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Electronic cigarettes

Electronic cigarettes (e-cigarettes) are designed for users to inhale nicotine without most of the harmful effects of smoking. They deliver nicotine by heating and vapourising a solution that typically contains nicotine, propylene glycol and/or glycerine, and flavourings. As there is no burning involved, there is no smoke. Unlike cigarettes, e-cigarettes do not produce tar and carbon monoxide. The vapour has been found to contain some toxicants also found in cigarette smoke, but at much lower levels.

What are electronic cigarettes?

E-cigarettes generally consist of a battery, a vapourising chamber and e-cigarette liquid. The liquid can be contained in a sealed cartridge or can be added to a tank system. Some e-cigarettes use an atomiser cartridge or ‘cartomiser’ that combines the vapourising system and e-cigarette liquid in a single unit.

The ‘first generation’ e-cigarettes are typically designed to look like a cigarette and generally use a cartomiser. ‘Second generation’ devices do not resemble cigarettes and contain a tank that the user fills with their choice of e-cigarette liquid, with various strengths and flavours available. More recently ‘third generation’ devices have emerged which have variable voltage and can be used with a range of atomisers, cartomisers and tank systems.

Are e-cigarettes safe to use?

E-cigarettes are not risk free, but on current evidence they carry a fraction of the risk of smoked tobacco. As well as nicotine, e-cigarette liquid and vapour can contain toxic substances, although these are either at lower levels than seen in cigarette smoke or at levels not associated with health risk. The current best estimate is that e-cigarette use carries only around 5% of the risk of smoking.

E-cigarettes are still fairly new and we won’t have a full picture on their safety until they have been in use for many years, so it will be important to continue to monitor the evidence as it develops.

Is there any risk to others from e-cigarette vapour?

There is no evidence of direct harm from passive exposure to e-cigarette vapour and available evidence indicates that any risk of harm is extremely low, especially when compared with tobacco smoke. In his report to Public Health England published in May 2014, Professor John Britton said: “Electronic cigarettes do not produce smoke so the well-documented effects of passive exposure of others to cigarette smoke are clearly not relevant…laboratory work suggests that electronic cigarette use in enclosed space exposes others to nicotine at levels about one tenth generated by a cigarette, but little else. The health risks of passive exposure to electronic cigarette vapour are therefore likely to be extremely low.”

Will e-cigarettes help me quit smoking?

Evidence from a number of studies indicates that e-cigarettes can help people quit smoking, with similar or better results than nicotine replacement therapies such as patches or gum. People who use e-cigarettes too little or too rarely have less success at quitting smoking because not enough nicotine is obtained to reduce the urge to smoke. The type of e-cigarette used may also make a difference. The findings of a study by researchers at King’s College London and University College London indicate that daily use of tank models that can be refilled with liquid may give smokers a better chance of quitting.

Can I get help from my local stop smoking service if I want to use e-cigarettes?

People who combine e-cigarettes with support from their local stop smoking service have a very good chance of quitting successfully. Although stop smoking services can’t provide e-cigarettes as they are not currently licensed as medicines, they can offer advice and support to help you though your quitting journey. You might want to bring your e-cigarette with you. If your adviser doesn’t already know about it, you can point them to the NCSCT briefing on e-cigarettes.

Does PHE recommend e-cigarettes for smokers?

If you are a smoker, the best thing you can do is stop smoking now, completely and for good, and e-cigarettes can help people to quit. We don’t recommend people carry on smoking alongside using e-cigarettes except as part of a plan to stop smoking.

Who is using e-cigarettes?

According to the 2015 ASH/YouGov Smokefree Britain Survey, 2.6 million adults in Great Britain currently use e-cigarettes. Of these, around 1.1 million have given up smoking while 1.4 million continue to use tobacco alongside their e-cigarette use. Among under-18s, while experimentation with e-cigarettes is fairly common, regular use is rare and almost entirely confined to those who have already smoked.

How are they regulated?

At present, e-cigarettes are only covered by general product safety legislation. This will change in May 2016 with the introduction of new regulations under the EU Tobacco Products Directive (currently under consultation. In the meantime, a number of manufacturers have applied to the Medicines and Healthcare Products Regulatory Agency (MHRA) for licensing of their products. Medicines regulation will enable high quality, safe and effective products to be made available by the NHS on prescription. With effect from 1 October 2015, the sale of e-cigarette products to under-18s in England and Wales will be prohibited. It will also be illegal for an adult to purchase e-cigarette products for someone under the age of 18.


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