What are the dangers of vaping for young people, and can they be protected while being spared the hazard of smoking? The Tobacco and Vapes Bill is expected to be passed into law shortly, and experts say it can’t come soon enough. Journalist Jo waters reports.
One of the most ambitious attempts to control tobacco and vape sales to children and young people is expected to reach the statute book this year. The aim is to create the first ‘smoke free generation’. It is hoped and expected that the Tobacco and Vapes Bill, as set out by the last government (Department of Health and Social Care (DHSC), 2024), will be passed into law after Parliament resumes.
Recent analysis suggests about 350 young adults aged 18 to 25 start smoking regularly each day in the UK (Action on Smoking and Health (ASH, 2024a). The number of 11- to 15-year-olds who have ever tried smoking or who regularly smoke has steadily declined in England since 1996 (NHS Digital, 2022). But the recent UK analysis amounts to an annual total of 127,500 18- to 25-year-olds ‘risking a lifetime of addiction’.
While almost 20% of 11 to 17-year-olds have tried vaping – amounting to about 980,000 in total who have tried it (ASH, 2024b). The vape reality on page 26 shows the wider picture of use for young people.
In response, the Royal College of Paediatrics and Child Health’s (RCPCH) vice president for policy Mike McKean, said that enacting the Tobacco and Vapes Bill was a ‘matter of urgency’ to protect children and young people’s health. ‘That almost a fifth of teens have tried vaping is extremely worrying,’ said Dr McKean, who stressed that ‘vaping is far from risk free and very often addictive’ (RCPCH, 2024).
THE VITAL GOAL
If the Tobacco and Vapes Bill becomes law, the legislation would mean that children in the UK turning 15 this year can never buy tobacco legally. The age of sale will then be raised by one year annually to prevent future generations ever taking up smoking. This makes the point that there is no age at which smoking becomes safe. The new legislation, which was flagged in the King’s Speech (Prime Minister’s Office, 2024) is due, if passed as intended, to come into force in April 2027. At present, it is illegal for shops to sell tobacco or vapes to anyone aged 18 or younger.
VAPING CAN CAUSE THROAT
AND MOUTH IRRITATION,
HEADACHES, COUGHING AND
NAUSEA. THE LONG-TERM
EFFECTS OF VAPING ARE
NOT YET KNOWN. CHILDREN
AND NON-SMOKERS
SHOULDN’T USE THEM
As well as the crackdown on tobacco sales, separate measures to control vapes sales to children are also expected, in response to a tripling of the number of children using vapes in the past three years (DHSC, 2024). Originally outlined by the last government, these measures may include banning disposable vapes, while also restricting vape flavours and packaging. The powers will allow the government to change how vapes are displayed in shops, as well as the issuing of £100 on-the-spot fines for shops selling tobacco and vapes to those who are underage.
A DHSC spokesperson told Community Practitioner that the Tobacco and Vapes Bill will protect future generations from the harms of tobacco and nicotine, saving thousands of lives and easing pressures on the NHS.
‘It will introduce a progressive smoking ban and stop vapes and other consumer nicotine products such as nicotine pouches from being deliberately branded and advertised to appeal to children,’ the spokesperson said.
CP HELP
Kimberley Garner, a schools health adviser with Trafford Local Care, delivers sessions for 10- and 11-year-olds preparing for high schools in the Trafford area, aimed at deterring them from vaping.
School nurse Ella Hornby runs pop-up board sessions in schools on vaping with colleagues from four school nursing teams across Trafford and the Healthy Schools Team.
Ella says students are very engaged and ask lots of questions. ‘If we [do] have students who were smokers who wanted To switch to vapes, we will refer them onto to a specialist service.’
ASH has worked with Sheffield City Council on preparing accurate information for young people on the risks of vaping, explaining they can also be useful for giving up smoking if you are an adult but are addictive and should not be used by children (Smoke Free Sheffield, 2023).
