IN A press release last November 2019, the Department of Health (DOH) disclosed the first case of e-cigarette or vape-associated lung injury (EVALI) in the country. The patient, a 16-year-old girl, was hospitalized and later required intensive care as a result of her “dual-use” of vape and combustible cigarettes.
Five months after this incident, the DOH issued a press release about an administrative order to strengthen regulations on electric nicotine and non-nicotine delivery systems (ENDS/ENNDS). National regulation efforts, coupled with the observed market trend of frequent ENDS/ENNDS consumption among university-age youth, point to the need to update University regulations to address the use of Juul and vape products within the campus.
Rising smoke
In the Philippines, the medical community struggles with the lack of ENDS/ENNDS product regulation. “Juuls are only the tip of the iceberg. Due to poor regulation, nearly anyone has access to these vapes,” asserts Loyola Schools Office of Health Services (LSHS) Director Henrietta dela Cruz, MD, MPH, FPCCP. In line with dela Cruz’ concerns on the regulation of ENDS/ENNDS products, the national Food and Drug Administration (FDA) admitted to the poor regulation of the industry throughout the country. According to the FDA, the regulation of ENDS/ENNDS products is challenged by hurdles to chemical component classification and the supervision of online sales.
The unregulated access of vapes in the country comes with severe costs due to the potentially harmful components of an e-cigarette. One example is the presence of diacetyl in flavored e-cigarettes, which has been found to be linked with bronchiolitis, a respiratory disease. However, the dangers go beyond the e-cigarette’s ingredients. In a study science and environmental journalist Nate Seltenrich conducted last August, it was found that e-cigarettes make use of “metal coils or ceramic elements powered by small batteries to heat and aerosolized liquid.” The paper claims that this mechanism inevitably “leech[es] metals” into the smoker’s lungs.
Health Undersecretary Eric Domingo shares similar sentiments with concerned scientific studies on ENDS/ENNDS products, noting that “if the DOH had its way, we would go for an outright ban.” The following month, Duterte announced that he would ban the importation of vape devices to the country.
Although the DOH has attempted to address the lack of regulation for ENDS/ENNDS products, the issue is currently “at a standstill.” Currently, two undisclosed Philippine e-cigarette companies have effectively stalled the implementation of the order by delaying the proceedings of the court on their business matters. Without enforced DOH regulation on the ENDS/ENNDS market, the University has since began addressing the usage of e-cigarette devices on campus with updates to its standing policy against smoking.
Clearing the air
The University has put in the effort to study the DOH’s policies against public smoking and apply the regulations on cigarette usage around campus. In 2013, smoking on campus became completely prohibited through the implementation of the updated No Smoking Policy of former Loyola Schools’ Vice President Nemesio S. Que, SJ. The new policy prohibited the use of tobacco products in enclosed areas and in public spaces such as schools and restaurants. A complete ban on smoking pocket gardens or “smockets,” which initially served as Designated Smoking Areas (DSAs), was also implemented. Areas that were initially independent of the University’s directive such as the Jesuit Residence, The Manila Observatory, Loyola House of Studies, San Jose Seminary, Arrupe International Residence, and East Asian Pastoral Institute were also mandated to follow the new policy.
Such regulation became further strengthened with the promulgation of Executive Order No. 26 back in 2017, which prohibited smoking nationwide in public and enclosed spaces except for DSAs that follow the specifications prescribed by law. Despite these regulations, both R.A. 9211 and EO No. 26 only prohibited the use of tobacco products or any substance that contained nicotine. With the onset of e-cigarette and tobacco technologies, “alternative smoking” through the usage of ENDS/ENNDS products without nicotine has made smoking on campus without prohibition possible. However, there is no specific University policy that addresses the use of ENDS/ENNDS on campus.
Instead, Office of Student Services’ Director Cholo Mallillin said that the Ateneo administration’s response to the popularization of ENDS/ENNDS products has centered on updating its No Smoking Policy by adhering to the DOH’s Administrative Order No. 2019-0007 to factor in tobacco-alternative products.
The Office of the Vice President for the Loyola Schools released a memorandum on September 24, 2019 that informed the rest of the University community about the new prohibitions against ENDS/ENNDS devices within the perimeter of the Loyola Heights campus. As per the memo, students are prohibited from consuming tobacco and non-tobacco ENDS/ENNDS products on campus, including usage within dormitory rooms and vehicles. Aside from these newly updated smoking policies, the memo also stressed that the rules are applicable to everyone; students will be sanctioned according to the Student Handbook, employees through the Employee Code of Discipline, and third party service providers and visitors would be issued violation tickets that would need to be resolved prior to their next visit to the campus.
As per the University’s updated No Smoking Policy, Mallillin notes that while the OSS has already printed “smoking tickets” to issue to violators, there have not been any incidents necessitating the issuance of these slips. Upon the update of the policy, Mallillin notes that campus dormitory security did report incidents of vaping or juuling within the residence halls, but asserted that they were handled accordingly. “If things happen in the dorm, they have their own processes to resolve such cases; they know their rules,” Mallillin says.
Meanwhile, even with the actions taken for the improved regulation, the areas near Gate 2.5 and Gate 3.5 remain as two prominent spots for smokers. In response, Assistant Director of the Campus Safety and Mobility Office (CSMO) Nhoy Almosera states that those areas fall under the 10-meter distance from the gates of the school as stated under EO No. 26. Though these DSAs are legal, Almosera notes that the CSMO will still pursue additional actions “to enhance and ensure the safety of the community.”
The discussions regarding the regulation of these spaces are still in process, and they are mediated among the Metropolitan Manila Development Authority (MMDA), Barangay Loyola Heights, and the Ateneo. Almosera added that these areas are considered a public matter because it is shared by individuals who are not under the jurisdiction of the University, thus requiring the participation of the local units.
Deep breaths
As part of the University’s efforts to reduce smoking within the community, LSHS also provides one-on-one smoking cessation programs to assist students who wish to curb their consumption of tobacco and ENDS/ENNDS products.
Even though regulations on ENDS/ENNDS devices have been updated, Mallillin still believes that the act of smoking must be avoided altogether. “Young people, don’t even pick up a cigarette. If you haven’t yet imbibed the habit in any way, don’t even start [if you have the choice],” he advises. It still rests on the students’ prerogative to choose to continue such activities, if not in school, then perhaps outside of campus. Nonetheless, regulations have already been set to foster a healthier environment for all members of the University.
