Research into the potential health impacts of vaping is starting to back up concerns that electronic cigarettes (e-cigarettes) are not as benign as many people think.
It’s a challenging message to get across when so many have converted to or are profiting from the practice, but research led by Telethon Kids Institute and Curtin University is helping to sound the alarm – particularly for the increasing numbers of non-smokers and teenagers taking up the habit.
The most comprehensive data to date on e-cigarette chemical composition in Australia is helping to guide advocacy efforts as researchers, health campaigners and regulators struggle to chart the best path forward when dealing with the exploding phenomenon that is vaping.
In a study funded by the Minderoo Foundation, Lung Foundation Australia (LFA) and Cancer Council of WA and published in the Medical Journal of Australia, respiratory health researcher Associate Professor Alexander Larcombe and colleagues found toxic and harmful chemicals in e-liquids readily available in Australia.
The team from Telethon Kids Institute and Curtin University examined the ingredients of more than 60 of Australia’s most popular over-the-counter, ‘nicotine-free’ liquids used for e-cigarettes and found the majority of e-liquids contained substances with known toxic effects, including causing respiratory issues and lung damage when inhaled.
In addition, nicotine was present in trace amounts in nine per cent of the liquids tested – despite them being marketed as nicotine-free.
At the time, Associate Professor Larcombe described the amount of nasty chemicals found in the liquids tested as concerning, saying many of the flavouring ingredients found by the team were known toxins and irritants which, when inhaled, can damage airways and lungs.
While the results sparked a predictably furious response from vaping advocates, they are being taken seriously elsewhere.
“There’s a lot of support from most of the scientific community, and most advocacy groups and scientists are pretty positive about it,” Associate Professor Larcombe said.
“Whenever I’ve presented our findings at scientific forums and conferences, including the state and national conferences of the Public Health Association of Australia and the Thoracic Society of Australia and New Zealand, it’s been met with interest. People are just pleased someone is doing this sort of research.”
In particular, the work has featured heavily in ongoing advocacy efforts by the Minderoo Foundation and Lung Foundation Australia.
“The Curtin e-liquid chemical study was a centrepiece of Lung Foundation Australia’s National Vaping and Young People Roundtable, held in December 2020, and foundational to both the outcomes from that roundtable and the subsequent public health resources developed for teens, young adults, parents and educators,” Lung Function Australia chief executive officer Mark Brooke said.
The promotional campaign for a suite of ‘Unveil what you Inhale’ public health resources – developed following the e-liquid study and roundtable – reached more than 300,000 people on social media, had more than 35,000 campaign views and more than 7,500 resource views, and generated 68 media stories with a total reach of more than 36 million people.
“The findings of the study have been used in Lung Foundation Australia’s election priorities document to reiterate the many unknowns of e-cigarettes, and will be used in ongoing advocacy to protect Australians from the harms of e-cigarettes, such as the National Tobacco Strategy which is currently under review, as well as supporting implementation of the National Preventive Health Strategy,” Mr Brooke said.
Director of the Minderoo Foundation’s Collaborate Against Cancer Initiative, Dr Steve Burnell, said the chemical analysis study remained a leading piece of research in an Australian setting. It had helped to inform state campaigns and its methodology had supported state/territory chemical analysis for seized products.
“E-cigarette research undertaken by Associate Professor Larcombe’s team has been vital to spotlight the toxic ingredients, mislabelling and nicotine contamination of e-cigarettes sold in Australia,” Dr Burnell said.
This research is so important to increase awareness of policymakers and the Australian public. E-cigarettes are not harmless, despite false claims made by those who shamelessly market them to our children. We need to continue to support such high-quality research needed to inform policy and allow effective regulation and controls.
Associate Professor Alexander Larcombe
Associate Professor Larcombe said that, worryingly, the e-cigarette market was becoming dominated not by smokers trying to quit, but teenagers and young adults who had never previously smoked.
“We often get the argument that we’re killing smokers by giving this information out because it’s preventing them from switching from cigarette smoking to vaping and, in that way, we’re consigning them to an early grave,” he said.
“But figures suggest now the proportion of non-smokers and teenagers taking up e-cigarettes is rapidly increasing, so it’s not just your older smokers trying to give up, it’s also high school kids who are using them and getting addicted really quickly. There is conclusive evidence showing that this leads to tobacco smoking as well.”
He said that while the jury is still out on the long-term health impacts of vaping and e-cigarettes, there is enough evidence now to show some adverse health effects – including lung disease, nicotine poisoning, people being burnt and batteries exploding in pockets.
“In terms of the long-term health effects, it’s still not conclusive from a clinical perspective because people haven’t been using them for long enough and there’s no evidence yet of, say cancer, but we know e-liquids and aerosols have carcinogens in them.”
Associate Professor Larcombe is part of the Wal-yan Respiratory Research Centre, a powerhouse partnership between Telethon Kids Institute, Perth Children’s Hospital, and Perth Children’s Hospital Foundation.
In addition to the advocacy work of the Minderoo Foundation and Lung Foundation Australia, his research is contributing to other policy and advocacy efforts around vaping and the regulation of e-liquids and e-cigarettes.
► He has provided an independent expert review of evidence underpinning a new CEO statement on e-cigarettes, shortly to be released by the National Health and Medical Research Council.
► Following changes to regulations governing e-liquids sold in Australia requiring people who want nicotine-containing e-liquids to obtain a doctor’s prescription, many doctors weren’t sure how to go about prescribing nicotine, so Associate Professor Larcombe and colleagues wrote a paper providing guidelines.
► He is part of a group of advocates, researchers and policymakers led by Cancer Council WA which meets several times a year to discuss issues and potential strategies to tackle the take-up of vaping by young people.