University of Oxford PhD Studentship ~ Developing and testing peer-led interventions to promote switching from smoking to vaping.

Developing and testing peer-led interventions to promote switching from smoking to vaping.

PhD Studentship ~ Closing date: 26th May 2017

Applications are invited from individuals with a strong academic record who wish to develop a career in behavioural or primary care research. The student will join the thriving Health Behaviours team in the Nuffield Department of Primary Care Health Sciences who are working on range of interventions to support harm reduction and smoking cessation.

The project: The rise in popularity of electronic cigarettes (‘e-cigarettes’) in recent years has been accompanied by a growth in the number of virtual ‘vaper’ communities, with people sharing their advice and experiences of e-cigarettes with peers on internet support groups and discussion forums, many of which address ways of reducing or stopping smoking. The rise of peer to peer support is unique to e-cigarettes; no other means of stopping or reducing smoking attracts such passionate engagement from members of the public. This raises the possibility that we could better harness this peer support to enable more people to reduce or stop smoking using e-cigarettes and this project examines this. Continue reading

How safe is vaping? Media coverage, dilemmas and solutions in work and social spaces

As part of on-going work in relation to tobacco harm reduction, Knowledge-Action-Change is organising a series of dialogues, to examine the often contentious issues that attach to the use of electronic cigarettes, or vaping, in workplaces, places of entertainment and public spaces.

The series entitled ‘How safe is vaping? Media coverage, dilemmas and solutions in work and social spaces’ will take place:
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Why these dialogues now?

There is still a lot of debate between scientists and policy makers about the nature, use and safety of nicotine containing products. The media has produced a lot of stories about e-cigarettes, not all of them either accurate, or supported by scientific evidence. Nonetheless these stories have an impact and can influence peoples’ thinking and reactions on issues. This dialogue is a place where everyone can bring their concerns, air them and hopefully become better informed about the products and their use.

Most vapers are former smokers who have switched to this safer way to use nicotine. Professionals working in public health largely accept that this is a much safer form of behaviour – for users and those around them – but there remain concerns about the impact of their use in some circumstances and in this dialogue we aim to identify some of these and try to address them.

What are the dialogues?

These short events are designed to enable interactive discussion and debate – involving public health professionals, academics and scientists, policy makers, consumers, owners and managers of premises and members of the public – on a range of issues surrounding the increasing use of safer nicotine products (including e-cigarettes) as an alternative to smoking.

During each dialogue a panel of speakers, representing different interests, each make short presentations, addressing different issues relating to e-cigarette use. Q&A and discussion involving the audience follow the presentations.

The dialogues are filmed with the proceedings posted on the web, with the aim of providing information to those who might be interested in the subject and to assist those charged with making policy in having a cross-section of views to draw upon.

Previous dialogues: Knowledge-Action-Change has produced a number of dialogues to date and some of these can be viewed here.

UKCTAS experts reaction to e-cigarettes and cardiovascular risk

Researchers publishing in JAMA cardiology compared heart rate variability and markers of oxidative stress between e-cigarette users and non-users.

Prof. Paul Aveyard, Professor of Behavioural Medicine at the University of Oxford, said:

“In this study, the authors compared 16 e-cigarette users with 18 non-users and compared the two groups for heart rate variability and markers of oxidative stress.  Heart rate variability is normal and healthy, but activation of the adrenaline system in our bodies can decrease this and this may be linked with heart disease.  On two of the four measures of heart rate variability, there were no differences between the e-cigarette users and the non-users and on two measures, the groups differed.

“Oxidative stress is probably one of the main ways that cigarettes cause heart disease.  It is an important part of why cigarettes block our arteries.  In four of five measures of oxidative stress, there was no evidence of difference between e-cigarette users and non-users, while e-cigarette users had higher oxidative stress on one measure.  However, the heavier the user, the greater level of oxidative stress seen.

