Tobacco and vaping framework: roadmap to 2034

2. Introduction

Tobacco is internationally recognised as a major public health threat. More than eight million deaths each year worldwide are as a direct result of tobacco use, with over one million attributed to second-hand smoke exposure. The production of tobacco is also destructive to the environment, with wide reaching health impacts.^[1]

There are no positive health benefits to smoking and it remains a leading cause of preventable disease and premature death. In 2021 smoking accounted for an estimated 8,260 deaths (250 deaths per 100,000 population) in those aged 35 and over in Scotland^[2].

Over the past 40 years, smoking prevalence among adults has declined across Great Britain, but has generally been higher in Scotland than in both England and Wales^[3]. Figures from the Office for National Statistics^[4] for 2022 show that within the UK, of the constituent countries, the lowest proportion of current smokers was in England (12.7%); Wales, Northern Ireland and Scotland reported 14.1%, 14.0% and 13.9%, respectively. The latter is the lowest level on record for Scotland.^[5]

The risk of developing smoking-related diseases increases with how long and how much someone has smoked. These risks substantially fall with stopping smoking, even for long-term smokers.^[6] Smoking remains a leading preventable cause of inequalities in health.^[7]

Ten years ago in 'Creating a tobacco-free generation: A Tobacco Control Strategy for Scotland'^[8] we set an ambitious target to create a Tobacco-Free Scotland, lowering smoking rates in our communities to 5% or less by 2034. This set an aim to protect children born since 2013 from tobacco so that when they start to turn 21 (from 2034) they will be tobacco-free and will come of age in a Scotland that will remain tobacco-free for generations to come.

This will create a generation of young people who do not want to smoke, with all the health and economic benefits that follow.

Our continued commitment to achieving a Tobacco Free Scotland by 2034 is made in the 2023 Programme for Government (PfG).^[9]

If current trends in smoking rate reductions continue, it looks likely that we will just miss our 2034 commitment across the population as a whole. However, smoking status varies by deprivation significantly in Scotland^[10], and we are less likely to meet the commitment in the most deprived groups (SIMD^[11] 1 and SIMD 2) without further action:

• In 2021 - 24% of people in SIMD 1 and 13% of people in SIMD 2 identified as current smokers compared to 5% in SIMD 5(least deprived)^[12]; and
• In 2022, 22% of women from SIMD 1 and 16% of women from SIMD 2 reported being a current smoker at their antenatal booking appointment (where smoking status was known). This compares with 2.5% of pregnant women in SIMD 5.^[13]

One approach (of many) that has gained traction in helping to reduce smoking rates is that of Nicotine Vapour Products (NVPs or "vapes"). On-going monitoring studies such as the Smoking in Scotland Toolkit Study^[14] have shown that e-cigarettes continue to be one of the most popular aids used in quit attempts.

An updated Cochrane Review^[15] published in 2021 found that nicotine-containing e-cigarettes are around twice as effective in supporting smokers to quit compared to the use of patches and gum. It is important that we support current smokers to stop in a way that suits them. Our Quit Your Way resource will continue to play a vital role in supporting individuals, of any age to stop smoking.

Although vapes can be a valued tool to help smokers to quit, we are concerned by the growing number of children and young people that are using these devices. They are not intended to be used by children, young people or indeed adult non-smokers but only as one possible option to quit smoking.

The recent Health Behaviour in School-Aged Children 2022 (HBSC) (Scotland) reports^[16] that 3% of 11-year-olds, 10% of 13-year-olds and 25% of 15-year-olds said they had used an e-cigarette in the past 30 days. The report also found that there have been increases in current e-cigarette use since 2018 for 13-year-old girls (2% to 13%) and larger increases for 15-year-olds (girls 6% to 30% and boys 8% to 20%).

Current research indicates that there is a significantly lower relative exposure from vaping compared to smoking in biomarkers that are associated with the risk of cancer, respiratory conditions, cardiovascular conditions and other health conditions.^[17] However, we do not fully understand the long-term effects vaping has on our health. Emerging evidence indicates that they are not harm-free.^[18] The World Health Organization (WHO) states that even though many of the long-term health effects of vapes use are still unknown, there is growing evidence to demonstrate that these products are not harmless to health and should be "strictly regulated."^[18]

It is this unknown risk of harm that means we must take a precautionary, low-risk approach to the use of these devices within this Framework until further evidence is developed regarding longer-term harms.