On February 24, the report "e-cigarette use in the UK: evidence update 2021" was published on the British government website. This is an annual update report by the UK Department of public health (PHE). The main content is to update the latest data on the use of e-cigarettes in the UK to provide information and insight for policies and regulations.

Britain is one of the best countries in the world to control tobacco, and it is also the first country to officially support e-cigarette as a tool to quit smoking. But in this report, because of a set of data, the British Department of public health appears a little anxious.

A survey by the British Department of public health found that the British people's awareness of the harm reduction of e-cigarettes is increasingly inconsistent. Only 29% of the people think that the harm of e-cigarettes is less than that of cigarettes. In addition, 38% of the people think that the harm of e-cigarette is the same as that of cigarette, 18% don't know which is more harmful, and 15% think that the harm of e-cigarette is greater than that of cigarette. In other words, 71% of people misunderstood e-cigarettes.

As early as 2015, the British Department of Public Health issued an independent report, pointing out that although e-cigarettes are not 100% safe, the content of harmful chemicals can be almost negligible, and there is no doubt about the harm reduction of e-cigarettes.

Then the first question is, why is the Department of public health in a hurry?

The core reason is that the UK should ensure the smooth progress of the 2030 smoke-free target. According to the UK's 2030 smoke-free target, it is planned to phase out combustible cigarettes by 2030 and allow smokers to quit smoking completely or switch to nicotine delivery systems with lower risks, such as e-cigarettes.

Until 2019, the UK government's smoke-free target has been progressing smoothly. The adult smoking rate continued to decline, and the use rate of e-cigarettes increased steadily. However, in 2020, e-cigarette usage in the UK will decline for the first time (see the figure below). From 7.1% in 2019 to 6.3% in 2020, a year-on-year decline of 12%.

We need to find the reason for the decline. The survey found that only 29% of the people think that the harm of e-cigarette is less than that of cigarette. Will low cognition lead to the decline of e-cigarette usage?

A 2020 UCL study answers: Yes!

The study, published in BMC medicine by University College London, points out that for every 1% reduction in people's perception of e-cigarette's harm reduction compared with cigarette, the utilization rate of e-cigarette will decrease by 0.48%.

So the next question is, what's causing the decline in awareness of e-cigarettes among British adults.

Another study published by University College London, on whether the outbreak of illegal e-cigarette related lung injury (evali) in the United States in 2019 will lead to a change in smokers' perception of the hazards of e-cigarettes and cigarettes.

University College London surveyed 3215 smokers. Before the outbreak of evali, 37% of the respondents thought that the harm of e-cigarettes was less than that of cigarettes. After the outbreak of evali, the proportion decreased significantly to 30.9%. Correspondingly, the number of e-cigarettes that were considered equally harmful increased from 39.9% to 43.8%. 7% to 17. 2%. The outbreak of evali has directly led to the deterioration of British smokers' views on e-cigarettes.

In fact, after several months of investigation in 2019, the US Centers for Disease Control and Prevention (CDC) has clearly pointed out in its official page that "illegal e-cigarette products containing tetrahydrocannabinol (THC) play a major role in cases." The culprit is vitamin E acetate in illegal thc products, which is not found in regular nicotine e-cigarettes.

It is also for the above reasons that the UK Department of public health stressed in the 2021 report: "more efforts need to be made to pass on the evidence of harm reduction to smokers in a better way, so that they can fully consider the various options to help them quit smoking."

People's correct understanding of e-cigarettes has become the key to achieving the 2030 smoke-free goal in the UK.

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