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Fresh position statement on e-cigarettes


About this statement


This is an updated version of the position statement first published by Fresh in March 2015, and revised in September 2016, 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


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 12 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.


The Royal College of Physicians' 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."


Latest evidence


We welcome and endorse the findings of the 2018 annual update 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.


Since the report was published, 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.


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


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