KUALA LUMPUR, June 25 — It may be the most challenging question for parents and public health experts alike: how to keep a new generation from starting to smoke?

Despite decades of advocacy efforts and awareness campaigns, the answer to that question seems to be getting harder day by day.

Unlike a decade ago, the effort is no longer about tobacco control.

Today, there are enticing new products such as e-cigarettes and vapes designed to look like sleek gadgets with a wide range of flavours — even more diverse than candies.

The attractive design coupled with affordable pricing and easy accessibility have made the product extra attractive to many teens and young adults who easily hop onto new trends to fit in with their peers.

According to the newly-released Global Adult Tobacco Survey 2023 by the Health Ministry, the number of e-cigarette users in Malaysia has increased by over 600 per cent over the past 12 years.

Based on the data, there were only 0.8 per cent of e-cigarette users in Malaysia in 2011, but the number rose to 5.8 per cent in 2023.

The study also found the majority of e-cigarette users were aged 15 to 24.

Although many may know about the health risks and potential complications of e-cigarettes and vaping, the real question may be how these gadgets have become so appealing to the youth over the past decade.

Stylish look and flavourful

According to the National Cancer Society of Malaysia medical officer Dr Leevyadhashiny Ganasan, several factors might have contributed to the surge in e-cigarette use in Malaysia over the past decade.

"These could include aggressive marketing by e-cigarette companies, perceptions of e-cigarettes as a fashionable or modern alternative to traditional smoking, the availability of various flavours appealing to consumers, and potentially misconceptions about their safety compared to traditional cigarettes.”

She said marketing gimmicks appeal to the younger generation by producing flavours that mask the harshness of nicotine and make vaping seem more enjoyable and flavourful compared to traditional tobacco products.

"Packaging their products as trendy accessories may also contribute to the perception that vaping is modern, stylish and socially acceptable.”

Easily accessible and cheap

According to respiratory medicine practitioner Dr Liza Ahmad Fisal, e-cigarettes and vapes are relatively accessible and affordable in Malaysia, which contributes to their widespread use.

"The ease of purchasing these products online or in stores, coupled with their relatively low cost compared to traditional cigarettes, makes them an attractive option for young users.”

Sharing similar sentiments, Dr Leevyadhashiny said easy access to these products, whether through physical stores or online platforms, especially with competitive pricing, can contribute to increased usage.

Does vaping help to quit smoking?

Despite advertising campaigns that aim to portray e-cigarettes and vaping as an effective method to quit smoking, it seems such an alternative is just a myth.

Dr Liza, who is also attached to Pantai Hospital Cheras, said the nicotine content in e-cigarettes can vary widely but is often comparable to or even higher than that in traditional cigarettes.

"This high nicotine content can lead to strong addiction, especially among young users, and can have significant implications for lung health, including the development of nicotine dependence and associated respiratory problems.”

She said e-cigarette vapour may also contain harmful chemicals such as formaldehyde, acrolein and diacetyl, all of which are known to cause lung damage.

"These substances can lead to inflammation, scarring of lung tissue and other serious respiratory issues over time.”

While long-term studies on the effects of vaping on lung health are still ongoing, Dr Liza said early research indicates that vaping can cause chronic lung conditions, such as bronchitis and reduced lung function.

"Some studies also suggest a potential link to an increased risk of developing respiratory infections and other lung diseases.”

Citing other studies, Dr Leevyadhashiny said potential health risks of e-cigarettes and vapes include lung damage, cardiovascular issues, nicotine addiction and exposure to harmful chemicals present in e-cigarette aerosols.

Strict enforcement needed

Despite ongoing awareness efforts, Dr Leevyadhashiny said several regulative measures should be implemented to keep the underage population away from e-cigarettes and vapes.

"These may include stricter age verification protocols for online sales, enforcing laws prohibiting sales to minors in physical stores, implementing educational campaigns to raise awareness about the risks associated with vaping and imposing penalties for retailers who violate age restrictions.”

Meanwhile, Dr Liza said there are promising interventions such as behavioural counselling and nicotine replacement therapies that may be effective in helping individuals quit vaping.

"Support groups and educational programs can also be effective in helping users understand the risks and develop strategies to quit.

"Public health campaigns that highlight the dangers of vaping and provide resources for quitting can further support these efforts.”