Making a difference by changing health behaviors

As an alternative to a traditional cigarette, an electronic nicotine delivery system, or vaping, is becoming more popular around the globe. Over half of the world's population live in the 62 countries that have available mechanisms for vaping.^[1] In the case report, "Beliefs and reality of e-cigarette smoking," Menakuru et al report that an overwhelming 94% of 680 students said that e-cigarettes did not cause any harm to the body. They describe a patient who had never smoke a traditional cigarette. "[H]e admitted to smoking e-cigarettes throughout the day during his free time while driving, between meals and even during breaks at work…. His nicotine consumption would be about 192 mg/day." The patient lost his job and was unable to continue purchasing the necessary materials for vaping. As a result, the patient was diagnosed with nicotine withdrawal after presenting with "diaphoresis, restlessness, tachycardia, chills, nausea and a temperature of 38.3" which occurred after abrupt cessation of his smoking habits.

A study surveying marketing techniques for tobacco in countries across the globe, "detected substantially higher levels of tobacco marketing in the lower-income countries.^[2] The use is particularly pronounced among students.^[3] Despite some experts saying vaping is, "'95% safer'…. A BMJ report brought out the problems with the [claim, and]… can make one question [the experts'] scientific credibility." The case report quotes the multiple health risks associated with vaping, including the amount of nicotine, the inflammation present in the air was, and even toxic heavy metal exposure.

The World Health Organization Framework Convention on Tobacco Control (FCTC) released a report on electronic nicotine delivery systems.^[1] While the FCTC has long stood against traditional cigarettes, this report also took a strong stance on vaping. This is a method which is pushed by some as a healthy alternative to traditional tobacco, but its efficacy in stopping traditional cigarette use has never been shown. The FCTC invited all countries to combat the rapid expansion of vaping with education, forbidding sale to minors, limiting advertising, prosecuting false health claims and monitoring among other interventions.

The regulatory fight against tobacco has in many ways been successful in many locations. Vaping, however, presents a new public health challenge that many practitioners may not be prepared to face. As health care professionals, part of advocating for our patients is ensuring their safety against predatory corporations which would trade their life and health for financial gain. Political action, education and treatment all play roles this endeavor.

BMJ Case Reports invites authors to submit global health case reports that describe the effects of health behaviors. These cases could focus on:

• The factors contributing to these behaviors
• The perception and knowledge surrounding these behaviors
• Interventions that impact the behaviors of patients

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at www.bmjcasereports.com. For more information, review our guidance on how to write a global health case report and look through our online collection

To read more about deleterious health behaviors at BMJ Case Reports, please review:

• Childhood obesity in Mexico: social determinants of health and other risk factors
• -Self-medication complicating pseudo membranous conjunctivitis
• Snorting the clivus away: an extreme case of cocaine-induced midline destructive lesion

To read more about health behaviors, and specifically nicotine use globally from other cited sources, please review:

^[1] World Health Organization. Provisional agenda item 4.4.2 Conference of the Parties to the WHO Framework Convention on Tobacco Control. Moscow, Russian Federation. Sixth Session, October 2014.

^[2]Savell E, Gilmore AB, Sims M, Mony PK, Koon T, Yusoff K, Lear SA, Seron P, Ismail N, Calik K, Rosengren A. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bulletin of the World Health Organization. 2015;93:851-61.

^[3]Murthy VH. E-cigarette use among youth and young adults. JAMA pediatr 2017; 171:209.

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