Briefing on the science and policy of e-cigarettes and vaping

Welcome to this briefing on e-cigarettes, vaping and public health: a summary for policymakers – now with translations in French and German. Here is the table of contents:
Table of contents

Version 3 Updated 27 February 2015

Intended users. This briefing has been produced to assist consumers, businesses, public health advocates and open-minded researchers in understanding and communicating the science and policy issues arising from e-cigarettes and vaping. It takes a positive but evidence-based approach to vaping and ‘tobacco harm reduction’.

Intended use. I hope it will be used to persuade law-makers, regulators, media and public health to taken an enlightened approach to these innovations. If you wish to use this for advocacy purposes, you do not need permission – the PDF is freely available, though I welcome feedback if you are using it.

logo-adobe-pdf E-cigarettes, vaping and public health: A summary for policy-makers

I have also made the editable version in Microsoft Word available. If you wish to create you own briefing or modify this to your own circumstances, please do.

Microsoft_Word_logo E-cigarettes, vaping and public health: A summary for policy-makers

En Français. Briefing pour les décideurs et les politiques – Traduction AIDUCE : Les cigarettes électroniques : un résumé pour les décideurs.

In Deutsch. Grundsätze zu E-Zigaretten und wissenschaftliche Informationen, ins Deutsche übersetzt IG-ED… Die Politik, die Wissenschaft und die E-Zigarette bzw. das Dampfen– Eine Zusammenfassung für Entscheidungsträger

Authorship: If you do use this to create your own briefing, I would be grateful for acknowledgement and a link back to this page.  If you wish to modify this and list me as a co-author, I will need to see and agree to any final text.

Feedback: I hope you find this useful.  Please provide feedback, especially if there is anything you find wrong or unsatisfactory or where there is scope for improvement and please make suggestions for future versions.  Please use comments below to comment publicly or the contact form to contact me directly.

34 thoughts on “Briefing on the science and policy of e-cigarettes and vaping”

  1. At the top of page 8, in the first paragraph, the line ” There is a simple protective measure available: to insist on tamper resistant packaging, for which there is an ISO standard” appears to actually refer to child-resistant, rather than tamper-evident packaging. Tamper resistant packaging would presumably make it difficult for adult consumers to open, which might be unhelpful!

  2. The chart on page 11 (3.2.3 Gateway effects) should be printed and carried by any and EVERYone who has to fight the “gateway effect” argument among the public. Thank you so much for making this accessible and useable!!!!

  3. 1.2 E-cigarettes first emerged first in China,which is still the largest manufacturer by far, with increasingly sophisticated plant and designs.

    Would read better: E-cigarettes first emerged first in China,which is still
    the largest manufacturer of hardware by far, with increasingly sophisticated plant and designs.

  4. Page 5, a typo: Royal Collage of Physicians
    I smiled as I pictured that.

    And – thanks for this and all you do.

  5. will this report be translated in french or is it worth for me tu translate it for french users ?

  6. Thank you posting this useful information and actively posting content regarding e-cigarettes :) I have recently created a website to encourage more people to give up smoking and make finding ecig and vaping shops more accessible in the United Kingdom at http://www.ecigdirectory.co.uk – hope you don’t mind me posting the link.

  7. Hi clive, (sorry for my bad English language)

    I am sorry but i do not agree with you at all about DIY … You wrote that DIY is for you a DANGER like black market is a DANGER !

    No no no 1000 times no !

    DIY is the best way (the only one ? )to keep smokers and vapers far away from all nefast and addictive products that Big Tobacco will put in the future in e-liquide or locked caps from cigalike. The best way because with diy, vapers keep the control about the contents.

    I totally respect all what you do for Vape but on this point i think you are wrong.

    Zecat
    alias VulgusPecus Vapotus

    1. Hi Zecat

      Your English is just fine… thanks for contributing.

      I raise the point about DIY because it is likely to be an unintended self-defeating consequence of over zealous regulation, and therefore from the perspective of the regulator it provides a limit on how burdensome their regulation can be before consumers defect and do their own thing. The European Commission, FDA etc need to consider this seriously: pretending that you have a highly regulated market when many people simply ‘defect’ and avoid the regulated products is just poor regulatory practice.

      I personally have no objection to DIY – I would hope a lightly regulated consumer focussed market would make it largely unnecessary. But if it helps some people stay in vaping then any risks are worth accepting.

      I have the same view of the black market – I am glad that Canadians and Australians have access to much safer ways to take nicotine than smoking, despite the efforts of their public health advocates and regulators to reserve the nicotine market for the cigarette trade.

