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Balancing Act: Navigating the Complexities of Underage Vaping and Adult Harm Reduction





This paper delves into the prevalence of underage vaping, examining recent survey data and shedding light on the dynamics between vaping and traditional cigarette use among young individuals. It also explores the health benefits vaping offers to smokers seeking alternatives, challenges posed by underage access, and proposed regulations, including the controversial issue of flavour bans and potential taxation. The paper advocates for a nuanced approach that balances the concerns of underage vaping with the proven benefits vaping provides to adult smokers, highlighting the need for targeted interventions and stricter regulations.

 

Introduction Vaping has been a topic of contentious debate, with public perception often shaped by media portrayals. This paper aims to provide a well-rounded understanding by examining the prevalence of underage vaping, health implications, and proposed regulations. The focus is on fostering a balanced discourse that acknowledges both the concerns surrounding underage use and the potential harm reduction benefits for adult smokers


.- Local Underage Vaping Statistics

In a recent Youth Survey conducted by Southend Council during July 2023, it was found that approximately 30% of the children surveyed have experimented with vaping (average of 20% in the UK), whereas only 15% have tried traditional cigarette (1). This data reveals that twice as many young people vape compared to those who smoke, which is indeed a concerning statistic. However, it is important to note that out of the 15% of youths who smoke, a majority are likely to continue smoking into adulthood. On the other hand, there is strong evidence suggesting that none of the 30% of youth who vape will transition to smoking ("there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers" - Gov Document). Furthermore, the same document highlights that in the short and medium term, vaping poses only a fraction of the risks associated with tobacco smoking.


- Geneal UK Statistics on Underage Vaping

In a June 2023 report conducted by ASH, findings revealed that 20.5% of youths in the UK have either experimented with or currently engage in vaping. This percentage represents the most recent national average, with 7.6% currently using e-cigarettes. “Among those who have tried vaping, the majority (11.6%) did so only once or twice, while 7.6% were actively vaping, with 3.9% vaping less than once a week, 3.6% more than once a week, and the remaining 1.3% indicating they no longer vape” (2). Notably, the report highlighted that e-cigarette use primarily occurs among current or former smokers, as 88% of individuals who have never smoked have never vaped.- Underage Smokers Transition to VapingConsidering these statistics and the declining average percentage of underage smokers, it appears that a significant number of underage individuals are transitioning from smoking to vaping. Despite vaping being subject to age restrictions and illegal for purchase by minors, it presents fewer health risks compared to traditional cigarettes or tobacco. While access to vaping through stop smoking services is restricted to those aged 18 and above, there is a pressing need for targeted interventions to address underage smoking using alternative approaches. Although achieving a complete cessation of underage vaping through alternative methods may be an ambitious goal, it underscores the greater concern of underage smoking, given that 88% of underage vapers are former smokers. If this ambitious goal were to be realized, the underage vaping would stand at a much lower and not so concerning rate.

 

-Urges and Addiction in Underage Users

In terms of youth addiction and urges, the number of respondents who’s urges to vape was ‘extremely strong’ was double that of urges to smoke cigarettes, 8.6% vs 3.4%. However, ‘very strong’, ‘strong’, and ‘moderate’ remained higher in smoking. The overall percentage of respondents with no urges is significantly higher in vapes when compared to smoking; 30% vs 16%. This evidence could show that although a small percentage have an extremely high urge or addiction to vaping, overall, the addiction and urges remain higher in smoking.

-Where underage users purchase vapes and tobacco

Approximately 48% of underage individuals obtain vapes through various means, including direct purchases or proxy acquisitions from shops. However, there is a lack of detailed information regarding the specific types of shops facilitating these transactions. This missing breakdown is crucial in shaping potential legislative measures aimed at curbing underage access to vaping products.

 

Concurrently, 40% of underage tobacco users continue to make their purchases from retail establishments, a persistently high figure that necessitates urgent intervention. Addressing this issue aligns with the broader effort to combat underage vaping, and proposed actions include heightened vigilance from trading standards, implementation of test purchase operations, and active involvement of youth councils. By addressing both vaping and tobacco use through coordinated measures, it becomes possible to create a more effective and comprehensive approach to mitigate the accessibility of harmful products to underage individuals. These percentages were obtained by ASH in June 2023.


