Public Health England have stated their fears that media scare-mongering and misinformation about vaping is preventing millions of smokers from making the life-changing switch to vaping. Now in its sixth installment, the PHE (Public Health England) independent report into e-cigarette use provides an insightful study of vaping developments in the UK. The latest report aims to present an update on the prevalence of vaping among young people and adults, whilst taking an unprecedented look at vaping among people with mental health conditions as well as pregnant women.
It also highlights the recent EVALI (E-cigarette or Vaping Use-Associated Lung Injury) deaths within the US in late 2019, and sheds some much needed light on the release of misinformation deterring smokers away from the harm-reducing potential of vaping. We take a look at the key findings and developments of the report as well as its possible impact on the future of vaping.
Overall, current vaping use has remained relatively the same in adults and young people since the last report released in February 2019.
The report states, ‘Current vaping prevalence (weekly or less than weekly) among young people in England has remained reasonably steady with the best recent estimates putting it at 6% of 11 to 15-year-olds in 2018 and 5% of 11 to 18-year-olds in 2019. Older children are more likely to vape. Current use among 11-year-olds was estimated at less than 1% in 2018, compared with 11% of 15-year-olds.’ This highlights that the vast majority of young people do not vape, contradicting the age old myth that e-cigarette use fuels nicotine addiction in minors which has predominantly influenced anti-vaping legislation in the US.
It also claims, ‘Current vaping is mainly concentrated in young people who have experience of smoking. Less than 1% of young people who have never smoked are current vapers.’ Although it is essential to discourage young people from any form of nicotine consumption including vaping, the fact that a large proportion of the small number of underage vapers come from a smoking background can be considered a positive step in the right direction.
What’s rather worrying however is that, 'young people’s perceptions of the relative harms of vaping compared with smoking are increasingly out of line with the evidence. The proportion of 11 to 18-year-olds who thought that vaping was less harmful than cigarettes declined from 68% in 2014 to 52% in 2019.'
It is equally as worrying in adults, as the report goes on to say, ‘The proportion (of adults) who thought vaping was less harmful than cigarettes declined from 45% in 2014 to 34% in 2019. These misperceptions are particularly common among smokers who do not vape.’ This could be attributed to the recent reporting of the EVALI deaths in the US. It is widely known among scientists and health professionals that the cause of the EVALI outbreak was in fact illicit THC vape products (THC being the psychoactive ingredient in Marajuana). Due to the misinformation spread by the media on the subject, the distinction between this and vaping as a harm reduction alternative to smoking was not made, and has resulted in severe impacts on the perception of vaping. Unfortunately, this will only deter people away from vaping as a form of quitting, whilst continuing to smoke cigarettes and increasing the risk of illness or premature death.
Furthermore, ‘Vapers said that banning flavoured liquids would deter them from using vaping products to help them quit or reduce their smoking. It could also push current vapers towards illicit products.’ This is extremely important in light of the recent changes in US law, where flavours other than tobacco and menthol have been banned from pre-filled vape pods, fuelled by the much reported ‘youth vaping epidemic’ in the States. Although open system products remain unchanged, this has still had a negative impact on the millions of adult vapers using the pre-filled products.
Rather than tackle the issue of retailers illegally selling products to minors, they have decided to completely shutdown and legislate against the legal products themselves. These stats from PHE show exactly why such a move is shortsighted. Removing the adults ability to choose a flavour they find palatable could have very detrimental effects, sending many vapers back to smoking, as well as preventing many smokers from ever making the switch.
One of the main targets of the government’s Tobacco Control Plan for England was to look at the need for more reliable data amongst people who suffer from mental health conditions. Due to the distinctive lack of studies related to mental health sufferers who vape or smoke, PHE were unable to report conclusive rates or statistics.
The report however did find that, ‘High rates of smoking and vaping together suggest that smokers with mental health conditions should be advised and supported to quit smoking completely, as soon as they feel able to do so. More research is needed on vaping among people with mental health conditions and its efficacy and safety for quitting smoking.’
Dan Marchant, director and spokesperson of the UKVIA, claims, ‘Smoking prevalence amongst adults with mental health conditions is estimated to be over 40%, almost triple the national average of 15%.’ With most mental health centres and trusts allowing vaping on premises, Marchant also states, ‘I believe it is extremely sensible for PHE to call for better training amongst the mental health professionals, to ensure they fully understand the harm reduction benefits of vaping and are able to help patients begin their journey away from tobacco.’
This echoes the alarming statistic released by the Daily Express in April 2019 that ‘93 percent of healthcare professionals were unaware of Public Health England’s position that vaping is at least 95 percent less harmful than smoking.’ It seems that more can and needs to be done to educate not only patients but also GPs and healthcare workers in advocating for the use of vaping to quit smoking.
When examining vaping during pregnancy, PHE found that ‘Pregnant smokers and health professionals are unsure about the relative risks of vaping for mother and baby and clinical practice on vaping in pregnancy varies.’ In similar fashion to data concerning mental health sufferers and vaping, the distinct lack of evidence suggests more clinical research is needed on the associations between vaping in pregnancy and smoking cessation and health outcomes.
PHE goes on to state, ‘the common reasons for vaping in pregnancy are to stop smoking, prevent a return to smoking and reduce harm. So, any uncertainty about the harms or risks of vaping in pregnancy is likely to discourage vaping by pregnant smokers. The inconsistent attitudes of health professionals to vaping in pregnancy show that guidance is urgently needed.’ Whilst PHE continually stand by the often quoted statistic that ‘vaping is 95% less harmful than smoking’, the disregard of healthcare professionals in using, or aligning their stance, with this finding remains unclear. This can be viewed as somewhat contradictory against one of the most respected public health organisations in the world.
This PHE report was warmly welcomed by the vaping industry as well as anti-tobacco enthusiasts, disenfranchised with the consistent slandering of e-cigarettes over the last few months. It obviously generates concern that the spread of misinformation during the height of the EVALI outbreak has heavily impacted smokers perception of switching to vaping, as does the shortage of information relating to vaping amongst pregnant women and those suffering with mental health. Saying this, the fact that vaping amongst young people remains low can only be seen as an overwhelming positive.
Hopefully this report will act as a defiant cry for more data to be gathered across a variety of topics and groups, as well as the development of knowledge in healthcare professionals, which in turn could go on to help those in need.