Are fears about the impact of vaping on young people justified?

While many shops on the high street struggle, one type of retailer is bucking the trend – vape shops. Vaping or e-cigarette use has risen dramatically over the last decade, up from an estimated 800,000 users 10 years ago, to 4.3 million this year.

Unlike other businesses, there is a logic to vape outlets having a high street presence. Customers want to try various products before they part with their cash, which is not something they can do satisfactorily online.

The rising popularity of vaping has been accompanied by a decline in cigarette smoking, something to be celebrated given the health harms caused by smoking. It is perhaps the greatest public health achievement after the provision of clean water introduced by the Victorians.

Despite some suggesting otherwise, the scientific evidence clearly supports the health benefits of cigarette smokers swapping to vaping. However, that doesn’t mean vaping is risk-free. There has been growing concern about the risks of vaping for young people. The most obvious of these is that some young people will never have smoked conventional cigarettes, so their introduction to nicotine is via vaping.

Nicotine is highly addictive, meaning that it doesn’t take much exposure before physical and psychological dependence develops. Vaping also contains many more chemicals than just nicotine, and it is these additional substances that present a health risk to all vapers, including young people.

It is illegal in the UK to sell e-cigarettes containing nicotine to anyone under the age of 18, and responsibility for enforcing the law falls within the remit of trading standards. This is not a branch of local government that has fared well since the cuts to public services that started in 2010, reducing their ability to act even when breaches are reported.

An insight into just how impotent enforcement has been is revealed in a survey conducted by Action on Smoking and Health (ASH) which found that 47 per cent of 11-17 year olds had purchased vaping products from shops, while only 10 per cent had done so via the internet.

The rising popularity of vaping, along with the ease with which young people can obtain products, has made some commentators put two and two together to make five. There has been no shortage of scare stories about the way young people are impacted by vaping – for example, suggestions that vaping serves as a gateway into traditional cigarette smoking.

Alas, as with the theory that cannabis serves as a gateway into heroin use, the data simply doesn’t back either of these routes. Given the numbers of young people who vape or, come to think of it, use cannabis, we’d have millions of young people taking up smoking and using heroin – which thankfully we don’t.

Where there is uncertainty is over the long-term impact of vaping on young people’s health. As with traditional smoking, it can take decades before the harms to health emerge. Given the relative novelty of vaping, it could be at least another decade before we know with any certainty what the health risks of vaping from an early age are.

All we currently know is that some young people will develop asthma or other respiratory problems from regular vaping, but fortunately, there are far more young experimental vapers than hardened and committed ones.

The answer to exploring the health risks are not to be found with adult vapers either. There are some obvious problems with trying to explore the health risks in a group that will have made the switch from smoking to vaping. It is difficult – if not impossible – to attribute emerging health problems they experience to vaping, given their personal history of tobacco use.

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Perhaps the best-kept secret resource for gathering and publicising information about the adverse effects of vaping is the Yellow Card scheme, provided by the Medicines and Healthcare Regulatory Agency (MHRA). This allows anyone to report side effects of using e-cigarette products in the same way they might report the adverse effects of a medicine.

The information is collated and then made available to anyone who is interested. This is potentially a rich source of information but for the fact that few people know about the Yellow Card scheme and even fewer contribute to its bank of data.

Overall, vaping has been a public health triumph in helping to reduce the number of people who might have died prematurely or developed life-changing illnesses due to smoking. While vaping is safer than smoking, we still don’t know how much harm it may cause in the long term. Until that smoke clears, we should be careful about making any assertions about the harms of vaping. Not least because if you remember your teenage years, the things that sounded risky had an attraction – particularly if it was older people warning you against them.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York