A different story

Contrary to its U.S. counterparts, Public Health England sees no evidence of a vaping epidemic.

By Marina A. Murphy

An independent report commissioned by Public Health England (PHE) reveals that the level of vaping among young people remains low in Britain, a finding that contrasts with reports from the U.S. suggesting that there has been a surge in e-cigarette use among teenagers there. The report also reveals, however, that vaping has plateaued among adults in the U.K. and says that more needs to be done to encourage smokers who want to quit smoking combustible cigarettes to try e-cigarettes.

Less than 2 percent of those in the U.K. under the age of 18 use e-cigarettes regularly, compared with reports of one in five teenagers regularly vaping in the U.S.

The PHE report, which was led by researchers from King’s College London, reveals, however, that “experimentation and use of e-cigarettes has been increasing steadily over time.” The number of children and teenagers in the U.K. trying vaping has doubled in five years, with around one in six children aged between 11 and 18 having tried e-cigarettes. A total of 15.9 percent in this age group tried vaping in 2018 compared to 8.1 percent in 2014.

The majority of those who vaped said they just wanted to give it a try. Only 1.7 percent of those under the age of 18 use e-cigarettes weekly or more, and the vast majority of those minors smoke combustible cigarettes as well. Among those who never smoked, only 0.2 percent use e-cigarettes regularly.

“While more young people are experimenting with e-cigarettes, the crucial point is that regular use remains low and is very low indeed among those who have never smoked,” said John Newton, health improvement director at PHE.

This contrasts with the U.S., where authorities have pronounced e-cigarette use by teenagers to be “epidemic.” In the U.S., the Juul brand claims some 70 percent of the e-cigarette market. But while the Juul is also available in other countries, including the U.K., there is a difference in that European law restricts the amount of nicotine in e-liquid. Nonetheless, Deborah Arnott, chief executive officer of Action on Smoking and Health (ASH) in the U.K., says that stakeholders need to remain vigilant. The 2019 ASH annual survey, which is about to start, will be asking about Juul.

Smoking, vaping, quitting …

The PHE report also reveals that while experimentation by teens has steadily increased, regular vaping has plateaued in adults. This is a problem, according to the authors, in so far as it may be negatively impacting quit rates.

“We could accelerate the decline in smoking if more smokers switched completely to vaping,” says Newton. “Recent new evidence clearly shows using an e-cigarette with stop-smoking support can double your chances of quitting. If you smoke, switching to vaping could save you years of ill health and even your life.”

PHE is well-known for having thrown its weight behind vaping, which it says is 95 percent less harmful than smoking. PHE recommends that smokers trying to quit should be offered devices like e-cigarettes.

This latest report says combining e-cigarettes with face-to-face support should be an option available to all smokers. It also calls for stop-smoking practitioners and health professionals supporting smokers to receive education and training in the use of e-cigarettes in attempts to quit.

“With just over a third of adult smokers having never tried an e-cigarette, there is a clear opportunity for more smokers to try a method which has helped many others to quit,” says Ann McNeill, professor of tobacco addiction at King’s College London and lead author of the report. “Smokers should be advised to stop smoking as soon as possible and explore all available options, including e-cigarettes.”

“With e-cigarettes currently used so rarely in services, it’s time for change,” adds Newton. “Every stop-smoking service must start talking much more about the potential of vaping to help smokers quit.”

The report is the first in a new set of three, commissioned by PHE under the government’s tobacco control plan for England. It looks specifically at the use of e-cigarettes rather than health impacts. Health impacts will be the subject of a future report.

This report was commissioned to summarize evidence that will underpin policy and regulation of e-cigarettes in England. It focuses on the latest evidence on prevalence and characteristics of e-cigarette use in young people and adults in England. The context for the report is that smoking remains the leading preventable cause of illness and premature death and is one of the largest causes of health inequalities. So, alternative nicotine-delivery systems, such as e-cigarettes, could play a major role in improving public health.

The FDA and Juul

In September 2018, the U.S. Food and Drug Administration (FDA) threatened to ban the Juul vapor device and four other leading e-cigarette products unless their makers took steps to prevent use by minors. In an attempt to curb teenage vaping, the FDA has also proposed a ban on most e-cigarette flavors.

Many public health experts think the FDA is overreacting. In a letter in November 2018 to FDA Commissioner Scott Gottlieb, who announced his upcoming resignation from the agency on March 5, several of these public health experts pointed out that the U.S. figures fail to distinguish between occasional and regular users, thereby potentially greatly overestimating the number of regular users. They also point out that most regular vapers are likely to be smokers and that vaping in youth should only be a concern to the extent that it may lead to smoking combustible cigarettes but that there is little evidence to suggest that this is the case.–M.M.