Vaping: helpful or harmful?

New Zealand is putting its faith in e-cigarettes as part of the arsenal of quitting tools available to help us reach our target of being smoke free by 2025

As Italy went into lockdown to stop the spread of Covid-19, among the businesses to be closed were vape shops. But then the Italian government did a U-turn and allowed them to stay open, largely thanks to lobbying from one man, respiratory specialist Riccardo Polosa. He pointed out that if Italy’s million or so vapers couldn’t access e-cigarettes, they were going to turn to smoking tobacco instead to meet their nicotine needs, damaging their health even more in the process.

Polosa’s research had shown that among people with smoking-related diseases - in particular COPD (chronic obstructive pulmonary disease) - there are harm reduction benefits in switching to vaping.

In New Zealand, where around 12.5 percent of us continue to smoke tobacco daily, we are putting our faith in e-cigarettes as part of the arsenal of quitting tools available to help us reach our target of being smoke free by 2025.

“Cessation rates need to increase a lot if we’ve got any chance of meeting the 2025 goal,” says Janet Hoek, a public health specialist from the University of Otago and co-director of ASPIRE 2025.

“For some people vaping has been a way to stop smoking but the challenge is to give them that option without creating another problem along the way.”

Since 2018, when the sale of nicotine e-cigarettes was legalised in New Zealand, it has become a free-for-all, with thousands of outlets including dairies, petrol stations and even post shops now supplying them. Stylish devices and a range of flavours have appealed to a new younger generation who aren’t necessarily smokers and Big Tobacco, now a major player in the industry, hasn’t been shy of marketing products to them.

So far it seems to be working. The Youth 19 Survey, conducted in New Zealand schools last year, found that 48 percent of those between the ages of 13 and 18 who regularly vaped had never smoked cigarettes.

And there are more statistics to tell a worrying story. Over the past 20 years there had been a sharp drop in cigarette use among adolescents. But recently, as the numbers of young vapers has increased, that decline has shown signs of levelling out - even seeming to be starting to rise again.

“If vaping was displacing smoking, which is the argument that some people have presented, then we would expect that downward trajectory in smoking to continue. In fact we’d expect it to accelerate, and that’s not what the data is showing us,” says Hoek.

Even for those who want to use them to quit smoking, vapes aren’t a magic bullet. The largest New Zealand study so far found that between only 7 percent and 17 percent of participants using a combination of patches and nicotine e-cigarettes were smoke free after six months. International research backs up those modest rates of success.

“For some people it’s not a smooth transition,” explains Hoek. “They need to persist, they need to show resilience and that can come as an unwelcome surprise for people who think vaping is going to present them with a solution that is a lot easier than the other stop-smoking treatments they’ve tried. So we need to make sure they get good advice. The work we’ve done with generic retailers, particularly dairy owners, shows they’re not getting good advice there. We also know those corner stores are outlets that young people are likely to go to.”

The type of advice that quitters might need includes guidance on the best device to choose, the ideal nicotine level of their e-liquid, and how quickly or slowly they should attempt the transition from cigarettes. ASPIRE 2025 believes vape outlets should be seen as providing a health service, rather than a recreational tool, and so proper training and a licensing system is crucial.

While the evidence so far suggests that vaping poses a lesser risk than smoking cigarettes or using heated tobacco products, it it isn’t harm-free. There is convincing science to show vaping can damage the cardiovascular system as well as impair the immune response within our airways.

Chris Bullen of the University of Auckland has been researching e-cigarettes for a decade - it was his study that showed they do have a modest benefit for quitters - and he believes that ideally the devices should be a step towards reaching the point of inhaling nothing but clean air.

“If you’re a vaper, and you used to be a smoker, stopping would be fantastic,” he advises. “If not, then try to vape as little as possible to keep from smoking.”

Bullen advocates that vape stores should be graded from A to D - much like food outlets - to show how well the staff have been trained in giving quit smoking advice and that the products sold have passed quality standards. “If they lose that rating, then they go out of business,” he says.

Currently Parliament is considering a proposal to ban sales of vape products to under 18s, limit the flavours available in general stores such as dairies and ban advertising. Hoek for one believes we are missing an opportunity to not only control the vape industry and prevent it targeting young users, but to improve our chances of being smoke free by 2025.

“Smoked tobacco is available at more than 8000 outlets in New Zealand,” she points out. “We don’t have a register, we don’t have a licensing scheme, anyone can sell tobacco. If we want to get to a Smokefree Aotearoa, a much better approach would be to reduce the availability of smoked tobacco and then gradually to increase the availability of vaping products through specialist outlets rather than generic retailers.”