You may be aware that the UK government is in the process of caving in to a moral panic on vaping while taking pointless action on smoking.
Here is the government’s press release…
Disposable vapes banned to protect children’s health
Disposable vapes will be banned in the UK as part of ambitious government plans to tackle the rise in youth vaping and protect children’s health.
- Ban on disposable vapes which have driven alarming rise in youth vaping
- New powers to restrict vape flavours, introduce plain packaging and change how vapes are displayed in shops so they don’t appeal to children
- New law will make it illegal to sell tobacco products to anyone born on or after 1 January 2009, delivering on the Prime Minister’s pledge to create a smokefree generation
Disposable vapes will be banned in the UK as part of ambitious government plans to tackle the rise in youth vaping and protect children’s health, the Prime Minister has announced today (29 January 2024) on a visit to a school.
The measure comes as part of the government’s response to its consultation on smoking and vaping, which was launched in October last year.Government press release, 29 January 2024
I’m not going to repeat the whole press release, which consists mainly of a litany of bad takes from people with no experience or any idea what they are talking about.
How do bans work?
The key insight to appreciate here is that a ban on a product does not cause the banned product to disappear. Nor does it guarantee the people using it will become abstinent and free of all proscribed sins. A ban on one type of product amounts to a perturbation in a complex adaptive system of economic relationships and personal behaviours.
The behavioural response to a ban
What matters is how people using these products (or who might have used them in future) respond to this perturbation. These are some of the plausible responses:
- Return to smoking.
- Take up smoking instead of vaping.
- Fail to switch to from smoking to vaping in the future.
- Become or remain a dual-user (vaping and smoking) instead of exclusive vaping.
- Switch to vaping products that are not banned.
- Switch to illegally supplied banned vaping products.
- Switch to other non-tobacco nicotine products, such as nicotine pouches.
- Switch to heated tobacco products or snus (if available).
- Try other substance use or other risky behaviours.
- Try user workarounds (e.g. to respond to flavour bans and nicotine limits).
- Enter the illicit supply chain as a seller or distributor.
- Become abstinent and switch to only virtuous behaviours.
Frankly, no one knows the balance of 1-12 in each of the populations of interest (adults, low socioeconomic status adults, youth, and youth who would otherwise have smoked).
However, it is possible to do a coarse sensitivity analysis. It would only take a small uptick in smoking (1-4) for the whole thing to become net negative. This is because vaping “poses only a small fraction of the risk of smoking”, according to the Government’s own advisers.
The UK government has a naive view of youth risk behaviours. Just because someone is using a disposable vape and didn’t previously smoke does not mean that they (1) would not have been smoking in a counterfactual world without vapes (2) will not smoke or find other nicotine products to use in the event of a ban. They cannot just assume that banning disposable vapes or flavours will stop young vaping or smoking.
Who may be harmed by a ban on disposables?
We know from the just-published Jackson et al. that the disposable ban will affect 2.6 million adults (18+).
A ban on disposable e-cigarettes would currently affect one in 20 adults in Great Britain (approximately 2.6 million people). The proportion who would be affected would be greatest among young people, including the 316,000 18-24 year-olds who currently use disposables but who have never regularly smoked tobacco, which may discourage uptake of vaping in this group. However, a ban would also affect 1.2 million people who currently smoke and a further 744,000 who previously smoked. It would also have a disproportionate impact on disadvantaged groups that have higher rates of smoking and typically find it harder to quit.Jackson, S. E., Tattan-Birch, H., Shahab, L., Oldham, M., Kale, D., Brose, L., & Brown, J. (2024). Who would be affected by a ban on disposable vapes? A population study in Great Britain. Public Health. https://doi.org/10.1016/j.puhe.2023.12.024
The government is coy about the youth figures in its release, but the ASH/YouGov survey gives the following for 11-17-year-olds in 2023 (data from this survey is cited selectively by the government):
In the United Kingdom and children means those aged 11-17 years old, unless otherwise specified
In 2023 20.5% of children had tried vaping, up from 15.8% in 2022 and 13.9% in 2020 before the first COVID lockdown. The majority had only vaped once or twice (11.6%), while 7.6% were currently vaping (3.9% less than once a week, 3.6% more than once a week) and the remainder (1.3% in 2023) saying they no longer vape. (emphasis added)ASH, Use of e-cigarettes among young people in Great BritainUse of e-cigarettes among young people in Great Britain, June 2023
From ONS, the population of 11-17-year-olds in 2021 was 5.33 million (Britain), so as I don’t have population numbers for 2023, a crude approximation would be:
- Adults using disposables = 2.6 million (Jackson et al.)
- Youth using any sort of vape less than once per week = 207,000 [3.9% of 5.33m]
- Youth using any sort of vape more than once per week = 192,000 [3.6% of 5.33m]
- So that’s just shy of 400,000 teenage vapers in total, about half of whom vape less than weekly.
- Also, the ASH survey finds the proportion of teen vapers saying they most frequently use disposables was 69% in 2023. That would be 275,000 young people using disposables (with an unknown split between less than and more than once weekly)
In summary… combining these numbers, about nine times as many adults compared to teens will be affected by the ban. And many of these young people will be very occasional users. Adult use, however, will be dominated by people who smoke or previously smoked – and this prohibition puts them at risk of serious diseases if they revert to smoking or dual use.
