Here’s a couple of thoughts on a number of key e-cigarette and vaping issues.
The Gateway Effect
This is the idea that children will see e-cigarettes and vaping as a ‘gateway’ to taking up cigarette smoking.
Clive Bates, a well-known global figure in public health says:
No, despite a great deal of hype from the US, the facts are very different. Although there is a rise in e-cigarette use among school age adolescents, that does not prove anything bad is happening – it simply mirrors what is going on in adult society. Whether it is harmful depends what you think would have happened in the absence of e-cigarettes. It is quite possible that e-cigarette use is displacing smoking in adolescents. Even where they have never smoked it might be acting as an alternative to taking up smoking. For there to be any real harm, you would need to show that students were taking up vaping and then going on to develop a life-long smoking habit, because of the vaping. In fact in the data presented from the US there were much more encouraging signs: e-cigarette use was a small fraction of the smoking rate among school students; the rise of e-cigarette use coincided with a much larger drop in smoking; and e-cigarettes use was concentrated among those already smoking. Here is the full picture in graphic form, and you can read more discussion on the bogus claims for gateway effects in my ‘Cease and desist’ letter to scientists trying to perpetrate this fraud and a background discussion on ‘gateway effects’: we need to talk about the children: the gateway effect examined.
Further to this, Michael Siegal, a professor at Boston University’s School of Public Health with 25 years of experience in tobacco control, has a great article in The Wall Street Journal titled ‘The E-Cigarette Gateway Myth’. Here is a segment of the full article:
“The gateway hypothesis is a myth. The evidence shows that very few nonsmokers "vape." The primary reason people use e-cigarettes is to quit or cut back on smoking conventional cigarettes. Moreover, of the few nonsmoking youths who do experiment with e-cigarettes, there is currently no evidence that they subsequently progress to cigarette smoking.
The first study to examine the gateway hypothesis was by Dr. Ted Wagener from the University of Oklahoma Health Sciences Center. His research, presented at the annual meeting of the American Association for Cancer Research last October, found only one young person out of a sample of 1,300 college students who initiated nicotine use with vapor products and then went on to smoke cigarettes.
In June, Dr. Constantine Vardavas of the Harvard School of Public Health published a broader analysis of 26,566 European smokers in the journal Tobacco Control. It showed that e-cigarette users are likely to be heavy smokers who have tried to kick the cigarette habit over the prior year. Dr. Vardavas and his two colleagues found that just 1% of nonsmokers tried vaporizing products like e-cigarettes.”
And finally, there is the Expert Independent Evidence Review by Public Health England (PHE) ‘E-cigarettes: an evidence update – A report commissioned by Public Health England’, that says:
“The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes. It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).
“It is therefore relatively unlikely that availability and use of electronic cigarettes causes or will cause significant additional numbers of young people to become smokers than do at present.”
The ‘Dual-use’ Concern
Some public health commentators are concerned that dual use – both vaping and smoking intermittently could lead to more health issues.
Expert research conducted in this area is by New Zealander Dr Hayden McRobbie, a professor of public health interventions at the Wolfson Institute of Preventative Medicine at Queen Mary University of London.
In a study published in Cancer Prevention Research titled ‘Carbon monoxide, acrolein decrease in smokers who switch to e-cigarettes’ Dr McRobbie says:
E-cigarette use in smokers who quit and in dual users demonstrated a significant decrease in tobacco smoke toxicant exposure, according to study results.
“We found that e-cigarette use significantly reduced exposure to carbon monoxide and acrolein over a 4 week period,” Hayden McRobbie, MB, PhD, a professor of public health interventions in the Wolfson Institute of Preventive Medicine at Queen Mary University of London, said in a press release. “The reduction was greatest in those who switched to e-cigarettes completely, but even those who were dual users at 4 weeks had reduced exposure to carbon monoxide and acrolein.”
“These results suggest that e-cigarettes may reduce harm compared with conventional cigarettes, even in dual users, but longer-term studies are needed to confirm this.”
