Widespread use of tobacco cigarettes is a public health issue of particular concern to the Asian-Pacific Islander (API) population. According to Oakland-based Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL), tobacco smoking is associated with three of the top killers of Asian Americans nationwide: heart disease, cancer and stroke. 80% of lung cancer deaths are caused by smoking and it is the leading cause of cancer fatalities among Asian Americans. While the American Lung Association reports Asian Americans and Pacific Islanders have the lowest smoking rates among adults of all racial/ethnic groups, unfortunately the true rates of smoking among APIs are often not accurately tracked because of common research practices such as dumping data collected from various Asian subgroups into one category or conducting surveys only in English.
A 2006 National Latino and Asian American Study cited by APPEAL indicated roughly 1 in 3 Vietnamese and Korean American men smoke. Last year, APPEAL conducted community-based studies in Asian languages which revealed high smoking prevalence rates among men of the following groups: Cambodian (13–58%), Chinese (11–36%), Korean (22–37%), Lao (32%), and Vietnamese (24–41%). A 2001 research paper published in the journal Tobacco Control reviewed internal tobacco industry documents from the 80s and 90s and found a concerted effort to target API communities because of their population growth, high prevalence of smoking in countries of origin, high purchasing power, cultural predisposition to smoking, high proportion of retail businesses under API ownership, and desire to assimilate. The documents also revealed Asian American women were targeted because they might connect smoking with a sign of gender equality and start “smoking more as they believe they should enjoy the same freedom as men”.
Having grown up in Hawaii, the only state with a majority API/multiracial population, I witnessed first-hand a high prevalence of smoking among Asians and Pacific Islanders, especially among working class young adults. My brother used to smoke and was fortunately able to quit (but not until after multiple failed attempts) and I myself smoked for a short period during college.
A few years ago during one of my regular trips to Hawaii to spend time with family, I happened to visit Pearl Ridge Shopping Center and noticed a long line of people waiting to make purchases at a small kiosk in the middle of the mall. It turned out the kiosk sold e-cigarettes and refill cartridges. It was the first time I heard of such devices. Though I no longer smoked, it stoked my curiosity because it made me wonder what made them so popular, if they were any more addictive than regular cigarettes and if it was more harmful or less harmful. When I found out my brother quit smoking cigarettes for good with the help of an electronic cigarette two years ago, it motivated me to research it and eventually get into the industry.
The earliest documented electronic cigarette invention is attributed to Herbert Gilbert who patented a smokeless cigarette in 1963. The device allowed users to inhale nicotine steam by heating a nicotine solution but was never commercialized. Fast forward forty years to 2003, when a Chinese pharmacist, Hon Lik, created a device which used an ultrasound element to vaporize a compressed jet of propylene glycol nicotine liquid. In 2006, the cartomizer, a type of cartridge containing an atomizer (an innovation adopted by many major e-cig brands) was developed by British entrepreneurs Umer and Tariq Sheikh.
The nicotine liquids (or e-liquids) used in e-cigs typically contain a mix of propylene glycol, vegetable glycerin, flavoring and nicotine. Propylene glycol and vegetable glycerin are products which are both found in processed foods and allow the liquid to be infused with flavor, vaporized and felt in the throat as it’s inhaled. The flavoring can either be synthetic or natural, depending on quality and price. There’s even flavors for health-conscious consumers made from organic fruit extracts.
Nicotine has been shown to have an adverse effect on development so it should be avoided by children and women who are pregnant or breastfeeding. Some people can have a sensitivity or allergy to nicotine as well as propylene glycol. While no studies have shown nicotine to be a cause of cancer, it has been shown to facilitate growth of cancer cells so those with cancer shouldn’t intake any form of nicotine. Nicotine increases blood pressure and heart rate so anyone with heart problems or high blood pressure should also avoid it. Since nicotine liquids can be absorbed through skin and often smell like food, extra care must be taken not to contact it with skin or leave e-liquids unattended around children and pets. E-cig users traveling on airplanes should never carry a device filled with e-liquid because the cabin pressure has been known to cause normally water-tight cartridges to leak.
Nicotine is also addictive, and while there needs to be more studies on long-term effects of e-cig use, the most up-to-date studies suggest that they’re a safer habit than tobacco cigarettes. According to a recent issue of the journal Addiction, scientists reported risks to users and passive bystanders from electronic cigarettes are far less than those posed by tobacco cigarette smoke, e-cigs contain fewer toxins than tobacco smoke and at much lower levels, there’s no current evidence that children move from experimenting with e-cigarettes to regular use, and conclude the products do not encourage young people to go on to conventional smoking habits. Their analysis also suggests switching to e-cigs can help tobacco smokers quit or reduce cigarette consumption. This may be due to the fact that many brands of tobacco cigarettes are treated with additives such as ammonia which increase their addictiveness and users of e-cigs can more precisely control how much nicotine they consume. E-liquids are typically available in 36mg, 24mg, 18mg, 12mg, 6mg and zero nicotine varieties, allowing vapers to gradually decrease nicotine consumption at their own pace if they choose to do so.
Another concern I had about e-cigs was how much Big Tobacco was profiting off the vaping trend. While Big Tobacco initially was resistant to electronic cigarettes, they have since embraced it by buying out or creating some of the largest e-cig brands in the market (mostly cheap devices with disposable cartridges and limited selection of flavors). However, unlike with tobacco cigarettes, Big Tobacco has not yet reached a monopolistic hold on the market so consumers have a wider variety of independent brands and varieties of e-cigs and e-liquids to choose from.
A recent multiethnic study of e-cig users in Hawaii published by the American Journal of Public Health found that smokers who used e-cigs reported higher motivation to quit, higher quitting self-efficacy, and longer recent quit duration than did other smokers. Though I have yet to come across data showing e-cig vaping prevalence rates among the API community, Judging from what I’ve seen in Hawaii, Oregon and Seattle, it seems to be catching on faster than in the general population. It wouldn’t be surprising because the Asian-Pacific Islander demographic are often sought after by marketers because they are statistically early adopters of new technologies. However, the trend is growing globally as more people become aware of relative health benefits as well as other compelling reasons to switch such as flavor variety, convenience, cost savings, fire safety, concern for physical appearance and higher social acceptability. E-cig use may not be as healthy as being completely drug-free but it has proven to be healthier than smoking tobacco cigarettes, and if it can help smokers to quit or at least switch to a healthier habit (which data from studies have supported), then it is in fact a societal trend which can greatly reduce the harm of cigarette smoking among groups most affected which includes the API community.