德莫斯研究所-2022年的電子煙監(jiān)管：確定電子煙監(jiān)管中的差距（英）

VAPING

REGULATIN

IN2022

IDENTIFYINGGAPSIN

THEREGULATIONOF

E-CIGARETTES

ALICEDAWSON

JOSHSMITH

AUGUST2022

2

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CNTENTS

INTRODUCTION&SUMMARY

PAGE4

BACKGROUND

PAGE

6

AREE-CIGARETTESHARMFUL?

PAGE7

ISTHECURRENTFRAMEWORKWORKING?

PAGE

8

APPEALANDUSEOFE-CIGARETTES:

REGULATINGFORGOOD

PAGE1

2

CONCLUSIONS

PAGE1

7

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INTRODUCTION&SUMMARY

Thereisatangleofregulationgoverningthedevelopment,useandsaleofe-cigaretteproducts,whichhasevolvedtosettheparametersfortheiruseandstillencouragepeopletostopsmokingtraditionalcigarettes.WhiletheUK’ssmokingregulationisinmanywaysworldleading,thereisvastroomforimprovementifwearegoingtomeetbothoftheseobjectives,protectthehealthandsafetyofvapersandsmokers,andeffectivelysupportthewiderpublichealthagendaintheUK.Arebalancingisneeded.Thispaperexploreshowthismightbedone.

E-cigaretteproductspresentanovelchallengetoregulatorsintheUK.Repeatedstudieshaveshownthevalueofe-cigaretteproductstosmokersassmokingalternatives,andoverthepastfiveyearsthisvaluehasbeenrecognisedinofficialadvicefromhealthcareproviders.1One2019clinicaltrialfounde-cigarettestobetwiceaseffectiveinsupportingpeopletostopsmokingthanothernicotinereplacementproducts.2

SmokingremainstheleadingpreventablecauseofillnessandprematuredeathintheUKwithanestimated191,900deathsattributedtosmokinginEnglandintheyears2017to2019.3Accordingtothelatestdata,14percentofadultsintheUKsmoke.4Itremainsoneofthemaincausesofhealthinequalities

inEngland,withtheharmconcentratedindisadvantagedcommunitiesandgroups.ONSdatasuggestsnearlyaquarterofthoseonincomeslessthan￡10,000arecurrentsmokers,comparedwithjustover10%ofthoseonincomesover￡40,000.Tacklingsmokingshouldbothbeamajorpublichealthpriorityandamajorpriorityinthelevellingupagenda.

Policiesencouraginge-cigaretteuse,however,needcarefuldesigningtoavoidcausingnegativeoutcomes.First,poorlytargetedpoliciescouldintroducethosewhodonotsmoke-whomayneverhavesmoked-tonicotinethroughe-cigaretteproducts.Second,caremustbetakennottoincentivisethedevelopmentofsubstandardorcounterfeitproducts,posingasignificantandsubstantialriskofharmtoconsumers.Finally,thereistheriskthatyoungpeoplewillbeencouragedtousee-cigaretteproducts-despiteagerestrictions,latestdatashowsthat16%ofchildren11-17havetriedvaping,anincreasefrom14%in2020.Thisnumberrisesto29%for16-17yearolds.5

Theregulatorylandscape,bothhereintheUKandinothermarkets,isshiftinginrealtime.IntheUS,theFoodandDrugAdministration(FDA)recentlyissuedamarketingdenialorderonthesaleofJUULproductsintheUnitedStates,citingalackof

1NHS.Usinge-cigarettestostopsmoking.NHS.Availableat:https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/(accessed11/08/2022)

2Hajek,Petal.ARandomizedTrialofE-CigarettesversusNicotine-ReplacementTherapy.TheNewEnglandJournalofMedicine,2019.Availableat:/doi/10.1056/NEJMoa1808779(accessed11/08/2022)

3PublicHealthEngland.LocaltobaccocontrolprofilesforEngland:shortstatisticalcommentary,July2021.PHE,2021.Availableat:https://.uk/government/statistics/local-tobacco-control-profiles-for-england-july-2021/local-tobacco-control-profiles-for-england-short-statistical-commentary-july-2021#:~:text=There%20were%20an%20estimated%20191%2C900,period%20(2017%20to%202019).