“The question is why these differences are occurring.  One explanation is that this is a small study.  Whenever you test several measures, as they did in this study, the greater the chance you find differences that are not real, they are simply down to chance.  It’s possible to correct for this kind of problem, but the authors did not do this.  Another possible explanation is down to psychological factors.  Most people who were using e-cigarettes had smoked in the past, while the large majority of the non-users of e-cigarettes had never smoked.  People with some psychological disorders or who are stressed show reduced heart rate variability.  On average, people who smoke or who have smoked have a higher rate of stress or psychological disorders than people who have not, so this could explain the findings on heart rate variability but not the single finding in oxidative stress.  Overall, then, this is a small study with several possible explanations for the findings, only one of which could be that using e-cigarettes is a possible risk for heart disease.

“It is important to put these results in context.  In this study, most people who were using e-cigarettes had smoked in the past.  Nearly everyone using e-cigarettes in Britain either smokes currently or has smoked, and people who are continuing to use e-cigarettes say that they do so to prevent them going back to smoking.  We know without any doubt that smoking is a major cause of heart disease and we still don’t know whether e-cigarettes pose a small risk or no risk, but we do know they are much less risky than smoking.  If a person cannot stop smoking in other ways, public health advice is to switch to e-cigarettes either partially or wholly.  This small study does not change that advice.  Compared with smoking, e-cigarettes are a better option.”

Prof. Linda Bauld, Professor of Health Policy at the University of Stirling, said:

“It is important to assess the cardiovascular effects of e-cigarette use as we know that tobacco smoking is the main preventable cause of heart disease, and e-cigarettes provide an alternative to tobacco. This study looks at the short term effects of vaping on markers of increased risk of cardiovascular disease (CVD) amongst people not currently smoking. It concludes that vaping might be associated with increased risk. However, these findings cannot conclude that heart disease will develop as a result of vaping without smoking. In order to develop our understanding of whether vaping causes any potential pathophysiological effects, further mechanistic research is required.

“A number of questions arise from looking at the study. First, the measures used are mainly applied to people who have already had a cardiac event rather than healthy young volunteers, which may pose challenges for interpretation. Secondly, sensitivity or specificity for nicotine effects is not adequately discussed in the paper. Nicotine is known to stimulate the sympathetic system, but nicotine replacement therapy is considered safe and is approved even for long term use by smokers (including those with cardio-vascular disease) and this is not made clear.  Finally, there is no direct comparison in the study between the risks of tobacco smoking to cardiovascular health and to vaping. This is particularly relevant because, for example, the response of vapers to controlled breathing was found to be normal in this study, unlike the response observed in smokers in other studies. These comparisons are important when communicating any risks or benefits of e-cigarette use.

“However, the questions posed in this study do merit research with longer term follow up particularly for CVD researchers who specialise in arrhythmias – irregular heartbeat. In the meantime, this study should not be used to suggest that vaping is as dangerous as smoking, for CVD or any other conditions. This study does not provide this evidence, and does not prove that vaping causes heart disease.”

* ‘Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users’ by Roya Moheimani et al published in JAMA Cardiology on Wednesday 1 February.

Declared interests

Prof. Linda Bauld: None to declare

Prof. Paul Aveyard: “Paul Aveyard has no personal financial connections to e-cigarette or pharmaceutical companies but in one study on smoking cessation, Glaxo Smith Kline is supporting the study by donating nicotine patches to the NHS.”

 

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Clearing the air around e-cigarettes

Fears that “vaping” is a gateway to tobacco smoking are unfounded, shows a comprehensive review of available evidence on the harms and benefits of electronic or e-cigarettes and vapour devices, released today by University of Victoria’s Centre for Addictions Research of BC (CARBC) in a report called “Clearing the Air.”

Researchers surveyed the rapidly increasing academic literature on e-cigarettes and found evidence that vaping is replacing—rather than encouraging—the smoking of tobacco cigarettes among young people. The CARBC researchers identified 1,622 articles on the topic, of which 170 were relevant to their review. Evidence shows that tobacco use by youth has been declining while use of vapour devices has been increasing.

