6 February 2018
Action on Smoking and Health has strongly welcomed a new report on e-cigarettes, produced by independent experts for Public Health England.  The report updates the evidence on e-cigarette use among adults and young people; their effectiveness as an aid to quitting by smokers; the risks to health compared to smoking and public understanding of those risks. PHE goes on to urge smokers and public bodies to act on the evidence.
The report suggests that just under 3 million people currently use e-cigarettes, but that the numbers using them have now levelled off. E-cigarettes are likely to be helping at least 20,000 people to quit smoking every year. Those smokers who switch completely to vaping are likely to substantially cut health risks. The report concludes that the evidence does not support concerns that e-cigarettes are a route into smoking among young people. Youth smoking rates continue to decline, and regular vaping is negligible among young people who have never smoked.
However, the report raises serious concerns about public misunderstanding of the risks and benefits of e-cigarette use. Millions of smokers wrongly think that vaping is as harmful as smoking. Around 40% of current smokers have never tried e-cigarettes. And fewer than one in ten adults know that most of the health damage caused by smoking comes from the by-products of cigarette combustion, and not from the nicotine content.
These findings support the evidence from successive YouGov surveys commissioned by ASH. Between 2013 and 2017 a growing proportion of both the general public and smokers failed to recognise that e-cigarette use is much less harmful than smoking. In 2017 only 13% of adults correctly identified that e-cigarettes are much less harmful, compared to 21% in 2013. The proportion of adults thinking that e-cigarettes are at least as dangerous as smoking nearly quadrupled from 2013 to 2017 from 7% to 26%. 
The PHE report follows a recent report by the US National Academies of Sciences, Engineering and Medicine, which concluded that “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.” 
Commenting, ASH Chief Executive Deborah Arnott said:
“The PHE report is part of a growing scientific consensus that e-cigarettes are likely to be very much less harmful than smoking and can help smokers quit. E-cigarette use has stagnated in recent years, which is hardly surprising as many smokers incorrectly believe that vaping is as harmful as smoking. We hope this report will provide the reassurance needed to encourage the 40% of smokers who’ve failed to quit but never tried vaping to go ahead and switch.
She went on to say:
“ASH supports PHE’s recommendation that smokers who have struggled to quit should try vaping as an alternative to smoking, and that e-cigarettes should be made available on prescription. Smoking remains the leading cause of preventable premature death, responsible for over 1,000 hospital admissions a day in England. Providing support to smokers to quit is highly cost-effective and essential for the sustainability of the NHS.”
In order to be provided on prescription e-cigarettes have to be licensed as a medicine by the MHRA. The Tobacco Control Plan for England makes a commitment to “maximise the availability of safer alternatives to smoking”, and it goes on to say that, “The Medicines and Healthcare products Regulatory Agency (MHRA) will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.” 
Notes and Links
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash. ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.
ASH staff are available for interview and have an ISDN line.
For more information contact ASH: 020 7404 0242, or out of hours, Deborah Arnott on 07976 935 987 or Hazel Cheeseman on 07754 358 593.
 The evidence review was conducted for Public Health England by Professor Ann McNeill, Professor of Tobacco Addiction at King’s College, and Professor Linda Bauld, Professor of Health Policy at the University of Stirling.
 The latest YouGov survey can be downloaded from: https://ash.org.uk/download/use-of-e-cigarettes-among-adults-in-great-britain-2017/
 National Academies of Science, Engineering and Medicine. Public Health Consequences of E-Cigarettes 23 January 2018. The US report can be downloaded from https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes. The quote included in the press release comes from the summary. Section 19-4 page 500 goes into more detail:
As concluded in previous chapters, e-cigarettes are likely to be less harmful than combustible tobacco cigarettes. Estimates of how harmful they are relative to combustible tobacco cigarettes range from 5 percent estimated by the U.K. Royal College of Physicians (TAG, 2008) to 30 to 50 percent estimated by Glantz (2016), with most agreement concentrated around the lower figure.”
 ONS Adult smoking habits in the UK: 2016. Published June 2017.