4OfficeforNationalStatistics.AdultsmokinghabitsintheUK:2019.ONS,2020.Availableat:.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2019(accessed11/08/2022)

5ActiononSmokingandHealth.Fearsofgrowthinchildrenvapingdisposablesbackedupbynewnationalsurvey.ASH,July2022.Availableat:.uk/media-and-news/press-releases-media-and-news/fears-of-growth-in-children-vaping-disposables-backed-up-by-new-national-survey/(accessed11/08/2022)

5

evidencethattheproducts‘wouldbeappropriatefor

theprotectionofpublichealth”.6

TheFDAhassinceagreedtoanadministrative

stayofitsmarketingdenialorder,untilaregulatory

reviewprocessiscompleted,allowingJUULproducts

tocontinuetobesoldintheUnitedStatesinthe

meantime,whilenotingthe“scientificissuesunique

totheJUULapplicationthatwarrantadditional

review”.

Thisincidentshowsthespeedatwhichtheworld

ischanging-sharpeningtheimperativefortheUK

todevelopandenforceregulationwhichstrikesthe

rightbalance,andencouragessmokerstoswitch

withoutinadvertentlycausingharm.

Thisdilemmaformsthebasisforthispaper.

Regulationshouldlikelyimproveaccessto

e-cigaretteproductsforthoselookingtoquit

smoking,whilesettingclearparametersaroundtheir

use.Weidentifycleargapsintheregulationandfind

thatthecriticalleverstoclosethemare:

1.Stringentageverificationprocessesatpointofsale

2.Closingloopholesthatmakeitlegaltohandoutfreevapesamplestochildren

3.Preventinge-cigarettesbeingdisplayedas‘impulsebuy’productsinshops

4.Tacklingpackagingthatappealstoyoungpeople

5.Increasingtheenforcementactivitiesofexistinge-cigaretteregulations

6.Betterprotectingchildrenfromexposuretoage-restrictedproductsonsocialmedia

6FDA(2022)FDADeniesAuthorizationtoMarketJUULProducts.RetriedAugust2022from/news-events/press-announcements/fda-denies-authorization-market-juul-products

6

BACKGROUND

Todevelopandapplyregulationistoattemptcomplexactionatadistance-aimingtoindirectlychangethebehaviourofchaotic,humansystems.Assuch,it’snotalwayseasytopredictwhatwillwork,andhistoryislitteredwithexamplesofwell-intendedregulatoryregimescausingunintendedconsequences.Interventionsdesignedtopreventoverfishinghaveledtostockbeingdumpedoverboard;attemptstoguaranteefarmersafairpriceforproduceledtomountainsofbutterandmilkpowderpilingupinEurope;stringentrestrictionsonemployersinItaly,designedtopromotejobsecurity,haveledtomorepeopleworkinginprecarious‘underthecounter’jobs.7,8,9

Throughout,wefocusononecorequestion:arethereadjustmentstobemadethatcanensurevapingisanattractivealternativetosmokerswhilereducingaccessandappealtonon-smokers?

Outsideoftheinherentchaosofoursocial,

politicalandeconomicsystems,therearemore

straightforwardreasonswhyregulationcanfail,from

poorenforcementtonarrow,inflexibledesign.One

challengeisofparticularinterestwhenthinking

aboutvapingintheUK.Thisisatypeofregulatory

leakage:howdoweincreaseaccesstovaping

productsforadultslookingforsmokingalternatives

whilerestrictingaccesstonicotineproductsfornon-

smokersandchildren?Howdoweensurethemarket

fore-cigarettescontinuestoprovidesmokerswith

easyroutestotriallingthemwhilerestrictingaccess

andappealtoyoungpeople?

Thispaperexploresarangeofpotentialregulatory

approachesinpublichealthinthecontextof

thisdilemma.Itexploresthecurrentregulatory

environment,highlightingareaswherecarefully

tunedinterventioncouldmakearealdifference.It

alsodrawslessonsfromexistingregulatoryregimes,

intheUKandworldwide,forexamplerelatingtoanti-

obesitydrivesanddietimprovements.

