During November’s Mouth Cancer Action month, one of the questions raised in discussions with Speech and Language Therapy students at the University of Manchester, was is vaping good or bad for you? This has taken me on a journey through the internet, to Public Health articles, papers in the journals of Nature and Addiction, press articles about prosecutions in Greater Manchester, discussions with local teenagers, and a visit to the local E-cig shop for further education and the photos you see here. I have put some of the references below , which may be of interest to you also, should you be a parent , teacher or student doing your own research.
July 1st 2007 was a big day in England’s public health legislation with tobacco smoking being banned in public places . Ambient air in restaurants and pubs improved dramatically. The smoking population was given an incentive to stop smoking tobacco , and since that time, vaping has become more widespread. The Cochrane Review Electronic Cigarettes for Smoking Cessation (Jamie Hartmann-Boyce et al Nov 2022) concluded e-cigarettes in the UK have now superceded nicotine gum and patches as an effective way to stop smoking. E-Liquid on being heated in vaping/e-cigarette devices gives off a vapour containing lower levels of nicotine (commonly graded amounts from max 2.0 down to 0.3 mg nicotine) compared to 18mgs in a cigarette, enabling the smoker to reduce the amount of nicotine they are inhaling over time. However, readers beware, as these photos show, there is an inticing array of flavours which are attractive to not only the smoker, but also to previously non-smoking young people.
The risk of Vaping among young people was first raised in the USA in the summer of 2019, with a sharp rise in cases of EVALI (E-cigarette Vaping Associated Lung Injury) amongst vaping among young people By February 2020, 2807 hospitalisations and 68 recorded deaths had been recorded across the states of the US. The Centre for Disease Control (CDC) investigated patient data and analysed their Vaping product samples. 57% of the products contained nicotine. Vitamin E Acetate was found in the lung fluid samples of 48/51 EVALI sufferers – ok as a skin product or a swallowed vitamin supplement , but harmful if inhaled as a vapour. Many chemicals were identified , but 82% of the EVALI group were using products containing THC (TetraHydroCannabinol), the substance primarily responsible for the effects of feeling high when taking marijuana.
The FDA Federal Drugs Agency and the CDC initiated a strong public health awareness campaign, warining against purchasing products from informal sources such as family, friends, on-line dealers and local pop-up shops. Law inforcement was also strengthened againsit illicit products and vaping products containing vitamin E acetate and THC were removed. By spring 2020 the peak had died down and data collection resources switched to The Covid pandemic. The CDC continues to monitor trends and advises e-cigarettes should not be used by youths, young adults or pregnant women.
In the light of this, the Journal Addiction published an article “Characterstics of Vaping Products in the UK” in March 2021. The content and emission data given by manufacturers of nicotine- containing UK vaping products was analysed- a total of 40 785 products.
A large range of ingredients and emissions was found. There was an average of 17 ingredients in each product. The most commonly reported non-flavour ingredients were propylene glycol (97% of products) and glycerol (71%). The most common flavour ingredients were ethyl butyrate (42%), vanillin (35%) and ethyl maltol (33%) . Nicotine (65%), formaldehyde (48%) and acetaldehyde (40%) were the most commonly reported emissions. For the most part, the median level of emissions was below the safe limits for ambient air.
So to Smokers looking to quit cigarettes, ensure you buy from a regulated distributor. During my Ecig shop visit my attention was drawn to to UK flag as a quality marker on some E Juice packaging. The Nicotine content is clearly highlighted- you must be 18 or over to buy. Apart from nicotine and glycol, detail about the other contents is usually limited to “herbal extracts” or flavourings” . The store employee advises avoiding purchasing from informal sources such as Internet or Ebay, as it is these products which can be adulterated with harmful chemicals. As per the EVALI outbreak in US, avoid any products that have Vitamin E acetate , THC or cannabinoids in them. Be aware the great range of flavours you like can be attractive and draw the young people around you to the product as well. Longer term, look after your mouth, throat and lung health – give thanks for benefits of e-cigs helping you quit smoking, but then switch to fresh air and benefit financially as well.
What about protecting young people?
Vaping has quite an allure for young people. But with 59% products containing nicotine , there is potential for addiction, plus cheap, illegal vaping products could be harmful to their physical and mental health.
In the Stockport Borough of Greater Manchester , Trading Standards have found that although smoking in young people has halved since 2017, the uptake of vaping has more than trebled in the town. Over a third of children they interviewed said they vaped because they liked the flavours , it is cheaper than smoking and easier to obtain than tobacco cigarettes. Disposable vapes are popular.
Magistrates recently brought a successful prosecution against a Stockport Shopkeeper, fining him £2,200 for selling an e-cigarette to a 14 year old trading Standards Volunteer. His company was also fined £3500 for supplying the product without packaging or an information leaflet (MEN news Nov 13th 2023).
The BBC reported 6 arrests on October 23rd 2023 after £80 000 worth of illegal vapes were seized by Trading Standards and Greater Manchester Police in Stockport. Operation Rimini was set up as a dedicated response to tackling theft, shop-lifting and anti-social behaviour offences. Thank you GMP and Trading Standards improving the lives of the families and friends communities in central Stockport and Edgeley!
So while Vaping is good news to those who are quitting smoking, the public should be mindful and proactive in protecting our young people from using products. I shall leave you with Stockport’s Public Health Director Jilla Burgess-Allen words “E cigarettes are safer than smoking tobacco and are a good cigarette replacement for those trying to quit , but our message is clear- if you don’t smoke, don’t start smoking or vaping“
References
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
https://hub.jhu.edu/2022/10/13/vaping-risks-and-regulations/
Nyakutsikwa B, Britton J,Bogdanovica I, Boobis A, Langley T (2021) Characterising Vaping Products in the United Kingdom: an analysis of Tobacco Products Directive Notification data. Addiction,116: 2521-2528 https://doi-org.manchester.idm.oclc.org/10.1111/add.15463