Should we ban vaping like San Francisco

I’ve been asked this question 4 times over the last few weeks since the proposed ban in San Francisco broke.

My answer is No, in short.

This blog explains Here is my reasoning, in 4 parts.

Regulatory framework vaping commencement in children

Long term effects

Commencement in children

Striking the right balance

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1). The regulatory framework in USA is completely different to UK.

The US surgeon general has been calling (absolutely rightly) for tighter regulation, but the USA is in a completely different space

 With regards to the US also they have varying advertising guidelines which means that the tobacco industry are more freely able to target their products at children and young people – this is one of the founding factors in their high prevalence of e-cigs amongst the youth. In addition to this they have stronger does of nicotine allowed in the e-cigs which some have indicated has led to stronger addiction and continued use.  

The U.K. has a far tighter grip on regulation, marketing, advertising, what products are and aren’t available here than US

Consistent with other EU Member States, the UK has strict regulations for e-cigarettes. Australia, by prohibiting sale of nicotine e-cigarettes, and the US by currently having no regulatory standards and few marketing restrictions are very different.  

 

So, we have far more regulation i.e..

•  advertising or promotion (directly or indirectly) of e-cigarettes and refill containers in print media, on the radio and television is prohibited;

• promotional elements are not allowed on e-cigarette packaging and cross-border advertising and promotion of e-cigarettes is prohibited.

• e-cigarette tanks are limited to a capacity of no more than 2ml;

• the maximum volume of e-liquid for sale in one refill container is restricted to 10ml;

• e-liquids are limited to a nicotine strength of no more than 20mg/ml;

• e-cigarettes and refill products must be: ─ child-resistant and tamper evident; ─ protected against breakage and leakage;

• Age of sale and Proxy sale 18 years

Other countries have different approaches

New Zealand have launched a new “vaping facts” website: Australia, Canada and New Zealand all had policies prohibiting e-cigarettes not licensed as medicines and the absence of any medicinally licensed products had the effect of banning nicotine containing EC. Canada and New Zealand have since changed their policies and are now more closely aligned to the UK. Canada has consulted on statements on EC packs to make it clear that they are less harmful than cigarettes and this week the New Zealand Ministry of Health has launched a new Vaping Facts website.

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2) A concern is children starting to use e cigs. Watchful vigilance, but the U.K. isn’t the USA (see above)

This then has potential to become 1) lifetime of nicotine addiction, 2) as you say uncertain long term effects esp in developing lungs – bluntly nobody knows, 3) worst of all gateway to tobacco. Nobody thinks this is good!

There IS some youth commencement in the UK, small scale. There will always be some experimentation – arguably less bad folk experiment with vape than cigarettes. The worry this will generate a NEW cohort of experimenters (ie those that would not otherwise have experimented with cigarettes) isn’t well founded. The data that IS available in the UK tends to tell us this isn’t happening

 

There was a study in the BMJ just this week that concluded that between 2017 and 2018, among 16 to 19 year olds the prevalence of vaping increased in Canada and the US, as did smoking in Canada, with little change in England.

Our own Every Child Matters survey leads us in a similar direction. We frequently get reports from parents who observe the now very visible plumes of e-cigs and assume this means it is more prevalent. We continue to monitor this through our schools programme and surveys.

However, it DOES warrant continual vigilance.

 

PHE frequently do updates on the latest evidence. The most recent set I saw:

• In the UK, youth experimentation with EC is not uncommon but – unlike in the US – regular use remains rare and confined to youth who have previously smoked. There was a fairly sharp increase around 2013 but in recent years regular use among adults and youth remains remarkably flat.

• Vaping is not on the increase. It has been pretty stable for the last five years

• So far three studies this year have shown e-cigarettes to be around twice as effective as NRT for smoking cessation

• Leading agencies in the US and around the world agree, vaping is far safer than smoking

• E-cigarettes are not renormalizing smoking, in the years when youth vaping was increasing, anti smoking norms were hardening

• There is no evidence of harm from passive exposure

• E-cigarettes are tightly regulated in the UK

• Higher perceived risk is linked to more dual use and less quitting

Use of e-cigarettes among young people in Great Britain, 2019
last week ASH published an updated fact sheet on the use of e-cigarettes among young people in Great Britain. The fact sheet includes data from ASH’s latest Smokefree GB survey of 11-18 year olds (conducted by YouGov).

