Nicotine vaping products were the most popular quit-smoking aids (27.2 percent) in England in 2020, according to Public Health England’s (PHE) seventh independent report on vaping, carried out by researchers at King’s College London. Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates—between 59.7 percent and 74 percent in 2019 and 2020. An estimated 50,000 smokers stopped smoking with the aid of a vaping product in 2017.
Despite these trends, 38 percent of smokers in 2020 believed that vaping is as harmful as smoking; with 15 percent believing that vaping is more harmful
The coronavirus pandemic is likely to have had an impact on smoking and vaping behaviors in both adults and young people. However, it is still too early to assess the full effect of the pandemic, with much of the data examined in this report being pre-pandemic.
Vaping has plateaued in adults and young people since the last PHE report in March 2020. Around 4.8 percent of young people (aged 11 to 18 years) reported vaping at least once a month—the same as last year—and most of these were either current or former smokers (only 0.8 percent of young people who had never smoked currently vape). Smoking prevalence among young people, including those who smoked sometimes or more than once a week, was 6.7 percent in March 2020, similar to March 2019, at 6.3 percent.
Similar to last year, around 6 percent of adults are current vapers, equating to about 2.7 million adult vapers in England. Smoking prevalence continues to fall and is between 13.8 percent and 16 percent depending on the survey. Vaping prevalence was between 17.5 percent and 20.1 percent among current smokers, around 11 percent among former smokers and between 0.3 percent and 0.6 percent among those who have never smoked. The proportion of vapers who also smoke, or “dual users,” has declined since 2012.
“Our report draws together findings from randomized controlled trials, stop-smoking services and population studies and concludes that nicotine vaping products are an effective way of successfully quitting smoking,” said Ann McNeill, professor of tobacco addiction at King’s College London.
“What is concerning is that smokers, particularly those from disadvantaged groups, incorrectly and increasingly believe that vaping is as harmful as smoking. This is not true and means fewer smokers try vaping.
“The goal for 2030 is to be smokefree in England. The development of a new Tobacco Control Plan and this year’s review of the Tobacco and Related Products Regulations 2016 is an opportunity to ensure that the regulations around vaping are appropriate. The regulations are also hoped to help smokers to quit, while not attracting people who have never smoked.”
Public Health England’s (PHE) latest evidence review reinforces vaping’s role in smoking cessation as well as the low rate of use among underage never-smokers.
As the U.K. prepares to reevaluate its Tobacco & Related Products Regulations following Brexit, the report shows great successes in harm reduction and smoking cessation linked to vaping products.
In every region of the country, quit rates among adult smokers were found to be higher with the use of vaping than with other products, ranging from 49 percent success in the South West to 78 percent in Yorkshire and the Humber.
PHE states that the use of nicotine-replacement therapies (NRT) among long-term former smokers is declining while the use of vaping products is increasing. Citing data from Action on Smoking and Health, the review highlights that the most common reasons given for vaping were to quit combustible cigarettes (29.7 percent), stay off cigarettes after quitting (19.4 percent) and to reduce tobacco consumption (11.2 percent).
Flavors remain an important driver for those using vaping products, with 31.6 percent of vapers reporting fruit flavors to be their preference.
Uptake among “never-smoker” youth remains very low, between 0.8 percent and 1.3 percent, with PHE confirming that this rate has not increased in recent years.
John Dunne
“This a defining moment for the vaping sector and truly shows the considerable progress it has made against a backdrop of significant misinformation around the industry, with Public Health England once again stating that perceptions of the harm caused by vaping compared with smoking are increasingly out of line with the evidence,” said John Dunne, director general of the U.K. Vaping Industry Association (UKVIA).
“This latest data, which the review is based upon, provides incontrovertible evidence as to the importance of vaping to successful smoking cessation and the nation’s public health.”
Dunne also pointed to challenges that need addressing by the industry and policy makers.