THE VAPE REALITY
ASH figures for 2024 (covering Scotland, Wales and England) reveal that of the 980,000 11- to 17-year-olds
who have tried vaping (that’s 18% of that age group):
> 47% have tried vaping more than once or twice, suggesting more regular use
> 72% report being exposed to some form of vape promotion, with the main sources being in shops (55%) and online (29%)
> 48% had bought vapes from shops, despite selling vapes to under-18s being an offence
> 54% The most commonly bought product was disposable vapes
ASH, 2024b
In Northern Ireland
> 21% of 11- to 16-year-olds reported having used an e-cigarette at least once
Department of Health (NI), 2023
LAW UNDER THE SPOTLIGHT
John Waldron, ASH’s policy and public affairs manager, expects the Bill to be enacted broadly as originally drafted. ‘There may be some further powers. We don’t know the specifics yet, so we have to wait and see when it’s published – hopefully when Parliament sits again in September,’ he says. On vaping, he notes: ‘We understand a separate ban on disposable vapes could be introduced from April 2025, although there hasn’t been a public statement on this yet.’
John says the legal shake-up is desperately needed to protect young people from taking up smoking. Nearly 100,000 people die from smoking-related illnesses in the UK each year, he points out. ‘Diseases such as lung cancer and chronic obstructive pulmonary disease take decades to develop, so we need action now to protect people now.
‘Smoking becomes an addiction in more than half of people who try it and two in three long-term users of tobacco die. There’s no other product on the market that does this [and] if tobacco had just been discovered now it would be banned immediately. The legislation will stop the next generation from picking up this addiction.’
Although the latest vaping rates (ASH, 2024b) appear to have stabilised after a period of increase, they are not yet in decline. There is also ‘an indication that young vapers may be more dependent than they were four years ago’, which could suggest that ‘newer products may be increasing dependency, underscoring the urgency for stronger regulations’ (ASH, 2024b).
In his response to the ASH report, Dr McKean from the RCPCH said: ‘We need our government to have the necessary powers to regulate these products and companies, to protect children and young people, by implementing a ban on disposable e-cigarettes [vapes], limiting flavours, introducing plain packaging and restricting advertisements both online and in stores.’
‘THESE ILLEGAL VAPES
COULD HAVE ABSOLUTELY
ANYTHING IN THEM, IT’S SO
DANGEROUS. WHEN WE TELL
YOUNG PEOPLE ABOUT
THIS, THEY ARE USUALLY
VERY SURPRISED’
Professor emeritus of health psychology at University College London (UCL) Robert West, believes that the most significant part of the legislation is the ambition to create a ‘smoke free’ generation. ‘There seems to be cross-party support for that, so I think we can be pretty confident that it will go through, and as far as I know they are consulting on the best way of approaching vaping, which obviously they are concerned about too.’
HOW DANGEROUS IS VAPING?
The nicotine in vapes is addictive – and vaping is an expensive habit to develop, especially at a young age – but they do offer one of the most effective methods of quitting smoking (NHS Better Health, 2024). And herein lies the dilemma: how do you discourage those who have never smoked from taking up vaping, without also discouraging those smokers who vape in a bid to kick their tobacco habit?
In a speech last year, England’s chief medical officer Professor Chris Whitty said: ‘If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable,’ (DHSC, 2023).
‘Vaping is undeniably not as dangerous as tobacco smoking, but it is not completely safe by any means,’ says Professor West. ‘Do you really want to become addicted to nicotine and waste your money on something that will probably decrease your quality of life?’
‘SMOKING BECOMES
AN ADDICTION IN MORE
THAN HALF OF PEOPLE
WHO TRY IT AND TWO IN
THREE LONG-TERM USERS OF
TOBACCO DIE. THERE’S NO
OTHER PRODUCT ON THE
MARKET THAT DOES THIS’
According to Cancer Research UK (2023), there is no good evidence that vaping causes cancer. However, it is not risk free, the charity states. Vaping can cause throat and mouth irritation, headaches, coughing and nausea. The charity adds that the long-term effects of vaping are not yet known, and that children and non-smokers shouldn’t use them.
John from ASH says there are now six million vapers in the UK and if vaping caused serious lung problems that would have become evident by now. ‘We would have seen many more hospitalisations for lung conditions,’ says John. ‘Restriction of ingredients applies to the legal vapes that are sold in the UK, but many illegal vapes are being sold too and we don’t know what chemicals are in those, but we do know that some of them are harmful.’
From a public health perspective, Professor West says that vaping can help people who can’t quit smoking using other means. He has a caveat, however: ‘If you’re not a smoker you would be crazy to start vaping because it could still do you harm.
