Frequently Asked Questions
Vaping products are currently not regulated in South Africa. Specifically, in South Africa, e-cigarettes are not covered by the Tobacco Products Control Act or the Medicines Act. National Government has proposed the Control of Tobacco Products and Electronic nicotine Delivery Systems Bill in hopes to regulate vapour products in the same way as cigarettes.
Although without risk, vaping products are less harmful alternatives to combustible cigarettes. According to the World Health Organisation, smoking remains the leading cause of preventable death worldwide and is responsible for killing six million people annually, especially among the world’s low- and middle-income population. VPASA considers vapour products to be the most effective alternative for smokers. We believe these products offer smokers a similar experience, devoid of dangerous smoke. The body of supporting research and knowledge in respect of the lifestyle advantages and disadvantages of vapour products in South Africa is growing. VPASA seeks to contribute to this and work in partnership with Government, regulators as well as other key stakeholders to ensure the industry is well-regulated, and that consumers have access to all available scientific and health information. With sensible regulation, vapour products have the potential to make a major contribution towards social inequalities in health.
EVP liquid is made from nicotine, propylene glycol and/or glycerine with flavourings. There is no side-stream vapour released as you would find in a cigarette, only exhaled aerosol. Public Health England’s report has not found any health risks of passive vaping and their upcoming 2022 report will review the evidence again.
While surveys show that young people experiment with EVP’s, there is no evidence to support concern about EVP’s increasing youth smoking rates. The gateway myth is concisely detailed by Clive Bates of ‘The Counterfactual’, a vaping advocacy blog.
Being addicted to smoking is harmful. Cigarettes are lethal because they burn tobacco, not because of nicotine. Vapour products offer smokers an escape from decades of addiction to smoking. The e-liquid comes packed in different nicotine strengths categorised in milligrams: ranging from 2mg in freebase liquids, through to 60mg in nicotine salt liquids. There is even 0 milligrams which contains no nicotine for those who just want to vape without the nicotine. This means consumers of vapour products have a wide range of choice when it comes to buying vapour products.
Around 12,000 of us Google this each month in the UK. And you can understand why – there are a lot of mixed messages out there when it comes to e cigarettes, with many headlines proclaiming that vaping is just as bad or worse than smoking. Some studies have shown harmful effects of e-cigarette vapour. However, these are usually conducted on animals or cells in the lab, rather than with people. And the concentrations of e-cigarette vapour used are often much higher than people would be exposed to in real life. Whilst these studies are useful to explore the potential effects of e-cigarettes, they shouldn’t be used to estimate the real-world impact on humans. The best evidence available in humans shows e-cigarettes are far less harmful than smoking. For example, one study found significantly lower levels of exposure to harmful chemicals in people who switch from smoking to vaping compared with those who continued to smoke. These levels were similar to people using nicotine replacement therapy (NRT). There’s also no good evidence that second-hand e-cigarette vapour is harmful to bystanders. In fact, research shows that vaping is far less harmful than smoking. (https://news.cancerresearchuk.org/2021/04/26/e-cigarettes-what-weknow-and-what-we-dont/)
All conventional cigarettes produce tobacco smoke that contains diacetyl, and the levels of diacetyl in cigarettes are a lot higher than those produced by e-cigarettes. Daily exposure to diacetyl from smoking is therefore 750 times higher, on average than exposure to diacetyl from vaping. Average inhaled daily diacetyl dose associated with smoking vs. vaping: Vaping: 9 micrograms and Smoking: 6718 micrograms.
Despite the much higher levels of diacetyl in tobacco smoke than in e-cigarette vapour, smoking has not been associated with “popcorn lung.” Thus, it is clearly misrepresenting the scientific evidence to conclude that vaping increases the risk of “popcorn lung” or that vaping causes “popcorn lung.”
“The high levels of formaldehyde emissions that were reported in a previous study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e-cigarette users and are thus avoided.” – Konstantinos E Farsalinos (https://pubmed.ncbi.nlm.nih.gov/28864295/)
Testing limitations and establishing safety thresholds is important, however, more emphasis should be placed on outcomes based on realistic usage. It is unlikely that car seatbelts would achieve the same safety rating if tested in a scenario where the vehicle was travelling at 300km/h before coming
to an immediate stop.
