Vaping products: Information for health care workers and stop-smoking services

This page may be helpful when talking to people about vaping products (also known as e-cigarettes or vapes). It provides answers to common questions and issues.

What are vaping products?

Vaping products are battery-operated devices that heat a solution (or e-liquid) to produce a vapour that the user inhales or ‘vapes’. The ingredients of the e-liquid may vary, but currently, most contain propylene glycol (also used in asthma inhalers and nebulisers) and flavouring agents. In New Zealand, flavoured e-liquids are only available at specialist vape stores, except for tobacco, menthol and mint flavours, which are available at generalist stores such as dairies, petrol stations, chemists, and supermarkets. Some, but not all, e-liquids contain nicotine. 

Vaping products are a less harmful way of delivering nicotine than conventional tobacco cigarettes. However, vaping products cannot be regarded as being harmless: they still produce a range of toxicants, including some known carcinogens, in the vapour that users inhale, but at much lower levels than those found in cigarette smoke and at levels unlikely to cause harm (Ministry of Health, 2020b).

Types of vaping products

Vaping products come in a range of styles. Some devices look like conventional cigarettes with refillable cartridge ‘tank’ systems. In contrast, others are appliances with larger batteries that allow the power to be adjusted to meet an individual’s specific vapour requirements, or closed systems with low-powered batteries and replaceable cartridges (known as pods). The pods contain the heating coil and the e-liquid, which can be replaced as needed. These devices are far more discrete than tank systems, with little vapour and the size and appearance of a memory stick.

The rapid evolution of devices has hampered research into the effectiveness of vaping for smoking cessation. The studies used products that are now considered obsolete, which typically had limited battery life and poor nicotine delivery. Contemporary devices can deliver nicotine far more effectively than earlier products. Very experienced vapers can achieve nicotine levels similar to those from smoking cigarettes (Prochaska, Vogel, & Benowitz, 2021).

Availability of vaping products in New Zealand

From November 2020, vaping products are regulated under the Smokefree Environments and Regulated Products Act 1990. People can use vaping products to support smoking cessation, but vaping products cannot be marketed as a stop-smoking medication. 

As a regulated tobacco product, vaping products are subject to the provisions in the Act for smoke-free indoor workplaces (including restaurants and bars) and early childhood centres and schools. From November 2021, vaping will be illegal in vehicles carrying children under the age of 18. Some of the Smokefree Environments Act requirements also apply to vaping and heated tobacco products, such as banning advertising of these products and making it illegal to sell them to young people under the age of 18.

How many New Zealanders vape?

Many people report having ‘ever used’ vaping products. They say that they have tried or experimented with vaping, and that is all. Some people vape more regularly, such as daily or weekly. In the 2019/2020 New Zealand Health Survey, 24% of respondents said they had tried vaping at least once, but only 3.5% of adults reported vaping daily (Ministry of Health, 2020a). ‘Ever use’ of vaping products is very common among people who smoke tobacco: a 2017 survey of people who smoke tobacco found more than 60% of them reported having ever vaped (Guiney, Oakly, & Martin, 2019).

Of the people that had made recent quit smoking attempts, a third (32%) vaped daily or vaped on most days. The 2019 ASH (Action on Smoking and Health) Year 10 smoking survey found 3% of Year 10 students were daily vapers, and most were also daily smokers. Less than 1% of never smokers were daily vapers (ASH, 2021). However, with recent changes in the regulation of vaping products and other tobacco control measures taking effect, these figures are likely to change quite rapidly.

Stop-smoking support options for vapers

Emerging research suggests that people can use vaping products to help them transition from smoking cigarettes. Combining behavioural support with stop-smoking medication gives a person the best chance of quitting smoking. Using behavioural support with vaping products is likely to have a similar result. Both Quitline and local face-to-face stop-smoking services can support people who wish to use vaping products in their smoking cessation attempt.

Stop smoking services should:

  • be ‘vaping friendly’ towards clients who choose to use a vaping product in their quit smoking attempt
  • provide accurate information to people about the benefits and risks of vaping so that people can make an informed decision
  • be able to provide accurate advice about where people can obtain a vaping product and get advice on using and maintaining the product

Stop smoking services should also help people who wish to transition off vaping once confident that they will not relapse to smoking cigarettes.

