E-cigarettes around 95% less harmful than tobacco estimates landmark review

Expert independent review concludes that e-cigarettes have potential to help smokers quit.

An expert independent evidence review published today by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

Key findings of the review include:

  • the current best estimate is that e-cigarettes are around 95% less harmful than smoking
  • nearly half the population (44.8%) don’t realise e-cigarettes are much less harmful than smoking
  • there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers

The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people. Following the review PHE has published a paper on the implications of the evidence for policy and practice.

The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes. It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).

However, the review raises concerns that increasing numbers of people think e-cigarettes are equally or more harmful than smoking (22.1% in 2015, up from 8.1% in 2013: ASH Smokefree GB survey) or don’t know (22.7% in 2015, ASH Smokefree GB survey).

Despite this trend all current evidence finds that e-cigarettes carry a fraction of the risk of smoking.

Emerging evidence suggests some of the highest successful quit rates are now seen among smokers who use an e-cigarette and also receive additional support from their local stop smoking services.

Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England said:

Smoking remains England’s number one killer and the best thing a smoker can do is to quit completely, now and forever.

E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm. The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting. Local stop smoking services should look to support e-cigarette users in their journey to quitting completely.

Professor Ann McNeill, King’s College London and independent author of the review, said:

There is no evidence that e-cigarettes are undermining England’s falling smoking rates. Instead the evidence consistently finds that e-cigarettes are another tool for stopping smoking and in my view smokers should try vaping and vapers should stop smoking entirely.

E-cigarettes could be a game changer in public health in particular by reducing the enormous health inequalities caused by smoking.

Professor Peter Hajek, Queen Mary University London and independent author of the review said:

My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health. Smokers differ in their needs and I would advise them not to give up on e-cigarettes if they do not like the first one they try. It may take some experimentation with different products and e-liquids to find the right one.

Professor Linda Bauld, Cancer Research UK’s expert in cancer prevention, said:

Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realised based on the evidence assessed by this important independent review. In fact, the overall evidence points to e-cigarettes actually helping people to give up smoking tobacco.

Free Stop Smoking Services remain the most effective way for people to quit but we recognise the potential benefits for e-cigarettes in helping large numbers of people move away from tobacco.

Cancer Research UK is funding more research to deal with the unanswered questions around these products including the longer-term impact.

Lisa Surtees, acting director at Fresh Smoke Free North East, the first region where all local stop smoking services are actively promoted as e-cigarette friendly, said:

Despite making great strides to reduce smoking, tobacco is still our biggest killer. Our region has always kept an open mind towards using electronic cigarettes as we can see the massive potential health benefits from switching.

All of our local NHS Stop Smoking Services now proactively welcome anyone who wants to use these devices as part of their quit attempt and increase their chance of success.

What is the biggest vaping survey worldwide?

Over 5,000 people worldwide took part in an online survey about e-cigarettes and vaping from April to May 2017. Depending on nationality and gender, there were interesting results about vaping behaviour, flavour preferences, decisive purchasing criteria and acceptance in society. First findings are available for World No Tobacco Day

About the study

The survey began in April 2017. In the first phase in May 2017, a global survey was put online on behalf of VON ERL., in which over 5,000 people took part. 

The analysis of the online questionnaire was performed by the University of Innsbruck and enables initial general statements about the worldwide vaping community to be made. As a special focus was put on the European markets of VON ERL. in this first step, representative results for Austria, Germany and Italy are already available and can be published. Designed as a long-term study, the intention is to repeat these surveys in a yearly rhythm, in order to regularly record global developments in the vaping community.


Vaping behaviour

People around the world have been asked about their attitude towards vaping. The results gave interesting insights into why people vape and the acceptance in society in general. Further, the study showed the perceived damaging effects of e-cigarettes and the preferred nicotine content

Why do you vape?

When asked “why do you vape?”, 75.2% of active vapers selected the option “healthier than smoking”. The second most frequent reason for vaping was the variety of flavours (68.4%), and stopping smoking came in third place (65.8%). Over half of the respondents (50.2%) also see a financial upside to vaping. Those who have bought the hardware – the e-cigarette – once can refill it with comparatively inexpensive liquids, called e-liquids.

How high is the nicotine content of your e-liquid?

Liquids with less nicotine are trendy. Many smokers are actually switching to vaping with the goal of completely coming off cigarettes. The consumption of e-liquids with lower nicotine content also proves to be true in the answers given by the respondents. 67.2% use e-liquids containing between 1 and 5 milligrams of nicotine per millilitre. 

How dangerous / damaging to health do you consider vaping in comparison to smoking normal cigarettes?

Almost all vapers (97.2%) are convinced that e-cigarettes are less harmful to their health than conventional cigarettes. Increased acceptance has also become apparent amongst non-vapers; 43.2% perceived vaping to be less harmful in comparison to smoking, and only 12.2% say that it is more dangerous. The rest stated it is just as dangerous. 

Where have you had negative experiences with vapers?

The study showed a high acceptance of non-vapers: When asked “where have you had negative experiences with vapers?”, more than half of the respondent said they have had no negative experiences. 


The classical vaper

… is young, fruity and likes quality. The surveys shows that the classic vaper is primarily male and 35 years old. He/she earns between RM4,000 and RM8000* net per month, mainly uses open systems** and vapes fruity aromas (e.g. apple, strawberry etc.) with nicotine content of 1-5mg nicotine per ml. The preferences of the female respondents are very similar to those of the male ones; only when it comes to what they are willing to pay are men usually prepared to pay more.

* Currencies are adjusted depending on the country

** When an e-cigarette has an open system, it means that the e-cigarette can be filled with any liquid. Closed systems have their own so-called liquid pods, which can be inserted in the model they are intended for.