EVALI (e-cigarette or vaping use-associated lung injury). Correctly stated, this event has received much attention and has been linked to tetrahydrocannabinol (THC) containing e-cigarettes with vitamin E-acetate. It needs to be noted that nicotine e-liquids cannot contain Vitamin E-acetate or any other oil (a lipid) as these liquids are water-soluble and will not mix. This event extended over a 7-month period between 2019 and 2020, with a peak experienced in September 2019, and only occurred in the USA. No EVALI cases were reported in any other region or country worldwide. It
also needs to be noted that EVALI has not occurred prior nor since, which logically suggests a specific contamination issue. The event has been strongly linked to the illicit trade, even prompting the Center For Disease Control (CDC) to place a recommendation:
“CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping, products,
particularly from informal sources like friends, family, or in-person or online dealers.”
Causes: Chest injury, Lung disease, Ruptured air blisters, Mechanical ventilation. There has been a hand full of cases. It is more common in tobacco and marijuana smoking. “Vaping may lead to spontaneous pneumothorax, but there are few published reports on this phenomenon” – (https://casereports.bmj.com/content/14/12/e247844)
Many of the cancer-causing chemicals are produced from burning tobacco in cigarettes or roll-your-own tobacco. If you’re a smoker, switching to vaping will greatly decrease your risk of cancer.
There are some toxins in vapour, but these are generally at much lower levels than what’s in cigarette smoke, or at levels that are unlikely to cause harm.
Research shows that ‘most toxins responsible for health damage from smoking are absent in e-cigarette aerosol and that those that are present are there at much lower levels …than in tobacco cigarettes.’ For more information, check out: The Evidence Review of E-cigarettes and Heated Tobacco Products 2018, a report commissioned by
Public Health England.
McNeill et al, 2021 (Vaping in England: an evidence update including vaping for smoking cessation,
February 2021 (publishing.service.gov.uk)
Almost all of the harm from smoking comes from the inhalation of tobacco smoke rather than nicotine. There are some risks to health from nicotine but overall they are relatively minor.
While some smokers can stop smoking without any great problems, others continue to smoke despite a strong desire to stop and multiple attempts to do so. The addictive potential of smoking is linked closely to the tobacco alkaloid nicotine. The Royal College of Physicians’ 2000 report on nicotine addiction states that “it is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration” and concludes that: “Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.” It is important to note that it is the delivery of nicotine through tobacco smoke which makes it potentially addictive as this is the fastest way of delivering nicotine to the bloodstream.
Tobacco smoke may also include chemicals that make nicotine more potent because nicotine separated from tobacco is not particularly addictive. Studies have shown that animals do not self-administer nicotine readily even if provided rapidly, and nicotine replacement treatments have virtually no addictive potential for non-smokers and only limited appeal to smokers. (https://ash.org.uk/wpcontent/uploads/2019/10/NicotineAndAddiction.pdf)
Animal model studies have found that nicotine can affect the maturation of brain parts associated with executive function and decision-making, potentially leading to more impulsive behavior, cognitive deficits, and greater likelihood to self-administer other drugs.134,135 In addition, there is evidence in humans of neurological changes attributed to nicotine in the brains of adolescent smokers, interpreted by some as reflecting similar harmful effects to those in the animal models. These studies lead some researchers to suspect that adolescent nicotine use in any form may lead to long-term structural and functional brain changes with associated negative implications for cognition or impulse control. However, given species differences and questions about the relevance of experimental animal nicotine dosing paradigms to human use patterns, the validity of extrapolation
to humans is speculative. Whether impaired brain development with behavioural consequences occurs in young nicotine consumers is difficult to determine because of potential confounding of genetic and socioeconomic factors, the influence of other substance abuse, and the role of preexisting neuropsychiatric problems associated with youth smoking. Research has yet to isolate nicotine use in the adolescent years and then examine later sequelae.