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What do vapes contain and who can legally buy them?

A solution in the vape, known as an e-liquid, contains varying strengths of nicotine and sometimes flavourings, allowing for a tapered nicotine withdrawal. King’s College London senior lecturer in tobacco harm reduction Debbie Robson says vapes were first used in the UK in 2005.

‘Vapes tend to come here from the US and China,’ Dr Robson says. ‘The US stopped the sale of many flavoured e-cigarettes in 2020 and the manufacturers needed a new gap in the market. That is one reason why they have been promoted more over here in recent years.’

Most adults in this country who vape are ex-smokers and use the devices as an aid to stop smoking, according to a recent YouGov survey.

An evidence review by Public Health England, now known as the UK Health Security Agency, found vaping was 95% less harmful than smoking.

Selling vapes that contain nicotine to under-18s is illegal. Shops in England used to be permitted to offer free samples of vaping products to children, but on 31 May 2023 this loophole in the legislation was closed. UK prime minister Rishi Sunak has also raised the prospect of a government ban on the sale of nicotine-free vapes to under-18s.

How many people use e-cigarettes?

Health charity Action on Smoking and Health (ASH) policy manager John Waldron says 8.3% of UK adults use vapes. ‘The vast majority of these are smokers or ex-smokers,’ he says.

According to a YouGov survey for ASH, the number of children aged 11-17 in England, Scotland and Wales who have tried vapes has increased from 7.7% in 2022 to 11.6% this year. The number of children vaping regularly has increased from 3.1% to 3.7%.

How are vapes regulated? And how much of a problem are illegal vapes?

Vaping products are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA). Its rules include a limit on the amount of nicotine in e-cigarettes. The agency is not required to check the claims made by manufacturers applying for product registration, but can refer suspicious products to another body. It has no power to investigate unregistered products, which is the responsibility of the Home Office and Trading Standards bodies, a spokesperson for the MHRA said.

What did a recent investigation find that worried health experts?

E-cigarettes confiscated from school pupils recently were found to contain high amounts of lead, nickel and chromium when analysed by the Inter Scientific Laboratory in Liverpool.

The MHRA said these results will be reviewed to see if vapes pose a health risk. Levels of lead in vapes were found to be twice as high as the daily safe amount for humans to be exposed to, while those for nickel were nine times the safe amount.

University of Oxford associate professor of evidence-based policy and practice Jamie Hartmann-Boyce, who was a senior researcher in health behaviours for the Cochrane Tobacco Addiction Group, says legal vaping products remain less harmful than traditional cigarettes.

‘If you are not a smoker, no one recommends vaping,’ she says. ‘Because putting anything other than fresh air into your lungs has health risks. If you’re a smoker, you are already doing something deadly and vaping instead is a good move: it will improve smokers’ life expectancy.

‘Most people working in this area will agree that if vapes were as bad as cigarettes, we would probably know by now.’

What are some of the possible side effects of vaping?

According to the NHS, vaping side effects include a dry mouth, cough, shortness of breath and headaches. It recommends that changing products or vaping technique can reduce these. ‘Adults tend to vape to quit smoking,’ says Ms Hartmann-Boyce. ‘They’re not necessarily doing it as a long-term thing. But if the side effects are too severe, you can also look at nicotine replacement therapy, which is licensed for use by anyone over 12 years old.’

Has anyone died as a result of vaping?

In November 2019, the deaths of 39 people in the US were connected to e-cigarettes. There were also 2,051 cases of e-cigarette or vaping product-associated lung injury (EVALI), the US national public health agency, the CDC reported. Most of these cases were linked to e-cigarettes containing THC and prompted worldwide safety concerns.

‘EVALI is associated with an additive called vitamin E acetate,’ says Professor Hartmann-Boyce. This is often found in vapes that contain tetrahydrocannabinol (THC) because it produces the same bubbles in the vape’s e-liquid, which can make buyers think the product contains more THC than it does. It is banned from e-cigarettes in the EU and is not found in legal vaping products.

How can nurses advise patients and service users on e-cigarette use?

‘Be aware of the evidence, so you can advise people properly,’ says Mr Waldron. He recommends using resources from the National Centre for Smoking Cessation and Training, modules from E-learning for Healthcare, ASH guidance and the Smokefree Sheffield website.

Dr Robson recommends that nurses talk to patients and service users about the risks of smoking compared with vaping for those who smoke and the risks of vaping for those who do not smoke. ‘Have robust research studies backing up what you’re saying,’ she says. ‘Patients will ask questions because they see alarmist news headlines. You want to be able to say, “Yes, but that study was in mice” or whatever the case may be.’

This is an abridged version of an article at rcni.com/vapes-and-ecigarettes