PHE publishes independent expert e-cigarettes evidence review

A new PHE e-cigarette evidence review, undertaken by leading independent tobacco experts, provides an update on PHE’s 2015 review. The report covers e-cigarette use among young people and adults, public attitudes, the impact on quitting smoking, an update on risks to health and the role of nicotine. It also reviews heated tobacco products.
The key findings of PHE’s Evidence Review are that:

• Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits;
• E-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more;
• E-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country;
• Many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette;
• There is much public misunderstanding about nicotine. Less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine;
• The use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million;
• The evidence does not support the concern that e-cigarettes are a route into smoking among young people. Youth smoking rates in the UK continue to decline. Regular use is rare and is almost entirely confined to those who have smoked.

PHE’s evidence review comes just a few weeks after a US National Academies of Sciences, Engineering and Medicine report on e-cigarettes. Their conclusion on e-cigarette safety also finds that based on the available evidence “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.”
Prof. John Newton, Director for Health Improvement at PHE said:
“Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.
“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.
“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.”
Prof. Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London said:
“It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.
“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death. There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes.”
Prof. Linda Bauld, author and Professor of Health Policy, University of Stirling and Chair in Behavioural Research for Cancer Prevention, Cancer Research UK said:
“Concern has been expressed that e-cigarette use will lead young people into smoking. But in the UK, research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1%, and youth smoking continues to decline at an encouraging rate. We need to keep closely monitoring these trends, but so far the data suggest that e-cigarettes are not acting as a route into regular  smoking amongst young people.”
PHE is calling on smokers and a number of bodies to act on the evidence:

• Smokers – anyone who has struggled to quit should try switching to an e-cigarette and get professional help. The greatest quit success is among those who combine using an e-cigarette with support from a local stop smoking service.
• Local stop smoking services and healthcare professionals – should provide behavioural support to those smokers wanting to quit with the help of an e-cigarette. A new training course on e-cigarettes for healthcare professionals by the National Centre for Smoking Cessation and Training is now live.
• MHRA – continue their work in regulating and licensing e-cigarette products and support manufacturers to expedite the licensing of e-cigarettes as medicinal quit aids. PHE believes there is compelling evidence that e-cigarettes be made available to NHS patients.
• NHS Trusts – to become truly smokefree Trusts should ensure: e-cigarettes, alongside nicotine replacement therapies are available for sale in hospital shops; vaping policies support smokers to quit and stay smokefree; smoking shelters be removed; and frontline staff take every opportunity to encourage and support patients to quit.

The Government’s new Tobacco Control Plan for England, includes a commitment to “maximise the availability of safer alternatives to smoking”. It makes clear that e-cigarettes have an important part to play in achieving the ambition for a smokefree generation.

1. McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of e-cigarettes and heated tobacco products. A report commissioned by Public Health England. London: Public Health England. Report available here.
   Authors:
   Ann McNeill ^1,2, Leonie S Brose ^1,2, Robert Calder ¹, Linda Bauld^2,3,4, Debbie Robson ^1,2
   Additional contributors to individual chapters:
   Ilze Bogdanovica (Ch 11) ^2,5, John Britton (Ch 11) ^2,5, Jamie Brown (Ch 7)^2,6, Peter Hajek (Ch 4,9) ^2,7, Hyun Seok Lee (Ch 12) ¹, Magdalena Opazo Breton (Ch 11) ^2,5, Lion Shahab (Ch 7,9)  ^2,6, Erikas Simonavicius (Ch 12) ¹, Robert West (Ch 7)^{2,6
   1} King’s College London
   ² UK Centre for Tobacco & Alcohol Studies
   ³ University of Stirling
   ⁴ Cancer Research UK
   ⁵ University of Nottingham
   ⁶ University College London
   ⁷ Queen Mary, University of London
2. Over the past few years e-cigarette use has hovered at just under 6% of the adult population in Britain. The most common reason for e-cigarette use continues to be to help with quitting and they are the most popular quitting tool in England. At the same time, quit success rates have been improving and we are also seeing an accelerated drop in smoking rates (currently 15.5% in England): smokinginengland.info/latest-statistics
3. 79,000 people in England die every year as a result of smoking (http://digital.nhs.uk/catalogue/PUB24228), and over half of long-term smokers will die from a smoking-related illness if they do not quit.
4. Resources:
5. PHE 2015 e-cigarettes evidence review: McNeill A., P. Hajek et al, E-cigarettes – an evidence update: A report commissioned by Public Health England, Public Health England, August 201
6. Authors’note on evidence for ‘around 95% safer’ estimate.
7. Nicotine without smoke: tobacco harm reduction, Royal College of Physicians, April 2016
8. Smoking Toolkit Study
9. ASH (May 2017) Use of e-cigarettes (vapourisers) among adults in Great Britain
10. Bauld, Linda, Anne Marie MacKintosh, Brian Eastwood, Allison Ford, Graham Moore, Martin Dockrell, Deborah Arnott, Hazel Cheeseman, and Ann McNeill. “Young people’s use of e-cigarettes across the United Kingdom: Findings from five surveys 2015–2017.” International journal of environmental research and public health 14, no. 9 (2017): 973.
11. Towards a Smokefree Generation: A Tobacco Control Plan for England, Department of Health, July 2017
12. NHS Digital, Statistics on Smoking: England, 2017
13. US National Academies of Sciences, Engineering, and Medicine (January 2018) Public Health Consequences of E-Cigarettes

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