Key findings include: 

• More than three quarters of 11-18 year olds have never tried (76.9%) or are unaware of e-cigarettes (6.6%)

• Young people vape mainly just to give it a try (52.4%) not because they think it looks cool (1.0%)

• Vaping is much less common among young people who have never smoked – a large majority of never smokers aged 11-18 have either never used an e-cigarette (87.8%) or are unaware of them (6.0%)

• Of young people aged 11-18 years old who have never smoked, 5.5% have ever tried e-cigarettes, 0.8% are current vapers, only 0.1% vape more than once a week, and not a single never smoker reported vaping daily

 

read the full fact sheet here, but in summary. 

A similar proportion of 11-18 year olds have tried vaping to last year (15.4% in 2019 compared to 16% in 2018) but slightly more are current vapers (4.9% in 2019 compared to 3.4% in 2018). However, the increase is only in occasional vapers (less than once a week), while the proportion vaping regularly (once a week or more) is down slightly and only 0.6% vape daily compared to 0.9% in 2018.

 

Vaping is much less common among young people who have never smoked, 5.5% of whom have tried e-cigarettes compared to 15.4% of all those in their age group. Of young people aged 11-18 years old who have never smoked 0.8% are current vapers, only 0.1% vape more than once a week, and not a single never smoker reported vaping daily.

 

Those that have never smoked but have vaped are more likely than average to say the main reason was just to give it a try (71% compared to 52% on average). 11% of never smokers said the main reason they tried e-cigarettes was because other people used them so they joined in; 10% said they liked the flavours; while under 1% (0.5%) said it was because they thought it looked “cool”.

 

When US e-cigarette brand Juul entered the UK market in summer 2018, (although with nicotine content capped by EU legislation at much lower levels than in America) US anti-tobacco campaigners called on the British government to take action. [2] They warned that this brand with its “super-cool” image could take off among children in the UK as it is said to have done in the USA. [3] Given these concerns specific questions were asked about brand awareness and use among young people in this year’s ASH Smokefree GB youth survey.

 

When the survey was carried out in March/April 2019 Juul had the highest brand awareness among 11-18 years olds, but only 7% were able to name it unprompted. When those who had ever tried e-cigarettes were asked which brands they had used in the last 12 months, Smok was the most commonly used at 15%, followed by Juul (14%), Vype (13%), blu (10%) and Logic (4%). Unsurprisingly given the low levels of regular use, 55% of those who had ever tried e-cigarettes said they didn’t know what brand they used.

Juul, which remember is a tobacco industry owned e-cig, is a completely different product in the US with significantly higher doses of nicotine than is allowed here. Furthermore e-cig experimentation is high amongst our young people but uptake remains at less than 1%.

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3). There ARE unknown long term effects. We should be very watchful of this

the CMO discussed this recently with the Science and Tec Committee. See Q17

This probably requires some careful consideration

The balance of the science at the moment is very much in favour of them being significantly safer than burned tobacco, a route out of cigarettes

The science is clearly suggesting that e cigs are as (or more – twice as) effective as NRT as a smoking cessation device.

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4). Striking the right balance on this is tough. This remains a polarising issue

So to date we have been pushing this line as a smoking cessation aid in current smokers and being honest with people about what we know.

We know we have c2.3 million smokers who have chosen of their own free will to switch to e-cigs and around 20,000 people quit smoking with e-cigs per year in England. Whilst we know they are not risk free it is minimal compared to smoking, but we do know the risks of the latter: it kills 1 in 2 of its users.

Vaping in indoor, enclosed public places remains unsolved. My personal view is as per CMO – I wouldn’t go for allowing vaping indoors (uncertainty, enclosed space, many of those exposed cite irritation from passive inhalation). It remains difficult.  

 

 We are pushing AGAINST use in children and non smokers – why would you start etc? we don’t think there is much of that happening

 there is a role for e-cigarettes in helping adult smokers quit, but it is vitally important that we do all we can to protect children and young people from taking up vaping. That is why we supported the introduction of substantial restrictions on advertising, promotion and sale of e-cigarettes in the UK.  The Government has committed to review the regulations within five years of their implementation to ensure that they continue to provide adequate protection for children and young people.

One note of caution

There’s a big concern re industry using harm reduction as an opportunistic tactical adaptation to policy change rather than a genuine commitment to harm reduction. Designed to undermine gains by inappropriately influencing policy and weakening the FCTC

Recently, PMI were given social good award at Cannes festival  

 Thanks to @breathe2025 and Sarah in my team for helpful views

 

 

 

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