“Despite the many positives in this report, a great deal remains to be done,” he said. “Action on Smoking and Health, for example, has found that just 11 percent of local authority stop-smoking services are offering vaping products to some or all of those trying to quit smoking. With the clear efficacy of vaping evidenced in this report, we must ensure this figure grows.
“As an industry, we also share PHE’s views on stronger enforcement in preventing underage sales. In our response to the government’s TRPR consultation, which we will be publishing shortly, we call for fully funded regional and national test purchasing schemes to better understand compliance and to help educate retailers on their legal requirements. The UKVIA has already published the first ever Preventing Underage Sales Guide for vape shops and online retailers, which has been supported by Trading Standards.
“The review’s finding that more than 50 percent of people believe vaping to be as harmful or more harmful than the use of combustible cigarettes means we need to keep educating smokers about the fact that vaping is a fraction of the harm of smoking, has literally changed the lives of former smokers for the better and is acknowledged as one of the best ways to quit conventional cigarettes.”
The U.K. Vaping Industry Association (UKVIA) has urged British health authorities to continue their pragmatic policies on vaping.
Last month, U.K. Health Secretary Matt Hancock announced that Public Health England (PHE) was being scrapped and merged into the new National Institute for Health Protection. PHE has supported vaping as a vital tobacco harm reduction tool.
In the nicotine business, PHE is best known for its 2015 assertion that vaping is 95 percent less harmful than smoking.
“Whenever responsibilities are transferred there is a risk that invaluable institutional knowledge and memory is lost. This would be to the detriment of the U.K.’s millions of smokers and vapers and cannot be allowed to happen in this case,” said John Dunne, director of the UKVIA.
“The UKVIA calls upon the custodians of PHE’s former responsibilities, in the event that they are indeed reallocated, to continue their positive approach towards harm reduction technologies. Independent reviews, studies and statements, all focused on facts rather than hearsay, have been a cornerstone of a successful British vaping industry which supports adult consumers to make a positive change for their health,” Dunne said.
The abolition of Public Health England (PHE) puts at risk staff who specialize in tackling alcohol abuse, obesity and smoking, according public health experts.
Earlier this week, U.K. Health Secretary Matt Hancock announced that PHE was being scrapped and merged into a new National Institute for Health Protection alongside National Health Service Test and Trace and the Joint Biosecurity Centre.
PHE had come under fire for its performance in the coronavirus crisis, but critics suspect government officials view the agency as a convenient scapegoat for flawed decisionmaking in the early weeks of the coronavirus crisis.
The timing is also controversial. “It’s an incredibly stupid move,” a health official told The Economist. “We’re in the middle of a pandemic.”
PHE was created in 2013 with responsibilities including preparing and responding to health-related emergencies, such as pandemics. It currently employs around 5,500 full-time staff made up mostly of scientists, researchers and public health professionals.
In the nicotine business, PHE is best known for its 2015 assertion that vaping is 95 percent less harmful than smoking. The agency has been credit with Britain’s comparatively pragmatic vapor policies and progressive attitude toward tobacco harm reduction.
Buried under the Covid-19 headlines, a recent Public Health England report reiterates the value of vaping for smoking cessation. By George Gay
Amid the unfolding tragedy and chaos on March 11, when the World Health Organization (WHO) declared that the spread of Covid-19, the disease caused by the SARS-CoV-2 coronavirus, had reached pandemic proportions, it was easy to lose sight of the fact that the world was in the grip of a number of pandemics, one of which, according to the WHO, is the “smoking [tobacco] pandemic.”
I have never understood how smoking can sensibly fit into the definition of a pandemic, but then it seemed to me that Covid-19 had been of pandemic proportions for a while before it was declared to be so. What do I know? I’m just some mug in lockdown whose rights have been taken away by the people who should have avoided the necessity to do this by having been part of a global initiative to prevent the emergence of such viruses or at least to deal with their effects far more efficiently than has been the case. Still, you know me—I don’t like to complain.
