THE recent announcement by the government to regulate electronic cigarettes by three ministries

(Health, Domestic Trade, Co-operatives and Consumerism and Science, Technology and Innovation) is
indeed of interest to the Malaysian Association for Adolescent Heath.

The e-cigarette (otherwise known as vape) is a handheld electronic device that produces liquid flavoured
vapours.

Concerns have arisen after the National E-cigarettes Survey 2016 reported that the majority of the e-
cigarettes used, especially by adults, contained nicotine.

A national survey among school going adolescents from 10 to 19 years age found an alarming 9.1%
students to be current e-cigarette users, with 40.9% vaping once a day and 33.9% doing it two to five
times per day.

Important strides have been made over several decades in reducing conventional cigarette smoking
among youth and young adults.

We must make sure this progress is not compromised by the initiation and use of new tobacco products,
such as e-cigarettes. We have more to do to help protect Malaysians from the dangers of tobacco and
nicotine, especially our youth.

The use of other nicotine products, including e-cigarettes is creating a new generation who are at risk of
nicotine addiction and toxicity.

The 2015 American Academy of Paediatrics policy statement provided evidence on the effects of
nicotine on the developing brain. Nicotine is highly addictive and is the primary psychoactive component
causing addiction in tobacco products.

It has neurotoxic effects on the developing brain of an adolescent whose executive functions and
neurocognitive processes have not fully matured.
Adolescents are more likely to engage in experimentation with substances such as cigarettes and they
are also physiologically more vulnerable to addiction.

Particularly in adolescence, nicotine also has an effect on the brain as a gateway drug for cocaine and
other illicit drugs. There have also been cases of unintentional exposure and toxicity to nicotine from e-
cigarettes.

Nicotine is well absorbed from the respiratory tract, mucosal surfaces, skin, and intestines; thus, nicotine
exposure can occur from inhaling, ingesting or coming in physical contact with a nicotine-containing
solution.

There have been reported cases of nicotine exposure from e-cigarettes which led to hospitalization and
even death.

In the United States on Jan 14, a six-year-old girl was reported to require emergency medical treatment
after accidentally swallowing liquid nicotine intended for her parents electronic cigarettes.

The 2016 report of the United States Surgeon-General on e-cigarette use among youth and young adults
reiterates the fact that e-cigarettes can expose users to other chemicals, including carbonyl compounds,
and volatile organic compounds, known to have adverse health effects.

The health effects and potentially harmful doses of heated and aerosolised constituents of e-cigarette
liquids, including solvents, flavourants and toxicants, are not completely understood. In simple terms,
the e-cigarette aerosol is not harmless water vapor as claimed by some.

Apart from clean air, any non-approved product inhaled into the lungs is harmful to health.

Hence, to protect young people from initiating or continuing the use of e-cigarettes, a total ban is the
mainstay strategy to be adopted by the Government.
The Health Ministry must continue to take aggressive steps to protect our youth from the harmful effects
of using e-cigarettes by banning manufacturing, distribution and marketing of e-cigarettes.

The Malaysian Association of Adolescent Health congratulates the ministry for their tireless efforts on
tobacco control towards the end-game and a smoke-free generation, and calls for similar actions for e-
cigarettes. The health and well-being of our nations young people depend on the actions we decide to
take today.

DR MYMOON ALIAS

President

Malaysian Association of Adolescent Health