The UK’s Parliamentary Office of Science and Technology updates current knowledge on vaping in the country and releases its POSTnote 533. Research on e-cigarettes has been running fast since the last report of January 2014 and the British officials keep track of what sciences tell about e-cigarette.

The possible health risks, whether e-cigarettes act a gateway to smoking amongst children and non-smokers, and their potential as a tool to help people to stop or reduce their smoking are scrutinized in this report that addresses several questions on:

  • The e-cigarette,
  • Its impact on consumers,
  • Wider social impacts and
  • Its regulation.

Smoking is decreasing

In a 5 page report, much of the current concerns are addressed, starting with the remarkably low smoking prevalence since only 18% of adults and 3% of 11-15 year olds smokeThe observed decrease in smoking rather corresponds to fewer people who take up with smoking than increased quit rates.

Vaping gains popularity

In parallel, vaping is gaining popularity with more people taking up, buidling up a body of 2.8 million people.

Key vaping statistics are extracted from ASH data and reveal the increased popularity among smokers and former smokers who more voluntarily try the e-cigarette, even use it on a daily basis and keep the habit on the medium term (at least one year). In contrast, regular use by teenagers is scarce and most ften associated to smoking.

A flourishing market

A description of the market reveals that the UK’s vaping market is in second position after the US. E-cigarettes are widely distributed online and in convenience stores, supermarkets, pharmacies and vape shops.

The report warns that many stakeholders (including public health figures, vaping advocates and charities) highlight a conflict of interest in tobacco companies’ involvement and their influence on the public health agenda.

The report comes back on the two major achievements on e-cigarette safety and quality that are the reviews of the Royal College of Physicians and Public Health England. They provide insights into public perception of harm, health effects on vapers and bystanders, technical safety and quality and their value as a stop-smoking tool.

Relative harm perception and the 95% health risk consensus on the long-term

Among adults, more people are aware of relative harm aspects, especially among smokers who do not vape. Statistics indicates that some flavors dampen the perception of the risk of vaping, especially among teenagers. But most of the 11-16 year olds think that e-cigarettes are harmful.

Current data suggest that the health risk is not significant when vaping although inflammation and irritation have been found in vitro; the risk to bystanders is also minor. The amount of chemicals inhaled, rather than their presence alone, is the important. The consensus is that long-term health risks to vapers require monitoring, but are “unlikely to exceed 5% of the harm from smoking tobacco”.

Safety and quality

Battery explosions and poisoning from ingestion of e-liquid remain concerning but PHE judged they were “comparable to similar electrical goods and potentially poisonous household substances“. The EU TPD requirements in term of labelling and packaging are going towards increased safety.

The place of the e-cigarette in smoking cessation

E-cigarettes have become more popular than classical NRT among smokers to quit smoking concomitant with a substantial decrease of the NRT market value (£8 million) but without any established effect-cause relationship. The popularity of the e-cigarette as a smoking cessation tool is advertized by vapers who are prompt to communicate on their successful switch, nevertheless, PHE’s conclusions about this fact are mitigated:

  • 50% more effective than unsupported attempts, including over-the-counter NRT used without professional support
  • of similar effectiveness as prescribed NRT or drugs
  • less effective than NRT or drugs used with regular faceto-face support from NHS Stop Smoking Services.

In the domain of randomised controlled trials, the type of study dedicated to such issue, it appears that vaping technology evolves faster than scientific observation, which causes an offset in the conclusions. Nevertheless, later-generation products that deliver nicotine more efficiently are probably associated to more success and ongoing studies will probably confirm this hypothesis within two years.

Stop Smoking Services are not unanimous to recommend the e-cigarette but many organization backed up with PHE ad RCP conclusions and have updated their guidelines.

The question of the addictiveness of the e-cigarette is addressed to researchers since an online survey showed that users of a third-generation device reported higher levels of dependency than those using a first-generation e-cigarette

Researchers are concerned by dual use of electronic and traditional cigarettes and wonder if it is a barrier or an aid to stop smoking.

Whether e-cigarettes re-normalise smoking, act as a gateway into smoking for non-smokers and children are crucial question addressed by officials, like that of vaping in public places undermining smoke-free policies. On all three themes the larger organizations share different points of view and are free to prohibit or allow vaping.

Regulation aspects

Regulation aspects are also discussed in the light of recent developments at the House of Lords, for example. Advertising bans, marketing restriction and licensing of the product under medicine to increase the level of nicotine strength are being discussed and will probably be addressed in a close future.

POSTnotes, POST-PN-0533, Sarah Bunn & Alex Hall, August 2016.