Health Concerns Associated with E-cigarettes

E-cigarettes are devices that make vapour for smoking. They are often marketed as a way to quit smoking. Despite their growing popularity, little is known about the chemicals they may contain or their health effects. Perceptions of potential risks and benefits of e-cigarette use vary widely among the public, users of e-cigarettes, health care providers, and the public health community. This writeup responds to the following questions/concerns:

  • Outline the public health concerns associated with e-cigarettes
  • What are the public health concerns regarding e-cigarettes that have been identified both in Australia and internationally?
  • What is the extent of e-cigarette usage in Australia?
  • Describe some of the health outcomes that have been associated with smoking e-cigarettes. 
  • Who does it affect? Is there a population that is most affected in terms of using e-cigarettes?
  • What is the strength of the evidence that you have identified around the health impacts of e-cigarettes?
  • Describe the main stakeholders who would have an interest in a policy on e-cigarettes and why
  • Who are the stakeholders? Consider the range of stakeholders, who may not all be from the health sector
  • What would be the perspective of each of these stakeholders on e-cigarettes?
  • Make a recommendation on which would be the best policy option, including the reason you have selected this option
  • Make a case for one policy option
  • What evidence supports your recommended option?
  • What alternative policy options did you consider? 


In the world, there are about 1.1 billion people who smoke cigarettes. Among this number, 60% of them intend to quit smoking. There have been numerous writings on electronic nicotine delivery systems (ENDS) like e-cigarettes that have been perceived to help smokers to quit smoking (Hartmann-Boyce et al., 2018). While the evidence of the effectiveness of e-cigarettes remains debatable, there is a growing trend in their usage across the world.  Reports from various health departments, including the world health organization, have linked some health conditions to the usage of e-cigarettes, commonly referred to as “vaping”  (WHO, 2020). There have been a lot of non-conclusive reports on this subject. Therefore, it has been difficult for governments to formulate informed policies to control the usage of e-cigarettes. This paper seeks to identify the various health concerns associated with e-cigarettes. It also proceeds to confirm the evidence that has already been found about the claims. Further, it is suggested in this paper the most ideal policy based on the available information and other suggestions that can be considered.

Various health risks have been linked to using e-cigarettes (Traboulsi et al., 2020). The WHO has confirmed such risks as real, which has struck debates concerning the safety of e-cigarettes (WHO, 2020).In Australia, e-cigarettes have been linked to lung diseases. This was after the announcement made by the chief medical officer about electronic cigarettes. This announcement explained how cigarettes lead to lung illnesses (Department of Health, 2019). The public in Australia raised issues concerning the effects of these cigarettes due to the health problems that people were experiencing in the name of using the commonly known as “vaping” to help quit smoking (Douglas et al., 2015). Worldwide, the advice by world health organization confirmed that the ingredients of electronic cigarettes include nicotine, and some flavours lead to health concerns by people (Armstrong-Mensah et al., 2019). This is because nicotine contained in normal cigarettes is the same content in e-cigarettes, potentially leading to lung cancer and other related illnesses (Sanner & Grimsrud, 2015). Children and adolescents have increasingly started using e-cigarettes across the world due to the ease of acquisition and use without being noticed by their guardians (Grapatsas et al., 2017). This has been argued to double their chances of beginning to smoke cigarettes. The general public worldwide remains confused about the safety of e-cigarettes due to the limited data and evidence available on the same issue (Yang et al., 2019).


The extent of e-cigarette usage in Australia

Across the world, the usage of e-cigarettes has increasingly been adopted by people with more prevalence of current smokers (Ahmed, 2020). In Australia, three studies were carried out by the National Drug Strategy in 2013, 2016, and 2019. Shockingly, 11% of the total population reported having used e-cigarettes. Among all the smokers in Australia, half of them had tried e-cigarettes in 2019. 5.25 of adults who have never tried smoking reported having tried e-cigarettes. The use of e-cigarettes increased among smokers between 2016 and 2019. The 2019 data also showed the rise of ex-smokers using e-cigarettes, higher than in previous years. 7.8% of the current smokers in 2019 reported also using e-cigarettes. Among the population of Australia, 1.1% use e-cigarettes daily, 0.6% use at least every week, 0.4% use monthly but not each week, 0.5% use rarely, 2% no longer use, 6.7% who ever tried once or twice (The Cancer Council, 2020). This data shows the growing uptake of e-cigarettes among Australian citizens despite the health concerns people have in the country and across the world.