7Milmo,C.ThousandsoftonnesoffishstillthrownawayatseaasBritainfailstoenforcebantoconservestocks.i,February2019.Availableat:https://inews.co.uk/news/uk/thousands-of-tonnes-of-fish-still-thrown-away-at-sea-as-britain-fails-to-enforce-ban-to-conserve-stocks-report-255692(accessed11/08/2022)

8Livingstone,E.Europe’shiddenmilklakethreatensfragilemarket.Politico,January2018.Availableat:https://www.politico.eu/article/europes-hidden-milk-price-lake-threatens-fragile-market-eu-commission/(accessed11/08/2022)

9Melchiorreetal.TheUnintendedConsequencesofItaly’sLabourLaws:HowExtensiveLabourRegulationDistortstheItalianEconomy.EconomicAffairs,June2013.Availableat:/publication/264622190_The_Unintended_Consequences_of_Italy’s_Labour_Laws_How_Extensive_Labour_Regulation_Distorts_the_Italian_Economy(accessed11/08/2022)..

7

AREE-CIGARETTESHARMFUL?

E-cigarettescausefarlessharmthantobacco

products,andPublicHealthEnglandestimatesthat

theyare95%lessharmfultohealththansmoking

tobacco.10Contrarytopopularbelief,nicotine

doesnotcausecancer-thechancesofdeveloping

lungcancer,heartdiseaseandchronicobstructive

pulmonarydisease(COPD)-theleadingcausesof

prematuredeathamongsmokers-areintroduced

bythetarandsmokeproducedbyburningtobacco,

ratherthantheinhalationofnicotine.

Useofe-cigarettesisnotentirelyriskfree.Along

withmostsmokingalternatives,thevastmajorityof

e-cigarettesdelivernicotine,anaddictivesubstance

whichinrarecasescancausechestpainsand

palpitations-thoughseriousadversephysicaleffects

fromnicotineareextremelyrare.11

Theeffectsofvapingarestillbeingstudied,and

itiscrucialthatregulatorsstayontopofadvances

inmedicalsciencewhenweighingoptions.For

example,studiesusingrodentshavesuggestedthat

exposuretonicotineduringadolescencecandisrupt

partsofthebrainresponsibleforattention,learning,

moodandimpulsecontrol,sharpeningtheneedfor

effectivecontrolsonunderageuseofproducts.12

TheOfficeforHealthImprovementsandDisparities

(OHID)shouldcontinuetheirannualevidence

updatessoregulatorscanmaintainanaccurateand

up-to-dateunderstandingoftheeffectsvapinghas

onyoungpeople’shealth.

10PublicHealthEngland.E-cigarettesaround95%lessharmfulthantobaccoestimateslandmarkreview.PHE,August2015.Availableat:

.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review

(accessed11/08/2022)

11Boyceetal.Nicotinereplacementtherapyversuscontrolforsmokingcessation.CochraneLibrary,May2018.Availableat:https://www./pmc/articles/PMC6353172/(accessed11/08/2022)

12Slotkin,TA.Nicotineandtheadolescentbrain:insightsfromananimalmodel.NationalLibraryofMedicine,2002.Availableat:Nicotineandtheadolescentbrain:insightsfromananimalmodel-PubMed()(accessed11/08/2022)

8

ISTHECURRENT

FRAMEWORK

WORKING?

Theprimarylegislationcoveringtheuseand

saleofe-cigaretteproductsintheUKare“TheTobaccoProductsandNicotineInhalingProductsRegulations”,lastupdatedin2020.13Thisisenforcedbymultiplebodies.TheMedicinesandHealthcareproductsRegulatoryAgency(MHRA)establishessafetystandardsforvapingdevices,governing,forexample,nicotinestrengthinproducts.14TheAdvertisingStandardsAgency(ASA)specifieshowtheseproductscanbemarketed,andanetworkoflocalauthorities,healthcareprovidersandtransportservicescontrolwheredevicescanbeused.15Basedonevidencebelow,thissystem,designedtoreducesmokingandpreventharm,iscurrentlyfailinginbothoftheseobjectives.

