E-cigarettes: a burning issue for future public health policy?

Although some of the Labour party’s early thinking on public health policy has recently been leaked, in the run-up to the general election all political parties will need to develop their ideas for improving the public’s health, from policies on alcohol and food, to the role of industry and taxes. With plain (or rather standardised) cigarette packaging now close – in no small measure thanks to the compelling Chantler Review – the next political issue on tobacco must surely be a clearer view on e-cigarettes.

While there are concerns about the appropriate safety regulation of e-cigarettes, with recent reports of poisonings and fires, and issues about the standardisation of nicotine delivery, these concerns will be addressed by the EU Tobacco Products directive. The burning question is how the broader regulatory approach will develop and whether parties will be welcoming or shunning e-cigarettes? 

The answer to that will depend to large degree on three issues: the role e-cigarettes play in introducing people to smoking (gateway effects); in encouraging people to continue smoking (maintenance); and in supporting people to give up smoking (exit effects). Views on these issues and the strength of evidence for each have been polarising the public health community. Some see e-cigarettes as renormalising smoking, especially for children, and it is striking just how many billboards are plastered with e-cigarette advertising, with ads making their way on to TV too. Others see e-cigarettes as the opportunity to help thousands of smokers to stop smoking, swapping a highly toxic product for a much less harmful, albeit highly addictive, one. There is also a contested middle ground, where people smoke both tobacco and e-cigarettes – is this reducing harm or stopping people from quitting tobacco entirely? Surrounding all of this there is, for many, a clear distaste for the commercial resurgence of the big players of the tobacco industry as they move into e-cigarette production.

In the past few weeks there has been a slew of new papers, surveys and other evidence on e-cigarettes, both here, and across the Atlantic. And today, 50 public health specialists have written to the World Health Organization supporting their use. So what does all this tell us? The latest survey by Action on Smoking and Health (ASH) – broadly in favour of e-cigarettes – has shown a huge increase in the numbers of adults using e-cigarettes since 2010 – now up to 2.1 million people across Great Britain, 700,000 of whom are ex-smokers. Around 38 per cent of those who had used e-cigarettes said they did so to help them quit smoking entirely. The same survey showed only 1 per cent of children who had never smoked a tobacco cigarette reported using an e-cigarette. ASH interprets this in a positive light in terms of e-cigarettes seeming to lead people into tobacco smoking, and Public Health England’s (PHE) review paper agrees, stating, ‘to date there is no data’ to support the claim that using e-cigarettes encourages people to start smoking tobacco. The PHE paper also sets out who uses e-cigarettes and how: use is more common among heavier smokers, younger smokers and ex-smokers. There is also evidence that e-cigarettes are used in preference to other nicotine replacement therapies, suggesting that people are using them as an aid to quitting or reducing smoking. Indeed, although subject to understandable caveats, the latest study suggests that quit rates with e-cigarettes may be as high as 20 per cent.

So, overall the message about e-cigarette use seems to be cautiously positive. But there are important subtleties that remain, especially among the 1.3 million people in Britain who continue to practice dual e-cigarette and tobacco use. Essentially, how big are the two groups of dual users: those who can’t or don’t wish to stop tobacco smoking and by switching some of their consumption reduce harm, versus those who would otherwise make ultimately successful quit attempts, but are stopped from doing so by being ‘maintained’ smokers? There has also been little debate or evidence to date on whether e-cigarettes narrow or widen socio-economic and other patterns of tobacco use, which is critical to wider health inequalities policy. We in England also need to keep abreast of how policy is shaping up further afield. For example, Public Health Wales has already called for a ban on e-cigarettes in enclosed public places and in the United States the balance of the policy debate (and seemingly the evidence) is clearly more anti e-cigarettes than it seems to be in the United Kingdom. 

Getting the policy right on e-cigarettes is critical. Public Health England, recently criticised for being rather meek in big public health policy debates, will have an important role in navigating the tangled web of evidence and opinion as the parties start to develop positions on this critical issue. We therefore welcome the work it has commissioned in this important area, and the fact that it is starting to speak out. This debate is not going to go away, and much is at stake. Given that every tobacco cigarette smoked is estimated to reduce life expectancy by 11 minutes, politicians’ decisions on e-cigarettes will end up affecting the health of hundreds of thousands of people.

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Comments

#42188 Peter M B English
Public Health Physician
Not relevant - this is a personal comment

Given Big Tobacco's history of distorting the evidence I am very suspicious of any claims that a new way of marketing nicotine addiction could be helpful.

