Smoking prevalence among Malaysian adults has been relatively static at 23% for the past few years. Many in our country have replaced or co-used smoking with vaping or e-cigarettes.
In developed countries such as Australia, the United Kingdom and New Zealand, vaping is used as a form of smoking cessation treatment for adult smokers; they are closely monitored and followed up by general practitioners and quit smoking providers under the NHS, UK. The amount of nicotine allowed in an e-juice is controlled under the closed system of the e-cigarettes, and manufacturers abide by the regulations set by their government.
In Malaysia, the prevalence of vaping among adults, and more among teenagers, is at a worrying number of 14%, based on data in 2022. The misperception of vaping as a safer alternative is worrying, as more research and data published shows the harmful chemical contents were more than 250. What is more, the e-juice can be easily manipulated and modified. Many are self-manipulated by adding illicit drugs such as cannabis and magic mushrooms.
Associate Professor Dr Nur Amani Ahmad Tajuddin, a senior lecturer and deputy coordinator of the Nicotine Addiction Research and Collaborating Group (NARCC) of Universiti Malaya, said teenagers could get access to vaping products too easily, especially after nicotine was denounced from the poisons act on 1st April 2023. This has caused upset and increasing worry among healthcare professionals, teachers, and parents as more and more teenagers and children less than 12 years old have never smoked before becoming vapers. This trend is expected to increase and cause many known and unforeseen detrimental physical, mental health, social, and financial problems.
Lecturers from the NARCC Universiti Malaya, University Malaya Medical Centre (UMMC) clinicians, and UM student advocates of Generational Endgame (GEG) have tirelessly conducted programs to increase awareness of the dangers of smoking and vaping to secondary school students in Klang Valley since the year 2015, and to promote cessation of the use of smoking and vaping. School teachers welcomed and encouraged this effort; however, it must be done more broadly to educate Malaysian adults, teenagers and children.
A GEG Trainer and final year student from the Faculty of Business and Economics, Universiti Malaya, Mr Wong Kim Yiew, said that he was puzzled by the statement that the Minister of Health of “removing liquid nicotine (e-cigarettes) from the drug law is not a problem, but it does not deny that liquid nicotine is a drug”.
He said that during his visits to many schools as a trainer and advocator of smoking prevention programs, he had seen many secondary school students who had accidentally smoked e-cigarettes and had become addicted to them, making quitting difficult. These secondary school students know that long-term smoking must bring much harm to their bodies, but they have no choice but to suffer from the difficulty of quitting. One even told him he would finish smoking a whole e-cigarette in one day. An e-cigarette has a total of 6,000 puffs, and the amount of nicotine is equivalent to 600 cigarettes. He believes it goes without saying how much damage a child who has not yet developed physically can do if he smokes 600 cigarettes daily.
Wong Kim Yiew urged the public not to take the dangers of e-cigarettes lightly, as they are far more trivial. Although the chemical content of e-cigarettes has yet to be analysed, as they are a new product, there are many unanswered questions and unknowns. However, he believes that the unknown is scarier, as we can prevent and treat known risks and hazards, whereas we cannot.
What is known and particular is that e-cigarettes and cigarettes are both nicotine products, and the nicotine content is even higher than that of cigarettes. Nicotine affects brain activity, leading to poor memory, reduced concentration, learning disabilities and anxiety. Nicotine has cardiovascular, respiratory, neurological and digestive effects and is a catalyst for cancer. Nicotine reaches the brain receptors in 12 seconds and can be addictive after two puffs.
In addition, he has personally visited many shops selling e-cigarettes and found that they are very attractive to the younger generation. Because of the wide range of packaging and flavours, there can be as many as 20 flavours in a single span, which is dazzling and can appeal to customers with a wide range of preferences. Therefore, Wong Kim Yiew combines the three characteristics of e-cigarettes: nicotine plus their attractiveness and addictive nature, as the reasons why many primary and secondary school students are easily addicted to e-cigarettes today.
Secondly, he believes that the harm caused by e-cigarettes is probably underestimated, considering the many cases at home and abroad. In Malaysia, for example, a 16-year-old girl who had been smoking e-cigarettes for three years died of heart failure due to a suspected EVALI (lung embolism) related to e-cigarette use. Another distressing case of a 2-year-old girl who suffered nicotine ingestion and seizures due to mistaken e-cigarette use could have been avoided.
In the United States, a 38-year-old man died in his bedroom in 2016. The autopsy report stated that the cause of death was an e-cigarette explosion, with fragments piercing his skull and brain. In 2019, CNN and other media reported that an e-cigarette exploded, causing the jawbone of a high school student in the United States to partially fracture and shatter, with some gum tissue and several teeth blown away.
Dr Nur Amani and Wong Kim Yiew hope that the Ministry of Health, Ministry of Education, Ministry of Higher Education and many more NGOs join forces to curb the use of vaping and smoking to achieve a smoke-free nation by 2040 and become a healthy and productive individual that will contribute to the growth and development of our beloved country, Malaysia.
By Associate Professor Dr. Nur Amani Ahmad Tajuddin, Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya
