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expert reaction to us surgeon general’s report on e-cigarettes and young people

The U.S. Surgeon General has published a report on e-cigarette use among youth and young adults.


Prof Kevin Fenton, national director of health and wellbeing at Public Health England, said:

“We recognise the concern about youth uptake of e-cigarettes in the US where establishing regulations, especially on marketing has been difficult. The position in the UK is very different. We have comprehensive regulations in place including a ban on selling e-cigarettes to under-18s and tough restrictions on advertising, as well as minimum standards for safety, maximum nicotine levels and health warnings on packs.

“Our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year. No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence.”


Prof Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL), said:

“The UK Royal College of Physicians published its ground-breaking report Smoking and Health in 1962. The US Surgeon General Report followed two years later and replicated the findings and recommendations. Things are very different this time. The RCP report on e-cigarettes published earlier this year identified vaping as a great public health opportunity. The new US report on e-cigarette use among youths portrays vaping as a threat to public health. Which one is right?

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers. The prevalence of smoking among young people is at all time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. On-going vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike.  The report also ignores the huge benefits of vaping for adult smokers who are switching from deadly smoking to much less risky vaping in large numbers.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate.”


Prof Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, a multi-agency group set up to support action to reduce smoking in pregnancy , said:

“This report mentions the issue of e-cigarette use in pregnancy, stating that nicotine delivered by e-cigarettes can affect fetal and post-natal development including causing sudden infant deaths (SIDS) and obesity in children.

“This is a fundamental misunderstanding of the evidence and leaps from studies in mice and rats to what might happen in humans. We know Nicotine Replacement Therapy is safe – a recent study from the University of Nottingham found no adverse impact on the children of mothers who used it in pregnancy and followed up these infants until they were two years old. The evidence on sudden infant deaths primarily relates to the tobacco smoking in pregnancy which is hugely harmful and is one of the main causes of SIDS. To conflate this with e-cigarettes is inaccurate.

“The priority must be to support pregnant women to stop smoking both for the sake of their own health and that of their child. While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations. Clinicians and others could be concerned by this report from the USA and be more hesitant about discussing Nicotine Replacement Therapy and e-cigarettes with pregnant women who smoke as a result. That would be harmful to maternal and child health and must be avoided. “



Declared interests

Prof Hajek received researcher funding from and provided consultancy to manufacturers of stop-smoking medications. He has no links with any e-cigarette manufacturers. His research into e-cigarette safety and effects has been funded by NIHR, PHE, UKCTAS and MHRA.

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