 DH. Tobacco Control Plan for England. July 2017.
29 August 2017
UK’s largest ever analysis of data shows no evidence that e-cigarettes are leading young people into smoking
Concerns that use of e-cigarettes by young people in the UK could be leading to smoking are so far not borne out by the evidence, shows a new study published today.
The study, a collaboration between UK Centre for Tobacco and Alcohol Studies, Public Health England, Action on Smoking and Health, and the DECIPHer Centre at the University of Cardiff is an analysis of five large-scale surveys conducted in the period 2015-17 involving over 60,000 11-16 year-olds. 
The findings show a consistent pattern: most e-cigarette experimentation among young people does not lead to regular use, and levels of regular e-cigarette use in young people who have never smoked remain very low. 
Regular (at least weekly) use of e-cigarettes amongst all young people surveyed was 3% or less. This was highly concentrated in those who also smoked tobacco. Among young people who smoke regularly (at least weekly), use of electronic cigarettes ranged from 7% to 38%. . However, among young people who have never smoked, regular use of e-cigarettes was negligible – between 0.1% and 0.5% across the five surveys. 
Most studies of e-cigarettes and young people in the UK and elsewhere have looked at experimentation – involving ever or recent use, rather than regular use. Some of these studies have suggested that trying an e-cigarette leads to young people becoming smokers, which is not justified by the evidence.
Professor Linda Bauld, Professor of Health Policy, University of Stirling:
“Recent studies have generated alarming headlines that e-cigarettes are leading to smoking. Our analysis of the latest surveys from all parts of the United Kingdom, involving thousands of teenagers shows clearly that for those teens who don’t smoke, e-cig experimentation is simply not translating into regular use.
“Our study also shows that smoking rates in young people are continuing to decline. Future studies on this subject need to continue to monitor both experimentation and regular use of e-cigarettes and take into account trends in tobacco use if we are to provide the public with accurate information.”
Martin Dockrell, Tobacco Policy Manager, Public Health England:
“The findings in this study suggest that in terms of protecting children we are broadly getting the balance right in the UK. We have a regulatory system that aims to protect children and young people while ensuring adult smokers have access to safer nicotine products that can help them stop smoking. This includes a minimum age of sale, tight restrictions on marketing, and comprehensive quality and safety requirements. We will continue to monitor the trends in e-cigarette use alongside those in smoking.”
Deborah Arnott, Chief Executive, Action on Smoking and Health:
“ASH will continue to monitor the potential impact of e-cigarettes on young people, however this study provides reassurance that to date fears that they are a gateway into smoking are just not born out by the facts on the ground. A small proportion of young people do experiment with e-cigs, but this does not appear to be leading to regular vaping or smoking in any numbers, indeed smoking rates in young people are continuing to decline.”
Graham Moore, Deputy Director, DECIPHer:
“Few people would argue that e-cigarette use in young people should be encouraged. However, these surveys consistently show that the rapid growth in experimentation with e-cigarettes among young people throughout the UK has so far not resulted in widespread regular use among non-smokers. Taken alongside our other recent analyses which suggest that among young people who use both e-cigarettes and tobacco, tobacco nearly always comes first, concerns that e-cigarettes are leading large numbers of young people into addiction and tobacco use increasingly seem to be implausible.”
Young people are defined as aged from 11-16 in the surveys analysed.
Contributors to the research paper include: Public Health England, Action on Smoking and Health (ASH), members of the UK Centre for Tobacco and Alcohol Studies (The Institute for Social Marketing at the University of Stirling, The Addictions Department at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London) and The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement at Cardiff University.
Contributors are available for interview. Please contact Stevie Benton from Action on Smoking and Health (ASH) on 020 7404 0242
 The five surveys are:
 Bauld L et al Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017, International Journal of Environmental Research and Public Health 2017, 14, 29 August 2017 http://www.mdpi.com/1660-4601/14/9/973/pdf
This briefing examines the impact of the EU Tobacco Products Directive on e-cigarette regulation in the UK.The impact of the EU Tobacco Products Directive on e-cigarette regulation in the UK