AsDemoshasarguedinpreviouspapers,

e-cigaretteshavebeenfoundtobeoneofthemosteffectivesmokingalternativesandaresubstantiallylessharmfulthantobaccosmoking.16,17Adultsmokersshouldbeencouragedtotake

upvapingasameanstoquittobacco.18,19Thispositionwasechoedinarecentindependentreviewofthegovernment’ssmokingreductionpolicies,publishedbyDrJavedKhan.Oneoffourcriticalrecommendationsinthisreviewcalledforthepromotionofvaping,advocatingforthegovernmentto‘embracethepromotionofvapingasaneffectivetooltohelppeopletoquitsmokingtobacco.’20AsKhangoesontosay,encouragingsmokerstoswitchisnota‘silverbullet’,anditiscrucialthatUKregulationisabletokeeppacewithanypotentialharms.

Throughrestrictionsonnicotinelevels,banson

promotionaladvertisingandtheprohibitionof

e-cigarettesalestounder18’s,theaimofe-cigaretteregulationsistoprotectthehealthandsafetyofvapersandpreventyoungnon-smokerstakingupvaping.However,existingregulationshaveconsistentlyfailedtoprovidetheseprotections,allowingunsafeproductstoreachthemarket,

13TheTobaccoProductsandNicotineInhalingProducts(Amendment)(EUExit)Regulations2020-retrieved2022fromhttps://www..uk/ukdsi/2020/9780348212532

14MedicinesandHealthcareproductsRegulatoryAgency.E-cigarettes:regulationsforconsumerproducts.MHRA,February2016.Availableat:.uk/guidance/e-cigarettes-regulations-for-consumer-products#:~:text=The%20requirements%3A,no%20more%20than%2020mg%2Fml(accessed11/08/2022)

15ASA.ElectroniccigarettesCAPCode.ASA.Availableat:.uk/type/non_broadcast/code_section/22.

html#:~:text=The%20Tobacco%20and%20Related%20Products%20Regulations%202016&text=The%20Regulations%20prohibit%20the%20advertising,set%20out%20in%20rule%2022.12(accessed11/08/2022)

16Mackenzie,P.RegulatingtheFutureofVaping.Demos,March2022.Availableat:https://demos.co.uk/project/regulating-the-future-of-vaping/(accessed11/08/2022)

17Mackenzie,PandDawson,A.MythsandMisinformation:Mappingthebarrierstosmokingcessationandtheuptakeofnicotinealternatives.Availableat:https://demos.co.uk/project/myths-and-misinformation-mapping-the-barriers-to-smoking-cessation-and-the-uptake-of-nicotine-alternatives/(accessed11/08/2022)

18Mackenzie,P.RegulatingtheFutureofVaping.Demos,March2022.Availableat:https://demos.co.uk/project/regulating-the-future-of-vaping/(accessed11/08/2022)

19Mackenzie,PandDawson,A.MythsandMisinformation:Mappingthebarrierstosmokingcessationandtheuptakeofnicotinealternatives.Availableat:https://demos.co.uk/project/myths-and-misinformation-mapping-the-barriers-to-smoking-cessation-and-the-uptake-of-nicotine-alternatives/(accessed11/08/2022)

20Khan,JDr.MakingSmokingObsoleteIndependentreviewintosmokefree2030policiesDrJavedKhanOBE.OHID,June2022.Availableat:.uk/government/uploads/system/uploads/attachment_data/file/1081366/khan-review-making-smoking-obsolete.pdf(accessed11/08/2022)

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andfailingtostopunderagepurchasesofvapingproducts.

CURRENTREGULATIONSAREFAILINGTOPROTECTE-CIGARETTEUSERS

TheUKisinthemidstofanenforcementcrisisaroundthesaleofillicitvapingproducts.DespitetheMHRAdevelopingclearregulationsrestrictinge-cigarettetanksizes,nicotinelevelsandstrength,non-compliantproductswithinadequatehealthwarnings,andtanksabovethelegalcapacityhavebeenfoundbeingsoldinUKshopsandbymajoronlineretailers.21,22AccordingtotheUKVapingIndustryAssociation(UKVIA),somedistributorsaremanagingtogetthesenon-compliantproductsimportedintothecountryandaresellingthemontoretailers,aproblemcompoundedbyalackofscrutinyofonlinemarketplaces.23,24