The youth harm case has not been made or understood by the government
Nor has the government articulated the harm that this youth vaping is supposed to cause. Most youth vaping will be experimental, not especially intense, transient, and not actually that harmful, given vaping poses “a small fraction of the risk of smoking”, according to the government’s own advisers. It takes decades of sustained smoking for most of the major diseases associated with smoking to develop. For most youth, vaping is of no material public health consequence – and stopping it would be like trying to stop teenagers from trying alcohol.
However, for some adolescents, the use of vapes will be an alternative to smoking and be beneficial – a diversion from risky behaviour. This is not because they smoked already but because they would have become smokers in a world without vapes.
So, the harm profile of youth vaping is mainly a mixture of inconsequential and beneficial.
None of that stops parents being concerned – but it is a reason why politicians, officials and senior advisers need to keep a cool head and do more to explain the reality of the risks. We also have to bear in mind that most people really
I have set out the evidence behind all this in a short evidence brief: Understanding Youth Use (January 2024)
If there is a worse idea than banning disposable vapes, it would be the beyond-terrible idea of banning major categories of flavours in vape products and therefore damaging the underlying value proposition that has made much-safer vaping work as an effective competitor to smoking.
Might this just protect the cigarette trade, promote smoking and cause more harm than good?
Yes… recent economic appraisal of vape flavour bans introduced in the United States concluded that they increased smoking.
Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use (“smoking”), a more lethal habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 15 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used by underage youth. Thus, any public health benefits of reducing ENDS use via flavor restrictions may be offset by public health costs from increased cigarette sales.Friedman, A., Liber, A. C., Crippen, A., & Pesko, M. (2023). E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales. https://papers.ssrn.com/abstract=4586701
An earlier study by Abigail Friedman established that smoking increased among young people when a flavoured e-cigarette ban was implemented in San Francisco.
Friedman, A. S. (2021). A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2021.0922
In summary… Really, in a rational world, these studies should have ended all discussions worldwide about e-liquid flavour bans and caused their primary advocates (the Michael Bloomberg complex, WHO, FDA, SRNT and thousands of tobacco control activists) to retire from public debate, reflect, reconsider and apologise. Yet, it seems to have done nothing and suggests that evidence plays only a walk-on role when it can be used to justify favoured policy dogma.
Smoke-free* generation proposal
* This applies to all tobacco products, even smoke-free tobacco products, including those deemed appropriate for the protection of public health in the US system. So, it is wrong to refer to this as a smoke-free generation proposal.
This means making it illegal to sell tobacco products to anyone born after 1 Jan 2009 – so that, over time, adults will not be able to buy legal tobacco.
This has attracted support from many poorly-informed commentators as if writing a law guarantees an outcome. Again, it should be understood as a perturbation of a market (see above) with unpredictable results, some of which may be worse than without the measure. Hopefully, the ‘smoke-free generation’ proposal will be largely irrelevant as few people born after 1 Jan 2009 (some now age 15) are smoking or will ever smoke.
But that’s the problem: it’s a headline measure on smoking but basically fails to deal with the main issue – the large stock of adult smokers in the UK who were born before 1 Jan 2009 and at risk from the gradual tightening grip of smoking-related disease.
The measure will have little effect unless, of course, the government’s efforts to promote smoking by being against vaping prove successful. Youth smoking has declined to low levels, and those still smoking will not be deterred by a mere age restriction.
In 2021, the proportion of pupils who were classified as regular smokers has dropped to 1% (confidence interval 0.2-0.7%), down from 2% in 2018. The government’s tobacco control plan aims to reduce the number of 15 year olds who regularly smoke to 3% or less. In 2021, 3% of 15 year olds were regular smokers, down from 5% in 2018, and from 30% in 1996.NHS Digital, Smoking, Drinking and Drug Use among Young People in England, 2021, June 2022
The extent of the evidence does not go beyond a justification for “C-21”, or setting an age-of-sale restriction at 21 for combustible tobacco products. Beyond that, everything is subject to unknown or unintended consequences and reflects evidence-free political preferences, at best backed by modelling that codifies the outcome into the assumptions.
Absurdly, many tobacco control activists want to include all tobacco products in this measure, apparently having learned nothing from the egregious error of banning snus in 1988, triggering the EU to do the same, and denying smokers much safer tobacco products for 30 years, something for which an apology rather than a repetition would be a better response.
What approach should be taken?
There are four main elements to a proportionate approach to youth vaping and tobacco harm reduction:
- Responsible retailing: a system of age restrictions (18 for smoke-free, 21 for smoking products) and a licensing system with conditions regarding display, promoting in-store trials, etc.
- Responsible marketing: a focus on how the products are portrayed and described, as well as thematic and placement controls on advertising, promotion and sponsorship.
- Responsible supply: a standards and notification regime governed by standards for electrical, chemical and thermal safety, backed by disclosure and controls to address emerging problems.
- Responsible communication: this is about having a well-informed public and consumers. It is important for the public to understand the risk, as that affects the public reaction to vaping (etc.) and, to some extent, drives politics. Consumers also need to understand the harm reduction proposition.
I have provided more detailed views in my response to the UK consultation on smoking and vaping measures – see UK smoking and vaping policy consultation – my final response.
My advice on policymaking for tobacco and nicotine is contained in an evidence brief here: Policies for novel and emerging products