Loading

Association of Directors of Public Health North East Position Statement on Nicotine Vaping

November 2022

The Association of Directors of Public Health North East (ADPHNE) is the North East regional arm of the representative body for Directors of Public Health in the UK. This position statement on nicotine vaping should be read in conjunction with the ASH briefings and guidance for local authorities and schools, the ADPH position statement on tobacco and the ADPHNE and Fresh Vaping Communications Guide. It has been developed following publication of the Nicotine vaping in England 2022 evidence update. Please note that for the purposes of this document, any references to vapes, vaping or e-cigarettes relate to nicotine-containing vapes, nicotine vaping and nicotine-containing e-cigarettes that comply with UK regulations.

Our position on nicotine vaping

  • Smoking tobacco will kill up to 2 out of 3 long term users. Tobacco remains the single biggest cause of preventable illness and death with approximately 5,000 people in the North East dying each year from smoking.
  • Smoking tobacco products is a significant driver of health inequalities. Our priority for tobacco control must be to reduce the number of people who smoke a known uniquely lethal product.
  • The evidence is clear that, for smokers, vaping is a far less risky option and, in the short and medium term, vaping poses a small fraction of the risks of smoking. We must ensure that vaping is an affordable and accessible alternative for smokers who want to reduce their risk of dying from a smoking-related disease.
  • A critical recommendation to the government from Dr Javed Khan OBE’s independent review on making smoking obsolete is to promote vaping as an effective tool to help people to quit smoking tobacco, outlining the role that vaping can play in an effective tobacco control strategy.
  • At the same time, we recognise that vaping is not risk-free and therefore vaping must be presented as an alternative to or replacement for smoking, not an activity which is appealing to the wider non-smoking population.
  • Vaping is not for children and whilst it can help people quit smoking, those who don’t smoke should not vape. We need to reduce the number of young people accessing vape products and the amount of non-compliant products available for sale. We need to work closely with our Trading Standards colleagues to support compliance with regulations and to take enforcement action when necessary. We also need to continue to advocate for tighter e-cigarette regulations where needed, ensuring the right balance is taken around protecting young people and supporting smokers to quit.
  • In households where tobacco smoking occurs, vaping offers a less harmful alternative for non-smokers. Exposure to secondhand tobacco smoke is dangerous. Compared with cigarettes, vaping products produce no or little side-stream emissions. The evidence update found that there is no significant increase of toxicant biomarkers after short-term secondhand exposure to vaping among people who do not smoke or vape.
  • There are concerns that only a small proportion of adults who smoke accurately believe that vaping was less harmful than smoking. We therefore support the delivery of evidence based communications among stakeholders and the public to widen understanding and to ensure smokers understand that switching to vaping is a significantly less harmful option than continuing to smoke.

The problem with smoking

Tobacco smoking is our biggest killer and a key contributor to avoidable health inequalities. Cigarettes are the only legal consumer product that, when used exactly as the manufacturer intends them to be used, will kill up to two thirds of long term consumers. Tobacco and vapes both contain nicotine which is an addictive substance, but nicotine itself has been used safely for many years in medicines to help people stop smoking. However, tobacco and the smoke it produces, contains a toxic mix of over 6,000 chemicals, many of which are known to cause cancer and as well as other fatal and life limiting conditions such as respiratory and cardiovascular disease, not just among smokers but also among those who are exposed to secondhand smoke.

15.3% of adults in the North East smoke, down from 29% in 2005 but despite faster progress in this region than other areas, an inequalities gap remains. The smoking rate among routine and manual workers is 24.3%, resulting in a significantly negative impact on income as well as employment, due to ill health and disability. Among those with mental health conditions, the smoking rate is 27%, with smoking being a leading cause of reduced life expectancy. Overall, smoking costs the North East nearly £888 million every year, £67 million of which is spent on smoking-related social care and £125 million on health care.

The evidence base on vaping

The most robust evidence on nicotine vaping is contained within the Nicotine Vaping in England: 2022 evidence update. The report is the most comprehensive to date, its main focus being a systematic review of the evidence on the health risks of nicotine vaping. Based on the evidence within the review, a summary of conclusions is that:

  • In the short and medium term, vaping poses a small fraction of the risks of smoking, but that vaping is not risk-free, particularly for people who have never smoked
  • 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. However, there is similar or higher exposure to harmful substances from vaping compared with not using any nicotine products.
  • There is no significant increase of toxicant biomarkers after short-term secondhand exposure to vaping among people who do not smoke or vape

The role of vaping in helping smokers to quit tobacco

Vaping products are helping people to quit smoking. The Cochrane living systematic review on electronic cigarettes for smoking cessation shows that vaping is effective at stopping people smoking. NICE recommends that smokers are encouraged to vape in their quit attempt and they are currently the most common aid used by people to help them stop. However the majority who use them are doing so without behavioural support: quit rates will increase if behavioural support is provided alongside switching to vaping.

E-cigarette regulation

E-cigarettes are regulated in the UK through legislation relating to quality, safety, age of sale and advertising. Enforcement of laws on underage sales, sales of illegal products, and point of sale advertising is the responsibility of Trading Standards. Enforcement of other advertising and promotion of vaping to under-18s, for example on social media, is the responsibility of the Advertising Standards Authority. However, there are concerns about the attractiveness of some vaping to children, that a proportion of retailers are selling to under 18s and that products that don’t comply with UK rules are easily accessed. These issues need to be looked at nationally to ensure the products available are compliant and aren’t sold to children while at the same time ensuring that vapers can access devices that can support them to quit and stay quit.

Footnotes:

The ADPHNE

The Association of Directors of Public Health North East (ADPHNE) is the North East regional arm of the representative body for Directors of Public Health (DsPH) in the UK. The ADPH seeks to improve and protect the health of the population and is a collaborative organisation working in partnership with others to maximise the voice for public health.

General resources

For smokers

For health care professionals and public health colleagues

For enforcement colleagues

For schools

Appreciate