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Swap to Stop E-cig Plan at Risk from Public's Vaping Worries

Anti-smoking campaigners are warning that the Government's strategy of promoting e-cigarettes to cut smoking rates might be at risk, after a survey found an increase in the proportion of people who think vaping is at least as harmful as smoking tobacco.

Results from an annual survey by Action on Smoking and Health (ASH) found that 39% of smokers in 2023 considered vaping to be a lot more, more, or equally as harmful as cigarettes – up from 32% last year and 22% in 2019.

In April this year, the Department of Health and Social Care announced a 'swap to stop' campaign, offering free vaping starter kits and behavioural support to a million smokers to help them quit smoking. 

ASH is warning that growing scepticism about the safety of e-cigarettes could damage this approach. Its deputy chief executive, Hazel Cheeseman, said: "The Government has backed a vaping strategy as its path to reduce rates of smoking, but this approach will be undermined if smokers don't try vapes due to safety fears or stop vaping too soon and revert to smoking."

Ex-smokers Who Vaped Are the Most Informed

The survey findings are based on online polling of 12,271 British adults undertaken by YouGov in February and March this year.

Among the 1.8 million smokers who were yet to try vaping, 43% believed e-cigarettes were as harmful, or more harmful, than smoking – up from the 27% in 2019.

Reasons for not giving e-cigarettes a try included:

  • Not wanting to substitute one addiction for another (20%)
  • Safety concerns (14%)
  • Not believing e-cigarettes could help (13%)
  • Not knowing enough about e-cigarettes (8.4%)

Among the 2.9 million smokers who had tried vaping but stopped, 44% believed vaping was harmful or more harmful than smoking – an increase from the 25% who held that view in 2019. 

A third of smokers indicated they understood that vaping was less harmful than smoking, but fewer than one in 10 believed e-cigarettes were a lot less harmful than vaping, the survey results suggest.

The most accurate risk perceptions were among the 2.7 million ex-smokers who vaped, and the 2.9 million ex-smokers who were former e-cigarette users, where 75% and 45% respectively believed that vaping was less harmful than smoking, emphasised ASH.

Misperceptions Pose a Health Risk

Dr Sarah Jackson, principal research fellow at the Tobacco and Alcohol Research Group, University College London (UCL), said that the findings were "concerning, but not surprising". She pointed to an ongoing disconnect between scientific evidence on the relative harms of vaping compared with smoking, and how these risks were communicated to the public. 

"Misperceptions about the risks of vaping vs. smoking are a health risk in and of themselves," according to Dr Jackson. "Cigarettes are uniquely lethal, vaping is much less harmful than smoking," she said, but "this is not what people are being told when they turn on their TV or read a newspaper".

According to ASH, the change in perception about e-cigarettes could be linked to "widespread media coverage of youth vaping which has not always clearly distinguished the differences between the harms from smoking and vaping". Dr Ruth Sharrock, clinical lead for tobacco dependency at North East and North Cumbria NHS ICB emphasised that vaping was an "important tool" to support smokers to quit, but that too many patients had seen "alarmist" media headlines that worried them and put them off giving vaping a go.

The "poor" conducting and reporting of studies had led to "widespread misperceptions" – a trend that "needs to be stopped and reversed" urged Dr Sharon Cox, principal research fellow in behavioural science and health at UCL. 

Improve Public Understanding

Almost one in ten (9.1%) of the population were currently using e-cigarettes, the highest rate ever, said ASH. 

The main reasons why ex-smokers vaped was to help them quit (31%), to prevent relapse (22%), enjoyment of the experience (14%), and save money (12%). For current smokers it was to cut down on smoking (19%), to help them quit (17%), and prevent relapse (13%). Never-smokers vaped because they enjoyed it (39%), or wanted to "give it a try" (27%).

Professor Ann McNeill from King's College London, and author of a Government commissioned review on the harms from vaping, underlined it was "wrong to say we have no idea what the future risks from vaping will be". Levels of exposure to cancer causing and other toxicants were "drastically lower" in people who vaped compared with those who smoked, she said, which indicated that any risks to health were likely to be a "fraction" of those posed by smoking.

Ms Cheeseman urged the Government to "act quickly" to improve public understanding that vaping posed "a fraction" of the risk of smoking.

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