e-cigarettes friend or
foe?
To set the development of e-cigarettes in the context of
tobacco use and its impact on health and health
inequalities
To review the arguments that have been advanced in
favour of and against the use of e-cigarettes
To share participant views about e-cigarettes and
responses to the information presented
E-cigarettes: friend or foe?
Session aims
Major causes of death in England
Impact of tobacco smoking
Single largest preventable cause of ill health,
premature death & health inequalities in Lancashire
- Kills 1,673 adults aged 35 and over each year1,2
Smoking accounts for half of the difference in life
expectancy between social classes I and V3,4
Smoking rates are higher in:
Routine & manual workers (30%)5
Offenders (80%)6
People living with a mental health condition
(32-70%)7,8
Smoking rates remain higher in Lancashire than
England in:
Adults5 – 21.2% vs 20%
Pregnant women9 – 16.8% vs 12.0%
Young people10,11 – 16% vs 11%
Financial impact of tobacco smoking
1 in 20 hospital admissions are smoking
related12
Nationally costs the NHS 2.7 billion
each year13 & £41.49 million in
Lancashire14 (£22.6 million primary care
& £18.83 million secondary care)
Exposure of adults and children to
secondhand smoke in Lancashire costs
the NHS a further £15.67 million to treat
annually14
Total cost of smoking is estimated to be
£316.6 million each year14
Novel nicotine delivery devices that were developed in China more
than 10 years ago.20
Battery operated devices that aim to simulate combustible cigarettes.
Don’t contain tobacco, operate by heating nicotine and other
chemicals into a vapour that is inhaled.21
Three main types:22
Disposable products (non-rechargeable)
Electronic cigarette kit – rechargeable
with replaceable pre-filled cartridges
An electronic cigarette that is rechargeable and has a tank or
reservoir filled with liquid nicotine
E-cigarettes: what are they?
E-cigarettes
Estimated 2.1 million e-cigarette users nationally15
Currently unregulated and unlicensed, so safety and efficacy remains
undetermined
Research regarding clinical effectiveness as a stop smoking aid is
currently limited
WHO recommendation16
‘Until such time as a given electronic nicotine delivery system is
deemed safe and effective and of acceptable quality by a competent
national regulatory body, consumers should be strongly advised not to
use any of these products, including electronic cigarettes’
E-cigarettes and young people
Some e-cigarette devices replicate smoking.
Marketing strategies focused to appeal to youth
audience17,18:
Wide range of flavours
Brightly coloured designs
Customisation of devices
Celebrity endorsement
2013 Trading standards survey with 3,471 young
people aged 14-17 years across Lancashire County:
1 in 4 (27%) bought or tried e-cigarettes
Of these, 39.9% were non-smokers
Government intend to introduce legislation to ban
sales to under 18s within Children and Families Act in
201519
Part of a harm reduction strategy23
Could be a less hazardous way to maintain nicotine
addiction24
E-cigarettes: friend?
A potential gateway to smoking and renormalisation
Long term safety not known
Nicotine addiction remains
Causes confusion and undermines compliance with
smokefree legislation
E-cigarette companies owned by Tobacco Industry –
produce a product that kills 1 in 2 lifelong users
E-cigarettes: foe?
E-cigarettes: any questions?
References 1. London Health Observatory (2011). Local Tobacco Control Profiles for England – Public Health Observatories in England Nov 2011.
http://www.lho.org.uk/Download/Public/17712/1/Tartan%20Rug_FINAL_Nov2011%20v2.pdf
2. The Information Centre for Health and Social Care (2012). Statistics on Smoking: England, 2012 and Census 2011 all population aged 35 and over.
3. Wanless D. (2004) Securing good health for the whole population. London: TSO
4. Marmot M et al (2010) Fair Society, Healthy Lives: strategic review of health inequalities in England post 2010. Marmot Review Secretariat London.
5. Office for National Statistics (2014) Integrated household survey, self-reported smoking prevalence, persons, aged 18+, 2011-12.
6. Singleton N et al (1998) Psychaitric morbidity among prisoners in England and Wales: the report of a survey carried out in 1997 by Social Survey Division of the
Office of National Statistics on behalf of the Department of Health.London: The Stationary Office.
7. McManus S, Meltzer H & Campion J (2010) Cigarette Smoking and Mental Health in England: Data from the Adult Psychiatric Morbidity Survey 2007. National
Centre for Social Research. www.natcen.ac.uk/study/cigarette-smoking--mental-health
8. Jochelson K & Majrowski W. (2006) Clearing the Air: Debating Smoke-Free Policies in Psychiatric Units. London: King’s Fund.
9. NHS Information Centre for Health and Social Care (2014). Statistics on women’s smoking status at time of delivery: England. http://www.ic.nhs.uk/statistics-and-
data-collections/health-and-lifestyles/smoking
10. The Information Centre for Health and Social Care (2012) Smoking, drinking and drug use among young people in England in 2011.
11. Trading Standards (2013). Young Persons Alcohol and Tobacco Survey 2013, North West Results. TSNW, June 2013.
12. The Information Centre for Health and Social Care (2012). http://www.ic.nhs.uk/news-and-events/news/about-1260-hospital-admissions-a-day-due-to-smoking-
new-figures-show
13. Callum C, Boyle S, Sandford A (2010). Estimating the cost of smoking to the NHS in England and the impact of declining prevalence. Health Economics Policy &
Law 2010 doi:10.1017/S1744133110000241.
14. Health Economics Research Group, Brunel University; Queen's Medical Centre, University of Nottingham & London Health Observatory (2012) Building the
economic case for tobacco control: A toolkit to estimate economic impact of tobacco. http://www.brunel.ac.uk/herg/research-programme/building-the-economic-
case-for-tobacco-control
15. Public Health England. (2014) Public Health England, tobacco harm reduction and e-cigarettes: a discussion paper. Public Health England, May 2014.
16. World Health Organisation (2013). Questions and answers on electronic cigarettes or electronic nicotine delivery systems.
http://www.who.int/tobacco/communications/statements/electronic_cigarettes/en/
17. De Andrade M, Hastings G, Angus K (2013) Promotion of electronic cigarettes: tobacco marketing reinvented? BMJ 347:f7473.
18. Hardcastle K et al (2014) “Most people I know have got one”: young people’s perceptions and experiences of e-cigarettes. Liverpool: Centre for Public Health,
Liverpool John Moores University.
19. BBC (2014) E-cigarettes to be stubbed out for under-18s. http://www.bbc.co.uk/news/uk-25900542
20. https://www.rcplondon.ac.uk/commentary/what-you-need-know-about-electronic-cigarettes
21. Bauld L, Angus K , de Andrade M (2014) E-cigarette uptake and marketing. A report commissioned by Public Health England
22. ASH. (2014) Electronic cigarettes http://www.ash.org.uk/files/documents/ASH_715.pdf
23. Statement from specialists in nicotine science and public health policy. (2014) http://nicotinepolicy.net/documents/letters/MargaretChan.pdf
24. Britton J, Bogdanovica I, (2014) Electronic cigarettes A report commissioned by Public Health England