Health chiefs across the UK have been urged to take a less negative attitude towards e-cigarettes and embrace their use in the battle against more harmful tobacco smoking. The Royal Society for Public Health (RSPH) says a public education programme is needed to differentiate the problem of addiction to nicotine, which is an ingredient in both e-cigarettes and tobacco, from the inhaling of dangerous chemicals such as tar and arsenic in tobacco cigarettes.

NHS stop smoking services should offer more help to people seeking to end their habit by using e-cigarettes, the society says, calling also for new “exclusion zones” barring smoking, but not e-cigarettes, outside schools, bars and pubs and in public squares and parks.

Smoking cessation services are unable to provide e-cigarettes to people trying to quit tobacco because none yet have a medicines licence, unlike other nicotine replacement therapies (NRTs), such as gum, lozenges and patches. But the RSPH says more services should follow the example of those in Leicester and north-east England in offering behavioural support to those wanting to quit tobacco and using e-cigarettes to try to do so.

Chief executive Shirley Cramer said: “Over 100,000 people die from smoking-related disease every year in the UK. While we have made good progress to reduce smoking rates, one in five of us still does [smoke]. Most people smoke through habit and to get their nicotine hit.”

The RSPH would rather people didn’t smoke, said Cramer, but getting people on to nicotine rather than using tobacco would make “a big difference” to the public’s health.

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“Clearly there are issues in terms of having smokers addicted to nicotine, but this would move us on from having a serious and costly public health issue from smoking-related disease to instead addressing the issue of addiction to a substance which, in and of itself, is not too dissimilar to caffeine addiction.”

The society, which commissioned an online survey of 2,072 adults from polling company Populus earlier this month, said it was concerned to find that nine in 10 still regarded nicotine itself as harmful. It was more encouraged by indications that half those surveyed would be more likely to use areas outside bars and restaurants if there were tobacco exclusion zones and by support for other parts of its package.

The RSPH advocates licensing all tobacco sellers so that local authorities can ban sales by any shops that fail to obey legislation such as age restrictions and display bans. It calls too for the mandatory sale of NRTs in shops selling tobacco, and repeats a call first made last year to rename e-cigarettes nicotine sticks, vapourisers or nicotine control products.

The package put forward by the charity – which includes more than 6,000 public health professionals in its ranks – would, if widely adopted by the government and other authorities, represent the biggest shift in attitudes towards e-cigarettes in the decade since they came on to the UK market.

An estimated 2.6m people now use e-cigarettes, which have experienced such a surge in popularity that more than one in seven tobacco smokers are now thought to use them. But official and medical attitudes towards both some forms of tobacco control and e-cigarettes vary considerably across the UK and there are already signs of alarm that putting nicotine addiction on a near-par with that for caffeine might undermine the wider no-smoking message.



Public Health England, a government body, has commissioned a review of evidence on e-cigarette safety and the behaviour of both tobacco and e-cigarette users by academics at King’s College, London and Queen Mary University, London. It is expected to be published within months.

Boris Johnson, the Mayor of London, has shown no interest in the capital following New York in banning smoking in many open public places, although a voluntary ban has been tried in two public squares in Bristol and is being evaluated. Brighton and Hove council, which already has voluntary bans in its children’s play areas, is considering extending the measure to beaches and other open spaces.

Meanwhile, the Welsh government is preparing to extend the current ban on tobacco smoking in enclosed public places to e-cigarettes too, believing it will help prevent e-cigarettes “re-normalising” smoking. Yet legislation soon to take effect in both England and Wales will ban smoking of tobacco, but not e-cigarettes, in cars carrying under-18s.

The Department of Health in England said:“The best thing a smoker can do for their health is to quit completely. However, for those not ready to quit, evidence shows using e-cigarettes, in the short term, poses a lower risk to health than smoking.”

It added: “We are regulating these products to make sure they are even safer and want to see local stop-smoking services welcoming smokers wishing to use e-cigarettes to support their quit attempts. Although we recognise that e-cigarettes may help adults to quit, we still want to protect children from becoming addicted to nicotine, which is why we have made it illegal for under-18s to buy them.” There were no proposals in the pipeline to introduce any further smoke-free legislation.

Hazel Cheeseman, director of policy at health charity Ash, was more positive about the RSPH package. “Scientists have known for many years that it’s the smoke in cigarettes that’s deadly, not the nicotine. Unfortunately, this is not well understood by smokers, medical professionals or the media, many of whom still think nicotine causes heart disease and cancer,” she said. “The persistence of this misconception will cost lives as smokers who otherwise would switch to alternative sources of nicotine are put off. The time for this misunderstanding to be put right is long overdue.”

The Electronic Cigarette Industry Trade Association (Ecita) welcomed recognition that e-cigarettes “have an important role to play in reducing the harm associated with smoking combustible cigarettes”. They were “first, and foremost, a low-risk alternative to lit tobacco, and studies show that users can become smoke-free when using these products,” it said.

“It is unfortunate that so much misinformation has been disseminated about electronic cigarettes in the last few years. This has contributed significantly toward a growing fear and confusion surrounding these products.”

Pro-tobacco group Forest supported proposals that would make it easier for smokers to use e-cigarettes, but director Simon Clark said renaming e-cigarettes was a “silly” idea. “It ignores the fact that e-cigs are popular because they mimic the act of smoking. The name is part of their appeal.

“Calling them nicotine sticks or vapourisers suggests a medicinal product, and that misses the point. For many consumers, e-cigarettes are a recreational product. If public health lobbyists don’t understand that, they could sabotage a potentially game-changing device.”