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Fresh position statement on e-cigarettes

Our position on e-cigartettes and vaping - for the public and health professionals


This is an updated version of the position statement first published by Fresh in March 2015 which backs a harm reduction approach to helping smokers to quit or to switch to a less harmful product, and aims to encapsulate the latest evidence for both members of the public and colleagues working in local authorities and the NHS.


One in two long term tobacco smokers who don't quit will die from a smoking related disease with an average of 10 years of life lost, and half of those deaths happen during middle age.  Research from Australia suggests that, for heavier smokers who started as children, this figure may be more like 2 in 3. 


This presents an appalling and unacceptable loss of life in the North East, resulting in around 38,000 hospital admissions a year in the region, and in England, where around 80,000 people a year die from smoking. 


Most smokers who die or who lose years of quality life and mobility as a result of tobacco use, will have probably tried to quit smoking several times and probably regret ever starting.


In 1976 Professor Michael Russell wrote that "smokers smoke for the nicotine but die from the tar".  When we urge people to stop smoking, we explicitly mean to quit smoking tobacco.  The harm from smoking is caused primarily through the toxins produced by the burning of tobacco.


By contrast, non-tobacco, non-smoked nicotine products are considerably less harmful. There is now widespread agreement from organisations such as Action on Smoking and Health, Public Health England, Cancer Research UK, the Royal College of Physicians and the Royal College of GPs that, on the basis of current evidence, electronic cigarettes represent a significantly less harmful alternative to cigarettes for smokers who are unable or unwilling to stop using nicotine.


Harm Reduction and reducing smoking to 5% or fewer people


Fresh is uniting partners around a long term vision of reducing tobacco smoking among adults to a prevalence of 5% in the North East, which is endorsed by all Health and Wellbeing Boards in the North East. 


As part of this, more widespread adoption and promotion of evidence-based harm reduction approaches could result in significant health gain across North East communities.  This could be particularly effective in reducing the health burden amongst groups such as people with mental health problems who have higher smoking rates and a much lower life expectancy, smokers who are more addicted, and people with long term conditions such as chronic obstructive pulmonary disease.


North East Vaping Standard for the NHS - download


The North East Smokefree NHS and Treating Tobacco Dependency Taskforce has provided five key recommendations to NHS Trusts aimed at a consistent position around vaping to adopt a harm reduction approach to e-cigarettes and their use within NHS Trust grounds.

This is part of the Taskforce work to implement National Institute for Health and Care Excellence (NICE) guidance on smoking in Acute NHS services by April 2020Regular e-cigarette use among adults has plateaued over recent years, and remains largely confined to smokers and ex-smokers, with 'quitting smoking' the main motivation for adult vapers.

1. Regular vaping among young people remains low in BritainAll Health Care Professionals should routinely discuss smoking with patients, including relative risks of continuing to smoke, and be open to e-cigarette use in patients who are keen to try them.

2. Patients should be advised that e-cigarettes are deemed to be substantially less harmful than smoking and that switching completely from tobacco to e-cigarettes will substantially reduce health risks. Using e-cigarettes without stopping smoking (dual use) does not provide health benefits; anyone who is using both should be strongly encouraged to stop smoking tobacco as soon as they can.

3. E-cigarette use does not meet the legal or clinical definition of smoking and there is no evidence of harm from exposure to second hand Vape. E-cigarettes are almost exclusively used by smokers and ex-smokers to help smokers stop smoking and stay Smokefree. Vapers should not be required to use the same space as smokers. All Trusts should have clear policy as to where e-cigarettes can be used within the grounds.

4. There are no known additional specific risks to charging e-cigarettes– the risks associated with charging e-cigarettes and vape devices should be considered alongside the charging of any other battery-operated device such as a mobile phone.

5. Patients should be advised that 'Heat-not-Burn' products contain tobacco, so are not recommended and use of these products should not be allowed on NHS premises and grounds

Useful blogs have been written by Public Health England outlining the report's key questions and findings, and Cancer Research UK, highlighting the concern that misconceptions about e-cigarette safety might be stopping smokers using them to quit.


National Evidence


Royal College of Physicians


The RCP report in May 2016 'Nicotine without smoke: tobacco harm reduction' examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine.  The RCP's recommendation was that "in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK."


Public Health England: 


March 2018 -  Fresh endorsed the findings of Public Health England's e-cigarette evidence review on e-cigarettes and heated tobacco products. These findings were


  • e-cigarettes are the most common quitting aid for smokers in England.
  • Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial short-term, and is likely to deliver long-term health benefits. One assessment of the published data on emissions from cigarettes and e-cigarettes concluded that the cancer potencies of e-cigarettes were largely under 0.5% of the risk of smoking.
  • E-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more.
  • E-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country.
  • Many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette.
  • There is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine).
  • The use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million.
  • The evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked). E-cigarette use among never-smokers in GB remains very rare at less than 1%, similar to the level of use of nicotine replacement therapy.  Most e-cigarette trials do not become regular use.
  • The most common reason for e-cigarette use continues to be in order to stop smoking, and smokers who use e-cigarettes on average have higher motivation to stop smoking than other smokers.
  • To date there have been no identified health risks of passive vaping to bystanders.  There is no side-stream vapour emitted from the end of an e-cigarette, just the exhaled aerosol entering the atmosphere.
  • In 2019 Public Health England updated this review:


Feb 2019 - Public Health England published the latest update to its evidence on e-cigarettes: Vaping in England: an evidence update February 2019. This provided important context for discussions about their role in smoking cessation.


The findings show that while experimentation with e-cigarettes among young people has increased in recent years, regular use remains low. Only 1.7% of under-18s use e-cigarettes weekly or more, and the vast majority of those also smoke. Among young people who have never smoked, only 0.2% use e-cigarettes regularly.


Regular e-cigarette use among adults has plateaued over recent years, and remains largely confined to smokers and ex-smokers, with ‘quitting smoking’ the main motivation for adult vapers.


Fresh, through the Making Smoking History in the North East Partnership, held an evidence update session in February following publication of the report and presentations from the event can be found on our website.


E-cigarette use in the North East (awaiting 2019 update)


We have two sources which give us useful indications on the extent of e-cigarette use in the North East. 


1. Smokefree Survey - independent survey on behalf of ASH by by YouGov (2018):

  • An estimated 18% of adults in the North East have tried electronic cigarettes.
  •  An estimated 6% of adults have tried and still use them.


2. North East Illegal Tobacco Survey by NEMS (2017):

  • Three-fifths of current e-cigarette users were smoking no tobacco.
  • For every one in two recent quitters, e-cigarettes have played some role in the quit attempt.




There is an increasing range of materials and resources to assist the development of evidence-based policies on the use of electronic cigarettes in public places and workplaces, and a range of materials for healthcare professionals on what advice to give to patients.  These include:


E-cigarettes: a guide for healthcare professionals from the National Centre for Smoking Cessation and Training


The Smoking in Pregnancy Challenge Group briefing on e-cigarettes


The Mental Health Challenge Group briefing on e-cigarettes


The Royal College of General Practitioners statement.


Fresh has also set up a dedicated section for electronic cigarettes within the North East Smokefree NHS/Treating Tobacco Dependency Knowledge Hub.


Future review


This is a rapidly evolving area of tobacco control and Fresh is committed to monitoring emerging evidence and research and will update this position statement as appropriate.


For any queries, please contact