he current era is marked by rapidly changing behaviours and emerging fads influenced by technology, social media and cultural shifts. Cigarette smoking and e-cigarettes are significant trends these days. The latter is gaining popularity, especially among the youth, as it is perceived to be a safer alternative despite concerns about its health impacts.

Cigarettes have long been known to pose significant health hazards. Cigarette smoke contains more than 5,000 chemicals that harm the body, starting with tar coating the teeth and gums, leading to decay and enamel damage. Smoking also impairs the nerve endings in the nose, reduces the sense of smell, and damages the cilia in the lungs, increasing the risk of infections and chronic diseases like bronchitis and emphysema. Smoke fills the alveoli, where carbon monoxide binds to haemoglobin, displacing oxygen and causing shortness of breath. Nicotine, a stimulant, reaches the brain within 10 seconds of inhalation, releasing dopamine and other neurotransmitters, making smoking addictive.

Additionally, nicotine and other chemicals constrict blood vessels, damaging their linings and increasing blood clot risk, potentially leading to heart attacks and strokes. Carcinogenic chemicals in cigarettes can cause mutation in the DNA, leading to various cancers, including those of the mouth, lungs, throat and gastrointestinal tract. Smoking can also impair vision, weaken bones and cause reproductive issues such as erectile dysfunction in men and pregnancy difficulties in women.

Quitting smoking offers immediate as well as long-term health benefits. Within 20 minutes of cessation, heart rate and blood pressure normalise. After 12 hours, carbon monoxide levels decrease, improving the oxygen-carrying capacity of the blood. One month after quitting, the risk of heart attack decreases and lung functions begin to improve. The cilia in the airways fully recover by nine months. After five years, the risk of stroke declines significantly. After ten years, the likelihood of lung cancer drops by 50 per cent. Early nicotine withdrawal symptoms, such as anxiety and depression, are temporary, and various nicotine replacement therapies (gums, patches, sprays) and support systems (counselling, cognitive behavioural therapy) are available to help individuals quit smoking successfully.

E-cigarettes, launched in China (2005), the UK (2005), and the US (2007), were promoted as smoking cessation tools but lacked scientific support and regulation in the United Kingdom (until 2014) and the United States (until 2016). In the United States, youth usage rose by 900 per cent between 2012 and 2015, raising concerns about their popularity and impact. Finally, in 2016, the US Food and Drug Administration began regulating e-cigarettes under tobacco products and restricted sales to individuals under 18. More stringent measures were taken by the United Kingdom and the European Union. In 2014, the New European Union Tobacco Products Directive was issued to control ingredients, packaging and advertising, focusing on reducing youth initiation and promoting public health regarding tobacco and its related products. The directive also covers electronic cigarettes and herbal products, ensuring consistency in safety and consumer protection measures across the European Union. In the UK, which has over 2 million vapers, recent crackdowns have targeted companies marketing to children. NHS data from 2021 indicates that nine per cent of 11 to 15-year-olds use e-cigarettes, up from six per cent in 2018. Moreover, research on these devices has not been able to keep up with their rapid market growth, resulting in lagging regulations on the components of e-cigarettes and e-liquids. This regulatory has resulted in challenges in addressing the potential health risks associated with e-cigarette use.

Vape devices vapourise nicotine or non-nicotine liquids, providing an alternative to traditional tobacco products. These include both electronic nicotine delivery systems (ENDS) and electronic non-nicotinic delivery systems (ENNDS). E-cigarettes heat a liquid containing propylene glycol, glycerin and over 15,000 flavourings to create aerosols for inhalation. While these additives are deemed safe for ingestion, their long-term effects through inhalation are poorly understood. Additionally, the aerosols may contain metallic particles such as chromium, cadmium and lead.

E-liquids often contain alcohol, sometimes in high concentrations, which can have toxic effects on the brain. The developing lungs of teenagers need clean air. These concerns highlight the need for comprehensive research into the potential health risks associated with e-vaping and the substances used in e-cigarettes.

E-cigarettes may help in smoking cessation by providing nicotine with fewer harmful chemicals than traditional cigarettes, potentially reducing withdrawal symptoms. According to the Royal College of Physicians UK, vaping poses only 5 percent of the health risks associated with smoking, which kills 2 out of 3 smokers. However, the long-term adverse effects of e-cigarettes are still undocumented. A review of 29 studies found that e-cigarettes achieved modest smoking cessation rates and provided behavioural and sensory gratification. Yet, many users continued vaping instead of quitting entirely.

The long-term health effects of vaping are still under study. It is known already that e-cigarettes can contain harmful substances such as nicotine, flavouring chemicals and metals from the device. Short-term effects can include throat and mouth irritation, coughing and shortness of breath. Inhaling e-cigarette vapour, even if less harmful than cigarette smoke, can cause inflammatory effects and impede lung growth, making them vulnerable to lung issues.

Vaping is becoming increasingly prevalent in Pakistan, pervading schools and colleges nationwide. Online vape sale in Pakistan is widespread and lacks proper regulations. Immediate regulatory actions are required to limit the proliferation of online vapes. The lack of early regulation in the US led to wide variations in nicotine formulations. In contrast, the UK implemented more strict controls from the outset, ensuring regulated substance use and nicotine levels, highlighting the importance of proactive regulation to mitigate potential health risks. To safeguard our health and that of our children, we should refrain from unquestionably embracing new technologies and instead adopt a critical approach, possibly from a medical perspective. Our well-being and future generations are too precious to risk, whether from traditional smoke or modern aerosols.

The writer is a family physician