SMOKING AND VAPING SHOULD BE BANNED IN PUBLIC ?

Ban smoking and vaping in school to protect young people

26 September 2023 Departmental update Geneva Reading time: 1 min (388 words)

Today, the World Health Organization released two new publications, “Freedom from tobacco and nicotine: guide for schools,” and “Nicotine- and tobacco-free school toolkit” to help protect children’s health just in time for back-to-school season in many countries. 

The tobacco industry  relentlessly targets young people with tobacco and nicotine products resulting in e-cigarette use increasing and 9 out of 10 smokers starting before the age of 18. Products have also been made more affordable for young people through the sale of single-use cigarettes and e-cigarettes, which typically lack health warnings.

Regulators in the US last month warned companies to stop selling illegal e-cigarettes that appeal to youth by resembling school supplies, cartoon characters, and even teddy bears. 

“Whether sitting in class, playing games outside or waiting at the school bus stop, we must protect young people from deadly second-hand smoke and toxic e-cigarette emissions as well as ads promoting these products,” said Dr Ruediger Krech, Director of Health Promotion, World Health Organization.

The new guide and toolkit are step by step manuals for schools to create nicotine- and tobacco-free campuses, but it takes a “whole of school” approach – which includes teachers, staff, students, parents, etc. The guide and toolkit include topics on how to support students to quit, education campaigns, implementing policies and how to enforce them.

The guide highlights four ways to foster a nicotine- and tobacco-free environment for young people: 

• banning nicotine and tobacco products on school campuses;

• prohibiting the sale of nicotine and tobacco products near schools;

• banning direct and indirect ads and promotion of nicotine and tobacco products near schools; and

• refusing sponsorship or engagement with tobacco and nicotine industries.

Countries worldwide were highlighted in the publication as having successfully implemented policies that support tobacco and nicotine free campuses including: 

India, Indonesia, Ireland, Kyrgyzstan, Morocco, Qatar, Syria, Saudi Arabia, and Ukraine. 

The new WHO guide can help create nicotine- and tobacco-free schools that help keep kids healthy and safe. Nicotine- and tobacco-free policies help to prevent young people from starting to smoke; create a healthier, more productive student body; protect youth from toxic chemicals in second-hand smoke; reduce cigarette litter; and cut cleaning costs. 

To protect people’s health, WHO encourages all countries to make all indoor public places completely smoke-free in line with Article 8 of the WHO Framework Convention on Tobacco Control.

From : https://www.who.int/news/item/26-09-2023-ban-smoking-and-vaping-in-school-to-protect-young-people

Should e-cigarette use be included in indoor smoking bans?

Electronic nicotine delivery systems, also called e-cigarettes, are devices that vapourize liquid, typically comprising nicotine, propylene glycol, glycerine and flavourings. Switching from smoking tobacco cigarettes to using e-cigarettes – known as vaping – may reduce user harm, by supporting quitting or acting as a lower risk substitute. However, the degree of harm reduction is uncertain. Governments that are considering policies to restrict vaping should consider the optimal regulation of e-cigarette products, including defining where vaping may occur. Here, we explore some of the arguments for and against extending indoor smoke-free laws to also cover vaping.

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Arguments for vaping

First, allowing vaping in indoor public places may encourage smokers to switch to vaping, by making it relatively more attractive as vaping would be allowed where tobacco smoking is not. Some e-cigarette users have voiced this potential benefit of normalization of vaping when arguing against any bans on public vaping.1 Nevertheless, we are not aware of any clear evidence supporting this argument as an important driver for smokers switching to vaping. Other factors, such as health reasons or the lower cost of vaping, seem to be more important for switching from smoking to vaping. Furthermore, if vaping indoors does actually normalize vaping for smokers, then logic would suggest it might also normalize vaping for non-smokers.

Second, allowing vaping in indoor public places where smoking is not permitted could minimize any discomfort that e-cigarette users may experience from nicotine withdrawal when being in such settings. However, evidence suggests that this discomfort is fairly modest. For example, in a survey conducted among exclusive e-cigarette users in the United States of America, only 12% (124 of 1034) reported finding it difficult to refrain from vaping in places where they were not supposed to.2

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Arguments for prohibiting vaping

First, at a distance, smoking and vaping may look similar to some people, since both activities produce visible clouds exhaled from people’s mouths after they have drawn on a cigarette or device. Some e-cigarette users admit to this similarity, e.g. some cite visual similarity as a reason why they do not vape around people who are eating.1 Given such similarities, permitting indoor vaping might renormalize tobacco smoking in smoke-free indoor environments and may lead smokers to query: if vaping is permitted, why is smoking not allowed. Renormalization of tobacco smoking would be particularly problematic if it increases the risk that children become susceptible to or initiate smoking. Indeed, some research suggests that children may misperceive vaping as smoking.3Nevertheless, the authors of this study speculated that “once these products are more common and the purpose of them is known, seeing people use them should normalize quitting behaviour.”3

