E-CIGARETTES are targeted at university and college students in South Africa, according to Lekan Ayo-Yusuf, professor of health and executive director of Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) at Sefako Makgatho Health Sciences University, while referring to a recent report by health researchers.
Ayo-Yusuf said the research in question found that of the over 240 vape shops in South Africa, 39 percent were within a 10km radius of a university or college campus, while 65.3 percent were within a 20km radius of a university or college campus.
The professor of health noted that although the e-cigarette industry had positioned itself as a cessation aid, the research found out that the products had limited effectiveness.
“While the tobacco and e-cigarette industry likes to position e-cigarettes as cessation aids, the limited effectiveness of these products for long-term quitting, the health harms associated with usage and the industry’s clear and targeted marketing to the youth are facts which are conveniently omitted from their narrative. This series of studies provides very useful information to guide policymakers in South Africa,” Ayo-Yusuf said.
Based on two large population-level surveys, the research being referred to by Ayo-Yusuf, showed a growing prevalence of regular e-cigarette use by South Africans older than 16 years. It noted that 2.71 percent of adults, translating to 1.09 million people, used e-cigarettes during 2018. Most of these e-cigarette users were concurrently regularly smoking cigarettes, the research found.
The research, conducted by the ATIM and the South African Medical Research Council (SAMRC), assessed local e-cigarette use, evaluated the effectiveness of e-cigarettes as cessation aids, and analysed the costs of e-cigarette usage while using geospatial mapping to understand the distribution of vape shops across South Africa and how this might impact youth usage.
The second part of the research concluded that any presumed benefits of e-cigarettes on cessation might be partly attributable to pharmacotherapy and counselling, given the concurrent use patterns among past quit attempters using e-cigarettes.
The study showed that awareness of cessation aids among current smokers was 50.8 percent for smoking cessation programmes; 92.1 percent for nicotine replacement therapy, and 68.2 percent for prescription cessation medication.
Among current combustible smokers who attempted to quit in the past, ‘ever’ e-cigarette users were more likely than ‘never’ e-cigarette users to have used other cessation aids. Furthermore, among current smokers who had ever attempted to quit, past users and over half of current e-cigarette users were more likely than ‘never’ e-cigarette users to have used cessation aids.
For ‘ever’ smokers who had tried to quit, e-cigarette use was associated with a higher likelihood of short-term, but not long-term quitting. The study, in fact, showed a higher likelihood of smoking relapse among ‘ever’ smokers in South Africa who had tried to quit using e-cigarettes
The likelihood of long-term quitting lasting 6-12 months was 80 percent lower among those who used e-cigarettes rarely, 70 percent lower among former e-cigarette users, and 77 percent lower for regular e-cigarette users compared to ‘never’ users.
Despite this evidence of limited effect on cessation, the study also suggested more e-cigarette ‘ever’ as compared to ‘never’ users still believed e-cigarettes could assist smokers completely quit (35.5 percent vs. 20.4 percent) or cut down (51.7percent vs. 26.5percent). This dominant belief among those who had ever tried e-cigarette was likely a result of the manufacturers’ marketing of these products as cessation aids, despite not having scientifically tested them as such in South Africa or similar poor resource settings.
The cost study revealed that, contrary to claims made by e-cigarette manufacturers, using e-cigarettes was more expensive than smoking cigarettes when comparing daily users over a one-year period. Annual cost associated with daily use was 6,693 rand for manufactured cigarettes and up to 19,780.83 rand for e-cigarettes.
The study further stated that implementing excise taxes on e-cigarettes at 75 percent of the cigarette excise tax rate could generate annual revenue of up to 2.20 billion rand for South Africa.
“Untaxed for more than a decade in South Africa, e-cigarettes will only be taxed from this year, at a rate of 75 percent of the tax on tobacco. This will likely reduce initiation by youth and provide additional revenue to cover the health and economic harms they cause while contributing to NHI funding,” said Catherine Egbe of SAMRC.
Ayo-Yusuf recommended pending the signing of the Tobacco Control Bill 2018 into law, saying that advocacy groups and researchers could maintain vigilance in relation to the tobacco industry, to identify and publicise any evasive or deceptive marketing.
He also urged pharmacies to voluntarily remove e-cigarettes from their shelves as a health promotion initiative, suggesting that parents and caregivers could adopt voluntary smoke-free home and car rules prohibiting all forms of tobacco and e-cigarette use.
“Globally, research on these relatively new products is guiding better regulation, and we trust that South Africa will implement the Tobacco Control Bill as a comprehensive, evidence-based policy,” Ayo-Yusuf stated.