Context is crucial: wading through public health information

In the June issue of Practice Nursing, Graham Cope (2019) made a series of claims that go to the heart of the debate on e-cigarettes. His argument, one that will be familiar to many readers, was that nicotine contained in e-cigarettes may be harmful, that nicotine replacement therapy should be attempted before e-cigarettes, that the House of Commons Select Committee on Science and Technology had concluded that the vapour from them is ‘harmless’ and that the ‘increasing use’ of vaping by young people is a worrying trend. While each was stated as a fact, here at Public Health England (PHE) we would like to put forward our advice on e-cigarette use.

In England, where smoking has fallen to just one adult in seven, smoking attributable deaths remain at 78 000 every year

Context is crucial when discussing the role of nicotine and its place in starting, and potentially ending, smoking. In England, smoking in adults has declined to 14.7% in 2019, but smoking still causes 489 000 hospital admissions and 77 800 deaths per year, with 10% of mothers still smoking at the time of delivery (NHS Digital, 2019). As for nicotine, nothing is completely free from risk, but there can be few medicines safer and better tolerated than nicotine replacement therapy (NRT). Any risks from e-cigarettes come largely from the flavourings, the carrying fluid and the devices themselves – all of which are regulated by the Medicines and Healthcare Regulatory Agency. E-cigarettes function by electronically heating this liquid, which contains nicotine