'There are many myths about e-cigarettes and vaping'

E-cigarettes (vapes) are currently the most popular aid used to quit smoking in England and are used by around 4.3 million adults in Great Britain, the majority of whom are ex-smokers (ASH, 2022a).

A recent Cochrane systematic review found that e-cigarettes are a more effective quitting aid for smokers than nicotine patches or gum (Hartmann-Boyce et al, 2022).

"In 2022, there was significant growth in the number of 11-17 year olds using e-cigarettes compared to previous years"

A major independent review of the evidence on the health effects of vaping, commissioned by the Office for Health Improvement and Disparities, concluded that “vaping poses only a small fraction of the health risks of smoking and that smokers should be encouraged to use vaping products (or medicinally licensed products) for stopping smoking” (McNeill et al, 2022).

Vaping is not risk free and is not recommended for children and non-smokers. In 2022, there was significant growth in the number of 11-17 year olds using e-cigarettes compared to previous years, from 3.3% in 2021 to 7% in 2022, (ASH, 2022b) which is of concern and needs addressing.

However, it is important to put this figure into context. E-cigarette use among 11-17 year olds who have never smoked remains low, with only 1.7% of never smokers vaping at least monthly. While we are seeing an increase in vaping among children and young adults, the vast majority are young people who’ve already tried smoking. Vaping among those who haven’t tried smoking has to date largely been experimental with people just trying it once or twice.

Although youth use remains low, there is still action which could be taken to limit the possible risks of youth uptake. For example, single-use e-cigarettes have increased in popularity in recent years. These are often brightly coloured and come in a variety of sweet and fruit flavours. To reduce availability of single-use e-cigarettes, ASH has called for an excise tax to be placed on these products.

There are also opportunities to further regulate the way e-cigarettes are marketed to reduce their appeal to children such as prohibiting the use of cartoon characters and bright colours on packaging. In 2022, over half (56%) of 11-17 year olds reported being aware of e-cigarette promotion, most frequently in shops followed by online.

Better enforcement is also needed of existing regulations which prohibit the sale of e-cigarettes to under 18s. To do this we need better funding for enforcement to tackle underage sales; mandatory age verification in shops for anyone looking under 25; and to prohibit free distribution to under 18s (currently legal to anyone of any age).

In addition to these recommendations, ASH and Smokefree Sheffield have produced a set of resources for schools to help them address youth vaping and inform children and young people about the facts around vaping.

As well as taking action to reduce youth vaping, it is important that the potential of e-cigarettes as a smoking cessation aid for adult smokers is preserved. Evidence from the Smoking Toolkit Study (an ongoing series of monthly surveys of the adult population of England) shows that e-cigarettes may have been responsible for an estimated 69,930 additional ex-smokers in England in 2017.

Encouragingly, e-cigarettes are increasingly being used as quitting aids in stop smoking services in local authorities and the NHS, as recommended by the National Institute for Health and Care Excellence (NICE). In 2022, ASH's annual survey of local government tobacco control services found that 52% of local authorities offered e-cigarettes to users of stop smoking services.

Similarly, in a recent survey of NHS tobacco dependence treatment services, 30% of respondents said their trust would be offering vapes a stop smoking aid. This rose to 79% in mental health inpatient settings where vapes appear to have particular value. E-cigarettes are also being included in North East and North Cumbria ICS’s smoking cessation offer for NHS staff, and have proven popular and effective.

There are many myths about e-cigarettes and vaping, frequently reported in the media, which risk undermining the use of these products as cessation aids for adults. ASH has developed a briefing to address these myths and set out the evidence (ASH, 2023).

It is vital that health professionals are provided with accurate, evidence-based information on vaping so that they can deliver advice and support to smokers, children and families.

While action to reduce the appeal of vapes to children is needed, the biggest threat to child health is still smoking, where two thirds of those trying one cigarette will go on to become daily, addicted, smokers, at least half of whom will eventually die from smoking-related disease.

John Waldron is policy manager, Action on Smoking and Health (ASH); Dr Debbie Robson is senior lecturer in tobacco harm reduction, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Professor Ann McNeill is professor of tobacco addiction in the Department of Addictions, King’s College London