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E-cigarettes: A Global Issue to Address

February 16, 2023

In a recently released global health Feature article in Pediatrics, Dr. Corinna Victoria M. Puyat from Manila, Philippines and a team of physician colleagues alert readers to key regulatory struggles regarding electronic cigarette (e-cigarette) sales that are poised to negatively impact youth and adult health in the Philippines (10.1542/peds.2022-057825). Tobacco control legislation and regulations in the Philippines, including graphic warning labels, increased tobacco taxes, and bans on public smoking, were associated with decreased smoking among Filipino teens and adults. But the Philippine Vaporized Nicotine Products Regulation Act, known as the Vape Bill and signed into law July 25, 2022, threatens to reverse this trend. The Vape Bill moves regulatory oversight of e-cigarette sales and marketing from the Philippine Food and Drug Administration, whose focus is public health and safety, to the Department of Trade and Industry, whose focus is economic growth. The bill lowers the age limit for e-cigarette purchase from 21 to 18 years, lifts flavor bans (flavors are popular among youth), and permits online advertising, all of which facilitate youth e-cigarette use, a known “gateway” for adult tobacco use.1 Dr. Puyat and colleagues walk readers through the social turmoil and political factors that unfortunately allowed passage of the Vape Bill.

Tobacco-related illnesses continue to be a global health burden. The World Health Organization Fact Sheet informs us that tobacco use kills more than 8 million people annually, 7 million from direct tobacco use, and the remainder from secondary exposure.2 In 2020, the world prevalence of adult smoking was 32.6% among men and 6.5% among women, and 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries (LMICs).2,3 While smoking prevalence has declined by 27.2% for men and 37.9% for women since 1990, the declines have been largest in high-income countries, with little change in LMICs, most notably Asia and the Pacific Islands.3 Unfortunately, teen e-cigarette use is associated with a 3.6 times greater risk of adult tobacco use4, so effective regulation of e-cigarettes is critical. This global health Feature on e-cigarette regulation in the Philippines gives a concerning “boots on the ground” perspective on regulatory changes that facilitate, rather than combat, youth e-cigarette use.

The authors emphasize that a global strategy and united efforts are needed to fight tobacco and e-cigarette sales and use. Pediatricians have multiple opportunities to participate:

  • Stay up to date: participate in informed legislative advocacy
  • Learn more: gain knowledge from direct surveillance of tobacco industry efforts to derail tobacco control
  • Get involved: work with colleagues to collaborate and research strategies to prevent tobacco uptake
  • Support patients: Screen for tobacco use and intervene with your own patients

Want to get started? You can visit the AAP’s Julius B. Richmond Center of Excellence after you read this excellent article to learn more!


  1. Jones K, Salzman GA. The Vaping Epidemic in Adolescents. Mo Med. 2020 Jan-Feb;117(1):56-58. PMID: 32158051; PMCID: PMC7023954
  2. World Health Organization. Fact Sheets, Detail, Tobacco. Accessed 1/24/2023
  3. Dai X, Gakidou E, Lopez AD. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022 Mar;31(2):129-137. doi: 10.1136/tobaccocontrol-2021-056535. PMID: 35241576
  4. Jenssen BP, Wilson KM. What is new in electronic-cigarettes research? Current Opinion in Pediatrics. 2019;31(2):262–266. doi: 10.1097/mop.0000000000000741 
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