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Irish Times: Irish Teenagers' Obsession with E-cigarettes Rises for First Time in Decades

Joymy reports that on October 16, the Irish Times reported at length on the use of e-cigarettes teenage users in the country, saying that e-cigarettes have become an obsession for teenagers, with e-cigarettes teenage users rates rising for the first time in decades.

Christina was first introduced to e-cigarettes when she was in fifth grade, in an empty classroom next to her engineering class on Friday mornings.

"I coughed. I was too scared to get caught."

By the time she was in sixth grade, brightly colored disposable e-cigarettes were on the market. "That's when the trend exploded" and swept through her Donegal school with the same fervor as the Loom Band phase 10 years earlier. 

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The most popular brands of disposable e-cigarettes in her circle of friends currently sell for about €7 each, with one offering 500-600 puffs. They come in flavors like watermelon ice and raspberry orange blossom.

"They're like the happy ranchers of e-cigarettes," Christina says, referring to a popular sweet treat - except that most contain 20 mg or 2 percent nicotine. That's the same amount of nicotine a smoker gets from 20 cigarettes, although traditional smokers are, of course, exposed to additional harmful chemicals. Christina's friends often pass once a day. After a night out, "you get this horrible feeling in your chest - like someone sprayed strawberry air freshener in your mouth."

Almost overnight, or so it seems, e-cigarettes are everywhere. tikTok influencers are doing just that. In schools, "everyone is using them. People are smoking e-cigarettes left, right and center, they're leaving class to go smoke them, they're smoking them in the bathroom during break time."

Now 19, she prefers to smoke cigarettes at night when she's out, and e-cigarettes can last up to two weeks. But in the chip store where she works, "every 10 or 15 minutes, someone asks me if they can go out and smoke an e-cigarette. Everyone is doing it because everyone else is doing it."

Christina's observations were echoed by Alison, a teacher at a school in south Dublin. Her school has begun monitoring bathroom breaks to curb e-cigarette smoking. Students write in their homework journals during the times they leave and return.

"I hate it when I have to question and time students when they go to the bathroom. I know it's bad. But it's for their health and safety. If parents find out their kids are regularly smoking e-cigarettes during class time, they won't be impressed."

After nearly 25 years as a teacher, she seems perplexed to find herself re-monitoring young people's nicotine use. "In fact, for a long time, smoking wasn't even an issue. Kids didn't seem to smoke."

"Child smoking rates have been declining for 20 years. From 1995 to 2015, every time we measured it, it went down." said Professor Luke Clancy, founder of the Tobacco Free Institute in Ireland and one of the authors of the European School Project on Alcohol and Other Drugs (ESPAD). Then, apparently out of nowhere, "it went up in 2019."

Professor Luke Clancy, founder of the Tobacco Free Institute of Ireland, said that smoking rates among teenagers had been declining every year since 1995 until they suddenly rose again in 2019.

The survey found that the number of 15- to 17-year-olds who smoke has risen - from 13 percent in 2015 to 14.4 percent in 2019. At the same time, e-cigarette use among young people is also on the rise.

The ESPAD survey found that e-cigarette use among 15- to 17-year-olds in Ireland increased from 10 percent to 18 percent between 2015 and 2019. A State of Tobacco Control report released earlier this year reported an increase in e-cigarette use among 15-year-olds from 1 percent to 24 percent from 2015 to 2021.

I think it's reasonable to expect this trend to continue to rise," said Dr. Paul Kavanagh, public health medical advisor for the HSE's Tobacco Free Ireland program.

Chris Macey, director of advocacy for the Irish Heart Foundation, puts it more bluntly. He sees an explosion in the use of nicely packaged disposable e-cigarettes as they enter the market.

"They're cheaper and easier because they don't require a charger. According to the World Health Organization, there are 16,000 different flavors. There's bubble gum, chocolate chip cookies, gummy bears. How do you need the taste of gummy bears to get you to quit smoking?"

He is concerned about stealth marketing of e-cigarettes through social media, the use of hashtags linked to parties external to GAA events and concerts, or promotion through influencers.

We are seeing an increase in both youth smoking and e-cigarette use. The question that has not been satisfactorily answered is which came first. A review of evidence commissioned by the Health Research Board in 2020 found that "children who use e-cigarettes are three to five times more likely to continue smoking and to start smoking than children who have never smoked an e-cigarette. I don't think we need to wait until we rule out reasonable doubt that there is a relationship between e-cigarettes and smoking before we can intervene," Dr. Kavanagh said.

"Nicotine is one of the most addictive substances known to man. So you only have a certain amount of time before the horse runs away,"

Macey believes that we should be absolutely shocked that all the hard-won gains of the last generation of tobacco control will now be lost, and they will be lost through complacency. Nicotine is one of the most addictive substances known to man. Therefore, you only have a certain amount of time to deal with this problem before the horse runs away.

