E-cigarettes: Is vaping safe?

The recent Government missing opportunity with e-cigarettes report from the Commons Select Committee on Science and Technology, found e-cigarettes to be 95 percent less harmful than conventional cigarettes. 

In July the Office for National Statistics published 2017 smoking data, which makes for encouraging reading. Smoking in adults is down to 15.1 percent, the lowest since records began in the 1940s. This represents a drop of smoking prevalence of around 25 percent in six years (from 20.2 percent in 2011) – good news indeed. So, 7.4 million adults still smoke, and with around 50 percent of smokers destined to die prematurely, there are 3.7 million avoidable premature deaths, not to mention the morbidity suffered prior to death. In 2016, 95,800 deaths across the UK were attributed to smoking.

People with mental health problems more likely to smoke

Further to this, smoking remains responsible for approximately half of the difference in life expectancy between the most affluent and deprived groups of our society1,2. Those in managerial and profession job roles have a smoking prevalence of 10.2 percent, compared to 25.9 percent of those in routine and manual working roles – this ratio has widened in recent years - Adult smoking habits in the UK: 2017. Additionally, people with mental health problems are 2.5 times more likely to smoke than the general population. In my opinion, if we are to address these inequalities of health, we need to embrace smoking cessation energetically. It is recognised that smoking cessation is one of the most cost-effective health interventionsiv .In this context it seems paradoxical that in many areas of the UK there has been a disinvestment in smoking cessation services.

40 percent of smokers have never tried e-cigarettes 

With this back ground, where then, do e-cigarettes fit in? A review from Public Health England suggests vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits. A conservative estimate is that vaping has contributed to over 20,000 successful quits per year, which equates to 10,000 premature deaths prevented. The review also suggests that over 40 percent of smokers have never tried an e-cigarette, which is around 90 people per full time GP. In many cases because they incorrectly believe vaping to be as harmful as smoking. An informal "Slido" poll at the 2017 RCGP Annual Conference, suggested that over 20 percent of GPs have similar misinformed views. 

Positioning our advice on vaping 

As primary care clinicians, how should we be positioning our advice on vaping. In a nut-shell, we should be presenting it as a substantially less harmful alternative to smoking. If the options are smoking or vaping, it will be emphatically vaping, though if 'neither' is a third option, then this is the only truly 'safe' option.

If you want more information on:

  • the relative harm of smoking compared to vaping
  • whether vaping is an entry into smoking for our younger patients
  • the risks of passive vaping
  • the best evidence based quit method
  • the advice we should be giving our patients who continue to smoke

You could:

  1. Department of Health (2017). Towards a smoke free generation: a tobacco control plan for England. London: Department of Health.
  2. Scottish Government (2013). Creating a tobacco-free generation - a tobacco control strategy for Scotland. Edinburgh: Scottish Government.
  3. The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. Eur J Health Econ. 2013; 14(5): 789–797.  

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