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E-cigarettes and E-liquids looming public health concern in Guatemala

Electronic cigarettes (e-cigarettes) and e-liquids are readily available in Guatemala. While marketed as a way to sidestep the smoke-free law, these products are not regulated and do not contain warnings unlike like cigarette marketing protocols.

Joaquin Barnoya, MD, MPH, associate professor of surgery, conducted the first study analyzing e-cigarettes and e-liquids in a low/middle income country to highlight the importance of the potential public health consequences. The findings were published in March 2017 in Nicotine and Tobacco Research.

Barnoya and his team, including Patricia Cavazos-Regh, PhD, associate professor of psychiatry, purchased e-cigarettes and e-liquids from a variety of Guatemala City locations including mall retailers, grocery stores, pharmacies, wholesale distributors, and gas stations. Among the sample, 58% of e-cigarettes and 46% of e-liquids did not include warning labels. The most common label warned consumers not to use the product during pregnancy or nursing. Nicotine content was only reported on 39% of e-cigarettes and on 79% of e-liquids packaging.

In most low/middle-income countries cigarettes are not taxed and few packages include warning labels.  Therefore, e-cigarettes and e-liquids pose an additional challenge to this already unregulated tobacco and nicotine market. This opportunity gives e-cigarettes and e-liquids distributers’ flexibility in how they sell and market these products. The research team did find that some distributers advertised these products as ways to bypass smoke free laws in the country.

E-cigarettes and e-liquids may also encourage youth to try products containing nicotine, possibly leading to increased youth who then would smoke cigarettes. The lack of regulation may normalize e-cigarettes and e-liquids use in public, and should be a research priority for low/middle-income countries to address for public health reasons.

”Guatemala is already struggling with the lack of implementation and enforcement of the Framework Convention on Tobacco Control (FCTC) that aims to halt the tobacco epidemic,” Barnoya said. “Therefore, healthcare advocates and legislators should take action to regulate e-cigs and e-liquids as they pose an additional threat to the already weak tobacco control scenario in the country.”

This work was funded by the Institute for Public Health at Washington University in St. Louis in 2015 as part of the Public Health-Cubed Awards.