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Fresh welcomes PHE's 6th vaping report

Fresh has welcomed Public Health England's (PHE) sixth independent e-cigarette report, commissioned from researchers at King's College London, which has been published today (Wednesday 4 March 2020) alongside new PHE advice on vaping in NHS mental health Trusts.

The report provides an update on the use of nicotine vaping products among young people and adults, and public perceptions of the harmfulness of vaping. It also takes an in depth look at the evidence on e-cigarette use in people with mental health conditions and pregnant women.

Current vaping use has remained stable in adults and young people since the last report. Of concern is the increasing number of smokers that now believe vaping is more harmful than smoking. This is out of line with expert reviews from the UK and US concluding that using regulated nicotine vaping products is far less harmful than smoking.

With smoking tobacco continuing to be the key cause of premature death in the North East with around 15 people dying on a daily basis form smoking related illness it is a grave concern to Fresh that perceptions of harm from vaping have increased in recent years.

PHE's and Fresh's advice remains that smokers should switch to e-cigarettes to help them quit smoking, but non-smokers should not take up vaping.

The PHE report is published in the same week as Fresh has relaunched the Every Breath campaign to highlight the risks of developing COPD from smoking and to motivate smokers to make a quit attempt. 1 in 4 smokers are likely to develop clinically significant COPD, and one of the recommendations is that smokers should consider switching completely to an e-cigarette if they can't quit yet.

E-cigarettes are much less harmful than tobacco but are not completely safe. They contain significantly less harmful chemicals which cause diseases related to smoking but the long-term impact of using an e-cigarette will remain unknown for some time.

The mistaken belief that e-cigarettes are more harmful than smoking increased rapidly among UK smokers following the US lung injury outbreak in autumn 2019. This outbreak was found to be caused by vaping the cannabis derivative tetrahydrocannabinol (THC) oil and vitamin E acetate – both substances which are banned from UK regulated nicotine vaping products.

The PHE report identifies a need for continued monitoring of public perceptions, as the researchers fear that smokers are being deterred by safety fears from using e-cigarettes to quit, which will ultimately cost lives. The report also warns that a ban on flavoured liquids could also deter some smokers from switching to e-cigarettes completely.

Smokers should continue to be encouraged to try regulated nicotine vaping products along with other stop smoking aids and behavioural support, to increase their chances of successfully stopping smoking.

The report also reviews the evidence on vaping among people with mental health conditions and pregnant women, two of the groups among whom the Government is focusing its efforts to reduce smoking rates, as set out in the Tobacco Control Plan for England.

In the North East both Mental Health Trusts (Cumbria, Northumberland, Tyne and Wear and also Tees, Esk, Wear Valley) have policies in place that allow patients to vape and they provide evidence based support for smokers to stop. They also offer e-cigarettes to patients on admission to help them to abstain from smoking.


In addition the North East Smokefree NHS/Treating Tobacco Dependency Taskforce has produced a Vaping Standard which provides a series of recommendations for the NHS to adopt in relation to the use of e-cigarettes and vaping.


The researchers also reviewed the available literature on vaping among pregnant women and found that more research is needed to understand the prevalence, safety and effectiveness of using e-cigarettes in pregnancy. In the meantime, health professionals should use the currently available advice on using e-cigarettes during pregnancy.


Ailsa Rutter, OBE FKC, director of Fresh said:"16% of North East adults are regular smokers and the reality is that every day 15 local people will die from a smoking related illness. For every one person who dies there are another 30 living with a smoking related illness such as COPD. Smoking is the key cause of premature life expectancy and we know in some groups we have much higher rates of smoking. It is vital that we do all we can to reduce smoking rates across all groups and this can include a role for tobacco harm reduction including vaping and use of e-cigarettes.

"People smoke for the nicotine but die from the tar, carbon monoxide, arsenic, benzene and the thousands of other chemicals contained in tobacco smoke. Whilst e-cigarettes aren't risk free they are significantly less harmful than smoking tobacco and smokers should not be put off by some of the scare mongering that they have seen. It is also vital that health care professionals are using official guidance from PHE and send clear messages to smokers on the benefits of quitting smoking including the role that vaping can play."

Deborah Arnott, chief executive of Action on Smoking and Health (ASH) said: "There are over 6 million smokers in England and smoking is still the leading cause of premature death and disease particularly among the most disadvantaged in our society. Helping more smokers quit is vital if we're to achieve the Government's vision of a smokefree society by 2030, and vaping has a role to play.


"Vaping has helped many thousands of smokers quit to date. But many thousands more could benefit if they were not put off by the persistent, worsening and inaccurate beliefs the public hold about vaping. Smokers should be reassured by today's authoritative and detailed report which shows that the UK's e-cigarette regulations are effective and vaping remains a safer alternative to smoking. I urge smokers to have confidence in our regulatory system and not be put off by alarmist headlines about the risk of vaping which are not backed up by the evidence."

Professor John Newton, Director of Health Improvement at Public Health England, commented on the review: 

"It is concerning to see how much the US lung disease outbreak has affected smokers' views on e-cigarettes here in the UK. Safety fears may well be deterring many smokers from switching, leaving them on a path to years of ill health and an early death due to their smoking. The US authorities have now confirmed that vitamin E acetate, a thickening agent added to cannabis vaping liquid, was the main primary cause of the US outbreak. This substance is banned in UK-regulated vaping products.


"E-cigarettes are far less harmful than smoking, which causes 220 premature deaths a day in England. Our advice remains that for anyone who smokes tobacco, the most important thing is to stop smoking altogether and e-cigarettes can be an effective way to help smokers do that.

"Our new advice on vaping in mental health trusts is an important step forward in empowering healthcare professionals to talk more confidently with their patients about the benefits of using e-cigarettes to stop smoking. This advice is another step towards the overall goal of a smokefree generation."

Professor Ann McNeill, Professor of Tobacco Addiction at King's College London, and lead author of the report said:

"It is currently very hard for smokers to make sense of the many contradictory reports on the impacts of vaping and smoking. In our review we present evidence that suggests in England, vaping has not undermined declines in adult smoking, and for youth, vaping is mainly concentrated in those who were already dabbling in cigarette smoking. However, we need to remain vigilant and ensure that vaping products, alongside regular cigarettes, are not easily accessible to young people."