New-Age Gateway Devices and Public Health

New-age gateway devices once marketed as safer alternatives to smoking, are now causing a public health crisis

What Are The New-Age Gateway Devices?

New-age gateway devices like e-cigarettes and vaping pens, Electronic Nicotine Delivery Systems, or ENDS, heat-not-burn (HNB) devices and other heated tobacco products (HTPs) are modern alternatives to traditional smoking.

• Marketed as Safer Alternatives: These devices have gained popularity as they offer a perceived safer or more socially acceptable way to consume nicotine or other substances. 
• Concerns Raised: However, they have instead caused a public health crisis. These devices are harming both the physical and mental health of children, making the problem worse.

An overview of these devices

• E-Cigarettes: E-cigarettes are the most common form of Electronic Nicotine Delivery Systems (ENDS). 
  • These are basically devices that do not burn or use tobacco leaves. Instead, they vaporise a solution using a battery. This vapour is then inhaled by the user.
  • Working: When the user inhales, the battery powers a heating element (atomizer) that turns the e-liquid into vapor, which is then inhaled.
• Electronic Nicotine Delivery Systems (ENDS): ENDS is a broad category that includes all electronic devices used to deliver nicotine or other substances to the user through inhalation of aerosolized liquid. 
  • This category encompasses e-cigarettes, vape pens, and similar devices.
• Heat-Not-Burn (HNB) Devices: HNB devices are tobacco products that heat tobacco rather than burning it, producing an aerosol containing nicotine and other chemicals for inhalation.

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Concern with the New Age Gateway Devices

• Misleading Health Claims: All these devices were portrayed to offer a healthier alternative to smoking that would make it easier to quit tobacco. However, they have caused a public health crisis, causing physical harm and affecting the mental well-being of children.

• Youth Addiction Epidemic:
  • Targeting Youth as a Market: Targeted Marketing to lure Children from Early Age: Children have been lured into trying and becoming addicted to e-cigarettes and vaping devices through a targeted marketing of flavors such as strawberry, cotton candy, pop rocks, and lemonade. 
    • New Pandemic: This has led to a surge in youth vaping, creating a new pandemic. 
    • For example: According to the Centers for Disease Control and Prevention, in 2023, e-cigarettes were the most commonly used tobacco product among middle and high school students in United States
      • With 2.1 million (7.7%) students using e-cigarettes, including 5,50,000 (4.6%) middle school students. 
• Impacting Physical and mental well-being of children:
• • The use of such devices Impacts lung damage and the spread of e-cigarette or vaping use-associated lung injury (EVALI).
    • A 2018 study found the use of electronic cigarettes daily was associated with a 79% increase in heart attack risk after other variables were taken into account.
  • Mental health challenges: Challenges such as depressive symptoms, anxiety, perceived stress, and suicide-related behaviours among adolescents are associated with such new-age gateway devices
    • Loneliness & Social Isolation: Those who vape are more likely to experience feelings of loneliness and social isolation when compared to their peers who abstain from these.
• Highly Addictive: E-cigarettes are highly addictive, particularly for individuals up to around the age of 25. 
  • American Medical Association, revealed that more adolescent e-cigarette users reported using their first tobacco product within five minutes of waking when compared to users of cigarettes and other tobacco products combined.
• Substances to Sustain Addiction: E-cigarettes are highly engineered drug delivery devices designed to create and sustain addiction. 
  • The addition of benzoic acid to the nicotine e-liquid produces protonated nicotine, which enhances the addictive potential by making it easier for users to inhale significant quantities of nicotine 
• Gateway to Harder Substance Abuse: These new-age gateway devices are also being used to experiment with harder substances such as cannabis, and even cocaine and heroin. 

Regulation of e-Cigarettes in India: Prohibition of Electronic Cigarettes Act, 2019

The Act seeks to prohibit the production, trade, storage, and advertisement of electronic cigarettes.

• Electronic cigarettes Definition: The Act defines electronic cigarettes (e-cigarettes) as electronic devices that heat a substance, which may contain nicotine and other chemicals, to create vapour for inhalation. 
  • These e-cigarettes can also contain different flavours and include all forms of electronic nicotine delivery systems, heat-not-burn products, e-hookahs, and other similar devices.
• Banning of e-cigarettes: Act prohibits the production, manufacture, import, export, transport, sale, distribution and advertisement of e-cigarettes in India.   
• Storage of e-cigarettes: No person is allowed to use any place for the storage of any stock of e-cigarettes.  
  • If any person stores any stock of e-cigarettes, he will be punishable with an imprisonment of up to six months, or a fine of up to Rs 50,000 or both. 
• Powers of Authorized Officers: If an authorized officer believes that any provision of the act has been contravened, he can search any place where trade, production, storage or advertising of e-cigarettes is being undertaken.  