‘Understanding precisely the extent and nature of possible harms from vaping is a key priority for research, as is how smokers can best use them to stay off cigarettes long term,’ Professor West continues.
For instance, researchers who carried out a recent international review said there was a lack of evidence on the mental health impact of vaping on children and that there was an urgent need to address this (Kahn et al, 2023).
And a 2022 study showed impaired blood vessel function among ‘chronic’ users of e-cigarettes [also known as vapes], which put vapers at risk of heart disease (Mohammadi et al, 2022).
NEED FOR VAPING CONTROLS
‘We know that some [illegal vapes] have been found to contain lead, or higher concentrations of nicotine, which make them more addictive,’ highlights John. ‘The worry is that the shops that sell to underage children are also the ones that are more likely to sell illegal vapes.’
School nurse (SN) Ella Hornby says she has heard of students being taken to hospital because they have used illegal vapes that had been adulterated with the illegal drugs spice and cannabis.
‘There’s been a rise in hospitalisations in our area where children have used these illegal vapes and collapsed in school,’ says Ella who is a SN with the Trafford School Nursing Service in Greater Manchester. ‘Some of the local vapes shops are advertising vapes with 2500 puffs in them, which is illegal (the upper limit is 600). These illegal vapes could have absolutely anything in them, it’s so dangerous. When we tell young people about this, they are usually very surprised.’
Ella says some schools have apparently installed vape alarms in their toilets as children used them to vape in class breaks, and were then unable to focus on their work. They then felt anxious due to withdrawal effects and that they needed another vape as a result.
‘I think banning disposable vapes and raising the price will discourage young people taking up vaping, which has to be a good thing,’ says Ella. ‘I think there are definitely more school-age children vaping than smoking at the moment. Somewhere, they’ve picked up the message that it’s healthy.’
Kimberley Garner, a schools health adviser with the Trafford Local Care Organisation, notes: ‘I’ve also heard of young people being able to buy vapes on Uber Eats and on Snapchat and TikTok. There seem to be so many ways to buy them these days. The illegal ones can contain things like weedkiller and nail varnish remover.’
Meanwhile, a survey by NASUWT, the Teachers’ Union (2023), revealed some pupils repeatedly left lessons in order to vape – an issue reported by just over half (54%) of participating teachers. Around one in three teachers said some pupils were struggling to concentrate in lessons due to the effects of nicotine.
GETTING THE MESSAGE RIGHT
‘The hard thing is how to convey the message to young people that vaping is something that is going to be detrimental to them – but obviously not as detrimental as smoking – without exacerbating the current myth circulating that vaping is at least as harmful as smoking,’ says Professor West.
Similarly for John, striking the right balance between the possible harms and addiction aspects of vaping with its effectiveness in helping people quit smoking is vital. It’s a potential minefield for key professionals caring for young people.
‘I think we need some centralised information for [practitioners such as] SNs on vaping,’ says John. We know there are lots of people out there trying to do their best but there are mixed messages, and it is potentially confusing.’
He suspects that some public health campaigns aimed at young vapers in the US risk overstating the dangers of vaping compared to smoking. This may have contributed to a widespread belief among young people that vaping is worse for their health than tobacco smoking. He warns that ‘similar patterns’ have emerged in the UK.
Media scare stories such as myths that vaping causes ‘popcorn lung’ (a type of bronchiolitis which causes scar tissue in the lungs) haven’t helped, says Professor West. The condition was linked to US popcorn factory workers in the US who inhaled a chemical (diacetyl), which was used in e-cigarette production. But the chemical was banned from vapes by EU regulations in 2016 and no confirmed cases of popcorn lung have been linked to vapes (Cancer Research UK, 2024).
Schools health adviser Kimberley recalls that one of her daughter’s friends recently began smoking after having vaped. Apparently, her friend said she hadn’t heard much about the dangers of smoking compared to vaping. It’s a similar point to one raised by a parliamentary research briefing earlier this year, which highlighted the fact that questions are being raised on whether vaping ‘acts as a gateway to smoking tobacco’ (UK Parliament, 2024).
Kimberley concludes: ‘There is definitely a lot of peer pressure. I think this legislation is really needed.’
