E-cigarettes have grown rapidly in popularity in recent years and are currently the subject of heated debate as to whether they are effective in helping smokers quit or whether they actually make tobacco attractive to young people. Are they a way of protecting profits in markets where smoking is declining and attracting people to nicotine addiction, or are they simply a fad that will quickly lose its appeal?
Given that vape has been around for only a decade and that studying the long-term effects takes time, we cannot answer these questions with certainty. The benefits of electronic cigarettes "continue to be debated - and the potential risks to non-smokers and young people remain under-explored.
This makes it difficult to make recommendations, but politicians around the world must decide what to do. Scotland is the latest country to tackle this issue. Parliament has just voted to ban the use of electronic cigarettes by under-18s. One of the many restrictions imposed is the same as for traditional cigarettes, bringing Scotland largely into line with England and Wales. Was this the right thing to do?
Different countries have taken different approaches to steaming. Canada has technically made sales illegal, although the regulations remain largely unenforced. While regulations in the U.S. are mixed, San Francisco has just raised the minimum purchase age from 18 to 21 years.
In some European countries, notably Bulgaria, Ireland and Poland, sales and advertising are unregulated. However, in May, new European regulations will require standardized quality control of liquids and sprays throughout the union, as well as disclosure of the ingredients contained in spray liquids, and the protection of children and fraudulent handling of liquid packaging. They will also limit cross-border advertising. Wales seems likely to extend its restrictions by introducing a ban on electronic cigarettes in public places.
Yes and no
Opponents and supporters of regulating electronic cigarettes have been fiercely debating which approach makes the most sense. Opponents generally argue that vaping is less harmful than traditional cigarettes and effective in helping smokers quit. They want minimum restrictions on availability and complete freedom for advertising, promotion and use of electronic cigarettes in public. Restrictions, they say, could prevent smokers from switching to safer alternatives and reduce the chances of reducing tobacco consumption.
Proponents of regulation say that children and young people must be protected from the use of products that imitate smoking and from developing nicotine addiction. They also favour regulations to ensure product safety and quality. They advocate a precautionary approach until it is demonstrated that electronic cigarettes do not undermine our recent successes in tobacco control.
In addition to banning sales to those under 18, the new Scottish laws require retailers to ask for proof of age when selling to someone under 25 (similar to alcohol). They prohibit the sale of electronic cigarettes from vending machines, make it an offence to purchase on behalf of a person under the age of 18, and require retailers to enter their name on a product register. Scottish Ministers will also have the power to further restrict or ban advertising and promotions in the future.
The risks
While the evidence of the risks associated with electronic cigarettes will probably remain obscure for several years, the Scottish Parliament can at least say that it is doing what the country wants. A large majority of respondents supported the regulation in the 2014 consultation, including representatives of health agencies, local authorities, charities, academics and members of the public. Respondents not only supported banning the sale to under-18s or adults who purchase electronic cigarettes on their behalf and preventing young people from seeing advertisements and promotions, they also broadly supported restricting the use of electronic cigarettes in public places.
The reality is that, until the jury returns, it makes sense to trust the public to get a view of the best available information on electronic cigarettes. Even if the current regulations were to appear disproportionate in the coming years, no one can accuse the governments of ignoring public concerns and taking public health issues lightly. In a situation where no one really knows what is best, regulation that restricts access and promotion to young people seems to be the best policy.