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Policy briefing: Vaping in young people

Health Policy team
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Vapes, or e-cigarettes, are devices that enable users to inhale nicotine in vapour, generated by heating a liquid (e-liquid), rather than smoke. In the UK it is illegal to sell vapes to under 18s; however, data shows that the number of children and young people using vapes is rising. This briefing sets out the evidence, our policy recommendations and the role of paediatricians in discouraging children and young people from using vapes.
Last modified
6 June 2023
Post date
6 June 2023
Table of contents
Contents

Background 

  • Vapes, or e-cigarettes, are devices that enable users to inhale nicotine in vapour, generated by heating a liquid (e-liquid), rather than smoke.
  • These types of vapes are regulated by the Tobacco and Related Products Regulations (TRPR) in the UK. In 2015, it became illegal to sell vapes containing nicotine to under 18s or to purchase them on their behalf.
  • Advertising or promotion of vapes and re-fill containers on a number of media platforms is prohibited, as regulated under the EU Tobacco Products Directive (TPD). The only advertising still allowed is at point of sale and other local advertising.  
  • Non-nicotine containing vape liquids are available, which are usually flavoured, and are not regulated by the TRPR but by the General Product Safety Regulations (GPSR).  
  • The Medicines and Healthcare Products Regulatory Agency (MHRA) published guidance in October 2021 to license vapes as medicines in the UK which could be prescribed on the NHS. However, it remains the case that non-smokers and children are advised against using vapes.

The problem

Prevalence

  • More than one in five (22%) of 11-15 year olds had reported to have used vapes in 20211  in England.
  • Amongst 11-15 year olds in the UK, 4.0% currently use vapes, compared to 14.1% of 16-17 year olds and 20.2% of 18 year olds in 2022. This has doubled across all age groups since 2021, which was reported to be 2.2%, 5.9% and 9.6% respectively.2
  • The proportion of 11-17 year olds in the UK reporting to be current users doubled from 3.3% in 2021 to 7.6% in 2023, while trying vaping once or twice is up by 50% compared to 2022.3  

Access

  • In 2023, 11-17 year olds in the UK were most aware of promotion of vapes in shops (53%) and online (32%). Of those who reported seeing vapes promoted online the most common place was on TikTok (49%)4 .  
  • The most common ways to access vapes in the UK among 11—17 year olds was through shop purchase (48%) and being given them (46%).5
  • In 2022, 46.1% of 11-17 year olds said the vapes they used most often always contained nicotine, an increase from 36.4% in 2021.6

Disposable vapes

  • The most frequently used device in 2023 for young people in the UK was a disposable vape at 69%, a significant increase from 7.7% in 2021.7  
  • Disposable vapes are increasing in popularity amongst young people and simultaneously creating a huge waste problem as they contain single use plastics and only a small number are disposed of correctly - they should be discarded with electrical waste.8
  • These devices contain precious metals such as lithium, which is in short supply and critical to the UK’s green transition, and the e-liquids contain toxic chemicals that qualify as hazardous waste. When littered improperly, the devices can leak these materials into the environment.8

Evidence base on harm

  • Vapes are a relatively new product; they aren’t risk free and their long-term impacts are not known.9
  • The harms of tobacco smoking are known: tobacco has led to millions of deaths and is a significant cause of morbidity. The harms of vaping are, as yet, not fully established but there are concerns regarding acute toxicity, especially when misused, and risks of adverse health outcomes including addiction.10
  • Exposure to second-hand tobacco smoke has well-established negative health consequences, including for children. The harms of second-hand vaping are not yet conclusive.
  • There is growing evidence that vapes are becoming a gateway product to nicotine addiction amongst young people and that young non-smokers who use vapes are more likely than non-users to take up smoking.11

RCPCH policy recommendations

  • The current marketing tactics, easy access to disposable vapes and risk of nicotine addiction are factors driving the increasing use of vapes by young people. In the absence of conclusive evidence that vaping is safe, as opposed to safer than tobacco, our policy recommendations aim to prevent youth uptake of vaping.  
  • The College’s approach is to protect young people from any known and unknown risks to ensure optimal health outcomes, separate from vaping as smoking cessation policy for adults.

RCPCH recommendations to prevent uptake and protect young people from the harms of vaping: 

  • UK Government to strengthen legislation on non-nicotine e-cigarettes by extending coverage of the Tobacco and Related Products Regulations (TRPR) to cover nicotine and non-nicotine containing products. 
  • UK Government should revise the TRPR regulations for e-cigarettes and e-liquids to:
    • require plain packaging of e-cigarettes and nicotine and non-nicotine e-liquids packs
    • include prohibiting free samples of nicotine products.
  • UK Government should transition advertising of vaping products so they are only advertised for their medicinal purpose as a smoking aid rather than a lifestyle product.
  • UK Government should implement a ban of disposable vapes to reduce their accessibility to young people and harm to the environment.

Children and young people voice

Vaping and e-cigarettes are seen as a healthy alternative, but we think that some people are using them to smoke drugs as people are less likely to ask questions.

Voice Matters, RCPCH State of Child Health

Role of paediatricians  

  • As we do not know the long-term effects of vaping, paediatricians should discourage its use in young people and take a proactive approach in preventing uptake.  
  • Young people who have never smoked should also be discouraged from using vapes.