It is urgent for electronic cigarette regualtion when teenagers become its potential users

One night at the end of August, Zhou Xing, who was more than five months pregnant, and her husband took a walk in a shopping mall in Beijing. When passing by an electronic cigarette counter, the salesperson greeted them warmly: let’s have a try.

The billboard next to the counter said, “you can smoke without quitting.” Zhou was surprised that even if the sales couldn’t see that she was pregnant, they could see that she was a woman. She has never had the experience of grandly selling tobacco products in the market.

“When my children are born and grown up, can their generation live in a smoke-free society?” Zhou said with worry.

Zhou is not much concerned. E-cigarettes not only enter shopping malls, KTV, bars and other places, but also “occupy” the publicity territory of friends circle, microblog and online advertising.

The report on the supervision of e-cigarette industry (2019) (hereinafter referred to as the report) recently released by the research group of public health and technology supervision of Tsinghua University reveals that 95% of the marketing scripts of e-cigarette retail websites Link e-cigarette with health and cleanliness, and 89% of online stores will publicize health-related benefits.

Under such “Characteristics settings”, the most worrying thing is not that the smokers who can’t stop smoking turn from traditional tobacco to e-cigarettes, but that the people who were not among the smokers, especially the majority of teenagers, become “vapers” under the marketing propaganda with novelty, innocuity and fashion as the selling point.


The brand of e-cigarettes: cool, healthy and fashionable

Li Zhe bought e-cigarettes for his father with the view that e-cigarettes are a little stronger than traditional cigarettes. He has always resented his father’s smoking and would not be forced to inhale second-hand smoke. Even e-cigarettes, he didn’t want his father to try. “Are not electronic cigarettes and cigarettes all cigarettes?”

However, more than ten years ago, Li’s father saw the advertisement of e-cigarettes. At that time, the main theme of e-cigarettes was “high texture, no pungent smell”. Li’s father and friends agreed to buy e-cigarettes together, quit smoking by using e-cigarettes, and return a good living environment for his wife and children.

This is Li Zhe’s compromise and the victory of e-cigarette propaganda.

Health, abstinence and anytime anywhere are common expressions in the marketing scripts of e-cigarette retail websites. The report found that consumers chose to use e-cigarettes rather than traditional cigarettes, mainly because they believed that they did not burn, were less harmful or even harmless; they could help quit smoking or reduce smoking.

The role of mass media in shaping the cognition of e-cigarettes is also summarized in the report: in advertising and marketing, e-cigarettes are symbolized as consumer goods of upper class society and represent independent personality and life style; in cultural products, especially TV series and MV, e-cigarettes are connected with happy, relaxed and enjoyable atmosphere.

“E-cigarettes are divided into one-off pod vape and refilling ones.” When Shi Linxiao, a female college student, introduced e-cigarettes, she said, “what I smoke now is a refilling one. I can match it by myself, and the amount of vapor is also large.”

Shi Linxiao also told reporters that there are many “popular science” videos about e-cigarettes in station B and Zhihu, all of which are teaching newbie who just entered the field and learn how to select and vape.

In her freshman year, Shi Linxiao worked as a part-time job in the bar around the school, where the figure of e-cigarettes was not uncommon. The meaning of e-cigarettes for her is “buy to quit smoking or to play cool.”

Is it easier to quit smoking or to become addicted?

It’s easier to quit smoking than traditional tobacco, which is one of the most common e-cigarette slogans. Similarly, there are “no smoking hazard”, “no heartbreak”, “no addiction”…

The report cites a survey of 3587 consumers from many countries. The results show that 84% of them think that the harm of e-cigarettes is lower than that of traditional tobacco, and 77% think that e-cigarettes can help to quit smoking or prevent relapse.

The UK Public Health England (PHE) released its report on e-cigarettes in 2014 and updated it in subsequent years. According to the 2015 update report, e-cigarettes are 95% less harmful than traditional paper cigarettes and help 20000 smokers quit smoking every year. In the report update in 2018, PHE found that the health risk of e-cigarettes was lower than that of traditional cigarettes in many aspects according to existing research.

But in the 2018 report update, PHE also pointed out that this does not mean that e-cigarettes are safe. Phe recommends that policy makers and regulators ensure that e-cigarettes are produced in a way that minimizes harm.

The report points out that unsubstantiated or exaggerated claims of safety and smoking cessation are common marketing methods for smokers.

The World Health Organization’s global tobacco epidemic report 2019 points out that there is insufficient evidence to quantify the level of risk associated with e-cigarettes. Both users and non users of e-cigarettes may face health risks. At the same time, the World Health Organization also pointed out that the evidence of e-cigarettes as a method of quitting smoking is limited, and the related research is less definitive, so it can not be concluded.

