Electronic cigarettes – more good than harm?

I first encountered electronic cigarettes on a stand at the Royal Welsh Show and subsequently wrote about them for an article in the Western Mail back in 2009 when I was Research and Policy Officer at ASH Wales.

At that time, electronic cigarettes were being marketed by celebrities such as Rhys Ifans and were only really available over the internet. Some devices were of a very different quality to those available on the market today and Trading Standards faced many issues with these products not complying with UK product safety law.

 

How was I to know that five years later, in 2014, the number of electronic cigarette users in Wales would be estimated at over 100,000? Or that the Welsh Government would be consulting on including them under the existing ‘smoking ban’ regulations?

Electronic cigarettes have divided public health opinion in Wales as elsewhere. On one hand, they are viewed as having a potentially significant impact on the quit success of smokers who do not wish to engage with stop smoking services.

The Smoking Toolkit Study in England, led by Professor Robert West at UCL, has shown that at the same time electronic cigarette use has been increasing, motivation to quit smoking is up, the number of quit attempts made is up and more people are quitting smoking.

The smoking cessation rate in England is higher than at any time since 2007. The survey also shows that more people are using electronic cigarettes to quit than licensed nicotine replacement products.

On the other hand, a number of concerns have also been raised: that the long-term health implications of using the products are unknown; that seeing them being used may lead to a ‘renormalisation’ of smoking behaviour, and especially that they may act as a gateway for our young people to become addicted to tobacco cigarettes.

We are in no doubt that smoking kills. That people smoke for the nicotine, but die from the smoke. In Wales, as elsewhere, this burden falls disproportionately upon our most deprived communities.

At ASH Wales, we recognise the concerns that exist about electronic cigarettes, but above all, we support a harm reduction approach and measures that help as many of today’s tobacco smokers to quit as possible.

We must remember that electronic cigarettes are not cigarettes, do not contain tobacco and are not smoked.

The headlines from the Welsh Health Survey, published two weeks ago, show that adult smoking prevalence has been reduced by 2 percentage points in the last year, dropping from 23% to 21%. At the same time, attendance at NHS stop smoking services has also decreased. This is also true in Scotland, where in the latest report on smoking cessation data, it has been suggested that one of the reasons for this drop is smokers switching to electronic cigarettes.

Current evidence shows that the large majority of electronic cigarette users, known as ‘vapers’, are using these devices to either quit smoking or reduce their tobacco consumption. In the eyes of the public, electronic cigarettes are viewed as being less harmful than cigarettes. To date, the available academic literature largely appears to agree. We must, however, remain aware that this position could change as new data emerges.

With regard to the concerns highlighted above, potential long-term risks will not become known for some time. While renormalisation remains a possibility, no evidence has yet been published that substantiates this claim. It is also clear that, increasingly, many of these devices look less and less like tobacco cigarettes.

Recent headlines in the press regarding electronic cigarette use as a ‘gateway’ to smoking must be treated with caution. A ‘gateway’ effect would see young people who are experimenting with, or using, electronic cigarettes moving on to become addicted to tobacco cigarettes.

Two widely quoted studies that have been claimed to demonstrate this effect, one from the USA and one from Paris, actually show that the large majority of those young people who are experimenting with electronic cigarettes are either current smokers or experiment with tobacco products.

While there is a limited amount of evidence to show that a small number of never-smokers are trying them, it has yet to be demonstrated that they are going on to become regular users of these devices or moving on to smoke tobacco cigarettes. Whilst we must remain alert to the risk, we do not have the data collected over time which suggests that this is happening.

Electronic cigarettes may not be completely risk-free. They require appropriate regulation to ensure product safety and to minimise the possibility of their being marketed to young people and never-smokers.

It seems to me however, that we should recognise the significant public health opportunity presented by electronic cigarettes. The key is to maximise the benefits in reducing the number of smokers, whilst minimising the potential risks through regulation and monitoring.

While the emerging evidence must be kept under regular review, now is not the time to discourage those people who are using them to quit or reduce harm. Instead we should look to appropriate regulation of the product and not look to policies which oblige smokers and vapers to share the same space.