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Expert review of e-cigarettes raises concern over misperceptions

  • Many thousands of UK smokers incorrectly believe that vaping is as harmful as smoking
  • Less than 10% of UK adults understand that most of the harms to health from smoking are not caused by nicotine
  • The use and trial of e-cigarettes among smokers has plateaued in the UK

A new independent evidence review on e-cigarettes, commissioned by Public Health England and led by researchers at King’s College London, is an update on PHE’s 2015 review. The review covers e-cigarette use patterns among youth and adults, attitudes, impact on quitting smoking, an update on risks to health and the role of nicotine, and heated tobacco products.

The latest evidence indicates that e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more. But false beliefs may be deterring many thousands of the 7 million smokers in England from trying an e-cigarette to quit; 40% of smokers have not even tried an e-cigarette.  In 2017, when smokers were asked their reasons for not trying an e-cigarette, 23% said they were ‘concerned they are not safe enough.’ 

The new PHE review comes just two weeks after a report by the US National Academies of Sciences, Engineering and Medicine, which concluded that ‘e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes’. The PHE review concludes that switching completely from smoking to vaping will substantially reduce risks to health.

The PHE review also finds there is much public misunderstanding about nicotine. Some 4 out of 10 smokers wrongly think nicotine causes most of the smoking-related cancer, when nicotine actually causes minimal risk of harm to health.

Public misconceptions are not limited to e-cigarettes but also apply to smokers’ beliefs about the risks from nicotine replacement therapies, with almost half of British adults believing they are as harmful as smoking.

The evidence does not support the concern that e-cigarettes are a route into smoking among young people. UK surveys show that young people are experimenting with e-cigarettes, but regular use is rare and confined almost entirely to those who have smoked. There appears to have been no impact on the declining trend in youth smoking rates, but the PHE review stresses the need for continued monitoring.

Over the past few years e-cigarette use has hovered at just under 6% of the adult population in the UK. The most common reason for e-cigarette use continues to be to help with quitting and they are the most popular quitting tool in England. At the same time, quit success rates have been improving and we are also seeing an accelerating drop in smoking rates, currently at a record low of 15.5% in England.

Prof. Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London's Institute of Psychiatry, Psychology & Neuroscience said:

'It is of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.

'People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death. There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes.'

Dr Leonie Brose, author and Senior Lecturer at King’s College London's Institute of Psychiatry, Psychology & Neuroscience added:

'It is of concern that smokers may be missing an opportunity to quit. Local stop smoking services report high quitting success rates (two out of three) for those who combine their support with e-cigarettes.  However, a minority of smokers are using stop smoking services to quit. Our review highlighted the importance of stopping smoking completely.  Healthcare professionals helping smokers quit should provide behavioural support to those wanting to use, including those who are using or want to use an e-cigarette.'

Considering the implications for policy, the authors emphasise that regulation is important to minimise risks. The UK has some of the strictest regulations on e-cigarettes in the world, enabling risks to be managed, while maximising the potential benefits these products offer in helping smokers quit. 



McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018).  Evidence review of e-cigarettes and heated tobacco products. A report commissioned by Public Health England. London: Public Health England.

For further media information on King's College London, please contact Robin Bisson, Senior Press Officer, Institute of Psychiatry, Psychology & Neuroscience, King’s College London on or 020 7848 5377.