The World Health Organization has also put forward a conclusion that can not be ignored: more and more evidence shows that in specific scenarios, young electronic cigarette users are more likely to start using traditional cigarettes in the future.

What’s more worrisome is that e-cigarette publicity has lowered the threshold of smoking to such a low level that the first link in the process of tobacco control is facing a huge threat.

Zhang Jianshu, President of the Beijing Association for tobacco control, said that in the field of tobacco control, it’s very difficult for people who already have the habit of smoking to quit. “We have learned that these smokers are also very distressed, and it is difficult to give up after they are infected with bad living habits, because nicotine addiction is very strong, once they are infected, they can only complete the withdrawal with the help of the doctor’s guidance.”

One of the key points of tobacco control is to popularize the knowledge of harmful health of smoking, so as to avoid people who have not yet had the habit of smoking to start smoking. The Beijing Association for tobacco control has come to young people to publicize the harm of electronic cigarettes. “The knowledge that smoking is harmful to health has basically been deeply rooted in people’s minds. And the electronic cigarette takes advantage of the emptiness, is very unfavorable propaganda for getting rid of the bad life style. ” Zhang Jianshu called on all sectors of society to resist e-cigarettes just like traditional cigarettes.

Zhang Jianshu pointed out that it was the time for freshmen to enter the University recently. According to past experience, the stage of new enrollment is a high incidence period for young people to enter the ranks of smokers. “(students) after breaking away from the constraints of their parents, they have entered a relatively free space. The fun and cool electronic cigarettes are very attractive among students.” Zhang Jianshu said that the development of e-cigarettes has put forward a new task for the school’s tobacco control management – since it is a smoke-free campus, no matter it is e-cigarettes or traditional cigarettes, they are harmful to the smokers and the people around them, and the school can’t miss e-cigarettes in supervision and publicity.


Short board of supervision needs to be made up

With the rapid development of the industry, there are still obvious shortcomings in the supervision of electronic cigarettes in China.

“The regulations of Beijing Municipality on smoking control was adopted in November 2014. At that time, e-cigarettes were not as popular as they are now, so the regulations did not restrict e-cigarettes. Now with the change of the situation, in the process of law enforcement, because there is no prohibition, e-cigarettes are not clearly listed in the legal provisions, so we feel more difficult. In the process of smoking control, when someone smokes electronic cigarettes in public, we can only dissuade them, but we can’t punish them. ” Zhang Jianshu said frankly that the previous regulations could not fully cope with the new situation and brought challenges to the tobacco control work.

This embarrassing situation is not just happening in China. Italy, Russia, Spain, Poland, Ukraine and other countries control e-cigarettes as electronic or food general consumer goods, while Poland and Ukraine respectively control their sales, use, advertising and promotion.

In August 2018, the state tobacco monopoly administration and the State Administration of Market Supervision issued a circular banning the sale of electronic cigarettes to minors. According to the circular, e-cigarettes are regarded as the supplement of traditional tobacco products such as cigarettes, which have great safety and health risks.

In fact, some areas in China have taken the lead in the supervision of e-cigarettes. Nanning, Guangxi, introduced the use of electronic cigarettes and other tobacco substitutes into the smoking category in 2014. In 2015, Shenzhen market supervision and Administration Bureau stipulated the general technical requirements for electronic smog liquid products.

In terms of tobacco control management, in June this year, the 34th meeting of the sixth Standing Committee of Shenzhen Municipal People’s Congress passed the revised regulations on smoking control in Shenzhen Special Economic Zone, which formally incorporated electronic cigarettes into tobacco control management and will be implemented from October 1. In this revision, the use of electronic cigarettes is included in the scope of smoking, and its use occasions and areas are also subject to more restrictions.

Hong Kong, China and Macao, China have also stipulated in the special legislation that electronic cigarettes and other tobacco products are also regulated by the non-smoking regulations.

Liu Shuangzhou, a professor at the school of law of the Central University of Finance and economics, once wrote an article on the qualitative analysis of electronic cigarette advertisements. He pointed out that the main purpose of banning tobacco advertising in China’s law is not to let “smokers” quit smoking, but to gradually reduce “smokers” by reducing the impact of tobacco and prevent non-smokers, especially teenagers, from joining the “smokers” team. The production, sale and advertising effect of e-cigarettes are contrary to the legislative purpose of banning tobacco advertising in China. Therefore, he advocated that electronic cigarette advertising should be included in the scope of tobacco advertising to be standardized.

“The chemical composition is very complex, and the current research on e-cigarettes is inadequate, because every new taste, research and regulation simply can’t keep up with it.” Zheng Rong, a professor at the school of international economics and trade at the University of foreign trade and economic cooperation and director of the WHO Center for tobacco control and economic policy cooperation, said. However, it is clear that e-cigarettes containing nicotine must be addictive.

