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Public Health England insists e-cigarettes are 95% safer than smoking

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5429 (Published 28 December 2018) Cite this as: BMJ 2018;363:k5429

Re: Public Health England insists e-cigarettes are 95% safer than smoking

The author reports that e-cigarettes are a safer alternative to wean off conventional smoking. It is reported that vaping devices such as E-cigarettes have helped thousands of people in the UK in quitting smoking. However, there is a substantial number (44%) of smokers that believe vaping is as harmful as smoking or are not aware (22%) that has a much lower risk than conventional smoking. Though the reports of the review from Public Health London (PHE) claim that e-cigarettes are 95% less harmful than tobacco, they still raise various concerns such as attracting teens early into smoking, as well as containing ecologically hazardous carcinogens such as formaldehyde, acetaldehyde and acrolein as classified by International Agency For Cancer Research (IARC)(1).

The author has briefly highlighted the opinion of a chest physician at Imperial College of London that though people switching from smoking to vaping get a substantial health benefit, still the best approach for helping people to quit smoking is a combination of psychological supports and pharmacotherapy such as dual nicotine. Similar conclusions were drawn from research studies conducted in India that suggest the use of a behavioural, counseling and education approach can effectively persuade people to quit smoking (2,3,4).

However, there is a lack of evidence on utilization, safety and efficacy of E-cigarettes in India (5). The risks of introducing vaping devices to the Indian market may include early indulgence of young teenage population in tobacco products, which would be a straight violation of COTPA Act 2003 banning sale of tobacco and related products to individuals under 18 years of age, and cheaper low quality imitation of vaping devices which may burst on repeated use posing physical threat. There is strong opposition from the Indian Government with a ban on the production of Electronic Nicotine Delivery Systems (ENDS) including e-cigarettes, Vape, E-sheesha, E-Hookah, etc., in view of protecting vulnerable populations (children, adolescents, women) from the ill effects of vaping devices (6).

According to the GATS (Global Adult Tobacco Survey, India) 2017 report, 10.7% (99.5 million) of all adults currently smoke tobacco and 21.4% (199.4 million) of all adults currently use smokeless tobacco. In total, 42.4% of men, 14.2% of women and 28.6% (266.8 million) of all adults currently use tobacco (smoked and/or smokeless tobacco), indicating a high burden of tobacco abuse in the country (7). Furthermore, a study by ICMR-NICPR government of India, reported poor compliance of COTPA for control of tobacco in and around schools (8), indicating gaps in implementation of welfare initiatives tobacco control. From the Indian perspective, e-cigarette is nothing more than a nicotine delivery device with an unknown health risk profile and no health benefits, and further needs to be warranted (9).

Thus it can be concluded that in a country with an already high burden of tobacco abuse, the use of E-vaping devices as a healthier alternative can prove to be an additional bane for welfare initiatives in place for smoking cessation. Thus we do not promote the use of e-cigarettes as a healthier choice, we rather suggest prioritizing the use of zero-damage approaches such as a combination of psychological, behavioural, educational and pharmacotherapy via the means of health education and behaviour change communication for cessation of smoking.

References
1) https://monographs.iarc.fr/agents-classified-by-the-iarc
2) Murthy P, Saddichha S. Tobacco cessation services in India: recent developments and the need for expansion. Indian J Cancer. 2010 ;47 (1):69-79.
3) Jayakrishnan R et al. Smoking Cessation Intervention in rural Kerala, India: Findings of randomized control trail.Asian Pac J Cancer Prev.2013;14(11):6797-802.
4) Muthusamy SK et al. Community based group Intervention for tobacco cessation in rural Tamil Nadu, India: a cluster randomized trial. Journal of substance Abuse Treatment. 2012; 43(1):50-60.
5) Thampi et al. A Review Study on Vaping and Status of Vaping in India. J Cancer Clin Trails. 2018;3:2.
6) https://google.com/amp/s/m.timesofindia.com/india/centre-asks-states-to-... rettes/amp_articleshow/65585399.cms
7) https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_...
8) Sayeed S, Labani S, Asthana S. Peertechz J BioinformBiostat .Compliance of a Government Act on Cigarettes and Other Tobacco Products around Educational Institutions of Noida. 2017; 001-003.
9) Asthana S, Rawat D, Labani S E- cigarettes: The Indian perspective. Current Medicine Research and Practice 2017;7:119-120.

Competing interests: No competing interests

11 January 2019
Dr. Satyanarayana Labani
Scientist G
Meenu Shanker
NICPR-ICMR , Noida, India
ICMR-National Institute of Cancer Prevention and Research, Noida, India