The Royal College of Physicians has assessed the available evidence on the use of e-cigarettes, from health effects to the issue of youth vaping, publishing a report with over 50 recommendations. It concluded that e-cigarettes represent a valuable aid in smoking cessation, but that much more can and should be done to reduce their appeal, availability and affordability to people who do not smoke, including children and young people, and reduce environmental harms.
The Royal College of Physicians has just published a review on electronic cigarettes, evaluating their effectiveness and the potential they represent in reducing the harm and disparities caused by tobacco use.
The results are summarized in over 50 recommendations, which explore trends in combustible tobacco use and vaping products, the differences in health effects of vaping in people who smoke, vape or do neither, ethical dilemmas presented by e-cigarette, environmental damage, and the role of the tobacco industry in the rising use of e-cigarettes.
The Royal College of Physicians’ report concludes that:
- since the 2016 RCP report the evidence of the effectiveness of e-cigarettes as an aid to quitting has become much stronger
- use of e-cigarettes by young people and non-smokers has increased substantially in recent years
- prompt remedial measures are needed to curb youth vaping without undermining use by adult smokers as an aid to quitting
- the government should commission a series of regular evidence updates on the use and effects of nicotine products to guide policy.
Regarding the effectiveness of e-cigarettes as a cessation tool, researchers emphasize e-cigarettes should be promoted as an effective means of helping people who smoke to quit smoking tobacco, particularly focusing on those population groups that could benefit the most, such as patients with mental disorders orthose who experience socio-economic disadvantage and people living in social housing.
Regarding potential health side effects resulting from vaping product use, researchers carried out a review of biomarkers of exposure to and harm from e-cigarettes using data published between 2021 and 2023 comparing people who vape, people who smoke, people who do both (dual use), and people who do neither.
Although lower levels of harmful substances were found in vapers compared to smokers for many of the biomarkers analyzed, researchers conclude agreement needs to be reached on the methods for vaping health risks research, including which biomarkers are the most relevant to study regarding the relative and absolute risks of vaping, to draw accurate conclusions. Studies with larger samples are needed both on vapers with a history of smoking and on vapers who have never smoked.
Regarding one of the hottest topics of the moment, the increased ecig use among people who have never smoked or the youngest, the Royal College of Physicians’ report insists on finding a balance between preventing these categories from accessing vaping while not demonizing such products in the eyes of those who use them to quit smoking.
Furthermore, information should be provided to young people and never smokers on the health risks of vaping, but such information should be carefully designed so as not to misinform people about the relative harms of smoking and vaping.
Regarding youth addiction specifically, Royal College of Physicians researchers concluded that standardised plain packaging combined with reduced flavour and brand descriptions together with retail display bans should be introduced to decrease youth interest in trying vaping.
E-cigarette price and taxation strategies should reduce the affordability of the cheapest products most commonly used by youth vapers (ie disposable e-cigarettes), while ensuring that the products most likely to be used by adults who smoke/quitters (ie rechargeable and refillable products), which are also less damaging to the environment, remain affordable.
The report also proposed to increase prices through the introduction of a consumption tax and a minimum unit price, prohibiting multiple purchases but ensuring that they remain a less expensive option for adults who use them to quit smoking, and limiting promotional materials in retail stores and product visibility, and restricting promotion on social media.
Finally, regarding the role of the tobacco industry, the report hopes that stringent regulations will be introduced to prevent these large international entities, which profit from tobacco sales, from playing a role in the development of national policies.