Thecurrentregulatoryframeworkisalsofailingtopreventproductsafetydisasters,puttingvapersandthoseintheirimmediatesurroundingsatriskofharm.IntheUKtherehavebeenincidentsof

e-cigarettebatteries‘exploding’inpeople’spockets,whilepoorlymadeorcounterfeitchargershavecausedhousefires.25WhileincidentslikethesearerareintheUK,whentheydohappentheycancauseseverelong-terminjuries.Muchofthisharmarisesfromafailuretocontrolthedistributionofproducts,withcounterfeitanddangerousproductsavailabletocustomersbuyingonlineandon“dodgy”marketstalls.26,27,28

ItisillegaltosellcounterfeitorfaultyproductsintheUK,includingcounterfeitvapingproducts,andin2020BEISranacampaignurginge-cigaretteusersto’takechargeofbatterysafety’byonly

usinggenuineandrecommendedbatteriesfortheirvapingdevices.29Despitethis,counterfeitvapingaccessoriescontinuetoreachconsumers,whoareunlikelytorealisethey’rebuyingapotentiallydangerousproduct.Moreneedstobedonetoeffectivelypreventthesaleofcounterfeitproductsaswellasmakingconsumersawareofwhatproductsareandarenotgenuine,andtherisksinvolvedinmakingthewrongchoice.

CURRENTREGULATIONSACTASABARRIERTOGETTINGSMOKERSTOSWITCH

Aswellasfailingtoprotectpeoplefromthepotentialrisksofe-cigarettes,someregulations,particularlyonadvertising,maybeinhibitingeffortstogetadultsmokerstoswitch.AsDemoslaidoutinMythsandMisinformation,misperceptionsoftherelativeharmsofvapingandnicotinearepervasiveamongbothsmokersandnon-smokers,andareakeybarriertosmokers’willingnesstoswitch.30Thesemisperceptionsaremorecommonamonglowersocioeconomicgroups,whoarealsomorelikelytosmoke,makingthemabarriertoreducinghealthinequalities-ourresearchfoundthatpeoplewhodon’twork(55%vs44%ofthosewhoareworking)aremorelikelytoincorrectlybelievethatnicotineisthemaincancercausingchemicalincigarettes.31

Theincorrectbeliefthate-cigarettesareequallyormoreharmfulthantobaccosmokingislikelytopreventsmokersfromtakingupe-cigarettesasameanstoquittobacco,andpreventsmokers’familiesandfriendsfromencouragingthemtoswitch.TherecentKhanreviewproposesthatavapingfactswebsitebecreatedsohealthprofessionalscanaccessaccurateinformationontherelativeharms

21MedicinesandHealthcareRegulatoryAgency.AdviceforRetailersandProducers.MHRA,March2022.Availableat:.uk/government/publications/advice-for-retailers-and-producers(accessed11/08/2022)

22UKVapingIndustryAssociation.UKVapingIndustryAssociationcallsfortoughactionagainstresellersofnon-compliantdisposablevapeproducts.UKVIA.Availableat:https://www.ukvia.co.uk/uk-vaping-industry-association-calls-for-tough-action-against-resellers-of-non-compliant-disposable-vape-products/(accessed11/08/2022)

23MedicinesandHealthcareRegulatoryAgency.AdviceforRetailersandProducers.MHRA,March2022.Availableat:.uk/government/publications/advice-for-retailers-and-producers(accessed11/08/2022)

24UKVapingIndustryAssociation.UKVapingIndustryAssociationcallsfortoughactionagainstresellersofnon-compliantdisposablevapeproducts.UKVIA.Availableat:https://www.ukvia.co.uk/uk-vaping-industry-association-calls-for-tough-action-against-resellers-of-non-compliant-disposable-vape-products/(accessed11/08/2022)

25Rough,E.TheRegulationofE-cigarettes.HouseofCommonLibrary,January2022.Availableathttps://researchbriefings.files.parliament.uk/documents/CBP-8114/CBP-8114.pdf(accessed11/08/2022)

26Rough,E.TheRegulationofE-cigarettes.HouseofCommonLibrary,January2022.Availableathttps://researchbriefings.files.parliament.uk/documents/CBP-8114/CBP-8114.pdf(accessed11/08/2022)

27Mason,D.BatteryandVapeSafety–Howtospotafake18650battery,ohmslawandmore.VapeandJuiceOnline,October2019.Availableat:https://vapeandjuice.co.uk/blogs/vape-advice/battery-and-vape-safety

