What should we say to young people about vaping?
Vaping was introduced to the UK market in 2007, and is a habit for a significant minority of young people (although this number does not seem to be increasing). They are readily available online and in retail outlets. Vape shops offering e-cigarettes, refills and colourfully flavoured e-liquids are now scattered on shopping streets across England, Wales, Scotland and Northern Ireland. Vaping is still a relatively new phenomenon and evidence is still emerging regarding safety. With between 20–25% of young people having tried e-cigarettes, more can be done to highlight what little is known about the health harms of vaping.
What is vaping?
Vaping is using a vaping product: e-cigarettes and refill containers and e-liquids, also known as vapes and e-cigs. These products allow you to inhale a vapour rather than smoke. The vapour can contain nicotine or not and is available in various flavours. This is unlike cigarettes where the tobacco smoke inhaled contains tar and carbon monoxide, two very dangerous elements, along with nicotine. Vaping products have become a popular aid to help adults stop smoking in the UK as nicotine alone, while an additive substance, is relatively harmless.
“These products allow you to inhale a vapour rather than smoke. The vapour can contain nicotine or not and is available in various flavours.”
Nicotine is key to how different types of vaping products are regulated in the UK. Those containing the substance are regulated by the Tobacco and Related Products Regulations (TRPR) under which it became illegal to sell e-cigarettes containing nicotine to under 18s in 2015. Advertising or promotion of e- cigarettes and re-fill containers on a number of media platforms is prohibited. The only advertising still allowed is at point of sale and other local advertising. However, non-nicotine vaping products are not covered by such a ban and are instead regulated under General Product Safety Regulations 2005, which is legislation across goods sold to consumers to ensure that they are safe.
Risk for young people
Research carried out by ASH looked at the use of vaping products amongst 11–18 year olds and found that young people had vaped just to give it a try, not because they thought it looks cool, which has long been, perhaps now dated, a way to describe smoking. It was also found that young people think of vaping as equally harmful, with less than half (44%) believing e-cigarettes were not as harmful as cigarettes. While over a third (36%) of regular vapers under the age of 18 said that the vapes they used most often always contained nicotine, there is no evidence that use of e-cigarettes is leading to an increase of smoking in young people in the UK. This insight is positive, but the lack of regulation and long-term evidence combined still means that young people may be exposed to unknown harms from vaping.
“It’s not yet fully established what the harms of vaping, or second-hand vaping, are.”
Reports of deaths and disease in the US linked to vaping caused concern in 2019 however a majority of these incidents were linked to vaping THC — a cannabis product. But in 2021 the marketing of vaping products came under particular scrutiny in the States when e-cigarette maker JUUL was accused of marketing to teens. The company, which produces e-cigarettes that resemble USB flash drives in flavours such as mango and crème brulée, began its marketing by focusing on social media techniques (it has since shut down its Facebook and Instagram accounts due to pressure from regulators). While this is distinct from the vaping in the UK, its an example of why marketing and sales regulations should be considered for all vaping products.
Concerns
These relatively new products are not risk free. It’s not yet fully established what the harms of vaping, or second-hand vaping, are and their long-term impact is not known but there is concern regarding acute toxicity, especially when misused. RCPCH’s approach is always to protect young people from any known risks. In the case of vaping, the College has set out in its vaping statement to protect them from both the known and unknown risks and prevent vaping uptake to ensure optimal health outcomes. More data collection is needed and until then caution is needed for the potential risks vaping poses to children and young people’s health.
The key takeaway message for young people is yes, it is thought that vaping is probably safer than smoking tobacco, but with so much uncertainty and the harms are still unknown, so paediatricians cannot advise their use.
