Sat I hairdressers on two seater couch and other woman waiting is chugging on e-cig

[whoahokeycokey]

Just this really. I've got colour on waiting for it to take and as it's a small hairdressers (3 chairs) they rotate us whilst colour set etc. The woman next to me is chugging away on her e-cig. It stinks of some rancid sweet smell.
Why is it acceptable to whip these things out? I've noticed a lot that they are used in places where smoking is not allowed. I know my 2nd hand inhalation isn't going to cause me a great harm but it's making my teeth itch!

I honestly think vaping is right up there with antibiotics in terms of its potential contribution to world health.

Important point.

There are clearly benefits to an individual of vaping rather than smoking, however given smoking is banned in the hair dressers there is no benefit (other than the fact less money is used to treat them by the NHS) to other customers of people vaping. In fact the other customers are subject to fumes and passive vaping therefore it should in my opinion be banned in all the places where smoking is banned.

I bloody luffs vaping. I smoked on and off for 20 years but I'll never go back now

I've got an addi five personality, fags, food, alcohol - i figure nicotine the lesser evil!

I do feel really self conscious about it though, more so than smoking infact i never vape in front of others

Great post HerOtherHalf.

Sconesnotscones I'm not the PP, but that long ago it was probably a cig-a-like or a basic pen model e-cig like the picture.

I started with a cig-a-like about six years ago when I knew I was going into hospital for a while. I came out and started smoking again 🙄. About a year later a friend had bought a basic kit and I tried it and loved it. That was it for me. I smoked stinkies socially for another couple of years and then I quit them completely.

Annoyingly, at the time I was a "healthy" smoker. I never had coughs or colds and never felt crap in the morning, so I never felt any health benefits. I also didn't really feel much financial benefit, as we went to Europe once a year to buy our baccy and smoked roll-ups. The worst bit about giving up was realising how bad I'd smelt for the last god knows how many years. I honestly didn't realise how awful the stink was on my clothes and hair until I'd given up.

After faffing around with various types of kit and wasting a million juices over the years, I've now got a fairly cheap sub-ohm setup and two juices that I like. It probably costs me about £1 a day in juice, plus £2 a week for coils. Given how long a mod and atomiser lasts, that averages maybe another £2 a week. I'm guessing I'd spend that much a day on stinkies so it's win-win for me.

HerOtherHalf brilliant post.

I'm not a smoker or a vaper but the illogic of vape-hatred is annoying.

There are people who hate smoking - I get that, they really REALLY hate smoking - and now there's much less of it around, their eyes have fallen on vaping, which, despite the fact that it isn't smoking, looks a bit like it and seems to enrage them nearly as much.

Suggesting that 'it should be banned in all places where smoking is banned'... why on earth should it be? It may look a bit like smoking but it isn't smoking

We didn't ban public smoking because of the smell, we banned it because of studies showing that second-hand cigarette smoke - not vape mist, not other people's perfume, not floor polish, not hairspray, but tobacco smoke - could be detrimental to others inhaling it.

Some people's train of "logic" seems to be: 'Smoking has been banned and I hate smoking so obviously vaping should be banned because it looks just like it. And it smells a bit. Though not of burning tobacco. Because it isn't burning tobacco. But I still think it should be banned.'

Womblingthree that seems like a lot of cash.
I have the totally wicked arc 4. Need a new coil every couple of months & go through 10ml liquid (bought on amazon for £1.50ish) every few days - and i chain vape

I get that it's brilliant for smokers who are desperate to quit and that for smokers who have successfully quit smoking using e-cigarettes, it should win a Nobel prize. It's nothing like vaccines, though - it does no physical good to the majority of people in this country, only to the minority who smoke and are thus already addicted to nicotine. The evidence so far is promising that it is unlikely to cause significant harm to non-vapers. It is not a banned product and I have never suggested it should be. Smokers should definitely be encouraged to swap from smoking to vaping and tobacco companies continue to be villified. However, for the majority of people in this country who do not smoke or vape, a bit of consideration would be nice - to those who dislike inhaling other people's vapes, it's just another form of antisocial behaviour and I no more appreciate being told I have to suck it up for your benefit than you appreciate being told it's antisocial.

Standing ovation for HerOtherHalf

Sconesnotscones get yourself over to the stop smoking topic for kit recommendations.

WomblingThree Thanks for that.

