Tobacco and vaping addictions begin in childhood, not in adults (A smoking gun?, G2, 20 November). The number of UK children vaping is being grossly under-reported. US trends inevitably cross the Atlantic. In America, 30% of high school children vape, most never having smoked tobacco. With forceful UK e-cigarette marketing directed at the young, similar rates will undoubtedly occur, with potentially devastating health effects.

We cannot sit back and accept a blanket message from Public Health England that vaping is 95% less harmful than tobacco smoking because (a) nobody knows exactly what substances are in these liquids, although we do know, in direct contravention of EU regulations, they contain chemicals toxic to the lungs; (b) there is an epidemic of vaping-related chest disease and deaths in America and (c) it took over 30 years for the long-term harmful effects of tobacco to be appreciated.

Children and young people who use e-cigarettes are more likely to smoke tobacco. The 2016 US surgeon general’s report concluded that “e-cigarettes are unsafe in children and adolescents”. Public Health England is out of step with him, the European Respiratory Society and other international respiratory societies, the American Academy of Pediatrics, India (where vaping has been banned) and Australia (where a ban seems imminent).

We in the British Paediatric Respiratory Society advocate urgent health education targeted at children on the dangers of vaping. Children are the most important group to target if long-term health has any hope of improving. We also recommend medicinal-standard controls for the advertising and manufacturing of vaping products and tobacco. This is not currently the case.

Warren Lenney, Andrew Bush, Jayesh Bhatt, Will Carroll, Frances Child, Gary Connett, Iolo Doull, Francis Gilchrist, Jonathan Grigg, Atul Gupta, Simon Langton-Hewer, Clare Murray, Jimmy Paton, Mike Shields, Ian Sinha and Edwina Wooler

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