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Is Vaping Really Helping You Quit Traditional Tobacco Cigarettes?



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Vaping, which is gaining popularity as a lifestyle trend and is an alternative to conventional smoking in what is an $80 million industry in South Africa, is not without its risks.

It has gathered steam over the last decade to become one of the most recognizable social gadgets. The mass appeal transcends age, culture and gender. From advances around Artificial Intelligence (AI) to medical explorations, handheld vaping devices have become one of the quintessential symbols of the digital era.

Vape stores have become a standard feature of every shopping precinct, whether large or small, in the upmarket areas of South Africa. The stores are as recognizable as retailers that have been around for decades and have etched themselves in the minds of consumers.

During its relatively short period in the space of consumer consumption, it has amassed polarizing views – primarily related to cost, exposure and health. Here are some of them:

Vaping to quit smoking

Various strategies have been used to market e-cigarettes, but none is more prevalent than the idea that they assist smokers to kick the habit.

Vapour Products Association of South Africa (VPASA) CEO Zodwa Velleman says electronic vaping has provided users an alternative that has been beneficial for their health as a result of quitting traditional cigarettes.

However, head of the Lung Clinical Research Unit at the University of Cape Town, Associate Professor Richard van Zyl-Smit, says the appeal of electronic vaping products (EVPs) is in the skewed manner in which it is marketed.

He says it appeals to the senses of those who weren’t smokers to begin with.

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“The attraction should be for those who are smoking and can’t give up the habit, to switch to something that is potentially safer. However, what has occurred is that the marketing comes across as trendy and as something you should be doing. So, non-smokers, those who wouldn’t have started smoking, are getting involved with vaping and are seeing it as a safe activity.”

“The appeal should be from a tobacco perspective. [It should] not be appealing to the non-vaper [and] non-smoker,” Van Zyl-Smit says.

Velleman says she cannot dismiss the claim that there would be interest from individuals who were not previous smokers but this would be a small percentage compared to former smokers who have completely switched from traditional cigarettes to vaping.

She says a study conducted by global management consulting firm Canback Consulting found that, “the people who try e-cigarettes are less than 0.1% and that is not the bulk of the users. The bulk of the users are your historic traditional smokers. So, you can say that 99% [of EVP users] are people that were smokers”.

Executive Manager at Vape King in South Africa, Sharri Van Zyl, observes that those who initially take up vaping use it as a means, “to get off cigarettes and then adopt it as a lifestyle later on”.

Founded in 2012, Vape King is one of the few recognizable e-cigarette retailers in an industry that is currently worth R1.1 billion ($80.4 million) in South Africa. A majority of the vaping stores operating in South Africa are “moms and pops corner shops”, according to Velleman.

These are small shops that are owned and run by families who are not commercially recognizable brands, she says. 

Van Zyl-Smit says the assertion that vaping leads to the quitting of traditional cigarettes, which contain carcinogens that cause cancer, is tenuous. He says he would not encourage smokers to take up vaping to quit cigarettes.

“When one looks at vaping as an option to quit smoking, the data is unfortunately very poor. It has helped some people. And certainly, if you look on the internet…there will be some people who tell you, ‘I smoked for 20 years and I quit. It’s the best thing ever’. 

“One person, unfortunately, from a scientific point of view, does not make a study.

“It’s not to say they [e-cigarettes] won’t help an individual. But if we, as a community of people, who are looking after smokers, are saying, ‘what are the best options?’. Vaping is way down the list of best options to help you quit.”

While 32-year-old Kim Salinger (not her real name), who has been vaping for two years, says it helped her quit smoking, she says her initial plan was to “not smoke anything but I’m still vaping”.

Associate Professor Richard van Zyl-Smit, says the appeal of electronic vaping products (EVPs) is in the skewed manner in which it is marketed. Picture: Motlabana Monnakgotla

“It makes me feel like it’s not such a bad habit. Also, now, is a habit that’s with me wherever I go.”

She says she eventually intends to quit.

This may prove to be challenging because of the physical and psychological effects EVPs have on the body, Van Zyl-Smit says. 

“There’s no question that vaping is addictive. Both tobacco cigarettes and vape liquids contain nicotine. There are a few nicotine-free vape liquids, but a majority of them contain nicotine.