Non-combustible tobacco devices should not be the gateway to smoking, if indeed that proves to be the case. The first products were patented in the 1960s in the U.S. as an alternative to cigarettes, but were never commercialized, and the idea was revived in 2003 by Chinese pharmacist Han Li after his father died of lung cancer.

Big Tobacco initially saw e-cigarettes as a flash in the pan, but has been on a roll since 2012, acquiring smaller e-cigarette companies and introducing sophisticated marketing and lobbying strategies to the emerging industry.

All of the Big Four - Philip Morris, British American Tobacco, Imperial Brands and Ochoa - subsequently began using their own brands for e-cigarettes. As you know, Ochia acquired a 35% stake in Juul for $12.8 billion in 2018. They use language such as non-smoking, next-generation products and a non-combustible future.

One of the strategies of some pro-e-cigarette groups is to confuse the actual use of e-cigarettes by simultaneously marketing them as a smoking cessation device and a cool new consumer product. Part of the purpose of this confusion is to delay regulation, says Tobacco Strategies at the University of Bath. It appears to be working.

In the U.K., the U.K. Department of Public Health has a much more relaxed approach to e-cigarettes than most EU countries, New Zealand and the United States. Ireland does not appear to be entirely sure which approach to follow.

The report of the Joint Committee on Health, Tobacco and Nicotine Inhalation Products, released last July, made 10 recommendations, including a ban on the sale of e-cigarettes to people under 18.

Several experts advocated it go even further, adding flavor bans and restrictions on packaging. Since then, the Public Health (Tobacco and Nicotine Inhalation Products) Bill 2019, which would implement a ban on sales to children under the age of 18, has not yet been enacted. This means that 10 years after the idea of the legislation was first proposed, Ireland remains one of the only countries in the EU where children can legally buy e-cigarette devices.

"The reality is that today a child can walk into an e-cigarette store in Bray, Mullingar or West Cork and sell the product. There is no legal prohibition in this area," There's no law against it," Dr. Kavanagh said.

"It's a huge gap that we need to bridge. We have good reason to be concerned that e-cigarettes may cause children to continue smoking. We need to recognize that for our children and young people, e-cigarettes [are] inherently associated with risk. E-cigarettes use nicotine, which is a highly addictive substance. There's a lot of evidence that nicotine has an effect on the developing brain. And then there's the question of what the long-term health effects might be in terms of. So we absolutely need to act on the government's current tobacco and nicotine inhalation products bill."

When you talk to people who support the freedom to use e-cigarettes, the same arguments tend to come up time and time again. While researching this article, I was contacted by Joe Dunne, who describes himself as the founder of Respect Vapers, "which represents up to 200,000 people who have quit smoking through e-cigarettes.

Dunne makes several of the same arguments that can be found in the e-cigarette companies' online FAQ sections, including the fact that the vast majority of e-cigarette users are smokers, and these are ex-smokers. Like other supporters of the e-cigarette industry, he favors a ban on e-cigarettes for people under 18, but opposes a ban on flavors, which he says 70 percent of ex-smokers use.

He suggests that if e-cigarettes did not exist, teenage e-cigarette users would switch to smoking, a claim that seems equally difficult to prove or disprove. "Doctors will tell you that those young people will have a tendency to smoke or inhale e-cigarettes. If there were no e-cigarettes, they would be smoking."

As it turns out, he is not a smoker himself. He got involved because he was working with the Irish Electronic Cigarette Vendors Association (IVVA). He explains that Respect Vapers receives no funding from the e-cigarette industry, not from tobacco, nor from anyone in the industry. It is funded by the Edmund Burke Institute, which describes itself as independent, nonpartisan and funded entirely through private donations from individuals and organizations.

However, this newspaper previously reported that the Edmund Burke Institute receives funding from the Atlas Network, a U.S.-based organization that is cultivating a global network of right-wing think tanks. the Atlas Network itself is a recipient of donations from the tobacco industry. A peer-reviewed study conducted by researchers at Simon Fraser University in Canada in 2017 described it as a longtime strategic ally of Big Tobacco.

When asked about it, Dunn said, I don't know anything about any U.S. groups.

David, a school principal in the south of the country, said that typically, the only sign of teenage e-cigarette users smoking e-cigarettes at school is the faint, sickeningly sweet smell emanating from the restrooms or locker rooms. He can't remember the last time he smelled cigarette smoke, but is finding evidence of e-cigarette smoking every day. He knocked on a large bag of e-cigarettes he had confiscated last year.

"You walk in and the place gives off a sweet smell, but usually you can't tell who's smoking the e-cigarettes. These kids have never smoked a cigarette, but they're all smoking e-cigarettes because it's something to do, it's a hint of rebellion, to be with the cool gang."

