Sharing the truth about vaping

• Nicotine vapes have caused much debate among the public health community, with some taking a cautionary approach whereas others see nicotine vapes as an innovation which is supporting hardened smokers to quit.
• The public continue to misperceive the relative harms of nicotine vapes, considering them to be more or equally as harmful as smoking.
• Regular e-cigarette users are mostly adults who are already smokers, there is no evidence that nicotine vapes are renormalizing smoking or increasing smoking uptake.
• There is strong evidence that nicotine vapes are effective for smoking cessation and reduction.

Source: ASH Fact Sheet – Electronic Cigarettes

Clearing up some myths around nicotine vapes

Source: UK Health Security Agency

MYTH 1 – Nicotine vapes give you ‘popcorn lung’

Popcorn lung is an inflammatory disease of the lung which causes narrowing and scarring. As Dr Irem Patel explains in this video, It was seen in the USA in workers from a popcorn factory using the chemical diacetyl to give popcorn a buttery flavour. During the process they had inhaled large quantities of the chemical which caused the lung problems.

Diacetyl is not permitted in legal vapes in the UK and no cases of popcorn lung have been seen in the UK.

MYTH 2 – Nicotine vapes aren’t regulated and we don’t know what’s in them

In the Tobacco and Related Products Regulations 2016, e-cigarette products are subject to minimum standards of quality and safety, as well as packaging and labelling requirements to provide consumers with the information they need to make informed choices.

All products must be notified by manufacturers to the UK Medicines and Healthcare products Regulatory Agency (MHRA), with detailed information including the listing of all ingredients.

These are products that have submitted the required information and paid a fee to the MHRA, they do not undergo any testing by MHRA so are not approved.. With the list of notified products, it is illegal to sell a product until the notification has been published The notifier will be the person who submits the notification to MHRA normally the manufacturer who may make products for a number of brands.

The published date is the date it can be sold from. MHRA’s website contains a list of e-cigarette notified products.

Nicotine vapes are not licensed as a medicine although this may change in the future.

MYTH 3 – Nicotine vapes must be harmful as they contain nicotine

Four out of 10 smokers and ex-smokers wrongly think nicotine causes most of the tobacco smoking-related cancer [Public Health England, 2018] when evidence shows nicotine actually carries minimal risk of harm to health. Although nicotine is the reason people become addicted to smoking, it is the thousands of other chemicals contained in cigarette smoke that causes almost all the harm.

E-cigarette vapour does not contain tar or carbon monoxide, two of the most harmful elements in tobacco smoke.  It does contain some chemicals also found in tobacco smoke, but at much lower levels. For this reason and alongside nicotine replacement products such as nicotine gum and patches it is known as “clean nicotine”

MYTH 4 – Exposure to vape vapour is harmful to bystanders

The evidence is clear that exposure to second hand cigarette smoke is harmful, which is why the UK has laws prohibiting smoking in enclosed public places and workplaces. These laws do not cover vaping and organisations are free to make their own policies on the use of nicotine vapes on their premises.

E-cigarette liquid is typically composed of nicotine, propylene glycol and/or glycerine, and flavourings. Unlike cigarettes, there is no side-stream vapour emitted by a vape into the atmosphere, just the exhaled aerosol.

PHE’s 2018 evidence review found that to date, there have been no identified health risks of passive vaping to the health of bystanders. People with asthma and other respiratory conditions can be sensitive to a range of environmental irritants, as well as pollen and cold air. The advice is now that organisations take this into account and to make adjustments where appropriate, when making their own policies on the use of nicotine vapes.

MYTH 5 – Nicotine vapes are being used as a Trojan horse – so the tobacco industry can keep people smoking 

There is currently no evidence to suggest that nicotine vapes are encouraging people to continue smoking – the picture in the UK suggests the opposite. The proportion of e-cigarette users who are ex-smokers has been increasing over recent years.

Of the 3.2 million adult e-cigarette users in the UK, more than half have completely stopped smoking. A further 770,000 have given up both smoking and vaping. At the same time, quit success rates have been improving and we’re seeing an accelerated drop in smoking rates, currently at a record low of 14.9%in England.

Myth 6 – Nicotine vapes don’t help you quit smoking

A major UK NIHR funded clinical trial was published in February 2019. Involving nearly 900 participants, it found that in Local Stop Smoking Services, a standard e-cigarette was twice as effective at helping smokers to quit compared with the quitters’ choice of combination nicotine replacement therapy (NRT). Both groups were provided with behavioural support and those in the e-cigarette group had significantly faster reductions in cough and phlegm. Plus, NICE recommends as does Cochrane – as per links in evidence review.

In summary, nicotine vapes and tobacco cigarettes are not the same and shouldn’t be treated as such. It’s important that Londons 900,000 smokers are aware of the differences and have accurate information to inform their health decisions.

Nicotine vapes aren’t completely risk free but carry a fraction of the risk of smoking and are helping thousands of smokers to quit and stay smokefree.