Call for evidence outcome

Youth vaping: call for evidence

Updated 4 October 2023

Applies to England

Introduction

In the UK, vapes (e-cigarettes) are regulated as consumer products that can be legally sold to anyone over the age of 18. The government encourages adult smokers to switch to vapes as they are substantially less harmful than smoking. However, vapes should not be used by people under the age of 18 (children) and we have a range of restrictions in place to prevent their uptake and use.

Vaping (using an e-cigarette) is an important tool to help the government achieve its ambition for England to be smokefree by 2030. This is because vaping is one of the most effective ways to help people quit smoking. A recent Cochrane systematic review found with ‘high certainty’ that vapes were more effective than nicotine replacement therapy. Ensuring vaping devices can continue to be made available to current smokers is vital to reducing smoking rates, and their use contributes to an estimated 50,000 to 70,000 additional fewer smokers per year.

However, vapes are not risk free. There is well established concern about the harms from vaping, specifically associated with younger people, as outlined in the Nicotine vaping in England report. There is considerable debate about the scale and nature of these harms. Recently, the Office for Health Improvement and Disparities (OHID), part of the Department of Health and Social Care (DHSC), has worked with the NHS to publish evidence-based information on vaping to quit smoking including facts to tell young people about vaping.

Over the past decade, use of vapes by children has been consistently low. However, recent data collected in NHS Digital’s Smoking, Drinking and Drug Use among Young People in England survey showed a doubling of regular vape use for 11 to 15 year olds to 4% in 2021, compared to 2% in 2018. This was also confirmed in the 2022 Action on Smoking and Health (ASH) survey report Use of e-cigarettes among young people in Great Britain. The survey showed a sharp increase in vaping among 11 to 17 year olds from 4% in 2020, before the first coronavirus (COVID-19) lockdown, to 7% in 2022.

Objectives

Given the changing circumstances surrounding vapes, OHID is leading this call for evidence to identify opportunities to reduce the number of children accessing and using vape products, while ensuring they are still easily available as a quit aid for adult smokers.

We are particularly interested in evidence for the following themes.

1. Building regulatory compliance: ensuring only adult smokers can access legally compliant vape products.
2. The appeal of vape products: how the appearance and product characteristics of vapes may attract children.
3. Marketing and promotion of vape products: how the marketing and promotion of vapes may attract children.
4. The role of social media: the impact of social media on the uptake and use of vaping by children.
5. Effective educational approaches to prevent the uptake of vaping by children.
6. The impact of vapes on the environment, particularly disposable products.
7. Understanding the vape market.

Evidence on vaping

The best thing a smoker can do for their health is to quit smoking. The Vaping in England report from February 2021 found that many thousands of people in the UK have already quit smoking with the help of vapes, making them the most popular quitting aid in England. Evidence on vapes for smoking cessation indicates that they can help smokers to quit, particularly when combined with additional support from local stop smoking services. They were shown to be more effective than traditional nicotine replacement therapy.

The National Institute for Health and Care Excellence guideline Tobacco: preventing uptake, promoting quitting and treating dependence recommends using nicotine-containing vapes as a safe and effective smoking cessation aid. While the evidence shows that vaping is substantially less harmful than smoking, it is unlikely to be totally harmless. Vaping has only been around in the UK since the mid-2000s, so we have not had enough time to fully understand the impact of long-term use.

The government has been monitoring the evidence base for several years and has commissioned a series of independent evidence reviews setting out the evidence on vaping. The latest report in this series Nicotine vaping in England: an evidence update including health risks and perceptions was published in September 2022. This report is the most comprehensive to date. It found that in the short and medium term, vaping poses a small fraction of the risks of smoking, but that vaping is not risk free, particularly for people who have never smoked. It also noted that interventions that provide advice on the harms of vapes need to be carefully designed so they do not misinform young people (particularly smokers) about the relative harms of smoking and vaping.

Data on children vaping

Until recently, children’s use of vapes has remained consistently low. In the report Smoking, Drinking and Drug Use among Young People in England in 2018, current and regular vape prevalence remained the same as in 2016, at 6% and 2% respectively. Due to school closures as a result of the COVID-19 pandemic, updates to the survey were delayed, and the most recent data was published in September 2022. The results showed an increase in vape use in 2021 to 9% of 11 to 15 year olds being current vape users and 4% being regular users.

Other data sources also show a sharp increase in vaping among children. In their 2022 survey, ASH found vaping among under 18s increased from 4% in 2020, before the first lockdown, to 7% in 2022. While vaping among children has increased from 2021 to 2022, it is still largely confined to current or former smokers, and still mostly experimental. Ninety-two per cent of under 18s who have never smoked have also never vaped.

