Pre-teen girls have 'easy access' to e-cigarettes |...

“Children 'addicted to sweet tasting e-cigarettes',” is the alarmist headline in the Daily Mirror. A survey has found that a few pre-teen girls in Wales have experimented with the devices, but there is no evidence of widespread addiction.

The headline is based on an opinion piece written by Kelly Evans, a Director of the organisation Social Change UK, following the release of a report from the same organisation. The report looked at the prevalence of smoking, and the attitudes and behaviours towards the practice (including e-cigarettes), among girls aged 11 and 12 across North Wales.

Five focus groups were carried out, and the main findings were that most girls were aware of e-cigarettes at this age and many had also tried them.

The opinion piece focused on whether or not e-cigarettes are a gateway to taking up tobacco smoking. It is this opinion piece, rather than the underlying report, that the UK media have predominantly reported on.

Unfortunately, the media have failed to inform the reader that both the opinion piece (written by a single author) and the underlying report have not been peer-reviewed, so this should be taken into consideration when interpreting what has been presented.

What are e-cigarettes?

E-cigarettes, or electronic cigarettes, are electrical devices that mimic real cigarettes in that they provide a nicotine dose in a vapour (which is why the habit is often known as “vaping”).

The vapour is considered much less harmful than tobacco smoke as it does not contain many of the cancer-causing substances (carcinogens) that make smoking so dangerous. We don’t yet know the long-term effects of vaping on the body. There are other potential drawbacks to using them, including:

E-cigarettes aren’t currently regulated as medicines, so you can’t be sure of their ingredients or how much nicotine they contain – whatever it says on the label.
The amount of nicotine you get from an e-cigarette can change over time.
They aren’t proven as safe. In fact, some e-cigarettes have been tested by local authority trading standards departments and been found to contain toxic chemicals, including some of the same cancer-causing agents produced from tobacco.

Who produced the opinion piece and report?

The opinion piece, called: "E-cigarettes, children and adults who like gummy bears? Are e-cigarettes a good thing?" was written by a Director at Social Change UK. It was based on a report called “Smoking in girls aged 11 to 12 years in North Wales”, also written by Social Change UK. The report is part of a wider social marketing campaign funded by Public Health Wales and sponsored by the North Wales Tobacco Control Alliance.

Social Change UK is a social research and campaign company that works in the UK, Europe and Australia. According to its website, it carries out social research, as well as designing campaigns that build emotional connections and encourage people to think and act.

What points does the opinion piece make?

This opinion piece discusses the debate around e-cigarettes and reports that not enough is known about the role they play in introducing people to smoking (also known as “gateway effects”). The role of marketing is discussed, and a point is made by the authors that over the last 12 months the marketing of e-cigarettes has shifted from being an “aid” to stopping smoking to something desirable. She says there are over 300 flavours now available, including bubblegum, milkshake, red bull (a taste like the energy drink) and gummy bear. The author also delves into whether children should be stopped from trying to buy them.

Also discussed is the fact that e-cigarettes are not regulated in the same way that tobacco is. Plans to review this regulation from the Medicines and Healthcare Products Regulatory Agency (MHRA) are mentioned, as are the government’s plan to ban the sale of e-cigarettes for those under the age of 18.

Does the opinion piece and report provide any new evidence?

The opinion piece cites previous research carried out by the anti-tobacco public health charity Action on Smoking (ASH) Wales in 2014, which reportedly found that 79.6% of 13 to 18-year-olds were aware of e-cigarettes in Wales. Figures on how many young people are actually using them are less clear, however.

Also cited in this opinion piece are the findings from a survey carried out by Social Change UK in June 2014. Importantly, this research has not been peer-reviewed, so findings of the survey should be interpreted with caution.

A survey was carried out on headteachers and teachers from 72 schools across England, and 53 of these schools reported that they were confiscating up to 10 e-cigarettes a week.

Five focus groups were also carried out across Wales including girls aged 11 and 12 years in areas with high levels of deprivation and high adult smoking prevalence; however, it is not reported how many girls were included in these focus groups.

According to these focus groups, most girls were aware of e-cigarettes at this age, and many had also tried them. No specific figures have been reported.

There were varying attitudes to them and understanding of what they were and what they do differed among the focus groups. A large number of girls (again, figures not reported) described e-cigarettes as “not as bad” as cigarettes, and some did not believe they could be harmful.

It was reported that in one Welsh town, almost all the girls had tried e-cigarettes at least once and found they were easy to purchase from shops, parents and friends.

Other anecdotal figures are also provided in this opinion piece, citing some cases of poisoning from the chemicals in e-cigarette cartridges, as well as findings from an electrical safety point of view carried out by six north Wales Trading Standards services. These revealed a 100% failure rate against safety regulations.

It is unclear how robust these figures are and if they are representative.

According to recent data provided by the National Poisons Information Service (NPIS), there were 29 reported cases of e-cigarette poisoning in 2012 in the UK. It's possible that many of these were due to very young children mistakenly drinking the vaping liquid, rather than through using the devices in the prescribed manner.

Is there any evidence that e-cigs are acting as a gateway?

This opinion piece does not include any robust evidence that e-cigarettes are acting as a gateway.

A recent survey was carried out by ASH and found that non-smokers are not taking up the e-cigarette habit. However, the data only spanned from 2010 to 2014, meaning that longer-term smoking trends are unknown, so it is too early to be complacent.

To draw further conclusions about the potential gateway effects of e-cigarettes, longer-term studies (such as prospective cohorts) are required, and as the introduction of e-cigarettes is only fairly recent, it may be some time before these sorts of figures become available.

How accurate is the media’s reporting of the study?

This opinion piece has been widely covered in the UK media. The Independent, The BBC and The Daily Mail Online have focused their coverage on the findings from the focus groups on girls aged 11 and 12.

However, The Daily Mirror has taken a slightly different stance with the headline: “Children are ‘addicted to sweet tasting e-cigarettes’ after milkshake and bubblegum flavours are launched". This is inaccurate reporting, as the report provides no evidence of widespread addiction amongst young children.

Unfortunately, the majority of the media's reporting has failed to explicitly indicate to the reader that this is an opinion piece based on a report that has not been peer-reviewed.