Vaping has had a chequered history since the first electronic cigarettes landed on UK shores nearly 20 years ago. Initially the devices were viewed with uncertainty, then with intrigue as the appearance moved away from cig-a-likes to complicated modular systems.
This was followed by concern as stories of devices catching fire or exploding hit the headlines before the research base evolved to the point that e-cigs were brought into the ‘stop smoking’ fold. But more recently a new trend has emerged: vaping in children.
On the face of it, this should be a non-issue: since 2015, it has been illegal to sell e-cigs or e-liquids to people under the age of 18 years in the UK. Yet a survey carried out by Action on Smoking and Health (ASH) found that nearly 16 per cent of 11-17-year-olds had tried vaping, and seven per cent regarded themselves as current users, with both figures a marked increase on the previous year.
Unsurprisingly, the older the child, the higher the stats go, with the ASH data showing that just over 10 per cent of 11-15-year-olds had tried vaping compared to just under a third of 16-17-year-olds, and over 40 per cent of 18-year-olds. And they are feeling it: survey data collected by drugs education charity, the Daniel Spargo-Mabbs (DSM) Foundation, revealed that 90 per cent of students aged 15-18 years said that vaping was one of the main substances used by people in their year group, putting it in the same ballpark as alcohol which came out top at 93 per cent, and well ahead of third and fourth placed cigarettes and cannabis at 73 and 70 per cent respectively.
Perception versus reality
ASH deputy chief executive Hazel Cheeseman comments: “Looking at the survey young people clearly see this as one of the more common substances they and their peers are using. That may be right, however, use is not actually that high according to our data, with over 80 per cent of kids never having tried a vape.
“Availability may be playing a part in this: vapes are prominently displayed in lots of shops – and lots of different types of shops too – which makes them feel very easy to get hold of. But social media may also have an impact, with young people feeling that vaping is around a lot because they frequently see it on their feeds.”
Fiona Spargo-Mabbs, founder and director of the DSM Foundation, agrees that social media is skewing perceptions of vaping among young people, and states: “It is really important to challenge this, because it can normalise behaviours more than is actually normal – basically they are seeing it more on their social media feeds than they are in real life. Reinforcing social norms is vital, such as highlighting the ASH data and for those who have, it seems to be much more about experimentation rather than vaping regularly.”
Regardless of age, there seems to be a much lower correlation between someone trying vaping and going on to be a habitual user than is the case with smoking. Hazel explains: “When someone smokes a cigarette, the nicotine within it is absorbed through the buccal cavity, which is a very efficient way of getting something into the body. Vaping is different, with the nicotine getting more slowly absorbed through the upper airways (and for young people with less experience of nicotine, absorption may be particularly low). On this basis it is likely that vaping is less addictive and experimentation among kids will not result in the same uptake as we see when kids experiment with smoking.”
“While vaping is now accepted as a way to help people give up smoking, that doesn’t mean that it is safe”
How safe is vaping?
While vaping is now accepted as a way to help people give up smoking, that doesn’t mean that it is safe. Royal Pharmaceutical Society (RPS) chief scientist Parastou Donyai says: “Whilst e-cigarettes are considered likely to be significantly less harmful than smoking tobacco, more research is required on the long-term effects of inhalation of e-cigarette constituents to establish their absolute risk. Although many of the substances used in e-cigarettes may be considered safe for oral ingestion, little is known about the long-term effects of inhalation, or how the heating process can alter their chemical composition.
“The full picture of health risks from smoking tobacco products did not emerge until decades after cigarettes were first introduced and we continue to advocate e-cigarettes are only used short-term as an aid to smoking cessation. E-cigarettes should be treated in a similar way to tobacco products and not be used indoors, in enclosed places, or near children,” adds Parastou.
“This exposes other people to the negative effects of poorer air quality, particularly when groups of people are using e-cigarettes in the same place at the same time. Non-smokers should not have to inhale e-cigarette vapour without their permission.”
