In 2008, a year after smoking was banned indoors across the UK, e-cigarettes hit the market. By 2019, according to a YouGov survey, more than 3.6 million adults in Great Britain were using e-cigarettes or vaping, a total of 7.1 per cent of the adult population. However, as relatively new products, there is very little long-term evidence on e-cigarettes, and many people remain unsure as to whether or not vaping may pose a risk to children, particularly as more and more stories about the dangers of vaping are now hitting the headlines.
E-cigarettes, also called vapes, are designed for users to inhale nicotine through a vapour rather than smoke. They work by heating a solution that typically contains nicotine, propylene glycol or vegetable glycerine, and flavourings.
Unlike cigarettes, e-cigarettes don’t contain or burn tobacco and don’t produce tar or carbon monoxide, which are known to be harmful to babies. Without any combustion, there are no carcinogens produced, and the current estimate is that vaping is 95 per cent less harmful to health than smoking, both in terms of cancer risk and second-hand smoke exposure.
Parents who smoke can raise a child’s risk of suffering from asthma, pneumonia or sudden infant death syndrome (SIDS), but there is ‘little to no evidence’ that vaping leads to similar complications, according to Katherine East, a research worker at King’s College London.
Studies by the Royal College of Physicians have found no evidence that exposure to second-hand vapour causes harm, and according to Public Health England, there have been no identified health risks of passive vaping to bystanders.
‘Current evidence suggests that vaping exposes both vapers and those around them to lower levels of toxicants than smoking tobacco,’ Dr East says.
Martin Dockrell, tobacco control lead at Public Health England, adds, ‘Cigarette smoke is very harmful to young lungs, and parents should take whatever steps they can to protect their children from smoke. The risk from vaping is different. In this case, we would recommend that parents store their e-cigarettes, and especially their refills, safely out of reach of children.’
Although the vapour contains some toxicants also found in tobacco smoke, these are either at much lower levels or at levels not associated with serious health risk. However, Public Health England is concerned that more than half of smokers ‘falsely believed that vaping is as harmful as smoking’.
Mr Dockrell explains, ‘We know that e-cigarettes are probably not completely safe, but that’s not the issue. The question is, are [they] safer than the alternative? It’s really important that smokers understand how much safer e-cigarettes are, compared to smoking.’
Vicky Salt, policy manager at Action on Smoking and Health (ASH), says this distinction is key. ‘For every person, and especially for children growing up, we would prefer nothing to be used at all. But for a parent who would otherwise be smoking, switching to e-cigarettes would be much less harmful to them and their child.
‘We would recommend to nursery staff a similar approach to the one we give to health visitors. The best thing is to signpost families towards advice on how to keep a smoke-free home, and if vaping is helping to keep children’s homes that way, it’s a much better option than the risk of relapse to smoking.’
PREGNANCY AND BREASTFEEDING
While very little research has been conducted into the safety of e-cigarette use in pregnancy, current evidence suggests it is likely to be significantly less harmful to a pregnant woman and her baby than cigarettes.
In pregnancy, nicotine replacement therapy (NRT) products such as patches, lozenges and gum are recommended options as they are licensed as safe for use in pregnancy. However, if using an e-cigarette helps a person quit smoking and stay smoke-free, the Smoking in Pregnancy Challenge Group, a coalition of organisations committed to reducing rates of smoking in pregnancy, says it is ‘far safer’ for mother and baby than continuing to smoke.
However, it also warns that newborns and young children have small, developing lungs and it ‘may be advisable to take extra care around them’.
One way of achieving this, suggested by the guidance, would be to ban vaping in confined spaces at home or in the car, and using NRT instead where possible.
In its advice, the group adds that based on the available evidence on e-cigarette safety, there is no reason to believe that using an e-cigarette would compromise breastfeeding.
The group does acknowledge, however, that ‘more research is required to ascertain the effects of e-cigarettes on pregnant women and the foetus’, and studies are under way to further investigate the effects of e-cigarette use in pregnancy.
INFLUENCE
As an influencing factor on young people, vaping has been found to discourage children from taking up smoking. Dr East says her research suggests that while older children are likely to be influenced by seeing others vaping, they are actually less likely to try smoking.
‘Obviously it is bad for them to see vaping or vape if they are non-smokers, but smoking would still be the worst outcome,’ she says. ‘In fact, what we found is if they have friends who vape, they are more likely to become vapers, while having friends who vape actually has a protective effect against smoking.’
However, with only just over a decade of vaping culture in the UK, there is a lack of longitudinal studies into the effects of e-cigarettes, and many media reports raise concerns that our understanding could take as long to catch up with the science as it did for cigarette smoking.
With this in mind, a new review of vaping regulations is expected from Public Health England in March 2020, and in the meantime further study of the effects of vaping is likely to continue.
However, experts are optimistic. ‘Obviously we want to know more; we want ten-year studies and much more,’ says Ms Salt. ‘But with good-quality, independent evidence on e-cigarettes, we’re not seeing a parallel here between our understanding of vaping now and historical attitudes towards smoking.’
