Protecting children from harms of vaping
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-073824 (Published 16 December 2022) Cite this as: BMJ 2022;379:e073824Linked State of the Art Review
Impact of vaping on respiratory health
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Dear Editor
Macleod and colleagues raise serious issues about vaping and children including known and potential harms; and cynical marketing strategies.(1) Within the UK vaping is a neglected public health challenge that needs further research and debate.
We have previously raised our concern about Public Health England’s controversial claim that e-cigarettes are 95% less harmful than conventional cigarettes.(2) We still think it is far too early to promote a figure such as this: there is a lack of evidence on the long-term health consequences of e-cigarettes, and some of the constituents are untested. However, the statement is still on government websites and it is included in the latest review by the Office for Health Improvement and Disparities.(3) We are also acutely aware of vendors using the statement as a marketing tool on websites and in shop displays.
Many countries take a very different approach to e-cigarettes from the UK, including Australia, India, Japan and South Korea.(4) The World Health Organisation is very clear on their webpage:
“Evidence reveals that these products are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impact of using them or being exposed to them.”(5)
An area that is of growing concern in relation to vaping is the effect on the environment, particularly in relation to the boom in the market of “disposable” vapes.(6-8) Some communities are experiencing pollution from vapes in the form of: plastic materials, electronic waste (including circuit boards and lithium-ion batteries) and hazardous chemicals. E-cigarette manufacturers and vendors could do more to ensure consumers dispose of their waste in a more environmentally friendly way.
E-cigarettes can also cause unintended injuries.(9) Faulty devices have caused burns and fires. In addition, hospitals and poison control centres are reporting growing numbers of small children accidentally swallowing liquids from e-cigarette refills. In the UK national accident prevention charities have issued guidance and in America the Centers for Disease Control and Prevention has produced detailed fact sheets.(10-12)
Within the UK e-cigarettes are being promoted by manufacturers and the NHS, and in many high streets there is a strong presence. We have serious concerns for children and young people and conclude that there should be a radical rethink of policy.
References
1) Macleod K, Bush A, Coutts J, Langley R. Protecting children from harms of vaping BMJ 2022; 379 :e073824 doi:10.1136/bmj-2022-073824
https://www.bmj.com/content/379/bmj-2022-073824
2) Watson M C, Lloyd J. Why the rules should not be relaxed for e-cigarettes to encourage people to stop smoking BMJ 2019; 364 :l555 doi:10.1136/bmj.l555
https://www.bmj.com/content/364/bmj.l555
3) McNeill, A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R and Robson, D. Nicotine vaping in England: an evidence update including health risks and perceptions, September 2022. A report commissioned by the Office for Health Improvement and Disparities. London: Office for Health Improvement and Disparities, 2022.
https://www.gov.uk/government/publications/nicotine-vaping-in-england-20...
4) Global State of Tobacco Harm Reduction. (Accessed 20/12/2022)
https://gsthr.org/
5) World Health Organisation. Tobacco: E-cigarettes. 25 May 2022 Q&A. (Accessed 20/12/2022)
https://www.who.int/news-room/questions-and-answers/item/tobacco-e-cigar...
6) Hendlin YH. Alert: Public Health Implications of Electronic Cigarette Waste. Am J Public Health. 2018 Nov;108(11):1489-1490.
https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304699
7) Young L. 'Disposable' vapes and the damage they cause. Posted 14/10/2022 (Accessed 20/12/2022)
https://www.keepscotlandbeautiful.org/blog/disposable-vapes-and-the-dama...
8) Pourchez, Jérémie et al. From smoking to vaping: a new environmental threat? The Lancet Respiratory Medicine, 2022. 10(7), e63 - e64
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00187-4/fulltext
9) Stratton K, Kwan LY, and Eaton DL, (Editors). Public Health Consequences of E-Cigarettes. Washington: National Academies Press, 2018.
https://nap.nationalacademies.org/catalog/24952/public-health-consequenc...