The one I had was like a cigarette: same size, tip that glowed when you drew back, etc, and you put little cartridges into it. I bought probably two month's supply of cartridges, and only used a few and ended up sterilising it and passing it on to a friend of a friend. It was ceramic and the balance was completely off- it just didn't have the right balance and was far too heavy to actually feel like a cigarette. Additionally, I found no satisfaction in inhaling the vapour, not like drawing back on a cigarette.

I will have to check out newer ones for improved models, or maybe spend the money I have saved on really good quality Belgian Chocs as an oral substitute (sadly I have put on a lot of weight since I stopped smoking).

Rach5l maybe it is, but I like premium juice and ceramic coils and wanky mods. Obviously it doesn't have to be that expensive. I did overestimate the cost of the juice though, it's more like 50p-75p a day. I still think £8-£9 a week on average is better than £7ish(?) a day on stinkies.

I treat vaping like any other hobby, and accept that costs are inevitable for experimenting with new juice or coils. It's still a whole lot cheaper than most hobbies.

I'm not a statistician but I do use stats as part of my work on a regular basis so have a decent understanding.

Sample size is all about the margin of error you are willing to accept and your confidence that the results you get are within the margin of error of the actual result. The actual result is the result you would get if you sampled everyone in your population, so in this case if you sampled every vaper, which is obviously not usually possible.

A sample size of 5 has a margin of error of 43.8% so if your actual result is 100 for example, your sample size will give you results of between 57.2 and 143.8.

You have a confidence level of 16% with a sample size of 5. What that means is that 16% of the time, the result you are getting from your sample is within the margin of error, so 16% of the time, the result will be between 57.2 and 143.8. The rest of the time, it will be outside that margin.

That's a pretty simplistic explanation as there are other factors such as the population size and how the values are distributed. If there is a large actual difference between the items being compared you can accept a larger error margin. The percentage difference is not what's important so the fact that the values are double, or six times etc isn't what you look at. I'm not a chemist so I don't know what would be considered a large value for this.

You can run any set of numbers through a statistical package but the results are meaningless if you don't take into account the margin of error and confidence level.

While ideally you would have a large sample size, a large number of studies using small samples that measure the same thing can also give valid results.

Re the Nutt study - if PHE evaluated based on additional peer-reviewed literature, I would expect them to have included those references in their document. There is nothing wrong with Nutt's study in and of itself. However, it is the interpretation that is the issue here. It is important when using previous studies that incorrect or exaggerated conclusions are not drawn. Researchers don't usually do this deliberately. We tend to have unconscious biases that results in us seeing what supports our belief or expectations.

I will see can I access the full article and check the limitations of the study.

I checked the full paper (obviously I can't post it as that would be a breach of copyright) but they state: "We did not find statistically significant differences in cotinine concentrations from the non-smokers exposed to e-cigarette vapour versus those exposed to tobacco smoke." They also said: "cotinine concentrations among the non-smokers exposed to e-cigarette users (all of them former heavy smokers) were lower than those concentrations among the non-smokers exposed to seven or more conventional cigarettes." So being exposed to vaping is the equivalent to being exposed to a smoker who is smoking fewer than 7 cigarettes in their presence. However, there was no statistically significant difference so really, you can't conclude anything from this other than it's worth looking at in more detail.

They also say, as I had expected: "Our results should be taken with caution, because of the small number of volunteers exposed to e-cigarette users at home." They follow on with: "Nevertheless, the results of our study add new information that should be extended with other studies assessing the real impact of the e-cigarettes exposure among non-smokers."

That is exactly what I would see as the benefit of a study like this. It's small numbers but the results suggest that it's worth while conducting new research with higher numbers. They also state: "it is noteworthy that this is the first study attempting to assess passive exposure to e-cigarette vapour under a real-use condition, with real e-cigarette and cigarette users, and a long exposure time analysed (one week)." Again, a very valuable contribution.

In my view, it is a valuable piece of work that should be built on but, as the authors say, and the PHE do not say, the results should be taken with caution as the numbers are too small to conclude anything definite.

if PHE evaluated based on additional peer-reviewed literature, I would expect them to have included those references in their document.

They did

What might be confusing you is that their starting point was their 2014 report:

PHE commissioned a review of EC in 2014, which covered EC safety [131]. The review found that the hazard associated with use of EC products currently on the market “is likely to be extremely low, and certainly much lower than smoking” and “the health risks of passive exposure to electronic cigarette vapour are likely to be extremely low”.

The report we are discussing is called an 'Evidence Update' and is clearly meant to build on the 2014 report. The executive summary begins: Following two previous reports produced for Public Health England (PHE) on e-cigarettes (EC) in 2014, this report updates and expands on the evidence of the implications of EC for public health.

