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E-cigarettes: an evidence update <br /> <br />7 <br />Executive summary <br />Following two previous reports produced for Public Health England (PHE) on e - <br />cigarettes (EC) in 2014, this report updates and expands on the evidence of the <br />implications of EC for public health. It covers the EC policy framework, the prevalence <br />of EC use, knowledge and attitudes towards EC, impact of EC use on smoking <br />behaviour, as well as examining recent safety issues and nicotine content, emissions <br />and delivery. Two literature reviews were carried out to update the evidence base sin ce <br />the 2014 reports and recent survey data from England were assessed. <br /> <br />EC use battery power to heat an element to disperse a solution of propylene glycol or <br />glycerine, water, flavouring and usually nicotine, resulting in an aerosol that can be <br />inhaled by the user (commonly termed vapour). EC do not contain tobacco, do not <br />create smoke and do not rely on combustion. There is substantial heterogeneity <br />between different types of EC on the market (such as cigalikes and tank models). <br />Acknowledging that the evidence base on overall and relative risks of EC in comparison <br />with smoking was still developing, experts recently identified them as having around 4% <br />of the relative harm of cigarettes overall (including social harm) and 5% of the harm to <br />users. <br /> <br />In England, EC first appeared on the market within the last 10 years and around 5% of <br />the population report currently using them, the vast majority of these smokers or recent <br />ex-smokers. Whilst there is some experimentation among never smokers, regular use <br />among never smokers is rare. Cigarette smoking among youth and adults has <br />continued to decline and there is no current evidence in England that EC are <br />renormalising smoking or increasing smoking uptake. Instead, the evidence reviewed in <br />this report point in the direction of an association between greater uptake of EC and <br />reduced smoking, with emerging evidence that EC can be effective cessation and <br />reduction aids. <br /> <br />Regulations have changed little in England since the previous PHE reports with EC <br />being currently governed by general product safety regulations which do not require <br />products to be tested before being put on the market. However, advertising of EC is <br />now governed by a voluntary agreement and measures are being introduced to protect <br />children from accessing EC from retailers. Manufacturers can apply for a medicinal <br />licence through the Medicines and Healthcare products Regulatory Agency (MHRA) and <br />from 2016, any EC not licensed by the MHRA will be governed by the revised European <br />Union Tobacco Products Directive (TPD). <br /> <br />A summary of the main findings and policy implications from the data chapters now <br />follows. <br />