On balance last week was a good one for advocates of vaping.
If we leave aside the report that suggested, on very little evidence, that 'E-cigarettes act as [a] gateway to smoking for teens' (Daily Telegraph), there was general agreement, following the publication of yet another study, that 'Vaping is "far safer" than smoking cigarettes' (ITV News).
Campaigners – including public health advocates of vaping – naturally embraced the latter report and we were subjected to the usual sanctimonious drivel about e-cigarettes having the ability to secure world peace and make death history.
I jest but if you saw my Twitter timeline that's how it reads sometimes.
What really makes me laugh/cry is the apparent conviction that if every smoker switched to vaping the world would be a better, happier place and two billion people would live longer, healthier lives.
However there was (and is) one rather large elephant in the room that few people are willing to address and it's this – millions of people enjoy smoking tobacco and don't want to switch to an alternative nicotine product.
This simple, unarguable fact was one of the clearest conclusions of the recent report, The Pleasure of Smoking: The Views of Confirmed Smokers, funded by Forest and published in December by the Centre for Substance Use Research.
The report was ignored, inevitably, not only by the media but also by public health campaigners and the evangelical vaping community.
One leading public health commentator (and vaping advocate) told me the report echoed his own views but did he review it on his blog? Did he hell!!
To those who prefer to stick their heads in the sand and pretend otherwise, here's a gentle reminder of how our sample of 600+ confirmed smokers reacted when asked about alternatives to smoking:
Respondents were asked about which of the electric nicotine delivery products, if any, they had tried and what they had thought of them. In total 344 (59%) of the individuals who were questioned provided information on the new products they had used. That more than half of the smokers we were surveying had tried a reduced risk nicotine product is interesting in itself and suggests that even amongst this group of pro-smokers there was a willingness to try a reduced risk nicotine product. In total 336 of the 344 smokers who had used a reduced risk nicotine product reported having used e-cigarettes.
Respondents were asked about what they both liked and disliked about the vaping products they had used as an alternative to smoking. Below we set out the range of comments received and their frequency looking first at what the smokers had to say about what they did not like about the vaping products they had used.
The most commonly voiced criticisms had to do with the vaping experience with 133 smokers identifying negative aspects of the vaping experience. The next most common set of criticisms had to do with the equipment used (expressed by 65 smokers) followed by criticisms of the taste (46) perceived harms of vaping (30) and then finally a set of criticisms that related more to the reaction of other people to the smokers having been seen vaping (12). We illustrate a range of the comments received in each of these broad areas.
The most commonly expressed criticism of vaping was this was simply “not the same” as smoking. This view was expressed by 66 of the 133 smokers identifying negative aspects of the vaping experience. A small number of the smokers commented that they did not like what they described as the lack of a nicotine “hit” from vaping. Other critical comments to do with the vaping experience included the observation that with vaping (in contrast to smoking) you don’t know when to stop: “You never actually finish an e-cigarette so you end up puffing away continuously”.
Other smokers commented negatively that they missed the “smoke” and the “aroma” of combusted tobacco when they had vaped. Some said that they felt vaping was a “colder” less social more individualistic activity: “Its different to smoking more anonymous compared to smoking which is inherently social” It just felt artificial. Some of the smokers noted that they missed the crackle sound produced by combusting tobacco. Others commented that in their view the vaping experience was just not as “pleasurable as smoking” and that it was in their view no substitute for the “real thing” being somehow less natural than smoking.
The second most commonly expressed criticisms of vaping had to do with what were seen to be deficiencies in the technology itself chief amongst which were complaints that the technology was fiddly, that the batteries were often unreliable and required attention to ensure that they were sufficiently fully charged, and that on occasion the devices leaked e-liquid: “Not interested in e-cigs that require constant filling” “having to maintain the equipment”, “looks strange to me”, “complicated” “the hassle” “plastic metal feel, “messy, fiddly devices”, “battery life is an issue and until you know how to use them they are quite fiddly and prone to not working”, don’t like the size of the devices”, “Not as satisfying. Don’t want to have to bother with filling, recharging, they look awkward medicinal devices and I don’t think of smoking as medicinal”, “they’re too heavy to hang from my lips”, “the hard plastic feel on my lips”, “they’re too large to carry easily”.
