England Vaping Report No. 6: Keep Encouraging Vapes for Quitting

On March 5, according to foreign reports, public health in England has always adhered to its long-standing belief that smoking e-cigarettes is a better choice than smoking combustible cigarettes, and non-smokers should be encouraged not to smoke or smoke e-cigarettes.

Its sixth report on e-cigarettes, E-cigarettes in England: A summary of the 2020 Evidence Update, shows that the proportion of adults who believe e-cigarettes are less harmful than smoking dropped from 45% in 2014 to 34% in 2019. The report also pointed out that the use of e-cigarettes by young people has not increased significantly.

Based on the report, the PHE concluded that vapor products should be regulated for both nicotine and non-nicotine products, but that banning flavors could have a negative impact on adult smokers trying to quit smoking using vapor products.

The report also states that the UK's National NHS should issue guidance on electronic nebulization in Mental Health Trusts to ensure consistency and fairness across the NHS, and that in the United States, a large number of causes of lung injury and deaths are not attributed to regulated nicotine e-cigarette products, but all suspected adverse reactions or suspected deaths need to be evaluated.

According to the report, smokers 'perceptions of the dangers of smoking are increasingly inconsistent with the evidence.

John Newton, PHE's director of health improvement, said safety concerns are likely to deter many smokers from changing careers, putting them on the path of years of poor health and early deaths due to smoking.

Advocates of e-cigarettes welcomed the report.

The British E-Cigarette Industry Association said the report provides further and specific evidence that e-cigarettes play a vital role in changing the lives of smokers across the country, and it dispels the myth that e-cigarette use among young people is currently a major problem.

The association also said, however, that it also tells us that serious misunderstandings about the safety of e-cigarettes have influenced consumers 'views on e-cigarettes, which may greatly influence their decision to quit smoking, which will significantly increase health risks.

The following is the full text:

1. reporting purposes

This is the sixth in a series of independent reports commissioned by the Public Health Agency (PHE) that summarizes evidence on e-cigarettes to help inform policy and regulations.

Although smoking rates have declined, smoking remains the largest single cause of preventable death and disease and the leading cause of health inequality. Therefore, alternative nicotine delivery devices that are less harmful could play a key role in reducing this health burden.

This report describes the prevalence of e-cigarettes among young people and adults, and reviews the literature on e-cigarettes among people with mental illness and pregnant women.

A comprehensive e-cigarette safety review will be the focus of future reports.

1.1 the term

Vaping products refer to e-cigarettes and filled containers (e-liquids).

Vapers refers to people who regularly use e-cigarette products, while Vaping is the act of using e-cigarette products.

Our term does not include electronic atomization of marijuana or the atomization of other illegal substances, which is not the subject of this report.

1.2 current regulations

Nicotine-free electronic atomization products fall under the General Product Safety Regulations of 2005 (enforced by local trade standards).

The revised EU Tobacco Products Directive (2014/40 / EU)(TPD), which provides stricter regulation of electronic nebulized products containing nicotine, has been transformed into UK law through the Tobacco and Related Products Regulations 2016 (TRPR) and will be reviewed before May 2021.

There are no medically licensed electronic nebulizing products for nicotine in the UK.

It is prohibited to sell e-cigarette products to anyone under the age of 18, and it is prohibited to purchase e-cigarette products for anyone under the age of 18.

1.3 latest developments

Nicotine electronic atomization products continue to develop, and the use of nicotine salt technology is becoming increasingly popular.

Between May 20, 2016 (TRPR implementation) and January 9, 2020, the Medicines and Healthcare Products Regulatory Agency (MHRA) received 84 reports through its Yellow Card Program of 245 adverse reactions believed to be related to electronic nebulized products containing nicotine. The report did not prove that the reaction was caused by vapor products, but the reporter suspected that it might be caused by vapor products.

In the United States, where there is a very different regulatory system for electronic nebulizing products, including products used to electronically nebulizing marijuana, a range of serious lung diseases and deaths appear to peak at the end of 2019. The outbreak appears to be caused by people using the cannabis derivatives tetrahydrocannabinol (THC) oil and vitamin E acetate.# p#pagination title #e#

Although the MHRA has received reports of four deaths through the Yellow Card Program, suspected of e-cigarette smoking (two before TRPR was implemented and two recently), there have been no similar outbreaks of lung disease in England. However, links with electronic nebulizing products containing nicotine have not yet been established. More information is provided in the January 2020 MHRA drug safety update, and there are 2 published cases of serious respiratory diseases linked to e-cigarettes.

It has been reported that nicotine-containing aerosol products (and cigarettes) violate the age of sale, and social media is used to promote electronic aerosol products. The Advertising Standards Agency recently filed a complaint against the marketing of e-cigarette products that violated UK advertising rules.

Most mental health foundations in England allow e-cigarettes, but there are inconsistencies in policy and practice. The report on e-cigarettes is recommended by the House of Commons Science and Technology Committee inquiry into guidance on the Mental Health Trust, which remains excellent and is made in NHS England.

