The e-cigarettes ban in India: an important public health decision
Authors: Joy Kumar Chakma, Hemant Kumar, Stuti Bhargava, Tripti Khanna
Journal: The Lancet Public Health (2020)

In the interest of public health, electronic cigarettes (e-cigarettes) were banned in September, 2019, by the Indian Government. Indeed, concerns around the use of e-cigarettes have been mounting worldwide.1European Public Health AssociationFacts and fiction on e-cigs.https://eupha.org/repository/advocacy/EUPHA_facts_and_fiction_on_e-cigs.pdfDate accessed: September 23, 2019Google Scholar Beyond the issue of nicotine addiction, the ingredients used in flavouring agents and additive agents, like propylene glycol and vegetable glycerin, can also be harmful for health. When heated, these additive agents can produce various compounds, including formaldehyde and acetaldehyde, which are carcinogenic to humans.2WHOIARC monographs on the identification of carcinogenic hazards to humans. Report of the advisory group to recommend priorities for the IARC monographs during 2020–2024.https://monographs.iarc.fr/wp-content/uploads/2019/10/IARCMonographs-AGReport-Priorities_2020-2024.pdfDate accessed: November 21, 2019Google Scholar, 3Bitzer ZT Goel R Reilly SM et al.Effect of flavoring chemicals on free radical formation in electronic cigarette aerosols.Free Radic Biol Med. 2018; 120: 72-79Crossref PubMed Scopus (62) Google Scholar Disposal of waste from e-cigarettes and the manufacture of e-cigarettes could also pose potential environmental hazards. Notably, increased e-cigarettes use among adolescents has been a particular concern,4Cullen KA Ambrose BK Gentzke AS Apelberg BJ Jamal A King BA Notes from the field: use of electronic cigarettes and any tobacco product among middle and high school students—United States, 2011–2018.MMWR Morb Mortal Wkly Rep. 2018; 67: 1276-1277Crossref PubMed Scopus (374) Google Scholar and severe lung disease has been associated with the use of e-cigarettes in the USA.5King BA Jones CM Baldwin GT Briss PA The EVALI and youth vaping epidemics—implications for public health.N Engl J Med. 2020; 382: 689-691Crossref PubMed Scopus (60) Google Scholar The Indian Council of Medical Research, through its white paper on e-cigarettes, recommended that e-cigarettes be completely prohibited in India; this recommendation was made in the interest of protecting public health and in accordance with the precautionary principle of preventing harm.6Indian Council of Medical ResearchWhite paper on electronic nicotine delivery system.Indian J Med Res. 2019; 149: 574-583Crossref PubMed Scopus (9) Google Scholar The white paper stressed how harmful for health the use of e-cigarettes can be. In India, before the 2019 ban, the health authorities did not permit the use of e-cigarettes for pleasure, nor for smoking cessation. However, e-cigarette products have gradually entered the Indian market through various forms of marketing strategies to consumers. There are several alarming media reports of e-cigarette use among adolescents in India.7Soni P India's e-cigarettes ban hasn't stopped vaping - it only drove out Juul and Vape. Bussiness Insider India.https://www.businessinsider.in/india/news/indias-e-cigarettes-ban-hasnt-stopped-vaping-it-only-drove-out-juul-and-vape/amp_articleshow/76093490.cmsDate: May 30, 2020Date accessed: July 9, 2020Google Scholar Despite the ban, Indian authorities are struggling to regulate the use of e-cigarettes, in particular due to black market.7Soni P India's e-cigarettes ban hasn't stopped vaping - it only drove out Juul and Vape. Bussiness Insider India.https://www.businessinsider.in/india/news/indias-e-cigarettes-ban-hasnt-stopped-vaping-it-only-drove-out-juul-and-vape/amp_articleshow/76093490.cmsDate: May 30, 2020Date accessed: July 9, 2020Google Scholar This is threatening the country's efforts to control tobacco. The 2019 ban was a right, timely, and important public health decision, but preventing use of e-cigarettes, especially in adolescents, still remains a challenge and more needs to be done. We declare no competing interests.