There is growing evidence that disposable electronic cigarettes can be a gateway to cigarette smoking, especially for young people. Credit: LordHenriVoton/iStock/Getty Images Plus.
Scientific bodies and patient organisations are piling on pressure for the Italian health authorities to introduce tougher rules on the sales and marketing of electronic cigarettes. They are alarmed by data from the 2022 Global Tobacco Youth Survey (GYTS) that show that almost 20% of Italians between 13 and 15 years old use them — a sharp increase from 8.4% in 2014 and 17.5% in 2018. Even though they cannot be sold to minors, nearly 34% of them have tried the devices at least once. Trends in other European countries are similar, but a study1 concluded that between 2014 and 2019 Italian use was significantly above average.
E-cigarettes were initially promoted as an effective and risk-free aid to quit smoking, but concerns have risen regarding their rampant take-up among the youths. In December last year, the World Health Organisation (WHO) published a call to action claiming that there is no clear evidence e-cigarettes are an effective smoking cessation aid, while there is growing and convincing evidence that they can act as a gateway to cigarette smoking. This seems to be true particularly for young people, who are targeted by aggressive marketing campaigns, and lured by the wide variety of e-liquid flavours.Silvano Gallus, who leads the Lifestyles research laboratory at the Mario Negri Institute in Milan, coordinated one of the few prospective studies on the gateway hypothesis in Europe2. E-cigarettes gained popularity in Europe in the early 2010s, he says. To understand whether there is a causal relation between their use and taking up cigarette smoking, Gallus and coauthors contacted around 3,200 Italian adults twice, first in March 2020 and then seven months later. They found that the percentage of respondents who had started smoking during those seven months was 2% among those who never used e-cigarettes, and 20% among e-cigarette users. Similar results were found in the US among adolescents and young adults3. “E-cigarettes create addiction to nicotine and a substantial part of the adolescents who now vape will take up conventional cigarettes in ten years from now,” Gallus predicts.
Even the United Kingdom, whose public health agency once strongly recommended e-cigarettes as a way to quit smoking by claiming that they are 95% less harmful than tobacco, recently banned the sale of disposable e-cigarettes citing concerns about children’s health.
The Italian Society of Pediatrics, with other Italian pediatric scientific societies and patients organizations, recently sent a letter to the health minister advocating for a tougher regulation on flavours and marketing campaigns. Besides the risk of smoking initiation, the letter underlines the growing evidence about the acute effects of e-cigarettes on the respiratory tract, such as chronic cough, wheezing, and asthma. “Parents often consider vaping as totally safe and vape at home increasing their children’s secondhand exposure,” says Maria Elisa Di Cicco, a pediatric pulmonologist at the university hospital in Pisa and among the authors of the letter. Di Cicco adds that there is now evidence that also secondhand exposure can lead to respiratory symptoms4.
Emanuela Testai, a toxicologist at the Italian Institute of Health and chair of the EU’s Scientific Committee on Health, Environmental and Emerging Risks (SCHEER), says that it is difficult to thoroughly assess the toxicity of the chemicals inhaled by e-cigarette users, because of the growing number of different liquids and devices on the market. When it comes to flavours, she notes that most of them were approved as food additives, which means they are safe for ingestion, but their toxicity when inahled is unknown.
The Italian health ministry did not respond to Nature Italy on whether it has plans to review regulations on e-cigarettes.
