Smokefree Nurses back e-cigarettes

16 August 2016

E-cigarettes containing nicotine should be freely for sale and organisations allowed to decide where people can 'vape' to help people quit tobacco, says Smokefree Nurses Aotearoa.

The government is currently consulting on allowing nicotine for e-cigarettes to be legally available for sale to adults in New Zealand rather than people having to import nicotine e-liquids. The consultation document also proposes restricting the advertising of e-cigarettes and banning vaping (using e-cigarettes) in areas currently defined as smokefree.

Dr Grace Wong, director of Smokefree Nurses Aotearoa, said following the release of recent UK reports (see below) the nursing advocacy group was now "off the fence" and supporting nicotine e-cigarettes to be available for sale, to people aged 18 years and over, anywhere tobacco was for sale because e-cigarettes were a safer, cheaper alternative to smoking tobacco. "I think it's a positive for public health. It also gives people a way to quit that isn't medicalised and is something they want to use."

She said Smokefree Nurses were also advocating that individual organisations be left to make their own rules about whether vaping was allowed in tobacco smokefree areas or not (see also UK guidance below).

"Logically if you want people to quit then letting them vape where they can't smoke tobacco is going to help them quit and is going to protect their health," said Wong. So she said if any organisation asked them for advice their answer would be to consider on the one hand that there was no evidence of harm due to 'second-hand' e-cigarette vapour therefore the health risks were likely to be very low; and on the other hand the overwhelming evidence about the health risks of smoking tobacco and second-hand tobacco smoke.

"For me as a nurse I think you can't keep taking things away from people – you can't tax, and tax, and tax and tax people and you can't punish and punish people by saying you can't smoke here and you can't smoke there," said Wong. "You really have to think about people's lives and what that cigarette means to them… to keep punishing seems cruel. So to offer the option of getting nicotine in a cleaner form in a way that people choose – be it patches, lozenges or an e-cigarette  – and that protects their health, then why not."

Wong said she was aware that some smokers might continue to smoke tobacco along with vaping but other people would use vaping as a means of quitting.  "That fact that some people may continue to smoke shouldn't be a deterrent to having e-cigarettes available."  She said there was also research that showed that young children were able to distinguish the difference between e-cigarettes and tobacco cigarettes so

The UK's Royal College of Physicans earlier this year came out with its Nicotine with smoke: Tobacco harm reduction report that said it was "in the interests of public health to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products" as widely as possible as a substitute for smoking.

Then in July this year Public Health England (a division of the National Health Service) released a framework advice to help organisations create e-cigarette policies for e-cigarette use (known as vaping) in public places that would "support smokers to quit and stay smokefree, while managing any risks specific to their setting". E-cigarettes don't come under UK's smokefree legislation and new advice on vaping public places says there is "no one-size-fits-all approach". There are around 2.8 million adults in Great Britain using e-cigarettes with almost all smokers or ex-smokers.

The framework advice follows on Public Health England in August last year publishing an evidence review that concluded that e-cigarettes were around 95% less harmful to health than smoking tobacco and had the potential to help smokers quit smoking. It says vaping's potential role in reducing tobacco use and the serious harm it causes smokers should be at the centre of policies on e-cigarette use in workplaces or public places.

Submission on the New Zealand Ministry of Health consultation document on regulating e-cigarettes close on September 12. 

UK Advice on forming e-cigarette policy in public or workplaces 

  • Make clear the distinction between vaping and smoking
  • Ensure policies are informed by the evidence on health risks to bystanders
  • Identify and manage risks of uptake by children and young people
  • Support smokers to stop smoking and stay smokefree
  • Support compliance with smokefree law and policies

Source: Use of e-cigarettes in public places and workplaces (2016) Public Health England framework advice


E-cigarettes: the basics

Electronic cigarettes are a relatively new phenomenon, with Chinese inventor Hon Lik – who lost his father to lung cancer – patenting his nicotine-vapourising e-cigarette in 2003. The first versions went on the market in China in 2004 and the pioneering Chinese manufacturer Ruyan began exporting a few years later.

The market for e-cigarettes, also known as electronic nicotine delivery systems or ENDS, has since taken off with multiple manufacturers in China and around the world and the devices have evolved into a variety of forms including ’cigalikes’ (that look most similar to cigarettes with the nicotine contained in a mouthpiece cartridge),  the mid-size disposable or pen style e-cigarettes and the most recent generation which have refillable tanks (clearomizers). The tank variety of ENDS are said to be the most effective yet in delivering nicotine at levels closest to smoking tobacco cigarettes.

All ENDS are battery-powered and contain an electronic vaporisation system that heats e-liquids containing nicotine to release nicotine vapour that the user inhales. The e-liquid can contain levels of nicotine of varying concentrations (usually between 6–24mg of nicotine) and flavourings, which is atomised in a propylene glycol solution.

It is usually agreed that the vapour inhaled from e-cigarettes is less harmful than inhaling tobacco smoke but the long-term health impacts of vaping are not known. There has also been consumer safety concerns raised about some cases of battery explosions and the need for childproof containers for nicotine liquids.

In recent years, tobacco companies have moved into the e-cigarette market, with several multinational tobacco companies now marketing e-cigarettes and one tobacco company’s e-cigarette brand now being the most popular in the US. The US market for e-cigarettes was expected to top $3 billion in 2015.

Source: e-cigarettes: lifesavers or smokescreen? Nursing Review June 2015 

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