The recent increase in vaping among children appears to have been driven by the emergence of a new class of vapes: disposable products. Although disposables are more expensive to use in the long term, they do not require any initial outlay for equipment and are relatively cheap to buy. The ASH survey found that for the first time the most frequently used products were disposable vapes, which increased from 7.7% in 2021 to 52% in 2022. This was also reflected in results from the US Food and Drug Administration’s annual national youth tobacco survey.

The Khan review

The Khan review: making smoking obsolete is an independent review commissioned by DHSC. It was published in June 2022 and provided recommendations for the government to meet its smokefree 2030 ambition. One of the recommendations Dr Khan made, which he identified as critical to meet the smokefree 2030 ambition, was that vaping should be offered as a substitution for smoking, alongside accurate information on the benefits of switching. The review also made further vaping recommendations including:

• closing a loophole which means that there is no restriction on giving free samples of vapes to children
• restricting packaging images and descriptions to ensure vapes are not appealing to children
• commissioning a review on vape flavourings

International perspectives

Internationally, different nations have taken different positions on vapes, following advice from the World Health Organization to either ban or regulate vapes. About 40 countries worldwide have taken the decision to completely ban vapes. However, many countries support vaping use for adult smokers to switch, including New Zealand, Canada and the US. Recently these countries’ regulations have changed to focus on preventing the uptake of vaping by children. For example, Canada has restricted particular flavours and New Zealand has limited which type of retailer can sell flavoured vapes.

Tobacco industry declaration

The UK is a party to the World Health Organization Framework Convention on Tobacco Control and so has an obligation to protect the development of public health policy from the vested interests of the tobacco industry. To meet this obligation, we ask all respondents to disclose whether they have any direct or indirect links to, or receive funding from, the tobacco industry.

The call for evidence

In the following sections we set out the current evidence base across the 7 themes outlined in the objectives, followed by questions seeking further evidence to inform policy decisions.

There are a number of questions for each theme, and you do not need to answer all the questions in this call for evidence. Please focus on the areas that you are able to give us evidence in. You will be able to skip sections in the online questionnaire if you want to.

Some options may require changes to regulations. If the government identifies such an option to take forward, further consultation and regulatory development may follow.

While OHID is leading this call for evidence in England, we would welcome evidence from across the UK, and internationally.

Building regulatory compliance

The current regulatory framework was designed to prevent children from using vapes. This includes:

• The Nicotine Inhaling Products (Age of Sale and Proxy Purchasing) Regulations 2015 where the sale of vapes to people aged under 18 and proxy purchasing for someone aged under 18 is illegal
• The Tobacco and Related Products Regulations 2016 which outlines restrictions to protect children, such as making the vape child-resistant and having warnings on vape packaging

DHSC undertook post implementation reviews into these 2 regulations. They were:

• A post implementation review report of tobacco legislation coming into force between 2010 to 2015 (published January 2021)
• The Tobacco and Related Products Regulations 2016: post-implementation review (published March 2022)

While the reviews found the regulations to be achieving their aims and concluded that they should be retained in their current form, they identified some areas where the regulations could be amended to be more effective.

Since the publication of these reviews, new data and evidence has emerged related to regulatory compliance. There has been a significant increase in child use of vapes as well as increasing evidence of poor compliance with the ban on sales to under 18s and the sale of non-notified products (not registered for sale in the UK). A recent programme of test purchasing by the Chartered Trading Standards Institute using under 18s found a non-compliance rate of 33%. A quarter of the products they purchased did not comply with UK requirements and should not have been on sale in the UK. The premises where the biggest proportion of illegal sales to visit numbers were made were:

• market or car boot sales (100% non-compliant, or 3 sales from 3 attempts)
• discount shops (52% non-compliant, or 11 sales from 21 attempts)
• mobile phone shops (50% non-compliant, or 10 sales from 20 attempts)

We would welcome evidence on effective action to strengthen regulatory compliance on underage sales and non-compliant products, particularly for small and independent retailers.

Questions

Do you have any evidence to provide on building regulatory compliance?

• Yes
• No

What evidence is there about how and where children are accessing vapes?

What evidence is there of the type of products children are accessing?

What evidence is there of effective measures to limit children’s access to vapes?

Are there any potential unintended consequences to the measures you have suggested?

What evidence is there of children accessing nicotine-containing products, other than vapes and tobacco?

