Electronic cigarettes have come a long way since they were first launched in the UK more than a decade ago. Now more than three million ‘vapers’ in this country use e-cigarettes, which were invented by Chinese pharmacist, Hon Lik, when searching for a way to kick his own heavy smoking – a habit that had prematurely killed his father.
As sales of conventional cigarettes declined after smoking in public places was banned in 2007, e-cigs came into their own. When most people think of an e-cigarette, they picture a device that looks similar to regular cigarettes with a cartridge that must be filled and replaced. They are the kind you see in sale in petrol stations and come in limited (but growing flavor selections). In contrast, there is now a vast range of e-cigarettes known as Advanced Personal Vaporisers (or APVs) that allow you to regulate the power level and produce varying amounts of vapor. Up to 700 vaping flavours are available with these new devices, hence their increasing popularity.
Few could have envisaged that a whole culture of ‘vaping’ would emerge - users enthuse about cherry and apricot flavoured e-cigarettes and engage in 'cloud chasing', a competition to produce the largest and most artistic clouds of vapour.
In the last few years, e-cigarettes have replaced nicotine patches and gum to become the most popular choice of smoking cessation aid in England. But are they helping people to quit their smoking habit in the way intended?
Some researchers believe that vaping is attracting newcomers to the ‘cigarette’ market as vaping establishes itself as a trend in its own right. Fiona Measham, a professor of criminology in the School of Applied Social Sciences, at Durham University conducted a trial this year, which examined trends in smoking-related attitudes among 14-25 year olds. “Our study suggests vaping is establishing itself as a new phenomenon, independent of traditional smoking. Adults are bogged down by the similarities between smoking and vaping, whereas young people see them as different activities and do not associate vaping with the idea of a being a smoker or non-smoker. The young people we spoke with did not relate to the adult motivations ascribed to e-cigarettes, such as smoking cessation and nicotine consumption.”
Smoking kills nearly six million people worldwide every year and is the leading cause of ill health. But is vaping an entirely harmless alternative? We asked the experts:
How popular is it?
“Vaping has really taken off rising from an estimated 700,000 users in 2012 to 2.8 million in 2016,” says Amanda Sandford, information manager for the charity ASH (Action on Smoking and Health). “However, at least three times as many people smoke in the UK, so there’s a long way to go before it catches up with or overtakes smoking.”
How does it work?
E-cigarettes deliver a nicotine hit by heating a nicotine-containing propylene glycol (e-liquid) to create a 'vapour', which is inhaled by the smoker. What they don’t deliver is the large number of other chemicals present in tobacco smoke that come either from the tobacco itself, or are created as part of the burning process. “There are a lot of different devices with a range of power settings, and different e-liquids, all containing varying nicotine contents and flavours,” Sandford says.
Is it better for you than smoking?
Definitely, says Sandford. “There is no doubt vaping is certainly better than smoking and that view is shared across the public health community, even among those who are more sceptical about the potential benefits of vaping,” Sandford says. “The harm from tobacco comes largely from inhaling the smoke. As there’s no smoke in vaping, there is a considerably reduced risk of harm, compared to smoking.” A recent evidence review by Public Health England concluded tthat cigarettes were 95 per cent safer than regular cigarettes.
The NHS gives the thumbs up to vaping, as a way of stopping smoking, claiming that people who combine e-cigarettes with the free face-to-face support provided by NHS Stop Smoking services have the best chances of quitting. In 2014-15, two out of three people who tried this combination managed to stop smoking.
Can you expect withdrawal symptoms when you switch from smoking to vaping?
“Since most e-cigs contain nicotine - the whole point of them is to help smokers transition to a safer product – there should be mimimal withdrawl symptoms,” Sandford says. “However, e-cigs generally deliver less nicotine per puff than tobacco cigarettes so people may initially have to use more of them to get the same nicotine fix.”
Have there been any medical issues with vaping?
“The current evidence suggests that e-cigs don’t pose a major threat to health, at least in the short term,” Sandford says. “But the truth is that we don’t know what the long term effects might be. It’s possible that they may cause some injury to the lungs after years of continued use.”
A handful of studies have suggested that chemicals in the vapour produced by e-cigarettes can cause health problems. “But these studies have tended to use artificial conditions,” says Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training (NCSCT). “When good quality e-cigarettes are used normally and not overheated, there are far fewer harmful chemicals present in the vapour than in tobacco smoke.”
However, they are not without controversy. In 2009, the US FDA reported that some e-cigs contain diethylene glycol, an ingredient used in antifreeze, while last year, a study in the New England Journal of Medicine showed that aerosols from e-cigs contain formaldehyde, another carcinogen. Both chemicals have also been shown to be present in cigarette smoke.
Are there any restrictions about where you can do it?
Although there are no laws (yet) restricting where you can do it, some public venues set their own rules. Some sports stadiums - Manchester City, Manchester United and Chelsea football grounds, for example - have said no to vaping. Southern trains, Thameslink, Virgin, Cross Country and Great Northern rail companies have banned vaping on their trains and platforms, as have Transport for London. They are banned on most planes, although Ryanair allows its own "smokeless" cigarettes, which aren't electronic and work more like nicotine inhalers. Most pubs allow e-cigarettes, although you can’t use them in Starbucks, Caffe Nero, All Bar One or KFC.
Are there risks from passive vaping?
Dr McEwen says that, unlike regular cigarettes, “there’s no evidence that second-hand e-cigarette vapour is dangerous”. However, some research say that the chemicals emitted from e-cigarettes should not be dismissed as harmless. One study at the Lawrence Berkeley National Laboratory found that 31 harmful chemicals were released in some vapours, including two possibly cancer-causing compounds. Others have suggested levels of harmful chemicals are so low they weren’t considered harmful. In the UK, children are protected in a number of ways. There are bans on TV and radio advertising of e-cigarettes and laws banning the sale of e-cigs to under 18s, but nevertheless, there are concerns that the types of flavours involved in vaping - cherry crush for example - could make it attractive to children.
There's still so much we don't know about vaping that the only truly healthy answer is if you are a smoker, see it as a way to quitting entirely. And if you aren't a smoker or a vaper - don't be tempted to start.