While it is likely to benefit smokers if e-cigarettes reduce their exposure to cigarettes by acting as a cessation aid or a safer substitute, Big Tobacco will vigorously "sell" every bit of evidence that this is what e-cigarettes do; and will attempt to dismiss, distort, or rubbish any evidence to the contrary.

The marketing of e-cigarettes today has included clear attempts to make the products sexy and appealing to a younger audience - to seduce non-smokers into trying this "safe" product and thus become addicted to nicotine.

I have blogged on this at http://peterenglish.blogspot.co.uk/2014/05/big-tobaccos-trojan-horse.html .

#42189 Peter Rose
Retired
none

Nicotine is extremely addictive. It has not been shown that the long term use of e-cigarettes is not harmful. Why would we make legitimate another addictive product which has not got more benefits than downsides?
It may be that e-cigarettes can be helpful to enable people to give up cigarette smoking, but I believe signing up to an NHS quit smoking programme has better outcomes.
e-cigarettes should only be available on prescription to help in the few cases when they help to give up smoking.

#42191 Roger Turner
Retired
None

Nicotine is an addictive drug. It beggars belief that it can be sold over the counter without regulation. The cigarette industry hides behind the mantra that cigarettes are a legal product. However how many food stuffs or any other product for that matter , would be allowed to be sold if they were shown to be carcinogenic? None.

Let's get real and make e-cigarettes a highly regulated product and price cigarettes out of the market.

#42192 Fergus Mason

You are aware that many foodstuffs, including most vegetables contain nicotine, right?

#42193 Andrew Scotchmer
Data Analyst & Health Analyst
NHS

@Peter Rose and Roger Turner

Addictiveness is measured by the delivery system no the substance. Yes Nicotine has addictive qualities but e-cigs are less efficient at administering nicotine into the blood system than a conventional cigarette and so e-cigs are less addictive. If nicotine was drank it would probably be as addictive as caffeine. Which brings me on to my second point.

Roger Turner says "Nicotine is an addictive drug. It beggars belief that it can be sold over the counter without regulation." So where did you buy the coffee or tea you enjoyed this morning? Not from a pharmacist that's for sure.

#42197 Chris Price
Web business manager
A3webtech

Hilariously funny, but rather tragic. There isn't a single piece of evidence (let alone a clinical trial) that shows nicotine is 'addictive' unless delivered with tobacco and especially in tobacco smoke. This is why all clinical trials where pure nicotine was administered to never-smokers (often in large doses for up to 6 months) report that no withdrawal synptoms were seen, no dependence was seen, and no subject continued to use nicotine thereafter. It's also why vapers routinely reduce the strength and amount of nicotine they consume, and why many eventually transition to a zero-nicotine use group, and many quit totally.

If people are not aware that tobacco smoking causes a change in brain chemistry due to the 9,600 other compounds delivered and believed to be principally the MAOIs, creating a permanent or semi-permanent change in brain function and causing dependence, and that pure nicotine has no observable dependence effect on never-smokers, then they probably shouldn't be commenting on these issues.

What next? Nicotine causes cancer? Good god. A fine demonstration of the tragic incompetence of many connected with public health.

#42274 Lauren Bond
SEO
http://www.route34store.com/e-cigarettes

Good article on e-cigarettes.

#42330 Tom Teasdale
Retired

A.S.H. reports that 700,000 smokers have quit by using e-cigs , jury still out ? , I hardly think so. All surveys so far show the instances of non-smokers taking up vaping is negligible and the "gateway" effect to be non-existant. Legislating e-cigs as medicines or as tobacco products will destroy the thousands of small manufacturers and retailers and hand the industry over to big tobacco companies on a plate , look no further than what happened to Snus when it became a viable alternative to cigarettes.

#42362 Sean Ben

E-cigs are very safe smoking alternative and it can be taken as it is safe and don't contain nicotine that is very addictive substance.

#42364 osteopath windsor

This is a very good blog, containing some very helpful informations.

#42389 Aalana smith
http://www.shop4herbalincense.com/wholesale-herbal-incense

Best thing about e cigarettes is that they do not include nicotine. It is battery powered vaporizers that turn a liquid solution into an aerosol that can be inhaled. These are far much better than traditional smoking products.

#42392 Jane Mike
Osteopathy
totalhealthosteo.com.au

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#42407 Kelly Lewis
https://www.legalherbalonline.com/deal-of-the-day

We all know that smoking is silent killer. Tobacco present in smoking products is malefic for individual's health. E cigarettes are better than tobacco products. We can say that they are healthy alternative and are also quite potent in quitting smoking.