Is there some reason why I have drawn attention to the existence of the two pandemics, I sense you asking? Well, since you raise the issue, the two are loosely connected, at least in England. About a week before the WHO bestowed pandemic status on Covid-19, Public Health England (PHE) had issued its latest vaping report in March (“Vaping in England: An Evidence Update Including Mental Health and Pregnancy”), and vaping, as I think any fair-minded person would admit, has the power, in the parlance of our times, to help flatten the curve of smoking and no doubt, along with other initiatives, to eventually eliminate this pandemic.
PHE, which is an executive agency sponsored by the Department of Health and Social Care, has long said that vaping regulated nicotine products poses a small fraction of the risks of smoking and that vaping such products, in conjunction with other interventions, will greatly increase the chances of tobacco smokers stopping smoking. And these comments were confirmed in its latest report.
So everything is hunky-dory? Smokers can gradually move to vaping and other activities associated with next-generation nicotine products once those products meet their expectations, and at least one pandemic will have been dealt with? Of course, as anybody reading this magazine will be aware, things are not that simple. Ever since vaping came onto the scene, there have been no end of people willing to condemn it as smoking by another name, and their voices have been amplified in much of the media, which has reveled in running questionable headings to scare the pants off smokers and would-be vapers without the necessity of producing any evidence as to why they should be scared of vaping. “Is vaping riskier than smoking?” is the type of heading often used. Of course, the short answer to the question is “no,” but if you’re paid by the word …
Given these circumstances, the sane voice of organizations such as PHE are vital, and it is a pity that its latest report probably received much less coverage than it might have done if the media had not been preoccupied with the Covid-19 pandemic rather than, as usual, the smoking pandemic. After all, from what we are told, the former is not going to cause anything approaching the death toll attributed to the latter.
Certainly, British American Tobacco (BAT) welcomed the report. David O’Reilly, the company’s director of scientific research, was quoted on its website as saying, in part, that it was encouraging to see PHE continuing to highlight that “regulated vapor products are much less harmful than cigarettes and that vaping continues to help those U.K. smokers seeking an alternative to make the switch.”
So let’s try to give a little airing to the PHE’s March 4 report, the summary of which, to my mind, is admirable for combining science with common sense in a clearly written document that is easily digestible by ordinary smokers and vapers and by people, such as me, who are not scientists. The document confirms in part that the conclusions of PHE’s previous reports are still “important messages for preventing harm” and that these conclusions, broadly summarized, are as follows:
• Vaping regulated nicotine products has a small fraction of the risks of smoking, but this does not mean it is safe. • Smokers should be encouraged to try regulated nicotine vapor products along with smoking cessation medications and behavioral support. This will greatly increase their chances of successfully stopping smoking. • People who have never smoked should be encouraged not to smoke and not to vape. • Vapers should be encouraged to use regulated nicotine products only and stop smoking completely.
To my mind, it is one of the smallest figures within the PHE report that needs to be given the most airing—that needs to be used as a strap line on every vaping story. “Vaping remains most common among smokers and former smokers, with less than 1 percent of people who have never smoked currently vaping,” the report says. Less than 1 percent. That figure completely undermines a common claim made by those implacably opposed to vaping: that vaping will draw a wave of nonsmokers to nicotine addiction. In fact, taken together with other figures in the report, it demonstrates that vaping is a means to improving the health outcomes of individuals and the population at large. As PHE says, most adults use vapor products to help them quit smoking.
Growing misperceptions
It has to be of concern, therefore, that those opposed to vaping have been successful in getting their messages across. “Perceptions of harm from vaping among smokers are increasingly [my emphasis] out of line with the evidence,” PHE reports. “The proportion who thought vaping was less harmful than [smoking] cigarettes declined from 45 percent in 2014 to 34 percent in 2019. These misperceptions are particularly common among smokers who do not vape.”
O’Reilly was quoted on the BAT website as saying that the growing misperceptions regarding the relative risks of vaping and smoking were deeply concerning and likely to be contributing to a huge missed opportunity from a public health point of view. “It’s key that smokers have access to accurate facts regarding these important products in order to make an informed choice,” he said. “As one of the world’s largest vaping companies, which puts science, product safety and testing at the heart of everything we do, we are committed to working with public health bodies, harnessing our global resources and expertise, to help educate smokers regarding the potential benefits of vaping.”
