February 25th, 2016

Blending evidence and empathy - a new guide to e-cigarettes

NCSCT Electronic Cigarette briefing V2

“a new worldwide high point in the blending of evidence with empathy”

I would like to  draw your attention to a really excellent new briefing on e-cigarettes from the UK National Centre for Smoking Cessation and Training … this is version 2, February 2016.

I think this represents a new worldwide high point in the blending of evidence with empathy in official public health advice…

Please do have a read: it is full of wise advice and thoughtful insights which I think are useful to anyone involved in reducing death and disease from smoking.  I’ll just draw a few out.

I particularly like this quote on the nature of vaping – it is not a smoking cessation medication:

Don’t be alarmed about recreational nicotine. This is a choice some people make, and it is not the business of stop smoking services to make judgements about this. We are not a ‘stop nicotine service’ and if we think getting people off their e-cigarette is a good use of our time, we are ignoring a far more important opportunity to help people quit and to stay off cigarettes. Be open to their choices, and listen to them, especially when they say that they are doing really well with their e-cigarette.

…and a realistic take on ‘dual use’, which recognises this as part of a transition for many users, not some sort of lethal dead-end.

Is it OK to smoke and vape at the same time?
Yes. There is no evidence that smoking cigarettes and vaping at the same time increases health risks. However, the greatest health benefits are seen when people stop smoking tobacco completely, so quitting smoking should be the goal. Stop smoking services can provide advice and support to help.

Some people manage to switch completely to vaping quickly, whilst others take a little time. You may have to try a number of different e-cigarettes and e-liquids before you find the one that enables you to stop smoking completely, but this is quite normal.

… and properly captures the role of flavours in adult vaping, rather than working up hysteria that flavours are only there to entrap children – flavours are integral to the adult vaping experience.
How do I choose a flavour?
This is a personal choice. Some people start with tobacco flavour, or menthol flavour if they smoke mentholated cigarettes, but one of the advantages of e-cigarettes is that you can experiment and try new flavours. People usually try a few different flavours until they find the one that suits them. Some people choose to move away completely from tobacco flavours, preferring sweet and fruit flavours for example.
… and provides a straightforward insight into toxicology, something that many scientists in the field seem to ignore, “the dose makes the poison”…
I’ve heard that e-cigarettes can produce harmful chemicals?
Some studies have detected chemicals in e-cigarette vapour that are known to cause health problems. However, these chemicals have been found at very low levels that are unlikely to represent a serious risk to health. When e-cigarettes are used within normal operating levels (e.g. not overheated), there are far fewer harmful chemicals present in their vapour than in tobacco smoke. If the e-liquid is being overheated it tends to produce an acrid, unpleasant taste – you will know if this happens!
… what about second-hand vaping? Again, it’s a matter of getting the risk in perspective, and recognition that this may be a matter for etiquette and for owners and managers to decide policy, not for the law to make sweeping prohibitions:
Is secondhand vapour from e-cigarettes dangerous?
Some studies have found traces of toxicants in secondhand vapour, but at such low levels that they do not pose a health risk to bystanders. There is no evidence that secondhand vapour is dangerous to others; however, it helps to be respectful when using e-cigarettes around others, especially non-smokers.
… are e-cigarettes renormalising smoking? In fact it may well be the opposite:
Are e-cigarettes renormalising smoking?
There have been concerns that e-cigarettes might renormalise smoking, that is,  make cigarette smoking appear to be a normal activity. Whilst this is a valid concern we do not have any data to show that this is occurring. Indeed, available data points in the opposite direction because cigarette smoking prevalence among both adults and young people has continued to fall in England as e-cigarette use has increased; the same has occurred in the USA.

Credit due to…

The document was produced in partnership with Public Health England.  Very well done to the authors: Andy McEwen and Hayden McRobbie  …and to the reviewers: Jamie Brown, Lynne Dawkins, Peter Hajek, Wayne Hall, Elspeth Henderson, Sarah Jakes, Lorien Jollye, Joanne Locker, Louise Ross and Robert West.

In what must be a global first, the production of this guidance included vapers as reviewers: Sarah Jakes and Lorien Jollye are vapers and consumer representatives from the New Nicotine Alliance.  I hope we see more of that attitude of inclusiveness, and a recognition that vapers understand aspects of this behaviour better than health professionals and academics and can contribute to higher quality advice and insights.

Note: the NCSCT is a community interest company established to support the delivery of smoking cessation interventions provided by local stop smoking services, support the NHS and Local Authorities to deliver effective evidence-based tobacco control programmes, and deliver training and assessment programmes to stop smoking practitioners and other health care professionals.

More insights

For a more ‘robust’ account of what this report means for much of the conventional tobacco control discourse on e-cigarettes, see Dick Puddlecote: Slaughtering sacred cows

9 comments to Blending evidence and empathy – a new guide to e-cigarettes

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