E-cigarettes: a smokescreen for greater problems?

Nicotine is the addictive element of tobacco, but is not the element that causes most harm. Whilst quitting smoking is regarded as the best option for smokers, pure nicotine products, such as electronic cigarettes (e-cigarettes), are a recognised option to help smokers cut down or stop smoking.
2.8 million adults now use e-cigarettes in the UK, up from 700,000 in 2011 (Source: Action on Smoking and Health (ASH)). Marketed as a safer source of nicotine, are e-cigarettes risk-free, especially when it comes to minors (young people)?

Health concerns

Concerns exist about health risks, especially from long-term use, and of associated product liability claims arising. The lack of regulation and research to date has also been of concern.

Public health experts are worried that e-cigarettes may increase nicotine addiction and tobacco use in young people, with the marketing of flavours explicitly targeting them a particular concern. The concern is that they could be a gateway into tobacco use, although research is limited. In the UK, 4% of 11-18 year olds who have tried e-cigarettes (21%) had never smoked tobacco. (Source: ASH)

The current drive for technology means that new products often reach the market quickly. This should be of concern if insufficient time has been allowed for research and adapting any applicable regulation and poses a health risk.

For instance, even if the harmful ingredient of, say, nanoparticles presents a health risk to only 0.1% of the people who use e-cigarettes, that would be a significant number of people potentially at risk over time. Similarly, whilst vaping is taken by most experts to be much safer than smoking, that does not mean that it its long term use is necessarily ‘safe’.

The extent and nature of the ill health effects of e-cigarette use by young people may take time to emerge. How might such damage be caused? E-cigarettes deliver nanoparticles that can trigger inflammation and are linked to asthma. Among youths, risks involve accidental nicotine exposure, including poisoning by ingestion or inhalation. In children, exposure to Propylene Glycol (PG) may exacerbate or induce rhinitis, asthma, eczema and allergic symptoms; or increase the risk of asthmas, bronchitis and other inflammatory pulmonary disease. A thermal breakdown of solvents in the e-liquid can transform into carbonyls, including formaldehyde - a known carcinogen. Research also suggests that e-vapours may make MRSA harder to fight.


Until now there has been little regulation, with e-cigarettes regulated only as consumer products. Change does now appear afoot. Transport for London has banned smoking and vaping, and in June 2015, the Welsh Government announced planned legislation to extend the ban on public smoking to include electronic cigarettes.

From 1 October 2015, new legislation in England and Wales makes it illegal to smoke in a vehicle carrying someone who is under 18. Whilst the new laws do not apply to e-cigarettes, it is also now illegal for retailers to sell e-cigarettes or e-liquids to a minor and for adults to try to buy e-cigarettes (or tobacco products) for someone under 18. The UK Tobacco and Related Products Regulations 2016 came into force on 20 May 2016, which introduce requirements for e-cigarettes and refill containers; bringing e-cigarettes under the control of the Medicines and Healthcare Products Regulatory Agency (MHRA). From 20 May 2016 onwards, producers of new e-cigarette products will need to submit a notification to the MHRA six months in advance for approval. Producers of existing products have until 20 November 2016 to submit a notification. Going forward, there will be a greater emphasis on producers to report concerns about safety and risk to human health.

Regulation and research is key to providing certainty to insurers surrounding the long term risks associated with the exposure of young people and e-cigarettes. The product’s warnings must state it can be addictive or harmful.

Insurers and manufacturers should keep up-to-date with the risks and regulations in this area, including the potential long term implications for young people and provide suitable warnings as appropriate.

Read other items in Disease Brief - December 2016