While it might appear that the second-hand smoke from vapes is water-based – it doesn’t linger in the same way as cigarette smoke – WHO states that the aerosols generated by e-cigs contains nicotine and other potentially toxic substances. WHO has also highlighted the physical injuries some people have received from e-cigs, including burns from explosions or malfunctions.
This is in addition to recent studies which have shown that vapes can increase the risk of heart disease and lung disease, and the detrimental effect on brain development that nicotine exposure can cause to children and adolescents.
Legislation versus enforcement
Despite the legal ban on sales to under 18s, not all retailers adhere to this. Hazel suggests that some of this might be to do with the wide range of retailers who are involved – from pharmacies, tobacco sellers and vape shops to mobile phone kiosks and pound stores – as some might not be used to dealing with age-restricted products.
John Dunne, director general of the UK Vaping Industry Association (UKVIA) opines that enforcing the law is somewhat lacking. “The fines for breaking the rules are too low,” he says. “I’ve come across places that have been found to have made underage sales on four occasions, but have only been penalised £200 each time, so £800 in total. That’s no deterrent. The UKVIA would like to see these fines increased significantly, and a scheme introduced whereby vapes can only be sold from premises that have applied and paid for a license.
“We’d also like to see the introduction of mandatory documentation for those who import e-cigarettes stronger than those that can be sold in the UK, which is lawful if they are going to be exported; again, we know there are a small number of irresponsible people exploiting this legal loophole. If importers had to generate an audit trail, and were punished if they didn’t do so, this would be much more of a deterrent to breaking the law as it would expose those importing with no intention of exporting to a place where these higher strength products are allowed.”
The money generated from such schemes could be used for enforcement, continues John. “At the moment, local Trading Standards departments are so stretched that they simply can’t get on top of the issue. It’s also very uneven, for example, in one area of London where we know this import/export problem is rife, there is just one trading standards officer for that entire borough, trying to deal with this as well as everything else that falls under their work remit. That’s untenable.”
E-cig advertising is another area that is tightly regulated in the UK with – among other restrictions – a complete ban on any form of promotion that features, targets or appeals to children. Hazel states that this doesn’t cover user-generated content, highlighting TikTok as particular cause of concern. “There are lots of videos that show vaping, but because they are not created by the makers of the products, it falls outside the remit of the Advertising Standards Authority, though there is definitely scope for the social media platforms to crack down.”
John adds that while many manufacturers steer well clear of TikTok, saying “the demographic is so young that no reputable brand should be on there in any way, shape or form”, some still engage in paid work with influencers in order to raise brand awareness, which needs curbing. But he highlights another problem: user-generated content is not fact-checked, so can spread misinformation which in turn gains credibility even when it is very far from the truth.
Redressing the balance
This is where pharmacies can play their part, says John. “Giving that balanced view is so important. Explain that vaping is not 100 per cent safe but is far better than smoking. Tell people that nicotine is addictive, but it is the by-products of smoking that are so damaging to health, so buy e-cigarettes from reputable sources as this means the products will have been through all the necessary checks and will conform to all the necessary standards.”
Hazel builds on this, saying: “Pharmacies can really help smokers make the right decisions, and discuss the benefits of vaping versus licensed quit aids such as nicotine replacement therapy. But ultimately someone who doesn’t smoke doesn’t need to vape – that’s a crucial message to give. If parents or carers are concerned about their child vaping, reassure them that this is not as harmful as smoking though is not recommended – also highlight that the data shows most vape users who are young are using cigarettes as well, and parents may want to discuss this with their kids.”
“It is a very small number of young people who are regularly vaping,” continues Fiona. “Yes, vapes contain nicotine and are addictive, but use seems to usually stem from curiosity and remain occasional rather than becoming habitual, so is better used as a prompt for a conversation rather than panicking.” She adds that the other thing pharmacy staff can do to help is to keep abreast of current research and thinking, in order to provide the most accurate and up to date information.