Vaping and retail regulations from a paediatrician’s perspective

As a paediatrician, I have witnessed firsthand the anecdotal and objective [1] rise of vaping among adolescents. It is concerning that the vaping industry, and at times the tobacco industry under the guise of vaping, has actively targeted children and young adults with aggressive marketing tactics.

On the back of that, it may be surprising to hear, but I am very pro-vaping! The caveat here is that this is when it is used as a method of smoking cessation. For patients that have failed to quit smoking using traditional nicotine replacement therapy (patches, gum etc) and are still smoking, it is another option in our arsenal to rid people of a habit that kills around 2 in 3 people who smoke combustible cigarettes [2].?

Whilst as a doctor I am able to see the huge benefits to smokers that vaping offers, we need to be cautious and constantly analyse the evidence and evolving associated risks to other populations such as children and young adults.

Sainsbury’s Westhoughton

I was astonished when I recently walked into Sainsbury’s Westhoughton and found a floor to head-height stand full of nicotine vaping and nicotine pouch products (see image). The only products that were not able to be picked up were ‘Elf bar’ products which were available from the kiosk. Elf bars are the products that made the news recently as they were found to be overfilling their products above the regulated UK limit (2mL) and also adding higher strength nicotine to those products, up to 50% higher than the 20mg/mL UK nicotine strength limit.

Whereas cigarettes have been in standardised packaging for many years now, and kept behind the counter for obvious reasons –?all of these nicotine products were free to look at on the shelf. Not only that, but they were placed next to the ‘health and wellness’ shelf space, alongside products like Gaviscon and Compeed blister plasters.

Tobacco control laws and sales restrictions

Since the tightening of regulations surrounding tobacco sales in March 2005 [4], point-of-sale tobacco advertising has been banned in both large and small retail shops. Additionally, we have become accustomed to other rules, such as standardized packaging and health warnings, that aim to deter smoking. While it is important to strike a balance in making vaping accessible to smokers without overtly promoting it to non-smokers or underage individuals, one thing I am certain about is that having enticing vaping packaging within reach of young children is not a sensible approach within that balance.

My conflicts and the developing evidence

Australia have approached the vaping issue from a different angle, and changed to a prescription nicotine vaping model in October 2021. This has brought with it some challenges, such as the need to clamp down on a burgeoning black market for vapes [5]. Similar to the issue with the Elf bars in the UK, a common brand of vapes were being imported to Australia by simply removing nicotine as an ingredient from their list –?whilst in fact they still contained 50mg/mL of high strength nicotine.

A key driver for my interest in this sector comes from my consulting for an Australian private smoking cessation company Quit Clinics . As part of that, I have helped create medical content and information around vaping as a form of smoking cessation, as well as looking at the regulatory and governance processes within the business.?

One of the issues Quit Clinics grapples with is making their service as easy as possible to access for smokers who need help, whilst preventing it from being used by non-smokers. This balancing act is being approached differently all across the world with both national guidelines, and the policies of individual businesses affecting who the end users of vaping products are. Quit Clinics currently manages this by verifying all patients’ identities to ensure all are over the age of 18.?

My work in vaping, the growing evidence base [6], and my background as a paediatrician has left me feeling clear that we have some simple wins in the UK that we should be exploring.?

My opinion

I think there are various options, but the first two feel reasonably simple and don’t feel like they logically hinder smokers from accessing lower-risk nicotine products;?

1. Point of sales for nicotine vaping and pouch products should be subject to some restrictions, I think a non-child sales height is a simple win here that makes sense.
2. I think there is logic behind taking things even further and placing the products behind the kiosk, but allowing them to be visible and not behind a screen like cigarettes. This would keep the nicotine products in the place where cigarette smokers go to purchase their products –?leaving them open to considering a nicotine vaping or nicotine pouch product as a lower risk alternative.
3. There could be evidence based branding allowed on point of sale areas behind the kiosks next to nicotine vaping products. This could be statements such as the Royal College of Physicians' positioning statement [7] that “the hazard to health arising from long-term vapour inhalation was unlikely to exceed 5% of the harm from smoking tobacco.”
4. There should be funding to allow detailed audit of products that are on sale to prevent the episode that happened with Elf bars from being repeated. Companies should be adhering to the strength and volume regulations –?and be fined appropriately if they are found to be in breach.
5. We should have ongoing evaluation to understand the public health impact of vaping on the paediatric population. We should be trying to balance the goal of smoke-free by 2030 with ensuring we don’t have a new, albeit lower risk than cigarettes, but easily-accessible addiction to nicotine available to children.

I would love to know your thoughts, and whether you feel there are other things I have not considered, or ideas for balancing the smoking cessation and access to products conundrum.

[1] https://news.sky.com/story/number-of-children-trying-vaping-rises-50-in-a-year-in-tide-of-experimentation-12882899#:~:text=child%20vape%20experimentation%22.-,Experimental%20vaping%20among%2011%20to%2017%2Dyear%2Dolds%20in%20Britain,2014%20to%2011.6%25%20this%20year .

[2] https://www.who.int/news-room/fact-sheets/detail/tobacco

[3] https://www.thegrocer.co.uk/tobacco/over-strength-elfbars-found-on-supermarket-shelves/676054.article ?

[4] https://www.tobaccocontrollaws.org/legislation/england#:~:text=Sales%20Restrictions,under%20the%20age%20of%2018 .?

[5] https://www.news.com.au/lifestyle/health/health-problems/doctor-warns-the-vape-crack-down-will-cause-booming-black-market/news-story/895f9236b289a6041432ffb9ae293355

[6] https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-2021-coming-age-tobacco-control ?

[7] https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction ?