Leading respiratory paediatricians urge First Minister to act now to tackle Scotland’s ‘adolescent vaping epidemic’

Leading respiratory paediatricians have issued an appeal to First Minister Humza Yousaf to take urgent regulatory action to halt ‘what is a fast becoming a vaping epidemicin the adolescent population’ and avoid ‘sacrificing the lung health of the next generation’ in Scotland.

In an open letter to Mr Yousaf, Dr Kenneth Macleod, Professor Steve Turner, Dr Ross Langley and Dr Jonathan Coutts have highlighted their alarm at the widespread visibility and promotion of e-cigarettes, which has resulted in a rapid increase in children’s uptake and regular use of the health-harming and highly addictive products during the last two years.

The clinicians, who state their primary motivation and professional duty is to protect their patients’ current and future lung health, stress the need for swift regulatory intervention, emphasising that current trends indicate that children’s use of e-cigarettes show no signs of diminishing, and express their concerns that children who use e-cigarettes tend to become regular consumers of nicotine-containing products.

The letter says: “It is vital that we do not sacrifice the lung health of the next generation by failing to recognise the consequences of their increased e-cigarette use and we therefore encourage you to take all actions possible to prevent damage to Scotland’s health and wellbeing.

“We are calling on you to act now to halt what is a fast becoming a vaping epidemicin the adolescent population.

“We have particular concerns regarding the negative impacts of e-cigarette use on developing lungs (acute lung disease) and brains (increased addiction and adverse behavioural outcomes). Furthermore, we are concerned that long-term use of e-cigarettes will lead to serious disease outcomes in coming decades.”

Referring to findings by the World Health Organization (WHO) in 2021 and an umbrella global systematic evidence review published by Professor Emily Banks in April 2023, the group has also expressed concerns about young people who vape being at up to three times greater risk of moving on to using combustible tobacco.

They warn: “In Australia, the vaping industry has exploited regulatory loopholes to flood the market with vaping devices attractive to children and young people. The first rise in youth smoking rates in 25 years has recently been reported.”

The respiratory experts have added their voices to ASH Scotland’s calls on the Scottish Government to implement measures – enabled by the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 – to restrict the advertising and promotions of e-cigarettes, following the publication last year of responses to the government’s consultation on tightening the rules on advertising and promoting vaping products.

“We strongly advocate that regulations to restrict the visibility and availability of recreational e-cigarettes are introduced without further delay to help curb the experimentation and regular use of these tobacco related products by children.”

The group has requested a meeting with the First Minister to discuss their concerns at the earliest opportunity.

Sheila Duffy, Chief Executive of ASH Scotland said: “This call for immediate action by Scotland’s leading respiratory paediatricians is loud and clear, and demands an urgent response by the First Minister and his government.

“The Scottish Government has missed a series of opportunities to introduce robust restrictions on the advertising and promotion of recreational e-cigarettes for almost seven years now.

“The First Minister should instruct ministers to lay such measures for parliamentary approval as soon as MSPs return from summer recess to demonstrate his government is serious about tackling this epidemic and aspires to reclaim Scotland’s position as a leading public health nation.”

Open Letter to the First Minister calling for immediate measures to protect Scotland’s children from harms caused by use of e-cigarettes.

Dear First Minister,

Protecting the long-term health and wellbeing of children and young people across Scotland is a matter of paramount importance. As a group of respiratory paediatricianswhose primary motivation and professional duty is to protect our patients’ current and future lung health, we are writing to you to express our alarm regarding the widespread visibility and promotion of e-cigarettes and the rapid rise in children’s uptake and regular use, indicated by the Health and Wellbeing Census data (2022). We support the Scottish Government’s commitment to uphold people’s rights to health and to establish a wellbeing economy, and therefore we request a meeting to discuss our concerns with you at the earliest possible opportunity.

E-cigarettes are health-harming and highly addictive products; there is no reason to suppose that the rising trend in children’s use will halt or diminish. Meanwhile, established and emerging science on the health harms of the varied range of products covered by the term ‘e-cigarettes’ strongly suggests that urgent action and a precautionary approach are required.

We have particular concerns regarding the negative impacts of e-cigarette use on developing lungs (acute lung disease) and brains (increased addiction and adverse behavioural outcomes). Furthermore, we are concerned that long-term use of e-cigarettes will lead to serious disease outcomes in coming decades. The lessons from combustible tobacco marketing strategies of the early 20^th century and failure to recognise harms must be learnt, or we face long-term harms to the next generation once again.

In Australia, the vaping industry has exploited regulatory loopholes to flood the market with vaping devices attractive to children and young people. The first rise in youth smoking rates in 25 years has also recently been reported. This reversal of previous consistent success in driving smoking rates down is in line with the findings of the World Health Organization (WHO) in 2021 and the umbrella global systematic evidence review published by Professor Emily Banks in April 2023 that young people who vape are at up to three times greater risk of moving on to using combustible tobacco.

We understand proponents of e-cigarettes consider such devices a reliable and effective method of smoking cessation; however, the evidence for this is weak and disputed by global health authorities. What is clear is that children are using disposable e-cigarettes and that children who use e-cigarettes become regular users of nicotine containing products. The promotion of e-cigarettes for health reasons by the UK Government’s Department of Health and Social Care is an outlier globally, and should not be replicated in Scotland.

Scotland led the way on legislative change which has delivered falls in smoking rates. The Scottish Government has led the world in protecting children from the harmful effects of nicotine with the Smoking, Health and Social Care (Scotland) Act 2005 and through its ‘Take it Right Outside’ media campaigns run in 2014 and 2016. It is vital, however, that we do not sacrifice the lung health of the next generation by failing to recognise the consequences of their increased e-cigarette use and we therefore encourage you to take all actions possible to prevent damage to Scotland’s health and wellbeing. We are calling on you to act now to halt what is a fast becoming a vaping epidemicin the adolescent population.

We fully support the recent call by the Royal College of Paediatrics and Child Health (RCPCH) and Royal College of Physicians of Edinburgh (RCPE) for Scotland to ban disposable e-cigarettes on both health and environmental grounds.

The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 enables the Scottish Government to rapidly introduce regulations to close down the visibility and promotion of e-cigarettes (Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems) in retail outlets, on bus shelters and billboards, and to end free give-aways, nominal pricing and sponsorship. The Scottish Government’s consultation about proposed advertising and promotions restrictions on vaping products ended in April 2022, and was followed by a report published in September 2022 highlighting strong support for the measures from health organisations.

We strongly advocate that regulations to restrict the visibility and availability of recreational e-cigarettes are introduced without further delay to help curb the experimentation and regular use of these tobacco related products by children, and to make progress towards achieving Scotland’s ambition for a generation free from tobacco in 2034.

Thank you for considering the points we have raised in our letter, and we look forward to meeting with you as soon as is practicable.

Yours sincerely,

Dr Kenny Macleod – consultant respiratory paediatrician at NHS Lothian.

Professor Steve Turner –  consultant paediatrician in general and respiratory paediatrics at Aberdeen Children’s Hospital.

Dr Ross Langley – paediatric respiratory consultant at NHS Greater Glasgow and Clyde.

Dr Jonathan Coutts – consultant neonatal and respiratory paediatrician at the Royal Hospital for Children, Glasgow.