Clearly you are meant to refer back to that document for further references. PHE next reference the Nutt study and then Hajek's extensive literature review, both of which were published after PHE's 2014 report. Then they look at newer studies to see if they should revise their estimate based on those.

There is an additional Author's Note that accompanies the evidence update which clarifies what PHE have based their figure on and which also references West's evidence briefing to the APPG groups on pharmacy and on smoking and health.

This idea that PHE based their 95% figure on nothing but the Nutt study is getting ridiculous and is highly unfair.

I will accept that the airborne nicotine study is quite weak and PHE could have mentioned that. Nevertheless the levels of cotinine detected were negligible and within the range expected from eating nicotine containing vegetables.

So being exposed to vaping is the equivalent to being exposed to a smoker who is smoking fewer than 7 cigarettes in their presence.

I'm sure you meant in terms of nicotine absorption but it's really important to clarify this. Being exposed to vaping is no other way equivalent to being exposed to a smoker who is smoking even one cigarette in their presence. Of all the potential, theoretical concerns about vaping, nicotine is way down the list.

aside from minor and transient adverse effects at the point of absorption, nicotine is not a significant health hazard. Nicotine does not cause serious adverse health effects such as acute cardiac events, coronary heart disease or cerebrovascular disease,[27, 28] and is not carcinogenic.[29]

We have known for decades that the problem with smoking is not the nicotine, it's the hundreds of other ingredients in tobacco smoke.

In my view, there is little value in studies like this and I don't see much point in building on them save for idle curiosity. Studies measuring cotinine in vapers, and therefore helping to improve efficacy, would be worthwhile though.

Hajak et al do not use any figures in terms of harm. They simply state: "Health effects of long-term EC use are currently not known and a degree of risk may yet emerge. However, based on the data available regarding the toxicant content of EC liquid and aerosol, long-term use of EC, compared to smoking, is likely to be much less, if at all, harmful to users or bystanders." Fair enough, but nothing there to suggest vaping is 95% safer than smoking.

The only place the PHE got the figure of 5% is from the Nutt study and they do not refer to the limitations acknowledged by the original author.

In the author's note they again refer to the Nutt study for the 5% figure and state that it was endorsed by West. West states: "The precise extent of harm from long-term use is not known but has been estimated at around 1/20th that of smoking tobacco cigarettes (5)." (5) is the Nutt study. That is hardly an endorsement. They make no critical assessment of the finding. They are simply stating a study has estimated the harm as being 5% of that of smoking.

PHE state the Nutt figure: "remains valid as the current best estimate based on the peer-reviewed literature". It possibly was the current best estimate as it would appear to be the only estimate in the literature at the time. That does not mitigate the fact that the study had limitations, as identified by the original author.

My issue with the PHE report is not that they are using the Nutt study, or any other study for that matter, but that they are misrepresenting it by not referring to the limitations as identified by the original author. They quite rightly address the limitations of studies that oppose their position but ignore the limitations of those that support their position. This is, to my mind, sloppy research and would make me sceptical of their report.

Hajak et al do not use any figures in terms of harm.

No but they evaluated a lot of peer-reviewed literature, as did the 2014 report. These are the references you said you were looking for.

The 5% risk is PHE's own estimate:

The estimate that e-cigarette use is around 95% safer than smoking is based on the facts that:

- the constituents of cigarette smoke that harm health – including carcinogens – are either absent in e-cigarette vapour or, if present, they are mostly at levels much below 5% of smoking doses (mostly below 1% and far below safety limits for occupational exposure)

- the main chemicals present in e-cigarettes only have not been associated with any serious risk

You know what though, this is really tedious. You can spend your time nit-picking your way through a 113 page review with 185 references and the report it builds on if you want to (and then if you fancy it you can amuse yourself with RCP's rather good 206 page report from last year). I have better things to do.

Provide some evidence to show their estimate is wrong. Provide some evidence of harm from vaping, either to vapers or bystanders and I'll be interested. As HerOtherHalf points out, if you want to ban something (or 'restrict where it can be done') the onus is on you to provide evidence of harm.

None of the other studies produced figures. The figure of 95% less harm is taken from Nutt. They have stated that. The other numbers you quote do not refer to levels of harm. The figures for levels of chemicals are unlikely to directly translate to the same figures for harm. They are simply using them to reinforce the likelihood of the harm being less.

I don't need to nitpick the report. I have identified deficiencies in their research that call into question some of their findings. The number of references in the report is irrelevant if they are using them incorrectly or fudging the findings (e.g. Claiming West endorsed Nutt).