In a news release on the American Association for Cancer Research website ‘Switching From Conventional To Electronic Cigarettes Reduced Toxicant Exposure, Even For Dual Users, senior author Professor Peter Hajek PhD, and Director of Tobacco Dependence Research Unit said:
“The results are very reassuring,” said senior author Peter Hajek, PhD, professor of clinical psychology and director of the Tobacco Dependence Research Unit. “Dual users did not increase their acrolein intake; on the contrary, they reduced it substantially. The reason for this is that smokers who receive nicotine from e-cigarettes have a reduced need to smoke and so smoked less.”
Further to this, Professor Robert West, Professor of Health Psychology, Health Behaviour Research Centre, University College, London, and Editor-in-Chief of Addiction, writes ‘Electronic cigarettes: getting the science right and communicating it accurately’ says:
“Policy makers, smokers, clinicians and the public in general need accurate information on their safety and potential for reducing smoking rates. Unfortunately in some notable cases the science is being misused, with findings being distorted, misinterpreted or misrepresented. Interestingly, up until now this appears to be mainly (though not exclusively) by those who are opposed to electronic cigarettes.”
Second-hand Vapour Emissions
Perhaps the most authoritative comment about second-hand vapour emissions is again from the Public Health England report, which states on page 65:
“EC (e-cigarette)release negligible levels of nicotine into ambient air with no identified health risks to bystanders.
“Based on the available evidence, the risk to the health of bystanders from exposure to vapour from nicotine vapourisers is extremely low. A legal ban on the use of nocotine vapourisers in enclosed public places and workplaces would not be justified on the grounds of passive exposure.”
Further to this, more than 50 public health researchers wrote a ‘Statement from specialists in nicotine science and public health policy’ to Dr Margaret Chan, Director General of the World Health Organisation. In this statement, these specialists said:
“There are now rapid developments in nicotine-based products that can effectively substitute for cigarettes but with very low risks. These include for example, e-cigarettes and other vapour products, low-nitrosamine smokeless tobacco such as snus, and other low-risk non-combustible nicotine or tobacco products that may become viable alternatives to smoking in the future.
It is inappropriate to apply legislation designed to protect bystanders or workers from tobacco smoke to vapour products. There is no evidence at present of material risk to health from vapour emitted from e-cigarettes. Decisions on whether it is permitted or banned in a particular space should rest with the owners or operators of public spaces, who can take a wide range of factors into account. Article 8 of the FCTC (Protection from exposure to tobacco smoke) should not be applied to these products at this time.”
It is important to note that among the signatories to this Statement, there is eminent New Zealand public health figures including:
§ Associate Professor Chris Bullen, Director, National Institute for Health Innovation, School of Population Health, University of Auckland.
§ Dr Murray Laugessen, Director, Health New Zealand, Lyttelton, Christchurch.
§ Dr Hayden McRobbie, Reader in Public Health Interventions, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom.
The New Zealand Vaping Alliance believes that responsible marketing of these products should be permitted for adult New Zealand consumers.
This view is supported by the Statement from specialists in nicotine science and public health policy, which says:
“It is counterproductive to ban the advertising of e-cigarettes and other low risk alternatives to smoking. The case for banning tobacco advertising rests on the great harm that smoking causes, but no such argument applies to e-cigarettes, for example, which are far more likely to reduce harm by reducing smoking.
Controls on advertising to non- smokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, including protection of the cigarette market and implicit support for tobacco companies.
It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal. It is inappropriate to apply Article 13 of the FCTC (Tobacco advertising, promotion and sponsorship) to these products.”
The New Zealand Vaping Alliance notes the comment contained in the Statement from specialistss in nicotine science and public health policy which states:
“The tax regime for nicotine products should reflect risk and be organised to create incentives for users to switch from smoking to low risk harm reduction products. Excessive taxation of low risk products relative to combustible tobacco deters smokers from switching and will cause more smoking and harm than there otherwise would be.”
“If regulators treat low-risk nicotine products as traditional tobacco products and seek to reduce their use without recognising their potential as low-risk alternatives to smoking, they are improperly defining them as part of the problem.”
Further to this the New Zealand Vaping Alliance will be watching any developments in this area, particularly any research considering the appropriateness of taxing e-cigarettes.