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KUALA LUMPUR, Aug 26 (Bernama) -- Ever questioned why vape flavours seem to oddly mimic candies and desserts popular with children?
A study by the National Poison Centre in Aug 2023 revealed that out of 977 e-liquid flavours examined, fruit flavours constituted the largest category.
Some may dispute the idea that the tobacco industry is purposely targeting youths, but the reality of the ground proves otherwise.
Conducted in the capital cities of five Malaysian states – Georgetown, Kuala Lumpur, Seremban, Kuala Terengganu, and Johor Bahru – the study found significant concern regarding the accessibility of e-cigarettes and vape to schoolchildren.
Ahmad Shalihin Mohd Samin, the principal investigator of the study, reported that 704 premises within a 2-5km radius of primary or secondary schools were surveyed.
Of these, 259 (36.8 percent) were local convenience stores, 245 (34.8 percent) were 24-hour convenience stores, and 49 (7 percent) were petrol stations.
“The availability of e-cigarettes and vapes in convenience and 24-hour stores, petrol stations, and street vendors is worrying.
“Easy accessibility to these products poses a significant challenge in protecting schoolchildren from potential health risks,” Shalihin told Bernama.
The study also found widespread e-cigarette and vape advertising, with 28.8 percent of the surveyed stores offering enticing price promotions aimed at budget-conscious schoolchildren.
Approximately 68 percent of the premises sold disposable and non-refillable vaping devices, suggesting popularity among users who wish to conceal their activities.
Disturbingly, 96 percent of the stores displayed e-cigarettes and vapes visibly to children.
While some retail premises had signs and limited access to the products, they were generally visible and accessible to children.
About 36.5 percent of retail premises displayed notices prohibiting sales to those under 18, while 64.5 percent did not.
Over a third of the stores placed these products near candies, toys, gum, and ice cream—mimicking classic tobacco industry strategies to attract adolescents.
Moreover, 75 percent of the stores displayed e-cigarettes and vapes within easy reach, at three feet or lower.
Adding to the concern, e-cigarettes and vapes designed to resemble everyday objects like toys, watches, and food containers, known as 'disguised' or 'stealth' e-cigarettes, were found to be more expensive but still worrisome due to their ability to be easily concealed.
Shalihin urged stores to be prohibited from marketing e-cigarettes and vapes with promotions, sales gimmicks, floor displays, or placement near candies to entice children.
“Strict age verification and child-proof packaging rules are needed. Policymakers may also consider restricting the sale of discreet, disposable vapes and regulating nicotine levels in e-liquids,” he said.
A follow-up study by the team estimated that the price per ml of e-liquid varies significantly, ranging from RM0.60 to RM41.67.
Product volumes ranged from 1.8ml to 50ml, and disposables offered around 200 to 300 puffs, with some products allowing up to 12,000 puffs.
Shalihin expressed concern over high nicotine levels in e-liquids, which are especially attractive to new users due to the absence of the bitterness and harshness typical of freebase nicotine.
A recent study published in the Substance Abuse Treatment, Prevention, and Policy journal found that the tobacco industry employs various promotional strategies to attract youth online, including appealing flavours, starter packs, discounts, and free gifts.
The study revealed that most retailer websites provided contact information and physical store addresses (83 percent), but only half had 'click-through' age verification, and just 3 percent required identification proof for age.
The researchers recommended surveillance of online content and regulation of online marketing and sales by the Ministry of Health, Malaysia, to prevent youth initiation and access to e-cigarettes.
Echoing the study’s findings is the The Global Adult Tobacco Survey (GATS) 2024 by Malaysia's Institute for Public Health, which highlights a high prevalence of e-cigarette use among younger age groups compared to those aged 25 and above.
The report cites the availability of likeable flavours, the perception of e-cigarettes being less harmful than smoking, and greater enjoyment compared to tobacco as key reasons for their popularity.
A search by Bernama found that popular shopping and delivery platforms offer e-cigarette refills, often with a simple age-check mechanism that can be easily bypassed.
Clicking 'Over 18' grants access, while 'Under 18' hides product images behind grey boxes stating 'restricted.'
Professor Dr Wee Lei Hum from Taylor’s University’s School of Medicine learnt from a study she conducted that youths are not concerned with the nicotine content in e-liquids.
“To them, it is safe to use. We have observed that the initiation of tobacco product use starts at 19 years old,” she said.
The study included 513 respondents with a mean age of 22 years, from five different public and private universities in Kuala Lumpur, Selangor, Perak, Putrajaya and Kelantan.
The preliminary findings of her study showed that 77 percent of the respondents vape daily. About 70 percent also use e-liquids that contain nicotine.
Around 21 percent of them use less than 10mg of nicotine in the e-liquids, while 44 percent use about 10-19mg of nicotine.
For the record, 1mg of nicotine is what can be found in one cigarette stick.
To put it in terms of a 20-cigarette stick pack, the amount of nicotine they consumed a day would have been around what is in half a pack to one pack of cigarettes.
On a concerning note, 14 percent use 20-40 mg nicotine, 4 percent use 41-60 mg nicotine and 1 percent of the respondents use more than 60mg of nicotine products.
About 37 percent of them have their first puff of the day, just five minutes after waking up from their sleep.
This means, immediately after waking up or maybe even before they brush their teeth, they already have their first puff.
Wee says this reveals their level of dependency on nicotine.
About 63 percent of them find it difficult to refrain from vaping in places where it is prohibited and 40 percent of them vape at least 30 times in a day.
The study found that 59 percent need to vape even when they are sick and almost 50 percent of university students are highly dependent on nicotine which is worrying.
“The dependency may be due to their perception that vaping is safe and not addictive. Hence, their choice of brand depends primarily on the flavour rather than the nicotine concentration in the e-liquid.
“Additionally, the early years of vaping without being conscious of the nicotine concentration may have contributed to the high dependency from an early stage,” she said.
This is why promoting e-cigarettes for harm reduction can be counter-productive.
This idea that it is less harmful is constantly pushed in marketing, while product design and taste caters to what appeals to the young.
This poses a challenge for the government in terms of enforcement, as they would need to expand their focus to e-cigarettes. This, while they are struggling to find the manpower to curb conventional smoking.
“At the stage we’re at, it seems as if we are reversing the progress we have made to reach the goal of reducing smoking prevalence to less than five percent by 2040.
“These new tobacco products may be the reason we have likely reversed the number (of smoking prevalence) as the initiation age for tobacco products is getting younger,” said Wee.
Based on her observation, once initiated, it is hard for them to stop.
“The younger they start, the harder it is for them to quit.”
The problem with e-cigarette and vape is that Malaysia does not regulate it, so it becomes difficult to know how much nicotine has been consumed.
For example, the disposable ones do not typically indicate how much nicotine is carried in one cartridge.
It will be a future of complication for young users if they started with a higher concentration of nicotine in their e-cigarette, and continue to up their intake as they go through adulthood.
“They won't go back or will find it harder to lower the concentration as it won’t be as satisfying because they started with a higher concentration of nicotine.
“That is why I urge that the regulation on labelling be done properly. Display how much nicotine content there is within an e-liquid.
“We are waiting for the minister to regulate e-cigarette and vape. We need it,” she said.
Experts agree that the enforcement of the Control of Smoking Products for Public Health Act 2024 (Act 852) is crucial.
However, enforcement must be strict to ensure that these addictive products do not slip through regulatory cracks, thereby safeguarding younger generations in Malaysia.
-- BERNAMA