As Stoptober rolls around again, the minds of many turn to smoking cessation. However, the state of smoking in the UK is changing. Fewer and fewer are starting smoking, rather turning to vapes such as the near ubiquitous Elf Bar.
There has been a decrease in numbers of school children taking drugs and smoking cigarettes but a rise in vaping, with nearly 10% of 11 to 15 year olds currently using e-cigarettes, new figures from NHS Digital show. This, twinned with suggestions that the UK could raise the age of legal smoking, could lead us to a situation where cigarettes are a thing of the past, while vapes become far more prevalent.More on this topic
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The Khan review, led by Dr Javed Khan, former CEO of children’s charity Barnardo’s, looked into the Government’s ambitions of creating a smokefree UK by 2030. One of the key recommendations of the review concerned raising the age of sale from 18 by 1 year every year, until eventually no one can buy a tobacco product in this country.
‘Without immediate and sustained action, England will miss the smokefree target by many years and most likely decades,’ said Dr Khan.
‘A smokefree society should be a social norm – but to achieve this, we must do more to stop people taking up smoking, help those who already smoke and support those disproportionately impacted by smoking.
My holistic set of recommendations for government will deliver this, whilst saving lives, saving money and addressing the health disparities associated with smoking.’
While many nurses would celebrate the widespread elimination of cigarettes in the next decade, the effects of vaping are still relatively unknown, and we could end up trading one public health problem for another.
Vaping
The number of young people vaping has increased, with 9% of secondary school pupils currently (either regularly or occasionally) using e-cigarettes in 2021, an increase from 6% in 2018, the NHS Digital shows. The Smoking, Drinking and Drug Use among Young People in England, 2021 report also found that cigarette smoking has decreased, 3% of pupils were current smokers, a decline from 5% in 2018. In addition, 12% reported having ever smoked, a decrease from 16% in 2018, and the lowest level ever recorded.
‘Though not risk free, evidence overwhelmingly suggests that nicotine e-cigarettes are substantially less harmful than smoking. The harm from smoking comes from the burning of tobacco, and not the nicotine. A growing body of evidence shows that nicotine e-cigarettes can help people stop smoking,’ said Dr Jamie Hartmann-Boyce, senior researcher in health behaviours and managing editor of the Cochrane Tobacco Addiction Group, University of Oxford.
‘Preventing people from taking up smoking is also a central component of the review. A small number of other countries have led the way in increasing age of sale, and to be a leader in tobacco control, it is clear that England should follow suit.’
Another survey, performed by YouGov on behalf of Action on Smoking and Health (ASH), shows current vaping among children aged 11-17 up from 4% in 2020 to 7% in 2022. The proportion of children who admit to ever having tried vaping has also risen – from 14% in 2020 to 16% in 2022.
Disposable e-cigarettes are now the most used product among current vapers, up more than 7-fold from 7% in 2020 and 8% in 2021, to 52% in 2022. Elf Bar and Geek Bar are overwhelmingly the most popular, with only 30% of current users having tried any other brands.
‘The rise in vaping is concerning and we need to understand what lies behind this such as packaging, accessibility, taste or addictiveness,’ said Ann McNeill, professor of tobacco addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.
‘Our response must be proportionate given that smoking is a much bigger risk to the health of young people and the good evidence that e-cigarettes can be an effective stop smoking aid. Government should ensure existing laws are enforced and identify where regulations could be extended. However, this must be done alongside securing a much quicker decline in young people taking up smoking and helping more smokers to stop.’
According to the ASH report, ‘Just to give it a try’ is still the most common reason given by never smokers for using an e-cigarette (65%). For young smokers the most common reason for using an e-cigarette was ‘because I like the flavours’ (21%) followed by ‘I enjoy the experience’ (18%) then ‘just to give it a try’ (15%), but they also said ‘because I’m trying to quit smoking’ (11%) or ‘I use them instead of smoking’ (9%). Fruit flavours remain the most popular (57%).
Vaping behaviour is strongly age related, with 10% of 11-15 year olds ever having tried vaping, compared to 29% of 16 and 17 year olds (the figures for those currently vaping are 4% and 14% respectively). And while underage vaping has risen, underage smoking is lower than it was in 2020 (14% in 2022 compared to 16% in 2020).
‘The disposable vapes that have surged in popularity over the last year are brightly coloured pocket-sized products with sweet flavours and sweet names, and are widely available for under a fiver, no wonder they’re attractive to children,’ said Deborah Arnott, Chief Executive, ASH.
‘As the Khan review recommended to the Government, an additional £15 million needs to be invested in enforcement, and this should include vaping as well as tobacco products. The laws also need strengthening to prohibit child-friendly packaging and labelling of vaping products and to prevent promotion on social media.
‘But online platforms like TikTok don’t need to wait, they must act now. The flood of glamorous promotion of vaping on social media is completely inappropriate and social media platforms should take responsibility and turn off the tap.’
Health risks of vaping
With their colourful packaging and eclectic flavours, many e-cigarettes seem almost designed to give the impression that their use constitutes a harmless past time. However, many medical experts are warning that, while not as harmful as smoking, these products should not be treated lightly.
‘There is limited scientific evidence regarding these products, mainly regarding the liquid used to vape with rather than the vaping device itself as they have continued to change over the last 10 years,’ said Dr Gareth Nye, a lecturer of physiology at Chester Medical School and is programme leader for BMedSci Medical Science.
‘Because e-cigarette liquid and smoke have been shown to contain nicotine and many of the same harmful toxicants and carcinogens as cigarettes, it is reasonable to assume that there is the potential for similar health effects for e-cigarette use which include long-term cardiovascular damage, lung damage and cancer and other metabolic changes.’
Recently, the Government indicated that E-cigrettes may be prescribed on the NHS, to help lower smoking. The Medicines and Healthcare products Regulatory Agency (MHRA) has published updated guidance that paves the way for medicinally licensed e-cigarette products to be prescribed for tobacco smokers who wish to quit smoking. Manufacturers can approach the MHRA to submit their products to go through the same regulatory approvals process as other medicines available on the health service. This could mean England becomes the first country in the world to prescribe e-cigarettes licensed as a medical product.
‘On the one hand, the initiative provides a positive message that e-cigarettes are much less risky than smoking and help smokers quit,’ said Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London.
‘On the other hand, I am not sure that medicinal licensing of e-cigarettes is a good idea as it is likely that only tobacco industry will be able to face the costs that medicinal licensing entails, and they may only want products that will not endanger their core business.’
Conclusion
Most studies and surveys seem to point to smoking cigarettes becoming an increasingly rare practice, particularly as the Government steps up to promote e-cigarettes and crack down on tobacco use. However, the long term impacts of this, particularly when one considers the popularity amongst children, are unclear. While time is running out for smoking, the jury is out on what comes next.