The Public Health (Wales) Bill
E-cigarettes are a new phenomenon yet controversial. Their health effects, use in public places and effectiveness as an aid to quitting smoking are the cause of much debate in the media, and governments and health organisations remain opposed (see below). E-cigarettes came to the market in 2004 as a ‘healthier’ alternative to cigarettes, and the industry has grown rapidly ever since.
E-cigarettes are electronic devices that mimic the act of smoking (Caponnetto, 2012). They use a battery powered heating element to disperse liquid (usually containing nicotine, in a solution of glycerine and/or propylene glycol) into an aerosol that can be inhaled in the same way as a conventional cigarette (Goniewicz, 2013). They are seen as the healthier or safer cigarette as they do not combust tobacco, and are therefore used as a smoking cessation tool.
The unknown effects of e-cigarettes to both individuals and to others (e.g. passive vaping) is among one of the reasons why Wales is proposing an e-cigarette ban in public places.
The Proposal in Wales
The Public Health (Wales) Bill was introduced by the Welsh Government on the 8th of June 2015. This bill is the first in the UK to propose a ban of e-cigarettes in public places. Smoking has been banned in public places across the UK since 2007. The bill in Wales will subject e-cigarettes to the same regulation.
The new tobacco and e-cigarette measures in Wales will:
- Restrict the use of nicotine inhaling devices such as electronic cigarettes in enclosed and substantially enclosed public and work places, bringing the use of these devices into line with existing provisions on smoking (including lorries and taxis);
- Create a national register of retailers of tobacco and nicotine products;
- Prohibit the handing over of tobacco or nicotine products to people under the age of 18 (including online sales).
If the bill passes through parliament as expected, the e-cigarette ban could be implemented by late 2016.
Reasons For The Ban
The reasons behind this proposed ban are to protect the public from the unknown health consequences of passive vaping, ensure smoking is not renormalized and to not undermine the current smoking ban in place. A WHO-commissioned report on e-cigarettes suggested that bystanders could inhale significant levels of toxins from e-cigarette vapour. However, a critique of this report argues that concentrations are too low to present a significant health risk. There is mixed evidence as to whether passive vaping is harmful but research generally shows that whatever is inhaled is less toxic and harmful than cigarettes (Goniewicz, 2012) . Regardless of trace amounts of toxicants in e-cigarette vapour, it is proposed that passive vaping is possible and the impact of vapour inhalation into human lungs should be of primary concern (Markewitz, 2013).
Another reason behind Wales’ decision to ban the use of e-cigarettes in public places is the fear that it will renormalize smoking for minors and prove to be a gateway into conventional cigarettes.
Although there is evidence of e-cigarette experimentation in youths in Wales , current use in the UK is rare. In a recent report on young people and smoking, the proportion of children who have ever smoked continues to decline, suggesting e-cigarettes are not a gateway to smoking. Furthermore, data collected by Action on Smoking and Health (ASH) shows that regular use of e-cigarettes is predominantly by current or ex-smokers, and use by never smokers or youths is negligible.
The Welsh government is pressing forwards with this bill, yet it is gaining opposition from many MPs and organisations. The reasons against the ban are the limited evidence on the harms of passive vaping, and the concern that a ban of e-cigarettes could impede progress in those who are using them to quit smoking. Cancer Research UK state that they “do not believe there is enough evidence to justify an indoor ban on e-cigarettes”. In agreement, Plaid Cymru MP Elin Jones said: “E-cigarettes are used widely by people who are trying to give up smoking, so we should be very careful not to halt that trend.”
There are many organisations that are for and against the banning of e-cigarettes in public places, however it will be unknown who is correct until more research is performed and evidence presented.
The Future
Malta, Belgium and Spain have already imposed the ban and WHO is urging governments to do the same. With such controversy and opposition in the views on this bill, the future is unpredictable as to whether other countries will also enact the ban.
The Public Health (Wales) Bill is still in development and currently progressing through parliament, therefore information outlined above may be subject to change. If it is implemented, it will be interesting to see if the rest of UK follow in Wales’ footsteps. Due to e-cigarettes being such a new and under researched field; it is likely to take a few more years before a solid evidence base is gained and to see if Wales have created an unnecessary protection or are innovators passing a law improving the health of the public.
For more information:
Electronic Cigarettes: a report commissioned by Public Health England
Electronic Cigarettes Fact Sheet: Action on Smoking and Health
Elle Wadsworth, King’s College London
References
ASH (2014). Electronic cigarettes: also known as vapourisers). [Online] Available from: http://www.ash.org.uk/files/documents/ASH_715.pdf [Accessed: 22nd July 2015].
Bauld, L., Angus, K., & Andrade, M. (2014) E-cigarette uptake and marketing: A report commissioned by Public Health England. [Online] Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311491/Ecigarette_uptake_and_marketing.pdf [Accessed: 22nd July 2015].
British Medical Association (2015) E-cigarettes. [Online] Available from: http://bma.org.uk/working-for-change/improving-and-protecting-health/tobacco/e-cigarettes [Accessed: 22nd July 2015].
Cancer Research UK (2015) Our policy on harm reduction and e-cigarettes. [Online] Available from: http://www.cancerresearchuk.org/about-us/we-develop-policy/our-policy-on-tobacco-control-and-cancer/our-policy-on-harm-reduction-and [Accessed: 22nd July 2015].
Caponnetto, P., Campagna, D., Papale, G., Russo, C., & Polosa, R. (2012). The emerging phenomenon of electronic cigarettes.Expert Rev Respir Med;6(1):63-74. doi: 10.1586/ers.11.92
Deans, D. (2015) E-cigarettes set to be banned in enclosed public spaces in Wales as soon as next year. Wales Online. 9th June. Available from: http://www.walesonline.co.uk/news/wales-news/e-cigarettes-set-banned-enclosed-public-9414640 [Accessed: 22nd July 2015].
Deans, D. (2015) Opposition grows to the Welsh Government’s plan to ban smoking E-cigs in public places. Wales Online. 9th June. Available from: http://www.walesonline.co.uk/news/wales-news/opposition-grows-welsh-governments-plan-9419048 [Accessed: 22nd July 2015].
Goniewicz, M. L., Lingas, E. O., & Hajek, P. (2013). Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey. Drug and Alcohol Review, 32(2), 133-140.
Grana, R., Benowitz, N., Glantz, S. (2013) Background Paper on E-cigarettes (Electronic Nicotine Delivery Systems). [Online] Available from: http://www.arizonansconcernedaboutsmoking.com/201312e-cig_report.pdf [Accessed: 22nd July 2015].
McNeill, A., Etter, J. F., Farsalinos, K., Hajek, P., Houezec, J., & McRobbie, H. (2014). A critique of a World Health Organization‐commissioned report and associated paper on electronic cigarettes. Addiction, 109(12), 2128-2134.
Moore, G., Moore, L., Ahmed, N., Littlecott, H., & Holliday, J. (2014). Exposure to secondhand smoke in cars and e-cigarette use among 10-11 year old children in Wales: CHETS Wales 2 key findings report.
National Assembly for Wales (2015) Public Health (Wales) Bill. [Online] Available from: http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=12763 [Accessed: 22nd July 2015].
Schripp, T., Markewitz, D., Uhde, E., & Salthammer, T. (2013). Does e‐cigarette consumption cause passive vaping?. Indoor air, 23(1), 25-31.
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.