10) CAPT. E-cigarettes (Accessed 20/12/2022)
https://capt.org.uk/e-cigarettes/
11) RoSPA. Vaping. Is vaping safe? (Accessed 20/12/2022)
https://www.rospa.com/home-safety/advice/product/vaping
12) CDC. Electronic Cigarettes. (Accessed 20/12/2022)
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm#:~:....
Competing interests: No competing interests
Dear Editor
We read with interest the article on “Protecting children from the harms of vaping” It struck a tone which we fear will further mislead the public.
The proportion of young people who currently vape has increased (1) however this is not due to vaping being promoted as a cessation tool for adults. Claims that youth vaping risks becoming a potential ‘public health catastrophe’ leading to a ‘generation hooked on nicotine’ are not substantiated by the evidence in the UK.
Most children and young people do not vape, 98.3% who have never smoked are also not currently vaping according to a recent survey from ASH UK (2), meaning that current use is predominantly amongst ex-smokers and most overall use remains experimental. Access via shops being one of the key issues.
We agree that vaping is not risk free, however vaping is much less harmful than smoking and vapes remain an important tool for helping adult smokers to stop. The counterfactual smoking kills one in two users if used as intended and costs the economy, the NHS and social care billions each year. Harm reduction in this context is part of the solution in lifting people out of poverty and reducing health inequalities.
It is important to harness the population benefit of e-cigarettes to support adults away from tobacco addiction whilst avoiding unintended consequences of children starting to vape. We support the strengthening of nicotine vape regulations under the Tobacco and Related Product Regulations (2016) (3) to prohibit child-friendly packaging and labelling of vaping products and to prevent heavy promotion of vaping on social media and at point of sale.
Furthermore, flavours have been found to be extremely important in adults switching to vaping and sustaining use away from tobacco, banning these could potentially dissuade adults from trying nicotine vapes or lead to a return to tobacco.
With regards to knowing what is in vapes, the latest review from OHID (4) suggests there is significantly lower exposure to harmful substances from vaping compared with smoking, as shown by biomarkers associated with the risk of cancer, respiratory and cardiovascular conditions There are a number of ingredients which are prohibited in nicotine vapes including vitamins, stimulants such as caffeine or taurine, colourings and chemicals which are carcinogenic, mutagenic and reprotoxic in their unburnt form.
E-cigarettes have been on the market in the UK for 15 years and have been the most popular quitting aid since 2013. During that time vaping has not been associated with widespread health problems in the UK (5).
UK regulations prohibit the use of any ingredient in nicotine vapes that poses a risk to human health, including vitamin E acetate which causes serious respiratory disease when vaped (known as ‘EVALI’), This occurred predominately in the US where people altered the content of their vapes.
Most young people who try vaping do not get addicted to nicotine. Those who vape are much less likely to be dependent than those who smoke disputing the claim that lifelong addiction to nicotine is inevitable.
The current UK policy aims to balance the benefit of a harm reduction to both protect children and support adult smokers to quit. Regulation needs to be balanced and continued monitoring of trends and surveillance of youth use is needed, as is more funding for enforcement nationally. Restrictions on advertising also need to be strengthened in the UK.
1.Use-of-e-cigarettes-among-young-people-in-Great-Britain-2022.pdf (ash.org.uk)
2. The Tobacco and Related Products Regulations 2016 (legislation.gov.uk).
3. Nicotine vaping in England: 2022 evidence update - GOV.UK (www.gov.uk)
4. Chapter 6 - Ingredient Guidance - Great Britain - GOV.UK (www.gov.uk)
5. ASH-brief-for-local-authorities-on-youth-vaping.pdf
Competing interests: No competing interests
Re: Protecting children from harms of vaping
Dear Editor
Vape-Free Environment
Health education about the harms of vaping must be addressed to parents, teachers and children.
Health effects of vaping and it's prevention must be include in the school textbooks.
In each school hostels and in home environment, vape detectors installation can help to prevent vaping.
Competing interests: No competing interests