1.4 meaning

Since non-nicotine electronic nebulization products are not as regulated as nicotine-containing electronic nebulization products, a review may need to be carried out simultaneously with the upcoming review of nicotine electronic nebulization regulations.

England's National Health Service (NHS) should issue guidance on withdrawing the Mental Health Trust Fund to ensure consistency and fairness across the national health system.

In the United States, the large number of lung injuries and deaths are not attributed to the regulated nicotine nebulization products currently sold in the UK. However, all suspected adverse reactions or suspected deaths need to be evaluated.

The conclusions of our previous report remain important information for preventing injuries. These can be summarized as follows:

Electronically atomized regulated nicotine products account for only a small proportion of the risk of smoking, but this does not mean they are safe;

Smokers should be encouraged to try using regulated electronic nicotine nebulizing products, as well as smoking cessation drugs and behavioral support, which will greatly increase their chances of successfully quitting smoking;

People who have never smoked should be encouraged not to smoke or smoke e-cigarettes;

Smokers should be encouraged to use only regulated nicotine products and quit smoking completely.

2. method

We used data from six nationally representative surveys to examine the prevalence and characteristics of e-cigarettes in England. We also screened international academic literature to study studies published between November 2018 and October 2019 that reported high prevalence.

We used data collected by NHS Digital from smoking cessation services, data from MHRA's Yellow Card Program and data from peer-reviewed publications.

We conducted 2 systematic reviews of published academic literature and identified evidence for electronic nebulization in people with mental illness and during pregnancy.

3. Use of e-cigarettes by young people

3.1 main findings

The current prevalence of e-cigarettes among young people in England (weekly or less) remains fairly stable, with recent estimates indicating that it accounted for 6% of people aged 11 to 15 in 2018 and 5% of people aged 11 to 18 in 2019.

Older children are more likely to use e-cigarettes. It is estimated that the current usage rate among 11-year-olds in 2018 was less than 1%, while the current usage rate among 15-year-olds was 11%.

The current smoking of e-cigarettes is mainly concentrated among young people with experience in smoking. Less than 1% of young people who have never smoked are current e-cigarette users.

No survey reported a significant increase in the prevalence of electronic atomization.

The current prevalence of smoking (per week or less) among people aged 11 to 15 has halved between 2009 (11%) and 2018 (5%), but has remained relatively stable since 2014.

Young people's understanding of the relative dangers of smoking e-cigarettes compared to smoking is increasingly inconsistent with the facts. The proportion of children aged 11 to 18 who believe that smoking e-cigarettes is less harmful than cigarettes dropped from 68% in 2014 to 52% in 2019.

More than one-third of young people aged 11 to 15 believe they can use e-cigarettes, while less than one-quarter believe they can use e-cigarettes every week.

Most young people who have tried e-cigarettes are out of curiosity.

The open model is a reusable and rechargeable kit that users can replenish with cigarette oil and remains the most popular type of e-cigarette device used by young people.

A recent UK survey did not ask young e-cigarette users about their use of flavoring agents.

Nearly 60% of children aged 11 to 15 who smoke e-cigarettes regularly (more than once a week) say that the e-cigarette products they receive are mainly provided by friends. However, many people also reported purchasing e-cigarette products from others from stores and the Internet.# p#pagination title #e#

Inconsistent questions and survey methods hinder comparisons between countries. A survey that used a consistent methodology to compare e-cigarettes among children aged 16 to 19 between 2017 and 2018 found that levels of e-cigarettes were lower in the UK compared to Canada and the United States.

3.2 meaning

E-cigarette and smoking rates among young people in England should continue to be closely monitored.

Questions about taste preferences and why young people like e-cigarettes should be added to large nationally representative surveys.

The implementation of the sales age requirement needs to be improved.

4. Use of e-cigarettes by adults

4.1 main findings

Current e-cigarette penetration among adults in England (any current use) has remained stable since 2014, ranging from 5% to 7% in 2019.

In various surveys, the current e-cigarette smoking rate among smokers has varied between 14% and 20%, again showing small changes since 2014.

Among former smokers, the current e-cigarette penetration rate continues to rise, at 12% to 13% in 2019.

Smoking e-cigarettes remains the most common among smokers and former smokers, with less than 1% of people who have never smoked currently smoking e-cigarettes.

Between 2018 and 2019, the proportion of smokers who have not yet tried e-cigarette products remains at 37%.

Smoking rates among adults in England have continued to decline over the past 10 years, reaching around 15% in 2019.

The incidence of smoking is highest among people with weaker socioeconomic status, reflecting their higher level of smoking.

Smokers 'perceptions of the harm caused by steam are increasingly inconsistent with the evidence. The proportion who believes that smoking e-cigarettes is less harmful than cigarettes dropped from 45% in 2014 to 34% in 2019. These misunderstandings are particularly common among smokers who do not smoke e-cigarettes.

Most adults use electronic aerosol products to help them quit smoking.

E-cigarette users say banning flavored liquids will prevent them from using e-aerosol products to help them quit or reduce smoking. It could also push current e-cigarettes into illegal products.

Similar to previous years, smoking cessation service data in England shows that when electronic nebulisation products are used alone or with licensed drugs, success rates are comparable to, or even higher than, those for individually licensed drugs.