- Youth Perception on Tobacco and Vapes

Over the past decade, there has been a significant shift in the way young individuals perceive harm, particularly among those aged 11-17. Astonishingly, in the latest report by ASH, only approximately one-third of individuals in this age group now possess accurate knowledge that smoking poses a greater risk than using e-cigarettes. This shift not only highlights the fact that the perceived threat of harm does not dissuade underage individuals from engaging in smoking or e-cigarette use, but it also underscores a glaring deficiency in education on this subject. Whether attributed to insufficient guidance from parents, educational institutions, or governmental initiatives, the evident lack of awareness among the youth signifies a pressing need for comprehensive education and awareness campaigns.- Parents and Guardians of underage vape users.


From my perspective, a significant number of parents actively engage in purchasing vapes for their underage children. This observation is supported by anecdotal evidence obtained through conversations with other vape shop owners and my personal experiences working directly with the public in a retail environment. Additionally, ASH statistics indicate that 46% of underage users were "Given" their vape, although the report does not provide further details. It is reasonable to assume that a considerable portion of these instances involve parents or responsible adult family members. During these encounters, it is not uncommon for staff members to find themselves in situations where it becomes evident that individuals are acquiring vaping products on behalf of their underage children. It is important to emphasize that law-abiding stores consistently reject such transactions, adhering to the principle of refusing proxy sales to minors.

The motivations behind this parental behaviour are multifaceted. Some parents may opt to buy vapes for their children as a way of exerting control over the source of these products, potentially avoiding the risks associated with their children resorting to acquiring them from illicit sources. Another segment of parents may, in fact, perceive no harm in these devices and remain unaware of the associated risks, contributing to their willingness to facilitate such purchases for their children. Lastly, there exists a subset of parents who, upon discovering their child's engagement in smoking, may attempt to steer them away from traditional cigarettes by introducing them to vaping as a potentially less harmful alternative.

 

Understanding the diverse motivations behind parental involvement in providing vapes to their underage children is essential for devising effective strategies to address this issue. It calls for targeted educational initiatives to enhance parental awareness about the risks associated with vaping, along with potential regulatory measures to deter such proxy sales and encourage responsible parenting in matters related to substance use by minors.


Flavours –

Amidst the evolving landscape of vaping trends, recent data has underscored the prevalence of flavoured e-liquids, particularly among youth and certain age demographics. As highlighted in the ASH report of 2023, flavours play a pivotal role in shaping the preferences of underage users, with Fruit flavours dominating at 60%, followed by sweet/soft drink variants at 25%. These statistics find reinforcement in a survey conducted by The British Psychological Society, which delves into the specific flavours favoured by vapers in Southeast England. Notably, fruity options, spearheaded by apple, lead the pack, while a diverse array of flavours, including cherry, watermelon, mango, pineapple, and others, contribute to the rich tapestry of preferences among vapers.


Interestingly, this flavour fascination extends beyond the youth demographic, as evidenced by the preferences of middle-aged adults (35-44 years old). This group, too, showcases a penchant for 'Fruit' flavours, closely followed by an affinity for 'Sweets and Desserts.' The convergence of flavour preferences across age groups signals the pervasive influence of flavours in the vaping landscape.

On March 21, 2023, research conducted by Medrxiv, primarily commissioned by Public Health, was publicly released in a re-print. The study employed a decision aid, utilizing data from various sources, to assess the potential consequences of implementing a flavour ban in the UK and the US. The analysis specifically examined three populations: the general UK population, the low-socioeconomic position UK population, and the general US population. In all cases, the results suggested an overall adverse impact of a flavour ban on these populations. The subsequent reports were presented to the all-party parliamentary group for vaping.

 

It's important to note that although the study was originally conducted in 2022, it has been updated to reflect the continuously evolving sociocultural landscape. However, the overall conclusion of a negative impact has remained consistent.

Concurrently, debates on potential regulatory changes have brought the role of flavours to the forefront. Traditional favourites like Pear Drops, Blackjack, Apple, and Energy Drink, integral to the vaping experience for many years, now face scrutiny. The rise in youth vaping, especially with the popularity of disposable vapes, has sparked discussions on the necessity of regulations targeting flavoured e-liquids. An online petition has gained significant momentum, amassing over 40,000 signatures in a short period. Opponents of flavour restrictions argue that such measures may impinge on individual freedom of choice and restrict access to products seen as a safer alternative to traditional smoking.


