By Megan Warren-Lister

Hospital admissions associated with vaping are on the rise in children and young people, NHS data shows. According to an FOI request by Naked Politics, the number of under 10s with a vaping-related diagnosis increased by more than 300% between 2020-21 and 2021-22. In response, experts and Local Government Association (LGA) representatives have called for better regulation and enforcement.

But isn’t selling vapes to kids illegal?

It’s been illegal to sell e-cigarettes to children in England and Wales since October 2015, but the law hasn’t stopped under 18s from vaping. Concerns around the potential health implications for children were specifically cited in the preamble to a new bill tabled by Caroline Johnson MP to prohibit sales of disposable vapes altogether. 

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 Andrew Bush, professor of paediatrics at Imperial College London, said there is “not nearly enough being done” to combat the uptake of vapes by children, who he explains are particularly vulnerable to addiction. Vapes may not contain the same carcinogens associated with tobacco, but they have repeatedly come under fire for their high levels of nicotine. Those produced by the UK’s most popular brand Elf Bar contain levels equivalent to between 40 and 50 cigarettes

In the last twelve months, 32 children were admitted to hospital across 46 separate admissions. According to Shahab Lion, an expert in health psychology at UCL, this is indicative of a broader social trend. “Prior to the proliferation of disposable puff bars, there was very little evidence that adolescents or young adults were using e-cigarettes. This may be because e-cigarettes were not seen as ‘cool’ as they were marketed as a smoking cessation tool rather than as a lifestyle item in the UK,” Lion explains.

Public Health England maintains that e-cigarette use among young people “remains low”. Despite this, an NHS survey published last year found that as many as one in five 15 year old girls were considered to be e-cigarette users whilst Action on Smoking and Health (ASH)  found that the percentage of children who have tried vaping rose from 14% in 2020 to 16% in 2022. Promoted by PHE as a tool to quit smoking, there appears to be a worrying uptake by young non-smoking users. Last year the British Paediatric Respiratory Society claimed that statistics are only half the picture, with the total number of UK children who vape “grossly under-reported”.

Aren’t vapes safer than smoking though?

Nick Hopkinson, a respiratory consultant at the Royal Brompton Hospital says: “Although much less harmful than smoking, it is likely that vaping will tend to aggravate lung disease such as asthma and that vaping long term will cause some lung disease in later life.” Whilst there is still a lack of research around the consequences of vaping, the risks are exacerbated for children whose lungs are still developing, he adds.

Young people are also particularly vulnerable to the effects of nicotine. High levels of consumption are associated with a range of diseases including impaired cognitive development and increased anxiety.  “Although the health harms for children and young people from vaping are much less than from smoking, the best thing for lungs is to breathe clean air,” says Hopkinson.

Market regulation

The professor isn’t alone in his thinking either. In February, the local government association (LGA) recommended improved regulation to better protect children. Despite the ban on underage sales, experts have criticised the marketing of brands such as ElfBar which uses bright colours and includes flavours such as ‘Green Gummybear’ and ‘Watermelon Bubblegum’.  

According to psychologist Lion, the marketing of vapes has been integral to their uptake. “With the latest push of these puff bars, which have a sweet taste, with flavours and colours appealing to younger users, we have seen a rise in their use among younger kids,” Lion says. The professor is an advocate for responsible marketing, adding “the easiest solution to this problem would either be to ban this class of e-cigarette completely or to make them less appealing.”

Javed Khan, former chief executive of Barnados and leader of the eponymous Khan Review on smoking, previously described the online e-cigarette market as a “wild west”. According to an investigation by the Observer, ElfBar products had been promoted to children on TikTok in breach of Advertising Standards Agency regulations. This lack of enforcement has also contributed to real-world sales.

Enforcement issues

According to the Chartered Trading Standards Institute, which last year reported a rise in underage vape sales, 60 per cent of its local teams said high street shops selling illicit vapes or vaping products to children was their biggest enforcement concern. In response, London councils have run undercover operations to prosecute outlets selling e-cigarettes to underage customers. Barking and Dagenham Council is currently investigating three shops after its trading standards team sent teenagers aged 13 and 14 to buy vaping products.

Intervention & Solutions

Other organisations are tackling the issue in the form of educational interventions.  In Cambridgeshire and Peterborough, young people can access the Catch Your Breath campaign, a free school-based programme run by the Healthy Schools Stop Smoking and Vaping Service. Its offering includes workshops on prevention, as well as cessation interventions. In alignment with NICE guideline NG209, it recommends a coordinated whole school approach, including a curriculum that discourages young people who don’t smoke from experimenting with vaping.

ASH has also developed guidance for schools and colleges, to help safeguarding leads and other staff develop consistent, evidence-based policies on vaping. According to Shahab, “in an ideal world no-one should be admitted for vaping-related illnesses and children should not have access to e-cigarettes”. This however, is not the reality. As well as tightened enforcement of age-of-sale laws, the professor called for restricted advertising, and more school campaigns to highlight the risks of vaping. 

The Khan report which tabled some of these suggestions is currently awaiting a government response. In the meantime, the position across the Atlantic provides some hope, with the recent news that vape manufacturer Juul reached an almost half a billion dollar settlement with the state after a years-long investigation into its role in teen vaping.

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Last Update: April 01, 2023