As I stated previously, I believe that they have decided the benefits to smokers are such that they are willing to take a chance on the impact on non smokers. They are fudging the literature to support this position. You, as a vaper, are obviously happy with that.

I, as a non smoker and non vaper, am not. I am also, as a researcher, disappointed that a public body that is meant to provide unbiased research would not at least acknowledge the limitations of their findings.

And I also have no evidence their findings are incorrect. However, I have provided evidence that the way in which they arrived at those findings is questionable.

PHE have repeatedly stated that the 95% figure is based on a review of all the evidence, of which Nutt's study was one reference among many. They looked at all the literature, didn't find any evidence of harm, but kept 5% as an estimate of possible long term risks from some of the ingredients. They have stated that it is their best cautious estimate based on all the current evidence. Roughly similar figures were being talked about informally by scientists in the field even before Nutt's study was published. The phrase 'safer by two orders of magnitude' was commonly used. In published papers, scientists were of course more cautious and used wording like 'the risk is likely to be extremely low and much lower than smoking'.

PHE chose to put a figure on the level of risk even though it was an estimate because public perception of the risks were drifting further and further from reality. They were highly alarmed that each year more people wrongly believed that vaping was as harmful, or more harmful than smoking. Putting an estimated figure on the level of risk was designed to give a clear, impactful message in order to urgently address this issue.

The figure is nothing to do with the risk of harm to bystanders. The 5% represents possible harm from long term use. It's a risk vapers themselves carry. They found no identified health risks to bystanders.

There's a great discussion here by Clive Bates, who is an ex-director of ASH UK, on PHE's use of the figure. It's an opinion piece, obviously, but it explains well how and why PHE came up with 95%.

When the report was published in 2015 critics raised all the same quibbles that are concerning you, as well as engaging in some nasty, baseless character smearing of Nutt's team and of PHE staff. Much discussion ensued, especially of the 95% figure. The upshot was that an even stronger consensus formed around PHE's general findings, regardless of whether the 95% figure itself was strictly accurate or whether they could have put a few more caveats in the report itself. The joint statement was signed by some PH orgs who had previously been highly critical of PHE's harm reduction stance.

And I also have no evidence their findings are incorrect.

No, and neither do any of the experts in the various relevant fields, two years on from publication. Now the dust has settled there's a broad consensus that the 95% figure is about right, if a bit too cautious.

There's also still no evidence of any harm to bystanders and so no justification for a public ban.

Stating that the risk is 5% without any actual data is very, very poor research. All the previous studies, other than Nutts, refered to low levels of risk. If they stated the risk is likely to be very low and that one study, with the following limitations, suggest it is the order of 5%, they would be reporting correctly. The problem is, when data is reported incorrectly, others then go on to use the incorrect reports to support their work and you have dodgy foundations. That is why it is so important to have unbiased research. For example, the claim they make that West endorsed Nutt's findings is absolutely incorrect but unless you go back to the source document for every reference, you can't know that. Unfortunately, not everyone does that so you get misinterpretation being espoused as fact.

Also, there is absolutely nothing wrong with Nutt's research. He had detailed the limitations correctly. The problem is in the interpretation.

I've already shown some of the methodolical faults in their report. That's enough to suggest that there is an implicit bias in the work.

In the author's note they again refer to the Nutt study for the 5% figure and state that it was endorsed by West. West states: "The precise extent of harm from long-term use is not known but has been estimated at around 1/20th that of smoking tobacco cigarettes (5)." (5) is the Nutt study. That is hardly an endorsement. They make no critical assessment of the finding. They are simply stating a study has estimated the harm as being 5% of that of smoking.

Yes, right under a statement in bold that says Safety: E-cigarettes are much less harmful than smoking but not 100% safe

Clearly West was referencing Nutt in support of that statement. This is nit-picking.

You seem to want the 95% figure itself to be backed up by multiple sources. Both Nutt et al and PHE state their figure is a best estimate based on the research available and expert opinion. Both state there are still some unknowns. It was never the intention of either group to produce an exact, verifiable figure, just a best expert estimate so the general public could have a bit of a clue and not be lost in vague, arse-covering caveats. Maybe 95% is wrong but nobody sensible believes it will turn out to be badly wrong. Do you think it would really matter if, say, vaping turned out to be actually 97% or 93% safer than smoking?