Drawing on professional insights and independent research involving local vape shops, a notable pattern emerges. A substantial majority, ranging between 80-90% of sales, is attributed to e-liquids featuring non-tobacco and non-menthol flavours. The potential prohibition of these flavours raises concerns about the unintended consequences it might unleash, including a potential reversion to smoking or a dampening of enthusiasm for transitioning to a healthier vaping alternative.

Examining nationally representative survey data provides a nuanced understanding of the potential impact of flavoured e-liquids. The analysis reveals that restrictions on flavours could lead to adverse outcomes, with 39% of smokers likely to experience increased smoking or encounter challenges in quitting without access to flavoured e-liquids. Additionally, 14% of ex-smokers, who have turned to vaping for harm reduction, may face a relapse into smoking if denied their preferred flavours.


These findings align with a broader scientific study on U.S. adults, where 62.9% of vapers reported using non-tobacco flavours, correlating with higher satisfaction levels. However, a pertinent concern arises regarding the potential rise of illegal trading and counterfeit products should certain flavours be banned. A U.S. study on flavour bans found that, even post-ban, respondents continued using banned flavours, either through legal channels or by seeking out illicit sources.The latest adult vaping statistics follow a survey conducted by One Poll earlier in 2024, which revealed that 83% of vapers said that flavours helped them quit smoking, with 1 in 3 saying that a ban on them would lead them back to conventional cigarettes, which would represent around 1.5m former smokers.


Moreover, qualitative research adds depth to the understanding of the issue, revealing diverse perspectives among vapers and smokers regarding potential flavour restrictions. While some express support for regulations, others contemplate resorting to illicit means to maintain access to their preferred flavours.

A government survey further underscores the complexity of public opinion on the matter, with 52% of respondents expressing opposition to restrictions on vape flavours. These multifaceted insights collectively emphasize the intricate nature of the vaping landscape, demanding a balanced and well-considered regulatory approach that weighs public health concerns against individual choices and potential unintended consequences.


John Dunne, the UKVIA’s Director General, added: “Why should 4.5m adults who have spent years trying to kick a habit that kills some 250 people a day, and have managed to do so through vaping, be at risk of having their lifeline taken away. If the government goes down the path of banning (single use vapes and/or) flavours a return to smoking amongst current vapers will be very much on the cards, bringing with it catastrophic consequences for the public health of the nation and wrecking any chances of the government’s smoke free ambition.  The only winners from any potential bans on the vaping industry are the tobacco industry and illicit markets, something that no one in their right mind wants to see.”


Prices -

 In the aforementioned government survey, respondents were asked whether an increase in the price of vapes would reduce the number of young people who vape. The majority, accounting for 51.5%, answered in the negative.


 The introduction of a new vape tax in the UK prompts noteworthy considerations, and a case study from June 2023 in Southend provides a striking illustration. An article in the Evening Echo newspaper celebrated Southend as the first town on track to become smoke-free by 2030, attributing this achievement to the increased utilization of vape services. The reported quit rate of 45%, surpassing the minimum target of 30%, stood out as notably higher than success rates reported by local General Practitioners (GPs) for traditional cessation methods.


The positive impact of vaping services in Southend have been validated and the reported figures, affirming the accuracy of the reported quit rates. This underscores the efficacy of vaping as a smoking cessation tool and challenges the notion of imposing additional taxes on vaping products, potentially hindering access to such services and impeding progress toward achieving smoke-free status.


Southend's success story highlights the potential for vaping services to exceed traditional quit rates and contribute significantly to public health objectives. Policies promoting harm reduction through vaping can yield tangible results, as evidenced by the substantial increase in quit rates in the community. Policymakers weighing the decision to introduce a vape tax should carefully consider the broader implications for public health and the potential stifling effect such taxation may have on successful smoking cessation initiatives. The Southend case study serves as a compelling reminder that embracing harm reduction strategies can lead to remarkable outcomes in the pursuit of smoke-free communities, which of course, is one of the government’s ultimate goals.