Is there any other evidence on building regulatory compliance that the government should be aware of?

The appeal of vape products

We know that the branding of tobacco products made them more appealing to children. This led to the government introducing standardised packaging across cigarettes and hand rolling tobacco. The Standardised Packaging of Tobacco Products Regulations 2015: post-implementation review found evidence that suggested the ban on branding reduced the appeal of tobacco products to children, with young non-smokers and occasional smokers potentially affected the most.

We are keen to understand if vapes are appealing to children, and if they are, what characteristics make them appealing. If evidence shows they are appealing to children, we would welcome evidence of changes that can be made to product characteristics that would reduce their appeal to under 18s.

Questions

Do you have any evidence to provide on the appeal of vapes to children?

• Yes
• No

What evidence is there about the appeal of vapes to children?

What evidence is there about the appeal of vape flavours to children?

What evidence is there of effective measures to limit the appeal of vapes to children?

Are there any potential unintended consequences to the measures you have suggested?

Is there any other evidence on the appeal of vapes to children that the government should be aware of?

Marketing and promotion of vape products

The marketing and promotion of vapes is restricted through The Tobacco and Related Products Regulations 2016. Advertising is tightly restricted, to protect children from the promotion of vaping products.

No advertising is allowed in print, broadcast, online and other electronic media. Vapes are allowed to be displayed in retail outlets and there is no ban on giving out free vape products to people of any age, although products may not be labelled that they are for free distribution. As a comparison, the advertising of tobacco products is illegal, and so is displaying tobacco products in general retail outlets and giving out free tobacco products.

With an increase in the use of vapes by children, we would welcome evidence on whether vapes are being promoted to children. And if they are, what changes could be made to prevent this.

Questions

Do you have any evidence to provide on the marketing and promotion of vape products?

• Yes
• No

What evidence is there that vapes are being targeted specifically at children?

What evidence is there of effective measures to limit the marketing and or promotion of vapes to children?

Are there any potential unintended consequences to the measures you have suggested?

Is there any other evidence on the marketing and or promotion of vapes to children that the government should be aware of?

The role of social media

In recent months there have been increased reports of user generated content (rather than vape industry generated) on social media portraying vapes as an attractive product. This has included videos and other content created by under 18s or appearing to be aimed at under 18s. In the 2022 ASH survey, the most common place people reported seeing vape promotion online was on TikTok (45.4%). Under current regulations, marketing communications must ensure that they do not appeal particularly to people under 18, especially by reflecting or being associated with youth culture. They also must not encourage non-smokers or non-nicotine users to vape.

In the 2022 ASH survey, over half (56%) of 11 to 17 year olds reported being aware of vape promotion, most frequently in shops, or online. TikTok followed by Instagram were the most frequently mentioned online sources of promotion reported.

We would welcome evidence on whether adults or children are promoting vapes to children via social media and if government and social media companies have a role to play in stopping this.

Questions

Do you have any evidence to provide on the role of social media?

• Yes
• No

What evidence is there that social media influences children’s behaviour relating to vapes?

What evidence is there of effective measures to ensure vapes are not targeted to children through social media platforms?

Are there any potential unintended consequences to the measures you have suggested?

Is there any other evidence on the marketing and promotion of vaping products to children through different channels that the government should be aware of?

Effective educational approaches to prevent child use of vapes

There is growing misinformation about vapes. Children should be provided with the facts on vapes to understand the risks.

Across schools, behaviour policies on vaping vary dramatically. It is not illegal to smoke or vape underage (just to sell the products to under 18s), so any punishments should be proportionate.

We would welcome evidence about the most effective ways to educate children about the potential risks and the long-term unknowns from using vapes along with policies schools could take to limit their use in educational settings.

Questions

Do you have any evidence to provide on effective educational approaches?

• Yes
• No

What evidence is there (either directly or by inference from other topic areas) of effective interventions in educational settings that could reduce vaping among children?

Are there any potential unintended consequences to the interventions you have suggested?

What evidence is there of children receiving misinformation about vapes?

What evidence is there of schools developing behaviour policies that have been effective in reducing children’s use of vapes?

Is there any other evidence on educational approaches to prevent children using vapes that the government should be aware of?

The impact of vaping products on the environment

The use of disposable vaping products has increased substantially in recent years. The ASH survey found that among children aged 11 to 17 who vaped in 2022, 52% used disposable products. This is a rapid increase from 7.7% in 2021 and 6.9% in 2020.

