1Introduction
1.E-cigarettes and conventional cigarettes are substantially different products. A lit conventional cigarette contains tobacco and produces carbon monoxide, tar and smoke, whilst an e-cigarette does not contain tobacco and heats up its nicotine liquid rather than burning it. E-cigarettes were first introduced to the UK market in 2007 (see Box 1). New rules for nicotine-containing e-cigarettes and refill containers were introduced in May 2016 by the Tobacco and Related Products Regulations 2016,1 implementing the EU Tobacco Products Directive.2 In 2016 it was estimated that 2 million consumers in England had used these products and completely stopped smoking and a further 470,000 were using them as an aid to stop smoking.3
2.In 2016, the Royal College of Physicians concluded that:
Large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking in society. Promoting e-cigarettes, [Nicotine Replacement Therapy] and other non-tobacco nicotine products as widely as possible, as a substitute for smoking, is therefore likely to generate significant health gains in the UK.4
The Government published its Tobacco Control Plan in July 2017, advising that e-cigarettes could be an aid for smokers attempting to give up conventional cigarettes, on the basis that “evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco”.5 Public Health England has concluded that “vaping is at least 95% less harmful than smoking”.6
3.There have nevertheless been a number of organisations and commentators that have seen e-cigarettes as a health hazard in their own right. Concerns were raised by the US National Academies of Sciences, Engineering and Medicine earlier this year7 and by the US Surgeon General.8 Some have raised objections to e-cigarettes on the grounds of being exposed to unpleasant second-hand vapour.9 E-cigarettes are banned in many workplaces and in most enclosed public spaces and on public transport.
Our inquiry
4.Against a background of contradictory national policies towards e-cigarettes and disagreement and apparent uncertainty over the health risks, we decided to examine the evidence on the health impacts and on e-cigarettes’ role as a smoking cessation tool. We received over 100 pieces of written evidence, and held five oral evidence sessions between January and May 2018, hearing from 25 witnesses. We are grateful to all those who contributed.
Box 1: A brief overview of e-cigarettes
2007 E-cigarettes are introduced to the UK market
2014 EU Tobacco Products Directive (TPD) comes in to force, covering the bulk of ecigarette regulation in Europe
2016 Tobacco and Related Products Regulations transposes TPD in to UK law—18.4% of adults (age 16+ years) surveyed in the ONS Opinions and Lifestyle Survey had tried an e-cigarette and 5.4% of adults considered themselves current e-cigarette users.
2017 The proportion of ex-smokers who regularly vape has risen from 1.1% in 2012 to 9.5% in 2017
Both the youth and adult data shows smoking prevalence has continued to decline as e-cigarette use has grown. Smoking rates are currently at their lowest recorded levels—15.5% for adults in England, down from 19.9% in 2010, and 7% among 15-year-olds in England, down from 12% in 2010.
Sources: Written evidence from Action on Smoking and Health and Public Health England and MHRA
3 Towards a Smokefree Generation - A Tobacco Control Plan for England, Department of Health, 2017
4 Nicotine without smoke: Tobacco harm reduction, Royal College of Physicians, 2016
5 Towards a Smokefree Generation - A Tobacco Control Plan for England, Department of Health, 2017
6 Evidence Review of E-cigarettes and Heated Tobacco Products 2018, Public Health England, March 2018
7 The National Academies of Sciences, Engineering, and Medicine, A Consensus Study Report by the Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems (January 2018)
8 E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General, The US Surgeon General, 2016
Published: 17 August 2018