From an economic standpoint, the vaping industry, experiencing substantial growth, may face a downturn due to the tax. Small businesses in the vaping sector, including vape shops and independent manufacturers, may struggle to absorb the additional financial burden, leading to potential job losses and business closures. Additionally, the tax could incentivize consumers to turn to the black market for cheaper alternatives, potentially increasing the prevalence of unregulated and unsafe vaping products.


In summary, while taxation is a common tool for revenue generation and regulatory control, the introduction of a vape tax in the UK raises concerns about its potential negative impacts on public health, consumer choices, economic stability within the vaping industry, and the exacerbation of health inequalities. Policymakers need to carefully weigh these factors and strike a balance between revenue generation and supporting harm reduction efforts.


Side Effects in Youths being Cut Off –

 Nicotine withdrawal in individuals under 18 who have been using vapes can present a unique set of challenges. Adolescents and young adults are particularly vulnerable to the addictive nature of nicotine, and abrupt cessation of vaping may lead to symptoms of withdrawal. These can include irritability, mood swings, difficulty concentrating, and intense cravings. It is essential to approach nicotine dependence in young individuals with sensitivity, recognizing that their developing brains may be more susceptible to the effects of withdrawal.


Dealing with the cessation of vaping in individuals under 18 requires a comprehensive and supportive approach. Education plays a pivotal role in this process, as it is crucial to inform young users about the potential consequences of nicotine addiction on their health. Establishing open lines of communication, both within schools and at home, allows for the dissemination of accurate information and creates a supportive environment for those attempting to quit vaping.

Moreover, the involvement of healthcare professionals, such as school nurses and general practitioners, can be instrumental in providing guidance and support during the quitting process. Counselling services, either in school settings or through established youth-oriented programs, can offer a platform for young individuals to discuss their challenges, seek coping mechanisms, and receive encouragement.


Recognizing that peer influence plays a significant role, implementing peer-led support groups or educational initiatives can foster a sense of community among young vapers attempting to quit. Sharing success stories and coping strategies within their age group may contribute to a more positive and effective approach to overcoming nicotine addiction.


In the UK, where efforts to curb youth vaping are crucial, tailoring interventions to the specific needs of this age group is essential. Combining educational campaigns, professional guidance, and peer support initiatives can create a holistic strategy for addressing sudden nicotine withdrawal in individuals under 18 who are transitioning away from vaping. This multifaceted approach aligns with a comprehensive public health effort to mitigate the risks associated with youth nicotine addiction and promote healthier choices among the younger population.When adolescents find themselves abruptly disconnected from vapes, whether they be disposables or other flavoured alternatives, two potential outcomes loom prominently. Firstly, there's a considerable risk that they may gravitate towards the expansive black market for vaping products. This illicit avenue poses numerous dangers, as products from unregulated sources may lack quality control, heightening health risks for unsuspecting users. Secondly, the sudden cessation could give rise to withdrawal symptoms, emphasizing the crucial need for adequate support mechanisms.


Addiction among Adults -

Addiction in adults spans a spectrum beyond traditional substances like cocaine or heroin, extending to various behaviours and substances that can significantly impact individuals' lives. Nicotine addiction is a pertinent example. While people may not smoke for the taste, the addictive nature of nicotine makes it a compelling factor. The grogginess and irritability experienced when individuals miss their nicotine fix illustrate the grip of addiction.

 

A comparable scenario unfolds with coffee, a widely consumed beverage containing caffeine, a stimulant akin to nicotine. The dependency on caffeine is palpable among a substantial portion of the UK population, evident in the morning grogginess and irritability that may ensue if their daily coffee ritual is disrupted. Despite these symptoms, society often refrains from labelling those reliant on coffee as addicts, even though caffeine dependence is a real phenomenon that doesn't necessarily lead to harmful addiction.


The analogy extends to individuals transitioning from smoking to vaping. While some argue it's merely swapping one habit for another, it's essential to recognize that this shift entails a habit with significantly reduced health risks compared to combustible alternatives and eliminates second-hand effects. For those dependent on their fix, whether it's caffeine, nicotine, or other substances, the drive to satisfy this need remains consistent.



Critics may downplay an adult's frustration over the unavailability of a specific flavoured vape as inconsequential. However, for some, it could be the crucial factor that enables them to opt for a healthier alternative. The potential consequences of restricting access to these alternatives might lead individuals back to unhealthy options or even the illicit market, emphasizing the importance of understanding and addressing the complexities of addiction and dependency.