Research on vape disposal by Opinium commissioned by Material Focus found that over 1.3 million disposable vapes are thrown away every week. This accumulates to 10 tonnes of lithium a year, equivalent to the lithium batteries of 1,200 electric vehicles. The report found 52% of 18 to 34 year olds who bought a vape in the last year bought a single-use product.

The rise in use of disposable (or single-use) vapes has led to an increase in the disposal of these products. When littered, disposable vapes introduce plastic, nicotine salts, heavy metals, lead, mercury, and flammable lithium-ion batteries into the natural environment. This contaminates waterways and soil, posing a risk to animal health. The fruit and saliva odour released by waste vapes attracts foxes and other animals which search them out and chew them. Disposable vapes also pose a potential fire risk when not collected for recycling as lithium-ion batteries can ignite when crushed in a refuse vehicle or at waste-processing plants.

It is important that these products are disposed of correctly. The Waste Electrical and Electronic Equipment Regulations 2013 (WEEE) require manufacturers and importers of equipment (including vapes) to finance the cost of collection and proper treatment of equipment that is returned to dedicated collection points (usually household waste recycling centres). Retailers, both those with stores and those selling online, also have take-back obligations for unwanted vapes on the sale of new products. There are also obligations under The Waste Batteries and Accumulators Regulations 2009. Emerging evidence suggests compliance with these obligations is low, given the recent surge of businesses supplying disposable vapes. Both the WEEE and batteries regulations are being reviewed, with consultations planned later this year.

The Scottish Government, recognising the concerns around the negative consequences of disposable devices, are undertaking an evidence review of the environmental impact of single-use vapes. The findings are expected to inform action within Scotland’s upcoming refreshed tobacco action plan, which will be published in the autumn.

The availability of disposable vapes also pose a threat to the drive towards the circular economy. This means products are designed to be more durable, last longer and consume less of the earth’s natural resources, all of which contributes to reducing greenhouse gas emissions. Disposable vapes consume natural resources in their use of metals, plastics and lithium.

We would welcome evidence on the environmental impact of disposable vapes.

Questions

Do you have any evidence of the environmental impact of disposable vapes?

• Yes
• No

What evidence is there of the impact of disposable vapes on the natural environment when they are discarded?

What evidence is there of the impact of disposable vapes during their manufacture or use?

If any impact has been identified how does that compare with the impacts of reusable vaping products?

What evidence is there of effective measures to reduce the environmental impact of disposable vapes?

Are there any potential unintended consequences to the measures you have suggested?

Is there any other evidence on the impact of the environmental harm caused by disposable or other vaping related products that the government should be aware of?

Understanding the vape market

We are aware that vapes are much cheaper than cigarettes or other tobacco products, which may make them more affordable. We are keen to gather evidence on the:

• price of different vaping products
• vaping market
• composition of the various types of vaping products, such as levels of nicotine strength and on non-nicotine products

We would welcome evidence on whether there are price-related factors that make vapes appealing to children. It would also be useful to understand the different types of vapes and how prices differ between these products.

Questions

Do you have any evidence of vaping’s wider economic impact?

• Yes
• No

What evidence is there on whether price makes vapes appealing to children?

What evidence is there of the impact on demand for vapes from children and adults if the price changes?

What evidence is there on the price range of vape products and the price differential between different product types?

For example conventional, disposable, flavoured varieties, and non-nicotine products.

What evidence is there that indicates how likely users are to switch from one product to another?

What evidence is there on the average price per unit of disposables and refillables?

What evidence is there that the price per unit differs for flavoured, non-flavoured or non-nicotine types?

What evidence is there on the average price per 10ml of refill liquid and does this differ depending on nicotine strength and flavour?

What evidence is there on the average amount of liquid in disposable products and does this differ for flavoured, non-flavoured or non-nicotine types?

What evidence is there on the average nicotine content or strength of disposables and does this differ for flavoured and non-flavoured types?

What evidence is there on the average nicotine content or strength of refillable liquids and does this differ for flavoured and non-flavoured types?

What evidence is there on the composition of the different types of vaping products, such as size of liquid containers and quantities?

What evidence is there on the market share of different types of vaping products?

What evidence is there of methods that estimate the cigarette stick equivalent to vape quantities?

This could include methods based on the number of puffs, the average amount consumed per day, the nicotine content, or other possible methods.

Is there any other evidence on the economic impact of vapes that the government should be aware of?

Further evidence on vaping

We would welcome any further evidence that you think would be helpful for the government to consider when developing policies around children and vapes. There are various other themes that you might want to consider when replying to this call for evidence. For example, themes related to the:

• unknown long-term effects of vaping
• relationship between cigarettes and vapes as substitute products
• impact of vaping on household expenditure
• changes to the regulatory framework made possible by the UK’s exit from the EU

Questions

Do you wish to provide further evidence?