CPHVA MEMBERSHIP VIEW
CPHVA Executive chair Janet Taylor says she welcomes the Tobacco and Vapes Bill, as it has the potential to save lives and sends a strong public health message.
‘The targeted advertising, flavoured vapes, and colourful packaging directly appeals to young people and indeed children who are unaware of the potential damage to their health.’
Janet, who also works as a nurse manager for children’s services at South Eastern Health and Social Care Trust, Northern Ireland adds: ‘The prohibition of sales of tobacco can only help reduce the uptake of smoking amongst young people and prevent long term addiction.’
WHAT’S YOUR VIEW?
How are you sending the right message on vaping and smoking to young people? What further research or policies would you like to see to help protect young people? Whatever your view or experience, get in touch with editor Aviva Attias aviva@communitypractitioner.co.uk
REFERENCES
Action on Smoking and Health. (2024a) Every day 350 young adults aged 18-25 start smoking regularly. See: ash.org.uk/media-centre/news/press-releases/every-day-350-young-adults-aged-18-25-start-smoking-regularly (accessed 20 August 2024).
Action on Smoking and Health. (2024b) Use of vapes (e-cigarettes) among young people in Great Britain. See: ash.org.uk/uploads/Use-of-vapes-among-young-people-in-Great-Britain-2024.pdf?v=1722505432#asset:236002@1:url (accessed 20 August 2024).
Cancer Research UK. (2024) Does vaping cause popcorn lung? See: cancerresearchuk.org/about-cancer/causes-of-cancer/does-vaping-cause-popcorn-lung (accessed 20 August 2024).
Cancer Research UK. (2023) Is vaping harmful? See: cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/is-vaping-harmful (accessed 20 August 2024).
Department of Health and Social Care. (2024) Department of Health and Social Care. Creating a smokefree generation and tackling youth vaping: what you need to know. See: healthmedia.blog.gov.uk/2024/04/15/creating-a-smokefree-generation-and-tackling-youth-vaping-what-you-need-to-know/ (accessed 20 August 2024).
Department of Health and Social Care. (2023) Chief Medical Officer for England on vaping. See: gov.uk/government/speeches/chief-medical-officer-for-england-on-vaping (accessed 20 August 2024).
Department of Health (NI). (2023). Young persons behaviour and attitudes survey 2022 – substance use. See: https://www.health-ni.gov.uk/publications/young-persons-behaviour-and-attitudes-survey-2022-substance-use (accessed 21 August 2024).
Khan MA, Ahmed S, Sarfraz Z, Farahmand P. (2023) Vaping and Mental Health Conditions in Children: An Umbrella Review. Substance Use: Research and Treatment 17: 2023.
Mohammadi L, Han DD, Xu F, Huang A et al (2022) Chronic E-Cigarette Use Impairs Endothelial Function on the Physiological and Cellular Levels. Arteriosclerosis, Thrombosis, and Vascular Biology 42(11):1333-50.
NASUWT. (2023) Rise in vaping in schools is failure of Government. See: https://www.nasuwt.org.uk/article-listing/rise-in-vaping-in-schools-government-failure.html
NHS Better Health. (2024) Vaping myths and the facts. See: nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/vaping-myths-and-the-facts/ (accessed 20 August 2024).
NHS Digital. (2022) Smoking, Drinking and Drug Use among Young People in England, 2021.
See: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2021/part-1-smoking-prevalence-and-consumption#pupils-who-are-regular-smokers (accessed 20 August 2024).
Prime Minister’s Office. (2024) The King’s Speech 2024. See: gov.uk/government/speeches/the-kings-speech-2024 (accessed 20 August 2024).
Royal College of Paediatrics and Child Health. (2024) RCPCH responds to latest ASH youth vaping data. See: rcpch.ac.uk/news-events/news/rcpch-responds-latest-ash-youth-vaping-data (accessed 20 August 2024).
Smoke Free Sheffield. (2023) Vaping: The Facts. See: smokefreesheffield.org/get-involved/campaigns/vaping-the-facts/ (accessed 20 August 2024).
UK parliament. (2024) Vaping and health. See: https://commonslibrary.parliament.uk/research-briefings/cbp-9933/ (accessed 20 August 2024).
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