Towards greater acceptance of e-cigarettes

A government committee has recommended easing regulation on e-cigarettes to better harness them as a means of stopping smoking. Backed up in part by evidence from psychologists, the Science and Technology Committee’s report has been released against a background of confusion about the risks the devices pose, whether they may lead children and young people to take up smoking, and whether they could be dangerous to bystanders.

The committee pointed to evidence that e-cigarettes, first introduced in the UK in 2007, are around 95 per cent less harmful than normal cigarettes and offer an opportunity to tackle one of the leading causes of death in the UK. An estimated 2.9 million people in the UK have used e-cigarettes to stop smoking, many tens of thousands successfully, but some remain concerned over their potential long-term effects.

In written evidence the British Psychological Society made recommendations to the government to better educate the public and current smokers of the relative benefits of e-cigarettes in quitting smoking. It also suggested raising the cost of conventional cigarettes further while reducing the cost of e-cigarettes as well as 'vape-free' legislation.

Several psychologists contributed to the report. Members of the University College London Tobacco and Alcohol Research Group, Health Psychology Lecturer Dr Lion Shahab and Deputy Director Dr Jamie Brown, said in their oral evidence to the committee that a lot of papers looking at longer term risk in this area overstate what has been found in press releases. ‘This may be partly because often the papers look at acute and not at chronic effects, and effects that are not very well linked to long-term health outcomes.’

Brown also pointed out that potential risks with e-cigarettes should be compared with the very definite risks of conventional cigarettes. ‘Any perceived risk associated with offering reassurance before we have the long-term data [on e-cigarettes] must be balanced against the risk associated with the opportunity cost of failing to inform the millions of people who are currently smoking uniquely dangerous products that e-cigarettes are safer when they believe they are not.’

Many commentators on this topic have pointed to worries about e-cigarettes being a gateway into real cigarettes for young people but this report points out there is little evidence for this. Similarly risks to bystanders from second-hand vapour, it says, have been difficult to measure as it is 'negligible and substantially less than that of conventional cigarettes'.

On Twitter, the University of Bristol's Professor Marcus Munafo was asked whether there is any evidence that non-smokers take up vaping; not as a gateway for smoking, just for its own sake? 'They exist but the numbers are relatively tiny,' he replied. 'Also, it’s complicated by the fact that many are not in fact never smokers (we have data on this) and they often use zero strength liquid. There does seem to be more of this in the US than UK (with reference to young people). My hunch is that the broad UK public health stance, promoting e-cig use as something to help smokers quit, has made vaping something older people do, and therefore deeply uncool!'

Dr Lynne Dawkins (London South Bank University) was also a contributor of oral evidence, particularly on 'real-world puffing patterns'. 'The key message is not to encourage vapers to switch to using lower nicotine concentrations,' she said. 'In fact – perhaps counterintuitively –using a higher nicotine concentration might result in less puffing. The nicotine delivery still seems to be much better with the higher nicotine concentration.'

Dawkins also pointed to gaps in the evidence. 'Much research is on current vapers. They are probably okay – they have made the switch. We need to concentrate on smokers. Why are smokers not making the switch? Why are half of those smokers who have tried electronic cigarettes not fully transitioning? This may be partly due to the nicotine concentrations, and it may be partly due to the health messages, but we need to make them as attractive as possible to smokers. That means having a variety of different products – one size does not fit all –and having different concentrations of nicotine available.' 

The report recommends that the government should stick to its planned annual review of the evidence on e-cigarettes and support a long-term research programme into their effects. It also suggests that the NHS should allow e-cigarettes in mental health facilities given that people with mental health problems have some of the highest rates of smoking and smoking-related deaths – yet the devices are banned by many trusts.

The report also urged the government to remove any regulation of e-cigarettes which prevent them being used as a stop-smoking device, and suggests that taxation should directly reflect the evidence about a product’s health risks. ‘While an evidence-based approach is important in its own right, it also may help bring forward the behaviours that we want as a society – less smoking, and greater use and acceptance of e-cigarettes and novel tobacco products if that serves to reduce smoking rates.’

See our behaviour change briefing on e-cigarettes