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UK public health experts move to quash e-cigarette fears in wake of US report

US and UK not comparable: don’t be put off helping smokers to switch, they advise

Caroline White

Friday, 09 December 2016

UK public health experts have moved to quash fears about the potential dangers of e-cigarettes in the wake of the US Surgeon General’s report* setting out the urgent need to curb the rising popularity of vaping among young people in the US.

Clinicians should not be put off from helping smokers to quit or cut their risk of harm by switching to vaping, they insist.

In his report,* published earlier this week, Dr Vivek Murthy pointed to the evidence on the impact of nicotine on the developing brain, and its ability to trigger lifelong addiction, as well as the potentially harmful additives found in some e-cigarettes.

Use of e-cigarettes among high school students in the US had soared by 900% in the past five years, surpassing all other forms of conventional tobacco use, he said.

“We must protect our nation’s young people from a lifetime of nicotine addiction and associated problems by immediately addressing e-cigarettes as an urgent public health problem. Now is the time to take action,” he urged.

But Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said that while he understood the concern about the rapid uptake of e-cigarettes in the US, attempts to regulate these products in the US had been difficult, and the situation in the UK was very different.

“We have comprehensive regulations in place, including a ban on selling e-cigarettes to under-18s and tough restrictions on advertising, as well as minimum standards for safety, maximum nicotine levels and health warnings on packs,” he said.

“Our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year. No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence,” he added.

Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL), reiterated the findings of the Royal College of Physicians report, which identified vaping “as a great public health opportunity,” rather than a threat.

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers,” he insisted.

“The prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. Ongoing vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike,” he continued. 

The report also ignores the huge benefits of vaping for adult smokers in helping them switch from “deadly smoking,” he added.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate,” he said.

Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, said the evidence presented in the report on the potential harms of vaping during pregnancy had been fundamentally misunderstood, and was based on studies in rats and mice, not people.

“While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations,” she pointed out.

The Surgeon General’s report might make clinicians more hesitant about discussing e-cigarettes with pregnant women who smoke. “That would be harmful to maternal and child health and must be avoided,” she insisted.


* E-cigarette use among youth and young adults. A report of the Surgeon General. US department of health and human services, 2016.

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