The question of how we should respond to electronic cigarettes has divided the public health community. Passionate advocates on either side use the same information to conclude either that these devices could significantly reduce the smoking rate, or could undermine decades of progress in youth smoking prevention. Developing an appropriate response to e-cigarettes is a difficult balancing act.
Yet the rapid growth in e-cigarette use, coupled with the vast ongoing harm caused by tobacco, mean actions have to be taken despite the unknowns. With the Scottish Government soon to introduce its Public Health Bill to the Parliament, steps will be taken to develop a national regulatory framework.
On the one hand, nicotine is highly addictive and long experience tells us to be wary of commercial interests seeking to build a market in addictive products. We cannot expect e-cigarette producers and retailers will be content to service a declining market of existing smokers and refrain from targeting new generations. The big tobacco firms, the market leaders in putting profits before the health of their customers, have all bought into the e-cigarette market, but I am concerned that much of their emphasis is on devices which project the appearance of smoking and seem to be least effective in helping smokers quit. For “Big Tobacco”, cigarettes remain the more profitable option and they will remain keen to sell both. On the other hand, the addictiveness of nicotine, and highly engineered cigarettes which are designed to maximise the nicotine hit, mean that despite much effort and significant progress in Scotland in recent decades, the tobacco companies are still getting their pound of flesh from more than a fifth of Scottish adults, the great majority of whom say that they want to quit.
Some smokers find it easier to quit successfully than expected. Some, often supported by Scotland’s free national stop smoking services and with nicotine replacement products when needed, are able to ease out of their dependency on smoking. But there are some smokers for whom e-cigarettes match the smoking experience closely enough to make these devices an acceptable alternative to lit, smoked tobacco. I’ve heard many anecdotal stories of heavily addicted smokers using e-cigarettes to quit cigarettes, and I am excited by the possibility that these devices could play a role in saving lives.
Our lungs are very sensitive and e-cigarette users inhale more than just water vapour. I cannot see that using an e-cigarette over an extended period will not result in some level of harm. But the toxic cocktail of chemicals in tobacco smoke is so highly damaging that we can be confident that for most people, moving completely from tobacco use to e-cigarettes should bring significant health benefits. Dual use of tobacco and e-cigarettes is less certain, though – even low levels of continued smoking are disproportionately harmful.
The tightrope that legislators must walk in determining how to regulate e-cigarettes is how to stop them being promoted to non-smokers while encouraging existing smokers to give them a try. I believe that the proposals expected in the Public Health Bill can take us some way forward. The Scottish Government proposes a ban on the sale of e-cigarettes to under-18s, supported by a ban on unstaffed vending machine sales, and on adults buying the devices for children. These are important , justified measures with widespread support.
Conversely, the Scottish Government does not propose to ban the use of e-cigarettes in enclosed public spaces. The smoking ban legislation was underpinned by a wealth of evidence of harm to others, evidence which is not there with regards to indoor e-cigarette use. Some forms of advertising, such as on TV or in newspapers, will be banned under a European directive from May 2016. It seems the government has signalled an intention to take powers to regulate local advertising, such as shop windows and billboards, but will consider further before using these powers. Again, this seems like a good balance.
I am concerned at the ubiquitous presentation of e-cigarettes, but appreciate the need to leave space for encouraging existing smokers to switch. It may be that the places tobacco is currently sold are the places stop-smoking advice and products, and e-cigarettes, should be promoted. Perhaps we should be looking at further restrictions on the sale of the more lethal product, tobacco.
I am glad we are finally taking steps towards an appropriate regulation of e-cigarettes, but am aware how much more learning, thinking and discussion we still have to do. As with Scotland’s legislation on smoking, our main aim should be to protect people’s health and to create better choices and environments for our children to grow up in.
• Sheila Duffy is chief executive, ASH Scotland, www.ashscotland.org.uk