At present, many electronic cigarettes on the market contain nicotine in varying degrees, and even some electronic cigarettes contain more nicotine than traditional cigarettes. In response, sun Jiani, a tobacco free action technical officer of the World Health Organization representative office in China, called for the establishment of relevant standards for the content of nicotine, spices and other substances contained in e-cigarettes.

In addition, there are also many e-cigarette brands in social networks and other platforms to carry out marketing advertising, commercial sponsorship and other activities. For example, RELX, an e-cigarette brand, launched a series of promotional activities after boxing player Zhang Weili won China’s first UFC (unrestricted integrated combat) World Championship, trying to create a brand image of burning, fighting and health.

A series of marketing activities are also attracting many young people to join the army of e-cigarette smokers. According to Sun Jiani, from 2011 to 2018, the proportion of American teenagers who smoke e-cigarettes has increased from 1.5% to 20%. Convenient purchase channels and timely access to the marketing network are the important reasons for this trend. She called for the electronic cigarette advertising promotion, commercial sponsorship, distribution network should consider to take a prohibited or restricted regulatory attitude.


Regulatory path game

For the supervision of e-cigarettes, countries have different strategies and paths, and the supervision subjects are slightly different.

In the United States, the world’s largest e-cigarette market, the food and Drug Administration (FDA) is the main Department of e-cigarette supervision. Previously, the FDA has explicitly banned the sale of e-cigarettes to teenagers under 18 years old, and issued more than 1300 warning letters and civil fines complaints to retailers who illegally sell e-cigarettes to minors.

Recently, the FDA and the Centers for Disease Control and Prevention (CDC) also announced that 215 cases of serious lung disease related to the use of electronic cigarettes are under investigation. The CDC said it has received more than 200 cases of respiratory disease after smoking electronic cigarettes in half of the States. The FDA said that the various lung disease cases reported in these states have many similar symptoms, in addition to chest pain, dyspnea and other problems, as well as gastrointestinal problems such as diarrhea and vomiting.

In contrast, the State Tobacco Monopoly Bureau, which is jointly operated with China Tobacco Corporation, is the main force advocating the supervision measures for electronic cigarettes.

Since 2017, the state tobacco monopoly administration of China has successively issued the notice on carrying out the identification and inspection of new cigarette products, the reply on the legal issues on the use of new cigarettes found in the monopoly law enforcement, and the reply on seeking the qualitative and other relevant opinions on emerging tobacco products such as electronic cigarettes.

In response to the proposal of the NPC Representative in 2018, the State Tobacco Monopoly Bureau believed that the HNB fully possessed the basic attributes of traditional cigarettes. Therefore, in essence, the cigarettes stipulated in the tobacco monopoly law should be managed according to the tobacco products.

The State Tobacco Monopoly Bureau also believes that nicotine based electronic cigarettes are simultaneous interpreting nicotine as the main consumer ingredient and have addictive and health risks. Therefore, they should also be included in tobacco products supervision.

Zheng Rong said that there are various kinds of e-cigarettes in the market at present, some of which contain nicotine and some do not, and the content and flavor of nicotine vary greatly, some of which are even higher than those of traditional cigarettes. This brings difficulties to the corresponding market supervision.

As for the supervision subject of e-cigarettes, Zheng Rong mentioned that if e-cigarettes are included in the supervision of cigarette products, according to the current supervision system of tobacco products, only China National Tobacco Corporation can produce and sell, and a large number of e-cigarette enterprises will lose the right to produce and sell. “The pattern of interests involved in this has a huge game, so it is not so simple from the perspective of tobacco or health, which needs to be considered comprehensively.” Zheng Rong said.

In fact, China’s enterprises have technological advantages mainly in electronic cigarette sets, while the four international tobacco companies have market advantages in vape juice products. Zheng Rong suggested that, in view of the fact that many electronic cigarettes can be separated from their vape juice and devices, smoking devices can be included in the regulation as ordinary commodities, while the oil containing nicotine and other ingredients can be defined as tobacco products and included in the relevant regulatory system.

“But e-cigarettes, whether nicotine or not, need to be brought into the regulatory system as soon as possible.” Zheng Rong stressed that from the public interest, the regulation of e-cigarettes is imminent.

Sun also pointed out that when considering the regulation of e-cigarettes, the first thing to consider is how to avoid harm to the greatest extent, rather than who should supervise it. “The World Health Organization Framework Convention on tobacco control mentions that all policies on tobacco control should be formulated to protect these policies from the vested interests of tobacco industry. We should try our best to avoid the influence of tobacco companies and e-cigarette companies when we make e-cigarette regulatory policies. ”

(reporter Li Chenhe, Wang Lin, intern Huang Qichu)



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