Would you prefer it if PHE had not attempted to quantify the relative risk of vaping at all unless they could produce an exact figure? Who would benefit from that? Public health orgs have a duty to provide the best information they have, as clearly as possible to the public (who are laypeople) so that they can make a realistic assessment of risks they face in their own day to day lives.

West is listing the literature that refers to the safety of vaping. Stating that people have reported a particular finding is not the same as endorsing. Endorsing would require that they critically examined Nutt's work and agreed it was sound. Generally, endorsing would be as a result of repeating the study and getting the same results as the original study.

I don't care how many sources they used to arrive at the 95% figure. I would just like honest reporting and analysis of the sources they are using.

You are absolutely right when you say: "Public health orgs have a duty to provide the best information they have, as clearly as possible to the public (who are laypeople) so that they can make a realistic assessment of risks they face in their own day to day lives." That is why they should try to eliminate bias and be honest and accurate when presenting data.

As I said previously, stating "the risk is likely to be very low and that one study, with the following limitations, suggest it is the order of 5%" would have been an accurate reporting of the data.

If the data is poorly presented, then the public will end up with an incorrect understanding. This works both ways. For example, the PHE identified the shortcomings of the formaldehyde studies. That was good, accurate research that helped to inform the public of the facts. Unfortunately, they are not applying the same standard to research that supports their position.

Hats off to you, PencilsInSpace - you really do know the papers inside out and backwards, rather than having skimmed through them like I did. I'm enjoying reading the informative discussion between you and theymademejoin. Whilst I may hate the smell, this thread has had the huge benefit to me of making me considerably less concerned about vaping than I was at the start, when I did feel a lot more cynical about the confidence of its supporters that it was pretty safe. Provided they continue to test the safety of the products as the industry grows and develops, and continue to keep tabs on who uses e-cigarettes and why, I shall feel a lot less twitchy about the whole thing than I did a few days ago and a lot more tolerant of vapers than I did before. It is certainly a huge improvement on smoking and the two years I had to spend working with a chain smoking boss I had to sit in a closed room with all day, who paid no heed to the evidence it was not only herself she was killing. I would go home with streaming eyes every day, smelling like I'd spent the day at the pub. She continued doing it after it was officially banned in the workplace, too. I hope she vapes, now, instead!! It's probably that experience that made me so cynical - it took an unbelievably long time from the point of view of a non-smoker, for government to react to overwhelmingly strong evidence of harm.

Problem is though, roundaboutthetown, that while pencil knows the papers inside out and backwards, s(he) seems to be accepting the findings without sufficient critical analysis. Propagating faulty research as fact is how we end up with misinformation, as happened with the newspaper reports on the formaldehyde research.

s(he) - Just FTR, I'm a woman.

The PHE report is not faulty research it's just not as precise as it could be and doesn't provide as many caveats as it could. You can pick a few holes in it but come on, they're not big holes. I don't actually know the papers inside out, there are a lot of areas I rely on experts to interpret for me because I am not a scientist, I have an arts backround. Nevertheless I have trawled through enough papers to know that despite the small holes you are picking, this report is basically sound, stands up perfectly well compared to the general standard of evidence we use to create policy and is head and shoulders above most things that are published in this field.

You've chosen to pick holes in this particular report because you don't like vaping and are looking for a reason to disallow it in public. Shall I start picking holes in the evidence that informed the ban on smoking in cars with children present? Shall I start picking holes in the evidence behind the ban on smoking in enclosed public spaces? Both of these would be easy pickings.

Or shall we just decide that common sense has a role and that imperfect, human-produced research is still worth paying heed to if it's obviously broadly correct?

No misinformation has been propagated on the back of that report. It is true that according to everybody's best estimate e-cigarettes are around 95% safer than smoked tobacco and they can help smokers to quit. Nobody is going to build dangerously wrong research on the back of PHE saying that the current best estimate is that vaping is around 95% safer than smoking. Because of the words 'current best estimate' and 'around'. If scientists are reading that and deciding that 95% is a rock solid reliable figure on which to base future research then what the hell is wrong with you?

PHE producing a rough estimate is in no way comparable to the flaws in the formaldehyde study.

PHE used the best data available and said this is the best estimate we can make currently. If someone comes up with new evidence that casts doubt on that figure they will revise it.

The formaldehyde study ignored all evidence available about how vapers actually use their equipment. Since publication they have been told time and again by just about everybody in both the research and the vaping community that they are wrong and exactly why they are wrong. Vapers have had to resort to making youtube videos replicating their study conditions to show how ludicrous they are in a real world setting. The study is still up and the authors have not responded to any of the criticisms from either vapers or scientists.