28Johnson,L.UsingReplaceableVapeBatteries:WhatYouNeedtoKnow.Ashtrayblog.Availableat:https://www.ecigarettedirect.co.uk/ashtray-blog/2018/07/external-vape-batteries-guide.html#Counterfeit(accessed11/08/2022)

29DBEISandOPSS.Takechargeofbatterysafetywhenusinge-cigarettes.February2020.Availableat:.uk/government/news/take-charge-of-battery-safety-when-using-e-cigarettes(accessed11/08/2022)

30Mackenzie,PandDawson,A.MythsandMisinformation:Mappingthebarrierstosmokingcessationandtheuptakeofnicotinealternatives.Availableat:https://demos.co.uk/project/myths-and-misinformation-mapping-the-barriers-to-smoking-cessation-and-the-uptake-of-nicotine-alternatives/(accessed11/08/2022)

31Mackenzie,PandDawson,A.MythsandMisinformation:Mappingthebarrierstosmokingcessationandtheuptakeofnicotinealternatives.Availableat:https://demos.co.uk/project/myths-and-misinformation-mapping-the-barriers-to-smoking-cessation-and-the-uptake-of-nicotine-alternatives/(accessed11/08/2022)

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ofvapingandbeinabetterplacetochallengemisconceptionsamongsmokersandencouragethemtoswitch.32Ifthisisseenasatrustedsource,thisresourcecouldprovideavaluableofficialsourceofinformation,andcouldgosomewaytocombattingmisinformation.

KhanalsoproposesthatvapeshopsshouldbeallowedtosupportcampaignslikeStoptober,andrecommendstheGovernmentshouldmodifyadvertisingrulessovapescanbepromotedasa“l(fā)essharmful”product,andallowsmokersto“seemoremessagesthatswitchingtovapesishugelybeneficialtotheirhealth”.33CurrentregulationsprohibitingthiskindofpromotionbyvapeshopsandinpopularformsofmedialikeTVbroadlypreventthisatpresent,andmaybeabarriertotacklingmisperceptionsandreducingthenumberofsmokersintheUK.

Inaccordancewiththelegislationone-cigaretteadvertisingintheTobaccoandRelatedProductsRegulations(TRPR),theASAprohibitsmostadvertisingofnicotine-containinge-cigaretteswhicharenotlicensedasmedicines.34,35WhiletheMRHAhasexpressedaninterestincertifyingproductsformedicaluse,therearecurrentlynovapingproductsavailableforsalewhichhaveachievedthiscertification.36Asaresult,therearesevererestrictionsonhowe-cigarettescanbeadvertised.37

Theserulesapplytotelevision,radio,onlineorprintedadvertisements,butnotoutdoorpostersandbillboards.38Whileretailersareallowedtoprovideinformationaboute-cigarettesontheirwebsites,andinresponsetoemailrequests(orother

electronicmessages)fromconsumersforproductinformation,thisinformationmustbe‘factual’ratherthan‘promotional’.39Whereadvertisingisallowed,theASAstipulatesthatitmustnotencouragenon-smokerstotrye-cigarettes.40Targetedmarketingtowardsadultsmokersisalsorestrictedbytheseregulations-bansonretailersprovidingpromotionalinformationtoconsumersviaemailmeansmarketerscannotsendemailstoknownadultsmokerspromotingvapingasasmokingalternative.Further,TRPRprohibitsinsertsandadditionalmaterialsintobaccopacksmeaninginsertswithswitchingmessagesarenotallowed.41

Thereareclearriskstochangingthisstance.A2015studyfoundthatviewinge-cigaretteadvertisementsonTVledtoundereragenon-smokershavingamorepositiveattitudetowardse-cigarettesandahigherintentionoftryinge-cigarettes.42Increasing‘positive’attitudestowardsvapingamongnon-smokersisnotnecessarilyabadthing.Demos’ownresearchfoundthat32%ofsmokerssaidtheywereaccessinginformationaboutvapingandsmokingfromfriendsandfamily43-ifnon-smokershavemoreaccurateperceptionsontherelativeharmsofvapingandinturnamore‘positive’attitudetowardse-cigarettesasausefultooltoquitsmoking,itmeanstheyarebetterplacedtoencouragetheirpeersandfamilymemberswhosmoketoswitch.However,advertisingrisksencouragingnon-smokers,particularl