A second argument is that close exposure to vaping among people who have recently quit smoking or vaping might trigger them to relapse to smoking. For example, an experimental study among young-adult tobacco smokers reported that exposure to a video showing vaping significantly increased their urge to smoke as well as their desire for tobacco cigarettes and e-cigarettes.4 Similarly, another experimental study found that exposure to the e-cigarette cue but not the tobacco cigarette cue also significantly increased desire to smoke an e-cigarette.5

Evidence suggests that many smokers support smoke-free areas, because this helps encourage them to quit.6 It seems plausible that this reasoning would also apply to e-cigarette users, who wish to either constrain the level of their vaping or to quit vaping and may therefore favour indoor areas being vape-free.

Third, passive exposure to e-cigarette vapour might lead to adverse health effects according to a systematic review of 16 studies.7 A 2016 report from the World Health Organization (WHO)8 also concluded that second-hand aerosols from e-cigarettes are a new air contamination source for hazardous particulate matter (PM). The levels of some metals, such as nickel and chromium, in second-hand aerosols are not only higher than background air, but also higher than second-hand smoke. Furthermore, compared to background air levels, PM1.0 and PM2.5 in second-hand aerosols are 14–40 times and 6–86 times higher, respectively. In addition, nicotine in second-hand aerosols has been found to be between 10–115 times higher than in background air levels, acetaldehyde between two and eight times higher, and formaldehyde about 20% higher.8 The report suggested that the increased concentration of toxicants from second-hand aerosols over background levels poses an increased risk for the health of all bystanders, especially those with pre-existing respiratory conditions.8

As a result of the report, WHO recommends to Parties of the Framework Convention on Tobacco Control (FCTC) that they consider prohibiting by law the use of e-cigarettes in indoor spaces or at least where smoking is not permitted.8Furthermore, the International Agency for Research on Cancer9 now considers particulates such as PM2.5 to be carcinogenic. These data seem to support the case for fairly strong precautionary arguments for governments to protect the public from involuntary exposure to second-hand aerosols.

Fourth, regardless of the potential health risks, some people find second-hand aerosols from nearby vaping to be a nuisance, since the e-cigarettes can include strong flavours and leave pungent odours. While such nuisance concerns do not appear to have been quantified in surveys, we note that the 2016 vaper-friendly Global Forum on Nicotine conference, actually banned participants from vaping in certain indoor areas due to the nuisance that aerosol clouds caused.10

Fifth, a law aiming to achieve high compliance needs to be readily understandable to people who vape and those around them, hence a law restricting smoking should support a smoke-free encompasses vape-free approach. Exemptions that permit vaping in some indoor smoke-free settings (e.g. certain workplaces, restaurants or pubs) but not others, may risk generating confusion. The problems with a lack of simplicity have been illustrated by jurisdictions that have adopted complex smoke-free laws (e.g. exemptions for some types of small pubs/bars, permitting smoking rooms and defining half an indoor area smoke-free). Simplicity might also favour citizen-led promotion and enforcement of the law by reducing confusion between a cloud of vaped aerosol at a distance and a cloud of cigarette smoke.

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Conclusion

Considering the above arguments collectively, we believe that, from a public health perspective, central and local governments should adopt regulations that effectively determine that all designated indoor smoke-free areas are also vape-free areas. We note that this approach is being implemented by many jurisdictions, with vaping being banned in enclosed public spaces, such as bars, restaurants and other workplaces, in 25 countries.11 This approach is also recommended in the 2016 WHO report to the Parties of the FCTC.8

Nevertheless, further research on the risks of using e-cigarettes is still desirable.12Research is needed to determine whether smoke-free outdoor areas should also be vape-free or not, as the issues differ somewhat from indoor public spaces (e.g. greater dilution of second-hand aerosols outdoors).

An important perspective is whether a society is considering vaping as a permanently acceptable activity or as a temporary way to provide nicotine for people giving up smoking and transitioning to be nicotine-free. If public health policies are based on the latter perspective, it may be unwise to adopt any policy permitting indoor vaping areas, since that could suggest vaping should be a permanently allowed activity. Furthermore, governments wanting to encourage smokers to shift to vaping might be better advised to evaluate the potential of other strategies, such as differential prices, that is, via high tobacco taxes and untaxed e-cigarettes. A potential advantage of price instruments over vape-free policies is that price instruments might be more easily and quickly adjusted via tax changes than changes to the legal designation of vape-free areas.

From : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487972/