The effects of vaping on public health remains a newsworthy and interesting topic of discussion, with a range of views and opinions. Public Health England (PHE) is committed to reviewing the evidence regarding e-cigarette use and the effects of vaping on consumer health. PHE has recently (February 2018) published a 250-page independent review of e-cigarettes, updating its 2015 review, covering a wide-range of critical topics. These include the applicable regulations, usage patterns in adults and children, public perceptions of vaping, the effect of e-cigarette use on smoking cessation and reduction, and the addictiveness and health risks of e-cigarettes (including reported poisonings from e-liquids). In order to obtain recent information on these topics, PHE consulted peer-reviewed literature, survey data and a range of other data sources including the National Poison Information Service (NPIS) and the Medicines and Healthcare products Regulatory Agency (MHRA). PHE have also briefly considered heated tobacco, or the so-called ‘heat-not-burn’ products, for the first time.

As tobacco smoking remains the leading preventable cause of illness and premature death in England, PHE believes that e-cigarette use has a major role to play in reducing numbers of traditional tobacco/cigarette smokers. Quit success rates in England were at their highest recorded rates in early 2017, and PHE has estimated that at least 20,000 people per year are quitting smoking with the help of e-cigarettes. This is encouraging, but with an estimated 7 million smokers in England, not to mention the huge numbers in Europe and the rest of the world, there is clearly a long way to go to reduce the numbers of preventable smoking-related illnesses and premature deaths. Indeed, as of 2017, the number of adults using e-cigarettes plateaued at about 6% in the UK, and about 2% EU-wide.

According to PHE, widespread misperceptions regarding the health risks of vaping compared to smoking are postulated to play a major role in preventing cigarette smokers switching to e-cigarettes. For example, PHE reports that only half of adults believe that e-cigarettes (and other nicotine replacement therapies) are less harmful than smoking, and the majority of smokers/ex-smokers do not think that complete replacement of traditional cigarettes with e-cigarettes would lead to major health benefits. Furthermore, the vast majority of the population incorrectly believes that the major health hazards of smoking are caused by nicotine, with 40% of smokers/ex-smokers thinking that it is the cause of most smoking-related cancers. Such worrying and widespread misunderstandings need to be addressed if these quit success rates are to improve. Furthermore, PHE recommend that the strict advertising regulations for e-cigarette products are revised, particularly those concerning health risks of vaping compared to cigarette smoking, to help readdress these misperceptions, and that a competitive pricing advantage of e-cigarettes over smoking is maintained.

Of course, there are potential health risks associated with inhaling e-liquid emissions, but PHE is keen to reinforce the concept that vaping is a good way to encourage smoking cessation. Such an aim is not currently widely shared by other national authorities and international organisations around the world, and this disparity in expert opinion is likely a major factor in the continuing misperceptions and uncertainties of consumers and the wider general public.

In reviewing a number of studies on the health risks of e-cigarettes, PHE has reported the following key findings:

  • In one identified assessment of the published literature, the lifetime cancer risks of vaping were estimated to be < 0.5% of those of smoking.
  • Risks of cardiovascular/lung diseases are likely to be markedly reduced in vapers (compared to smokers).
  • Although there is no clear evidence, as yet, that specific flavourings in e-liquids pose health risks, the inhalation of some (e.g. diacetyl) could well be a preventable source of risk.
  • Potentially worrying aldehydes are produced when e-liquids are overheated, but an aversive taste is likely to prevent consumers from repeatedly inhaling such emissions.
  • Whilst some studies of adolescents have reported respiratory symptoms caused by vaping, respiratory improvements have been demonstrated in studies of “switching” (from smoking to vaping).
  • The levels of metals identified in e-cigarette aerosol currently do not give rise to any significant safety concerns, and are lower than those found in combustible cigarette smoke. Nonetheless, they should be reduced as far as is possible.
  • Biomarkers of exposure assessed to date are consistent with significant reductions in harmful constituents, and for a few biomarkers, similar levels to smokers abstaining from smoking or non-smokers were observed.
  • To date “there have been no identified health risks of passive vaping to bystanders”.
  • Reporting of “some academic studies has been misleading”.

Cases of e-liquid poisoning in the UK have usually involved the accidental ingestion of the liquid (particularly by young children or when the e-liquids are in unsecured or unmarked containers). The resultant toxic effects are usually short-lived and of minimal severity but, on very rare occasions, have resulted in severe toxicity and fatalities. Such incidents are expected to decline with the continuing improvement of safety features, warning labels and instructions on nicotine-containing e-liquid containers. These improvements are driven by key industry players acknowledging consumer and general population safety, consumer/customer pressure, and the relevant regulations (notably the with the introduction of the revised Tobacco Products Directive, and also EU CLP, and national enforcement agencies), and making significant changes to their products with these in mind; helping to ensure only safe products are placed on the market, and particularly the reduction in risks of accidental ingestion by children.

Based on the available evidence, PHE continues to believe that vaping poses only a small fraction of the risks of smoking (i.e. “vaping is at least 95% less harmful than smoking”), and that switching completely from smoking to vaping conveys substantial health benefits over continued smoking. In addition, the available evidence suggests that heated tobacco products may be considerably less harmful than combustible tobacco cigarettes but more harmful than e-cigarettes.

Read the full review from Public Health England here:



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