Tougher controls urged for e-cigarettes in China

A visitor watches an assistant demonstrate "cloud chasing" at an e-cigarette exhibition in Beijing in July.

Although they may appear to be a safer option than tobacco products, electronic 'vapes' are coming under fire from health groups, who say they are being marketed to impressionable young people as fashion accessories, as Shan Juan and Wang Xiaodong report. Anti-tobacco campaigners and pressure groups are calling for tough regulations to cover the rising use of electronic cigarettes in public places in China. They said e-cigarettes pose a threat to public health and could derail the country's efforts to limit the use of tobacco and related products. Electronic or e-cigarettes were invented in China in 2003. They use battery-powered cartridges to produce a flavored vapour that often contains nicotine, although not always.

Campaigners are concerned that a device with potentially harmful health effects is being touted as a fashion item that also provides health benefits.

They say the point was underscored at Beijing's first exhibition of e-cigarettes, where attendees, predominantly young people, were fascinated by an emerging "extreme sport" known as "cloud chasing", where "vapers" modify their devices and puff hard to produce a dense vapour that resembles a cloud. Contests are usually sponsored by e-cigarette manufacturers and held at promotions that cater mainly to the younger generation.

China has the world's largest population of cigarette smokers, but there are no regulations covering other products that can deliver nicotine. As a result, e-cigarettes are becoming increasingly popular, particularly with young urbanites, especially as tougher controls on tobacco use come into force nationwide, according to Gan Quan, China director of the International Union against Tuberculosis and Lung Disease.

By the end of last year, there were approximately 900 e-cigarette manufacturers in China, a rise of 200 per cent from 2012, producing 80 per cent of the global supply. The value of exports of the devices soared to nearly 4 billion yuan (S$867.97 million), more than 150 per cent higher than in 2013, and the global market was worth more than US$3 billion (S$4.13 billion).

Gan predicted that sales would continue to rise in China because e-cigarettes are widely available online and in brick and mortar "boutiques" that are springing up to exploit the trend.

Circumventing the ban Wang Li, a saleswoman at an electronic tobacco store in Beijing's Chaoyang district, said the June 1 introduction of a ban on smoking indoors in the capital has boosted the public profile of e-cigarettes. "More customers have come to our store to inquire about electronic cigarettes since the new smoking regulations took effect," she said.

"You can see people using electronic cigarettes in many places, such as nightclubs," she added. "Now, smoking is banned in many places, but electronic cigarettes are generally exempt from inspection. You see? Puffing out the fog can be fun," she said, pointing at a young man who was testing an e-cigarette.

Wang said her store sells dozens of different types of e-cigarettes-prices range from about 400 yuan to 3,000 yuan each-and stocks more than a dozen different liquid tobaccos, including some that are high in nicotine and taste like cigars and others that have lighter, fruity flavors, such as lemon and strawberry.

Liquid tobacco doesn't contain tar and is less harmful than traditional cigarettes, but e-cigarettes are unlikely to help smokers stub out the habit, she said. "They won't help smokers to quit quickly, but some electronic cigarettes use a liquid that contains less nicotine, so they can be a healthier substitute for cigarettes."

The cheaper items sell best, but many people prefer to buy expensive products imported from the United States. "Nowadays, people are more concerned about their health, so why not buy one as a healthy gift for a friend?" the assistant said.

A customer, who gave his surname as Zhao, has smoked for 10 years, but recently decided to quit for the sake of his health. "I bought one because I want to quit smoking. I wasn't sure if it would work, so I just wanted to give it a try," he said.

The owner of an e-cigarette store in a Beijing shopping mall said the product is very popular in fashion-able bars and nightclubs, and many young people buy them as fashion items, not as aids to quit smoking.

"Usually, no one will punish people for using electronics cigarettes in public places," said the man, who declined to give his name. "You can smoke one right here in the mall and no one will care."

Zhang Jianshu, head of the Beijing Tobacco Control Association, said the vaping trend is an emerging social problem. "We have received complaints about the unlimited use of e-cigarettes in public places," he said.

However, a lack of regulations means that "at present we can do nothing about it. Besides, traditional cigarettes are, of course, our top priority for tobacco control," he said.

The Beijing government has opened two public platforms-a telephone hotline (12320) and a public account on WeChat, a popular instant messaging platform-to allow people to report smoking in violation of the capital's ban.

Youth appeal

Zhang warned the public, particularly young people, to be wary of "rampant media hype" that markets e-cigarettes as an aid for people who want to quit or control smoking, or as a "cool" accessory.

This emerging threat has been felt in other countries, such as the US, where the use of e-cigarettes among middle and high school students tripled last year from 2013, according to the US Centres for Disease Control and Prevention and the Food and Drug Administration's Center for Tobacco Products.

Findings from the 2014 US National Youth Tobacco Survey showed that the use of e-cigarettes-defined as at least one day in the past 30-among high school students rose to 13.4 per cent last year from 4.5 per cent in 2013, or from about 660,000 students to 2 million.

Use among US middle school students at least tripled to 3.9 per cent last year from 1.1 per cent in 2013, which translates as 450,000 students from 120,000. It was the first time since 2011, when the survey began collecting data on e-cigarettes, that their use has surpassed that of conventional cigarettes.

Last year, the World Health Organisation published a report urging a ban on the use of e-cigarettes indoors and called for tougher controls. The report concluded that there is little evidence e-cigarettes help smokers to quit, and they pose a "toxicant emissions" risk to nonsmokers nearby.

"Legal steps need to be taken to end the use of e-cigarettes in public indoor spaces and workplaces, and their sale to children should be banned," the organisation said. The WHO recommended that producers should not be allowed to advertise the devices as 'smoking cessation aids' until they can provide scientific evidence. It also called for a ban on liquid tobaccos flavored with sweet-tasting fruits or alcohol, which may encourage young people to try e-cigarettes.

Current regulations The regulation and management of e-cigarettes varies from country to country, according to Gan from the International Union against Tuberculosis and Lung Disease.

Brazil banned e-cigarettes in 2009, but they can still be bought online or via the black market. Canada followed suit in the same year by prohibiting domestic sales of e-cigarettes that contain nicotine. In 2013, Spain became the first country to ban their use in public places.

In the UK, the product has been regulated by the health authorities since June 2013. However, a recent study commissioned by the UK Department of Health concluded that electronic cigarettes are around 95 per cent less harmful than conventional tobacco and should be promoted as a tool to help smokers quit.

Margaret Chan, the WHO's director-general, expressed concern and urged caution. "E-cigarettes will prompt young people to take up smoking. I recommend that national governments ban, or at least regulate, them," she said.

Douglas Bettcher, director of the WHO's Department for the Prevention of Noncommunicable Diseases, called for more research. "We want to maximise the potential health opportunities and minimise the number of nonsmokers taking up e-cigarettes," he said.

China plans controls

Mao Qun'an, spokesman for China's National Health and Family Planning Commission, said the government is planning a pre-emptive strike to protect the public from e-cigarettes, and will soon regulate their production, sale and use.

"E-cigarettes have rapidly become popular throughout the world, but the health authorities will coordinate the related agencies and lobby for regulation of the sector," Mao said. however, he conceded that uncertainties still exist regarding issues such as who will be targeted and the measures that will be taken.

He said more research is required to discover an effective solution, but insisted that new regulations will be formulated soon: "China will act quickly to protect her people, especially as this is a crucial time for general tobacco control in the country."