The author is an associate professor of cardiometabolic health at the University of Exeter and chair of the BMA Board of Science
Smoking is deadly. In a world where doctors can’t reach consensus on other major health threats, this unequivocal fact is something we can all agree on.
Tobacco use is the biggest cause of preventable disease in the UK and widens 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 about 70 percent of lung cancers – as well as cancers of the mouth, throat, esophagus, bladder, intestines, kidneys, liver, stomach and pancreas . Passive smoking increases the risk of lung cancer by about 25 percent, with devastating effects on children’s health and development and a disproportionate impact on the already needy.
Helping people to stop smoking is one of the most helpful things we can do and we use all the tools available. Sitting in my acute stroke clinic, I discuss why people smoke. If it’s the taste, we’ll try bubble gum; for cravings, nicotine patches; and if it is the whole ritual, including the “hit” obtained by pulling the cigarette, then vapes (e-cigarettes) are recommended. Vaping is one of the best modern treatments for cigarette addiction, but in the back of my mind I worry we don’t have any long term data on e-cigarettes, which were only introduced to the UK market in 2007. patients from a lifetime exposure to tobacco to a lifetime exposure to a nicotine delivery method with unknown long-term consequences? However, compared to the approximately 5,000 chemicals and 70 proven carcinogens in tobacco, I am convinced that the switch is a positive step for health.
But at no point in my stroke clinic have I felt the need to discuss bubble gum flavored vapors. No patient recovering from a heart attack has rejected the need to quit smoking until they were offered a cherry-scented cessation aid. The color of the packaging is never the deciding factor in getting someone to focus on the impact of their habit on their children. On the contrary actually.
A person who wants to overcome his smoking addiction for the benefit of his family will probably not want his chosen withdrawal technology to be more attractive to the children than to them. But the commercial rather than medical exploitation of vaping has led us down a peculiar path: These products are now a ubiquitous, harmful mass phenomenon.
There is no reason to produce flavored vaporizers with bright packaging designs unless it appeals to children. Highly addictive nicotine-based 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 at the time, it was perfectly legal for companies to offer children free samples of single-use flavored vaporizers to entice them. That these “starter packs” are nicotine-free is little consolation — they can act as a gateway to long-term nicotine use. This week Prime Minister Rishi Sunak announced that the loophole would be closed.
My public health colleagues tell me that youth vaping is one of the biggest threats to future generations. Given the level of marketing and promotion of vapes, it is also one of the easiest to tackle. They speak of an increase in the number of 11- to 15-year-olds using e-cigarettes from 6 to 9 percent in four years, and a doubling of use among those aged 11 to 17 since 2014. The availability of illegal products in the UK is also a concern. Children are found in possession of illegal fumes, with potentially carcinogenic levels of lead and similar volatile organic compounds.
The £3 million illegal vape enforcement team is a welcome start to getting this under control. School health programs and the discontinuation of free samples for children are welcome, but this does not go far enough. The BMA is calling for the same restrictions on packaging as on tobacco products, mandating one color and font and making it illegal to display products at the point of sale. Flavorings should also be restricted, in accordance with tobacco product regulations.
E-cigarettes must have proper 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. While many of the flavorings are safe for oral consumption, they have an unknown impact when inhaled deeply into the lungs. Some legal products contain nickel, tin and lead in very small doses: in the long term, if inhaled, this may be associated with lung disease.
The effects are not yet known at this stage. For smokers, encouraging the switch to vaping undoubtedly lowers health risks. But here’s another unequivocal fact: we need to discourage people from using vapes and completely prevent them from being marketed and sold to children.