What You Need To Know About Vaping

    "All the evidence we have is that e-cigarettes are far safer than tobacco."

    Kelly Oakes
    by Kelly Oakes

    BuzzFeed Staff, UK

    Later this month new regulations around e-cigarettes come into force in the UK. Figures from last December, the latest available, show that e-cigarette use in people trying to quit smoking is on the increase, although overall growth in e-cigarette use has slowed. Meanwhile, there's been a lot of conflicting information floating around about the possible harms and benefits of vaping.

    So to clear up some myths and misconceptions, here's what we know and what we don't know about e-cigarettes.

    What are the main differences between e-cigarettes and tobacco ones?

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    Electronic cigarettes contain a liquid that is heated to form an aerosol, which you then inhale. They give you a nicotine hit, like conventional cigarettes, but they don't contain tobacco. They're generally thought of as safer alternatives to normal cigarettes because of this.

    There are different kinds of e-cigarettes: Older versions tended to look like traditional cigarettes, and come in disposable and rechargeable models, but newer ones are rechargeable "tank" models, aka vape pens, which have to be filled with e-liquid.

    What will change once the new rules come in?

    The new regulations require e-cigarette packaging to be childproof, and for e-cigarettes to provide a consistent dose of nicotine and be refillable without leaking. They also limit the size of e-liquid cartridges to 2ml and the maximum concentration of nicotine allowed in an e-liquid to 20mg/ml. E-cigarettes and liquids with higher nicotine levels than that will need to be licensed as medicines and will be regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA)

    Do they actually help you stop smoking?

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    The short answer is: Yes, they probably do, although we don't a ton of evidence so far that proves it.

    Last year the Cochrane collaboration published a review of evidence looking at whether e-cigarettes can help someone stop smoking, and if they are safe to use for that purpose. Cochrane reviews take all of the studies published on a specific health topic and work out what conclusions can be drawn about the effect of a treatment.

    For e-cigarettes, they found 13 studies, two of which compared e-cigarettes containing nicotine to those not containing nicotine. The remaining 11 trials couldn't be used to compare e-cigarettes with anything else, so aren't as useful in working out how good e-cigarettes are at helping someone quit smoking.

    The two trials showed that using an e-cigarette containing nicotine increased someone's chances of stopping smoking in the long term, and also helped smokers reduce the amount they smoked, compared to using an e-cigarette without nicotine.

    "That Cochrane review came out saying there was a small amount of evidence to say that e-cigarettes help people stop smoking," Ann McNeill, a professor of tobacco addiction at King's College London, told BuzzFeed News. "Obviously we need more research, but that was very positive."

    Can I get one on the NHS to help me stop smoking?

    One e-cigarette in the UK has been given a medical licence already, meaning its manufacturer, British American Tobacco, can advertise and sell it as a device that helps people stop smoking. The company says it plans to launch the licensed e-cigarette, Voke, in the UK later this year.

    The licensing paves the way for it to be prescribed on the NHS, although before that can happen the National Institute for Health and Care Excellence must rule that the device provides value for money.

    Aren't they just as bad as actual cigarettes, though?

    Dan Kitwood / Getty Images / Sian Butcher / BuzzFeed

    Nope. A report published by Public Health England last August (for which McNeill was an author) concluded that vaping was at least 95% less harmful than smoking.

    That report was criticised in an editorial published in the Lancet medical journal that claimed the 95% figure came from a single study that was funded by organisations with links to the tobacco industry. The authors hit back at that criticism, explaining how they got to the figure.

    Linda Bauld, a professor of health policy at the University of Stirling, told BuzzFeed News that because of the criticism she doesn't quote that exact figure in public talks, but said it's "in the right ballpark".

    Either way, we can be pretty confident that e-cigarettes are much less harmful than tobacco. "All the evidence we have is that e-cigarettes are far safer than tobacco," says Bauld. "They're not risk-free, but the magnitude of risk is going to be small compared to tobacco, which is really deadly."

    Are there any ways in which e-cigarettes are worse than traditional ones?

    Some of the harmful constituents of cigarette smoke are present in vape too – but all the evidence so far shows that they're present in smaller quantities.

    "Cigarette smoke contains about 7,000 constituents and about 70 are known to cause cancer," said McNeill. "E-cigarettes have a much smaller number of constituents – it's largely glycerin, propylene glycol, nicotine, and flavourings."

    The Public Health England report from last year says that when overheated, e-cigarettes can release high levels of chemicals called aldehydes, formed when oxygen reacts to alcohols. But, crucially, aldehydes are also released in tobacco smoke. The two studies cited by the report found aldehydes were released in much lower levels during vaping – between one-fiftieth and one-sixth of that found in cigarette smoke. On top of that, if you ever tried to vape at a temperature high enough to release these chemicals, you'd get a harsh, bitter taste – what vapers call a "dry puff" – that would alert you immediately.

    Because e-cigarettes are relatively new products, we don't know much about their long-term health effects. And there are other unknowns, like what happens to the flavourings used in some e-liquids when they're heated and inhaled.