Where international information is available, adult e-cigarette penetration in England appears to be higher than in other countries.

4.2 meaning

The data provided here suggests that electronic atomization has not undermined the decline in adult smoking.

Growing public misperceptions about the dangers of e-cigarettes may deter some smokers from quitting using e-cigarette products.

Banning the use of flavoring liquids may have adverse effects and unexpected consequences on smokers who use e-cigarette products to quit smoking. Only careful consideration.

5. Use of e-cigarettes by mentally ill patients

5.1 main findings

In our systematic review, we did not find any smoking rate studies from England, so we cannot report smoking rates among people with mental illness in England or other parts of the UK.

We identified 17 studies that reported on smoking rates among people with mental illness outside the UK.

Current definitions of electronic atomization varied throughout the study, such as any use or daily use in the past 30 days, several days or very little use. Therefore, study results and any comparisons between studies should be treated with caution.

Overall, current smoking rates among people with mental health conditions range from 3% to 20% in a nationally representative sample of the population. In a representative state or regional survey sample, the rate ranged from 0.3% to 21%, and among participants recruited from the clinical setting, the rate ranged from 7% to 45%. Such a high smoking rate may reflect the high smoking rate among people with mental illness.

Among nationally representative samples and statewide or regional samples, current smokers have the highest smoking rates (up to 75%) and current smoking rates (up to 41%).

There is currently no published randomized controlled trial (RCT) to evaluate smoking cessation or electronic aerosol products for smokers with mental health conditions. We identified four single-arm ex ante studies, a participant study before and after intervention and a secondary data analysis of RCT data, which included samples of patients with mental illness. In four of the studies, participants had no motivation to quit. During a follow-up period of 4 weeks to 12 months throughout the study, 7% to 14% of participants completely quit smoking. Study participants who smoked significantly reduced their cigarette intake.# p#pagination title #e#

The scarcity of literature on health professionals 'knowledge and attitudes towards e-cigarettes suggests that many people have conflicting attitudes towards the role and use of e-cigarette products by smokers with mental illness. This also suggests that training needs have not yet been met.

5.2 meaning

One action in the government's UK Tobacco Control Plan is to explore how to collect more reliable data to better inform tobacco control measures to support people with mental illness. Ongoing research on these people smoking (and smoking) in the UK will help fill some evidence gaps. However, there is still a need for more nationally representative data, especially for people with severe mental illness.

The high rates of e-cigarette smoking and smoking suggest that smokers with mental health conditions should be advised and supported to quit smoking completely as long as they believe they can.

Further research is needed on the use of e-cigarettes in people with mental health conditions and its effectiveness and safety in quitting smoking.

There are signs that health professionals need more specialized training in the use of e-cigarette products among people with poor mental health.

Resources on smoking among people in mental health settings are available from the Mental Health and Smoking Partnership in England. Since most mental health trusts in England allow the use of e-cigarettes, experiences with using e-cigarette products over time in these environments should be explored, including its effect on the complete transition from smoking to e-cigarettes.

6. E-cigarette use during and after pregnancy

6.1 main findings

Our systematic review shows that in the UK, there is a lack of evidence on the prevalence of e-cigarettes during pregnancy, the impact of e-cigarettes on smoking during pregnancy and after childbirth, and the impact of e-cigarettes on pregnant women's health or pregnancy outcomes.

Like other groups of people, pregnant women who use e-cigarettes may also do so to stop smoking.

Among non-smokers, smoking during pregnancy is very rare.

Pregnant smokers and health professionals are uncertain about the relative risks to mothers and babies using e-cigarettes, and clinical practice of using e-cigarettes during pregnancy also varies.

6.2 meaning

A research plan needs to be adopted to address the lack of representative data in England on e-cigarette use during pregnancy.

More research is also needed on the relationship between pregnant e-cigarettes and smoking cessation and health outcomes.

A common reason for electronic atomization during pregnancy is to stop smoking, prevent smoking again and reduce harm. Therefore, any uncertainty about the hazards or risks of e-cigarettes during pregnancy may deter pregnant smokers from using e-cigarettes.

Discordant attitudes among medical staff towards e-cigarettes during pregnancy suggest an urgent need for guidance.

While waiting for the results of ongoing studies, health professionals can use the guidance and recommendations of the Smoking During Pregnancy Challenge Group to conduct electronic nebulization before, during and after pregnancy for pregnant women and other health professionals. The guidance says electronic atomization should be supported if it can help women or families with children quit smoking or remain smoke-free, and that regulated nicotine atomization products will always be preferable to smoking.

7. authors and citations

7.1 Recommended citations

McNeill，A.，Brose，LS，Calder，R.，Bauld, L. and Robson, D. (2020). Vaping in England: March 2020 Evidence Update Including Mental Health and Pregnancy: Report commissioned by Public Health UK. London: Public Health in the UK.

7.2 author

Ann McNeill (King's College London), Leonie S Brose (King's College London), Robert Calder (King's College London), Linda Bauld (University of Edinburgh, UK Cancer Research), Debbie Robson (King's College London).