UK Government Publishes Detailed OHID Review of 400 Vaping Studies

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UK Government Publishes Detailed OHID Review of 400 Vaping Studies

On 29th September, 2022, the UK Government’s Office for Health Improvement and Disparities (OHID) released a 1468-page review of 400 studies related to vaping.

The OHID review is the eighth in a series of independent reports commissioned by Public Health England (PHE). The review aims to summarise the available evidence on vaping and vaping products to inform government policies and regulations.

Nicotine vaping in England: an evidence update including health risks and perceptions, 2022

Their findings strengthen claims that vaping is less harmful than smoking, but urge that vaping is not risk-free and should be kept out of the hands of non-smokers and youths.

The nearly 1500-page review, titled “Nicotine vaping in England: an evidence update including health risks and perceptions,” covers everything from cancer risk and biomarkers from vaping to usage prevalence among young people.

The incredibly extensive text has a lot of medical jargon, so we’ve broken down the key points for you in this article.

Spoiler alert: it’s pretty good news for vapers.

OHID Review: Key Findings

  • Vaping poses a small fraction of the risks of smoking in the short- and medium-term
  • Long-term studies (longer than 12 months) are needed before we can assess the effects of longstanding e-cigarette use
  • Vaping is not risk-free, particularly if you’ve never smoked
  • Smoking will kill one in two “regular sustained smokers”
  • Around two-thirds of adult smokers have skewed perceptions of harm from vaping

What does the OHID review say about cancer and vaping?

The OHID review examined existing evidence on how vaping might affect cancer risk.

Do vapes contain carcinogens?

When it comes to the exposure to toxicants and carcinogens (cancer-causing chemicals) from vaping versus smoking, the available evidence suggests that those who vape are exposed to lower levels of these compounds compared to those who smoke cigarettes, as most of the cancer-causing chemicals found in cigarettes cannot be found in vapes.

Still, the study referenced in the review presses the need for further research. The various studies and reports found no available evidence about the relative risk of cancer from vaping compared to smoking or non-use, so this will need more focus in future studies.

Does vaping increase your risk of cancer?

The OHID review identified a growing amount of literature covering how vaping might affect cancer risk in humans, though the authors note that the evidence is still modest at best.

In their review of human studies, biomarkers (measurable indicators) of exposure to carcinogens in tobacco smoke were much lower in those who vape compared to those who smoke.

The authors state that the studies compiled in the review provide conclusive evidence that “vaping generally leads to lower exposure to many of the carcinogens responsible for the health risks of smoking.” (p. 49)

[V]aping generally leads to lower exposure to many of the carcinogens responsible for the health risks of smoking.

OHID Review, p. 49

What does the OHID review say about respiratory diseases and vaping?

The review looked at existing evidence of how vaping might cause or influence respiratory disease, which is one of the primary causes of mortality among smokers.

In their “Implications” section, the authors of the OHID review note that while evidence on the respiratory effects of vaping are limited, they can safely conclude that encouraging smokers to switch to vaping is likely to slow the development of respiratory diseases.

[D]eveloping and implementing policies and interventions that support smokers to completely stop and switch to vaping is likely to slow down the development of respiratory diseases.

OHID Review, p. 56

Does vaping cause respiratory disease?

The OHID review identified conclusive evidence that under typical usage conditions, acute (single use to 7 days) exposure and medium (8 days to a year) exposure to potential respiratory toxicants from vaping was significantly lower compared to smoking cigarettes. Several biomarkers saw substantial reductions.

And for the respiratory toxicants that were assessed for long-term exposure (over 12 months), evidence was “moderate” that biomarkers remained reduced among vapers compared to smokers.

Overall, the review’s findings showed no detrimental effects to vapers in short, medium, or long-term studies. Conversely, there was a clear worsening of lung function in vapers who switched back to smoking for 7 days. (p. 53)

The authors of the OHID review note that there were too many methodological differences in the various studies to make absolute conclusions about how vaping affects lung function.

What does the OHID review say about cardiovascular disease and vaping?

When conducting their review on vaping and cardiovascular disease, the authors write that the studies they reviewed show a substantial reduction in biomarkers of toxicant exposure among vapers compared to smokers.

And for this very reason, the authors suggest that the risk of cardiovascular disease is expected to be much lower with vaping compared to smoking cigarettes. This is great news for vapers.

Still, they note that it’s difficult to determine the degree of risk to cardiovascular health, given the residual effects of a prior smoking habit.

OHID Review: Cardiovascular Disease

Does vaping affect cholesterol?

More good news for vapers!

The review found that studies of low-density lipoprotein (LDL), otherwise known as “bad cholesterol” showed no difference after short- and medium-term use of vaping products. Similar findings were seen for high-density lipoprotein (HDL), or “good cholesterol.”

Does vaping affect heart rate?

The OHID review found that immediately after use, vaping increased heart rate less than smoking did. Generally speaking, the review found that while vaping may acutely increase heart rate, this increase is less than that of smoking, even in the long-term.