“Nicotine is the substance that causes the physical chemical addiction.

 “There is also the behavioral element, that when you’re feeling anxious or angry, you grab a cigarette. And similarly, because vaping has that same mechanism whereby, ‘I respond to my environment… by grabbing a vaping device’, bringing it to your mouth, inhaling and getting a positive feedback.

“So, it becomes both a chemical addiction and a habit. Both of them link together. Even if you take, nicotine-free vape, you will still become addicted because of the habit element, and to necessarily the chemical addiction. Which, is more important when trying to give up [a habit],” Van Zyl-Smit says.

Despite the varying insights, all parties seemingly spoke with the same breath – but for different reasons, saying that vaping was still in its infancy and more research was being conducted.

Health risks versus health benefits

The consensus on the hazardous effects of traditional cigarettes is unanimous across all spectrums. Not so much with e-cigarettes, although there have been reports that claim their flavorants have adverse effects on the respiratory system. The most prominent being bronchiolitis obliterans, commonly referred to as ‘popcorn lung’.

“It is a condition that damages your lungs’ smallest airways and makes you cough and feel short of breath. It’s sometimes caused by breathing in a chemical used to flavor microwave popcorn. But other chemicals or lung illnesses can also cause popcorn lung,” webMD writes.

The chemical called diacetyl in the popcorn flavorant that causes this illness has previously been used in some vapor liquids.

Salinger, who emphasizes that she does not enjoy the sweeter vape flavors and has “defaulted to the mint”, says she has read a fair amount about popcorn lung and is personally concerned about it but also commends the improvements to her health since she started vaping.

“I’ve seen improvements in my health, my breathing, my skin since I stopped smoking cigarettes. But there are still other problems which are attributed to vaping,” Salinger says.

Van Zyl-Smit says the question of the adverse health effects of vaping needs be viewed from two perspectives – the smoker and the non-smoker’s perspective. 

From a non-smoking point of view, research has been conducted, “showing that if you expose people and animal cells to vaping liquid, you can induce a whole lot of changes that look similar to what would happen if you exposed them to cigarettes”.

“And so there is data to show that if you are vaping, you may have increased risks for viral infections, for pneumonia… it may increase your risk for TB [tuberculosis].”

“There are a whole lot of small experiments showing that if you vape, there are definitely biological factors that may cause problems.”

From a smoking point of view, Van Zyl-Smit says: “If you are smoking and you switch to vaping, your risk for infections and cancer seems to be reduced. But to what extent, we haven’t seen dramatically at this particular point.”

Velleman contends that there are other alternative views from the medical fraternity. She says Dr Konstantinos Farsalinos, who has “done the most amount of research on vaping and its impact on health”, has a different assessment.

She says Farsalinos, who is a doctor at the Onassis Cardiac Surgery Centre in Greece, spoke at a conference hosted by VPASA.

“He says one of the challenges that we face is the product that had been used by the [popcorn] manufacturer was used by some of the people who manufacture the [vaping] liquids that are used in e-cigarettes,” Velleman says.

“If you look at the products that go into the making of the liquid – that product is longer there. It’s actually been banned and is not allowed to be used.”

Velleman says these incidents occurred during the earlier phase of the establishment of the industry, “because it has always been an industry in evolution”.

The health challenges presented by popcorn lung in the vaping industry were “identified and dealt with”, she says.

Another concern about flavors is that spices used in vaping liquid contains food flavorants. “The same types of flavors that are being heated to several hundred degrees and are being inhaled. We just don’t have enough data to suggest what happens to the so-called safe flavorants when they are heated and inhaled,” Van Zyl-Smit says.

As EVP products find their way into social dialogues, the discussions span beyond recreational use, or as a tool to quit smoking. There are theories that, with enough exploration, the devices might be used to dispense medication.

The idea is that oral medications and hypodermic needles would be replaced by EVPs, which, in theory, would absorb the medication directly into the bloodstream. The health benefit being that the elimination of needles could prevent mishaps such as overdoses, as well as, HIV and hepatitis.

As it stands, it has been widely reported that medical marijuana is being used via EVPs by patients, as part of pain management therapy for illnesses such as cancer.

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