    A report from the Royal College of Physicians published last month said: "Although no study so far shows any clear hazards of flavours in e-cigarette vapour, those derived from flavours seem the most likely to pose appreciable health risks from long-term use."

    "We need to keep an eye on the products and how they're made, and if we can make them even less harmful," said McNeil. "But smoking is the most dangerous thing people can do, so [e-cigarettes] hold much lower risks in comparison."

    I don't smoke but I want to try an e-cigarette. Is that a bad idea?

    Press Association / Sian Butcher / BuzzFeed

    "For anybody who doesn't smoke, they should't use e-cigarettes," says McNeill. "The clear message should be to use e-cigarettes to stop smoking."

    There are no benefits, but there are potential harms, if you take up vaping for a reason other than stopping or decreasing your smoking. Nicotine is highly addictive, so if you start regularly using an e-cigarette containing nicotine, you might become addicted.

    Isn't there evidence that vapers go on to smoke tobacco products later?

    Some studies have claimed e-cigarettes are a gateway to tobacco, but when you look closely at the evidence, it's not so clear.

    "The trouble is the people who are most likely to experiment with e-cigarettes are also the people who are most likely to experiment with cigarettes," says McNeill. "Studies that show that somebody uses an e-cigarette and then goes on to smoke don't necessarily show that it was the cigarette that caused them to smoke. They may have just been more likely to take risks anyway."

    And the numbers of people who have never smoked and use e-cigarettes is very low to begin with. The most up-to-date statistics we have on smoking in the UK show that less than 0.5% of adults who have never smoked use e-cigarettes. That's roughly about the same proportion of adult never-smokers who use other nicotine replacement therapies, like gum (which apparently is a thing some people do).

    Will e-cigarettes lead to more children and young people taking up smoking?

    Sian Butcher / BuzzFeed

    One nail in the coffin of the suggestion that e-cigarettes might be causing more young people to take up smoking is that we've actually seen smoking rates go down in the UK, even after e-cigarettes came on the market, says McNeill.

    "If you see the figures from the US, it looks like there are thousands and thousands of teenagers using e-cigarettes and there's this huge panic, but actually we've done really careful analysis here in the UK," Bauld told BuzzFeed News.

    "The Americans are right in that there's a lot of experimentation going on. Around 12 to 15% of UK teenagers have tried an e-cigarette, but the levels of regular use are really low, they're around 2 to 3%. When you look at this 2 to 3% almost all of them are already using tobacco. So we're not seeing e-cigarettes as a gateway to a new form of addiction."

    Ideally, if a young person has never smoked, we'd never want them to try an e-cigarette, says Bauld. The age of sale law that's been put into place (since October 2015 it's been illegal in England and Wales to sell e-cigarettes to people under the age of 18), and the marketing restrictions that are coming in with the new regulations at the end of this month, will play a part in making e-cigarettes less attractive and less easily available.

    Are there any harms from second-hand vapour?

    Press Association / Sian Butcher / BuzzFeed

    When somebody smokes a tobacco cigarette there are two types of second-hand smoke. There's the smoke they exhale and the smoke that comes off the burning tip of the cigarette – the latter is about four times more toxic. With vaping, you don't get anything coming off the end of an e-cigarette – so the only second-hand vapour is what people exhale.

    "It's nowhere near as harmful as second-hand smoke," says Bauld. "There is nicotine that's released into the ambient air, but nicotine in the air or on surfaces is basically largely harmless." (One example she says her colleague gives is that you would have to lick a 30 square metre area of floor to ingest just one milligram of nicotine, if someone was vaping around you.)

    As for the other components, she says, they can be unpleasant if you're around someone who vapes all the time, but there's no substantial health risk. "There are things like metals that are released, and there's also small particulate matter," says Bauld. "It's probably a bit like being in a room where there's a lot of air fresheners being used, or scented candles."

    Should e-cigarettes be banned in public places, like smoking has been?

    Sian Butcher / BuzzFeed

    "The UK's taken a really different view on this to other countries," says Bauld. "Many US states have decided to ban vaping in all public places, and they've just amended their tobacco control laws to include e-cigarettes."

    In the UK, some companies have chosen to ban vaping on their premises, but as of yet there's no widespread ban like there is with smoking. Earlier this year a bill that would have banned e-cigarettes in some public places in Wales failed to make it through the Welsh assembly (although it was a political disagreement that led to the bill's downfall, rather than any arguments scientists had made). Bauld says that's a good thing: "It's not an evidence-based policy."

    There's a possibility that bans could nudge ex-smokers into relapsing. "I think the danger with that is that if you force people who use e-cigarettes to go outside where smokers are congregating, they'll be in a position where they could relapse to smoking," says McNeill. "I'm not saying that everyone should be allowed to vape wherever they want to – people should be respectful of those around them – but there are some dangers if you just put [e-cigarettes] into smoke-free laws."

    The's also the worry that by banning vaping in the same places that smoking is banned, it sends a message that they are basically the same – and, when it comes to health impacts, they are clearly not. "They're very different products," says McNeill. "What we're trying to get across is the relative risks of the two products. We're not saying e-cigarettes are safe, but they're much less harmful."