#42511 Ellie Brown

Nice and helpful information. E cigarette industry is booming recently due to its non malefic nature. These are great substitute of traditional smoking products.

#58729 sean ben

The best thing about electronic cigarettes are they are very healthy and safe unlike the tobacco cigarettes that contains harmful effects in them and best thing is it is an economical device unlike cigarettes.

#81988 amy

E-cigarette are teh most best alternative to e-cigs that provides with the soothing and pleasing vapors and it really help in quiting real smoking habit easily.

http://www.atmostechnology.com

#114123 jerry page
Marketing Professional
ecigs

No !!! No burning issues, E-Cigs are healthier alternative to tobacco regular cigarettes which cause millions of deaths every year. More on http://soulblu.com

#162775 Emma Logan
Director
JAC Vapour Ltd

The comments section of articles such as these is always more interesting, in many ways, than the article itself. It reflects differing opinions and often highlights the distinct lack of cohesive education on e-cigarettes.

As a director of an independent global e-cig company, JAC Vapour, I have spent much time ploughing through scientific research, market research, proposed legislation and general opinion.

The fact remains, e-cigarettes are a healthier alternative to cigarettes. This is proven, and agreed by many top scientists. A simple google search on reputable sites verify this. Similarly, there have also been studies to show that e-cigarette vapour has no harmful second hand properties.

Much vilification surrounds the visual aspect of the devices (visible vapour) and the fear that e-cigarettes will glamourise smoking and be attractive to children and create a gateway effect - whereas national studies carried out by ASH points to the exact opposite. Opinion should not be read as fact.

Smoking is not healthy, smokers are more than aware of that. However, most people start smoking young and find it very very difficult to give up. Nicotine is addictive, as are all the additives added to tobacco cigarettes. In particular it is the habituation of smoking that is so difficult to break. Some sources suggest that 3 days without nicotine in the system means that a person is no longer addicted - why then is it so difficult to give up? Over years, smokers develop ingrained habitual behaviours which are very hard to break. This is where the 'hand to mouth action' of using e-cigs and the simulated 'throat hit' is particularly effective.

Rough stats show that 7% of people who give up cold turkey will succeed in quitting, this is the same number who will give up successfully using NRT products. Whereas, a JAC Vapour study in 2013 of over 7k of our customers showed that 75% of them had given up cigarettes completely. These stats speak for themselves.

Nicotine is addictive but then so is caffeine. And both are about as dangerous to health as each other. If caffeine were inhaled instead of consumed via an artisan coffee in a pretty cup -would we try and ban coffee too?

E-cigarettes work. Is it preferable to give up altogether? Yes. Can e-cig users give up vaping? Yes. I am one of them. from 30 cigarettes a day to a vaper for 3 years, to using 0mg nicotine liquid, to nothing. Where NRT, Alan Carr, cold turkey and hypnotism failed. Do they need universal regulation? Yes. As with any new industry there are retailers out to 'make a quick buck' and others who take their products and duty to customers seriously.

ECITA (Electronic Cigarette Industry Trade Association) exists to ensure that all of their 26 UK members follow best practice guidelines. Contrary to some misleading press articles - e-cigarettes are not unregulated. All e-cig vendors should have ROHS and CE certification for their hardware, and this should be checked by Trading Standards.
Customer safety is of the utmost importance, an e-cigarette is subject to the same standards and regulations as all electrical devices sold in the EU, from phones to mp3 players. E-liquid should also be CHIP compliant and tested independently in labs to confirm its contents.

Consumers should be aware that they should look for the ECITA stamp of approval to make sure the products they are buying have been certified as safe, as per EU guidelines.

Education is key. Instead of trying to shoe horn e-cigarettes in with tobacco products - understanding the role they have to play to break the cycle of smoking related deaths is key. Brands that enforce safety best practices and follow ASA guidelines to only advertise to smokers should be promoted, not vilified.

Our blogs cover a wide range of topics, including safety, info on nicotine free products, how e-cigarettes work etc - easy to digest information for anyone who would like to know more on these potentially life saving products

http://www.jacvapour.com/blog

#543806 Michael bersil
vapordelight.com/

I think electronic cigarettes are best alternatives for harmful tobacco smoking. There are thousands of smokers in world those are quitting smoking with the help of electronic cigarettes.

#545214 Maria Johnson

Personally i m very happy with both tobacco products and smoking alternatives like e-cigs. i have found them great both in terms of being able to use them indoors and the money i save every week.More info if you click here: http://vapeconnection.com.au/

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