Careless Vaping Legislation Could Lead to Increased Smoking

Legislation, policy, and the official messages to nicotine users were at the forefront when researchers and health experts gathered at the E-Cigarette Summit held at the Royal College of Physicians in London in December. High on the agenda were the UKs, as well as other countries’, plans to restrict access to e-cigarettes and prevent underage use.

“Vaping is not risk-free, especially for minors. But it is significantly less harmful compared to the real problem—smoking. It’s a balancing act between preventing use among non-smokers and still convincing smokers to switch to e-cigarettes. The pitfalls are numerous,” says Martin Dockrell, Head of Tobacco Control at the Office of Health Improvement and Disparities (OHID), part of the Department of Health and Social Care.

A High-Stakes Gamble

Next year, stricter regulations on e-cigarettes and vaping products will be introduced in the UK. The goal is to reduce use among minors and former non-smokers. However, this is a high-stakes gamble, notes Martin Dockrell. Throughout 2024, the authority has mapped out the opportunities and pitfalls associated with upcoming e-cigarette regulations in the UK.

“It takes very little for the public health gains to turn into losses when regulating e-cigarettes. The consequences of careless legislation could be an increase in smoking. And even a small rise in smoking would outweigh the risks associated with more young non-smokers starting to vape,” said Dockrell during a discussion at the E-Cigarette Summit UK 2024.

Rare for Non-Smokers to Vape

Currently, nearly 6 million people in the UK smoke—12% of the adult population. Among economically disadvantaged groups, the proportion is significantly higher, close to 20 percent.

At the same time, vaping rates are increasing in the country. Eleven percent report using e-cigarettes regularly, and over half of these are former smokers.

It is rare for non-smokers to take up vaping. They account for only 8 percent of vapers, or 1.6 percent of the total population. According to the organization Action on Smoking and Health, a third of those who quit smoking in the UK over the past three years used an e-cigarette during their last quit attempt. Furthermore, one in four vapers who are now completely smoke-free state that they use e-cigarettes to prevent relapse.

Youth vs. Adults

This data was central to discussions among several researchers specializing in e-cigarettes and public health, who gathered to discuss the potential consequences of reforms and policies from a scientific perspective.

“The question is, how do we reap the benefits of reducing e-cigarette use among minors without losing the significant health gains seen among adults who have quit smoking?” Dockrell asked the panel.

Effective Measures—Perhaps Too Effective

With the new legislation passed by the British Parliament, including a ban on disposable e-cigarettes set to take effect in 2025, e-liquids can be taxed, and a licensing system for retailers will be introduced. Lawmakers will also have the option to regulate flavorings in e-liquids in the future.

“We know these measures work to reduce e-cigarette use among youth—price increases, reduced availability, neutral packaging, flavor restrictions, and so on. But we have also seen that such measures tend to increase the risk of cigarette use instead, both among young people and adults,” Dockrell noted.

“Gateway Theory Does Not Hold”

Currently, 7 percent of those under 18 have used an e-cigarette in the past month, and 4 percent in the past week. The Office of Health Improvement and Disparities sought to delve deeper into the statistics to assess how the upcoming legislation could affect young people who have never smoked before starting to vape, representing the so-called “gateway theory”—that vaping at a young age leads to smoking later in life.

“The gateway theory has been shown not to align well with reality, but we also know this is very individual, and use is influenced by factors beyond e-cigarettes,” says Dr. Jasmine Khouja, Senior Research Associate in smoking studies at the University of Bristol. She has investigated the potential consequences of the upcoming legislation on behalf of the health authority.

“We identified a group of young people likely to be most affected by the measures being proposed. These are young people who have not smoked before but are at high risk of transitioning to cigarette smoking later in life. Another factor was that they cited flavors as the primary reason they started vaping. This group includes around 48,000 minors who could be most impacted by a flavor ban,” says Khouja.

Flavors Important for Adult Smokers

Jasmine Khouja and her colleagues also identified a group of adult vapers who stated that, in the event of a flavor ban, they would likely return to smoking. This group included current smokers who use e-cigarettes to reduce smoking and those who have quit smoking entirely. All indicated that flavors were essential for their switch to vaping and for their continued use of e-cigarettes.

“This group includes 460,000 current smokers who vape to smoke less and 381,000 who vape to stay smoke-free. Nearly 840,000 people in total,” says Khouja.

The conclusion was that a potential flavor ban would increase the number of smokers among adults to a much greater extent than it would reduce the number of smokers among youth.

“This assessment suggests that it would result in significantly more negative health effects than positive ones from a public health perspective,” Khouja concluded.

Smoking Impacts Children More

According to Martin Dockrell at OHID, it is crucial to ensure the debate about e-cigarettes becomes more balanced than it is today. He is particularly critical of what he perceives as a one-sided view of e-cigarettes relative to the larger problem—smoking. This is especially true when considering the safety of children.

“Smoking also affects young people and children, particularly those in socially disadvantaged families. This includes secondhand smoke, early deaths of parents and grandparents, affected family incomes, and poverty. Protecting children from vaping risks while increasing smoking rates has far-reaching consequences, especially for children who are already vulnerable in society. It becomes very cynical to ignore this, given that we know the health effects of vaping are so dramatically lower compared to smoking,” Dockrell concluded.