Less harm

The UK Ministry of Health has recognized vapes as a healthier alternative to smoking

Oleg Lischuk, N+1

The British Ministry of Health and Social Security has published a report on vaping, including a review of more than 400 scientific studies and statistical data. Its authors concluded that switching from conventional cigarettes to nicotine-containing electronic cigarettes can significantly reduce the health risks for smokers. At the same time, the report notes that vapes are still harmful, which is especially important to take into account with the observed increase in their popularity among teenagers.

Since the advent of electronic cigarettes (vapes) in 2004, manufacturers have positioned them as a healthier alternative to smoking and a type of substitution therapy (akin to nicotine patches and chewing gum) for those who want to quit smoking. At the same time, the position of official medicine was much more cautious and generally came down to considering the harm of vapes to health, legally in most countries electronic cigarettes are subject to similar regulation with tobacco products.

In England, there is a program adopted by the government to achieve a "non-smoking generation", according to which it is planned to gradually reduce the prevalence of tobacco smoking so that by 2030 the proportion of smokers does not exceed five percent of the population. As part of this initiative, experts from the British Ministry of Health have published a series of reports on vaping. The current version, the eighth and final, prepared under the supervision of Ann McNeill from King's College London, has 1,468 pages. It provides detailed statistical data, as well as an overview of more than 400 scientific papers from around the world on the effects of conventional and electronic cigarettes, including the ingestion of nicotine and various toxic substances (carbon monoxide, volatile organic compounds, nitrosamines, metals, polyaromatic hydrocarbons, and others), as well as levels of biomarkers of inflammation, oxidative stress, endothelial dysfunction and platelet activation. In addition, the document contains a meta-analysis of the risks of oncological, respiratory, cardiovascular and other diseases.

According to the report, in 2021, the proportion of ordinary cigarette smokers among British adults was, according to various surveys, from 12.7 to 14.9 percent, electronic — from 6.9 to 7.1 percent. The prevalence of vaping among adults who have never smoked did not exceed 0.7 percent, while vapes were the most popular means of substitution therapy for quitting smoking; the success rate when using them reached 64.9 percent (without them — 58.6 percent).

The share of episodic and regular smokers among adolescents aged 11 to 18 years in 2022 is 6 percent compared to 4.1 percent in 2021 and 6.7 percent in 2020. The vaping rate increased to 8.6 percent in 2022, compared to 4 percent in 2021 and 4.8 percent in 2020. The majority of teenagers who have never smoked (98.3 percent) do not practice vaping either. Among vapers, the popularity of disposable electronic cigarettes has sharply increased — in 2022, the share of their consumers was 52.8 percent compared to 7.8 percent in 2021 and 5.3 percent in 2020.

Based on a systematic review of scientific publications, the authors of the report made the following main conclusions:

• in the short and medium term, vaping represents only a small proportion of the risks that tobacco smoking carries (there is not enough data for the long term), and does not give significant reasons for concern;
• e-cigarettes are not completely safe, especially for those who have never smoked;
• vaping supplies significantly fewer potentially dangerous substances to the body than tobacco smoking, as evidenced by the levels of biomarkers for the risk of cancer, respiratory and cardiovascular diseases;
• a similar or greater amount of potentially harmful compounds enters the body during vaping compared to non-consumption of nicotine-containing products;
• short-term passive smoking of electronic cigarettes by non-smokers does not lead them to a significant increase in the level of biomarkers of intoxication;
• in general, vapes contain less nicotine than tobacco products; the risk and severity of dependence when using them is less, although they vary greatly depending on the specific product.

The report also says that in 2021, only 34 percent of British adults knew that e-cigarettes are less harmful than conventional ones, and only 11 percent were aware that the main harm of smoking is not related to nicotine. At the same time, the opinion about the potential harm of vaping affects the choice between conventional and electronic cigarettes, and providing people with verified information helps to cope with the corresponding misconceptions. Informing non-smoking youth about the absolute harm of vaping should be carried out in such a way as not to cause adult smokers false ideas about the relative harm of conventional and electronic cigarettes, the authors conclude.

In 2017, British researchers showed that the body of people who smoke exclusively electronic cigarettes contains fewer toxic and carcinogenic compounds than in the body of ordinary smokers. At the same time, two years later, their American colleagues came to the conclusion that vapers have an increased risk of myocardial infarction and depression compared to non-smokers. In addition, a meta-analysis conducted in the United States in 2020 showed that the purchase of nicotine-containing electronic cigarettes on their own does not generally increase the likelihood of quitting smoking, but if such a product is prescribed by a doctor, its use can help quit smoking.

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