Effectiveness of vaping products in smoking cessation

Vaping products can provide nicotine, which people most desire from smoking, while also replacing some of the sensorimotor, behavioural, and social aspects of smoking. Some vaping products are better than others at delivering nicotine. Practice also makes a difference and can improve a person’s ability to retrieve nicotine from vaping products (Royal College of Physicians, 2016).

The most substantial evidence for the effectiveness of vaping products in aiding smoking cessation comes from randomised controlled trials (RCTs) that compare the long-term outcomes (at least six months) in vapers using vaping products against a control or comparison group.

Vaping products containing nicotine are effective in increasing long-term quit rates by 69% compared to Nicotine Replacement Therapy (NRT; RR 1.69, 95% CI [Confidence Intervals] 1.25-2.27, 3 studies, n=1498) and 71% compared to non-nicotine vaping devices (RR 1.71, 95% CI 1.00-2.92, 3 studies, n=802) (Hartmann-Boyce et al., 2020). Nicotine vaping products more than doubled long-term abstinence compared to behavioural support alone (RR 2.50, 95% CI 1.24-5.04, 4 studies, n=2312). However, the findings should be interpreted with caution due to imprecision in the estimates and the risk of bias (Hartmann-Boyce et al., 2020). 

There is limited evidence of the effects of non-nicotine vaping products compared to other smoking cessation support. Two studies have found higher quit rates in participants using non-nicotine vaping products (one as an adjunct to NRT) than other smoking cessation support (Hartmann-Boyce et al., 2020).

A trial of vaping products in pregnant women who smoke is currently underway in the UK, with results expected in 2022. Until then, vaping products may be considered for use by pregnant women who have been unable to stop smoking through other methods, but only after they have been informed of and have weighed up the risks and benefits.

Combining smoking with vaping

Cutting down the number of cigarettes smoked and using vaping products as partial substitutes (‘dual use’) reduces some health risks. Still, it does not provide the same health benefits as switching completely from smoking to vaping. Anyone who is switching from smoking to vaping should stop smoking tobacco as soon as possible.

Some people manage to switch completely to vaping quickly. Others can take some time to adjust and may need to try several different vaping devices, and strengths and flavours of e-liquids, before finding one that can help them stop smoking.

Ideally, people should eventually stop vaping if they can do so without relapsing to smoking.

Combining vaping with stop smoking medicines

Some people may choose to use vaping products in addition to approved stop-smoking medicines, such as NRT. There are no known harms from this practice. People should not be discouraged from using vaping products; instead, they should be encouraged to stop smoking completely.

The evidence on the effectiveness of combining vaping products with other smoking cessation aids is limited. A recent RCT conducted in New Zealand (with 1124 participants) compared NRT alone to NRT in combination with vaping products, with and without patches, and found increased long-term abstinence was highest in the group receiving NRT and nicotine vaping products (Walker et al., 2020).

Health risks and safety

There is evidence that vaping products pose fewer health risks to smokers who switch completely from tobacco smoking to vaping. Short-term use of vaping products may cause mild adverse effects such as headaches, dry mouth or throat, and throat or mouth irritation. The short-term risks of using vaping products appear to be no different than those with NRT (Hartmann-Boyce et al., 2020). The health risks of long-term use of vaping products are unknown, but the hazards of smoking are much more significant (Committee on Toxicity (COT), 2020; Royal College of Physicians, 2016).

Nicotine

The nicotine found in tobacco does not cause the adverse health effects associated with smoking. The other chemicals found in tobacco smoke are known to be very harmful (Royal College of Physicians, 2016). 

However, nicotine is an addictive chemical that encourages smoking. People who smoke are already dependent on nicotine, so vaping products do not create a new addiction. Many vapers feel less dependent on vaping products than they do on traditional cigarettes. They often choose to reduce the strength of nicotine they use over time and eventually stop vaping altogether.

The amount of nicotine that vaping products deliver depends on many factors, including the concentration of nicotine in the liquid, heating of the liquid, other constituents of the liquid, and the user’s technique. Typically, vaping products deliver nicotine at lower levels than traditional cigarettes, although experienced users can obtain nicotine delivery comparable to cigarettes.

Nicotine can be lethal in high doses, especially in children. Vaping devices and e-liquids should be stored carefully to prevent accidental poisoning. 

Other vaping liquid ingredients 

The risk of adverse events (such as nausea) when using vaping products appears to be no different from NRT. However, more long-term follow-up of regular users is needed.