Does vaping affect blood pressure?

While, again, there were some issues in the review with analysing studies using differing methodologies, the authors conclude that vapers who have been vaping for at least three months to a year had lower blood pressure than people who smoked.

The OHID review also found that there was no measurable difference in blood pressure between people who vape and non-users/non-smokers.

What does the OHID review say about vaping and other health conditions?

The OHID review also analysed studies on vaping and various health conditions, including ocular, reproductive, and oral health.

Most of these studies were small and not necessarily credible, so much of the information couldn’t be interpreted by the review’s authors.

Oral Health & Vaping

The authors of the review note that while there have been more studies on vaping and oral health than other miscellaneous health concerns, the quality of the studies was often low and there was a risk of bias in the findings.

Still, the review concludes that while vaping may be detrimental to oral or dental health among those who have never smoked, vaping would be beneficial for smokers making the switch. The authors note, “We found no studies that would change that conclusion.” (p. 65)

As we know here at the Vapour Hut, dental studies about vaping are scarce and often uninformed, much like the British Dental Journal article which faced criticism from dental experts across the UK for a lack of evidence.

Public Perceptions of Vaping

Extensive research was conducted into perceived harms from vaping among both young people and adult smokers, including which factors swayed people’s opinions and how perceptions may impact smokers’ likelihood of taking up vaping as an alternative.

Interestingly enough, the review found that more young people (11-18 years old) accurately perceived that vaping was much less harmful than smoking (44.7%) than adult smokers did (34.1%).

A significant portion of smokers, non-smokers, vapers, and all-round non-users from all age groups wrongly believe that vaping is more harmful than smoking.

Worse still, many current smokers and vapers are misinformed, believing that the harms from smoking come down to nicotine, which as we know, is not the cause of smoking-related illnesses—though regular vapers are the least likely to believe this. (p.71). 

OHID Review: Public Perceptions of Vaping

The review calls for more carefully designed “interventions” and communications about the harms of vaping, as the public’s misperceptions are now proven to be tied to the many negative advertisements, media stories, and glaring warning labels found on all nicotine products.

The authors of the OHID review suggest that communications about the absolute and relative harms of vaping should be carefully worded to avoid confusion (for example, readers should not translate “less harmful” to “safe”).

And above all else, the review states that from an ethical standpoint, the main aim of these communications should be to educate people by providing accurate information—not scaring smokers away from vaping, which could improve their health. Everyone from young smokers to adults should be given accurate data about vaping so as to avoid further skewing of the public’s misperceptions.

Experts Respond to OHID Review

The response to the OHID review is overwhelmingly positive among experts in the field of tobacco harm reduction.

Dr Lion Shahab, Professor of Health Psychology and Co-Director of the Tobacco and Alcohol Research Group at University College London, says: “This latest report on nicotine vaping is by far the most rigorous, comprehensive, and up-to-date piece work on this topic ever published in the UK. It confirms findings from previous reviews in this area that nicotine vaping is far less harmful than smoking tobacco […].”

He continues on to say, “At the same time, the report acknowledges that vaping carries some risks compared with not using any product at all, but that these concerns are often overstated, resulting in false risk perceptions that may dissuade those using the riskiest product (cigarettes) from switching to lower risk products (e-cigarettes).”

Adding to this, Dr Jamie Hartmann-Boyce—Associate Professor at the Nuffield Department of Primary Care Health Sciences at Oxford—says, “This is a comprehensive, well-conducted review covering a large and ever-growing body of evidence showing that, though not risk free, vaping exposes users to considerably lower levels of harmful substances than cigarettes.”

All in all, the country’s top experts are in agreement: this is a comprehensive, in-depth review of all of the current credible evidence we have about vaping and its effects on health. It presents honest, unbiased evidence that the government and healthcare providers would do well to take into consideration when encouraging smokers to make the switch to vaping.

OHID Review Conclusions

Overall, the review’s conclusions are clear:

  • Vaping is effective for stopping smoking
  • Vaping carries a small fraction of the health risks of smoking
  • Smokers should be encouraged to switch to vaping products to reduce the harms of smoking
OHID Review: Respiratory Disease

Furthermore, the authors state:

  • The findings of higher toxicant exposure from vaping compared to non-use reinforce the need to discourage non-users from taking up vaping products
  • Cuts to government bodies responsible for overseeing vaping products are concerning, and the recent increase in youth vaping makes this an even greater concern
  • Educational materials are needed for young people who started vaping after never having smoked, and for those who need support to quit smoking

Overall, the OHID review delivers much of what we already know, now available in a ridiculously comprehensive 1468-page dossier which the UK government will hopefully use to inform future policies.

The review further presses that vaping is not as harmful as smoking, that it carries only a portion of the risks of smoking, and that it is not risk-free for non-smokers.

Let’s just hope the UK government listens and reflects these findings in future legislation.

Sources:

  • Nicotine vaping in England: an evidence update including health risks and perceptions, 2022 (download PDF)

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