Christopher Russell | 4 October 2015

The finding of a recent survey commissioned by the UK charity Action on Smoking and Health (ASH) [1] that the proportion of 11-18 year olds in the UK who have tried using an electronic cigarette at least once rose from 5% in 2013 to 13% in 2015 will almost certainly lead to calls for greater restrictions to be placed on the ability of manufacturers and vendors to advertise nicotine vapour products. Perhaps there will even be calls, in time, for nicotine vapour products to be sold only in plain packaging as now occurs with all tobacco products in Australia. But are greater restrictions on the advertising of electronic cigarettes consistent with the priority public health goal of reducing tobacco-related disease?

For those whose main concern is to protect young people from taking up use of nicotine products, there is a case for restricting advertising if, by doing so, the rate of regular use of nicotine-containing e-cigarettes among young people would be reduced. However, regular use (once a month or more) of an e-cigarette is rare among young people, and largely confined to young people who already smoke cigarettes. The most recent data suggest only 0.5% of 11-18 year olds use e-cigarettes at least once per week, and only 2.4% use e-cigarettes at least once per month. Moreover, only 4% of young never-smokers have ever tried an e-cigarette, compared to 77% of young regular cigarette smokers. Together, these data suggest that using an e-cigarette is not currently an attractive behaviour to the vast majority of young people in the UK, and even less attractive to young people who have never smoked.

Instead, what the data do show is that around 99% of the estimated 2.6 million regular e-cigarette users in the UK are adults (aged 18+) who are either current smokers (66%) or former smokers (33%) [2]. A recent survey by ASH found that 17.6% of current adult cigarette smokers are also regularly using an e-cigarette, most commonly, to help them quit smoking completely or to reduce the amount of tobacco they smoke without stopping completely. In contrast, only 0.2% of adult never-smokers are currently using an e-cigarette, and only 1.5% of adult never-smokers have ever tried an e-cigarette.

Given these data on who is using e-cigarettes, e-cigarettes appear to represent a significantly greater opportunity to prevent tobacco-related mortality and morbidity among current smokers than they represent a threat to the future health and wellbeing of young people. Indeed, the cumulative health gains that may come from millions of smokers switching to e-cigarettes will gulf, many times over, the negligible harms that may come from an extremely small proportion of young people beginning regular use of a product that is estimated to be at least 20 times less harmful than smoking tobacco. That is, for as long as e-cigarettes are used almost exclusively by individuals at risk of continuing to smoke or relapsing to smoking, the net population impact of advertising e-cigarettes to adult smokers will likely be hugely positive. Restricting the advertising of e-cigarettes may result in a fractional reduction in the already extremely small proportion of young people trying e-cigarettes, but at the possible cost of reducing the attractiveness of a vastly reduced risk product that have thus far lured millions of individuals away from tobacco and the harm it carries.

The growth in the prevalence of use of electronic cigarettes in the UK since 2010 has been remarkable in many respects, not the least of which is the fact that this growth has not been assisted by any major marketing campaigns by manufacturers or educational campaigns by government bodies. One may speculate as to how many more smokers would have already have switched to an electronic cigarette had these products been vigorously advertised by manufacturers and supported by public health harm reduction services. Rather than seek to constrain a manufacturer’s ability to communicate the potential health and social benefits of vaping to adult current smokers, we should, in the interest of net population health, be asking how manufacturers can maximise the attractiveness of e-cigarette advertising to adult current smokers, while continuing to remain unappealing to the vast majority of young people and adult never-smokers.

Public policy in this area should be driven more by the net public health benefit to be gained from the wider use of electronic cigarettes and on that basis there should be no diminution in the advertising of these products. By analogy, if a national health service discovered that a new vaccine saved one in three people affected by cancer, but a general population survey showed that the vaccine was being occasionally consumed by 1% of people who did not have cancer but without serious adverse effects, the health service would surely conclude that advertising this vaccine would likely prevent magnitudes of harm more than it would cause. In all probability, the health service would vigorously endorse the new vaccine for use by cancer patients while taking all care to discourage use by those for whom the vaccine is not indicated. In the case of electronic cigarettes, the public health community should, of course, do all it can to discourage the use of any nicotine-containing product by any person not already consuming nicotine, but we would argue that the public health is significantly better served by first and foremost avoiding the implementation of any regulatory measure that has the potential to reduce or stagnate the attractiveness and accessibility of e-cigarettes to current smokers.

Christopher Russell Ph.D.
Centre for Drug Misuse Research
Glasgow, U.K.


  1. Action on Smoking and Health (2015) Use of Electronic Cigarettes among Children in Great Britain. ASH Factsheet, Aug 2015. Accessed 20th August 2015 at: http://www.ash.org.uk/files/documents/ASH_959.pdf
  2. Action on Smoking and Health (2015). Use of Electronic Cigarettes (vapourisers) among Adults in Great Britain. ASH Factsheet, May 2015. Accessed 20 th August 2015 at: http://www.ash.org.uk/files/documents/ASH_891.pdf