministry of Health and the Ministry of Law, Mdm Rahayu Mahzam stated that in addition to strengthening enforcement and education measures, the Ministry of Health is evaluating the penalties under the Tobacco (Control of Advertisements and Sale) Act.

Under the Act, possessing, smoking, or purchasing e-cigarettes is punishable with a fine of up to $2,000.

To curb the sale and supply of e-cigarettes, the Ministry of Health and the Health Sciences Authority are working with the Ministry of Communications and Information and the Infocomm Media Development Authority to strengthen the detection and removal of online e-cigarette sales and advertising.

Mdm Rahayu also highlighted that in 2023, the Health Promotion Board helped 4,700 adults and 2,300 teenagers and children to quit smoking.

Original article from Shin Min Daily News, published on 15 Apr 2024.