Some of the health outcomes that have been associated with smoking e-cigarettes

Various health outcomes are directly linked to the usage of e-cigarettes (Polosa et al., 2017). These conditions closely resemble the health outcomes attributed to smoking cigarettes  (WHO, 2020). Lung disease is one of the health outcomes that have been presented as evidence against the use of e-cigarettes. This led to the death of six patients who were linked to e-cigarettes in the United States (Knowles & Sun, 2020).  Secondly, people who use e-cigarettes have been observed to have respiratory signs, including coughing, chest pains, shortness of breath, and other symptoms that are not common and specific (Tzortzi et al., 2020). These are the two major health outcomes identified among people who use e-cigarettes. There have been reported fatalities across the world due to the use of such electronic cigarettes in the name of helping to quit smoking. It has not been verified that e-cigarettes help in the cessation of smoking, and therefore, people are urged not to risk their health and, consequently, their lives. The above conditions may be due to the nicotine in e-cigarettes because it has been proven to lead to such medical conditions in past studies (Mishra et al., 2015).

Who it affects, the population that is most affected in terms of using e-cigarettes.

According to the research that was done in Australia by the National Drug Strategy between 2013 and 2019, the youth have been largely affected by e-cigarettes since they form the major group that is adopting this drug  (The Cancer Council, 2020).  Based on the same study, 14% of secondary school students reported having tried using e-cigarettes which is significant. The report shows that among students around 12 years old, 5% have tried the e-cigarette, with the rate going up with age up to 17-year-old students with a 22% prevalence of usage. Among the 14% of students who ever used e-cigarettes, there was more male than female. Focusing on the general population, the largest number of people who use or ever tried e-cigarettes are between 18 and 24 years old. All the other age groups have lower rates of using the drug. This is, therefore, a clear indication that the younger generation is more likely to indulge in using e-cigarettes and risk their health based on the reports of the adverse consequences of using them. This does not, however, mean that other age groups do not take e-cigarettes. They only have low rates of such cases.

Strength of the evidence identified around the health impacts of e-cigarettes

Many pieces of research have been done in the past to provide evidence to the claims of health risks of e-cigarettes. Some of the researchers studied the ingredients of thee-cigarettes. Some of the findings established that some e-cigarettes might contain propylene glycol, flavourings, glycerol, other chemicals, and nicotine which is the common ingredient. Some of these elements have been proven to irritate the throat leading to dry cough (Callahan-Lyon, 2014). Other research projects studied individuals who use e-cigarettes and observed health conditions that were present in most participants. Some health conditions identified included shortness of breath, lung diseases, and respiratory infections  (Department of Health, 2019). However, despite all these surveys that have been done, there has been little evidence of the connection between diseases and e-cigarettes. Therefore the evidence of the health effects of e-cigarettes is not very weak, as the effects of the ingredients used are known (Cooper & Silver, 2019). It would, therefore, be paramount for governments to take initiatives to fund research projects that help to bring more evidence to ensure that people are aware of the safety of using e-cigarettes (Palazzolo, 2013).

Main stakeholders who would have an interest in policy on e-cigarettes

The Stakeholders

Various stakeholders may be interested in the policy on e-cigarettes.  This may include e-cigarette manufacturers, e-cigarette users, the health department, consumer protection departments, health advocacy organizations, the general public, education organizations, legislators, and the media. All these stakeholders may have differing ideas, concepts, and interests in the policy on e-cigarettes (Shih & Etter, 2019). Such interests may be accustomed to what they stand for, financial gain, popularity gains, and health gain.

Reasons for the selection of these stakeholders

The e-cigarette manufacturers are automatic stakeholders since the policy that can be formulated on their business directly affects them. The users of e-cigarettes are stakeholders because a policy formulated on e-cigarettes may give them total freedom to use or create barriers. The health department is a direct stakeholder as it is mandated to ensure the safety of the public against health harm. The consumer protection department is also a possible stakeholder since they are mandated to ensure that consumers in their territory do not get goods that compromise their well-being. Health advocacy organizations, education organizations, the general public, and the media may not feel a direct impact from the policy. However, the policy formulated can guide their activities like advocacy, control, and dissemination of information. Lastly, the legislators are direct stakeholders who may not be affected directly by the policy. Still, they play a key role in formulating them and ensuring they are implemented.

Stakeholders’ perspectives

Considering the stakeholders’ different interests in the policy formulation, they would all have different perspectives on how the policy should be. It is anticipatable that the e-cigarette manufacturers would want a policy that allows them to continue with the business and confirms to the public that e-cigarettes are safe. This is intended to boost their sales and consequently, their profit, as any other business would want (Khan, 2017).

The users of e-cigarettes also would have a more specific perspective based on their interests. This would be relaxed rules around e-cigarettes. This would be to ensure that the prices remain stable for them. They would also want the policies not to put a barrier to their use of e-cigarettes.

The Department of Health and health advocacy organizations may have the perspective of having the use of e-cigarettes controlled. This ensures the public is protected from respiratory illnesses and other health conditions linked to e-cigarettes.  They would, however, present evidence against the drug confirming the effects on public health.

