On November 16, the United Kingdom’s National Centre for Smoking Cessation and Training (NCSCT), released: “Vaping: a guide for health and social care professionals.” It combines a summary of best available evidence with recommendations for how practitioners should act on this knowledge.
It’s the latest iteration of guidance that NCSCT first published in 2014, under the title “Electronic cigarettes: a briefing for stop smoking services.”
The term “e-cigarettes” has now been abandoned in favor of “vapes,” as the new guide explains. And its substantial evolution includes updated science, the deliberate involvement of people with lived experience in its creation, and responses to increasingly topical vape-related issues and misconceptions.
“Abstinence from nicotine is not necessarily a priority, the most urgent priority is to support people to switch away from smoking.”
An early statement of purpose is instructive and inclusive: “This briefing provides guidance on how to support those who smoke to switch to vaping, either as a means of stopping smoking or to reduce the harm of continued smoking should they feel currently unable or unwilling to quit,” it states. “Abstinence from nicotine is not necessarily a priority, the most urgent priority is to support people to switch away from smoking tobacco.”
And on the question of flavors, for example, which are so often characterized as a ruse to attract youth, it states: “E-liquid flavor is a personal choice and one of the advantages of vaping is that people can experiment and try new flavors,” while noting “emerging preliminary research evidence … that fruit and other sweet-flavored e-liquids are positively related to people who smoke transitioning away from cigarettes.”
The document represents “the most up-to-date research evidence-based guide for health and social care professionals,” Dr. Kirstie Soar, one of its coauthors, told Filter.
Soar—who is also trial manager for London South Bank University’s Project SCeTCH, evaluating vapes for smoking cessation among unhoused people—was responsible for updating the guide with new material from contributors.
“Importantly,” she said, “it also places people who smoke and people who vape at the center of the publication.” Two trustees at the New Nicotine Alliance, a British tobacco harm reduction consumer group, were asked to review the document to make sure it reflected lived experience, and it was Soar’s job to address and reconcile the reviewers’ comments.
The guide has a foreword from Neil O’Brien, a politician in the UK’s governing Conservative Party, who at the time the guide was written was parliamentary under-secretary of state at the Department of Health and Social Care. “I am enormously proud of the leadership that England has shown in supporting smokers to quit,” he writes, of what has been seen as one of the world’s most vape-friendly countries.
“Our policy has two goals—sometimes in tension but never in conflict—to maximize the opportunities to help smokers to quit smoking whilst preventing young people and non-smokers from starting vaping,” he continues. “They are never in conflict because they share the ultimate mission of reducing harm and improving health.”
It’s an assertion some would question. O’Brien references his government’s world-first plan, announced in April, to provide free vape starter kits to one million people who smoke. Yet government legislation currently on the table could include possible bans on flavors and disposable vapes, plus new vape taxes.
“While it is preferable for young people to neither smoke nor vape, when assessing the risks, priority should be given to supporting them not to smoke.”
The 55-page guide comes across as significantly more pro-vaping than the foreword. It draws upon studies and resources including data from Action on Smoking and Heath (ASH), the 2022 evidence review by King’s College London for the Office for Health Improvement and Disparities, the University College London Smoking Toolkit Study, and the 2022 Cochrane Review.
“The evidence isn’t cherry-picked, but based on the considerable amount of research which has been conducted over the last 15-plus years,” Soar said.
On the controversial issue of youth vaping, this evidence brings emphases that bear no resemblance to media and political outcry. For example, the guide notes,”vaping in adolescents is mainly amongst those who currently smoke or used to smoke.”
The UK’s increase in youth vaping “is being driven mainly by experimental use (trying once or twice),” it points out. The sweet vape flavors that are often blamed are “equally popular with adults and are not the most frequent reason for use in 11–18-year-olds who had never smoked.”
“While it is preferable for young people to neither smoke nor vape, when assessing the risks, priority should be given to supporting young people not to smoke,” the guide concludes.
Further sections address disproportionately high smoking rates among marginalized populations, and the role of vaping during pregnancy. The guide also cites plentiful evidence to refute persistent myths—like “popcorn lung,” the claim that nicotine impacts adolescent brain development, and the notion that harms of vaping are comparable with those of smoking.
“This evidence is reliable, unbiased and peer-reviewed research, rather than hearsay, anecdotal reports or sensational media stories,” Soar said. The guide “takes a balanced view around vapes relative to continued smoking, and actually challenges and corrects a lot of misinformation.”
“Services that are not vape friendly are vape unfriendly.”
In its “recommendations for practice” section, the guide acknowledges that this issue can be challenging for its target audience: “Vaping has posed some difficulties for health and social care professionals as it is a consumer-led technology that hasn’t been developed through traditional scientific and medical processes,” it states. “There have also been critical views from some public health bodies and a lack of training on vapes and vaping. In addition, it is a dynamic technology within a constantly changing landscape.”
That section outlines the vaping advice professionals should share with people they serve. Another declares that “Services that are not vape friendly are vape unfriendly,” and sets out characteristics of a truly vape-friendly smoking cessation service.
Some high-profile British medical professionals have helped fuel public concerns over vaping. But Soar doesn’t see these examples as typical. “I think health care professionals, certainly those in the UK, generally do agree on the benefits of vaping relative to continued smoking,” she said, “and have seen first-hand how [vapes] benefit their patients as an aid to quitting smoking.”
The judgment of some providers, she acknowledged, is affected when the youth-vaping narrative drowns out the bigger picture: “Health care professionals must assess the relative versus the absolute risk of vapes in the context of tobacco smoking.”
“Smoking tobacco (not the nicotine) remains the biggest cause of health harms (and indeed costs) and regulated vapes can help significantly reduce these harms,” Soar said. “Of course, if you don’t smoke, then I wouldn’t recommend anyone to start vaping, but if you smoke, then you could certainly benefit from switching.”
Health and social services far beyond the UK would certainly benefit if providers gave the NCSCT guide a careful read.
Photograph by Global Panorama via Flickr/Creative Commons 2.0
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