Originally intended as a smoking cessation tool for adults, electronic cigarettes (or e-cigarettes) have become the most commonly used tobacco product among younger generations in Bhutan. The National Health Survey 2023 reveals that e-cigarettes are most prevalent among individuals aged 15-24, who comprise 21% of total active users, while usage among those aged 40-54 is significantly lower.
Speaking at the two-day National Workshop for Strengthening Non-communicable Diseases (NCDs) Risk Interventions, which concluded on September 27th Dr. Jagdish Kaur, Regional Advisor for the Tobacco-Free Initiative, expressed concern that the tobacco industry is deliberately targeting the youth. “When e-cigarettes are designed to look like school stationery or flavored to taste like candy, it is clear that the tobacco industry is directly targeting young people,” she said.
She also highlighted the misleading tactics that position many nicotine products as “safer” than cigarettes, potentially distracting policymakers and consumers from the fact that nicotine itself is addictive and harmful, especially to children and youth.
Currently, there is a lack of comprehensive monitoring regarding e-cigarette usage among Bhutanese youth. Dr. Kaur pointed out that the last Global Youth Tobacco Survey (GYTS) was conducted in 2019, stressing the urgent need for a fresh round of the GYTS to assess current tobacco use trends among the youth. “We need another round of GYTS implementation as soon as possible to maintain the ranking and adequately address this issue,” she said.
Dr. Kaur also called for the strict enforcement of laws prohibiting the sale of tobacco products to minors, as tobacco use prevalence remains high among youth. Some countries in Southeast Asia, including the Democratic People’s Republic of Korea, India, and Thailand, have already enacted complete bans on the sale of e-cigarettes.
Findings from the National Academies of Science, Engineering, and Medicine (US ) indicate that e-cigarette use poses various health risks, with a consensus that these devices contain and emit a number of potentially toxic substances. The report also states there is moderate evidence that youth who use e-cigarettes are at an increased risk for coughing, wheezing, and exacerbating asthma symptoms.
A study from the University of North Carolina, U.S found that the two primary ingredients in e-cigarettes—propylene glycol and vegetable glycerin—are toxic to cells, and the more ingredients in an e-liquid, the greater the toxicity. The study also showed that e-cigarettes produce dangerous chemicals, including acetaldehyde, acrolein, and formaldehyde. These aldehydes can cause lung disease, cardiovascular (heart) disease, and are linked to severe respiratory conditions.
Warnings regarding the inhalation of secondhand e-cigarette emissions have also been issued by the U.S. Surgeon General and the National Academies. These emissions contain nicotine, ultrafine particles, and harmful compounds associated with serious respiratory conditions. The Food and Drug Administration has not found any e-cigarette to be safe or effective in helping tobacco users quit.
The public health, economic, and environmental benefits for Bhutan would be immense if the current rising trend of tobacco use is effectively addressed.
Although the latest data is unavailable, losses amounting to about Nu 1.2 billion, equivalent to 0.7% of Bhutan’s annual GDP in 2019, were reported in the investment case for tobacco control in Bhutan released in 2024. Tobacco use (both smoking and smokeless) accounts for around 12.4% of all deaths in Bhutan each year, with smokeless tobacco contributing to more than 22% of all tobacco-related mortality.
By Nidup Lhamo, Thimphu