The next most commonly expressed criticisms had to do with the taste produced by e-cigarettes with some of the smokers commenting negatively that e-cigarettes in their view lacked a sense of taste or were “too rough” that there was “no real tobacco taste” produced by the devices, that the taste was somewhat “artificial”. With regard to the reported harms that were associated with e-cigarettes the most commonly voiced criticism from the smokers had to do with the capacity of the devices to irritate their throat and produce a cough.
A small number of the smokers drew attention to what they said were the unknown longer term harms associated with vaping whilst others commented that the devices would make their lips sore. Finally, a small number of smokers drew attention to what they saw as the negative reaction of other people to vaping feeling that this had undermined their own experience of the devices “ “Same social stigma now as smoking so what’s the point, may as well keep smoking the real cigarettes as much more pleasurable” “still had to stand outside to vape often right next to rubbish bins this made it pointless to switch hence not using now” “restrictions on use” “vaping bans” “its naff may as well have the word addict tattooed on your forehead” “people laughing at me” the “hipster stigma and the holier than though apologetic attitude most vapers hold is off putting”.
On a more positive note:
In relation to what our sample of smokers most liked about vaping 225 individuals provided comments with the most frequent (94) highlighting the importance they placed on being able to use e-cigarettes in settings where smoking was not allowed: “Useful if you are in a pub and its cold and wet outside”, “ I can use it indoors”, “It's permitted in more places”, “Can use it in more situations where lighting up is prohibited”. The second most commonly noted positive about e-cigarettes expressed by 38 smokers related to the cleanliness and specifically the lack of smell that was associated with their use compared to smoking conventional cigarettes: “I like the fact that I and my flat did not smell of smoke”, “My clothes and house and breath don’t smell”, “No smoke, no ash”, “No smoke, no ash and nobody knows you have vaped”, “Sweeter taste in the mouth, no finger staining no ash or butts”. The next most common set of positive views (expressed by 38 smokers) related to the fact that vaping was significantly cheaper than smoking: “Less expensive” “Lack of 90% tax on e-cigarettes”, “Cheaper”.
Twenty-seven smokers identified taste and flavouring as the most positive aspect of their vaping experience: “Pleasant flavours”, “Variety of flavours and nicotine strengths”, “The variety of flavours compared to smoking. When I first started vaping I imagined that I would need a tobacco flavoured e-liquid and tried a large variety. Gradually I experimented with many other flavours available. Now I don’t use tobacco flavoured e-liquids and have actually come to dislike the taste of them."
The health related benefit of using e-cigarettes was the fifth most commonly voiced set of comments with smokers (26) noting that “They are better for my health”, “Better for breathing”, “Good for my health”. Given that e–cigarettes are often discussed and presented in terms of their being significantly less harmful than smoking combusted tobacco, it is interesting that our sample of smokers placed less importance on the health benefits associated with e-cigarettes than the greater variety of situations they could be used in, their greater perceived cleanliness, their cost, and their taste.
Nine smokers commented that they particularly liked the fact that the vaping was very close to the smoking experience and in some ways more convenient: “Closest thing to smoking”, “Similar throat hit to smoking”, “Similar to smoking”, “Not having to find my lighter”. There were only a small number of individuals who commented that they particularly liked the technology of e-cigarettes and the reactions of other people to the sight of them using the equipment: “I thought it looked cool”, “Easy to use”, “I enjoy the customisable options in both hardware and flavours”, “Less stigma”, “Not being treated like a leper”, “Less public opprobrium”.
Btw, I'm not discouraged by the lack of interest in The Pleasure of Smoking report. It merely confirms what we've known for a very long time – that the concept of 'pleasure' in relation to 'smoking' is increasingly taboo and even so-called 'libertarian' commentators and bloggers are reluctant to stick their heads above the parapet on the issue.
The good news is ... The Pleasure of Smoking: The Views of Confirmed Smokers is available online and in print.
Copies have been circulated widely already and the report will continue to be disseminated at home and abroad in the weeks and months ahead. You can do your bit by forwarding a copy to family, friends, your local MP and anyone who might be interested.
You can also support our event in London next week when Dr Neil McKeganey, director of the Centre for Substance Use Research and lead author of The Pleasure of Smoking, will give a short presentation highlighting the main conclusions.
Neil's presentation will be sandwiched between a drinks reception and a balloon debate on the subject 'The Best Nicotine Delivery Device in the World' so it should be an entertaining evening.
Full details here. RSVP events@forestonline.org.