Back in 2015, the bold conclusions of our previous e-cigarette (EC) report were controversial in providing qualified support for the use of ECs but have since contributed to a shift in international opinion.
Many experts and professional bodies now agree that vaping is likely to be far less harmful than smoking.
Our latest report, which takes into account all new evidence since this point, covers regulation, EC use, ECs as a tool to help people quit smoking, and the safety of ECs, nicotine, and novel heat-not-burn tobacco products.
Below we look at some of the key questions and findings from the report.
How safe are ECs?
The risks of cancer, cardiovascular disease, and respiratory illness due to ECs are expected to be much lower than smoking. This is because the harmful chemicals present in cigarette smoke are either not in EC vapour or only found at much lower levels compared to smoke.
The most useful evidence comes from studies that compare smokers and vapers who don’t smoke and show declines in levels of markers of the harmful chemicals in the body.
We also know that, compared with tobacco smoke, EC devices produce low levels of toxic chemicals called aldehydes, except when on high power settings generating a vapour people wouldn’t inhale. Taking all this into account, although not risk-free, ECs are much less harmful than smoking – at least 95%, with the risk of cancer calculated to be less than 1%.
Our review strongly criticises reporting of studies in which the likely risks from ECs have been exaggerated. It also highlights that a quarter of smokers in England wrongly believe that ECs are as harmful as smoking.
It would be tragic if smokers who could quit with ECs do not try them because of these mistaken beliefs.
Are ECs effective quitting aids?
EC use is associated with improved quit success rates and a decline in smoking prevalence. ECs produce an estimated 18 000 additional long-term ex-smokers in England each year; a recent update suggests that figure might be as high as 57 000.
Data from local stop smoking services in England show that smokers using ECs combined with behavioural support are at least as successful in quitting as those using licensed medicines.
What are missing are randomised controlled trials (RCT) on ECs as a quitting aid. However, well-designed observational studies may be better as these would reflect what’s happening in the real-world – which EC people choose to use can affect their chances of quitting successfully.
Does EC experimentation increase smoking among young people?
Some studies show that young people who use ECs could be more likely to try smoking but certain young people may be predisposed to try both products. Experimentation with ECs among young people is fairly common but regular use (as least once per week) is still confined to those who have previously smoked.
What’s more encouraging is that the growing popularity of e-cigarettes seems to have had no negative impact on youth smoking rates which continue to decline.
Where should use of ECs be allowed?
In 2016, there were at least 25 countries where use of ECs was banned in enclosed public spaces. In countries, such as the UK, that have no ban, EC use is still restricted in many settings—e.g., on public transport and in schools.
It’s an important balance to strike; the risk of encouraging use of ECs, especially among young people, and any discomfort they may cause to others, with the need to support smokers using ECs to stop smoking and remain smokefree. For this reason, many hospitals in the UK now allow ECs in some areas, whereas smoking is banned.
Do ECs undermine existing anti-smoking measures?
Smoking prevalence continues to decline in the UK which suggests that the policies we have here are not renormalizing smoking. The majority of the time it’s easy to tell whether someone is using an e-cigarette opposed to smoking and ECs do not seem to be preventing enforcement of existing restrictions on smoking.
What evidence would we like to see in future?
Overall, the results of the review are reassuring and continue to support the idea that ECs are much less harmful than smoking. Data suggest that ECs are being used by tens of thousands of smokers to quit completely and by many more to reduce how much they smoke.
ECs are not causing more young people to smoke in the UK and most people who try ECs or use them to quit do not become addicted.
What we’d like to see evidence-wise over the coming years includes:
- Investigations into the way ECs are being used in the community, including trials of ECs as quitting aids
- Long-term studies looking at cardiovascular disease
- Further assessment of potential risks from less well studied chemicals in EC vapour such as the many flavourings and some metals
In terms of policy, all smokers should be supported to stop smoking completely, including those who smoke and use ECs. Support from smoking cessation clinics remains important in helping smokers to quit.
If we want to achieve a smokefree generation, we need to continue to make bold decisions on ECs backed by the evidence we have so we may continue to reduce the harms caused by tobacco.
Read our news story here.