Public Health England’s latest report re-affirms findings of e-cigarettes being significantly less harmful than conventional cigarettes

Public Health England (PHE) has recently released a new report on e-cigarettes as a review of current evidence and an update on its 2015 report which stated that e-cigarettes are 95% less harmful than conventional cigarettes.

PHE, an executive agency of the Department of Health and Social Care in the United Kingdom, commissioned leading independent tobacco experts to review evidence on e-cigarette use among young people and adults, public attitudes, the impact on quitting smoking, an update on risks to health and the role of nicotine. The report also reviews heated tobacco products.

The report covers seven main findings:

  • vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
  • e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
  • e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
  • many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
  • there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
  • the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
  • the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked)

Its evidence review comes just a few weeks after a US National Academies of Sciences, Engineering and Medicine report on e-cigarettes, which also finds that ‘e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes’ based on the available evidence.

Professor John Newton, Director for Health Improvement at PHE said, “Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.”

“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know,” he stressed.

“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety,” he added.

Professor Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London said, “It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.”

“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death. There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes,” she added.

Many would think that cancer-causing agents come from the nicotine of the tobacco leaves. But it is the burning of leaves, even normal leaves, that produces particulate matter and hydrocarbons, which contain a number of toxic, irritant, and carcinogenic (cancer-causing) compounds.

Professor Linda Bauld, author and Professor of Health Policy, University of Stirling and Chair in Behavioural Research for Cancer Prevention, Cancer Research UK said, “Concern has been expressed that e-cigarette use will lead young people into smoking. But in the UK, research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1 percent, and youth smoking continues to decline at an encouraging rate.”

“We need to keep closely monitoring these trends, but so far the data suggest that e-cigarettes are not acting as a route into regular smoking amongst young people,” she added.

The report stressed that anyone who has struggled to quit should try switching to an e-cigarette and get professional help, noting that the greatest quit success is among those who combine using an e-cigarette with support from a local stop smoking service.

Singapore bans e-cigarettes 

Ministry of Health (MOH) of Singapore has announced earlier that new prohibitions on the purchase, use and possession of emerging and imitation tobacco products will come into force starting from 1 February 2018.

It noted that this is the first phase of implementation of the amendments to the Tobacco (Control of Advertisements and Sale) Act (TCASA), which were passed in Parliament in November 2017.

Under the amended Act, to further reduce opportunities for youths to take up smoking before they turn 21, and to better protect our population from the harms of emerging and imitation tobacco products, the Ministry of Health (MOH) stated that it will:

  • Increase the Minimum Legal Age (MLA) for tobacco from age 18 to 21 for the purchase, use, possession, sale and supply of tobacco products; and
  • Further tighten control over emerging and imitation tobacco products to prohibit the purchase, use and possession of these products.

It noted that the TCASA Amendment Act 2017 will come into force in phases.

Dr Khor:  No claim by anyone that (heated tobacco products) can be used for smoking cessation

In March 2017, Senior Minister of State for Health Amy Khor said in response to a question on e-cigarettes, “Evidence from other countries suggests that heat-not-burn tobacco products are not significantly different from traditional cigarettes in terms of emissions,”

“While there have been claims that such tobacco products are less harmful than traditional cigarettes, these claims are made by the tobacco industry and, to date, there is very little independent evidence supporting such claims.”

There is no documented evidence of any “safe” level of tobacco use, and “there has been no claim by anyone that (heated tobacco products) can be used for smoking cessation”, she added.

“I think our concern, really, is with the fact that allowing the use of such products could attract a much larger group of users, especially among youths. That could be the gateway to nicotine addiction and eventually, smoking,” said Dr Khor.

Dr Khor’s statement was based on findings of United States Centers for Disease Control and Prevention which reported an increase of e-cigarette use among high school students of more than 10 times, from 1.5 per cent to 16 per cent, between 2011 and 2015.

However, Dr Khor failed to note that in the same report, over the same period, 9.3 percent of high school students reported smoking traditional cigarettes compared with 15.8 percent in 2011.

While there is no proof that the drop in cigarette smoking as indicated in the report was caused by increased e-cigarette use, neither is there conclusive data to support claims that e-cigarettes are a gateway to the use of regular cigarettes.

As for the 2018 report by US National Academies of Sciences, Engineering and Medicine, it writes, “the evidence suggests that while e-cigarettes might cause youth who use them to transition to use of combustible tobacco products, they might also increase adult cessation of combustible tobacco cigarettes.”