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Smoking cessation

E-cigarettes: part of the solution or part of the problem?

Marketing e-cigarettes towards children undermines the positive impact they have had on smoking rates in the UK.

Coloured e-cigarette and vaping liquids


They are associated with a rapid drop in smoking rates across the UK and are being lauded by public health experts, and with good reason. E-cigarettes have only 0.5% of the cancer risk of smoking. The comparative risks of cardiovascular disease and lung disease in former smokers are also likely to be substantially reduced. But the jury is still out on whether e-cigarettes are tempting those who have never smoked into a vaping habit.

A Public Health England evidence review, carried out in February 2018, found that “despite some experimentation among never smokers”, e-cigarettes “do not appear” to be undermining the long-term decline in cigarette smoking in the UK among young people.

However, a study by the campaigning group Action on Smoking and Health found that 2.4% of young people aged 11–18 years use e-cigarettes. Another study in JAMA Pediatrics found that young people who are susceptible to e-cigarette advertising were more likely to try smoking.

The Pharmaceutical Journal also uncovered that e-cigarette refills resembling children’s juice cartons, sweets or biscuits have gone on sale in the UK. One even promises that “you will be like a kid in a sweet shop”.

In the United States, the US Food and Drug Administration has cracked down hard on manufacturers and retailers of e-cigarettes marketing to children, but there is no sign yet of such a strong approach in the UK. On the contrary, when presented with evidence of these products, a spokesperson for the Department of Health and Social Care said it will continue to monitor this area “very closely”. The Medicines and Healthcare products Regulatory Agency said it was not in its remit as it is a retail issue.

But are these responses enough? E-cigarettes are not harm free. There are measurable side effects and the nicotine in these products can rewire an adolescent’s brain, leading to years of addiction. Surely it is beholden on the authorities to work together to prevent children being exposed to this kind of marketing?

After a rapid increase, the number of e-cigarette users has flatlined recently. Perhaps it makes good business sense to go after the next generation of vapers, but the industry cannot continue to argue for soft-touch regulation if they behave like this.

Representatives of the vaping industry told a recent hearing of the House of Commons Science and Technology Committee that regulations should be eased to allow them to include statements on the relative health risk of vaping, compared with conventional cigarettes, in vaping advertisements.

It is clear that vaping firms are hoping to be seen as part of the solution, rather than as part of the problem. But dubious practices, such as appearing to target products at young people, must end before these companies undermine all the good e-cigarettes have done to reduce harm.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204859

Readers' comments (1)

  • I fully endorse the view expressed in this editorial. I also urge community pharmacists to consider developing self-pay schemes to replace abandoned public health schemes. Drive to reduce harm from tobacco must be maintained and community pharmacy must not give up that space. Smoking cessation is one of the most under-valued services when we consider the psychological and physical harm caused by tobacco to human body.

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