Among teenagers in general, e-cigarettes have reached epidemic proportions.

If e-cigarettes are designed for adults who want to quit smoking, he asks, why would it be sold in these childish fruit flavors? It's like what the beverage industry has done with alcoholic beverages.

Joanne O'Connell, a retailer and IVVA member, said the industry has been pushing and pushing for a ban on sales to those under 18. For the industry as a whole, it's not good to let teens smoke e-cigarettes. Ninety percent of the industry just wants to help people quit smoking.

In her own store, she refuses to sell products to anyone under 18 and is not opposed to a ban on e-cigarettes for anyone under 21. "Our main and only goal is to help smokers quit and use healthier alternatives," she says.

However, she draws the line at flavor bans. "We've never sold to anyone under 18, and the flavors are still very popular. People will start with tobacco flavors, but once you've quit for a while, your taste buds come back and you want to quit smoking for good." Perhaps, she suggests, "there needs to be a balance. You can have flavors that don't appeal to your kids."

"Let's do a reasonableness test here," Dr. Kavanagh says. "If you look at someone in their early 60s who may have smoked for 40 or 50 years and now they have lung disease and heart disease from smoking, do we really think bubble gum flavor, popcorn flavor or watermelon flavor? Are e-cigarette products what they're looking for?"

"As someone who works in tobacco control, there's a sinister familiarity to the script here. It's about recruiting and retaining new users of the product. The evidence that these flavors are associated with current smokers switching to e-cigarettes is not very convincing at best."

The researchers are concerned about e-cigarettes becoming a pathway to smoking, but they are also concerned about the unknown long-term health risks to young people.

"As a respiratory physician, I worry about people inhaling the taste into their lungs. If you ingest or eat melon, that's great. But if you breathe it into your lungs, we don't know what it will do," Professor Clancy said.

Little is known about the long-term effects of e-cigarettes. Preliminary studies have shown that smoking e-cigarettes can cause a bit of airway obstruction in the lungs. It has angered some people. But the effects of inhaling the chemicals will take years to fully emerge. But what we already know should be enough to raise an alarm.

"In addition to the physical effects, they are addictive. Nearly half of all kids in this country have tried them. 18 percent of 16-year-olds regularly use e-cigarettes. When you're addicted to nicotine as a child, it affects your brain development. No one seems to care that we are selling things that are intentionally addictive to our kids. If they're good for quitting, and they have some benefits, why don't we treat them like any other smoking cessation product and get a license?"

If so many teens are smoking e-cigarettes, do their parents know about it? Professor Clancy points to a potentially surprising finding in the study: children of highly educated parents are more likely to smoke e-cigarettes. "Parents also need to be targeted because they have apparently accepted that they are harmless, or that they are good."

Principal David said parents were concerned, but they were confused by the mixed messages. "They don't know what the long-term effects are."

He thinks most people don't know how widespread it is and are always surprised to find out their kids have been smoking e-cigarettes. "I think most teenagers have tried it. Almost everybody gets it from the age of 12."

Dr. Kavanagh says e-cigarettes may help some smokers who want to quit. "It's not a simple binary. It's not black or white. Everything has to be broken down for different parts of the population. If the people developing e-cigarettes are really interested in public health, then they have the opportunity to submit these products to the Health Products Regulatory Authority and have them inspected," he said.

"But we have to look at the reality here. Everything we're talking about between flavors, sponsorships, product placement, social media marketing - there's a lot of research showing how the tobacco industry has refined the library of these elements. Here we see the same script being played out in relation to e-cigarettes." 

The Ministry of Health said the Attorney General's Office is currently drafting the Public Health (Tobacco Products and Nicotine Inhalation Products) Bill. The bill is a priority for drafting and publication in the fall legislative program approved by the Cabinet in September. The draft bill is expected to be completed and published by the end of the year and submitted to the House of Representatives of Parliament for passage in 2023.

By banning the sale of e-cigarettes to persons under 18 and introducing a retail e-cigarette licensing system, the department said the bill aims to reduce access to e-cigarettes for young people and ensure greater regulation of the retail environment.

The National Clinical Guidance on Smoking Cessation was published in January 2022 to advise healthcare professionals on how to support people to quit smoking. The department said the guidance recognises that some people may choose to use e-cigarettes to try to quit, a fact confirmed by the 2021 Irish Health Survey, which found that 18% of people trying to quit use e-cigarettes - 38 In the 2019 Irish Health Survey, % of smokers reported using e-cigarettes to try to quit. 

The department added that the HSE Stop Smoking Service does not recommend the use of e-cigarettes to help quit smoking, but it does provide support for those who already use them.