Consumer protection agencies and organizations may have a similar perspective on the issue as the Department of health. They may, however, support lenient policies for the manufacturers of e-cigarettes that are not banned. This is to ensure that the consumers are not exploited by the high prices of the products (Productivity Commission, 2008).

The general public may not have a rhyming perspective since their opinions are mostly shaped by the media and the people of the organization that they support. However, a general perspective that may be from the public is people’s safety. They may need to see due diligence followed to ensure that they are given confidence in whether to use or not use the e-cigarettes. On the flip side, they may need policies to bar children below 18 from accessing e-cigarettes, as evident from a past report in Australia.

The education department and organizations that advocate for quality education and safety programs for children may have the perspective of banning e-cigarettes or strict measures to ensure that students and children cannot access them for their safety. From the report just reviewed in this article, it was evident that children the age of 12 years are using e-cigarettes in Australia.

The legislators and media may not have perspective cast on stones since they are the instruments of policy formulation and dissemination, respectively. However, their perspective, just like that of the public, may be subjective to their affiliations and each one’s school of thought.

Recommendation on which would be the best policy option

The process of formulating a policy requires the presence of evidence for each recommendation that the stakeholders make. It is a process through which all the perspectives are weighed and evaluated based on the available data. For a policy to be accepted as the law governing the subject matter, there must have been a sober consideration of its significance to the stakeholders and those who may be affected. It may also consider the reaction of each stakeholder. There are various ways through which evidence can be presented to support the policy being recommended. For example, the research can inform the selected policy by using the report to conclude. Reference from a different country using a similar policy as recommended can also be used if and only if the country shares characteristics with the one formulating the policy (Erku et al., 2019).

The case for one policy

With all this in mind and with the available data and reports in consideration, a policy that would restrict the use of e-cigarettes to adults would better serve the interest and perspective of each stakeholder. It would also save children under the age of 18 years from smoking problems. This would give adults the free will to use or not use e-cigarettes. It would also give the manufacturers the freedom to continue producing this product from the market. This would eventually contribute to the country’s gross domestic product. The production of e-cigarettes will also support job detainment and growth.

Evidence supporting the policy option

The reasons for restricting the usage of e-cigarettes by minors are due to their inability to make sound decisions about their choices in life (Robalino, 2016). Some of those who smoke or inhale e-cigarettes and other cigarettes attribute it to peer pressure, which may lead them to regretful life in adulthood, dealing with addiction (Anjum et al., 2016). Therefore, children below 18 should be under their parents’ guidance and let them make their own decisions at an adult age. The reason behind allowing people above 18 years is because; the evidence presented on the effects of e-cigarettes may not guarantee it to be banned. Policies allowing cigarettes to be smoked prove that e-cigarettes do not meet the threshold to be banned completely. The stakeholders should, therefore, agree on continued usage of e-cigarettes but not for medicinal purposes as it has been purported that it assists in quitting smoking, which may be a fallacy. It, therefore, should be allowed to be taken for recreational purposes at will. However, there needs to be continued research to establish solid evidence about e-cigarettes and sensitization to people on the identified health implications they cause.

Alternative policies

Many other policy options can be considered besides the policy suggested above and the evidence provided. Their selection can only be based on the evidence provided. Such policy options include; banning the use of e-cigarettes to save people from the health outcomes identified in the previous studies. The ingredients of e-cigarettes have been confirmed to be causing agents to respiratory diseases, itching in the throat, and lung illness. The other policy option that can be considered is barring the manufacturers of e-cigarettes from using harmful ingredients. The policy can help control the contents used in making the e-cigarettes by substituting them with less harmful or safer health-friendly ones. This would make the usage of e-cigarettes less fatal and safer for the general public to use. The last policy option that can be used in this process may be allowing everyone to use the e-cigarettes at their will. If one suffers from diseases linked to “vaping”, they should not be covered by their medical insurance or the government. This can be a great way of controlling the public from using e-cigarettes without directly banning them. This can eventually lead to people who are sensitive about their health stopping to use them. This can consequently lead to low usage and hence reduced sales by the manufacturers. This can eventually push them to stop the production of e-cigarettes from venturing into other products with demand.


From the above discussion and analysis of information, it has been established that there are health concerns attributed to using e-cigarettes. These health concerns have been evaluated through several research studies and verified to be connected to the use of e-cigarettes, commonly referred to as “vaping”. However, the evidence that has been drawn to connect these health problems with cigarettes has been considered weak since they have only been linked to the people who “vape” and not to the e-cigarettes themselves. There is limited scientific data that can be directly used to support this. The policy formulation process has been seen, and the stakeholders may be interested in formulating policies around the usage of e-cigarettes. The evidence for the policies has been tabled for consideration, and policy options have also been suggested. To conclude, the general public must remember that e-cigarettes may not be safe before concrete evidence is found.


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