      Clive

  8. Thanks for the answer Clive

    But DIY is not only a consequence of regulation. DIY is also the result of :

    – Need to have a best economic approach (Tobacco costed us 400 euro / month, “classic” vape made it 80 euro per month, DIY then made it 20 euro per month … for 2 vapers). That means 720 euro per year between classic and diy …

    – Need to keep an absolute control about the content. Of course we have no control about flavors contents wich is in my mind the only critical point (specially with natural flavor). So what has to be more regulated is not DIY which is not a danger but only flavors have to be regulated.

    – Need flexibility about nicotine % and / or flavor density and / or PG-VG %.

    And what is good for the earth : DIY is very ecologic (no plastic bootles in the trash …) ;)

    It is for all these reasons that i have been hurted to see DIY and Black market putted on the same plan …

    Anyway, I note that : “I personally have no objection to DIY – I would hope a lightly regulated consumer focussed market would make it largely unnecessary. But if it helps some people stay in vaping then any risks are worth accepting.” …

    Cool, i can keep my 600.000 mg in freezer :) <– It is my teasing face ;)

  9. Sorry, i forget the conclusion :

    What is “unintended self-defeating consequence of over zealous regulation” is not DIY … It is large stocks of DIY but not diy ;)

  10. Hello Clive
    Sorry for my poor english writting but i am a french vaper too:)
    First and foremost, i would like to thank you for your well-documented article.

    But i have to react about what you wrote about the DIY….
    I quote : “There is significant risk that loss of broad flavour categories will cause relapse among e-cigarette users, fewer smokers switching, and development of DIY and black market flavours – which may be more dangerous”
    I really do not understand why DIY may be “more dangerous”. More dangerous than??
    My home-made e-liquids are safe (even safer than some commercialy-purchased liquids !), but i must confess that there are harmful to Big Tobacco and Big Shops :)
    Doing one’s own e-liquid is not like making a black market! Black marked (one of the TPD’s consequences) is a threat but DIY is not a threat for people’s health.
    To get rid of cigarette addiction, DIY is more efficient than commercialy-purchased liquids because it is less expansive (smokers are “poor” because of cigarettes price) and allows to decrease the rate of nicotine more gradually.
    In France, regulation means rules and prohibition !
    Vaping is not only a market, it is the best way to protect smokers’ health ! The cheaper vaping is, the more efficient it is to fight against tobacco addiction!
    Best regards
    A vaper from France

    1. I also do not understand the expression : “development of DIY” because TDP is aimed to threaten the pratice of DIY by prohibiting the nicotined-e-liquid sale in bottles over 10 ml , as well as more than 20 mg / ml.

  11. Maybe a typo?

    Section 4.3.3:

    “This legislation was designed with the primary purpose of slowing innovation and creating burdens for the CIGARETTE manufacturers […]”

    Shouldn’t it read “[…] for the E-CIGARETTE manufacturers […]”?

    1. No, it’s correct. It refers to tobacco regulation, which is designed to prevent innovation or proliferation of tobacco cigarette products. The point is that this law has no relevance to non-tobacco products such as ecigs.

  12. Regarding the mice study, IMHO the best response is Berd Mayer’s. He points out that it is already well known that nicotine impairs immune function in mice, however there’s no evidence of this being the case in humans.
    http://www.bernd-mayer.com/electronic-cigarettes-airway-infections-update/

    Furthermore, the lead author admitted in a response to a comment that the results possibly attributable to nicotine alone, “my guess is that nicotine is a significant contributor to the altered immune response, but there could be other components as well.”
    http://www.plosone.org/annotation/listThread.action?root=85423

    The effects of nicotine on immunity in humans are certainly not significant to show in NRT RCTs, and they certainly don’t have a significant effect on all-cause-mortality of SLT users. This is in addition for other suggestive evidence cited by Mayer that nicotine doesn’t have the same effects on humans.

    Also, in a comment by 2 Duke U. researchers it was pointed out that the mice were exposed to the equivalent of 11000 – 13000 puffs per day(!!), based on plasma nic taking into account quick nic metabolism in mice.
    http://www.plosone.org/annotation/listThread.action?root=85496

    Also, ECITA’s Pruen estimates that measured used would certainly lead to mice being exposed to dry puff.
    http://www.ecita.org.uk/ecita-blog/new-study-mice-shows-remarkably-little-acute-toxicity-despite-major-methodology-problems

  13. Hi Clive,

    I’d like to submit this to the South Australian Government. They are establishing a Select Committee to investigate & report on health & regulatory issues of e-cigarettes. This is in addition to the Federal Government doing a similar thing which is still not resolved.

    Is it OK if I submit it in it’s original form with no alterations. All I’d be doing is providing a covering document which will reference local issues specific to Australia.

    Cheers

    Donna (aka @DaviMaree)

  14. Some great electronic cigarette informational resource here. It’s things like this that will allow people to become more aware of the positives with vaping and not media hype!.

  15. Thx for your help & hard work helping people understand that harm reduction is common sense & long overdue.

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