“Fears of a gateway effect are unjustified and overblown,” says principal investigator Marjorie MacDonald. “From a public health perspective, it’s positive to see youth moving towards a less harmful substitute to tobacco smoking.”

Among their other observations, CARBC researchers found strong evidence that the vapour from e-cigarettes is less toxic than tobacco cigarette smoke. Vapour devices do not release tar, and vapour emissions contain only eighteen of the 79 toxins found in cigarette smoke, including considerably lower levels of certain cancer causing agents and volatile organic compounds (VOCs). Almost all substances tested were substantially lower, or not detected, in vapour devices compared to cigarettes.

In addition, vapour from electronic devices is airborne for less than 30 seconds compared to 18 to 20 minutes for tobacco smoke, substantially reducing the time of second-hand exposure.

Researchers caution, however, that some vapour devices may contain potentially concerning levels of metals and particulate matter, noting that there has been insufficient research regarding some significant carcinogens that may still be present.

Finally, they found encouraging evidence that vapour devices could be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.

“The public has been misled about the risks of e-cigarettes,” concludes Tim Stockwell, CARBC director and co-principal investigator. “Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false.”

A media kit containing author photos, full report (for media only, not for publication), and an infographic is available on Dropbox. An executive summary is available here.

Click here to read the original story on University of Victoria’s website.

Media contacts:
Tim Stockwell (Director, UVic’s Centre for Addictions Research) at 250-472-5445 or timstock@uvic.ca
Marjorie MacDonald (Scientist, UVic’s Centre for Addictions Research/Nursing) at 250-472-4399 or marjorie@uvic.ca
Suzanne Ahearne (University Communications + Marketing) at 250-721-6139 or sahearne@uvic.ca

John Britton speaks to RegWatchCanada on #COP7FCTC and the World Health Organization’s view of E-cigarettes

Just as vapers in several countries began to feel like events may finally be turning in favor of e-cigarettes as a harm reduction tool, the harsh realities of the global public health movement shattered any optimism.

The World Health Organization is just wrapping its Conference of the Parties to the Framework Convention on Tobacco Control, known as COP7, in India and according to professor John Britton, Chair of the Tobacco Advisory Group at the Royal College of Physicians in Britain (RCP), the future for vaping looks bleak.

The RCP, Public Health England and the UK Centre for Tobacco and Alcohol Studies have all endorsed e-cigarettes as a vital tool in the battle to end the tobacco epidemic.

Tune in to this special edition of RegWatch and learn why officials from England’s top public health organizations fear that pending WHO regulatory action on e-cigarettes could kill millions of people.

RegulatorWatch.com

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Click here to read the UKCTAS commentary on the WHO report on e-cigarettes. –  Released 26/10/2016

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Last chance to register for the E-Cigarette Summit 2016

There are only a few spaces left for the forthcoming E-Cigarette Summit which will take place in London on 17th November at The Royal Society.  If you would like to view the programme or book a place please go to www.e-cigarette-summit.com .

This year has an unrivalled line up of speakers including Prof Neal Benowitz a global expert on nicotine, Pro David Spiegelhalter who is the Winton Professor of the Public Understanding of Risk from Oxford University and Tom Miller The Attorney General of Iowa, who historically led the successful multibillion dollar lawsuit against the tobacco industry for knowingly misrepresenting the risks of smoking.

At the Summit, AG Miller will look at whether the public are being given accurate information on e-cigarettes.

The key debates this year will include:

  • Communicating Research and Evidence on E-Cigarettes: How do you convey the relative risks of smoking and e-cigarettes based on what is currently known about them?

  • Should Nicotine Use Be Accepted in Society –  What are the absolute and relative risks?

  • Will regulation support or stifle the disruptive potential that e-cigarettes pose to the tobacco industry and smoking?

