August 28, 2024

expert reaction to new report on regulation of vaping

A report published by the British Medical Association offers recommendations for stronger vaping regulation. 

Prof Peter Hajek, Professor of Clinical Psychology and Director of the Health and Lifestyle Research Unit, Queen Mary University of London (QMUL), said:

“Some of the regulations that this report proposes are sensible, but the call to ban vape flavours other than tobacco is misguided.  The target that doctors should worry about most of all is smoking, and smokers of all ages prefer vapes with non-tobacco flavours.

“The headline concern, proffered to justify this demand, is that 8% of 11–17-year-olds tried vaping. But it is important to add that smoking in young people is at all time low, and that the figure includes would-be smokers who would otherwise be using the incomparably more risky alternative. Despite the report’s claim (supported by a reference to a blog!), vaping is less addictive than smoking. Only a small proportion of never-smokers progress to vaping daily.

“Regulations that prevent the uptake of vaping by youth are needed. However, regulators need to make sure that concerns about very hypothetical future risks of youth vaping do not trump concerns about the very real and present risks of adult smoking.”

Prof Lion Shahab, Professor of Health Psychology and Co-Director of the UCL Tobacco and Alcohol Research Group, University College London, said:

“The BMA report highlights the need for action to curb unnecessary use of vapes by youth, which may result in addiction. The report makes a number of sensible recommendations, including restrictions on marketing to youth, standardised packaging, point-of-sale display bans and tackling the illegal sale of vapes. However, in order to improve population health as a whole, it is also important to acknowledge the role that e-cigarettes have played in reducing smoking prevalence in the UK, which stands at a record low. To that end, legislation to protect youth has to be balanced with the need to support smokers to quit, including with e-cigarettes.

“In this context, some of the proposed recommendations by the BMA are likely to have unintended consequences. For instance, research has shown that flavours are important to adults switching from cigarettes to e-cigarettes, not just to youth; and an outright flavour ban may drive up cigarette use as has been shown in the US where such bans have been implemented¹. Banning product categories, such as disposable vapes, outright may have intuitive appeal but ignores the fact that most users of disposable vapes in the UK are either past or current smokers². In addition, such action may propagate the message that e-cigarettes are as (or even more) harmful than cigarettes – this is not true but is widely believed by the public, even among those who would benefit from switching, in particular smokers who have failed to stop with other means³.

“There is no question that never-smoking youth should not be using vapes. For the longest time, the UK seemed to strike the right balance: encouraging smokers who were struggling to quit smoking to use e-cigarettes as a means of harm reduction while use of vapes among youth who were never smokers remained low. E-cigarettes were seen as a helpful smoking cessation aid, mainly used by adult smokers. We must get back to this state. We need to reduce the appeal of vapes (and other nicotine products such as nicotine pouches) to youth, by changing the marketing and packaging of products, by limiting (though not eliminating) flavours and standardising flavour descriptors, by moving products out of sight from counter tops and increasing taxation on them (though not beyond combustible tobacco products), in particular those popular with youth, and by reducing access to illicit products and having clear public health messaging that e-cigarettes are for smokers to help them stop smoking.

“In short, we have to make vaping boring again, but we must be mindful that we do not throw the baby out with the bathwater. E-cigarettes, as part of a comprehensive tobacco control strategy that includes funding for smoking cessation services, provision of behavioural and pharmacological support to smokers and public health campaigns, have a crucial role to play in reducing smoking prevalence to achieve the government smokefree target of 5% by 2030. Proposed recommendations to curb youth use of vapes should focus on those evidence-based measures that do not also discourage harm reduction by smokers who struggle to quit that most dangerous of products: combustible cigarettes.”

‘Taking our breath away: why we need stronger regulation of vapes’ was published by the BMA at 00.01 UK time on Wednesday 28 August.

¹ https://dx.doi.org/10.2139/ssrn.4586701

² https://doi.org/10.1016/j.puhe.2023.12.024

³ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815561

Declared interests

Lion Shahab: No relevant COI

Peter Hajek: No COI.