The author is Associate Professor of Cardiometabolic Health at the University of Exeter and Chair of the BMA Board of Science
Smoking kills. In a world where doctors cannot reach consensus on other major health threats, this unambiguous fact is something we can all agree on.
Tobacco use is the leading cause of preventable disease in the UK and exacerbates the health gap between rich and poor. It damages blood vessels to increase the risk of coronary heart disease, stroke and dementia, while being responsible for around 70% of lung cancers – as well as cancers of the mouth, throat, throat and stomach. esophagus, bladder, intestine, kidneys, liver, stomach and pancreas. Second-hand smoke increases the risk of lung cancer by around 25%, with devastating effects on the health and development of children and a disproportionate impact on those already deprived.
Helping people quit smoking is one of the most beneficial things we can do and we use every tool available. Sitting in my acute stroke clinic, I discuss why people smoke. If it’s the taste, we try the gum; for cravings, nicotine patches; and if it’s the whole ritual, including the “hit” received by pulling on the cigarette, then vapes (e-cigarettes) are recommended. Vapes are one of the best modern treatments for cigarette addiction, but deep down I fear we don’t have long term data on e-cigarettes, which have only been introduced to the UK market than 2007. Have we transitioned patients from lifelong exposure to tobacco to lifelong exposure to a nicotine delivery method with unknown long-term consequences? However, given the approximately 5,000 chemicals and 70 proven carcinogens in tobacco, I am convinced that change is a positive health move.
But at no point in my stroke clinic did I feel the need to discuss chewing gum flavored vapes. No patient recovering from a heart attack has dismissed the need to quit smoking until offered a cherry-flavored quit aid. The color of the packaging is never the deciding factor for someone to focus on the impact of their habit on their children. Quite the contrary, in fact.
A person seeking to overcome their addiction to tobacco for the benefit of their family is unlikely to want their chosen cessation technology to be more appealing to children than to them. Yet the commercial rather than medical exploitation of vaping has taken us down a particular path: these products are now a pervasive and damaging mass phenomenon.
There’s no reason to produce flavored vapes with fancy packaging designs unless it’s to appeal to kids. Highly addictive nicotine products should not be marketed to anyone, let alone young people. In 2020, menthol cigarettes were banned in legislation aimed at discouraging young people from smoking. But back then, it was perfectly legal for companies to give kids free samples of single-use flavored vapes to entice them. That these “starter packs” are nicotine-free is only small consolation – they can serve as a gateway to long-term nicotine use. This week, Prime Minister Rishi Sunak announced that this loophole would be closed.
My colleagues in public health tell me that youth vaping is one of the greatest threats to future generations. Given the level of marketing and promotion of vapes, it’s also one of the easiest to get into. They report an increase in the number of 11-15 year olds using e-cigarettes by 6-9% over four years, and a doubling of use among 11-17 year olds since 2014. The availability of illegal products in UK is also of concern. Children are found in possession of illegal vapes, with potentially carcinogenic levels of lead and similar volatile organic compounds.
The £3million Illicit Vape Squad is a good start to getting the situation under control. School health programs and stopping free samples for children are welcome, but that doesn’t go far enough. The BMA is calling for the same restrictions on packaging as on tobacco products, imposing color and font and making it illegal to display products at the point of sale. Flavors should also be limited, in accordance with tobacco product regulations.
E-cigarettes must carry appropriate health warnings. Vaping is not without risk. At the very least, we know that nicotine is highly addictive. It has been shown to impair attention, learning, mood and impulse control in children and young adults. Many flavorings, although safe for oral consumption, have an unknown impact when inhaled deep into the lungs. Some legal products contain nickel, tin and lead in very low doses: in the long term, if inhaled, this can be associated with lung diseases.
The effects are unknown at this stage. For smokers, encouraging the switch to vaping undoubtedly reduces health risks. But here’s another unambiguous fact: we need to discourage people from taking up vapes and completely prevent them from being marketed and sold to children.