Executive Summary: British Medical Association report on the science behind e-cigarettes

Last fall, the British Medical Association (BMA) released a report titled, E-cigarettes: Balancing risks and opportunities, which looked at the scientific research on the health effects of electronic cigarettes and made numerous policy recommendations. The report focused on three main areas: “reducing tobacco-related harm; ensuring children and young people do not use e-cigarettes; and protecting bystanders.”

Safety

Overall, the BMA acknowledges that there are “clear potential benefits” to using e-cigarettes to reduce “the substantial harms associated with smoking” and that e-cigarettes “have the potential to make an important contribution towards the BMA’s ambition to achieve a tobacco-free society, leading to substantially reduced mortality from tobacco-related disease.”

According to the BMA, there is a “growing consensus that using an e-cigarette is significantly less harmful than smoking tobacco” and the “short-term risks associated with e-cigarette use appear minimal.” The BMA notes that although long-term exposure to nicotine vapour is not risk-free, “several reviews have concluded that it is substantially lower than inhaling tobacco smoke,” as it is is the tar and other carcinogens in tobacco smoke, not the nicotine, that results in most of the harms caused by smoking. The BMA cites numerous other British public health organizations that concur with this assessment, including:

  • Public Health England, which concluded in a 2015 report that vaping is 95% less harmful than smoking;
  • NHS Health Scotland, which released a statement in 2017 that was supported by a number of health organizations, saying that e-cigarettes are “definitely less harmful than smoking tobacco”; and
  • the Royal College of Physicians, which released a report in 2016 that found that “the hazard to health arising from long-term vapour inhalation is unlikely to exceed 5% of the harm from smoking tobacco.”

Effectiveness for smoking-cessation

The BMA found that a “significant number” of smokers are using e-cigarettes to quit smoking. In the U.K., a recent survey indicated that 34% of people trying to quit smoking are using e-cigarettes and numerous studies in the U.S. and the U.K. have found that the increased prevalence of e-cigarettes is associated with more people successfully kicking the habit. The BMA concluded that:

  • e-cigarettes are “the most popular device used in attempts to stop smoking”; and
  • most “studies demonstrate a positive relationship between e-cigarette use and smoking cessation.

Ensuring young people don’t use e-cigarettes

Questions about whether e-cigarettes are a gateway to youth smoking is of significant concern to policymakers around the world. However, the BMA found little evidence to support this hypothesis. It concluded that although “experimentation with e-cigarettes is increasing in the UK, few children are becoming regular users of e-cigarettes” and that “almost all” of those who do use e-cigarettes are former smokers. It also found that, “Current data on e-cigarette use and smoking does not support concerns that e-cigarettes will promote tobacco use among children and young people. Youth cigarette smoking has declined over the period of time that e-cigarettes have become increasingly available.”

Protecting bystanders

Many public health advocates have also expressed concerns about the risks of second-hand vapour, but the BMA found that those worries “have not been supported by the evidence,” which indicates that “the level of exposure to the constituents of e-cigarette vapour for bystanders is extremely low, and does not pose specific health risks.” In terms of fears that e-cigarettes will undermine existing tobacco-control efforts, the BMA said that the data “does not support concerns that e-cigarettes are re-normalising cigarette smoking.”

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