In the last couple of years, negative media stories have fueled a debate about whether vaping is an appropriate product for adult smokers to use, and there have been regular stories about the “safety” of vaping in the press. This is despite the fact that using an e-vapour product from a reputable manufacturer is relatively less harmful than smoking cigaretters, based on the vastly reduced toxicant load from inhaling e-vapour aerosol compared to cigarette smoke.
Public perceptions of vaping
Public attitudes to vaping are changing for the worse in response to ongoing negaive media coverage. Data suggesting that the worldwide population is becoming more skeptical about vaping over time. In the US, the respected Tobacco Products and Risk Perceptions Survey results showed that the proportion of adults who perceived e-cigarettes as less harmful than cigarettes declined from 39.4% in 2012 to 33.9% in 2017. This decline came before the emergence of the widely publicised EVALI (E-cigarette or vaping product use-associated lung injury) in the US in 2019. The Centre For Disease Control and Prevention now recognises that EVALI was not caused by nicotine vapes available on the high street, but by inhalation of illicit cannabis-derivative vapour products that contained harmful additives sold through illicit and informal channels.
Nevertheless, the headlines around EVALI have probably contributed to even more people believing vaping is as harmful, or more harmful, than smoking. The latest polling shows that 50% of Americans believe vaping should be banned outright for adults, while 77% believe non-tobacco flavours should be banned. Despite this, the science on vaping is well-established and unambiguous.
The concept of ‘relative risk’
No reputable vaping brand like blu claims its products are “harmless” or that they should be used by anyone other than existing adult smokers. For an individual adult smoker the best health outcome will always be to stop smoking altogether. However, relative to the risk of continuing to smoke cigarettes, the scientific evidence shows that an adult smoker would reduce the risk to their health by switching to vaping.
The well-publicised Public Health England statement that vaping is at least 95% less harmful than smoking cigarettes needs to be communicated to adult smokers to restore their confidence in vaping. The basis for this 95% claim is that most of the constituents of cigarette smoke that are recognized as causing harm are either not present in e-vapour aerosol or present at levels well below those in cigarette smoke. Multiple scientific studies of vapour toxicity compared to cigarette smoke toxicity have confirmed this. This evidence underpins the concept of tobacco harm reduction, and many public health practitioners around the world now encourage adult smokers to switch to potentially less harmful products, like vaping, because they believe this will lead to better population-level health outcomes.
In light of the factual underpinning of vaping’s role in tobacco harm reduction, it is essential to note that most of the science used to criticise vaping is based on the identification of potentially harmful constituents in e-vapour without any comparison with cigarette smoke and therefore ignore the concept of ‘relative risk’.
For example, formaldehyde is classified as a carcinogen, and is found in e-vapour aerosol. This has lead to alarming media headlines like “Cancer-causing agent in e-cigs” without the article explaining that the concentration of formaldehyde is found in e-vapour is at much lower levels than in cigarette smoke, and that formaldehyde is also frequently found in fresh air. The health implications of formaldehyde exposure at very low concentrations are likely to be insignificant, but this level of detail and context is rarely explained.
Ignoring relative risk leads to confusion
Ignoring relative risk when talking about vaping creates confusion among adult smokers, the media and inevitably across the broader population. This confusion damages the vaping category, and it is hoped that with the help of public health authorities worldwide and responsible journalism, we can reverse this through clear, fact-based communication explaining the relative risk of vaping verses continuing to smoke cigarettes. Such a reversal would help more adult smokers understand that there are alternative nicotine products available that represent a better personal choice than smoking.