  • Can there be a balanced debate on e-cigarettes and harm reduction, when there is no consensus on where the “middle ground” lies.

2017 will be a watershed year for electronic cigarettes as new regulations come in to effect across Europe and America.   These first attempts to regulate an entirely novel product category will set the agenda for decades to come and is likely to be viewed as a pivotal era in both tobacco control and combustible tobacco use in the future.  On the International arena, The Summit  is immediately after FCTC COP7 and it will be the first opportunity to examine and discuss the scientific responses and reactions to the likely position that the WHO recommend on e-cigarettes and harm reduction. The importance of this cannot be underestimated. The role that the WHO and the FCTC play in setting public health agendas and tobacco control policies is the single most important framework that those dedicated to reducing smoking related and tobacco death and disease has worked within.

Good regulation and policy is essential to ensure that consumers and the broader public health are protected from corporate invested interests and that products are safe, effective and marketed appropriately. How far regulation has to go to deliver these goals can only be informed by well-structured research and balanced analysis and communication of evidence.  The E-Cigarette Summit has a single aim of facilitating respectful dialogue and thoughtful analysis of the latest evidence in context of public health concerns. Knowing how to accurately convey information to the public, especially adult smokers about the available evidence on the harm of e-cigarettes has also been a contentious issue.  The number of people who believe that vaping is as dangerous as smoking has tripled since 2012, which some would argue is an appropriate caution for an addictive product, but very few scientists would argue that this is an accurate assessment- given the known harms of smoking.

The E-Cigarette Summit provides a unique opportunity to examine the latest research and to discuss how the evidence should be interpreted and communicated to deliver the most effective health strategies to reduce smoking related death and disease.

Confirmed speakers include:

  • Prof. Ann McNeill (Chair Person) – Professor of Tobacco Addiction (UKCTAS)
  • Attorney General Tom Miller – Attorney General for Iowa, USA
  • Prof Neal Benowitz – Professor of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, USA
  • Prof. Jean Francois Etter – Professor of Public Health, University of Geneva, Switzerland
  • Mr Ram Moorthy – Deputy Chair of the BMA board of science, British Medical Association (BMA)
  • Prof. Robert West – Professor of Health Psychology and Director of Tobacco Studies (CRUK)
  • Tim Baxter – Head of Public Health Policy and Strategy Unit, Department of Health (DoH)
  • Martin Dockrell – Tobacco Lead, Public Health England (PHE), Alcohol Drugs and Tobacco
  • Beryl Keeley – E-cigarette Notification Scheme Lead, Medicines and Healthcare Regulatory Authority (MHRA)
  • Prof David Spiegelhalter – Winton Professor for the Public Understanding of Risk, Centre for Mathematical Sciences, Cambridge University
  • Tim Phillips – Managing Director, ECigIntelligence.com
  •  Louise Ross – Stop Smoking Services and Tobacco Control Manager, Leicestershire NHS Trust
  • Prof. Marcus Munafo  – Professor of Biological Psychology, University of Bristol
  • Prof. Peter Hajek – Professor of Clinical Psychology, Queen Mary University, London
  • Dr Konstantinos Farsalinos – Researcher, Onassis Cardiac Surgery Centre, Greece
  • Prof. Ricardo Polosa – Director of the Institute for Internal Medicine, University of Catania
  • Prof. Linda Bauld – Professor of Health Policy, University of Stirling and UKCTAS
  • Fraser Cropper – CEO,  Totally wicked and Chair of IBVTA (Independent British Vape Trade Association)
  • Dr Lynne Dawkins – Associate Professor of Psychology, School of Applied Sciences, London South Bank University
  • Deborah Arnott – Chief Executive Officer, Action on Smoking (ASH)
  • Prof Scott Leischow – Mayo Clinic, USA
  • Prof. David Abrams – Professor , The John Hopkins Bloomberg School of Public

To see the full agenda please go to www.e-cigarette-summit.com