NEW DELHI: The vast majority of adult vapers (71.3%) who participated in a first-of-its-kind survey in India used e-cigarettes to quit (30%) or reduce (41.3%) smoking. Similar results were observed in smokeless tobacco (SLT) users. Most (79%) believe that e-cigarettes are less harmful than combustible cigarettes. Survey participants reported minimal side effects (cough, headache, dry mouth/throat) and some health benefits (improved general health, breathing, smell and taste) after they started vaping.
A total of 3,000 vapers aged 18 and older from eight of the largest metropolitan cities in India participated in the interview-based survey, which aimed to obtain data on the characteristics and tobacco use profile of adult vapers in India. Around 81% of respondents were men and 19% women, with average age of 29 years. The majority (80%) were first exposed to nicotine through combustible cigarette smoking, SLT use, or both.
“Our findings highlight the potential of e-cigarettes to be an additional option for tobacco control,” wrote leading tobacco harm reduction expert Dr. Konstantinos E. Farsalinos, one of the scientists who conducted the survey. The survey results were published on March 30 in Harm Reduction Journal.
India’s e-cigarette ban hurts smokers who have switched to vaping
According to the authors, the survey results may be especially relevant for countries such as India, which have a high smoking-related health burden, a complex tobacco landscape, and inadequate infrastructure and resources to help smokers and SLT users quit. They described India’s e-cigarette ban as a “missed opportunity” and urged public health authorities in the country to “encourage additional research and consider suitable modifications in the regulatory framework if findings support such a need.”
Commenting on the e-cigarette ban, the study authors wrote, “To benefit public health, a balance is needed between encouraging smokers who are unable or unwilling to quit with approved methods to use e-cigarettes as smoking cessation aids and preventing its use by non-smokers.”
The Indian government banned the import, manufacture, sale, advertisement, storage, and distribution of e-cigarettes in September 2019. Tobacco harm reduction advocates warn that India’s ban on e-cigarettes hurts smokers who have switched to vaping and will push them back to smoking combustible cigarettes. They stressed that India’s vaping ban is a tobacco control approach that other governments should not emulate.
India represents a complex public health challenge
The World Health Organization (WHO) estimates that there are over 120 million smokers in India, accounting for almost 12% of the 1.1 billion smokers globally. In the journal article, the study authors noted that a significantly larger proportion of the Indian population smoke tobacco in its local forms (e.g., bidis, hookah, chilam, shisha, water pipes); chew SLT in various forms such as khaini, zarda, gutkha, and paan masala in combination with or without betel nut; or combine the two (mixed users). They cited the 2016–2017 Global Adult Tobacco Survey (GATS) data, which shows that India has the second-largest tobacco consuming population in the world, estimated to be over 267 million, which includes at least 100 million smokers and over 199 million SLT users. While smoking tobacco in different forms, including cigarettes, is predominantly found among Indian men, SLT usage is widespread also among Indian women.
“Therefore, India represents a complex public health challenge. Tobacco-related deaths in India are estimated to be over 1 million a year and are projected to rise to 1.5 million by 2020,” the study authors wrote. They noted that smoking-related illnesses such as heart disease, lung cancer and chronic pulmonary obstructive disease (COPD) are prevalent in India. Therefore, reducing the prevalence of smoking and other harmful tobacco product use will have a substantial public health impact in the country. They also cited GATS data showing India has the second-lowest quit rate among GATS countries surveyed at the end of 2017.
“India’s tobacco control program needs to be strengthened by including additional smoking cessation aids,” wrote the study authors. “Our study suggests that there is a potential for e-cigarettes to substitute for smoking and SLT use among Indian tobacco users.”