There was once a point in time when opponents of vaping and tobacco harm reduction would frequently decry that there wasn’t enough known about “it”. Linda highlights that this is no longer the case: “Thousands of research papers have been published about these devices over the past decade. But we do not seem to be much closer to a global consensus on their risks or benefits, and arguably the debate is becoming more entrenched.”
She says that the opposition to vaping being used as a tobacco harm reduction tool has coalesced around a single point of opposition: “the consequences of e-cigarette use by young people, and the extent that youth vaping will lead to smoking.”
Highlighting that scientists on both sides of the Atlantic looked at the same evidence in 2018, they managed to come to different conclusions. While American institutions claimed to find an epidemic and links to a gateway effect, Public Health England clearly stated: “E-cigarettes are attracting very few young people who have never smoked into regular use, and e-cigarettes do not appear to be undermining the long-term decline in cigarette smoking in the UK among young people.”
Linda says that one explanation could be down to how the measurements are made – with the US focusing on “ever used” and the UK measuring “regular use”. She didn’t expand or speculate on the political reasons that might underpin the differing approaches.
She concluded: “We should not be forced to choose between protecting children and supporting the one in two adult smokers who will suffer and die prematurely from a smoking-related disease if they continue to smoke. The challenge in 2019 and beyond will be to ensure the right balance is struck.”
To that end, Clive Bates has updated the list of reliable sources of information he maintains on his Counterfactual blog. The list is split into a number of sections, and is being reproduced here (with his permission) for POTV readers to use as references when discussing vaping with others:
- Realistic science
- Practical professional guidance and public communications
- Reasonable public health consensus statements and policy positions
- Useful data
- Engaged consumers
- Groundbreaking conferences
- Forthright commentators
Significant scientific assessments
- Public Health England (2018): Evidence review of e-cigarettes and heated tobacco products 2018 Press release / Report page / Executive summary (20 pages) / Report PDF (243 pages) / Q&A blog / Ann McNeill video / Training resources / Lancet editorial / BMJ
“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know”
- Public Health England (2015): E-cigarettes: and evidence update, August 2015 – and press release E-cigarettes around 95% less harmful than tobacco estimates landmark review. See also: authors’ note on the claim that vaping is 95% lower risk than smoking, and my discussion: PHE says truthful, realistic things about e-cigarettes and critique of its critics, Smears or science .
- Public Health England (2014): Electronic cigarettes: reports commissioned by PHE, May 2014.
- Royal College of Physicians (2016) – Nicotine without smoke: tobacco harm reduction, April 2016 – and press release. Landmark quote:
“Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure“. (Section 5.5 page 87)
- A discussion of key quotes from this document, Clive’s submission to the Government of Ireland: Vaping and tobacco harm reduction in Ireland – consultation response in five quotes – February 2017.
- A PowerPoint that uses these quotes – see Slideshare.
- UK Centre for Alcohol and Tobacco Studies: Commentary on WHO report on ENDS, October 2016. A blistering critique of WHO’s vaping science.
- British Psychological Society: Changing behaviour – electronic cigarettes, October 2017
Collaborative research approach
- Cancer Research UK, UKCTAS, Public Health England, UK research councils: UK Electronic Cigarette Research Forum
Practical professional guidance and public communications
Pro-harm reduction national policy statement
- Tobacco Control Plan for England: Towards a smoke-free generation: tobacco control plan for England (PDF) – 18 July 2017
- Blog focussed on harm reduction aspects of the plan: English tobacco control plan embraces tobacco harm reduction – world first – 18 July 2017
On quitting smoking for professionals
- National Centre for Smoking Cessation and Training;
- E-cigarettes: a guide for healthcare professional, February 2018
- Electronic cigarettes: A briefing for stop smoking services, February 2016
- National Health Service (NHS) advice: Smokefree NHS – Advice on E-cigarettes
- Leicester (Louise Ross) Leicester Stop-smoking Service – an e-cig friendly service
- Smokefree Action: Smoking in Pregnancy Challenge Group – includes: Use of electronic cigarettes in pregnancy: A guide for midwives and other healthcare professionals with Infographic
- New Dec 2018: National Health Service Smokefree campaign – information on e-cigarettes – linked to…
- New Dec 2018: PHE public information video (below) with basics on why vaping is so much safer than smoking – and related BBC coverage.
- NHS “Live Well” advice: Using e-cigarettes to stop smoking
- NHS “One You” campaign: Using e-cigarettes / vapes to quite smoking
- Stoptober: The annual government-backed stop-smoking campaign Stoptober embraced e-cigarettes in October 2017 – see BBC Quit smoking campaign Stoptober backs e-cigs for first time
- The Switch – inspiring video accounts of real vapers talking about quitting smoking
- Say why to drugs podcast e-cigarette edition – Professor Linda Bauld and Dr. Suzi Gage discuss e-cigarettes, why UK and US are different, Juul and much else (January 2019)
On smoke-free policy
These reflect the view that vaping policy should be a matter for the owner or manager of the premises, not subject to a blanket legal ban.