 

Packaging –

The discourse surrounding the packaging of vape disposables and e-liquids has been a subject of considerable debate and investigation. A notable event occurred on the 4th of October 2023 when the results of a Youth Vaping Survey were unveiled. Despite being live for a span of eight weeks, the survey gathered a surprisingly low response of 441 participants. This lacklustre engagement suggests that the survey might not have been adequately accessible to the public, and efforts to encourage higher participation were seemingly insufficient. Nevertheless, the survey's findings indicated a prevailing sentiment among respondents, with a majority advocating for the introduction of plain packaging for vaping products.

While some vaping brands may push the boundaries with their packaging, utilizing cartoons and potentially appealing to a younger audience, such instances are few and far between, and they do not necessarily represent the industry as a whole. It's crucial to recognize that the vibrancy of packaging, though attractive to children, doesn't inherently exclude its appeal to adults. The call for plain packaging, however, raises concerns beyond aesthetics.


Implementing plain packaging could have practical repercussions, particularly in retail settings. The absence of distinctive packaging may elongate the time customers spend searching for their desired products, potentially leading to an increase in mistakes and write-offs. This aspect emphasizes the need for a balanced approach when considering regulatory changes in packaging design. Rather than limit packaging to be plain, a better approach would be to put out guidelines to what is allowed, for example, no cartoons, copies of brands, names of sweets and mascots.


A comparative analysis brings attention to the practices in the USA, Canada, and New Zealand, where plain packaging is not mandated. However, these countries have stringent regulations limiting the sale of vaping products to dedicated specialized vape shops, which, by law, are accessible only to individuals aged 18 and above. This structural restriction ensures that individuals under the age of 18 do not directly encounter vaping product packaging, as opposed to the current scenario in local supermarkets where such advertising is allowed openly.

In contemplating potential changes to packaging regulations, it becomes imperative to address the intricacies involved. Balancing the desire for plain packaging with the practical considerations related to retail operations and the lesson from international practices is essential. Striking the right balance ensures that regulatory measures not only address concerns related to youth exposure but also consider the broader implications for both consumers and the industry as a whole.


Additionally, the discussion surrounding the enticing packaging of certain vaping products prompts an inquiry into the potential applicability of similar regulations to other consumables, particularly alcohol. This consideration extends to brightly coloured beverages such as ‘WKD’, these brands are frequently displayed and visible to children in retail settings. Given the persistently high rates of underage drinking in the UK, surpassing those of underage vaping, there arises a question about the consistency of regulatory measures. If the packaging argument in vaping is genuinely rooted in the aim of safeguarding youth, it prompts reflection on why comparable guidelines cannot be extended to cover alcohol, cigarettes, and vaping alike. The need for uniform standards across these different products becomes apparent, especially in addressing concerns about the influence of packaging on the choices and perceptions of young individuals.The Black Market -Briefly mentioned earlier in the paper, current estimates indicate that one out of every three vapes in the UK has been sourced from un-regulated providers and/or do not met the standards set for UK sale. This predominantly comprises disposable vapes that surpass the 2ml e-liquid limit mandated by the current Tobacco Products Directive (TPD). This revelation is staggering and underscores the apparent lack of control the government currently exerts over the situation. Regrettably, all new proposed government proposals thus far seem poised to exacerbate the already rampant and unbridled illicit market.


This situation presents a tangible threat not only to underage users but also to adult consumers who find themselves compelled to obtain their preferred Cola-flavoured or Blue Raspberry flavoured vape liquid from informal sources, like Joe on the street corner, as a means to avoid reverting to traditional cigarettes. The burgeoning illicit market not only signifies a loss in direct tax revenue but also forewarns of reduced sales in legitimate stores, potentially leading to job losses.

The existing challenges in enforcing current regulations highlight a significant hurdle for future policing efforts. If the government struggles to control the regulatory framework presently in place, the prospect of effective enforcement in the future appears daunting.

 

Summary - 

While it is clear that there is a substantial increase in vaping among young people and action needs to be taken, it is crucial to consider the long-term health risks. Overall, the health risks posed by vaping are generally much lower than those of smoking. However, the current government plans, aimed at protecting children from vaping, may have a more detrimental impact on adult health in the long run. It is my belief that the government's approach to implementing new restrictions is misguided and may inadvertently lead to the emergence of a black market, which poses significantly higher health risks.

