E-cigarettes an evidence update A report commissioned by Public Health England

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E-cigarettes: an evidence updateas intended pose no risk of nicotine poisoning to users. However, e-liquids should be in‘childproof’ packaging.Duration and frequency of puffs and mechanical characteristics of EC play a major rolein determining nicotine content in vapour. Across the middle range of nicotine levels, inmachine tests using a standard puffing schedule, nicotine content of e-liquid is relatedto nicotine content in vapour only weakly. EC use releases negligible levels of nicotineinto ambient air with no identified health risks to bystanders. Use of a cigalike EC canincrease blood nicotine levels by around 5 ng/ml within five minutes of use. This iscomparable to delivery from oral NRT. Experienced EC users using the tank EC canachieve much higher blood nicotine levels over a longer duration, similar to thoseassociated with smoking. The speed of nicotine absorption is generally slower than fromcigarettes but faster than from NRT.Policy implicationsooGeneral labelling of the strength of e-liquids, along the lines used for exampleindicating coffee strength, provides sufficient guidance to consumers.Regulatory interventions should ensure optimal product safety but make sure ECare not regulated more strictly than cigarettes and can continue to evolve andimprove their competitiveness against cigarettes.Summary of Chapter 10: Safety of e-cigarettes in light of new evidenceTwo recent worldwide media headlines asserted that EC use is dangerous. These werebased on misinterpreted research findings. A high level of formaldehyde was foundwhen e-liquid was over-heated to levels unpalatable to EC users, but there is noindication that EC users are exposed to dangerous levels of aldehydes; stressed micepoisoned with very high levels of nicotine twice daily for two weeks were more likely tolose weight and die when exposed to bacteria and viruses, but this has no relevance forhuman EC users. The ongoing negative media campaigns are a plausible explanationfor the change in the perception of EC safety (see Chapter 8).None of the studies reviewed above alter the conclusion of Professor Britton’s 2014review for PHE. While vaping may not be 100% safe, most of the chemicals causingsmoking-related disease are absent and the chemicals which are present pose limiteddanger. It has been previously estimated that EC are around 95% safer than smoking.This appears to remain a reasonable estimate.12
E-cigarettes: an evidence updatePolicy implicationso There is a need to publicise the current best estimate that using EC is around 95%safer than smoking.oEncouraging smokers who cannot or do not want to stop smoking to switch to ECcould be adopted as one of the key strategies to reduce smoking related diseaseand death.Summary of Chapter 11: Other health and safety concernsThere is a risk of fire from the electrical elements of EC and a risk of poisoning fromingestion of e-liquids. These risks appear to be comparable to similar electrical goodsand potentially poisonous household substances.Policy implicationsoooThe risks from fire or poisoning could be controlled through standard regulationsfor similar types of products, such as childproof containers (contained within theTPD but which are now emerging as an industry standard) and instructions aboutthe importance of using the correct charger.Current products should comply with current British Standard operating standards.Records of EC incidents could be systematically recorded by fire services.Summary of Chapter 12: International perspectivesAlthough EC use may be lower in countries with more restrictions, these restrictionshave not prevented EC use. Overall, use is highest among current smokers, with lownumbers of non-smokers reporting ever use. Current use of EC in other countries isassociated with being a smoker or ex-smoker, similar to the findings in the UK. EC useis frequently misreported with experimentation presented as regular use. Increases inyouth EC trial and use are associated with decreases in smoking prevalence in allcountries, with the exception of one study from Poland.Policy implicationsooFuture research should continue to monitor and evaluate whether different ECpolicies across countries are related to EC use and to smoking cessation andsmoking prevalence.Consistent and agreed measures of trial, occasional and regular EC use amongyouth and adults are urgently needed to aid comparability.13
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E-cigarettes an evidence update A report commissioned by Public Health England

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