- Public Health England. Use of e-cigarettes in public places and workplaces including Advice on evidence-based policy-making (PDF) and a 5-point guide to policy making on this issue.
- Chartered Institute of Environmental Health. Electronic cigarettes – Will you permit or prohibit electronic cigarette use on your premises? Five questions to ask before you decide
- Action on Smoking and Health. Will you permit or prohibit e-cigarette use on your premises? October 2015
On e-cigarette advertising
These very sensible industry codes govern the advertising that is not banned by the wholly disproportionate EU Tobacco Products Directive Article 20(5) as it applies in the UK.
- Committee on Advertising Practice: E-cigarettes: Non-broadcast Code Section 22 / Broadcast Code Section 33
- Committee on Advertising Practice: Claims about health in e-cigarette advertising – this allows for truthful health statements to be made in e-cigarette ads.
Reasonable public health consensus statements and positions
Cabinet Secretary (Head of UK civil service)
Blog by Sir Jeremy Heywood: How the Nudge unit threw light on lighting up 2015
2016 statement by Public Health England, Action on Smoking and Health, Association of Directors of Public Health, British Lung Foundation, Cancer Research UK, Faculty of Public Health, Fresh North East, Healthier Futures, Public Health Action (PHA), Royal College of Physicians, Royal Society for Public Health, UK Centre for Tobacco and Alcohol Studies, UK Health Forum
- E-cigarettes: a developing public health consensus, July 2016
- E-cigarettes: an emerging consensus, September 2015
Individual organisations and people
- Public Health England – blogs giving e-cigarette positions
- Cancer Research UK: Our policy on e-cigarettes, 2016. Full position: Briefing, Q&A,
- Action on Smoking and Health: ASH Briefing on E-cigarettes, 2016
- Royal College of General Practitioners with Cancer Research UK: Position Statement on the use of electronic nicotine vapour products (Sept 2017) with a podcast and video (see below).
- British Medical Association: E-cigarettes: balancing risks and opportunities (substantially updated in Nov 2017)
- Royal Society for Public Health: Smoking cessation and e-cigarettes
- British Heart Foundation: E-cigarette policy
- British Lung Foundation: E-cigarette policy
- Jim McManus, Director of Public Health, Hertfordshire: How and why I changed my mind on e-cigarettes, with Kevin Fenton (PHE): Hertfordshire e-cigarette policy aims to help smokers quit
- Hertfordshire County Council: E-cigarette policy announcement, 2016 – Policy (PDF)
- Professor Ann McNeill, lead author of 2018 Public Health England E-cigarette evidence review , discussing the review:
UK Parliamentary inquiry – December 2017
The House of Commons Select Committee on Science and Technology inquiry in to e-cigarettes took evidence in December 2017. See:
Some highlights from the submitted evidence.
- Oral testimony
- Public Health England
- University College London,Tobacco and Alcohol Research Group (West, Brown, Shabab)
- ASH UK
- Royal College of Physicians
- British Heart Foundation
- Cancer Research UK
- Royal Society for Public Health
- British Medical Association
- Cochrane group
- UK Centre for Tobacco and Alcohol Studies
- National Institute for Health and Care Excellence (NICE)
- Smoking in Pregnancy Challenge Group
- Mental Health and Smoking Partnership
- New Nicotine Alliance
- Department of Health (England)
- Peter Hajek
- Caitlin Notely, Lynne Dawkins, Emma Ward and Richard Holland
- Leicester City Council (Louise Ross)
- Independent British Vape Trade Association
- Institute for Economic Affairs
- Clive’s contribution and a better formatted version here
- Office for National Statistics & Public Health England. Adult smoking habits in the UK Statistical bulletins (reports and analysis)
- Office for National Statistics. Smoking habits in the UK and its constituent countries (data – annual)
- Office for National Statistics. E-cigarette use in Great Britain (data – annual)
- Smoking in England: Smoking Toolkit Survey: latest statistics / all documents (monthly tracking, contains e-cigarette data)
- data.gov.uk. Statistics on smoking in England
- Public Health England: Local tobacco control profiles for England – link to data
- ASH Fact sheets (current menu) – check for current data
- ASH / YouGov survey: Use of electronic cigarettes (vapourisers) among adults in Great Britain (2018)
- ASH / YouGov survey: Use of electronic cigarettes (vapourisers) among children in Great Britain (2018)
- New Nicotine Alliance – consumer advocacy group
- Vapers.org.uk – with excellent daily news digest
- Vapers in Power (blog) – political movement
- The Switch – vapers talking about their experience of vaping
- The E-cigarette Summit (annual in London) and now in the United States
- Global Forum on Nicotine (annual in Warsaw)
- PHE National Symposium on e-cigarettes, 2014, [others to follow].
- Nicotine Science and Policy
- Velvet Glove, Iron Fist – Chris Snowdon
- Dick Puddlecote
- New Nicotine Alliance blog
- Planet of the Vapes (UK)
- Vapers in Power blog
- Facts do matter – vaping – Paul Barnes
- The Counterfactual by Clive Bates
Engaged trade associations
Planet of the Vapes extends its gratitude to Clive Bates.