 

In my perspective, a more impactful approach to curbing underage vaping in the long term nationwide, as well as protecting the safety of consumers; would require the implementation of stricter regulations. This could involve licensing the sale of vapes and related products exclusively to authorized stores, a matter under discussion with the UKVIA. However, in the interim, by concentrating on existing regulations and distributing additional funding to local trading standards, we can avoid the need for additional measures such as flavour bans or taxing.

 

Conclusion:

In conclusion, the multifaceted landscape of vaping, especially among underage individuals, demands a comprehensive and nuanced approach. The prevalence of underage vaping, as revealed by recent surveys, underscores the urgency of addressing this issue. While concerns about youth access are legitimate, it is crucial to recognize the harm reduction benefits that vaping offers to adult smokers.

The transition from smoking to vaping among underage individuals, as indicated by various survey data, suggests the need for targeted interventions to address the root causes of underage smoking. Parental involvement, youth perception, and educational gaps contribute to the complex dynamics surrounding the issue.

 

The role of flavours in vaping cannot be understated, as they play a significant role in attracting both youth and adults to vaping products. While debates about flavour bans persist, it is essential to consider the potential unintended consequences, such as increased smoking rates and the rise of illicit markets. The delicate balance between public health concerns and individual choices requires careful consideration.

 

The proposed vape tax raises concerns about its impact on public health initiatives, economic stability within the vaping industry, and potential consequences for consumers. The success story of Southend becoming smoke-free through increased vaping underscores the positive role vaping can play in harm reduction efforts.

 

Addressing nicotine withdrawal in youths and understanding addiction in adults further emphasizes the need for comprehensive strategies that include education, support mechanisms, and tailored interventions. The packaging debate, while focused on youth exposure, should consider practical implications for retail operations, and draw lessons from international practices.

 

Lastly, the growing black market for vaping products poses a significant threat to both underage and adult consumers, necessitating effective regulatory enforcement and a re-evaluation of proposed government measures.

 

In navigating the complex landscape of vaping, policymakers must strike a delicate balance between protecting youth, acknowledging the benefits for adult smokers, and fostering an environment that encourages harm reduction. A nuanced approach that addresses the root causes, engages all stakeholders, and carefully considers the potential consequences of regulatory measures is crucial for achieving a balanced and effective vaping policy.

 

 

References and Research

 

 

Background Information to readersThis paper has been exclusively authored by Sam Bignell, drawing from publicly available information, websites, government documents, meeting minutes, white papers, and a limited amount of independent research involving discussions with shop owners. It is important to note that my personal research has had minimal impact on the overall outcome and quality of this paper.

 

My involvement in the Vape industry dates back to 2014, and I established my first retail store in 2016. Since 2018, I have collaborated with Southend Council to support local Smoke Free services and conducted various trials for the 'Swap to Stop' scheme, both of my retail establishments are currently contracted to Southend (City) Council.

 

Beyond my stores and the Stop Smoking service, my contributions to the Vaping industry extend to advocating for improved recycling, increased local funding for trading standards (as emphasized in this paper), and enhanced training and support for educators, general practitioners, and youth workers.

 

Having successfully quit smoking, approximately 20 cigarettes a day, using Vapes after unsuccessful attempts with other Nicotine Replacement Therapies (NRT), I entered this industry with the primary goal of assisting others.

 

To combat the issues of the black market and underage sales in my locality, I collaborate closely with trading standards, passing on verbal reports received in-store and establishing a consumer reporting system for any related concerns. These reports are then compiled and forwarded to trading standards for appropriate action.

 

My knowledge is consistently updated through information provided by Public Health England, my local authority, the Stop Smoking Service, the National Centre for Smoking Cessation and Training (NCSCT) and supplemented by my personal independent training and research.

 

Despite my direct involvement in the Vaping industry, I am a private individual unaffected by government influence, large corporations, big pharma, or big tobacco. I have endeavoured to present this paper in an unbiased manner.

 

Peer reviewed by:

Alan Henderson – Vape Network

Jane Bignell – General Public Krishan Chohan– Evolution Vaping Tracey – Wick Addiction

 

 

 

 

 

 

 

 

 

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