• Yes
• No

Is there any further evidence on themes not included above that the government should consider when developing policies around children and vapes?

Personal information

We are collecting some personal information. These questions are optional and will only appear once. You can read more about the personal information we’re collecting, as well as your rights as a respondent under the UK General Data Protection Regulation, in the privacy notice below.

How to respond

You can respond to this call for evidence by completing the online survey on youth vaping.

Next steps

After a review of responses, the government will set out the opportunities to reduce the number of children vaping which have been identified through the call for evidence. We will aim to publish a response 12 weeks after the closing date.

Privacy notice

Introduction

This notice sets out how we will use the information collected through this call for evidence, as well as your rights as a respondent under the UK General Data Protection Regulation (GDPR).

Data controller

DHSC is the data controller.

What information we collect about you

When you respond to the consultation online, we will collect information on:

• whether you are responding as an individual member of the public or on behalf of an organisation
• the name of your organisation and where your organisation operates (if you are responding on behalf of an organisation)
• what sector you work in
• what the main focus of your work is

We also ask for some person information, which we will collect if you choose to respond. This includes:

• your age
• where you live
• your sex
• your gender identity
• your ethnic group
• your email address

Please do not include any other personal information in your responses to free text questions in the survey.

How we use your information

We collect your information as part of the consultation process:

• for statistical purposes, for example to understand how representative the results are and whether views and experiences vary across organisations
• so that DHSC can contact you for further information about your response

If you have given consent, DHSC can contact you to allow you to amend or delete your response or to send you a reminder before the consultation closes if you have not submitted your final response.

Legal basis for processing your information

The legal basis for processing your information is to perform a task carried out in the public interest. In this case asking the public to provide evidence to answer a range of questions about youth vaping.

The legal basis for processing your information is that it’s necessary for reasons of public interest in public health. It helps us ensure that the youth vaping call for evidence considers the views and experiences of different demographic groups and with different knowledge and experience of youth vaping.

Who your information may be shared with

Responses to the online consultation may be seen by:

• DHSC officials running the youth vaping call for evidence process
• officials from other government departments who will be reviewing the consultation responses
• DHSC’s third-party supplier (SocialOptic), who is responsible for running and hosting the online survey
• an approved Department for Environment, Food and Rural Affairs third-party supplier who will be responsible (under a non-disclosure agreement)  for analysing responses about environmental impacts of disposable vapes

International data transfers and storage locations

Storage of data by DHSC is provided via secure computing infrastructure on servers located in the European Economic Area. DHSC platforms are subject to extensive security protections and encryption measures.

Storage of data by SocialOptic is provided via secure servers located in the UK.

How long we keep your information

We will hold your personal information for up to one year after the online consultation closes. Anonymised information will be kept indefinitely.

We will ask SocialOptic to securely delete the information held on their system one year after the online consultation closes.

How we protect your information and keep it secure

DHSC uses a range of technical, organisational and administrative security measures to protect any information we hold in our records from:

• loss
• misuse
• unauthorised access
• disclosure
• alteration
• destruction

We have written procedures and policies that are regularly audited and reviewed at a senior level.

SocialOptic is Cyber Essentials certified. This is a government backed scheme that helps organisations protect themselves against the most common cyber attacks.

Your rights

By law, you have a number of rights and processing your data does not take away or reduce these rights, under the UK GDPR and the UK Data Protection Act 2018.

You have the right to:

• ask for and receive copies of information about you
• get information about you corrected if you think it’s inaccurate
• limit how your information is used, for example you can ask for it to be restricted if you think it’s inaccurate
• object to your information being used
• get information deleted

Some of these rights might not apply when the information is being used for research. We will let you know if this is the case.

Contact us or make a complaint

We will always try to respond to concerns or queries that you have about your data.

If you are unhappy about how your information is being used, or if you want to complain about how your data is used as part of this consultation, you should email data_protection@dhsc.gov.uk or write to:

Data Protection Officer
39 Victoria Street
London
SW1H 0EU

If you are still not satisfied, you can complain to the Information Commissioner’s Office (ICO). You can find out how to contact them at the ICO website. Their postal address is:

Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Changes to this privacy notice

We keep this privacy notice under regular review, and we will update it if necessary. All updated versions will be marked by a change note on the Youth vaping: call for evidence consultation page. This privacy notice was last updated on 11 April 2023.