Health and Care Services

The e-cigarette debate in Wales

12 March 2014

Article by Sana Ahmad, National Assembly for Wales Research Service

A report published by the Public Health Wales Observatory in 2012 shows that smoking continues to be the single greatest cause of avoidable mortality in Wales – with 23 per cent of people aged 16 and over describing themselves as smokers. It has been estimated that smoking costs NHS Wales around £1 million per day, which is seven per cent of total expenditure on healthcare and causes around 27,700 hospital admissions in people aged 35 and over each year.

Image from Flickr by Lindsay Fox. Licensed under Creative Commons.
Image from Flickr by Lindsay Fox. Licensed under Creative Commons.

The latest trend has seen the introduction of the electronic cigarette, often referred to as an ‘e-cigarette’. It is made up of three parts:

  • a battery-powered heating element
  • a cartridge containing a solution with nicotine, propylene glycol or glycerine and water, additives and flavourings
  • an atomiser that vaporises the cartridge contents when heated.

In its pure form, nicotine has shown to be less harmful in comparison to using it with tobacco, however nicotine is the substance responsible for addiction. The use of an e-cigarette through inhaling vaporised nicotine (often known as ‘vaping’) is currently the subject of an ongoing debate. It gives rise to the question: does vaping play a role in the reduction of smoking or is it causing the renormalisation of smoking in Welsh society?

Surveys show that users of e-cigarettes have reported less breathing difficulties, more nicotine control, dramatic reduction in cigarette consumption and the use of vaping as an aid to reduce and quit smoking. Although initial studies show that e-cigarettes deliver lower levels of nicotine and are generally less harmful than tobacco, it’s too early to be sure as research in this area is presently limited.

Some criticisms of e-cigarettes include: mouth and throat irritation caused by propylene glycol, flaws in labelling and design, lack of warnings and information, poor shelf life and even cancer causing substances such as nitrosamines. The overall evidence for the effectiveness of e-cigarettes as a quitting aid is again limited.

E-cigarettes are currently regulated according to EU Directives and national Acts relating to general product safety.  Medicinal regulation would allow health professionals to recommend and prescribe them, promote access to other quitting tools and ensure minimum standards of safety. However, many public health experts argue that e-cigarettes should not be regulated as medicines, but instead be included within the same sphere as tobacco, as they are recreational consumer products – not medicines. Following agreement of draft European legislation in December 2013, e-cigarettes will be considered consumer products unless companies choose to licence them with the Medicines and Healthcare Products Regulatory Agency (MHRA) as medicinal products.

E-cigarettes are not covered by the smoking ban but several councils, schools and businesses across the UK have banned them; reasons given included intrusiveness and difficulties with enforcement. Public attitude seems divided as awareness about e-cigarettes is not widely known among the non-smoking population compared to current or ex-smokers. Some local health boards have also banned their use across all of their sites.

Assembly Members have backed a Supplementary Legislative Consent Motion on the Children and Families Bill to ban the sale of e-cigarettes to anyone under the age of 18, due to increased fears that they encourage teenagers to take up smoking.

Although there is a general consensus that e-cigarettes are likely to be less harmful as opposed to tobacco, at the moment there is no evidence to show that vaping really is a helpful tool to quit smoking – more research is needed and the debate continues. 


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