Such misperceptions, which are not the results of accidents, have their consequences because “stop smoking services in England suggest that when a vaping product is used in a quit attempt, either alone or with licensed medication, success rates are comparable to, if not higher than, licensed medication alone,” according to PHE.
Such quit attempts have been largely stalled for the past five years, however. PHE reports that current vaping prevalence (any current use) among adults in England has remained stable since 2014, and in 2019, it was between 5 percent and 7 percent. At the same time, current vaping prevalence among smokers varied between 14 percent and 20 percent across the surveys studied, again showing little change since 2014. But current vaping prevalence among former smokers has continued to rise and was 12 percent to 13 percent in 2019. Vaping prevalence is said to be highest among people in more disadvantaged socioeconomic groups, reflecting their higher levels of smoking.
Meanwhile, the proportion of current smokers who have not even tried vapor products apparently remained at 37 percent between 2018 and 2019, suggesting that those “Is vaping riskier than smoking?” headings have been doing their job in creating an atmosphere of unfounded fear around vapor products.
Credit: Ciprian Tudor
No epidemic
Some of the most surprising aspects of the report have to do with vaping among young people, which seems to be at a low level, contrasting starkly with what we are often led to believe in England and what we are told is an “epidemic” of vaping among young people in the U.S. It is worth noting here that PHE points out in its report summary that comparisons across countries are hampered by inconsistent questions and survey methods, though it also says that “[o]ne survey that compared vaping among 16-[year-olds] to 19-year-olds from 2017 to 2018 using consistent methods found lower levels of vaping in England compared to [those in] Canada and the U.S.”
PHE reported that current vaping prevalence (weekly or less than weekly) among young people in England has remained reasonably steady with the best recent estimates putting it at 6 percent of 11-year-olds to 15-year-olds in 2018 and 5 percent of 11-year-olds to 18-year-olds in 2019. No surveys were said to have reported much increase in vaping prevalence. As you would expect, the older a youngster is, the more likely she is to vape; so current use among 11-year-olds was estimated at less than 1 percent in 2018 compared with 11 percent of 15-year-olds.
Again, as you could expect, current vaping is mainly concentrated in young people who have experience smoking. In fact, less than 1 percent of young people who have never smoked are current vapers, and PHE noted that current smoking prevalence (weekly or less than weekly) among 11-year-olds to 15-year-olds halved between 2009 (11 percent) and 2018 (5 percent), though it had remained relatively steady since 2014.
PHE reported that young people’s perceptions of the relative harms of vaping compared with smoking are increasingly out of line with the evidence, reflecting, but not as starkly, the situation among adults. The proportion of 11-year-olds to 18-year-olds who thought that vaping was less harmful than smoking declined from 68 percent in 2014 to 52 percent in 2019. Just over a third of 11-year-olds to 15-year-olds thought it was OK to try vaping, and just under a quarter thought it was OK to vape once a week. Most young people who have tried vaping did so out of curiosity.
Almost 60 percent of 11-year-olds to 15-year-olds who vaped regularly (more than once a week) reported being given vapor products, mostly by friends. But many also reported buying vapor products from other people, shops and the internet, and PHE believes that “enforcement of age of sale regulations needs to be improved.” Tank models remain the most popular type of vapor device used by young people in England.
The March-issued report, which presents updates on the prevalence of vaping among young people and adults and reviews literature on vaping among people with mental health conditions and pregnant women, is the sixth in a series of independent reports commissioned by PHE to summarize evidence on e-cigarettes to inform policies and regulations. PHE says that a “comprehensive e-cigarette safety review will be the focus of a future report.”
In setting out the aims of the report, PHE said that despite reductions in smoking prevalence, smoking remained the biggest single cause of preventable death and disease and a leading cause of health inequalities. “So, alternative nicotine-delivery devices that are less harmful could play a crucial role in reducing this health burden,” it said.