There are health risks with some of the chemicals found in vaping products or in the aerosol they generate when people use them. Aside from nicotine, the main ingredients in vaping liquids are vegetable glycerine and propylene glycol, which are considered safe for use in many consumer products (e.g., inhaled medicines, foods, cosmetics, and sweeteners). 

Several toxicants have been found in the vapour of vaping products. However, when vaping devices are used within normal operating levels (i.e., not overheated), these toxicants are present at very low levels – many times lower than in tobacco smoke (Royal College of Physicians, 2016).

The long-term safety of inhaling the flavours is unknown and continues to be assessed. In 2019, a severe vaping-associated lung illness outbreak in the United States was linked to vitamin E acetate in cannabis vaping products, which are illegal in New Zealand. No cases were reported in New Zealand.

Vaping devices

Some reports indicate malfunctioning vaping devices have caused harm (e.g., injuries when vaping devices have exploded). In many cases, the problem has been with the battery. People should treat vaping products like other electrical products (e.g., mobile phones) and follow the instructions for care and charging.

Second-hand vapour exposure

The risks of inhaling second-hand vapour are unknown at this stage. Exposure to second-hand vapour is likely to be far less harmful than second-hand tobacco smoke (Hess, Lachireddy, & Capon, 2016). As noted above, the toxicants found in vapour are lower in quantity than in tobacco smoke. 

Where can vaping products be used?

The Smokefree Environments and Regulated Products Act 1990 (ss5-9) prohibits vaping in smokefree places such as indoor workplaces, and early childhood centres and schools. However, beyond these legislated areas, individual organisations can ban vaping (e.g., in outdoor areas) as part of their policies. 

Classifying smokers and vapers

Vaping devices are not combustible tobacco products and should not be categorised as such.

  • If a person has switched from smoking cigarettes to vaping, they should be classified as an ex-smoker.
  • If a person still smokes cigarettes, even one per day, they should be categorised as a current smoker.

For more information

Here are some relevant documents from the United Kingdom. Note that legislation in the United Kingdom is different from New Zealand.

References

ASH. (2021). Factsheet - E-cigarettes and vaping 2019. Retrieved from https://www.ash.org.nz/ash_year_10

Committee on Toxicity (COT). (2020). Statement on the potential toxicological risks from electronic nicotine (and non-nicotine) delivery systems (E(N)NDS – e-cigarettes) London: Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment.Retrieved from https://cot.food.gov.uk/sites/default/files/2020-09/COT%20E%28N%29NDS%20...

Guiney, H., Oakly, A., & Martin, G. (2019). E-cigarette use and perceptions among current and ex-smokers in New Zealand. Wellington: Health Promotion Agency.

Hartmann-Boyce, J., McRobbie, H., Lindson, N., Bullen, C., Begh, R., Theodoulou, A., . . . et al. (2020). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews(10) 10.1002/14651858.CD010216.pub4

Hess, I. M., Lachireddy, K., & Capon, A. (2016). A systematic review of the health risks from passive exposure to electronic cigarette vapour. Public Health Res Pract, 26(2) 10.17061/phrp2621617

Ministry of Health. (2020a). Annual Update of Key Results 2019/20: New Zealand Health Survey. Wellington: Ministry of Health.

Ministry of Health. (2020b). Position Statement of Vaping.   Retrieved 6 April 2020, from https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco....

Prochaska, J. J., Vogel, E. A., & Benowitz, N. (2021). Nicotine delivery and cigarette equivalents from vaping a JUULpod. Tobacco Control, tobaccocontrol-2020-056367. 10.1136/tobaccocontrol-2020-056367 %J Tobacco Control

Royal College of Physicians. (2016). Nicotine without smoke: Tobacco harm reduction: A report by the Tobacco Advisory Group of the Royal College of Physicians. (1860166008). London: Royal College of Physicians Retrieved from www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm...

Smoke-free Environments and Regulated Products Act 1990, https://www.legislation.govt.nz/act/public/1990/0108/latest/DLM223191.html  (2020 11 November 2020).

Walker, N., Parag, V., Verbiest, M., Laking, G., Laugesen, M., & Bullen, C. (2020). Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. The Lancet Respiratory Medicine, 8(1), 54-64. https://doi.org/10.1016/S2213-2600(19)30269-3

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