Over recent years, electronic cigarettes (e-cigarettes) have become a very popular stop smoking aid in the UK and many people have found them helpful for quitting. Long term health effects use are still not known but compared with cigarettes, recent reports have suggested that e-cigarettes are as much as 95% less harmful to users.
We support clients who want to use an electronic-cigarette (e-cigarette) to help them quit smoking and welcome smokers considering using an e-cigarette to come to the service for behavioural support.
What is an e-cigarette?
An e-cigarette is a device that allows you to inhale nicotine without most of the harmful effects of smoking. The use of e-cigarettes is commonly known as ‘vaping’.
E-cigarettes work by heating and creating a vapour from a solution that typically contains nicotine; a thick, colourless liquid called propylene glycol and / or glycerine; and flavourings. As there is no burning involved, there is no smoke, though there may be a visible vapour cloud.
E-cigarettes do not produce tar and carbon monoxide – two of the main toxins in conventional cigarette smoke. The vapour from e-cigarettes has been found to contain some potentially harmful chemicals also found in cigarette smoke, but at much lower levels.
What are e-cigarettes made up of?
In general, e-cigarettes consist of a battery, a heating element or coil (atomiser) and e-cigarette liquid (e-liquid). The e-liquid can be in sealed cartridges or added to a tank system. Some e-cigarettes use cartomisers that combine the atomiser and e-liquid in a single unit. Although some cartomisers are refillable, most are disposable and designed for single use.
Figure 1: The three generations of e-cigarettes
There are different generations of e-cigarettes, with the first models being designed to look like a cigarette (see Figure 1 aove). Second and third generation models, often called personal vaporisers are particularly popular with people who have completely replaced their cigarette smoking with e-cigarette use.
Currently, there are no e-cigarettes on the market that are licensed as medicines, meaning they are not available on prescription from the NHS. E-cigarettes are marketed as consumer products and are therefore not subject to medicine standards.
What we know so far
- E-cigarettes are estimated to be at least 95% safer than smoking tobacco. (See ref 1)
- E-cigarettes do not contain the tar, carbon monoxide or levels of toxic substances that are harmful to human health that lit tobacco does. (See ref 1)
- E-cigarettes are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes. (See ref 4)
- E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking. (See ref 1)
- From May 2016, e-cigarettes came under new regulations as part of the revised European Union Tobacco Products Directive (TPD). Under the new TPD, e-cigarettes will either be licensed as medicines or, if unlicensed, will be subject to new quality and safety standards, packaging and labelling requirements and restrictions on advertising. (See ref 2)
- There are concerns that e-cigarettes will increase tobacco smoking by re-normalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking. To date, there is no evidence that any of these processes is occurring to any significant degree in the UK. (See ref 4)
- You can use Nicotine Replacement Therapy in conjunction with an e-cigarette. (See ref 1 & 2)
- You can at least triple your chances of success in stopping smoking tobacco with your e-cigarette by attending your local stop smoking service. (See ref 3)
A new Public Health England (PHE) e-cigarette evidence review was done in February 2018, undertaken by leading independent tobacco experts. The main points from this review are as follows:
- vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
- e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
- e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
- many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
- there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
- the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
Is nicotine dangerous?
Nicotine does not cause smoking related disease, such as cancers and heart disease. These are caused by other chemicals found in tobacco smoke. Nicotine is addictive however and it is why people continue to smoke despite knowing about the harmful effects of tobacco. (See ref 2)
Smoking in pregnancy, quitting and electronic cigarettes
Little research has been conducted into the safety of electronic cigarettes in pregnancy, however they are likely to be significantly less harmful to a pregnant woman and her baby than cigarettes.
Smoking during pregnancy can harm the baby in the womb from day one.
Licensed nicotine replacement products are safe to use during pregnancy and can increase your chances of quitting successfully. Nicotine replacement therapy (NRT) is free on prescription during pregnancy.
While licensed NRT products are the recommended option, if you are pregnant and using an electronic cigarette helps you stay smokefree, it is much safer for you and your baby than continuing to smoke. (See ref 6)
Using E-cigarettes within the Hackney Stop Smoking Service
You will need to purchase your own e-cigarette as they are not currently available on prescription.
If you are purchasing your first e-cigarette, we recommend visiting a local reputable shop; in that way you can buy a device that suits your needs with guidance from the specialists.
It is recommended that you start with at least a second generation device, (rechargeable battery, and refillable atomizer, preferably of “tank” style design) with the CE mark that indicates chargers comply with European Safety standards.
Only buy e-liquid from a reputable source; ensure it is labelled with nicotine strength, is in a child-resistant container, and contains sufficient information to trace its place of manufacture.
Any e-cigarette retailer should be able to advise on:
- The device that might suit you
- How much nicotine you need in your e-liquid
- Puffing techniques
Practical safety guidance in line with any rechargeable device
- Never leave an e-cigarette or e-liquid where a child or a pet could get hold of it.
- Always use the correct charger and follow the manufacturer's instructions.
- Check that your e-cigarette battery has overcharge or overheat protection.
- Remove the battery from charge when complete – don't over-charge.
- Never leave a battery on charge unattended - Don't use if wet or exposed to water.
- If your e-cigarette battery is not behaving as expected, or has been damaged externally, stop using it, and seek advice from the place of purchase.
- Do not over tighten the atomiser or when connecting the charger.
- Ensure that you dispose of batteries correctly.
- E-cigarettes: an evidence update. A report commissioned by Public Health England: McNeill A, Brose LS, Calder R, Hitchman SCd, 2015.
- Electronic cigarettes: A briefing for stop smoking services.
- Prospective cohort study of the effectiveness of smoking cessation treatments used in the “real world” in Mayo Clinic Proceedings: Kotz, D., J. Brown, and R. West. Elsevier 2014.
- Nicotine without smoke: Tobacco harm reduction Working party report: Royal College of Physicians Tobacco Advisory Group, 2016.
- Use of e-cigarettes (vaping) in the home: advice for parents.
- Use of electronic cigarettes in pregnancy: A guide for midwives and other healthcare professionals
Once you stop smoking, some of the benefits are immediate and some are longer-term.