Academy position statement: Tobacco and vapes

This statement from the Academy of Medical Royal Colleges summarises the health impacts of smoking, passive smoking and youth vaping. Medical royal colleges have joined together to highlight these health impacts and to urge the UK Government to bring forward a Tobacco and Vapes Bill without further delay, including establishing a smoke free generation.

Smoking and passive smoking

The harms of actively smoking tobacco products are well known, with an estimated 74,600 annual deaths [1] and a cost of £46 billion to society each year in England.[2] There is incontrovertible evidence that smoking is harmful to individuals with serious implications for wider society.

The harms from passive smoking are well-described in the literature, and begin before birth; unborn babies whose mothers smoke are smaller than unexposed fetuses and this difference is already apparent by mid-pregnancy.[3] Children passively exposed to smoke are at increased risk for sudden infant death, chest infections and meningitis.[4] The natural experiment of introducing smoke free public spaces was associated with improved child health outcomes, including fewer premature deliveries [5] and reduced asthma admissions.[6,5] Consistent with these observations, the introduction of the car smoking ban in Scotland was associated with a reduction in asthma admissions for under five-year-olds.[7] Adults exposed to passive smoking are also susceptible to harm from cancer and heart disease.[4]

These harms have led to the introduction of smoke free public spaces legislation in many nations; the motive for this legislation was to protect workers from the harm of smoke exposure in the workplaces. The UK has been a world leader in tobacco reform and introduction of legislation such as smoke free public spaces in the mid-2000s was followed by a 7% fall in adult smoking rates between 2011 and 2023,[8] and fall in annual smoking related deaths of 7,400 between 2009 and 2019.[9]

Vaping

Vaping devices are designed to provide smokers with nicotine and are one of a number of important avenues to smoking cessation.[10] We fully support the statement by England’s Chief Medical Officer that if you smoke, vaping is much safer; if you don’t smoke don’t vape; marketing vapes to children is utterly unacceptable.[11]

Data from NHS England showed that a quarter of 11-15-year-olds used a vape last year and 1 in 10 used a vape frequently.[12] The harms to children from illegal access to vaping and ensuing nicotine addiction have been recently described,[13] and include short term effects on learning and the longer term impact from vaping being a potential gateway to future cigarette smoking.[14]

The tobacco and vaping industry use marketing tactics to encourage the use of vaping among children by promoting their appeal and accessibility. The British Medical Association detail the tactics used including the use of flavours, brightly coloured packaging, and prominent shop displays.[15] In 2013, 12% of young people who’d never smoked said the reason they tried vaping was because they liked the flavours.[16]

Governments across the UK have confirmed that disposable vapes will be banned from 1 June 2025. This measure must sit alongside robust action to restrict the marketing of all vapes to children and young people.

Our call to action

As medical royal colleges and faculties we urge UK governments and assemblies to show resolve in achieving ending our nation’s current addiction to nicotine and protecting future generations. We now urge the UK Government to publish an ambitious tobacco and vapes bill without delay. This should include creating a smoke-free generation, restrict the appeal and accessibility of vapes, and encourage a public debate about other measures needed to protect everyone from the harms of smoking and passive smoking.

References

1. European Commission. Effects of active tobacco smoking on health. 2021.
2. Action on Smoking and Health. ASH Ready Reckoner Summer 2024: Costs of smoking to society. 2024.
3. Abraham M, Alramadhan S, Iniguez C, et al. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS ONE [Electronic Resource] 2017; 12(2): e0170946.
4. NHS. Passive Smoking. 2022.
5. Been JV, Dr, Nurmatov UB, PhD, Cox B, MSc, Nawrot TS, PhD, van Schayck CP, Prof, Sheikh A, Prof. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. The Lancet 2014; 383(9928): 1549–60. doi:10.1016/S0140-6736(14)60082-9.
6. Radó MK, Mölenberg FJM, Westenberg LEH, et al. Effect of smoke-free policies in outdoor areas and private places on children’s tobacco smoke exposure and respiratory health: a systematic review and meta-analysis. The Lancet. Public health 2021; 6(8): e566–78. doi:10.1016/S2468-2667(21)00097-9.
7. Mackay DF, Turner SW, Semple SE, Dick S, Pell JP. Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data. The Lancet. Public health 2021; 6(8): e579–86. doi:10.1016/S2468-2667(21)00129-8.
8. Office for National Statistics. Adult smoking habits in the UK: 2023. 2024.
9. NHS England digital. Smoking-related mortality. 2024;
10. Lindson N, Butler AR, McRobbie H, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2024; (1). doi:10.1002/14651858.CD010216.pub8.
11. Chief Medical Officer for England on vaping. 2023.
12. NHS England. Almost 1 in 10 secondary school pupils currently vape, new NHS survey shows. 2024.
13. Macleod K, Bush A, Coutts J, Langley R. Protecting children from harms of vaping. BMJ 2022; 379: e073824. doi:10.1136/bmj-2022-073824.
14. Martinelli T, Candel MJJM, de Vries H, Talhout R, Knapen V, van Schayck CP, Nagelhout GE. Exploring the gateway hypothesis of e-cigarettes and tobacco: a prospective replication study among adolescents in the Netherlands and Flanders. Tob Control 2023; 32(2): 170–8. doi:10.1136/tobaccocontrol-2021-056528.
15. British Medical Association. Tobacco. 2024.
16. Action for Smoking and Health. Use of e-cigarettes (vapes) among young people in Great Britain. 2023.