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Tobacco Epidemic in India

New-Age Gateway Devices users reported getting addicted to the tobacco products which led to the more tobacco consumption leading to Tobacco Epidemic in India

• Tobacco Consumers: According to WHO, India is the second largest consumer and producer of tobacco after China. 
• Risks Employees Health: Additionally, the health of more than 60 lakh people employed in the tobacco industry is also placed at risk because of the absorption of tobacco through the skin, which can cause various diseases.
• Impact on Soil: Tobacco’s deleterious influence extends beyond human health. It is a highly erosive crop that rapidly depletes soil nutrients.
  • This requires more fertilizers to be used which further worsens soil quality. The plant is also a major contributor to deforestation.
• Waste Generation: Up to 5.4 kg of wood is required to process 1 kg of tobacco. The production and consumption of tobacco generates nearly 1.7 lakh tonnes of waste every year in India.
• Heavy Economic Burden on India: A 2021 study estimated that the country incurred a loss exceeding ₹1.7 lakh crore as a result of tobacco’s effects on the health of its consumers in the fiscal year 2017-2018.
  • To compare, the Union Budget allocated for health in the same year was ₹48,000 crore. 
  • In addition, cleaning up tobacco waste has been estimated to cost close to ₹6,367 crore a year.
  • These estimates exclude the costs due to soil erosion and deforestation.

Tobacco Awareness and Control Programmes

Various Tobacco Awareness and Control Programmes has been implemented by Government: 

• WHO FCTC: India is one of the 168 signatories of the WHO’s Framework Convention on Tobacco Control (FCTC), launched in 2005.
  • It aims to reduce tobacco usage worldwide by helping countries develop demand and supply reduction strategies.
• Legislation to Govern Tobacco: A law to govern tobacco sales in India has existed since 1975 and was amended in 2003.
  • The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) 2003 has 33 sections governing the production, advertisement, distribution, and consumption of tobacco.
• National Tobacco Control Program (NTCP): India also launched the NTCP in 2007. NTCP is designed to improve the implementation of COTPA and FCTC, improve awareness about the harms of tobacco use, and help people quit it.
• Tobacco Taxation: Apart from these interventions, tobacco taxation is a globally accepted method to effectively control tobacco use and it is also applied in India.
  • However, existing measures are poorly implemented.
• Tobacco Regulation: Smokeless tobacco products (SLTs) have predominantly been non-compliant with COTPA packaging guidelines.
  • Smuggled tobacco products – both smoked and smokeless forms – have also been badly regulated.
  • To make matters worse, the fines for violating COTPA regulations have not been updated since 2003. For instance, a tobacco company is fined a maximum of only ₹5,000 for violating packaging restrictions for the first time.
• Rise in Surrogate Advertisements: While the COTPA bans direct advertisements, the position on indirect advertisements is unclear, which has allowed surrogate advertisements.
  • Surrogate advertisements popularise the brand using a proxy product like elaichi, to promote tobacco manufactured by the same brand.

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Way Forward

• Clarify and Expand COTPA: Amend the Cigarettes and Other Tobacco Products Act (COTPA) to explicitly ban surrogate advertisements. 
  • This should include clear definitions and guidelines on what constitutes a surrogate advertisement, ensuring that all forms of indirect promotion are covered.
• Strong Implementation: СОТРА and NTCP provide a strong framework to successfully control tobacco production and use in India. But they need to be implemented more stringently.
• Increase Taxes: In addition, the tax on tobacco products also needs to be increased in line with the recommendations of the FCTC, inflation, and GDP growth.
• Promoting Alternate Crops: With government support, it is also possible to help tobacco farmers switch to farming alternate crops, avoiding loss of livelihood, as shown by multiple studies conducted by the Central Tobacco Research Institute.
  • In fact, for large-scale tobacco farmers, the net return per rupee of investment in jowar cultivation (1.84) is higher than tobacco (1.48).
• Latest Data Generation: There is also a need for up-to-date data to understand trends in tobacco use to tackle the tobacco industry, which modifies its sales strategies based on readily available sales trends. 

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